So you don't like Nursing? Let's fix it!

Bugaloo · Mar 20, 2009

Yes, there has been a trend lately. I agree. And I have posted in a lot of those threads. I think nurses are just tired of being treated as if they do not count.

First of all, in an acute hospital setting, the nurse/patient ratio needs to be based on acuity and not numbers. And the numbers have to come down from 8:1 to more like 4-5:1 to provide quality care.

In some areas, factory workers make more than nurses. Raise the pay!

That is just two things. I will think of more later!

StNeotser, ASN, RN · Mar 20, 2009

Most of my solutions are going to cost someone money;

I do not wish to take responsibility for toilets that won't flush or burst pipes and other maintenance issues because I work on a weekend. I would rather they employ a maintenance person on a weekend rather than the one person for the whole place that tells me it's "not on the work order sheet". Of course it's not because the problem only arose five minutes ago and as there is no secretary to fill out the work order sheet. Same goes for trying to be a social worker or working for any other department for free. Nobody but nobody in a hospital/health care facility takes responsibility for something that is nursings job.

Press Gainey and other aspects of "customer service". It's about time that this got knocked on the head. No, a 300lb diabetic patient is not going to be happy when I tell them I don't bring trays of donuts around and nor are they happy that it takes the entire floor staff to roll them over and wipe their butt, meaning that it takes about 10 or 15 minutes to get everyone assembled in their room to do so. There is never going to be a 100% satisfaction with this patient or a lot of others. It also gives rise to a lot of employee abuse. Lets use infection control rates and good patient outcomes to rate hospitals.

Lets get people with some knowledge of health care running hospitals rather than MBA's and bean counters. This is how the problems in paragraph 2 arise in the first place.

I saw a post on here recently where the poster was complaining about a nurse with a masters degree who said "I didn't get a masters degree to wipe up s...." Maybe she didn't. However, if you look at the field of nursing and compare with other fields, does someone in an office get continually interrupted with menial stuff. For example, you've hired an accountant and right when they're in the middle of something pop in and say "here, I've got half an hours stapling and photocopying for you to do. What do you mean you didn't get a masters to do this? You think you're too good to photocopy or staple?" Then 45 minutes later have them man the reception desk..............I think you get the idea. So the "fix it" for this is to hire more support staff for nurses. I don't mind wiping up s... either, but I do get irritated when I'm on the phone and some family member thinks it's important that I just cut the phone call off and run like a mad woman to the patients room because Mom needs a soda, the bathroom or kleenex. I know it's very important that her Mom needs those things but I cannot be all things to all people.

Virgo_RN, BSN, RN · Mar 20, 2009

Acuity based staffing. Even with a four to one ratio, if those four, or even one of those four, are really sick, it's too much. I've been run ragged on several occasions when I only had three patients, because they required so much care. Accommodation codes need to be based on reality, and they need to be used for staffing, not just billing.

Education. As a cardiac nurse, I have received no education, zero, since taking my first classes as a new grad. We had an EKG class and a class on different cardiac conditions and the standards of care for them, but beyond that, I have had nothing. If we are expected to provide excellent care, we need education, education, education. I still have not had my ACLS yet, and I've been on the floor for over a year.

Better training and accountability for assistive personnel. These people are a part of the patient care team, and they need to understand why their role is so critically important. They need to understand not only the rationales behind the job tasks to which they are assigned, but also be held accountable for whether or not they perform these tasks. Too many of the UAP where I work leave too many of these tasks for the already overworked nurses to perform, because they do not understand why we need the support we need. Too many of them seem to think that nurses only ask them to do things that nurses either don't want to do because they are lazy, or don't want to do because they feel above it and don't want to get their hands dirty. This is an attitudinal problem that is not unique to my workplace.

So, in a nutshell, acuity based staffing, education, and support through better education, training, and accountability for UAP.

RNMariposa · Mar 20, 2009

I agree with what the other stated before: more education, more support, acuity based staffing.

I am a new nurse and I am really not liking the fact that even though I went to school, graduated, and passed NCLEX that I don't have enough experience to get a job... or even to get interviewed. I am not allowed to volunteer/ shadow because it is a liability because I am not an employee. I can't become an employee because they won't hire me as a tech, unit secretary, etc. I can't get an externship because it has been longer than 6 months since I graduated.

My thoughts are this... I think in order to solve the "no experience" problem for all of the other nurses in the future there should be a manditory externship for all new nurses after graduation and education seminars based on what specialty you want to enter. This way all nurses in the future will have experience on the floor and field specific education and can be ready to work immediately.

Jean1313 · Mar 20, 2009

I agree with acuity-based ratios. Also suggestions for accountability for support staff. Half the time we do their job and ours of they aren't invested in their job.

