Saturday, April 19, 2008

Venting - for a few minutes

Sorry all - but I have to vent a little bit.  I'm getting closer & closer to really thinking about travel nursing because:
My hospital is getting sooooooooooo very nit picky with all these insane things they want us to do.  It's at the point that they truly must be off in fantasyland thinking we can achieve everything they want. 
The latest is that they want us to bring our rolling (noisy) laptop computers into the patient's room.....chart in front of the patients- so that we can be "visible" & thus prevent falls (say what???).  Sounds good in fantasy...but the reality is...I have 5 patients.  Charting takes at least 20-30 minutes (I figure it's likely that if we are in the patient's room, there will be at least a few interruptions) and we have to chart at least 3 times a night on each patient.  So....let's see....30 min x 3 = 90 min x 5 patients = 450 min or 7 1/2 hours.....that's just charting.  Granted the first assessment should take the longest, but now they are saying the want full assessments charted at least twice a shift and one assessment where we just focus on why the patient is there.  Again, more unnecessary work.  See....what I don't understand...there is this one choice where we can say "No changes" if nothing has changed.  You would think that would suffice so that EVERYONE understands there has been no changes, right?  Nope, even when we get to choose "No changes"...we still have to chart the same exact things as the initial assessment.  Does that make sense to you?  It's like they are looking for ways to eat up our time - when really, that extra time could be spent actually with our patients minus the computer between us.  Patient care...that should be the priority here, shouldn't it?
Now let's move on and add in the medications we need to give & the time to actually assess our patients....probably another 30 min per patient (by the time we check the charts to make sure the medications are accurate - and the repeated faxes & calls to the pharmacy to get the medications we need and also do a full assessment) = 2 1/2 hours.  So now we're at 10 hours of our work day and all we've done is assess our patients, give medications and chart the basics.  10 hours! 
We get two 15 min breaks and a 30 min lunch break.  So it's 11 hours.  And that's not including any time for the needy type patients, the family members, the patients that are unstable or crashing, the patients that are incontinent, in pain, nausea/vomiting, admissions, discharges, calls to the doctors, ambulating the patient, dressing changes, and most importantly...keeping an eye on the heart monitor screens, etc.
Oh AND now they want us...every hour to assess how much our patients have urinated (seriously, does this really matter every single hour?  Who goes to the bathroom every hour anyways???  Especially at night?) 
Plus make sure they reposition themselves in bed on an hourly basis - regardless of whether they are alert and oriented and able to move on their own.  I see it going like this...ummm, excuse me Mrs. Smith, can you wake up (as if we don't wake them up enough at night to begin with), you were on your left side an hour ago when I last checked, can you please flip over to your right side so the hospital administration doesn't think I'm not doing my job???  How well will that go over?  It's ridiculous. 
Haha....oh AND they want us to always chart in the patients rooms.  It's impossible.  Our first assessment is at 8, but meds are usually due at 9 and 10.  How can I complete all my charting and get the meds to my patients on time?  Oh, and can you see me midnight and 4 am (our next scheduled times to chart)...rolling in my noisy computer & sitting next to my patient in the dark (cause they should be sleeping at those times) trying to type and chart without disturbing them or turning on a light?  Most importantly, do our patients really want us next to them while they are sleeping?  Doesn't that sound a little creepy?   
AND THE MOST OBVIOUS QUESTION OF ALL ----- UMMMM, WHO IS GOING TO BE WATCHING OUT FOR MY OTHER 4 PATIENTS WHILE I'M IN A ROOM FOR 30 MIN OR SO?  The same goes for the other nurses....who is going to be watching out for their patients if we're all in patient's rooms for extended times like that?  It's like they never thought of that.  So the quick answer was...utilize and negotiate with your patient care tech to watch your patients.  As if the PCT's are standing around waiting for something to do.  They are busy too at those times with vital signs and patient care.  And yet another good question was asked - what do we do when we don't have a patient care tech?  Not only that - at night we are lucky if we have a unit secretary, but they usually leave at 11 pm.  So who is going to be answering the phones, putting in orders, answering call lights, etc.
If I didn't enjoy being around my co-workers so much, I would be out of there.  Ahhh, the new ideas that "administration" comes up with.  I'd like to see them spend twelve hours on the floor doing what they propose we do.  It's obvious they haven't a clue what the real world of nursing is like. 
If they want to prevent patient falls and increase our visibility to the patients and their families - why not work on getting adequate staffing ratios and more patient care techs?  At times there is one patient care tech for 26 patients.  How realistic is it for that person to truly take care of 26 patients?  And many times there is no patient care tech at all - the nurse is expected to be both a nurse and the patient care tech.  I don't think they realize (or care) how tough that can be.  And why not get up to date beds in which the bed alarms actually work?  I think that would be the one feature that would work best towards preventing patient falls.  Combine that with adequate staffing and I would bet money patient falls would decrease.
