What I Wish Would Change/Be Different

Some of my thoughts and reflections on nursing that I wish would happen. They would make nursing a more perfect career for me. I think it can happen. I think as nurses we are a lot more powerful than we think we are and if we joined together, we could make drastic change. This is sort of an informal list with some paragraphs. Feel free to add your own thoughts in the comments section. Nurses Announcements Archive Article

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Julius Seizure

1 Article; 2,282 Posts

Specializes in Pediatric Critical Care.
It's not when they are barely conscious and their family members who are also high and screaming at you to give their meds and won't listen when you tell them they can't have their meds and threaten to get violent. Of course you can call the police but that takes a while. It's either do what I said or let them stop breathing from ODing them on meds

Squirting the narcs down the sink and then pretending to give them (and documenting such) is not the appropriate way to handle this.

If you truly believe that it is unsafe to give the med, then you dont give it. Thats all.

If the family gets violent or disruptive, you call security. You can even call secruity in advance so that they will already be standing by when you tell the family that you will not give the med.

You call the physician and tell them your concerns over giving the med. Even if the doc wants it given anyway, you document, document, document to cover yourself. Then you can either tell the doc to come give it themselves or you can give it and document that you had spoken to the MD about your concerns. You keep narcan available. You let your charge nurse know whats going on.

You do not pretend to give the meds and not. Even when you are squirting them down the sink, this could be construed as diversion.

Specializes in SICU, trauma, neuro.

I'm in agreement with most of this. However, a couple of things I'll differ with a bit:

1.) I don't put up with abusive behaviors. Of course there are patients who because of whatever brain pathology can't help it, but where I work if a patient is physically aggressive, he/she is physically restrained. If they are verbally abusive, if I must be in there for care, I ignore them--e.g. their drip needs to be adjusted as they're cussing at me. I don't look, don't respond past a "I will not engage with that behavior." If it's NOT something necessary like "Get me some coffee, b****," I won't go in the room. Families are removed if they are causing disruptions. Police are involved in cases of assault.

2.) Nursing is a 24/7/365 job, and if things need to be passed on, so be it. The oncoming nurse doesn't have the authority to "make" the offgoing nurse stay. Likewise when something is passed to me, I understand that sometimes you just can't get everything done in 8 or 12 hours.

3.) We are expected to tell a patient if he can do something for himself. Buttering someone's bread for him, or agreeing to lift when they can bear weight is not helping them get stronger and get out of the hospital.

K+MgSO4, BSN

1,753 Posts

Specializes in Surgical, quality,management.

Nurse managers not managing their staff. I have been dealing with a person regarding a clinical incident who should of been managed properly for about a year.

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
The focus on customer satisfaction is killing nursing and killing patients too. I think it's only a matter of time before the data comes out that we are doing more harm than good. This is another thing that we should not have to put up with.

It's already coming out:

The Problem With Satisfied Patients

In fact, a national study revealed that patients who reported being most satisfied with their doctors actually had higher healthcare and prescription costs and were more likely to be hospitalized than patients who were not as satisfied. Worse, the most satisfied patients were significantly more likely to die in the next four years.

Joshua Fenton, a University of California, Davis, professor who conducted the study, said these results could reflect that doctors who are reimbursed according to patient satisfaction scores may be less inclined to talk patients out of treatments they request or to raise concerns about smoking, substance abuse, or mental-health issues. By attempting to satisfy patients, healthcare providers unintentionally might not be looking out for their best interests. New York Times columnist Theresa Brown observed, Focusing on what patients want—a certain test, a specific drug—may mean they get less of what they actually need. In other words, evaluating hospital care in terms of its ability to offer positive experiences could easily put pressure on the system to do things it can't, at the expense of what it should.”

As a Missouri clinical instructor told me, Patients can be very satisfied and dead an hour later. Sometimes hearing bad news is not going to result in a satisfied patient, yet the patient could be a well-informed, prepared patient.”

KatieMI, BSN, MSN, RN

1 Article; 2,675 Posts

Specializes in ICU, LTACH, Internal Medicine.

