The Bad Old Days

[SharonH, RN]

I was reading nurscees's thread and some of the comments about nurse-patient ratios and I started remembering:

Back in 1991, I started my nursing career at Thomason Hospital in El Paso, Tx on the pediatrics floor. We also had adult orthopedic patients overflow on this floor. My shift was 7p-7A. This was a 45 bed floor and we routinely took 15 patients each. We were always full. On a good night, we had four nurses which means that 3 of us had "only" 11 patients while one of us had 12 patients. Those were considered "good" nights and they were rare. There was absolutely no IV team and we had to draw our own admission labs as well as blood cultures on the adults for some reason. We were also responsible for signing off our own charts. Naturally, I had anywhere from 10-12 hours overtime every paycheck because I had to stay late to finish charting, etc. Nurses who couldn't get it all done were excoriated. (guess which category I was in?) One of my coworkers who was actually one of the sweetest, nicest nurses I have ever known told me that they used to provide care to ventilated patients on the floor back in her first days in nursing.

When I moved back to GA, I switched to med-surg. On 3-11 shift, we had 12 patients each but there was an IV team who did everything including giving prn and routine meds. The charge nurse signed off all the orders and made all the phone calls to the docs. I thought I was working at a resort. But in a short period of time, this became harder and harder. The IV team began to be phased out. Staffing ratios were decreased but the patients began to be harder to take care of. We started to provide care that used to be done exclusively in the units.

When I finally left a couple of years ago, we were down to 1:5 ratio on day shift but I was working harder than ever. Patients were sicker, family and doctors were more demanding, and the hospital actually employed nurses whose only job was to walk around and making sure we were spouting our "scripts" and evaluate our customer service abilities. Our nurse manager routinely made comments about how she couldn't understand why we couldn't get our work done when we were taking care of fewer patients. This observation was meant to induce shame and guilt in us nurses. It didn't work on me.

What were your first days in nursing like? Do you remember those days with nostalgic fondness or a relief that its over? Are things better for you or worse?

[DidiRN]

In 1986, I worked on a surgical floor. On the evenings and nights, you could have up to 18 patients. I passed meds and did some of the charting (this was team nursing) and taped report. I had to write everything down, or I wouldn't remember the patient, lol. I vividly remember taping report and couldn't place the patient's face with what I was talking about on the tape. On nights you would have same day admissions come in early in the am; you would have to get their IV started, consents, labs drawn and make sure they were okay. Plus your other patients. It was awful. I didn't last long there.

In 1991 was on a stepdown unit with 12 patients at night. First rounds did my own vitals (only one PCA for 32 patients at night, she was too busy). Charting and meds.

With the exception of my first job things just seem to be alot worse today. I may have had more patients in the past, but the people, like you said, are so much more sicker. There's a lack of trust in the medical staff that I've seen change so much. You are not treated with as much respect anymore. People are much more demanding nowadays.

Sherri

[dazzle256]

In 1986, I worked on a surgical floor. On the evenings and nights, you could have up to 18 patients. I passed meds and did some of the charting (this was team nursing) and taped report. I had to write everything down, or I wouldn't remember the patient, lol. I vividly remember taping report and couldn't place the patient's face with what I was talking about on the tape. On nights you would have same day admissions come in early in the am; you would have to get their IV started, consents, labs drawn and make sure they were okay. Plus your other patients. It was awful. I didn't last long there.

In 1991 was on a stepdown unit with 12 patients at night. First rounds did my own vitals (only one PCA for 32 patients at night, she was too busy). Charting and meds.

With the exception of my first job things just seem to be alot worse today. I may have had more patients in the past, but the people, like you said, are so much more sicker. There's a lack of trust in the medical staff that I've seen change so much. You are not treated with as much respect anymore. People are much more demanding nowadays.

Sherri

I feel a lot less respected in these last few years. Was wondering if it was just me.

On my unit MICU I can remember 4 or 5 years ago only getting two patients... now its almost always 3 and I've even had 4.

[Leda]

Way back in 1978, I was on more than one occasion the only person on a 40 bed genreral med-surg unit for the 11 PM to 7 AM shift. Grant it the acuity levels were much lower than today, but it was beyond unsafe by today's standards. Typically the ratio was one RN, one LPN, and perhaps one aide for the forty patients but more often than not it was an RN (me) an an aide. This was standard practice in a decent hospital at that time. You just dug in, kept moving and prayed that you didn't get an admission or have a code.

[Tweety, BSN, RN]

Since I've started, I've noticed the acuity is a bit worse. I've noticed ICU bed are much more in short supply so sicker patients stay on the unit, or they take a long time to get transferred out.

I've also noticed while we've gone to computer charting and flow sheets, instead of those dreaded long narrative notes, we keep getting a new form to fill out, either by hand or on the computer. Usually the forms are driven by JACHO or to prevent lawsuits, or in response to a lawsuit we've had. Things forms include pain control issues, restraints, and teaching, all of which have been a major focus of JACHO.

Since I've started nursing there have been major studies published about the prevalence of medication/hospital errors, as well as studies proving better patient outcomes/safety, as well as less nurse burnout related to lowered RN to paitent ratios.

No, I don't long for the good old days, they were rough then and are still rough. I try to do my best, to advocate for better, but if I didn't like it, I can always quit and find another profression or job.

I might add that when I advocate and complain about my current 8:1 ratio, it does me no good whatsoever to say "when I was a nurse in the old days I had 12:1, so quit your whining". :rotfl:

[begalli]

...we keep getting a new form to fill out, either by hand or on the computer.

