Why are so many nurses so bad these days?

[ghillbert, MSN, NP]

First off, I am not talking old school vs new school, or hospital-trained vs university trained etc arguments.

I just wonder, since becoming the carer for my terminally ill mother, why there are so many crap nurses? I am sure they weren't this bad when I was working the wards some years ago. Granted, it's a long time since I did because I have worked ICU for a long time.. but still.

For example, Mum is in a palliative care unit for pain management and changing of meds. Last night, her 6pm pain drug hasn't been given by 7pm. I get her to press the call bell. Nurse comes 15 minutes later, and Mum asked about the med. Nurse says "I didn't forget you!" really rudely. It really steams me up - as a nurse, (and Mum was one too), I think we go out of our way NOT to ring the buzzer and not to be a PITA. But really? Morphine 75 minutes late, when the woman is in the unit for pain management? And no explanation/apology at all.

Mum has lung disease and has developed severe anxiety related to shortness of breath. SHe's on O2 constantly now. One nurse made her walk around the unit doing a lap on NO oxygen. I mean, she has oxygen to sit still in bed, but you think it's a good idea to make her trot around with none? Big surprise that she then got extremely SOB and had a panic attack because she can't breathe. It's amazing how many nurses say "oh, just relax" when she is anxious, as though it's voluntary. Maybe it's an automatic reaction to say that, but it's pretty dumb.. if you're panicking because you are unable to breathe, you can't just decide to "relax". Even worse because until this diagnosis, my mother was the most bossy, strong, NON anxious type of person and now is reduced to begging someone to help her.

Anyhow.. maybe I am just venting. Perhaps it took being on the "patient" side of things to understand how important communication and empathy is. Some of the nurses are fantastic - they hold her hand, and say "I will stay with you until you are comfortable", or make regular checks to see if she needs anything, give pain meds strictly, and just generally seem to give a crap. It's just a pity they are in the minority, especially in a palliative care specialty.

Has nursing changed? Is it just them? Different priorities? Too much to expect compassion?

[CNL2B]

Why are they making her walk laps (esp. without O2) if she is in palliative care? That's a post-op routine.

Yeah, that is crummy if her pain meds aren't on time if that is what she is there for.

[JulieCVICURN, BSN, RN]

I think it's ok to tell someone having difficulty breathing or anxiety to try to relax. Sometimes just having someone remind you helps you keep things a little more under control until the important part of the relief comes through and starts working, whether that's a bipap, medication, or intubation. What are we supposed to do? Get worked up and add to the anxiety level?

Other than that, though, yeah, it's pretty inexcusable to not stay on top of a person's pain when they're in the unit for pain management.

[greenA67]

i work in the oncology floor where we encounter both inpatient chemo and palliative care patients.

how i see it, working in this area demands a lot from the nurse. you cant be a "robot nurse" who goes into the room to give medications/take vs/etc without building rapport and showing EMPATHY.

i always remind myself that these patients are DYING patients. they need all the love and care they can get --- even if the patient is cranky, even if the relatives are demanding, even if you're handling 5 other patients who expect the same TLC.

i know that being a nurse can be toxic (most of the time), which doesn't permit us the luxury of time to "sit and chat" with out patients. youre right, ghillbert. being on the patient side can be a real eye opener. this gave me something to think about..

[shoegazer]

I am very sorry your mom had such a bad experience. I obviously have no idea what was going on with the nurses where she is being treated, but judging by some of what I have seen at the bedside I think nursing is just like every other profession-some people are wonderful at their jobs and others are not. I think the bad ones stand out a lot more when you or a loved one is on the receiving end of their care-one bad nurse can make a big impression. I also think that nursing is an extremely hard job a times and it can be very challenging to make people happy. I know there have been families/patients that have been less than impressed with me as a nurse, but they had no idea the world of crap I was dealing with when I left the room. I have had many assignments that have set me up for failure. All I try to do is remain polite and apologize when things are late (and secretly wish I could clone myself or have less patients). That being said I can't believe someone actually made your mom walk with no O2 and then told her to calm down when she was most likely hypoxic-I usually try not to be too judgmental, but WOW, that is a little crazy. If you are having problems I think it is appropriate to bring them up to the staff. If you are respectful I think bringing up issues doesn't automatically make you a PITA, it makes you her advocate. Like you said communication is really important, maybe they need a nudge in the right direction? Anyways I hope your mom gets better care and that coming here to vent helps your frustration a little!

[llg, PhD, RN]

My mom died of pulmonary fibrosis ... so, I can imagine quite vividly what you and your mom may be going through.

While I think my mother got very good care overall, the one thing I regret was not speaking up on her behalf earlier in her disease. I wish I had been more agressive about a few things than I was.

Based on that experience ... the best advice I can give you "Don't hesitate to be a PITA if that's what it's going to take."

I wish you and your mom all the best ...

As for your "Why?" question ... I believe there has been a general lowering of standards that includes nursing schools, the hospital admins. who don't provide the nurses with what they need to do a good job, some nurses themselves, and just about everyone else. People are just not as keen on quality anymore -- unless they are the recipient. That's sad.

llg

[Tweety, BSN, RN]

I agree with the "don't hesitate to be a PITA" if things aren't right. However, also know that no one is ever going to be good enough for your mother.

Best wishes. She's lucky you're there for her and I'm sorry you're going through this.

[jkaee]

Anyhow.. maybe I am just venting. Perhaps it took being on the "patient" side of things to understand how important communication and empathy is. Some of the nurses are fantastic - they hold her hand, and say "I will stay with you until you are comfortable", or make regular checks to see if she needs anything, give pain meds strictly, and just generally seem to give a crap. It's just a pity they are in the minority, especially in a palliative care specialty.

