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Seasoned Nurses - This one is for you

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

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Seasoned nurses are special, not only because of the knowledge they possess and the skills they have mastered, but also for the many changes and advances in medical technology they have seen over the years.

I need your help. As we are preparing the next issue of the allnurses magazine which will be published in January, I would love to get input from you seasoned nurses as soon as possible.

What are some of the biggest changes you have seen in nursing and medical technology, for better or worse?

What are some of the newest and latest pieces of equipment, treatments...the newest shiniest objects?

What are some of the newest trends that might have you raising your eyebrows or increasing your nursing curiosity and wanting to learn more? (some of the less seasoned nurses can join in this one) I would really like to see posts about new advances as we look toward the future.

I would love to get LOTS of posts because I want to share some of your insights and comments contrasting the past with the future in a section of the upcoming magazine. I know this is a particularly busy time of year, but please take a few moments to post some thoughtful comments as soon as you can.

Thanks in advance for your help.

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Pixie.RN, MSN, RN, EMT-P

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN.

Goodbye paper charting, hello EMR.

brandy1017, ASN, RN

Specializes in Critical Care.

Advances that are used to decrease staffing which only increases nurse stress levels such as getting rid of tele monitor techs and putting out lots of tele monitors and loud alarms everywhere so you are basically tortured by alarms for the entire 12 hour shift and adding tele alarms onto a phone so even when you get a call from a Dr you can't hear because the alarms are ringing, 90% false while you are trying to listen! Likewise getting rid of sitters for video monitors with cameras and a remote person that is supposed to watch your confused problem patients and tell them not to get out of bed and call you and/or ring an alarm if they start getting up or pulling at their IV or essential equipment. Again another blaring alarm to torment us. I'm giving report and hearing a loud alarm and asking where is it coming from it sounded like a code alarm, oh that's the video monitor. Wow! And let's not forget the BIPAP's that are being frequently used to prevent intubation and many times the patients kept on the floor even over 40% when they are supposed to be in ICU and their very loud disruptive alarms! I hate the alarms!

On the other hand, I like the lift equipment like sit to stands and hover mats that help us safely move patients where before we had to hoist them with our bare hands and back. Ceilings lifts would be even better but we don't have them, not in the budget.

KalipsoRed21, BSN

Specializes in Currently: Home Health.

I agree with everything brandy1017 said. I LOVE hover matts. I really think that was the best invention ever. And self turning bariatric beds!!! Those are sooooooo awesome. I also think there has been a lot of advancement in home chest tubes like pleurx drains. I love pleurx drains! But yes, the reduction of actual monitors to watch your tele patient's and visual hubs for sitters are very unsafe in my opinion. Reduction of phlebotomists has been the next big thing I've started to notice and that makes me angry, "please draw all your own labs on your 6 heme/onc patient's between 5-6 and then pass meds between 6-7 and be ready for report at 7." One thing I kinda wish could come back is a hospital ward instead of rooms, HIPPA be damned. Can you imagine how cool it would be to see all 6-7 of your patients at all times! I worked in a tiny ER that was still set up this way, so cool!

sallyrnrrt, ADN, RN

Specializes in critical care, ER,ICU, CVSURG, CCU.

We know what we know because we did it....there is a devolution on clinical in today's nursing education ....of course I'm coming from a '72 diploma program......our critical thinking skills were developed in our 70% clinical

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU.

1. Robotic surgery

2. Encrypted text messaging/paging

3. Self-scheduling

4. Tele-health

5. Remote monitoring of home patients

6. Urgent Cares

7. Free-standing EDs

8. Simulation labs with robotic patients

Daisy4RN

Specializes in Travel, Home Health, Med-Surg.

I would love to see visiting hours brought back and/or enforced. In my experience it causes more harm than good to have visitors (and sometimes many at one time) in at all times including spending the night.

Also agree that nursing education has not kept up with reality. Even when I went to school (20 yrs ago) we were taught the correct way and then told "in the real world you would do this/that..", and it is even worse now.

We know what we know because we did it....there is a devolution on clinical in today's nursing education.

