What can I (we) do? RANT

emtb2rn, BSN, RN, EMT-B · Dec 21, 2014

Amen!!

Libby1987 · Dec 21, 2014

It'll never change with a flooded new grad market and a system that is not slowing down on its production of new nurses anxious to get out there and obtain employment. Our industry does nothing to control its numbers and make us highly marketable the way other healthcare fields do.

Gooselady, BSN, RN · Dec 21, 2014

Nursing is so NOT what we dreamed it would be.

I almost gave up being a nurse at all, for a lot of the reasons you give, OP. Somehow I made 'peace' with it over the years. No matter how distorted nursing has become by the corporate climate, patient safety a la JCAHO and Press Ganey dictating priorities we don't really agree with -- the patients still need nurses.

My solution was to focus on what I COULD change, which was myself and how I prioritize my nursing care. This means taking ownership of yourself as a nurse, an agent of nursing, rather than seeing yourself as a helpless robot. Wherever I go, the way I do nursing is mine. No matter the environment, management, coworkers, I am responsible for how I do nursing care.

I can accommodate whatever the environment dictates, including cleaning up after someone else, if that's what will provide the best care. That's my decision. Other nurses just refuse and go to the manager complaining, that's their way of taking responsibility for how they do nursing. I could give a literal **** about Press Ganey, I don't need to because I'm respectful and conscientious, and if it results in lower scores, it's beyond my control.

I agree nurses can always improve in bonding together, looking out for each other, having a common goal. But I can't MAKE a lazy or depressed nurse do differently. All I can do is manage myself. If that means accommodating, complaining or some combination of the two, so be it.

I relate to the feeling of dissatisfaction, I had it for sooo long. I hope in some way you can 'find your peace' within yourself, and feel empowered 'ownership' of your nursing skills in spite of the environment you are doing it in. Some environments are much more conducive to this than others, and I seek those environments, they are out there.

firstinfamily, RN · Dec 22, 2014

It could be the environment you are in, I am assuming(that bad word) that you were in acute care and changed to LTC hoping for a better environment. The thing that makes us nurses is accountability. Everyone has to be held accountable for what they do and do not do!!! Are you saying there is false documentation in your facility, nurses documenting about treatments etc. that were not actually done just to meet reimbursement requirements?? Then that is fraudulent documentation and that particular nurse can be held accountable legally for her/his documentation. Charting by exception did help some of the duplicate charting, but yes, you have to chart what you did and if you assessed a pt you have to chart that. With charting by exception you would document the assessment with the findings if they were normal or abnormal and if abnormal in what way etc. There is paper documentation for LTC that does this type of charting. However, it sounds like your QA and MDS person is requiring a lot of documentation so they can justify the reimbursements. LTC facilities are under a lot of pressure right now because of all the medicare/caid cuts. Like the acute care facilities the LTC facilities have also had to change the way they track because of the new reimbursement systems and it will get worse before it gets better as I believe there are more cuts to come. This is a discussion you, as a change agent and an empowered nurse can have with your manager, and the manager can have with the QA and MDS personnel. The hammer always falls on the direct care staff. Perhaps a suggestion of a meeting with the QA and MDS reps so that they can explain why certain documentation is needed, that may open up the door for an exchange so that your side of the story is being told and they may be able to understand why it is impossible to do all the documentation they want and actually take care of patients!! Be an agent for change, do not feel so oppressed that you are willing to give up your career. Yes, there are more positive sides of nursing, but see this as an opportunity for change, a way to improve the system. I felt at times that when I was working LTC I was being treated more like a child than a professional nurse by upper management. Let them know you are interested in how the reimbursement process works and what you would like to see changed so it can be more compliant on your end of the nursing triangle. YOu might actually learn a few things and they may learn to respect you and treat you more professionally. Yes, most of nursing is about fighting your way and then finding the calm within yourself that is satisfied with nursing. Sometimes it does take a change of environment, sometimes a change in attitude, sometimes just learning to speak up professionally to empower yourself and others. Another approach maybe to bring up the tasks that are not considered nursing and qualify for "non=productive nursing tasks" which seem to fall on the nurse, start tracking these and look at how many things nurses are doing that are totally not related to nursing----secretarial work etc. Eventually management will see the light if you "shine" it in their faces!!

Lev, MSN, RN, NP · Dec 22, 2014

I am not totally dissatisfied. Nursing has been good to me. I've learned a lot. I try to not give in to the whole customer service thing. I have recently been "rebelling" and letting my documentation of rounding slip here and there. I do take a lunch break, and yeah, sometimes my meds are late because of it. That's my choice. You have to make yourself stop and if I didn't have so much documentation to do, this wouldn't have to happen.

I feel that with nursing's numbers, it should have a much stronger lobby. Unfortunately, we just don't seem to have the right momentum to make people pay enough attention to us. I am really grateful to the Robert Wood Johnson Foundation which has done more for nursing that many self proclaimed nursing organizations, such as the ANA. I have heard the ANA referred to as the Anti Nurses Association.

Lev, MSN, RN, NP · Dec 22, 2014

I've only worked in acute care, but I've heard horror stories about long term care. False documentation happens in acute care too, believe me. It is so easy to click through an assessment that says PERRLA without checking pupils. It's easy to just click click click. I'm sure my coworkers document rounding and incentive spirometry use falsely. I see nurses documenting it first thing in the beginning of the shift before they've even seen the patient, just to get it out of the way. There is just so much pressure.

