"Getting Good Care in the Hospital requires Vigilance"

[EmeraldNYL, BSN, RN]

Awesome responses guys!!! :)

[JulieBean2U]

WHEEEWWWW!!!! I just e-mailed Ms. Linn and really got into it. I took her through the typical issues nurses deal with every day, everything I have to do with 13 patients, WHY I had 13 patients.( the ratio supposed tobe 1:8 but if we lose one patient we lose a nurse and the other nurses have to pick up the extra pts), the extra "side jobs" we were assigned, like washing floors and walls in dirty utility rooms, testing equipment, moving furniture, and so on.....I told her that I have changed peoples lives and have had my life changed, and that none of us deserve to be approached with hostility or suspicion right from the get-go. Damn, I sure do feel better! KEEP SENDING HER MAIL. We need to be pro-active and stop being viewed as whiners.

[passing thru]

Why does everyone blame the nurses for sloppy housekeeping? The time has passed when nurses responsibility was to keep the room clean, IMHO. That's not to say I won't take out a full bag of trash, but it is infrequent. My priorities are not to empty wastebaskets.

AND !! I observe, nearly daily, in patients rooms.....someone (either patient or family member) tosses a kleenex, a paper towel, a paper cup at the waste basket. It misses and falls on floor. An hour later (eight hours later), the trash is still on the floor, in the vicinity of the wastebasket. Although now, it includes hamburger bags, wrappings, large soda cups, coke cans. THESE PEOPLE WILL SIT AND VISIT 3 HOURS AND NOT PICK UP THE TRASH, AND PLACE IT IN THE WASTEBASKET. IT IS '''MY JOB''' IN THEIR VIEW. WELL, 'SCUSE ME,

BUT I AM NOT THE ''HOTEL MAID''. YOU CAN CALL THE GOVERNOR IF YOU WANT TO, I am not cleaning up your slovenly room.

[fab4fan]

I sent this reporter an e-mail. I don't know how to copy something, so I'll just have to paraphrase what I wrote.

I told her that nurses are not responsible for a lot of what she outlined as problems; there is a difference between nurses, RT's, housekeeping, etc.

I advised her that nurses have been warning about declining care in hospitals for years, and the public basically turned a deaf ear to these warnings...now they are reaping the consequences of ignoring us.

Briefly touched on nursing shortage v. shortage of nurses willing to put up with subpar working conditions.

Concluded with comments about putting pts & families in an adversarial relationship with nursing staff. Also noted that call bell might not be answered promptly b/c nurse has 8 other call bells to answer "promptly."

I'll be interested to see if she answers any of our e-mails.

[colleen10]

Wow you guys!!! What thoughtful and eloquent responses. I'm so impressed by your quick action.

The more I see articles like this and the more I listen or "watch" rather what everyone here says to one another the more I understand that the public has no idea what nurses do or what their role is in health care and that there is a nursing shortage but is driven by hospitals. And it's not just via low wages, etc. I truly believe that most hospitals only see a "bottom line" and if they can get away with having two less nurses on duty to save a buck they will even though it increases stress for the staff and decreases patient care.

[Rock, LPN, RN]

I read with great interest, Colleen10's article. I had similar experiences here on Staten Island, when my mother was admitted with fx femur.

It's difficult to determine whether the nurses were overworked, or didn't want to leave the soap-opera conversation they were having with each other.

I believe we have to hold Administration accountable for the shortcomings. It seems that Administration is only interested in cutting costs, and have no idea of what it takes to run a desent hospital or ward. Administrators are business oriented, and will look at a budget on paper and make their decisions based on a piece of paper. They are not expected to have any human qualities to be Administrators.

What happened to Medical Personnel running hospitals as was the case in the past?????

Let's take a realist look at the situation and call for reform.

Rock

[canoehead, BSN, RN]

Dear Ms. Linn,

I compliment you on your recent article on how to get the best care during your hospital stay. I understand you have gotten a lot of replies from RN' s unhappy with the way nursing was perceived. I think the article was, for the most part, accurate. I am an RN, and also have had my mother in the hospital for extended stays. The care she received was absolutely unacceptable, but I also had the privilege of knowing what was happening on the nursing side, and I'd like to share that with you.

At that hospital the nurses were assigned between 8-12 patients, some requiring complete care. When I look at my mother's needs, she could probably have used 2 hours minimum for assistance with washing, eating, and physical assessment. . I believe in the American Journal of Nursing they found that for each hour of direct care there is 30-60 minutes of documentation required. My mother was one of the "light" patients, some of the women on that ward needed twice as much assistance, and did not have a family member to help with small requests. So, in a perfect world, nurses on that floor would have been assigned only 4 patients apiece- as opposed to 8-12.