I agree and the cause seems to be the productization of nursing education. For-profit schools are eager to mop up that student loan money and requiring meaningful clinicals creates a back log in their get 'em in/get 'em out diploma mills.

My two cents:

The boom in for-profit nursing education. These schools exist solely to access student loan dollars and churn out new grads.

This goes hand and hand with the elevation of the BSN as a requirement for bedside acute care. This is an artificial market-driven requirement.

The ongoing fight of ADN/Diploma vs BSN. We aren't using common sense, nor are our employers. The "magnet status" has created monsters and pushed for "higher education" that in truth has very little to do with critical thinking skills of a bedside nurse. I am an ADN. I once had a BSN tell me that she would never allow an ADN or Diploma nurse care for her when she delivered her child. Funny how that changed when she arrived to deliver and the only BSN was a new grad. We are cheating potential future nurses out of fabulous careers (for those that can only afford in time and money the ADN program), we are not supporting local community colleges and we are pitting one nurse against another. We are also forcing ourselves into a true nursing shortage when we no longer accept ADN's and the BSN's chose to move away from the bedside. While I personally have not experienced the "nurses eating their own", I certainly see it now. It has become more of a popularity contest than what is truly valuable for our patients and their safety. It's difficult to work as a team when a young BSN tells me it's "proven" that he has better critical thinking skills than my 20+ years of experience in acute care, let alone the Diploma nurses that truly had the most intense training. For those of us that choose to stay at the bedside, in acute care, with national certification and educational credentials specific to our field, what in the world is the point. And please, don't reference a study by a BSN program. Those are tainted at best and anyone can site a "study". I want a nurse, ADN, Diploma, BSN - that has the common sense, great judgement and critical thinking skills to save my life. Not a degree on a wall, or title on a badge.

After our BSN nurses were given special embroidered scrub jackets with their BSN titles, I chose to purchase my own scrub jacket, with my title, ADN. I was promptly told it did not meet dress code........

And what do I love about nursing? That our patients still need human interaction, education and compassion. That for the most part, they still appreciate and respect nurses. And I would say even more so as every aspect of our job becomes electronic.

I love wound vacs. These wounds heal so much better. Dressing changes used to mean deep packing wet to dry dressings every shift. We still do the occasional wet to dry, but there are some really effective newer products for wound care that didn't exist twenty years ago.

BeenThere2012, ASN, RN

Specializes in PICU, Pediatrics, Trauma.

I love wound vacs. These wounds heal so much better. Dressing changes used to mean deep packing wet to dry dressings every shift. We still do the occasional wet to dry, but there are some really effective newer products for wound care that didn't exist twenty years ago.

Yes! I was going to say wound vacs and all the various dressing supplies and wound care knowledge.

O2 sat monitors

Glucometers

IV dressing thingy's

Flush syringes

G-tube/Mic-key buttons

To name a few...

Also,all the different types of IV pumps. There were none of them on regular med-surg floors when I started, and calculating drips rates based on tubing lumen size etc was a pain in the butt and obviously not accurate.

I like the EMR's in principle, but hate the lack of accurate choices given at times and the way many nurses just repeat what was charted by the nurse ahead of them or pick something that is not entirely accurate. IMO, charting is often much less individualized to the patient. I understand the need for some standardization and more succinct wording. I like charting by exception and then having the opportunity to make comments to individualize and describe, but with the drop down menus provided in some systems, there often seems to be something lacking.

canoehead, BSN, RN

Specializes in ER.

I worry that there will be no one left that remembers how to do things without a computer. How to organize all the paper, how to communicate between floors. It's a skill we should maintain, but unless we're doing it daily, its going to be lost. That's too bad.

The patient satisfaction push. Yes we needed to be more responsive to patient input and keep them as part of the health team, but once they choose to endanger their own health, we shouldn't be a party to it. Yes, I want to control pain, but I want the patient to be able to do PT. Yes I want to encourage patient's making their own choices, but that fifth tub of ice cream...they need to walk to the kitchen and get it themselves. I' know my fellow nurses get this, but the suits seem oblivious.

