does the workload undermine the profession?

sandlewood_nurse · Mar 17, 2007

Yes why is that? Why are we put in these situations? I worked for an agency briefly (about 3 months). I would go to nursing homes where sometimes I would have to give meds to 60 patients. It wasn't even humanly possible. The first night I began my evening meds at 8pm, even though they were schedualled for 10pm (I was advised by charge nurse in the home to do this). I was finished about 12:30. I gave each and every single med, and did my checks because I was AFRAID !! I did not want to be responsible for giving the wrong medication or missing an important med. I had no time to check for interactions between the meds the patients were getting. Most patients had several meds. It was a nightmare, but I had to do it because I had no other job at the time and was desperate for money for food and rent. I learned and ended up going to each place/shift 30 to 45 minutes early to get organized just for the meds. I did my first check before my shift began to make sure that all the meds were in the right drawer at least, and then double checked as I gave the meds. I also started giving meds very soon after my shifts. There would be family members and patients who needed to talk with me/discuss things with me and I would get very anxious about the time.

I loved working in the homes because I felt like I was really making a difference for the patients. I however am no longer working in any homes because IT IS JUST TOO UNSAFE !! I will never send my mum to a nursing home, not because I'm afraid she will get abused, but because I will constantly be afraid she's not getting her meds or she will get someone else's. Its rediculous and something needs to be done. I also worked in a couple homes where the patient load was 20 or less. That was much more managable. Anything over 25 patients was TOO MUCH AND NOT SAFE !!

let's take the typical nursing home example. let's say you've got 37 patients, and you've got to give meds and treatments according to mars and tars.
the rule states you have to give all meds within an hour of the stated time. however, it's impossible for one human being to do and manage the floor, dealing with the families, the patients, etc.
it's not just impossible for me, it's impossible for the nursing supervisors, the d.o.n., the members of my state's board of nursing. it's humanly impossible, period. yet nurses will all tell you "yes, i give all my meds with an hour"... watch them go to work, and they're giving their 2 p.m. meds at 8 a.m. good nurses, no doubt... buy lying though their teeth. agency nurses just sign mars and tars, and don't bother to give many of the meds and treatments. it's epidemic, and anyone who says otherwise is full of .....
the entire industry is built around the fact that every day you go to work, you've got to lie by signing the mars and tars and pretending this is a doable job. it's beyond a joke.
integity? why can't regulators and employers at least get together and come up with reasonable guidelines that a human being can actually follow? what the hell, why not be honest about it? instead, the industry sweeps this issue under the rug.
the end result is that good nurses take care of patients in spite of the system... not because of it. it sucks, and i think it greatly undermines this profession.

Gromit · Mar 17, 2007

Never worked in a nusring home. Sounds nightmarish.

Our floor is tough enough -we are only 3:1 (rarely 4:1 -very rarely) -they are high-acuity patients. Each with enough meds (and often wound care issues among other things like trachs, cx tubes, etc etc) to set up their own pharmacy -po (tube) and IV as well as topical. Doing all of the treatments, meds, and different adjunct care protocols takes full time -god help you if one of 'em really tanks on you -your night is shot.

Aside from the patient care, the night shift has to also recopy all of the flowsheets, mars that need recopying, and various other protocol sheets get copied nightly. Do I think the workload undermines us? You bet! I spend the vast majority of my time doing paperwork and praying nobody tanks.

nurse4theplanet, RN · Mar 17, 2007

I can almost guarantee that protocols and guidelines like that were put in place due to med errors that occurred as a result of the very working conditions you describe in the first place. It's a vicious cycle.

Ratios like you describe are ridiculous and yes, it does undermine the profession! Nurses will not work under these conditions if they don't have to. Many are moving towards other areas of nursing, and even non-nursing feilds to avoid such impossible staffing ratios. Others are pursuing higher degrees for advanced practice. Others are going into management, research, etc.

That, in turn, adds an even greater strain to the shortage of nurses available to work in these facilities and on hospital floors that have similarly strained working conditions. This leaves a bad taste in the mouths of nursing students who are drawn more towards specialty areas due to better ratios and more resource nurses available when help is needed.

The only way to correct such staffing issues is to follow in California's footsteps and mandate a nurse pt ratio. Until then, these facilities will continue to add to the pt load as long as they find nurses willing to work under such horrible conditions.