Edit: Actually I have sort of worked in long term care. It was a rehab unit that was based in a hospital. The ratios were decent though. Usually I had 6 or 7 patients, and sometimes 5 on day shift. Night shift went up to 8, sometimes 9. I worked there for 8 months. I don't think it gave me a good picture of LTC.

Esme12, ASN, BSN, RN · Dec 22, 2014

Answer....organize/collective bargin

AmeliasAunt · Dec 22, 2014

Nursing is so NOT what we dreamed it would be.
I almost gave up being a nurse at all, for a lot of the reasons you give, OP. Somehow I made 'peace' with it over the years. No matter how distorted nursing has become by the corporate climate, patient safety a la JCAHO and Press Ganey dictating priorities we don't really agree with -- the patients still need nurses.
My solution was to focus on what I COULD change, which was myself and how I prioritize my nursing care. This means taking ownership of yourself as a nurse, an agent of nursing, rather than seeing yourself as a helpless robot. Wherever I go, the way I do nursing is mine. No matter the environment, management, coworkers, I am responsible for how I do nursing care.
I can accommodate whatever the environment dictates, including cleaning up after someone else, if that's what will provide the best care. That's my decision. Other nurses just refuse and go to the manager complaining, that's their way of taking responsibility for how they do nursing. I could give a literal sh*t about Press Ganey, I don't need to because I'm respectful and conscientious, and if it results in lower scores, it's beyond my control.
I agree nurses can always improve in bonding together, looking out for each other, having a common goal. But I can't MAKE a lazy or depressed nurse do differently. All I can do is manage myself. If that means accommodating, complaining or some combination of the two, so be it.
I relate to the feeling of dissatisfaction, I had it for sooo long. I hope in some way you can 'find your peace' within yourself, and feel empowered 'ownership' of your nursing skills in spite of the environment you are doing it in. Some environments are much more conducive to this than others, and I seek those environments, they are out there.

This is stated perfectly. I too went through an "I hate nursing and everything about it" phase but finally realized that I was putting my energy into the wrong areas. Much like Gooselady said, I chose to stop worrying about everything else, and just dedicate myself to be the best nurse I can be with what I am dealt. Yes, I still become frustrated (and there are plenty of reasons to be!) but if I can walk out of my shift knowing that I did the best I could, then I am happy. I also realized that during my lowest point I was working in an environment that had become toxic to me, and a culture that did not share the same ideals and values. Finding a new environment can definitely make a difference. Good luck, and I hope you find your spark again... I sure have! :woot:

AnnieOaklyRN, BSN, RN, EMT-P · Dec 22, 2014

I just called it quits in my ER. Had enough of the poor management! I am so glad I have my medic to fall back on and I have been happily doing that full time for many years!

Here is an example of how the ER managers deal with staffing: I called assistant NM to ask her kindly if I could work 11p-3am instead of the full eight which would have been until 7am. Explained to her that my niece is sick in a PICU, explained I was in the PICU with her at the time of the phone call because I was covering for her parents so they could just get away from the bedside for a while. I asked her if I could work half the shift because I was not going to get a chance to sleep and would be awake for 24 hours. Keep in mind I am a per-diem. Her response wasn't, sorry to hear your niece is in the hospital, it was with an attitude "well you need to start calling people to fill part of your shift". Ok, let me reiterate this I am in a PICU, I will not sit at my nieces bedside and make 30 phone calls begging someone to work. her response, again with a 'tude" "well then send an email out I cannot afford to loose you tonight". Guess I should have called out! I can understand fine you need me, I just verbalized i might be unsafe caring for patients because of no sleep, fine you still want me to come in.. at least show some sympathy for the situation!!!!

Here is another example: One of our nurses had a pre-planned surgery with approved time off already, both managers approached her at the nurses station and told her she needed to cancel her surgery because the ER staffing was critically low (Gee, I wonder why), her response was "uh, what? I cannot cancel my surgery". Their response was "you need to cancel your surgery or you can leave right now or work till the end of your shift, either way it will be your last shift". So that nurse, life the rest of us, had enough, gave report on her patients and left! Good for her!

Every nurse is looking for other employment and many others are leaving. I am per-diem, in school, and work another job full time and they recently suddenly told me I had to work 8 hours a week to keep my per-diem states. So i said I would try a night shift every week, since that is the only shift I will tolerate in that place. I am wasted for two days after this night shift because my body is confused about when it should sleep and when it should be awake, so I emailed the nurse manager and offered to work 11p-3 am (four hours a week) instead. She said no so I said **** you, BYE!

If this management team ever realizes the bottom line is you need to put forth the effort make your employees happy or you will continue to have a revolving door and no staffing...This is a 48 bed ER, I am positive even if they were criticallly short staffed, which is almost all the time now, neither would put on scrubs and help out!

HPRN

lindarn · Dec 22, 2014

And as we say in Brooklyn, the ANA is about as useful as tits on a bull.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN (ret)

Somewhere in the PACNW

Libby1987 · Dec 22, 2014

To add on to gooselady, I look at work and my employer as a medium to practice my skill. Nursing went beyond just a job once I took ownership of it. I don't work on the floor and I doubt I could handle it but I found my niche as a case mgr in home care where I have a lot of autonomy and my cases are my charges, more so than they are my company's. The documentation hoops are here to stay and the amount is absurd, no one, even our employers, will disagree but there's hardly a career out there that doesn't have bureauracy these days.