routinely missed care: nurseweek article

aileenve, ASN, RN · Oct 21, 2006

This is a prime reason for the need of nursing assistants in hospitals, RN's are busy checking charts, ordering meds, passing meds, making phone calls to other services, discussing pt condition, tubes and drains etc..with Drs. making sure pts receive trays, medications, treatments, we don't always get to turn, ambulate, I do make sure pts eat, we always do the discharge planning, give discharge instructions and discuss any follow-up at discharge. Is it no wonder we can't do it all? I generally have 4-5 for total pt. care, pass meds and monitor charts for 7-8!! Try fitting in the ambulation and turning q2hrs!

JenNJFLCA · Oct 21, 2006

I really wish I had more time to do these things with my patients. I had a pt the other day who really wanted to ambulate in the hallway but she needed some assistance and was a potential fall hazard. I had to pass meds, do my assessments, and get the new orders done before I could get to her. Luckily PT went in the room just as I was going to go in there, but I still felt bad that I just couldn't go in there as often. As a new nurse I am also slower than the experienced nurse, so that automatically puts me at a disadvantage. I try my best!

TheCommuter, BSN, RN · Oct 21, 2006

With nursing staff spread so thinly and staffed so cheaply, who in the world expects nursing care to be done by the book? Of course the routine stuff is going to be missed if too many patients are assigned to each nurse.

If hospital administrators cared about the quality of care, they would have hired sufficient staff many moons ago.

However, hospital administrators care more about the bottom line ($).

Tweety, BSN, RN · Oct 21, 2006

ambulation: "ambulation doesn't always get done." i have to admit a time or two when ambulation has had to be deferred.

turning: "turning q 4? q never!" not qnever, because i turn my patients, kind of anal about some things, but definately not q2h

feedings: "you would really be surprised to find out how many trays get returned to dietary untouched because no one got around to feeding the patients." shameful, and luckily i haven't seen that happen.

patient teaching: "if you want to get out on time, do you think you do as much teaching as you really should, or do you turn around and run for the computer to get your charting done?" i wish i had more time for patient teaching. i do it, but it's kind of on the run.

discharge planning: "i rarely know much about where the patient is going after hospitalization and whether there have been adequate preparations made." we've gotten better with this, now that we have rn case managers and rn home health co-ordinators, but sometimes it's thrown together at the last minute, without pre-planning. this drives me crazy, so i know think when i'm getting report, now that i'm on dayshift "what does this patient need when d/c'd"

emotional support: "you are pushed. you are busy, so you do not have time to spend with patients. i know the patient needs to talk with me, but i am afraid of getting in a situation where i can't easily get away." my biggest heartache as a nurse is that there isn't this kind of time in my day.

hygiene: "they don't always get a bath or their bed changed. one day when i came to work, i had three patients on strike. one refused to get back into her bed until the sheets were changed. another one needed a bath. it was just crazy." sad, but true.

intake and output documentation: "i don't have confidence that the i & o is correct." sad, but true

surveillance: "i hold my breath as i leave one wing and round the corner to the other. i think, it has been an hour since i was in his room. will he be all right? sad but true.

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