Where is all the basic nursing care

[bubbles64]

I work on a medical/surgical ward in Australia as a AUM ( Associate Charge nurse this means I'm in charge on my shift but answer to higher up) I need some help, advice as to what i should do.

I have worked now with a particular Division two nurse (nursing aid) on several shifts, her job is to attend to her 5 or 6 patients on the 3pm to 10 pm shift, she does not give out any medications that is one job which is allocated to me.

She spends most of her evenings at the nurses desk reading magazines or phoning home at least three times per shift while her patients go unattended, their buzzers seem to go off others answer and at the end of the night the rooms are a mess, the patients look like they have not been touched and she goes home happy to collect her pay.

Where is all the basic care, tidying the rooms, straighting the beds, if patient has been in bed most of the day, offer them a face washer to wash hands, face and maybe even give back a rub, brush their teeth or offer a bowl of water so they can do this before settling for the night.

I have spoken to this nurse and have said would you mind just giving them a freshen up and see if they want to brush their teeth she tells me she has (sorry i have checked up, tooth brush still dry)

I have spoken to nursing co-ordinator, this just falls on deaf ears

What next, why did she become a nurse, and some times it is not just her, nursing seems to be about doing the pills, doing observations and paper work.

am i being a perfectionist wanting my patients to be comfortable at the end of my shift?????????

Lynne.

[crissrn27, RN]

Sounds like a bad apple to me. Have you tried just telling her "go to Mr. Jones room, help him wash, brush teeth, and ready for bed"? If she says she has, hit her with the dry tooth brush, messy room, etc.

I have a question, is this a nurse aid or a nurse? I don't know how the titles are in Australia, and was curious.

[pagandeva2000, LPN]

Is this actually a nurse, or a nursing assistant? It sounds as if this woman had this position for many years, that people have tried to do things to her in the past with no success. Is there anyone else that can be approached besides the nursing coordinator? Again, this is probably not new; this seems to have been happening for quite some time.

[joannep]

Hi,

I too am a Div 1 in Australia, and yes, I have noticed that there is a drop in the care offered to patients/clients. I also was an AUM on a medical ward in a public hospital. The staff did not see that the ward needed to be tidied for the night staff, or that patients needed to be settled for the night.

I had asked the Div2's to get a trolley to collect the empty cups on the patient overbed tables so the night staff wouldn't send them flying, with no success. I also went to my unit manager about it and was told that it wasn't their job, it was the domestics job and the cups could sit there until the domestic staff came on in the morning. I told him it was on OH&S risk to the night staff & patient, but he wouldn't budge.

I also tried to get them to offer toothbrushes etc and was told by staff that if the patients asked for it they would give it to them.

Absolutely insane, and it can only be put down to the fact that nurse training doesn't have basic patient care, their safety & comfort emphasised in the courses. Whether or not nurses are trained in a hospital or not doesn't come into it, you can't change the system we have, but the courses lack a lot, and the clinical exposure is inadequate.

The educators I had as a student and the unit managers I worked with as a student would be turning in their graves if they knew what had happened to nursing.

[callmekipling]

I had asked the Div2's to get a trolley to collect the empty cups on the patient overbed tables so the night staff wouldn't send them flying, with no success. I also went to my unit manager about it and was told that it wasn't their job, it was the domestics job and the cups could sit there until the domestic staff came on in the morning. I told him it was on OH&S risk to the night staff & patient, but he wouldn't budge.

I also tried to get them to offer toothbrushes etc and was told by staff that if the patients asked for it they would give it to them.

What do div2's in australia *DO*? Because I'm a CNA (I think it's equivalent) here in the USA and *all* of that stuff falls to me.

I mean, yeah, there are nights when all you can do is get your vital signs and blood sugars, but then you're also too busy to catch up on your reading :trout:.

I guess they figure you can give more meds if you skimp on the actual care part..

[joannep]

Hi,

I don't know that the whole issue is related to this staff member being a Div 2. I have just been reading the thread "What has happened to simple, basic care?", where very similar issues are being discussed. There are some fantastic nurses out there, but it just takes one nurse to make you think nursing is going downhill fast.

I'll be interested to see if you manage to get this nurse to work anymore efficiently, she appears to be highly resistant to doing more than the minimal she will get away with. If discussion doesn't alter her attitude, then as a start, document via incident reports that patient's haven't received care and see how that goes.

[Roo71]

I have worked now with a particular Division two nurse (nursing aid) on several shifts, her job is to attend to her 5 or 6 patients on the 3pm to 10 pm shift, she does not give out any medications that is one job which is allocated to me.

Division 2 nurses are not nursing aids. They are registered division 2 nurses who work under the direct/indirect supervision of Division 1 nurses, and are registered by the same nursing board as as Division 1 nurses.

I think that Lynne is getting Div 2's confused with PCA's personal care attendents who mainly work in aged care and attend to patient care needs such as hygiene, toileting etc and basically do what nursing assistant's use to do.

What do div2's in australia *DO*? Because I'm a CNA (I think it's equivalent) here in the USA and *all* of that stuff falls to me.

Div 2's attend to patient care, give out meds, perform wound care, peg feeds some have a further range of specialities depending on their post education.

Absolutely insane, and it can only be put down to the fact that nurse training doesn't have basic patient care, their safety & comfort emphasised in the courses. Whether or not nurses are trained in a hospital or not doesn't come into it, you can't change the system we have, but the courses lack a lot, and the clinical exposure is inadequate.

I studied through Chisholm Tafe and have to say that the course content was very thorough when it came to patient care and hygiene needs. Alot of emphasis was placed on oral hygiene as well as pressure area care. Our teachers were exceptional and many had been nursing for 20+ years and had many pearls of wisdom to impart on us. The BA nursing students that i'm currently studying with get nothing like that in their training.

I've worked as a Div 2 nurse for 8 years mainly in aged care (private) and rehab and I've worked with some great nurses both div 1 and 2 as well as some real shocker's. I try to put my self in the resident or patients shoes each shift and make sure they have the care that i would want for myself ie; clean sheets, the choice to shower, clean teeth, extra food/drinks if they wish etc. It comes down to caring about what you do and having good time management skills. I know of many nurses who have the same philosophy as mine towards patient care and others that should leave nursing and get a job in a factory.

Its the nurse and their standards not their title that determines whether they give good patient care.

[callmekipling]

Division 2 nurses are not nursing aids. They are registered division 2 nurses who work under the direct/indirect supervision of Division 1 nurses, and are registered by the same nursing board as as Division 1 nurses.

Div 2's attend to patient care, give out meds, perform wound care, peg feeds some have a further range of specialities depending on their post education.

aha. That would make them more like american LPN's. In that case, under the american system, if you don't have an aide, personal care/hygiene falls as much to the div 1 as the div 2.

Its the nurse and their standards not their title that determines whether they give good patient care.

This I agree with wholeheartedly. It's the person, though education can help or hinder that, who makes the decision. In fact, personally I despise the idea that you can make anyone do anything if only you regulate or 'educate' them enough.. I'd rather let those people get written up and fired.