What is the most serious problem facing the bedside nurse today?

[leosasha]

Would like to know what others might think is the most serious problem facing the bedside nurse today? Am looking for opinions based upon the, "larger perspective" (or the bigger picture as they say). Have been working on this one for awhile and have arrived at my own conclusion. I would appreciate input.

[Flightline, BSN, RN]

profit vs. care. Med/Surg should be 4 patients max on days and nights. Tele/step-down should be 3. Most ICU's are 2, so I won't complain there.

But if a hospital can give you 8 patients, they will.

I don't know why nurses don't have a union.

[leosasha]

Some nurses do have a union.

[FireStarterRN, BSN, RN]

Two main problems I see are:

1) Out of touch regulatory oversight that trys to create systems and charting to accomplish their patient safety goals. These systems often just increase the workload by requiring copious documentation. That documentation ends up being meaningless since it is hurriedly filled out in order to meet regulations and avoid being dinged on surveys.

Every year a new goal added to the list. Now you have a required pain assessment, fall assessment, patient teaching assessment, care plans, what else? These sheets don't really drive care since assessing for falls, planning care, asking about pain, etc, are natural parts of bedside nursing anyways, and have always been a part of nursing care. But they do add time consuming charting busy work in order to satisfy the Joint Commission, non-bedside nurses who know better that us since they went to school longer types.

2) I think the whole customer service model of nursing and health care can be harmful when overdone. I'm talking about when nurses are forced to cater to the unreasonable demands of one patient or family member, are afraid to confront this behavior for fear of retribution, and this drains nursing time away from other patients, or is directly harmful to that patient.

[leosasha]

I agree that these are issues of the most serious content but believe that these are contributors to the single most serious problem and fall under it as a heading.

[loricatus]

It is my belief that one of the biggest problems, relative to bedside nursing, today is the administrative attitude that nurses are manual labor and not professional labor.

What may be a contributory cause to this is that there is no uniform educational requirement to confer a RN title, like there is for those who practice medicine. I have worked alongside those with Master's degrees (even holding NP degrees) who are unable to use their advance practice degrees as it was intended.

The lack of respect for the professional attributes required to practice nursing to it's highest extent is sorely lacking in the majority of hospitals in the US. Ever notice that doctors are given leeway on having to perform the 'customer service' rituals and the nurse is given the majority of the responsibility to do whatever it takes (usually in a manual capacity) to make the "customer"/"client" happy?

[lpnflorida]

I will answer it simply.

Time constraints/ need to be with the patient/ versus, required time to cover our behinds with excess charting which takes away from the patient. It is a circular problem.

[MoopleRN]

What's the most serious problem? Too much to do and not enough time to do it. We simply cannot provide the kind of care we ought/the patients deserve given the myriad of other crap we're expected to get done. Add in call lights/the unexpected poo-explosions (or whatever else demands our immediate attention)....

Staffing. Staffing. And more staffing.

[TopazLover, BSN, RN]

Emphasis of customer satisfaction to the detriment of patient care.

Spending too much time "coloring within the lines" eg. doing endless paper assessments rather than be available at the bedside to prevent falls, etc.

Lack of support by management for reasonable workloads and time scheduling eg. doubles, double backs, split days off.

Most of these also relate to the overall health of our health care system.

[llg, PhD, RN]

A term I have come to use for many of the problems described above is "complexity compression." With so many expectations, regulatory requiremens, standards, etc. to meet, even tasks that should be simple and straightforward become complex, cumbersome, and time consuming. The complexity of the task increases ... requiring more effort, more time, more staff, etc.

I know that is not the answer that the OP seems to be looking for, but I think it is a HUGE problem in health care today -- and the staff nurse is at the point of its maximum impact.

I suspect the OP will eventually share her idea of what the biggest problem is ... and it will be a general heading about attitudes that if improved, would improve things. But isn't that always the case?

[FireStarterRN, BSN, RN]

A term I have come to use for many of the problems described above is "complexity compression." With so many expectations, regulatory requiremens, standards, etc. to meet, even tasks that should be simple and straightforward become complex, cumbersome, and time consuming. The complexity of the task increases ... requiring more effort, more time, more staff, etc.

I know that is not the answer that the OP seems to be looking for, but I think it is a HUGE problem in health care today -- and the staff nurse is at the point of its maximum impact.

I suspect the OP will eventually share her idea of what the biggest problem is ... and it will be a general heading about attitudes that if improved, would improve things. But isn't that always the case?

wow, this post crystalizes the problem that I see. Well stated llg!!!!

[Virgo_RN, BSN, RN]

I think the shift toward health care as a product with patients as consumers, or customers, has eroded the respect that the general public used to have for the nursing profession. Too many people want "service with a smile" and view good nursing care as a measure of how nice the nurse is, rather than how skilled. The nurse has no authority, and is often viewed as a highly compensated waitress, not employed to keep the patient safe and alive, but rather, employed to make sure the patient gets everything they want. I don't know if this is the BIGGEST problem, but it is significant.

I think that media portrayals of nurses (i.e. either absent, peripheral and unimportant, or the good/evil dichotomy) have helped to fuel this way of thinking.