Where are the Nurses? Patient takes his inquiry about lack of nurses in the hospital to Heloise.

[tnbutterfly - Mary]

I was reading through my various nursing news feeds this morning and "Hints from Heloise" popped up. I wondered why Heloise was in a Nursing news feed so I clicked on the link. A man who was a recent patient was appalled by the lack of nurses. So he wrote the following letter to Heloise.

Quote

"Dear Heloise: I was a patient in a hospital recently and was appalled by the lack of nurses on staff. My nurse greeted me and told me to call her on my cellphone if I needed anything, then gave me her number and left. What if I had fallen out of bed, couldn't get up and needed help or possibly had a stroke after surgery and couldn't talk?

"Hospitals charge a hefty amount of money for patient care, but I don't think we're getting the care we need. It's not that nurses aren't trained properly, there just are far too many patients for the limited number of nurses available.

"There was a time when American medicine was the best in the world. But is it still? I have every reason to believe it's gone downhill."

Henry P. in Atlanta

Heloise did not post a response. As a nurse, how would you respond to this former patient? At least he gets the point that "there just are far too many patients for the limited number of nurses available."

If we get enough responses, I'll send them to Heloise and tell her these represent the voices of nurses across the US. It might be helpful for all of you to post what state you are in so Heloise will see that we are a good representation of the best nurses in the USA. You could also post your years of experience and whatever else you want to post.

Let's give Heloise and the public the hint that if you want to hear the voice of real nurses, ask the nurses at allnurses.com.

[guest974915]

On 3/21/2019 at 8:33 AM, Lil Nel said:

Excellent points.

Perhaps it would be wise for the healthcare giants in the US, to study the healthcare models of countries who have better outcomes, higher patient and employee satisfaction scores, and adjust accordingly.

Otherwise, I see the problem remaining the same, for the forseeable future.

Besides telling nurses to pursue another career, I also tell friends and family to do all they can to stay OUT of a hospital.

And if they must be hospitalized, I encourage them to bring along someone who will act as their advocate.

I also tell them to be nice to the nurses because more than likely he or she is doing the best they can, with an unmanageable patient load.

Good advice, however, the reason healthcare conglomerates in the US will never model healthcare based on other countries, is simple; profit! Corporate healthcare is well entrenched in this upside down scheme that richly rewards those at the top, while at the same time, cutting corners and disincentivizing loyal, productive employees with wage stagnation and a hacking away of their meager benefits year after year-sad!

[NurseBlaq]

On 3/20/2019 at 9:07 AM, nursej22 said:

I look at it this way. There are 60 minutes in an hour. Let's say on a perfect day you are assigned 5 patients, so you get an average of 12 minutes for each patient per hour. Fully 1/2 of that time is documenting, or at the PYXIS, or answering the phone, or gathering supplies. So now you have 6 minutes face to face time, per hour with your patient. Now if anything takes longer (say extended report, stat labs that must be addressed, IV to replace, missing meds) you lose that time. Sorry room 92, I just spent your 6 minutes trying to find your TV show, no time to find colder ice for you. Yes, room 31, I understand you take your metformin precisely with your first bite, but I am waiting for it to arrive (after 3 attempts at 2 PYXIS machines, 2 phone calls and a fax to Pharmacy). Oh, and room 18 wants 6 chairs for visitors. That is definitely going to take your 6 minutes for this hour and next. But of course I have the time. Oh that large crash? And people running down the hall? My phone that never stops ringing? I will look into those things once your 6 minutes is done. You just call if you need anything!

The accuracy! Don't forget the family member that stalks you around the unit asking for pain meds for the patient who's currently asleep or states they're just fine and need nothing but the family member feels guilty or helpless so they need you to be doing something nonstop as though that's your only patient. Oh, don't let me forget you're about to have a code yellow (bathroom emergency for yourself) because you have to tend to all these other things so your bladder is on overload.

[Jesuah, RN]

Here are some reasons I've seen why there are not enough nurses:

Baby boomer nurses are retiring.

It costs $100K - $200K to get a BSN in the United States nowadays.

It takes 1-2 years for a foreign nurse to get through all the red tape to get licensed in the US.

Wasn't sure how to respond directly on the post that was made so I did a copy and paste....the cost of a BSN is outrageous....what a house might cost in some areas of the country. My question is: why has it become so necessary in the eyes of management to become a "magnate" hospital, demanding BSNs. My diploma has served me well for 37 years so far and I know many associate degree nurses who do an absolutely wonderful job. I have yet to walk into a patient room and they or their family ask me what my schooling credentials are, or refuse to let me care for them because I do not have my BSN. Let's not be so concerned about whether the nurse has a BSN, let's just get some nurses educated and out on the floor taking care of the patients...presupposing management will hire appropriate ratios.

