Student nurse dismayed by bedside nursing attitude

[new gal]

Hello all, I am a student nurse currently in my first year. Before this I was a paramedic for a about a year and then decided to go the nursing route and get my feet wet by working as a CNA. I am the type of person who likes to research all aspects of what my next adventure will be. So as I am researching different aspects of nursing, I was a bit floored by the amount of people that hated bedside nursing, in particular on the Med/Surge floor. I get that the work load is high and that can bring stress as well as all the intricate details about day to day nursing, but is that any reason to hate bedside nursing? I thought that is what the nursing profession was all about. Getting right in there, getting your hands dirty and providing the best patient care possible. What exactly are some students thinking nursing entails when they get into school?!

[nursevjb]

OMG, are you kidding me? That's like saying you joined the ROTC in order to get a feel for the life of a Navy Seal Team Six. This is war we are in. Not a a virtual reality, video game version of the nursing "profession " What makes matters worse is that we are sent to the front lines, without ammunition. We have to wave our arms and jump up and down in attempt to scare the enemy. Which my friend, is often insidious. It could be the administration, management, the ones that's supposed to "have your six",but often times its the patients and/or their family. Today's patients believe that they are at the Waldorf Astoria and they pay you to serve at their every beckoning and call. This is the epitome of madness and... we love it.

[SpEdtacular, MSN, RN, EMT-P]

I think Med/Surg nurses are amazing people because I could not put up with what they deal with on a daily basis. They have to care for half a dozen or more able-bodied yet inexplicably needy patients who won't do what they are supposed to (e.g. ambulate, incentive spirometer, drink golytely for a GI procedure) and then they get b*tched out by **hole surgeons because the patients flat out refused to do xyz. They are entitled to some grumpiness.

[ArrowRN, BSN, RN]

Oh I know. I know how easy it is for me to have a blind eye on the matter. It was the same from paramedic student to actual paramedic.Very different, which I did expect to an extent. I was thinking of shadowing on the med surge floor, hopefully I can get a somewhat decent idea on what the nurses go thru day to day, from a CNA view, I only see how busy they are, but then again I am to busy to really follow them and get an idea of what their perspective is.

I went from EMT to nursing. Paramedic to nursing will be a slap in the face when it hits you. VERY different trains of taught which can be frustrating at the beginning, as paramedics/EMTs follow the medical model. Also as paramedic remember the pt only in your face for 5 10 maybe 30 mins. But when they at you for a full 12 hour shift and you got 5 to 8 of those at the same time and you can't drop them off and say hey he's your responsibility now..then you will really see what nursing is like.

[areensee]

You have q good point. Many nurses complain and they have good reason to. Our health csre system is operated by those who measure success in dollars, not in people. That being said, compromising patient care becsuse of one's attitude is not OK. Instead, get involv3d and work for change. Join nursing organizations, get politically involved and vote as a nurse. I have been a nurse for 22 years and I don't regret it.

[FolksBtrippin, BSN, RN]

I agree that there is an imbalance in power and responsibility. We do not have corresponding power to our very large responsibility.

[tyvin, BSN, RN]

Dear OP, I agree with you but apparently you stepped on a few nerves. Perhaps nerves wrought from overworking in med-surg. I am an RN who worked as a CNA when I was an RN (long story). Don't take the haters to heart. Keep up the good work.

Med-surg has always been a challenge for some, especially due to the high patient to nurse ratio. As a nursings student myself, I did clinical at several hopitals and some the nurses worked great together and others not so well. That's the reality. It's really about where you work mostly.

For me, I don't think your attitude is holier than thou. Nursing has a wide variety of positions and opportunities but you really do need that first year in med-surg or similar to get the jist of it than go...you must go after it is that you want. Research; there's a lot more to nursing than med-surg but there's also nothing wrong working in med-surg if you like it. Good luck :)

[Doodle69]

BEDSIDE NURSING: Everyone always said I was crazy but I worked on a Pediatric/Med Surg unit for almost 17 years and loved it. My unit was one of the biggest and busiest in our hospital. Everyone knew if you could work on it, you could work anywhere in the hospital. Yes it was hard at times, often times at the end of shift we would sit back after report and be grateful that we made it to the end of our shift because it had been so rough we weren't sure how we were going to make it. They weren't all bad days, we did have some good days in between-just seemed like FEW and FAR Between. We had a very dedicated staff and the supervisors took full advantage of pulling our help to other areas often leaving us with a minimal staff. If we could have kept the staff we had scheduled each shift, we would have had a lot better shifts. I worked 12 hour shifts as an RN on the floor at the bedside for several years on night shift before I eventually went to day shift. I became a charge nurse/shift care coordinator the last 10 years at the hospital. I continued to assist my nurses and cnas on the floor helping with our patients, even taking a team of patients if we were short staffed. I loved patient care (still do even though I no longer do it in my current job as a case manager), but it is not for everyone. I have precepted a lot of students and trained a lot of nurses. Some love it, others don't. Nursing is hard work, especially at the bedside. Some are not prepared for the reality of what is involved with caring for patients-the toll it takes on you. physically, emotionally, and mentally. Good Luck to You !

[Lady_Leijing, BSN]

I personally found my 2 years of med-surg to be very informative. You build excellent time management and teamwork skills. You see a lot of variety--well, at my 1st hospital you did. They didn't have specialty medical floors, so anyone who wasn't sick enough for ICU or step-down came to us. Some people love med-surg. We had a couple charge nurses that couldn't imagine working anywhere else; the rest of us were using it as a jumping off point. I'm currently working on a Postpartum and Newborn unit, so I use a lot of the adult assessment skills I learned, plus I've been able to show the nurses who have always been postpartum nurses a few things.

