Seasoned Nurses - This one is for you

Editorial Team / Moderator · Dec 14, 2018

Goodbye paper charting, hello EMR.

brandy1017, ASN, RN · Dec 15, 2018

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, RN · Dec 15, 2018

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 · Dec 15, 2018

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

Trauma Columnist · Dec 15, 2018

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 · Dec 15, 2018

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.

Alex_RN, BSN · Dec 15, 2018

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.

Alex_RN, BSN · Dec 15, 2018

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.

butterball1980 · Dec 15, 2018

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.

RNperdiem, RN · Dec 15, 2018

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 · Dec 16, 2018

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.