What is the toughest part of nursing?

Am curious - if you had to pick one thing related to the nursing practice that is the toughest, what would it be?

[dancinginthedark]

Working with RNs & NAs that hate their job. 

[Ann Fosque]

Managed Care gone rogue...Corporate Mentality...patients are people, not furniture. 

I understand there was a  need to cut off the "fat" now we are cutting into the "bone"

Insurance companies and other companies selling health care products  mindset is a lot for profit not patient and good outcomes.

Competent and Compassionate doctors at times must advocate for patient and verbally argue with Insurance Medical Directors to get tests medicines, etc approved.

[MoLo]

We need an education campaign for patients to realize what we are trying to do, and what we need from them (respect). And then a course for nurses on how to respond to it professionally patients just aren't able or willing, and JKL, I love the way you put it, people are some versions of themselves no matter what the circumstances!

And bad behavior from peers, management, etc cannot be tolerated. This is a tough one, having fought that battle. It takes a dedicated management to look hard at their own staff and themselves.

[MoLo]

The benefits of having an advanced care directive, so you can control decisions even when you cannot.

And Pondering - thanks for a laugh!

[MoLo]

Have you ever respectfully called her out? 1:1? "Debbie, I am doing my best for the patients, and I feel like you seem annoyed with me when I am giving report. Is there something I could do differently that would help?"  (I would hope Debbie would recignize she is being mean and it is impacting your relationship, and feel badly and vow to change). 

(I also believe in Santa, but you hae to be optimistic)

[MoLo]

Bladder scanners!  Why are they so hard to keep track of???  We are not talking about something the size of a dime!  

[delrionurse]

MoLo said:

Have you ever respectfully called her out? 1:1? "Debbie, I am doing my best for the patients, and I feel like you seem annoyed with me when I am giving report. Is there something I could do differently that would help?" 

I usually don't say anything, these types usually are loud and will be confrontational. It's not my style. Calling them out on it will make it worse.

[MoLo]

There is a balance somewhere that says this is not OK, and I want to work with you on it. Unfortunately we cannot control their response.

I'm a psych nurse, we process to the death!

[MoLo]

thinking of personalities, I think of things I can and cannot change. I attempt to reality check some truly out there behavior, but other than that, knowing it may not make any difference, I have to decide where my own limits are, and when and how I will approach someone, and deal with my anxiety about not being able to control the outcome. 

[toomuchbaloney]

Ann Fosque said:

Managed Care gone rogue...Corporate Mentality...patients are people, not furniture. 

I understand there was a  need to cut off the "fat" now we are cutting into the "bone"

Insurance companies and other companies selling health care products  mindset is a lot for profit not patient and good outcomes.

Competent and Compassionate doctors at times must advocate for patient and verbally argue with Insurance Medical Directors to get tests medicines, etc approved.

I don't recall a time of "fat" in nursing budgets.  I ran a good sized critical care unit in the 80s and 90s, no fat then.  

[Ann Fosque]

My statement was a general observation...in 1985, I worked in the ER and we were allowed to add a surcharge to patient's who had insurance for patients lacking insurance. 

Back then, I was able to stay 5 days for a vaginal birth. 

My due date was erroneous and my husband had used his vacation time the previous month, anyway 

I don't think insurance dollars would cover a 5 day stay today...there was an extenuating circumstance, so my OB Physician factored that in.

[MoLo]

Get into administration, or on committees!  It takes you away from patient care somewhat when you step into management roles, but then you can enact a lot of change, probably not everything you want, but a lot!  Best decision I made in my nursing career. Lasted 16 years until it was too much, but a lot of change happened.