Nurses on that floor, and in about 80% of the units around the country worked through coffee and lunch breaks. We saw them eating at the desk while charting, and interrupting their lunch to answer call bells. They remained relatively pleasant, but often became testy when asked for more Kleenex, or water, or even a bedpan, or a wash. Patients have a right to expect those items, but the nursing staff has been told to "manage their time" and "prioritize patient needs". So, some of those items were waiting for the next time the nurse made it in the room, or were neglected altogether. More patients were incontinent, and no one got a daily bath, so that meds could be given safely, and treatments administered.

Ancillary staff has been cut in many facilities, with the thought by administration that the nurse can take care of the many small requests while she is in the room with the patient. After all each item "only takes a minute". But with 10 patients, each requiring a 2 minute intervention every couple hours, each nurse has just used about 15% of her time, or about 2 hours of a 12 hour shift. You can imagine how that would be frustrating for a nurse with meds that are late, or an emergency going on in the next room, or the family of a dying patient to support. Unfortunately, no matter what that nurse decides to do, one of his/her patients has the perception that they have been neglected. Nurses spend every shifts knowing someone in pain and ill needs help and is waiting. No one disputes that the patients deserve prompt, unhurried, gentle care, but right now it seems impossible. The frustration of working in that environment can be credited for the large amount of nurses that choose to move on, making the situation even worse.

Emergencies are a part of working in a hospital, and it is reasonable to think that care of other patients will not suffer when they occur. Let's agree that daily about 10% of people currently admitted will have a problem that requires prompt intervention. First, the nurse must be there to identify the problem before it becomes life threatening- much more difficult with today's more intense patient load. Crisis work takes at least an hour for the intervention and then the (sigh) documentation. Most of the time two nurses are tied up until tings are back under control. An experienced nurse counsels grieving and angry families, coordinates care between all the other hospital departments, assesses and intervenes in medical emergencies, and is a safety net for residents and interns. These jobs cannot be delayed to a later time or done in slipshod fashion, and for that time the other patients in a nurses' assignment wait, no matter what their needs. If two patients are suddenly ill at once the entire floor's staff can be caught up in the crisis but luckily that doesn't occur often.

Each nurse can expect at least one admission during his her shift. It easily takes an hour to welcome and settle the patient, and carry out all the treatments that must be done immediately. Adding all this up, if we take an hour for an emergency, and another hour for the admission, plus and equal amount of time for documentation, we are down to 8 hours left from a 12 hour shift to care for the rest of his/her patient load.

Each patient now gets an hour for basic care. Keep in mind that documentation needs to be done, so decrease that to about 45min of direct nurse contact per patient. Remember, I estimated my mother needed at least 2h- but according to my calculations she can expect only half of that. Does she deserve more? Absolutely. As a daughter and a nurse I am caught between what is needed and what is possible.

Nurses argue that people should expect and get the highest quality care. That is why most of us went into the profession, and where we get our satisfaction. When I go home I love feeling that I was able to treat someone to the same care and attention I would give to a family member. Unfortunately, doing something special has become a quick hair wash, an extra warm blanket, getting pain meds to them within 15min, or a back rub. All those things should be routine, not special extras. That's why nurses ar giving up and going to other professions. The public should be aware of what to expect in a hospital setting, and if they want more they need to join us in lobbying for change.

Respectfully

canoe

[plumrn, BSN, RN]

canoehead, your letter is excellent! Thanks for saying what we nurses know, but aren't always able to put in to words.

[New CCU RN]

canoe, your letter is awesome and was right on target ....couldnt agree with ya more.....

[passing thru]

Great letter Canoehead. That describes my day. And Happy Birthday !

[Rohb]

Awsome replies you guys..

[Hellllllo Nurse, BSN, RN]

My letter to Ms. Linn is not the most articulate. I am TIRED, as are we all.

But, I did include some links to some great articles on the crisis.

"Ms. Linn,

Here are some links that I feel are invaluable in understanding the true causes of the crises in nursing and patient care:

Here are two links to a show about the current nursing situation as described on the PBS program "Frontline"

http://www.pbs.org/wgbh/pages/frontline/shows/hmo/nurses/

http://www.pbs.org/wgbh/pages/frontline/shows/hmo/nurses/ownwords.html

Here is a link to a very important article which was recently published in RevolutioN Magazine, a nursing journal.

http://www.revolutionmag.com/engineering.html

Here is a link to a book written by some of the most respected nursing leaders of today:

http://www.gift-of-life.com/nurse.htm

I am sending you these links because I am a nurse.

Nurses, and therefore patients, are in a desperate situation. Our only hope is that the media and the public will finally wake up and hear us.

Sincerely,

Christina C., RN "