[raemcclain]

I was a nursing instructor after nearly 20 years of bedside nursing. I loved both and felt I could make a real contribution to future nurses. But the
staff/student ratio was not good, as others have commented. It was unsafe.
Students didn't pay attention to my expectations such as checking on a patient a minimum of once an hour, talking to the patient to really determine patient status, and the almighty checks before AND AFTER giving meds.

I hated to leave teaching, but the schools, like the hospitals only care about the bottom line...$$$$$$$.

I was forced to get my BSN to continue teaching. That made sense to me until I had to do it online and just write endless, nonsense papers! I am NOT
proud of my BSN. I am immensely proud of my RN which was obtained at a
hospital nursing school. We got real hands-on teaching and experience and instructors were right behind us watching everything we did. It was wonderful! I won't even frame my BSN but proudly display my nursing
pinl
BSN's don't mean anything any more. They really never did...just a chance for academia to get its hands on the money to be made from nursing students. The real nurse is trained at the bedside.
It is interesting that we all went into nursing to care for patients. We loved bedside nursing while in school. But when out on the job...all of a sudden,
everyone wants to sit behind a desk. Those jobs don't even exist anymore.
No one wants to do bedside nursing! Staffing, and shifts that are too long and unsafe are just part of the reason.
I wonder if nursing will ever get its stuff together. This problem is very
long-standing. Good luck to those of you who are still working. I wish
CEO's would read our responses.

[JLBSN55, BSN]

I do agree that sometimes we are understaffed, but there should be no good excuse to for nurses not to make rounds on patients. When I read something like this, I cant help but wonder if there is more to this post than just the nurse didnt come and check on me

[guest52816]

My facility is frequently understaffed, and Friday night was a good example of when it is impossible for me to round hourly.

I had eight patients. Six of the eight had dressing changes, as I work in a physical rehabilitation hospital.

Five of those dressings changes took at least 10 minutes.

One dressing change, took 20 minutes, and two nurses.

One patient needed to receive two units of blood. We have no lab on site, so a blood bank must deliver the blood, one unit at a time.

The patient's IV went bad towards the end of the second unit transfusing.

I was doing dressing changes at 0100, 0200 and 0400.

And don't forget about medication passes, and a patient getting meds at 0000 and 0200.

Nope. No time for hourly rounding.

Nights like the one I described are not infrequent. Two other nurses on my unit were also giving blood, with an eight patient ratio.

It isn't hard to figure out why nobody wants to work the bedside.

An unmanageable patient load, coupled with endless charting and administrative add-ons.

The latter falls by the wayside when I am really busy.

[JayHanig]

15 hours ago, Lil Nel said:

An unmanageable patient load, coupled with endless charting and administrative add-ons.

If it makes you feel any better, I've been retired for almost ten years and I still have the occasional nightmare where I'm 9 hours into a 12 hour shift and realize I haven't made a single med run all day yet.

If I ever stroke out in my sleep, it will be because of these repetitive nightmares where no matter how I try, I am unable to make even that first med run. After I wake, I find myself in a foul mood for a while, then realize it was just a bad dream, and I don't have to make med runs any more.

Thank God.

[MaxAttack, BSN, RN]

On 3/22/2019 at 2:57 AM, morte said:

does not use of call light still come with admission? the patient was right, he was not well informed and left to deal on his own.

...what?

[bbyRN, BSN, RN]

On 3/20/2019 at 9:39 PM, guest52816 said:

I disagree.

The public does know.

I have had multiple patients at my facility tell me that we are short-staffed.

Patients have eyes and ears.

Sometimes my patients ask how many patients I am caring for, and I don't lie; six, seven, eight or nine, whatever the number is.

Like another poster, I tell nursing students to RUN to another career.

And nursing is a second career for me, as I have only been licensed for coming up on three years.

My friend has been a nurse for 21 years, and has had enough. Her house is nearly paid for, and once that happens, she is out.

Yes, the patients and families see a problem with staffing, but they do not comprehend the role administrators and other managers in hospitals play or won't play. Further, the patients and families have no idea of the complicated regulations nurses operate under: BON, State, Facility. Neither do they know how poor the electronic medical record (EMR) software is, for nurses and docs and the consequences of this poor quality. Most of the time the patients, families, and media blame the direct-patient care providers instead of facility management, state and fed legislators, shareholders, etc.