Why are so many nurses so bad these days?

[ghillbert]

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?

[kabish81054]

I understand you not wanting to be a PITA, because of fear of retaliation. I don't mean physical retaliation but I have heard more than one colleague say how they walk just a little slower or put them at the bottom of the list for meds when people speak up. My advice is document everything--time she called for med, time it came, nurse who brought it. Go up the chain of command if need be, let them know you understand the scope of their work and the overwhelming volume but you are there to support your mom and if that means being a PITA then so be it.

[Jules A, MSN]

I just wanted to say how sad your experience makes me feel. Please know that most of the nurses I work with are truly compassionate and love their work. Unfortunately there are always the few that don't. Sending warm thoughts to you and your Mother.

[jrivers]

I'm a tech in nursing school but I may offer some insight as I've worked on a med-surg floor and have a sense of things.

Are the respiratory therapists taking her out to check her O2 Sats? I often see that. It is necessary to ambulate, for obvious reasons, and they may want to see if her therapy is effective by getting a sense of her status on room air.

Pain meds late? The only thing I see is that the patient-nurse ratio is so high on floors the nurses give themselves (so we're taught in nursing school) a two-hour med dispensary window. The squeaky wheel often gets the grease but may create attitude problems with those nurses who haven't learned how to be more understanding and empathetic. They are the ones who should question what the hell they are doing in nursing to begin with!

I respectfully beg to differ with the suggestion to document everything, at least out in the open. If someone knows you're doing that, it creates a very negative atmosphere and will not help Mum. By offering to help with the ADL things, getting snacks, water or other things like helping to clean her if she needs it will go A LONG WAY towards a team/family approach to care. I know I find it galling that the son who's mother lives with him suddenly has a back problem when he's asked to help with a boost at the hospital. And many people, especially older women, act like they are at a hotel: where's lunch, the food sucks, I hate red jello, where's the sugar (and I'm a diabetic)". You know the types?

These days, it seems like cuts and staffing issues have forced us all to be more collaborative in our care. It does make positive outcomes feel a lot more fulfilling when everyone finds a way to make things work. This is just what I've learned so far. I hope it helps. J

[geekgolightly, BSN, RN]

I respectfully beg to differ with the suggestion to document everything, at least out in the open. If someone knows you're doing that, it creates a very negative atmosphere and will not help Mum.

I don't mind when someone is documenting what we are doing. I even relied on one family member to tell me what had happened in previous shifts, if I had questions. I think that family who do this, as long as you give the vibe of approval feel SO much more comfortable, and are less prone to sue, which might be part of the reason they are documenting. They feel they might have the need to sue later. I give those people lots of compassion, too, because it can be overwhemling to have your loved one gravely ill and feel so out of control.

I let them do their thing, basically. And I also start educating them on every little thing I am doing and the rationale. Some families don't want to know, but the ones documenting are having control issues and the more information they have, the better they feel.

I do not, however, give out opinions. That can bite you in the butt! But meds I am giving and rationales for cares, absolutely!

[Canuckgirl]

I think it's because people get into nursing nowadays because it has good pay, not necessarily because of a good heart. Therefore, a large proportion of modern nurses are compassionately bankrupt, and would rather spend time discussing their dates that weekend than tending after patients.

I'm a student planning to go to nursing school, and judging by the conversations I have with my cohort, money is the main motivator (especially because it's recession-proof as well). Not saying I'm not guilty of this either.

Sorry about your experience. My grandma was in and out of the hospital a lot when I was younger and fortunately we had some very good and sweet nurses.

[JenniferSews]

It's just hard to be a good nurse in many environments these days! I have a mix of LTC, sub acute, palliative and hospice patients. On a good day I have 13 patients, sometimes I have 20. It's not that I forget a patient but passing meds to 20 patients means that some are pushed beyond the 1 hr window.

However in my experience I have seen that being nice, but demanding, will get you everywhere. We know that what you are asking is not outrageous. There's nothing wrong with asking for pain meds, or a bed pan/change, or even a glass of fresh water for your family member. We all go above and beyond even with 20 pts when we feel like those efforts are appreciated. But we do spend less time in the rooms (not intentionally, but I never stop by just to say hi) when the family members confront me about every little thing and are writing down everything I do, don't do, or are imagined to be thinking or feeling, and it's reported to my DON every morning. I have a pt on my floor that everyone LOVEs and takes very good care of until the family member is there. Then everyone is afraid to go into the room for fear of providing more ammunition for complaints. In my short lived experience as a nurse it's just not that easy to be a great nurse even when the want, will and ability is there. There are some notable bad nurses out there, who are unfortunately the ones patients remember most. I learned that on this board, and they were dead on right. But the nurses I work with are by and large trying very hard to do a great job under some extremely difficult circumstances.

[dscrn]

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.

Just relax is an auto response...perhaps "just try to take a few deep, long breaths (which is really what you want pt to do) would work better-take it from an asthmatic-just relax has the opp effect...

[steelydanfan]

You answered your own question when you wrote" I'm sure they weren't this bad when I worked the wards..... and you would be correct.

