Reality Shock

nurz2be · Oct 3, 2007

Hi guys
I am nearing the end of my first year as a full time nursing student.
I am currently in a clinical placement in a sort of overflow ward - we have orthopaedic, medical and surgical patients.
I am suffering reality shock. The ward is incredibly busy and always understaffed. There is no such thing as therapeutic relationships or holistic care, such as that taught at univeristy. Rather it is RNs running around, flat out just trying to meet the necessities of immediate care. I am told to hurry up, that 'it is all very nice to talk to patients, but we don't have time'. I gave a gentleman a bed bath and of course took too long, but he said in the two weeks he had been in hospital, I had given him far better care than anyone else. When nurses asked if he was in pain he just said he was ok. Whilst I was bathing him and talking, I asked if he really was ok, as he was sweating, fast shallow breathing and restless. He said that actually he was on pain, but he wasn't sure if he was allowed any more pain relief and didn't want to bother the busy nurses. I spoke to the doctor who prescribed him some more pain relief, and he was finally sleeping when I left.
I was so sad to see that nurses were just too busy to talk to this fellow enough to find out how he was really feeling. And of course there are many other stories as well. I am sure you all know such stories well.
Also, I find that many nurses, perhaps because they are so busy, totally ignore me and avoid me. I assumed nurses would be nice people to work with, but so far they have all appeared to be annoyed by my presence.
I spent considerable time looking into nursing as a career, and I believe I will make an excellent nurse. I am 35 and did not make the career change lightly. Hence I want to find ways of dealing with this reality shock - of coping and not giving up hope that my values of patient care and the reality of practice can ever coexist in harmony. I have been reading about Kramer's reality shock, the Hinshaw-Davis model of student socialisation, Benner's Novice to Expert, and about biculturalism, all in an attempt to be better informed about how I am feeling and why. But what I really need is some advice, guidance or support on how best to deal with this phenomenon.
Does anyone out there have any advice to offer?
Thank you.

I think you are feeling this way because influences such as TV, idealistic notions, and just plain not understanding what REAL nurses deal with on a daily basis, plant an idea of hospitals running like those they show on television. Where they stand around the nurses station talking and laughing most of the shift. Where we see them only take care of 1 or 2 patients a shift. When the reality is, we all see it all over the US, Nursing shortage. Nursing shortage is just that. It implies there are understaffed, overworked nurses in an abundant amount of facilities in the US. We, as nursing students, want to believe that when we "get into the real nursing" we can take our time, read extensively through charts, take time to visit with the patients, and have co-workers who are experiencing the same. The reality, however, is not the same. Does that change the fact I want to be an RN, absolutely not. It does not deter me from going to class and clinicals. Nor will it deter me from being the absolutely best nurse I can be. I hope that you, and others, can make peace with that and become the fantastic nurses you want to be. GOOD LUCK.

Daytonite, BSN, RN · Oct 3, 2007

Don't compromise your own standards of care that you have set for your own performance. If you end up doing that, then you've gone over to the other side like everyone else you are talking about. Part of your frustration comes from being new at nursing and not having enough experience to cope with the fast pace. Time will remedy that. I have to tell you that in my many years of nursing I found that there were a great many nurses who just didn't take the time to listen and talk with patients. This is a choice each nurse makes on their own. I was taught in nursing school to use each minute of my time as efficiently as possible. That means multi-tasking. Sometimes it is impossible to pull up a chair and just sit and talk with a patient. But I can surely talk with them while I am doing a procedure or doing my daily assessment. It was pretty common for us to be very busy during our work shifts. It's interesting how some people handle this. Some dig in and are totally committed nurses; some are looking for the next break to take; some get frazzled and don't handle the pace well at all.