Plus they have thrown in this paperwork that insurance companies are demanding or they won't pay the hospital for certain's called quality measures.  In reality, it sounds fantastic....if you do this, this & that for a patient - the outcome is usually better than if you don't.  But it all needs to be documented and the doctors aren't doing it's left for the nurse to do it.  Just more work that really doesn't fall under our job role, yet they expect us to do it. 
Sigh......ok, I'm done.  I can only hope it's not like this all over the country.  I have faith that there are some hospitals out there that actually value nursing care and allow their nurses to focus mainly on hands-on nursing care.  I know charting is a must, but it shouldn't take up the majority of our time.  Nor should we be expected to work past our 12 hour shift to "finish up charting" that we weren't able to do during our shift.  12 hours is a long day/night and most of us just want to go home and get some sleep after working.  Sighhhhhhhhhh!
On a better note, I saw Lifehouse in concert Wednesday night.  They are awesome.  I could listen to them all night.  It went by so quickly though.  I'll be seeing Michael W. Smith in concert in 2 weeks.  He's very spiritual and I definitely could use some of that right now in my life.
Work has been ok.  I've been floating around to different floors.  Nothing major has really happened with any of my patients.  I've had a few that were a challenge.  Like this one gentleman - he came in with congestive heart failure.  For some reason, his blood sugar would not stay in a normal range.  It was running low repeatedly and I could not figure it out.  He started out at 70 one night, so I encouraged him to eat, gave him apple juice, peanut butter and graham crackers, whole milk, a sandwich...figuring that would keep him ok through the night.  I got a call from the lab around 5 am with a critical glucose level of 44.  I wake him up, luckily he's non-symptomatic, but I give him more to eat and drink - recheck it 30 min later and it's barely changed.  So I gave him D50 through his IV.  He was rechecked at 7 am and I think he was like 50 something.  We want it at least 70 or higher, but after all that he had consumed and the should be well over 100.  Throughout the day, he dropped as low as 31.  The day nurse had given him more D50 and then Glucagon.
So when I got him...his blood sugar had reached 100. Yay!  We rechecked it 2 hours later and it was 67.  Grrr!  I finally called the doctor to inform him of all that we've tried and he ordered D5NS.  We don't usually like to give patients with congestive heart failure extra fluids like that, but he definitely needed it to keep his blood sugar up.  Even with the fluids, he still floated around 75-98 blood sugar, but that was good enough for me to relax. 
I had another patient that wanted me to help her fill out her living will paperwork because she was having a cardiac cath the next morning and was worried.  It was 2:30 in the morning and I didn't think that was the best time to be making deicisions - but she insisted.  So I sat down with her and helped her fill it out.  After that she was able to go to sleep.  Turns out she did have something major wrong and was transferred over to a bigger hospital that could handle her cardiac problems.  I guess she just knew something was wrong and wanted to get her paperwork in order.  Kinda eery sometimes.
It's 4 am, time for me to go get some more sleep.  I must have been really tired yesterday as I slept for about 12 hours altogether (I would wake up for a little while, then fall back asleep repeatedly).  I should work tonight for the overtime - I probably will...but I'll decide later.
Hope everyone is having a great weekend!


l7cupid said...

Awesome entry!!  YOU ROCK!!  Hope you have a great weekend! :)


tendernoggle said...

Seemsto me that all you nurses at your hospital should get together and get a petition up that would be to appoint at least one or two nurses to oversee administation.......nurses that work there that actually know how the day help formulate all these new ideas that they are throwing at yall!
Love ya,

beachbumrn07 said...

LOL!!!  I am just coming up on my 1st year anniversary as an RN, but I have been following you since I started nursing school (almost three years ago now).  This blog cracked me up, I was JUST having this very same rant with my coworker.  They "updated" our electronic charting system so that it was "safer" for the patient.  All it seems to have done is add about 100 extra keystrokes to our already keystroke heavy regime.  Charting once, twice, oh and don't forget everytime you give pain meds the entire screen you need to fill out about the type, level, etc, then again to do the same screen all over again to prove we have re-evaluated with the proper amout of time (as if the pt wouldn't let us know that their pain med has not been effective).  I love what I do, but sometimes I feel like I'm not allowed to do actual nursing because of all the CYA tactics set in place by the facility.  My only sanity saver is that I work nights and I have a few less politics.  It's nice to know we are not alone.