Has nursing changed? Is it just them? Different priorities? Too much to expect compassion?

I think you just nailed it on the head....it took you being on the "other" side to REALLY understand how much we say and do (and sometimes just our body language) really affects people. Not everybody has that experience, and/or doesn't bother to try see it from a patient's eyes.

My direct supervisor and I were giving mandatory training yesterday, and she was telling the group that she has worked for the company for 25 years, and thought she knew a lot about how things ran. She thought that until her father was a palliative care patient. It puts a whole different spin on things.

[highlandlass1592, BSN, RN]

You know, you're in a difficult spot right now. (Like you need me to tell YOU that, right? :-) ) Your mom is not going to recover and is trying to get the best care she possibly can. You, as a nurse yourself, try not to be a PITA and only "bother" the nurses when it's really important, right? Well, STOP THAT! Stop being the nurse and just be your mom's daughter. Try to let others care for her and if they DON'T care for her, then do like other families do..raise holy hell!

Listen, my mom before passing was critically ill for an extended period. I too, tried not to bother the nurses but I forgot one important thing: while I had critical care knowledge and understood what was going on, I forgot to just be her daughter. I used my "knowledge" as a barrier to stop grieving. I didn't want to bother her staff nurses with things I felt I could do. I needed to realize that those nurses were there for a reason..as was I. I was there to be my mom's daughter, to think back thru the years of our relationship..to share joy and yes tears. I WASN"T there to provide care...even though I thought I was. That's what the staff nurses are for and sometimes, as staff nurses, we need reminders of that.

I just re-read that paragraph and realized it may sound a bit harsh. Please, pleasae don't think that's what I mean to convey to you. Just that this is a special time for you and your mom. Don't worry about what the staff nurses think. Enjoy the time you have with your mom and if you run across people not doing their job appropriately, SPEAK UP. Neither you or your mom should be subjected to substandard care but unfortunately it happens. And that definitely needs to be brought to the attention of someone higher up. I am sure you aren't asking anyone to do for your mom what you wouldn't try to do to your own patients: which is do the best job possible. It's a standard we all should have and strive for every day.

I'm not sure if you're here in the states or the UK based upon some of your verbage. I'm wondering if you are in the UK do hospitals there participate in care conferences? (where the team providing care for your mom get together and meet with you?) If so, I'd demand one ASAP. If your mom is on home O2, there is NO reason for someone to have demanded her to ambulate without it. That needs to be addressed and it seems like to me a care conference would be a good place to start.

Lastly, may I humbly recommend some therapy for you and your mom? Maybe a visit by a social worker or spiritual advisor? You stated your mom used to be the least anxious person but now has to depend upon others. (I'm paraphrasing here) And that your mom as a former nurse doesn't like to bother staff. These are huge issues to deal with as well as the whole end of life struggle....your mom should NEVER feel she's a bother by contacting her staff nurses for issues..but I think as nurses we've been trained differently. Your mom is the patient now...it's time she accepted care and gosh darn it, it's a hard position to find yourself in. Talking with someone (if she hasn't already done so) may help. And you have your own battles you're waging...the upcoming loss of your mom being the ultimate one. Talk to someone..anyone....get some help as you work thru this journey.

I lost my mom to medical malpractice 8 years ago..she was only 58 years old. Not a day goes by when I don't blame myself for her death...had I been "super nurse" I felt I should have been able to stop that. This is something I"m working on in my own life. And it's hard. Her death was sudden, we thought she had turned the corner...well, she had,just not the corner we wanted. Long story longer, take care of yourself and treasure this precious time with your mom. Hugs to you as you continue on this journey. And hey, if you ever need to vent, drop me an email. I've got big shoulders and don't mind at all.

[ayla2004, ASN, RN]

following the previous poster enquiry ive trawled though your posts are us in OZ?

it may be you have to become a very vocal relative to get your mum what she wants we all know it works. We know it hard to time mange at times do med have a 2 hr window which isn't bad. ive had pt not pain medicated (doses not given)and i feel annoyed as they are so vulnerable god only knows if that was my mum/dad.

Do you have macmillan nurses there that review symptom management, they can get act as advocate for pt with nursing staff.

[geekgolightly, BSN, RN]

I think 70+ minutes is too long to wait for pain medication, but if a nurse has seven patients all with medications due at the same time, it's difficult to get there on time. It sounds like she might need better prioritization, but then again, I wasn;t there and don't know what else was happening.

That said, nothing excuses nasty attitudes. I learned that long ago.

[Sam Kelly]

My brother was in a coma for seven years. He spent three years in a hospital and then the other four in two different nursing homes. The quality of treatment that he received was horrible! I made a surprise visit the day before he passed away to find that his oxygen had been off for over 48 hours, his feeding tube was not hooked up properly and he had not been turned in two days. He was burning up with a fever and there were no nurses to be found. When I finally located someone, she was extremely rude and told me that I didn't know what I was talking about!

I decided to go into nursing because I swore that I would be a better nurse. I, too, have had the unfortunate need to stay in hospitals.. the nurses seem to think that they are doing the patient some kind of favor by doing their job! I now keep tabs on what nurse is working if I have friends or relatives in the hospital.. it's absolutely ridiculous!!! Especially when I am sure that there are nurses looking for employment that would provide proper care for patients.

Where is compassion, understanding, etc.., these are not qualities of a nurse, but qualitites of a decent human being!