Leader25, ASN, BSN, RN

Specializes in NICU.

Suffocated by visitors,abused by visitors,tormented by too loud constant ding ding dang!Having to carry an ipod which battery is always low,a wireless phone that is set to call everyone for everything,like pharmacy calling on it,hard to hear due to loud alarms that ring when you breathe, and don't ring when iv infiltrated,carry a label maker /scanner,scan patient,meds /food/.No real upkeep on programs in computers,needs upgrades desperately.The worst offense I heard about was administration ruling that only BSN people could do fingerstick for glucose level.No valid explanation,only finger pointing,no plan to buy newer machines that were safe for all to use.So you ended up doing glucose on many patients besides your own busy assignment.Sure we do plenty of handwashing but we let in every kind of viral/bacterial feverish coughing visitors all the time,they slap a mask on and that's it,they wander about with the mask hanging off their chin and you can not say anything.Heaven help you if your named in any type of complaint by some deranged visitor,it is all your fault,you are wrong ,it will be in your evaluation.Too many classes on empathy,diversity forced down our throats and not enough on disease prevention,contagion,medications.

I could continue but what is the use.

Kallie3006, ADN

Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.

EMR- love /hate relationship, older programs with redundant, outdated systems, or lack of physician compliance- ease of access and patient safety check a plus, not having to play guess that word as much for written orders

Pyxis- wonders over a med cart

Medical information access- easier to find relevant patient education information but also harder for patient care whe. Dr. Google diagnosis a cancer not there

Work phones- direct number to be reach for needs or paging doctor: awful when also ringing for random crud all shift long

Insulin pumps and glucose monitoring systems

Cardiac devices that monitor pt in outpt setting sending data to phone program or dr office

Internet forums for advice, education, social interaction, and venting

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion.

I love all the new technologies in IV Therapy.The use of Tip Confirmation Sytems to verify tip PICC placement lessens treatment delays and saves nursing time and money.Also the use of Ultrasound to get that PICC well above the ACF in the Basilic or Brachial vein.The use of Ultrasound to start a PIV is a different matter.While still good, it's not as easy as many portray it to be and they have a much greater propensity to infiltrate than the standard method to start an IV.Do I use it.....yes...but only if I have toif other options do not exist.It does buy some time though to get IV therapies started while you work on central line access.It's also annoying that nurses fail to lrearn how to start an IV by palpation or visualization and want to go straight to technology.They pick these superficial veins with a vein light that last a few hours or fail multiple times with the US and fail to see or palpate the good veins right in front of them.I see this every day.Technology is only as good as the hands it is in .

work ethic in newer nurses (not all) isnt the same. some of our aides try to hide to avoid work. some coworkers are slobs, reports are often not accurate or complete. staff reduction in key areas to save money but at the risk of patient safety. I've been a nurse for 30 years and its definitely getting worse. sad but true.

Kitiger, RN

Specializes in Private Duty Pediatrics.

In home care, the newer equipment is wonderful. I work with LTV 1150 and Trilogy vents now, vents that hook onto the back of the wheelchair. I can carry all of the equipment on the wheelchair!

That's one wheelchair to push, with everything I need.

Remember how LARGE some of the old vents were? I worked with the LP4, LP5, & LP6 vents in the 80's. They were something like a 2-foot square cube of metal that was very difficult to lift. One family bought a full-size grocery cart to hold the vent with its boat battery, the Hot Pot with its bag of sterile water, the heavy suction machine, the big Pulse Oximeter, his Go-Bag, and an E-tank.

That cart was FULL. And we still had to push the wheelchair with the child. A trip to see the doctor used to be such a huge affair that a trip to almost anywhere else was out of the question.

Now-a-days, we can go pretty much wherever we want, whenever we want. The world has opened up for these people.

I wish there was a love this post option.

Yes! the Provena incisional wound vac dressing is very cool for surgical patients. One of my surgeons once said about Aquacel (that can stay on for up to 7 days), that it is like leaving a patient in a wet diaper. Don't know the cost to benefit ratio but if it reduces SSIs, I'm sure it will be worth it.

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