I think there are so many things about nursing that have to be fixed. I got tired of bedside nursing after a year. I am so tired of the bureaucracy, paperwork, and the focus on things others than quality care. I am so sick of rude people who think they're the only ones in the world. Bedside nursing is the backbone of nursing, so I shouldn't have a love hate relationship with it.
I am so tired of the documentation, the unclear expectations, and picking up slack for other people.
The ratios are unreasonable and not safe. Especially in long term care. Why should people have to falsify documentation in order to "show" that they did something at the right time even if they didn't even do it because there are simply not enough hours in the day to do what is expected of us?
Why can't nursing be just care and not computers?
I would love to go to work, hear about my patients. Look up a couple things in the computer and then go give out medications. OK, I'll document those, but why do I have to document an assessment every shift. Why can't I just do my assessment and write the abnormal findings in a short note or something, or not at all. Aren't doctors supposed to round on patients and actually put a stethoscope to their lungs, heart, and bowels? Why can't I just turn patients, do wound care, and have my patient use the incentive spirometer without documenting it all. It's all so tedious! Why can't I round on my patients and not have to document that I rounded on them? Why do I have to be the go to person for everything? Why do I have to do secretarial work? Need a copy? Ask the nurse. Need a form filled out? Ask the nurse. Need something faxed? Ask the nurse. Need the number for McDonalds? Ask the nurse.
How many people have died in the name of customer service?
So what can we do? Here are some things I've thought of. I'm sure others have mentioned these ideas before.
We need to unite as nurses. We need to stop thinking that nurses in other specialties aren't "real" nurses and that we are only "good ones."
We need to have less focus on titles and degrees and more focus on quality.
We need to respect ourselves as professionals and act in away that is deserving of respect.
We need to stop trying to prove ourselves and just let ourselves be.
Specializes in Mental Health, Gerontology, Palliative.
One of the things that seems to be endemic in the US is the 'fire at will" culture. Nurse makes a mistake "fire them", nurse makes a drug error "off with their heads"
Seriously, many of the things you US nurses seem to have to endure with too much frequency would simply not be tolerated here. We have a new 90 day trial legislation which means that technically a person can be let go at any time within 3 months without an excuse. However in a standard job, if an employee makes a mistake. They would first have to be given a verbal warning and a chance to rectify the issue/behavior of concern. If this persists the employer would then issue a written warning that if X behavior is not changed then the employment would be terminated.
The last shift I worked Sunday (week ago) when I made the stupid mistake of working febrile 38.4 degrees C (101 F). I made a monumental cock up and gave the wrong medications to the wrong person. My bosses focus was on ensuring the welfare of the patient. Full set of vitals and ongoing monitoring as outlined by the oncall doctor. She operates on the premise that we all make mistakes from time to time, and its more important to ensure that the patient is not harmed, and that we learn from it rather than beating us up about it
I know exactly how you feel. You come in and the prior shift decided to pass on the straight cath or tap water enema for you rather than do it themselves, then the CNA is nowhere to be found, hiding out when the call light goes off for that patient. Of course after you are in there cleaned them up and got them back to bed they come out of hiding and pretend to be how are you doing bullcrap! Makes me want to scream! Don't BS me just do your job already! I get so tired of doing the CNA work when they are MIA. I've even left the emergency light on as I was getting the patient back to bed and they never came in till after it was turned off! How convenient!
What makes it worse is all the altered mental status patients, we have gone from a true intermediate cardiac care unit to a jack of all trades med-surg and the latest is now we're the stroke floor. A simple medical patient that any RN should be able to care for has to come to our floor because the other RN's aren't qualified. It makes no sense! There is nothing magical we do that any other nurse couldn't do. The only interventions that could possibly treat a stroke patient is TPA which is done in the ICU and so few CVA patients are even candidates for TPA. The worst is every altered mental status patients that comes thru the door gets the R/O CVA diagnosis slapped on and they are headed our way! Oh what fun, NOT! Confused, combative, agitated patients to deal with is too much! All I ask for is an alert and oriented patient for a change. It is such a rare treat to get that gem of a patient. Then the family irate because you can't fix the confusion, or mad that you sedate them, but don't want to take them home either and they sit at the hospital for a month or more getting guardianship or finding a SAR that will accept them.
