Many changes have occurred in my profession over the past
40+ years. Many have been positive
changes resulting in an improved quality of care in various aspects of
nursing. Sadly, however, some changes
leave a negative impact not only for patients’ safety and outcomes but for our
profession in general. Nurses stuck to
computers and cell phones have become a situation that is out of control and
must be changed. Nurses using diagnostic
templates and care guides without incorporating individual patient goals and
outcomes has become common place and is completely contradictory to the overall
concept and core of nursing: The Nursing Care Plan. Our profession has essentially removed
itself from the bedside and chained the nurse to the desk.
This note comes after observing and caring for multiple
family members and friends over the past year while they received care at a
local hospital in Broward County, FL.
Since the majority of the observations occurred repetitively and during
various admissions it would appear that the nursing culture in this hospital
group has changed significantly and sadly, not for the better. I worked at the facility in question when
they first opened and over the past 40 years many friends and family have received
care at this hospital. Never have I felt the need to express concern as to the
care or lack thereof. In fact, I
constantly boasted to all I knew how wonderful this hospital is and how very
much I would recommend it and its sister hospitals. Now, sadly I hesitate to do so.
First and foremost let me say the nursing staff and most of
the physicians in the ER and ICU were superb and the quality of care in these
units was without a doubt excellent. Overall
the staff was pleasant and personable however, all the staff we encountered in
the last year stated how they hated their jobs, were eager to leave and
hated what nursing as a profession has become. One doctor even stated more than once,
"Nursing has gone to hell; they don't do much of anything anymore. Hospitals will kill you, get out
now!" In all
my years I NEVER heard a doctor speak about nursing like this. In all my experiences I have NEVER heard nursing
as a profession so disrespected and ridiculed.
Here is but an example of what I have observed more than
once based on just three people I know and cared for while in the hospital over
the last year with the most recent just this month.
While in the ER:
The PA and Paramedic both made no effort to clarify to the
patient their title and role when the patient called them doctor. (Lay people need this explained slowly and
clearly).
When the RN treating said relative asked the Case Manger for
help to find a doctor the reply was “he does not have insurance and I can’t be
bothered” (There’s no excuse for this)
On discharge with a large umbilical hernia the patient was
referred to a surgeon who only takes private insurance or cash. When the patient asked for help finding a
doctor who would take Medicaid he was told they (the nursing staff) are not
allowed to help. (This is completely
contradictory as to how to discharge a patient)
While on Telemetry at IPMC: The following occurred at least
twice with both people having the diagnosis of DVT and Bilateral PE:
A RN arrived to the room within 15 minutes of arrival to
enter demographic data into a bedside computer.
NO ASSESSMENT WAS DONE
A second RN arrived about 30 later minutes later stating she
would be the nurse tending to the patient.
She put on the halter monitor and yet again NO ASSESSMENT WAS DONE.
Neither of the two nurses looked at the affected extremity,
evaluated respiratory status, palpated for pulses, assessed hep lock site, took
vitals, etc. (This is beyond comprehension
that nurses do not do assessments anymore)
Nurse and PCA's were constantly interrupted by cell phones
while at the bedside, which they answered immediately and often abruptly left
the bedside to return 30 minutes to hours later. (This
facility uses cell phones to communicate among staff; these should be turned
off while at the bedside. This is probably one of the worse practices I have
ever seen)
O2 was knocked off
while the patient slept. The next day it
was still off, this went unnoticed. It
was well over 8 hours later when I finally pointed it out to the nurse. O2 Sat was not checked, the oxygen was
stopped.
Not one PCA/NA offered assist with hygiene yet patients were
on complete bed rest.
One nurse came into the room around 2 am and woke the
patient to try and discuss doctor assigned to the case! (You don’t wake people at
that hour to discuss such things)
Although patients were permitted to use the BSC (without a
doctor’s orders mind you) no one bothered to leave toilet tissue and no one
came to clean it out.
On two admissions the
nurse tried to state that the patient’s primary care doctor did not go to that
hospital and tried to assign a house doctor.
Both patients’ doctors most certainly do go to the hospital in question, I intervened to rectify that issue.
Tests were ordered which the patient did not understand and
subsequently did not want
On the day of discharge, after I mentioned
that not one RN did an assessment nor did one Aide offer assistance with hygiene during the entire stay did someone come in to help.
Again, let me reiterate that the staff was amazingly
pleasant and kind however, they did not provide quality nursing care.
In summary, It is obvious nurses need to get back to the basics. Fundamental care should not be overlooked and pushed aside.