I'm going to add better support for new nurses. There were talk of "support" and "mentors" with advanced degrees. I met my "mentor" once. And all she focused on was the skills list. To take this a little further, assistance with transfers. It shouldn't be that people get stuck in a position with no way out. I'm not advocating let people completely come/go as they please, but maybe the mentor could be of help here as well. When a nurse is frustrated, anxious, then depressed in a specialty, it does no one any good. Oh wait, but it does fill the "warm body" slot. So after a person has been off orientation awhile, and support from the nurse manager & mentor doesn't do it, let them go. Not many of us find the right job on the first (or even second) try.

Enough RNs to give every RN a break. We should get to eat and go to the BR at least once in 12 hrs. And not just shove food down our throats. If I know that my taking a break overloads an already overworked RN on the floor, I don't take a break. Especially if I know my pts won't be able to get what they need in that situation.

People think we are machines, not human beings.

Perhaps the solution is to let the "beancounters" work the floors once the "shortage" returns. Even if they do tasks that don't require certification. That might change things.

HouTx, BSN, MSN, EdD · Mar 20, 2009

What a great thread - thanks for introducing it.

IMHO, nurses cannot 'fix' nursing because the problems are not of our making. Rank and file nurses do not have sufficient power to make the widespread changes neccessary -- changes that have been identified in many well-known publications over the last decade. Read any of Suzanne Gordon's books - she has nailed it.

Increasing dissatisfaction (again, IMHO) is due to the fact that we want to live up to the ideals that drive our profession - simple stuff really; every patient deserves quality care by a nurse who is not too overworked to deliver it. But, nursing services come with the towels and sheets - it doesn't matter how much 'nursepower' is needed to care for patients because a hospital's reimbursement is not even remotely connected to this factor. Instead, it is based on 'medical' procedures - Nuts, right??

To top it off, when we do get nurses elevevated into positions of power, too often they morph into executives - more concerned the bottom line (from whence come their bonuses) than patient care or wellbeing of their nursing staff. The problem isn't that we don't like nursing -- it's that we don't like the conditions that have been imposed on us by the modern healthcare environment. Best fix? Courageous Nurse Executives who continue to be "nurses" and advocate for a more nurse-centric environment.

Valerie Salva, BSN, RN · Mar 20, 2009

Most of my solutions are going to cost someone money;
I do not wish to take responsibility for toilets that won't flush or burst pipes and other maintenance issues because I work on a weekend. I would rather they employ a maintenance person on a weekend rather than the one person for the whole place that tells me it's "not on the work order sheet". Of course it's not because the problem only arose five minutes ago and as there is no secretary to fill out the work order sheet. Same goes for trying to be a social worker or working for any other department for free. Nobody but nobody in a hospital/health care facility takes responsibility for something that is nursings job.
Press Gainey and other aspects of "customer service". It's about time that this got knocked on the head. No, a 300lb diabetic patient is not going to be happy when I tell them I don't bring trays of donuts around and nor are they happy that it takes the entire floor staff to roll them over and wipe their butt, meaning that it takes about 10 or 15 minutes to get everyone assembled in their room to do so. There is never going to be a 100% satisfaction with this patient or a lot of others. It also gives rise to a lot of employee abuse. Lets use infection control rates and good patient outcomes to rate hospitals.
Lets get people with some knowledge of health care running hospitals rather than MBA's and bean counters. This is how the problems in paragraph 2 arise in the first place.
I saw a post on here recently where the poster was complaining about a nurse with a masters degree who said "I didn't get a masters degree to wipe up s...." Maybe she didn't. However, if you look at the field of nursing and compare with other fields, does someone in an office get continually interrupted with menial stuff. For example, you've hired an accountant and right when they're in the middle of something pop in and say "here, I've got half an hours stapling and photocopying for you to do. What do you mean you didn't get a masters to do this? You think you're too good to photocopy or staple?" Then 45 minutes later have them man the reception desk..............I think you get the idea. So the "fix it" for this is to hire more support staff for nurses. I don't mind wiping up s... either, but I do get irritated when I'm on the phone and some family member thinks it's important that I just cut the phone call off and run like a mad woman to the patients room because Mom needs a soda, the bathroom or kleenex. I know it's very important that her Mom needs those things but I cannot be all things to all people.

My thoughts exactly. Great post.

I work in a very hectic outpt procedure environment. There are no secretaries, no clerks, no docs, no houskeeping- just 3 techs, all the pts and me.

Garbage can overflowing? Paper jam? A drink spilled on the floor? Toilet stopped up? A water leak? Pt's bathroom out of tp? Someone in the lobby wants to fill out an application? Phone ringing off of the hook? Corporate on the phone wanting a report compiled right now?