I must tell you that I find it pretty common for many older people not to talk or complain about their pain. My own mother was like this when she was dying of cancer. They can be very stoic about this pain business and will later tell you that they didn't want to be a bother to anyone. I've talked with a number of nurses who say the same thing. Keep this in mind when you are dealing with people. If their facial expressions and physical actions don't seem to be matching their denials of pain, pursue questioning them about it. The older generations have this thing about not being a burden to others, especially if they can see how busy the nurses are.

I had a patient one shift who was a elderly lady who liked to talk a lot. I was told this in the change of shift report--don't spend too much time in the room because you'll never get out of there. I learned a long time ago that people who are demanding attention in some way are usually doing it for a reason. Well, I never sat down during my shifts and I was always in and out of my patient's rooms and if they weren't ringing for some kind of assistance I was asking them if I could help them with something. So, during my shift I got a lot of interaction time with this lady. At one point toward the end of the shift she dropped "the bomb". She started telling me about how her ribs on one side were hurting. She had been mentioning this to the nurses for the past two days, she said, but no one was paying attention. So, I let her talk and started asking her about this. She didn't want to get the young man in trouble, she said (again, an older person not wanting to be a disruptive force), but when she was in x-ray 2 days prior, she had rolled off the x-ray table. The young x-ray technician had helped her back up, but nothing was ever said about it! This was a big mistake on the part of this x-ray technician. After talking with this lady I called her physician immediately and got orders for rib x-rays. Turns out that she had sustained two broken ribs. An incident report was made out and I don't know what happened to the x-ray technician who was originally responsible for this lady's fall. But, I mention this incident because this lady suffered with her pain for two days because she didn't want to be a problem to us busy hospital nurses. Worse, many nurses tagged her as being talkative and they just didn't want to take the time to deal with talking to her, so they failed to pick up an important piece of information about her physical condition.

Again, I'm telling you that what you do in your practice as a nurse is a personal choice. You will see all kinds of people who won't live up to the high standards you might have set for yourself. You can't concern yourself or worry yourself over them. It will drive you nuts. Your satisfaction comes from knowing when you put your head down on your pillow at night that you have done what was morally and ethically right to be able to live with yourself. I used to think that when I became a manager and supervisor that I could affect and change the way some of these nurses who I think don't perform up to snuff in their practice. I was wrong. You can't really make anyone do anything that they aren't prepared to do or don't want to do. It's because it comes from deep within our own character and ego and we each have the ultimate control of that.

KarafromPhilly · Oct 3, 2007

IMHO, this is exactly why so many nurses give up and leave. I worked on a med-surg unit for about two years, and I will never go back. On any given night I could have patients in alcohol withdrawal, confused elderly, brittle diabetics, paraplegic/chronic pressure ulcers/c-diff, a needy sickle cell patient, a patient with serious respiratory issues, a new admit with serious pain issues that I didn't even hear about in report, morbidly obese patients, or some combination of all of these. And they expect us to do oral care, range of motion exercises, patient education and reams of paperwork, and on and on, on all these people? It was totally ridiculous, an absolute fiction. I basically counted myself successful if nobody got hurt and everybody got their meds on time, and I frequently left work totally exhausted. I went to the ICU where I have a very supportive manager and a maximum of two patients and I feel much better about my ability to do a decent job for my patients.

There IS no shortage of nurses, only disastrously short-sighted policies regarding staffing.

HeavenBound0530 · Oct 6, 2007

I'm the saem way...I knew ahead of time that we're understaffed and it makes me mad because our clinicals give us 1 pt. and we're supposed to do all the stuff that we're never gonna do when we graduate...you don't have time to sit and read through a pts. chart!!! You don't have time to sit there and do a complete careplan and talk to the pt. and ask them all these questions. I'm now getting more experience by taking care of 3 pts. at my clinical unit, but I work in a hospital as an aide where I take care of 16 pts. everyday and I still don't get time to talk to the pts. even as an aide!! The field is going downhill from what it was many years ago..it's not that great of pt. care in my opinion...But that's not chaning my mind of nursing because I still want to help people even if that means sacrificing ime spent with the pt.