I'm sorry to say I don't have any advice to offer, but just wish I could retire already! Nursing is truly a crappy, depressing job, but you are supposed to pretend your happy and smile like everything is ok. I can only say I'm happy that I'm off today and hope the next time I have to work things go ok, but I reserve the right to take a mental health holiday if it gets to be too much! I literally take it one day at a time and my bills and paying off my house are what motivates me to go to work every day. The thing about nursing I do like using my brain to actually help my patients is such a small part of the actual work of nursing. If only I could use my brain and not my body then I could be truly happy, but that is not a possibility in bedside nursing!
What makes it worse is all the altered mental status patients, we have gone from a true intermediate cardiac care unit to a jack of all trades med-surg and the latest is now we're the stroke floor. A simple medical patient that any RN should be able to care for has to come to our floor because the other RN's aren't qualified. It makes no sense! There is nothing magical we do that any other nurse couldn't do. The only interventions that could possibly treat a stroke patient is TPA which is done in the ICU and so few CVA patients are even candidates for TPA. The worst is every altered mental status patients that comes thru the door gets the R/O CVA diagnosis slapped on and they are headed our way! Oh what fun, NOT! Confused, combative, agitated patients to deal with is too much! All I ask for is an alert and oriented patient for a change. It is such a rare treat to get that gem of a patient. Then the family irate because you can't fix the confusion, or mad that you sedate them, but don't want to take them home either and they sit at the hospital for a month or more getting guardianship or finding a SAR that will accept them.
I'm sorry, but why exactly should the rest of us "unqualified " RNs have to get the agitated combative dLOCs so you can have the "gems"?
I've been on a floor for only 6 months and I've already had to have "the talk" with another coworker. She's burning herself out trying to be the supernurse no one can be on your average Med-Surg floor. I keep trying to explain to her how we can't be everything and fo everything anymore, that kind of nursing is h one, but she keeps trying and going home 2 hours late and leaving in tears. Nursing has made me a more negative, cynical person who spends so much energy screaming silently behind my plastic Press-Ganey smile that I'm missing completely emotionally numb when I finally clock out.
The solution? I don't know. Organizing only goes so far and has its own set of cons. Politically we could be a force to reckon if we could ever get above the back biting the profession is renown for. But above all, we've got to be better educated. In American society doctors are held in high esteem partially because of their services and partially because of the amount of education and effort that goes in to becoming a physician. There's the MCAT, Steps and OSCEs, residency....Nursing education is a pump and dump game for the most part.
The biggest obstacles to improving nursing in America are the nurses who can't get out of their own way, and the upper ranking management /administration who have everything to lose when nurses find their voice.
Supporting ancillary staff could also help the working environment.
The documenting is the worst!! Here is what is personally maddening for me, I did clinicals at a big university affiliated medical center that uses Cerner and had their certain things that must be documented, then I did my preceptorship at an independent hospital that uses Sunrise and they had their certain things that must be documented now I work at another a big university affiliated medical center that uses Sunrise and has their things that must be documented and all three places emphasize on different things in the general charting (not speaking about specialty specific units here). Sadly, the worst is my current employer. They have us charting minutia Q4 or Q8. Really dumb stuff about their nose, lips, saliva gingiva and tongue. It's charting by exception but many RN's there feel that WNL/WDL isn't sufficient. I've met one who charts that way and he's one of the few that I see leaving on time. Coincidence? I think not. As a new RN, I am drowning in charting stupid stuff when I could be learning how to be a nurse to real live patients!!
TPTB in Healthcare in the US say that all of charting is regulated by CMS but that's is NOT true! All of the hospitals make up their own ways to cover their butts! It's not even as though I can point to State laws as all the hospitals I referred to above since they are in the same city but the differences are staggering! Sadly, I would have to say that patient care is the worst where I work, partly because the RN's are too busy charting perhaps??? They're getting EPIC next year and I'm hoping it will be better but I doubt it as they'll customize the crap out of it too.
Strangely though for all the CYA, at my employer there is no emphasis at patient education at all. Oh, patients get a general wellness booklet upon admission but that's it. Where I did cliniclas, it was a huge deal and every RN and Student had to at least chart that they educated their patients Q shift and it wasn't too tedious as there was a ton of things to print and pamphlets around that were patient friendly additionally, it could even be as small as reminding pt to use call bell and not go the the bathroom themselves and click one box under patient safety.
Oh BTW, a union isn't the answer either. Out of the three hospitals, my employer is the only one unionized and as you can see, charting is the worst there.
I'm sorry, but why exactly should the rest of us "unqualified " RNs have to get the agitated combative dLOCs so you can have the "gems"?
