Hi all, I am a new RN and am curious about some experienced RN's perspective on this topic. My dad recently had a very debilitating stroke. We have been to 6 facilities in 5 months and I have seen the good, the bad, and the ugly of nursing staff.
Often I find myself having to remind the nurses to float his feet for pressure wounds and turn him every 2 hours. He has been left in soiled diapers for longer then is acceptable among other communication issues.
I draw a line this past weekend when I went and asked to speak to the charge nurse just to get more info since his assigned nurse was an agency nurse and didn't know much about his history or long term care plan. She acted so unprofessionally. If you have a moment to read our dialogue it is below. (It is typed because I intend on sending a complaint to the company.) If you want to skip that part I totally understand.
[[[Nurse entered his room and immediately had an attitude which was demonstrated in her tone of voice and dismissive body language. She stated You asked to see me, what can I do for you?†and I responded by stating my observations of the treatment of the heal. I stated that there were 3 nurses sitting at the nurses station (one of which had their phone out) and she immediately interrupted me by saying I don't have 3 nurses so that's not true.†I responded by saying Well I saw 3 people at the desk none of which offered to assist with my concerns.†She interrupted me by stating What is your point, get to your point.†I stated My point is I came in and his heal was flat on the bed with a soiled bandage and I want to make sure it is off the bed as prescribed. There is available staff that are capable to attend to this task.†She interrupted me by stating I know you're a Registered Nurse so you think you know but I know how to run my floor and we are doing everything we can to assist him.†I asked to then speak to her manager who was currently unavailable. I asked her to please stick to the concern which was the wound as it had a green drainage that could indicate infection. She stated If the patient had an infection he would have a fever.†I responded by saying A fever is not the only systemic change a patient will have with an infection.†She interrupted me and stated I am not going to play this game with you. What else do you need?†I was completely floored at this point and requested she leave the room and please remind her staff to keep his extremities elevated.]]]
None the less, how do you balance being a nurse and having knowledge on how things should be handled versus being a concerned family member and letting things slide because you know how the system works? I am so disappointed in how some nurses have acted and feel sometimes (with any job) when you have been doing it for so long you really probably shouldn't do it anymore if you lost your passion.
Silly spelling errors, totally my bad. I appreciate everyone's advice. I did write my complaint in an emotional state so I will re read it.
I appreciate all feedback. This has been so rough for me. I have always relied on nurses to help me understand his condition but do struggle with lack of empathy and him getting hospital aquired complications such as cdif and pressure wounds.
I have very proud parents who boast to everyone their daughter is a RN and I have asked that they don't. Moving forward I will make sure I keep that quiet.
Sorry to say this, but there is no way you can be objective about the care of your father.
As a new nurse you know too much and don't know what you don't know.
The only way your father will get the care you think he needs is to take him home and care for him yourself, and in the end you won't be able to care for him the way you feel he should be care for.
Are you there to help your dad or cause trouble? When my hospitalized grandmother was waiting "too long" for a diaper change, I changed it myself ...and I wasn't even a nurse back then. If your dad's foot slipped off a pillow, prop it back up. Staff on their phones may be on break or even dealing with patient care. I often use the timer and calculator on my phone.
I'm curious what type of nursing work you actually do. Your heart may be in the right place, but you come across as somewhat obnoxious and controlling.
Wait...are you the charge nurse in question?
Even if she did prop his feet back up or change the dirty dressing herself, it is her right, and maybe her duty if her father is incapable, to advocate on his behalf for proper care.
OP, if you feel so strongly about it, I'd keep going up the ladder until you find someone who takes your concerns seriously.
This is hard - I have been thru this with both parents and several nursing homes. None of the situations were ideal.
There is no "right" way to handle the situation - everyone handles this differently. On one hand, you of course want the best care for your Dad. Nursing homes can't always provide the best care 24/7. They strive to, I'm sure but the sad fact is they can't due to staffing and the acuity of the patients under their care.
Is your Father there permanently or for rehab? What is the discharge plan?
Maybe a family conference is needed?
I hope you get some peace of mind with the care that your Father is receiving.
I just went through something similar when my mother was in the hospital for resp. distress. I found it very hard to keep my opinion to myself but she would say things that just made me furious! When the doctor didn't even listen to her lungs, just went by RT's report; when new RNs don't assess her because she's a "walkie-talkie"; etc. In the end I decided to limit my phone calls to RNs to once a day, and only ask about things that my mom wouldn't tell me. I can't be her nurse and her daughter, and in this case it's my job to be her daughter, to listen to her complain but know that she can exaggerate things; to empathize with her and send flowers, and be someone who can listen whenever she needs to vent.
The hard part is knowing that this is just the start; both my parents have COPD and will probably have exacerbations over the coming years. For right now I'm focused on being their daughter. I'll help answer their medical questions, but I can't be their nurse to. That will probably change but it is what has worked for me so far.
traumaRUS thanks for responding. He is there for rehab and our hope is he can come home but I'm not sure walking again is in the books for him and we all work full time jobs. Im not sure how we would be able to provide him around the clock care and maintain our jobs. Insurance doesn't cover much I am learning so we are kind of just playing it by ear.