Management doing CLINICAL MANAGEMENT, not what they think it is. Uniform colors, customer satisfaction and developing yet another form to be filled and filed yesterday is not clinical management; developing teaching protocols, coordinating between teams and services and finding opportunities to get more hands when they are sorely needed are.

Nursing residencies are controlled by Boards; attrition rate of new grads are reported and available for publuc, attrition of less than 90% of new grads and 85% of nurses working for more than 1 year for 6 months after hire automatically means Board investigation of the facility.

Measurable and NOT related to consumer satisfaction nursing outcomes used for access of quality of care. Some of them are here already, like VAP and CAUTI incidence... anything else? Successful weans, restoration of elimination functions?

Bulling is investigated under same rules as other actions potentially leading to bodily and emotional harm, i.e. same exclusions from recording laws applied, and, if proven, accounts for criminal conduct with all the trimmings.

NCLEX has optional section with additional questions regarding pathophysiology, pharmacology and critical thinking pertaining to acute care. The section is totally optional, free to take or omit, those who passed successfully got additional point if looking for jobs in ICU, ER and the like.

Just my dreams running wild...

megRNn

33 Posts

Specializes in ER, Med-Surg/Telemetry.
The ability to tell an able bodied patient "you can do that yourself", without fear of retaliation by management.

The expectation by the patient that no request is out of bounds.

Promoting health instead of helplessness.

Discharging patients who are noncompliant with their care, when they are perfectly capable of making informed decisions.

The return of "visiting hours".

Return the hospital to a hospital, instead of a hotel.

Screaming, yelling, and throwing things, is not rewarded with drugs the patient wanted in the first place.

Couldnt have said it better. The requests from patients can be so outrageous! We are conditioning pts to think hospitals are hotels and nurses are concierges. Its no longer about what the trained medical professionals think is best for the pt, its about what the pt thinks is best. More and more I see doctors and management catering to pts in this way and it frustrates the heck out of me! Literally pts dictating their care, please doctor let me stay one more day, when the pt has no medical need...they just like the free hot unlimited food and the q3h dilaudid. Ugh. #lifeofamedsurgnurse

Lev, MSN, RN, NP

4 Articles; 2,805 Posts

Specializes in Family Nurse Practitioner.
The ability to tell an able bodied patient "you can do that yourself", without fear of retaliation by management.

The expectation by the patient that no request is out of bounds.

Promoting health instead of helplessness.

Discharging patients who are noncompliant with their care, when they are perfectly capable of making informed decisions.

The return of "visiting hours".

Return the hospital to a hospital, instead of a hotel.

Screaming, yelling, and throwing things, is not rewarded with drugs the patient wanted in the first place.

I love this post. If you interview at a hospital with visiting hours, it's usually a GOOD sign.

OwlieO.O

193 Posts

I personally dislike patterned scrubs. Nursing has come a long way in being looked at as a profession. However, patterned scrubs in my opinion don't help this. At the very least I will wear solid scrubs because I care about my own professional image.

EllTee2B

195 Posts

I personally dislike patterned scrubs. Nursing has come a long way in being looked at as a profession. However, patterned scrubs in my opinion don't help this. At the very least I will wear solid scrubs because I care about my own professional image.

I feel the same way. Some of the things I have seen nurses wear are atrocious. It's fairly difficult to profess your professionalism when you are running around looking like a 5 year old at a pajama party. Thankfully, my hospital has a uniform policy.

Specializes in Med-Surg, Emergency, CEN.

"The focus on customer satisfaction is killing nursing and killing patients too. I think it's only a matter of time before the data comes out that we are doing more harm than good.'

Patient satisfaction is costly but maybe not so healthy - latimes

Incentives to increase patient satisfaction: Are we doing more harm than good?

http://www.ehospitalistnews.com/home/article/patient-satisfaction-doesnt-equal-better-hospital-care/87f0c38c2aa8f79203738c912a7a5800.html?ooct=HOSP-pebox

This has already been discussed for years. The problem remains that non-medical personnel are writing our medical rules. It's all (and ONLY) about the $$.

So nurses will continue to work in unsafe conditions becuase they won't budget for more help, doctors stay forced to follow formulas instead of using their own assessment of pt health and needs, and patients will complain that they didn't get poutine immediately s/p cholecystectomy.