The point is that stroke care is a basic medical procedure and any unit in the hospital outside of psyche and OB is capable of taking care of them thus the AMS patients would at least be spread out throughout the hospital rather on just one wing! On top of that the majority of the time the AMS patients are not having strokes, but it is the result of dementia or an infection or psyche issues. It is too much to stick one floor with all the AMS patients. Also stroke patients are very depressing to be around as many don't recover because most can't get TPA and those that do get TPA that is no guarantee that they will recover and in fact some have died from bleeding out after TPA. I wish there were better treatment options to restore function, but so far that is not the case. We see a lot more neuro cases from brain tumors or bleeds where they get debulking of the tumor or a craniotomy and again the postop quality is very poor at times left with debilitating side effects that we can't fix. We have national stroke certification and this is marketed as if a patient with a stroke will recover if they come to our hospital, how I wish that were really the case, but as we know, it is not! It is usually up to luck or God if a patient recovers or how much they recover!
It was just a more upbeat if intense time working strictly cardiac. With cardiac there are so many treatment options from PTCA, ablations, pacers, MCR, VAD's. We can do a lot more for the patients. We still get cardiac patients but they are a minority.
I would recommend cardiac nursing as a niche if you are able to hand the stress of emergency situations, administering IV meds and working codes and get your ACLS. It has a lot of positives.
The hospital system I work in is large, but the hospitals themselves are on the smaller side with some specialty hospitals in the mix, but the only one making any real profits is the orthopedic hospital, even the heart hospital doesn't have enough patients to do just that alone which I find surprising. Instead they are adding ortho to that hospital to keep it busy and make money. I have no desire to do ortho which guarantees you heavy lifting and I'm trying to save my back! lol Plus ortho is very routine just pass out pain meds around the clock and get the patient up and moving, that is not appealing to me at all!
I just wish nurses were able to use their mind and not be expected to break their back being a CNA as well. It annoys me that we are the only professional that is expected to do the CNA work and we are expected to like it. You wouldn't catch a HUC, respiratory therapist, PT/OT or lab or most supervisors or educators answering call lights, moving, turning and cleaning people, that would be the day! But just think if they expect this of us and they expected the same of all the other ancillary staff how much easier it would be with more hands on deck! lol But we are brainwashed that this is an essential nursing job because it saves the hospital money on hiring more CNA's! Just get the nurse to be a CNA too and look how much money they save! Ironically even an ICU nurse that has top training and abilities is reduced to a CNA as well because they don't have CNA's in ICU so all that training and ability is not really worth much to the hospital and when you are injured they will just toss you aside and hire a new grad to replace you! What is wrong with our health system!
Most people don't feel unions are THE answer - but a part of a bigger picture. Not sure how the union would be in charge of the EPIC EHR...
I didn't mean to imply that most people think that unions are THE answer but for the that do, it's not.
I didn't make any connection between EPIC and the union. I mentioned EPIC in terms of the kind and amount of charting we may have to do then vs. now in Sunrise.
A few years ago I was called into the supervisor's office for my annual performance evaluation. I got top marks in all but time management. The complaint was that I consistently clocked out late. Not too late, but about 15 minutes late on average. Because we are paid by the hour, this probably triggered the "needs improvement" factor. I told the supervisor the reason I clock out late was to make sure my charting was up to par. Most nurses on my unit already ate and charted through lunch, including me. But what I often did was chart the essential things in a timely fashion (meds, vital signs, I&Os) but save the other charting (normal assessments, position of the patient each hour, etc) for nearer the end of my day. I did this so I could give proper patient care, take time to listen to a patient or family's concerns, take time with my assessment (I have caught some pressure ulcer risks before they became actual pressure ulcers), provide hygiene care including a good shampoo of adolescent patients whose oily hair had been neglected too long, and organizing the room so my work can be more efficient, and it also gives a better impression to families when the room is organized. I told this to my supervisor, and she agreed that my priorities were in the right place. I tried to be more efficient with charting but still get out about 15 minutes late on average, and no one has said anything about it since. ;-)
Edited to add: I work pediatric critical care and step-down. Even though it's very busy and often sad, I love that I only have 2 or 3 patients at a time. It's a good area of nursing if you want to really work closely with patients and not feel too spread out over too many patients.
Specializes in Mental Health, Gerontology, Palliative.
The biggest obstacles to improving nursing in America are the nurses who can't get out of their own way, and the upper ranking management /administration who have everything to lose when nurses find their voice.
amoLucia
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