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
To answer a few points:
4. Being on phones is a risky behavior because it is all about perception. In my eyes regardless of what profession if you are on your phone you have time to be doing anything else. All I ask is simply peak your head in the door and make sure his feet are propped.
Thank you everyone for your posts. Opinions are always appreciated.
I only have the time (and desire) to respond to this.
I'll have to remind the lab, the MD, radiology, etc that the need to come to the unit to give or get information from me. After all, if I am on the phone, it must mean I am not at all busy and should be checking on a patients legs instead of worrying about the patient who is tanking.
The other day I had a patient tank at the beginning of my shift. As I carry a phone at all times, I was on it with the doctor, respiratory so they could come up and do an EKG, the phlebotomist so he would understand that stat means NOW, not in 3 hours. I call the doctor back to demand he come lay his eyes on the patient. Then I have to talk to radiology so they can determine how stat my stat pcxr is (some docs will order a stat on a stable patient). Once I got off the phone with them, I had to call report to the unit the patient was transferring to. I was on the phone no less than 8 times during this trying to prevent my pt from coding. Obviously I have all the time in the world to go check on a stable pts legs. So yes, sometimes it is too much to ask.
And before you start questioning a nurses motives and wether they should be a nurse, keep in mind that we all have bad days. You are making snap judgements about what they are thinking or feeling. Being new isn't a bad thing but it also means you don't really understand what we might be going through.
I am sorry you have been going through this with a loved one. I do understand. I just think you need to take a step back, take a deep breath and realize you might very well be the nurse in a similar situation as yours.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I'm a certified rehabilitation registered nurse (CRRN) who recently left the inpatient rehab setting after working there for eight years. I've done both SNF rehab and acute rehab at a freestanding rehab hospital, so I'll provide my insight.
1. Staffing is not ideal in these facilities. The nurse/patient ratio often exceeds 1:20 in SNF rehab. In addition, a freestanding rehab hospital can have nurse/patient ratios of 1:10 or greater. With ratios like these, top notch care is not always a possibility.
2. Management creates this staffing grid to save money. They know exactly how their facility is being run. Our hospital administrator expected approximately 10 percent of patients and families to complain. Hence, management will pretend to entertain your complaint, but the cold reality is that they do not care about your father's outcome.
3. As a charge nurse and house supervisor in this environment, I often had a large patient load of my own in addition to my charge duties (e.g. admissions, family complaints, kitchen runs, trips to central supply, endless questions from other staff). I usually listened patiently to patients and families as they complained, but secretly I did not have the time. I had many other things to attend to, such as the nine admissions that are bursting through the door.
4. The nursing employee turnover rate in rehab is sky-high. Rehab facilities in my area cannot keep nurses, which is why you see so many new faces, PRN/per diem nurses and agency staff. Rehab is generally considered an undesirable specialty due to the physicality, heavy workloads, and emotional states of families in crisis.
I am so very sorry about your father's condition and the subpar experiences you've witnessed. However, with conditions the way they are, you are going to occasionally find your father's heels on the mattress. He probably will not be turned every two hours if his nurse had 20+ other patients. I do not say these things to be brusque. I say these things so you can prepare for the future.
Families would walk up to the nurses station and attempt to 'get me busy' if I was seen seated and on the phone. However, I was on the phone verifying orders with a physician, or answering the upteenth call from a family about "any status changes" with Grandpa. Things truly do appear different on the outside looking in. It is all about perception. I left rehab nursing six weeks ago and hope to not return.
OP, I am sorry to tell you that, but if you just wanna to survive in this rough world, you got to learn how to separate emotions and facts, as well as facts from books and facts from life, and do so quickly.
There are 1001 thing which "may" signify infection. Approximately 1002 of them can also signify 1000 other things, discharge (any color, from any wound) is among them. So, if you want to get what you want, stop teaching people how to do their job, especially in the form of citing textbooks. Also, stop counting those who are so shamefully sitting at the station and apparently do nothing to adddress your "concerns", rightful or not (going a bit ahead, you probably will spend insane number of hours sitting there waiting for a doc to call back, for a lab calling stats, for Micromedex search, for searching the condition/drug on smartphone because hospital computer system does not allow Google or just way too slow, and the like activities), and stop seeking problems where there are probably none (I am talking about "attitude", for in the name of the God I cannot get what it is about).
I work in LTACH and know patients like your dad and their families rather well. You went through A LOT, we know it, nobody says it is not so. But all that doesn't change baseline of being polite, not attacking people for not moving their bodies precisely to your liking and finding who is actually responsible for the task before asking about it.
P.S. please also know that the nursing is, in fact, a very small world. Being a new one and behaving like you did may seriously compromice your future job search in the locality if you irritate someone in seniority enough to mark your last name. For the very same reason, it is highly recommended to speak about your nursing status as little as possible.
P.P.S. this is why we need a book named "A Total Idiot's Guide To Being A Hospital Patient" ASAP, and it must be written by floor warriors.
Thecommuter thanks so much for your post. It definitely gives me insight on the other side of things. This is exactly why I posted this. This is difficult but I also have said many times how difficult it is for the nurses and have thanked and thanked again the nurses for being so great. I appreciate your insight!
NurseOnAMotorcycle, ASN, RN
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