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?

[Multicollinearity, BSN, RN]

I think conscientiousness and ethics are declining in our society in general. I don't believe this is anything exclusive to nursing.

[JenRN30, BSN]

To the OP, sorry that this happened to you and your mom. I think there are a variety of reasons why there are some really bad nurses. It could be because, as multicolinearity said above, ethics in our society are declining. It may also be because many of the nursing schools are now going to a "waiting list." So anyone who meets the minimum requirements gets to go to nursing school if they put in their time. I think this is ridiculous. People should apply, have interviews, and get accepted based on their merits and personalities. That way, the best and brightest get to become nurses.

[nursel56]

Sorry about what's happening with your mom, ghillbert. Sounds like the nurse was brusque, which is exactly the opposite of what I hear is the experience of most patients and family members in Palliative Care. In fact, many are actually relieved to be there, just because the mission is to provide comfort and pain control. If it's going to be tantamount to a busy med-surg or oncology unit (ward:)), what's the point of being there?

In this scenario, a "PITA" would be the thing I would define as persistent, and one who makes sure everyone involved is on the same page, as very often they aren't. Realistically, no one else will step into that role. The wheels churn slowly in most hospitals. Nothing at all wrong about expediting the process.

Hope things settle down for you.

[Katie5]

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

May not always be such a good idea. What about report?

[ghillbert, MSN, NP]

Thanks for your responses, I appreciate the input. A few clarifications:

- I work in the US but have been on leave in Australia to look after my mother since December, when the drs told me she had 6-12 weeks left to live. My poor workmates and boss... They have been fantastically supportive, but it's hard being without me for so long.

- Mum lives at home with Dad and I. She is able to ambulate and shower independently (with home O2 and breakthrough morphine), just needs help with the medication management (high dose narcotics = confusion), pain, housework, etc.

We usually have visiting palliative care home nurses weekly, or when required. They arranged for her to go into the acute palliative care unit for symptom management because meds were going up but pain wasn't going down.

Honestly I have to say the hospital, her oncologist, the p/care home nurses, and this palliative care doc are absolutely incredible. We have been very included in all decisions and I couldn't be more grateful for their kind and proficient care.

It has only been on inpatient admissions that I'm so surprised. I mean, we have nurse-patient ratios here, so the nurses aren't overbusy. The unit isn't even full, so they have 4 patients at the most each. And I mean, pain management visit... give the meds on time!

They do have physiotherapy coming in to get patients to walk. I think it's good if they are able.. she's already had 2 PE's so moving is good.. but I got her an O2 tank and walking frame and she was able to trot around quite well.

Ativan is working well for the anxiety - getting her to take anything is hard as she's not a "pill popper"... but she's getting better.

Anyhow, as mentioned, I think I was just venting. It's frustrating not to be able to fix things as a HCW when they are your own. I started writing a diary after mum was diagnoses and the first sentence went "I always thought I was an excellent nurse until my mother was diagnosed with cancer". It's really surprising what makes a "good nurse" when you're the patient/family member. I'm not grateful for much about this process, but I am grateful that it's made me a much better nurse.

[happy2learn]

I can only imagine how you feel. I'm so sorry to hear this. My mom is my best friend. I don't have a father, so seeing her go through something so horrible would be a nightmare. And then to have her treated like that? It would be hard to not be a PITA. I always believe that being polite and professional will get you more than being rude. I would go to the management and keep going higher and higher in management until something is done. There is no excuse for her to sit in pain because the meds are delivered late. You aren't making ridiculous demands, you only want your mom to have proper care. I would make my voice heard until that care is received.

[highlandlass1592, BSN, RN]

Thanks for your responses, I appreciate the input. A few clarifications:

- I work in the US but have been on leave in Australia to look after my mother since December, when the drs told me she had 6-12 weeks left to live. My poor workmates and boss... They have been fantastically supportive, but it's hard being without me for so long.

- Mum lives at home with Dad and I. She is able to ambulate and shower independently (with home O2 and breakthrough morphine), just needs help with the medication management (high dose narcotics = confusion), pain, housework, etc.

We usually have visiting palliative care home nurses weekly, or when required. They arranged for her to go into the acute palliative care unit for symptom management because meds were going up but pain wasn't going down.

Honestly I have to say the hospital, her oncologist, the p/care home nurses, and this palliative care doc are absolutely incredible. We have been very included in all decisions and I couldn't be more grateful for their kind and proficient care.

It has only been on inpatient admissions that I'm so surprised. I mean, we have nurse-patient ratios here, so the nurses aren't overbusy. The unit isn't even full, so they have 4 patients at the most each. And I mean, pain management visit... give the meds on time!

They do have physiotherapy coming in to get patients to walk. I think it's good if they are able.. she's already had 2 PE's so moving is good.. but I got her an O2 tank and walking frame and she was able to trot around quite well.

Ativan is working well for the anxiety - getting her to take anything is hard as she's not a "pill popper"... but she's getting better.

Anyhow, as mentioned, I think I was just venting. It's frustrating not to be able to fix things as a HCW when they are your own. I started writing a diary after mum was diagnoses and the first sentence went "I always thought I was an excellent nurse until my mother was diagnosed with cancer". It's really surprising what makes a "good nurse" when you're the patient/family member. I'm not grateful for much about this process, but I am grateful that it's made me a much better nurse.

You made an important point about your mom "not being a pill popper" and the fact that she's a nurse probably plays into her desire not to take meds unless she absolutely has to. (I'm just guessing here, based upon some statements.) Keep reminding your mom (I'm not sure what her speciality was) that it's much easier to treat sx before they get to the breaking point so the meds can work. It's a hard position to be in, receiving care as opposed to delivering it. I know, going thru some stuff right now and I"m not liking it one bit (but nowhere near what your mum is going thru). Your mum has led a good life, it's now time to let others care for her. And I commend you for trying to be there to help...it's a difficult position to be in, daughter and nurse.

And I'm glad to hear you started a journal..I used to poo poo that kind of thing till I had to deal with real grief. I've found it invaluable now to be able to get stuff off my chest without someone else judging me. Keep at it, it will truly help.

I wish I had words of wisdom, something to ease the difficulties you and your family are going through. With what little comfort it can offer, know that there are people here in cyberspace thinking of you and sending thoughts of comfort your way. Make sure you take some time for you everyday so you don't burn out yourself. I am so glad you have the support of your co-workers and boss to allow you this time. Well, I don't have anything else..just know I'm thinking about you.

[pedicurn, LPN, RN]

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?

Either, they are overworked with too high p't-nurse ratios.

OR .... they don't have a professional orientation to nursing.

Nursing, to many newcomers, is just a highly skilled occupation where they come to work to administer IVF and meds, organise procedures, do vital signs.

This new orientation is evident by lack of real empathy toward p'ts. Many of my newer nurse coworkers have quite an impersonal manner toward their p'ts

Few are really invested in nursing as a profession ... they don't seem to be too concerned about the issues that plague nursing

eg low pay/lack respect/poor management/abuse. This stuff seems to drip off them like water off a ducks back.

They have different expectations and a different frame of reference.

Most think nursing is a great deal compared to what thy were doing before, or might have been.

Many of us older ones differ because we could have become more highly paid and respected professionals in other fields....but chose to enter nursing.

I am sorry about your mum - hoping her pain is better controlled