They were not. Nurses were not as stressed, overworked and overmanaged as they are today. pt.s were not as sick; yet somehow the hospital administrators lack the reasoning power to see that. They believe that giving a nurse a script to follow when interacting with "clients", or providing brownies at bedtime, is more beneficial than providing safe staffing ratios; or giving nurses the power to report problems without fear of retaliation, or even allowing nurse the time due for a lunch break with appropriate coverage. This is why your nurse looks stressed, occasionally gets a bit snippy, and your call lights don't get answered promptly. Want change? Find and support your legislators who support staffing ratios.

[mamamerlee, LPN]

There is no excuse for rudeness. And more than 30 min late for a pain med is very, very sad. I am a nurse, many years, and this past year I have been in the hospital twice.

I don't like to be a PITA, but when I waited over 2 hours for pain meds, and the doc had stopped by the nurses' station as well, I became rather annoyed. Four requests in 2 hours. So I PHONED the nurses' station and asked to speak to the charge nurse. Turns out my nurse was off the floor for the ENTIRE 2 hours and no one else bothered to follow thru.

Sometimes it is very hard to play 'catch-up' to the pain, and this was one of those times.

Do not hesitate to ask and ask again for any and all treatment for your loved ones.

[Redhead28]

Have you requested a PCA? They can help keep your mother's pain under better control and she will not have to wait on the nurse. Make sure your mother has something ordered for the anxiety. I'm an asthmatic and know how it feels to not be able to breathe, don't need someone to tell me to calm down just help me breathe!

[zofran]

Why do people advise others to be a PITA? Why?

You don't need to be a PITA to get what you need. Act like adults.

I agree it is not acceptable when a pt is admitted for pain management and does not get the pain meds on time. I find this happens alot on my floor...Pts are admited with fever and nausea and they get no anti emetics all night. When I get there in the morning the poor pts are a total mess.

I blame this totally on staffing ratios. 99% of the nurses I know want to do a good job. It is just not possible anymore.There is no possible way to get everyone's meds on time...so I just prioritize. If they are there for pain, pain meds are on time. If they are there for infection, abx are on time. And if i do somehow get my meds out on time, know that I havent documented anything, most likely havent eaten lunch, and have not gone to the bathroom.

sigh.....still looking for a new job.

[highlandlass1592, BSN, RN]

I'm a tech in nursing school but I may offer some insight as I've worked on a med-surg floor and have a sense of things.

Are the respiratory therapists taking her out to check her O2 Sats? I often see that. It is necessary to ambulate, for obvious reasons, and they may want to see if her therapy is effective by getting a sense of her status on room air.

Pain meds late? The only thing I see is that the patient-nurse ratio is so high on floors the nurses give themselves (so we're taught in nursing school) a two-hour med dispensary window. The squeaky wheel often gets the grease but may create attitude problems with those nurses who haven't learned how to be more understanding and empathetic. They are the ones who should question what the hell they are doing in nursing to begin with!

I respectfully beg to differ with the suggestion to document everything, at least out in the open. If someone knows you're doing that, it creates a very negative atmosphere and will not help Mum. By offering to help with the ADL things, getting snacks, water or other things like helping to clean her if she needs it will go A LONG WAY towards a team/family approach to care. I know I find it galling that the son who's mother lives with him suddenly has a back problem when he's asked to help with a boost at the hospital. And many people, especially older women, act like they are at a hotel: where's lunch, the food sucks, I hate red jello, where's the sugar (and I'm a diabetic)". You know the types?

These days, it seems like cuts and staffing issues have forced us all to be more collaborative in our care. It does make positive outcomes feel a lot more fulfilling when everyone finds a way to make things work. This is just what I've learned so far. I hope it helps. J

Because you are a tech you can offer insight? I'm not sure you read the entire post. There is NO reason to check a room air O2 sat on a pt who is in-patient for palliative care management. It is cruel and frankly not necessary. Due to dx this pt is not going to wean from O2 and to take it from her is just being downright mean. As a nurse, if I caught an RT doing this, I'd be all over them.

You then recommend the OP help provide her mom the care that the staff should be delivering. Getting water is one thing but this is HER time with her mom...she should be focusing on being a DAUGHTER not a NURSE. As for building bridges for care, if substandard care is given....then it should be brought to the attention of management and addressed. You speak of a pt's son who lives with her not helping with a boost....it's not advisable to allow any family members to assist with such an issue. If the family member is injured, a lawsuit will quickly follow. And admitting to such a family that you are short staffed will guarantee it.

Short staffing is never an excuse for substandard care. At that point, nurses should be at their strongest for advocating for their patients. Whether it's encouraging the team to work together to provide care in a sub-optimal situation and being willing to step-up and doing that extra bit or brainstorming with management to come up with creative ways to meet the needs of the patients or speaking up at a hospital board meeting to force them to address staffing issues, the nurses must learn to speak up and work together. Hopefully, this will be a lesson you learn as you strive to become a nurse and not fall back on excuses.