My main reason for leaving Med-Surg was the constant stress. We were chronically understaffed and everyone was burning the candle at both ends to keep the floor running. Our staffing ratios were usually decent, but only because our charge nurse took patients too. It became a running joke that if my phone rang when I was out somewhere, it was work calling. Unfortunately it was true more often than not. I was working 4 days a week, staying over 30 minute to finish charting on most of those days, showing up for meetings on my off days (or staying over for a 3 hour meeting after a grueling shift), and getting called on my every day off. We were understaffed and the management was not planning on hiring any new nurses.

[3ringnursing, BSN]

Come back in 10 years and tell us how you feel then? You may feel differently.

[TessLJ]

Im not stressed lol....ok i guess I could have worded what I truly meant better. As far as bedside nursing goes, what is it about it, that makes nurses dislike it the most? From what I gather it is the patient to RN ratio

It's usually something to do with administration making decisions that impact the nurse's ability to provide patient care. That's essentially the bottom line for most all nurses. I once said about a former job, "I love this job, I just wish management would leave me alone and let me do it." They toss obstacles in the way in terms of new policies that don't improve efficiency. They reduce the size of the essential auxiliary staff, like CNA's and Respiratory Therapists, PT Aides, and then "cross-train" the nurses to do the work. Back when I was bedside in the ICU, they cut back on the Lab Techs and told the RNs we had to draw all our own labs. They cross trained unit secretaries and CNAs and then expected them to both give baths and transcribe orders, only allowing one per unit. Thus the RNs were pretty much giving all the baths. I had no problem giving baths myself, but on a really busy day when patients were crashing, or there were a lot of admits, sometimes baths went to the back burner, and that's not right.

Administration is also quick to blame problems on the nursing staff. Years ago we had a serious event in the unit, and it occurred during an event where we were under inclement snow weather, so administration were strolling through the floors and units, saying hello and trying to convey the message that they were in it with us. After the event occurred, a week or so later, the Director of Nursing and our Unit Manager met with the staff and said that the administrators had come through the unit earlier before the event happened and that they observed the nurses all "standing around talking." It was administration's opinion the nurses needed to spend less time standing around at the nurses' station and more time in the patient's rooms, and that all of us were directly at fault (not the one imbecile nurse who should have been taking proper care of her patient). Basically what they observed was day shift giving report to night shift. The managers said, "That's what we told them, but they said you need to give shift report in the patient's rooms from now on." No, because 1, patient might be sleeping, and 2, there are times when we need to advise the oncoming shift of things the patient doesn't need to hear (path report came back malignant, Dr is going to inform the patient in the morning, this one keeps hitting the call bell, that one has a hostile family member, Mr So and So will try to grab your boobs, and so on...)

This is an example of the disconnect that leads to nurses, not hating their jobs exactly, but hating that they won't let us do them.

[cjcsoon2bnp, MSN, RN, NP]

I will admit that I only did about 8 - 12 months of Med/Surg before transitioning to the ED but here is the perspective that I have gathered why many nurses grow to dislike like beside nursing (and not just Med/Surg).

1. Patients who are hospitalized are sicker than ever before with shorter stays and are recovering from advanced procedures/interventions that were not available 10, 15, 20+ years ago.

Quite honestly, we have patients living longer with chronic disease and surviving acute episodes/conditions that they would not have previously (just think of STEMIs, O/D, and Cardiac Arrests for adults and the NICU babies born barely after 20+ weeks). These folks require a lot of speciality care and yet it feels like our hospitals don't provide enough resources and personnel to deliver the high-quality care that we go into nursing to deliver.

2. In the same vein as #1, bedside nurses are given a lot of responsibility but very little real power to affect change within organizations. This lack of power is evident when you see more tasks being added to the work list of nurses which were previously done by other members of the healthcare team because it makes their job easier and frees up the time of those other providers. Some organizations may have shared governance or some other forum for staff nurses to participate in unit-based leadership activities but rarely have the opportunity to be involved at a higher level. Staffing ratios, restructuring workflows, equipment purchasing are examples of things that should have input from direct care staff but rarely do. It's also frustrating to see the effects of budget cuts when delivering direct care to patients and yet many organizations are top heavy with a large number of administers who have unclear job roles and may not be necessary.

3. Changes in regulatory requirements from various organizations are now forcing RNs (and other healthcare professionals) to document at nauseum to meet certain core measures or risk losing reimbursement. This kind of charting takes away from our time with patients and is very frustrating because it is truly not necessary and can be very redundant.

4. Lastly, as others have mentioned, working in bedside nursing is mentally and physically stressful. It is extremely physically exhausting to provide complete care for a 300+ lb. bedbound patient who is incontinent and needs dressing changes when you are short staffed and the one aide/tech for the unit is busy helping other patients. Been there and done that, I still have to do this in the ED but I had to do it more in Med/Surg and it really sucks to be honest.

To the OP, I'm glad you're asking these good questions. Just keep in mind that how you feel as a student nurse, new grad. nurse and a experienced nurse will likely differ. Do your best to stay positive and open to new expieriences. Best of luck!

!Chris

[BSN_TN, BSN]

New nurse here literally about 7 months. Being a student and then an actual RN is a whole different world. I'm on a med surg floor and sister let me tell you I despise it. No resources, lateral violence, and constant HCAPS singing. Has my attitude changed? Yes greatly! It's hard caring for 6-7 pts that all want something and you only have one aide. The acuity of floor patients varies greatly. You may have 2-3 total cares plus more that need 2 people max assist. Be thankful you're still in school because once you get out talk about a total shocker!