These things all go to me- and incidentally, so does the pt care.

nursedani08 · Mar 20, 2009

I agree that patient acuity needs to dictate the nurse to patient ratio. I always feel like I'm behind, and if I have a patient who suddenly requires more attention, I have a difficult time finishing the rest of my assessments and documentation. I would like my hospital to go to electronic charting, so that charting can be quicker and more convenient. However, I realize that I'm a child of the computer generation and electronic use can be difficult to use. I've heard of some other uses of technology that I think would make our jobs easier, like to have PDAs with drug guides and nursing care plans on them. A great support staff is a must. Having good a good LPN work with me makes all the difference. Not only a good nursing team, but curteous and hard working staff such as RTs, PTs, social workers, transporters, care aides, you get the picture. I'd like to have a unit clerk on my shift. I work nights and there is only one unit clerk for the whole hospital, we have to page them if we get an admit so they can help us with the enormous amount of paperwork and orders to enter.

I guess put simply, less patients, less paperwork, less distractions so I can focus on what I'm trained to do.

Now I don't get what's so great about being union either. I have to pay the fee even if I choose not to take part, it's not optional. I have to wait a year for paid time off which the non-union employees wait 3 months, I have to wait 12months to post for another department, when non-union employees can do it in 6. I don't think our benefits package is all that great. I'm not happy with the nurse to patient ratios... I just don't really get what this union is doing for me.

Now this may be a bit skewed because I'm a new nurse, but that's my beef so far.

rbezemek: I agree with you completely. You are lucky you have the option to not take a break. I am mandated to take a break because If I don't punch out for a half-hour, I get overtime and which they do not want. I often punch-out and work on my charting during that time. It's also a big deal that we get out of report on time or we get paid for 15 min of overtime... heaven forbid.

A_Simp · Mar 21, 2009

Get thread!

Although I am a new RN, I have extensive experience running businesses and have work as a business consultant for a franchise company in my pass life. I know one of the issues is compensation and given the amount of responisibilty and accountability RNs have, we are not nearly compensated enough. However, in any business there are other factors that will aid in job satisfaction and ultimately retention such as supportive environment/culture/community, managable workloads, input on how unit is run, scheduling and equality.

Over the 3+ years that I've worked in a hospital environment, I have obversed many unhappy RNs. Alot of this I believe stems from managment and leadership. What is the criteria to become a Nurse Mgr or Administrator? Senority, longevity? As RNs, we become proficient at multi tasking, problem solving, etc but these skills do not necessarily translate into being great a Mgr or Administrator.

I believe it's all in the people skills, developing relationships, team builiding as well as creating a supportive profession/unit culture that will ultimately lead to improved job satisfaction/retention. It's not rocket science :banghead: , if you treat and keep your RNs happy/satisfied then in turn that will translate into better pt outcomes and ultimately, increasing the Hospitals bottom line.

In regards to my own personal experience both as a student nurse and now a RN, I have been the recipient of lateral violence on numerous occasions - having a Nurse Mgr tell her staff to treat us (SN) as "Aides" because that is all we are; Just 2-weeks off New RN orientaion, my night shift co-workers threw me under the bus by emailing my Nurse Mgr because I asked them to give the new admission thier catch-up medications. This "nurses eat their young" mentality needs to stop and as a profession, we need to support one another. We have all been "new" at something at one time or another Yes, it will take a bit longer to mentor new staff but in the long run it will decrease workload and improves the culture. I am always amazed by RNs, complaining about the CNAs but never take the time to foster a relationship by showing them or explaining why and how something is being done.

I for one would gladly work for less $$ on a busy unit provided I worked with a good group of RNs, UCs and CNAs, where everyone might agree it's not a great place/unit but as a team we all support and nurture each other and with good attitudes are making the best of it. :nurse:

DeepFriedRN · Mar 21, 2009

I'll repeat what everyone else has said--acuity-based staffing. If we have 30 people on the floor, and 15 of those can't eat, sit up, clean up, or go to the bathroom without help, it seems fairly obvious that it should take more people to deliver care on the floor than if it were only five of the 30 who were unable to do the above.

I also think it should be mandatory for those in nurse management positions to work on the floor for at least 2-3 weeks, same shifts as the rest of us, when they decide they need to cut our staff yet again. Let them do the same shifts as the rest of us and then tell us it's possible.

And on a completely unrealisitic note, let the bean counters who the cuts originate from have to come and stay a week in one of the beds on said floor where the cuts are made, with the stipulation that they act as many of our pts really are..unable to eat or get up to the restroom alone. Let's see how they like having to wait 20 mins to go cuz their nurse is in another room with an emergency, and there's just no one else to help them.

SummerGarden, BSN, MSN, RN · Mar 21, 2009

i agree with the staff ratio argument. however, has anyone noticed that the ana does not support measures that focus on staff ratios???? we (the nurses that work the floors) need to change the ana's mind!!!! the ana is supposed to be our organization! they are supposed to support us! :twocents: