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Was it always this way?

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Did nurses always have a high number of patients, even back in the day? As a big supporter of nurses I'm curious as to when this trend started? My guess when hospitals went "corporate." Something that boggles my mind is why our law makers don't make safe staffing a law. I get that corporations have lobbyist that go around and rally against having more staff.

But one would think they would say to themselves, we need safe staffing because I might be in the hospital someday and I would want the best care possible. So why isn't anything being done? I know hospitals use "it's not in the budget" but yet bonuses for the higher ups are? Does not make sense, our healthcare system could really be outstanding if the people in it were given proper staffing and supplies to do their job, because I'd say MOST healthcare workers DO care and WANT to help others get better, but unfortunately the way the system is set up it makes it harder for them to provide the care they would like to give. What are your thoughts?

TU RN

Specializes in ICU, PCU. Has 8 years experience.

Nurses used to take care of many more patients than we do now, granted healthcare has gotten a bit more complicated as medicine has. Nursing understaffing has led to a great many complications, adverse events, and burnout on our end. This of course leads to nursing turnover and staffing shortage, which in turn leads state legislators to mandate certain staffing levels and hospital administrators to give more competitive nursing pay. The newly attracted nurses are met with greater requirements once they enter this nice lower ratio/higher pay situation - justifiable of course by administrators who want more work/higher quality out of their higher paid nurses. Most of the problems of today have already been problems for years. Corporate healthcare is who we work for.

What's new is with ACA and HITECH: hospital corporations are pressured (by the government) to create electronic healthcare records and charting systems that satisfy certain "meaningful use" criteria. By meeting these criteria a hospital is given funds, and by not meeting them they are penalized. Who primarily uses electronic charting? Nurses and physicians. So our hospital admins are pushing down the ladder onto us to chart and chart and chart. This is moving our less tech savvy nurses to burnout and - I don't know about you - I feel that the documentation required of us is unrealistic for the amount of care we also have to provide. It's setting us up for failure and starting the whole cycle I mentioned previously over. I wish my gripes with corporate-run healthcare systems ended there.

I don't maybe I'm just paranoid or miserable or ignorant or not a good nurse. Anyway rant over.

Rant away!! I don't think it makes you a bad nurse, I'm not a nurse, I'm just a patient who wishes I could make things better for the people who have helped me when I needed it and got me though some rough times in my life. In my opinion nurses are one of the hospitals most valuable assets, I know they don't make money off of them as many on here have stated, because they don't bill for them but I think more staff would mean better patient satisfaction because a nurse would be able to spend more time with patients to educate them and explain things ect., but that's just me. We also need to get rid of the Hotel/spa model that would be a big start.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Back in the day we took care of many more patients. We did Team nursing. One RN one LPN and one Aide/Orderly for 20 patients...on days. All of our notes were hand written and all orders,labs, results were given verbally then written by hand and placed in the chart.

While advances in medicine makes some aspects of care more complicated back in the day every surgical patient had drains up the wazoo, tubes and lines everywhere. These patients were labor intensive and complicated. We worked very hard and had little time with the patients.

As time progressed new concepts in nursing were developed and we had "Pod nursing" which there were less patients and more Aides which we still had plenty of LPN's. Then we went to primary care lost our LPN's and the Aides were cut as well in favor of an all RN staff...which actually made us busier for we had no help with the tough complete care patients.

Now we had less nurses and less help making the job near impossible....it's sad.

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

I have had assignments of 10-12 patients, but less was expected of me as well (no phlebotomy or IV starts or breathing treatments). A lot of nurse are complaining about "nursing the computer", not the patient, and I am beginning to see this topic in literature. There HAS to be a better way to allow nurses to do their job.

1975, new grad, not yet licensed: just me and one aide on nights: 16 pediatric neuro pts. Maybe not as much technology to mess with, but the kids were pretty sick.

I have had assignments of 10-12 patients, but less was expected of me as well (no phlebotomy or IV starts or breathing treatments). A lot of nurse are complaining about "nursing the computer", not the patient, and I am beginning to see this topic in literature. There HAS to be a better way to allow nurses to do their job.

Is ALL of that charting really necessary?I get that documentation is need for many things, billing and staff to refer back to in terms of care ect., but surly there must be some that is rarely used. I had a few nurses tell me paper charting was faster than the computer, which I can see how it can be.

I bet many nurses have ideas on how charting and hospitals could be run better but no one will listen to them. What a higher-up should do is slowly implement a team of nurses ideas and see if they work and if they do slowly add more of their ideas.

Either way, You all do a great job with what you have to work with, and your patients are thankful for all of you that work so hard to try to make them better.

Is ALL of that charting really necessary?I get that documentation is need for many things, billing and staff to refer back to in terms of care ect., but surly there must be some that is rarely used. I had a few nurses tell me paper charting was faster than the computer, which I can see how it can be.

I bet many nurses have ideas on how charting and hospitals could be run better but no one will listen to them. What a higher-up should do is slowly implement a team of nurses ideas and see if they work and if they do slowly add more of their ideas.

Either way, You all do a great job with what you have to work with, and your patients are thankful for all of you that work so hard to try to make them better.

Seems to me the prevailing view from "upstairs" is that nurses must chart enough so the place gets paid but not enough they will be sued. *LOL*

In the old days of paper charting some nurses darn near wrote dissertations noting every minute detail with plenty of "pt c/o of.....", "pt appears.....", "observed....", and so forth along with whatever actions were taken "reported to....", "notified MD of.... at......"

Nurse to patient ratios since back in the days has fluctuated and often were much higher than even today. Much depended upon what model of nursing care was being used and who was defined as a "nurse" in terms of care.

By the latter one refers to the practice still in use late as the 1950's in some places of using students to provide routine floor care. Then there was staffing dictated by what one could get. That is during legitimate shortages (world wars or just lack of interest in the profession), places had to often make do with what they could lay hands upon. Well remember during the 1980's the nurses on duty would either receive a telephone call or visit from supervisor telling them *NO* relief was coming for the next shift so they would have to remain. This could be for the duration of the entire shift or until an agency or per diem could be run to ground and arrive.

On a med/surg floor you may have 50 or a bit more pts with two nurses and one aides (team nursing) and they just had to make things go.

Being as this may as others have noted back then much less interventions were available/expected and at least on the floors you had plenty of stable pts who today would be discharged to home, LTC or rehab. Also gone today by and large are pts. who check in the day or so before a procedure for pre-op and other testing. Indeed many of those test such as colonoscopies are not even done in hospital for many so there is that reduction as well.

So today while the numbers of patients per nurse may be lower the acuity level for most if not all is much higher so in reality there isn't a "reduction of workload" so to speak.