Gosh, I couldn't agree with this more. In the past two years we must have had at least a couple dozen new forms that are in constant revision. I agree that every form has something to do with JACHO and whatever their particular list of to-do's are in any particular year!!

[SmilingBluEyes]

I've only been a nurse since 1997. I am fairly new to the game, but my family has a LOOOONG history in nursing going back to my grandmother graduating her school in 1922. I have two cousins whose nursing careers span greater than 35 years.....So i guess I can't talk about the 'bad old days" but I am not blind or unable to hear and see what used to be and also, what is going on today. I think in some ways, things are getting worse than better.......(HMOs and insurance companies running things, not good)....however....

I do like that nurses are standing up for themselves, the profession and their patients much more..... THIS I see as very positive. I see some AMAZING people here at the boards and feel proud to be in your ranks.

Now if only we could unite on the other huge issues facing us.

[suzanne4, RN]

I remember getting floated from the ER my first year out of school to be the only RN on a 32 bed unit..............

Or working a city ER in Detroit when our entire ER staff was one RN, one LPN, and myself as a student..........plus one ER tech. Those were the days, brings back quite a few memories. But out triage part was comprised of only about 6 lines on the top page, much different than the four pages or so that ERs have today.............just for the triage section.

[Antikigirl, ASN, RN]

Started in 2000 actually, so pretty new still...but my first job was from hades, and has been progressively worse since! But, I am not alone, seems too common in my neck of the woods...and I think the burn out rate around here is severely high...you would think someone would try to stop this from happening!

We have many nursing schools here, about 4...so many fresh nurses are coming out of the woodworks every year, so I guess with that in mind, nurses with a bit of experience are still treated like newbies because they are cheeper to hire and if we complain they basically can say "we can hire a graduate...so you are expendable". That cycles...that bites!

I really don't feel that nurses are considered professionals here, because you can get a graduate for so much less than someone with experience so why consider them professionals or seasoned..and that hurts both new grads and experienced nurses! AND there is a trend to only hire nurses part time, have them delegate tasks to LPN's or even CNA's, so that they don't have to provide health insurance or other perks you can get from full time...is that the way to treat a professional????

Oh well...we will see if I am still a nurse in 5 more years..at this point I doubt it! (we just started work on our home on a few acres of land so I am not able to move to a more Nurse Friendly area any day soon...my dream home...I don't want to leave! So I am stuck here...so if things don't improve...well...). If things don't improve around here the burn out I already feel will be intolerable, and I will have to seek new options to keep myself from being a pesimist for the rest of my life (I use to be so lively and fun...funny and a very happy spirited person...I am not that person anymore..and it has only been 5 years...not a good start).

[BETSRN]

Gosh, I couldn't agree with this more. In the past two years we must have had at least a couple dozen new forms that are in constant revision. I agree that every form has something to do with JACHO and whatever their particular list of to-do's are in any particular year!!

I am on a floor with excellent ratios(LDRP) , but I keep wondering of the stuff JCAHO thinks up is supposed to keep us AWAY from patient care. Truly, I don't understand how one can do nursing care with all the extra crap we have to fill out, ask, etc. It's rarely vial to the patient's well-being.

[apaisRN, RN, CRNA]

I hear a lot about patients being less acute in the old days. I've only been a nurse for 3 years, so I don't have any basis for comparison. Does less acute mean that not everyone had IV meds and toileting help? Fewer dressing changes? Fewer tubes in every orifice? Tell me what it was like.

As a new nurse, I worked a general surgical floor on evenings and had 5-6 patients. Nearly all would have IV meds, fluids or TPN. A couple would have AC and HS fingersticks, everyone would need pain meds, some or most might be fresh postops. At least a couple dressing changes. Usually at least one vomiting or stooling all over, requiring multiple bed changes. They were all supposed to have help with TCDB/IS and ambulation. Usually not more than one total care, but on a really bad night you might have two. Charge nurse took off orders and checked labs. Lots of NGs, ostomies, drains and t-tubes. Our floor got the gastric bypasses, so in addition to your regular obese patients, you could count on a few postop bypasses who would need to be closely monitored so they didn't drink 200 cc at once and bust their stomach sutures.

Compared to what others describe, it doesn't sound hard. I ran my butt off. We had one aide on a good night for 40 patients and most of the aides were useless. We never had enough supplies or equipment, I was always hunting down a dynamap or glucometer. The pharmacy, lab, xray, orderlies, housekeeping and EKG techs seemed to be on perpetual supper break. God forbid someone crumped and needed stat labs, CXR and EKG. Granted I was a new grad and had some things to learn about organization, but nurses keep leaving that unit and from what I hear it just gets worse. I work in MICU now and in two years I don't think I've had to take more than 2. The various support services respond immediately. The nurses are less burnt out and more willing to support one another. It has its faults, and I'm moving on in any case, but you could not pay me enough to return to a med-surg floor.

[SmilingBluEyes]

I am on a floor with excellent ratios(LDRP) , but I keep wondering of the stuff JCAHO thinks up is supposed to keep us AWAY from patient care. Truly, I don't understand how one can do nursing care with all the extra crap we have to fill out, ask, etc. It's rarely vial to the patient's well-being.

this is perhaps, the ONE thing that may drive me away from bedside care one day....I can see it. I hate the paperwork and it's getting beyond ridiculous. In just 7 years, I have seen things get MUCH worse this way. It's obscene, really.