Thursday, 30 April 2009

Attitudes towards Nursing. Part one: The American Media

I found this today and it made me very happy.

It is sensible. It is not ignorant, inflammatory or insulting. It is a straightforward feature article on about nursing. It is American. The author did not use it as a jibe against nurses. The author did his research and spoke to real live nurses who are currently working in frontline care.

My favourite quotes are below. My own thoughts are in purple.

California's 2004 patient-nurse ratio law has helped with the workload in hospitals. But the sick have gotten sicker.

"Fifteen years ago, with a six- or seven-patient assignment, probably four of them could get up and about. A typical patient [today] has totally restricted movement, so we have to keep turning them as much as possible [to prevent] blood clots.

At the same time, this person can require IV medications every six hours and can be taking three different antibiotics every two to three hours and pain medicine every two hours. We are monitoring all of their lab results, making sure any tests that have been ordered have been followed through, and prepping patients for tests.That's just one patient -- and I can have up to five

It would be a good day if I had one patient who could get up and walk around and get to the bathroom and take care of washing up [on their own]. More often than not, I have at least three that require total care, meaning that everything has to be done for them.It's pretty hefty -- a day with four patients is OK, five is pushing it. It only takes one extra person to push you over the edge in terms of trying to manage your day".

Yes things are changing and moving faster. Patients are sicker and more complex. Here in the UK a nurse would be happy to have 6 patients. 6 Patients is the least I have ever had and it happened twice. My normal load can be anywhere between 6 and 35. And I have to perform just as well whether I have 6 patients or 35 patients...........................Anne

"As a new nurse in the 1980s, my patient load was probably three to four patients, which is what it is currently in pediatrics, but the patients were not as sick as they are now. There's been a definite change over time to a higher acuity [sicker] patient, requiring more technology, more paperwork, more intensive monitoring. If you had a patient assignment in the past, you might have one sick patient and several patients on the mend. But that has changed

I [used to] go home and be falling asleep and would wake myself up thinking, "Oh my God! Did I do such and such? Did I tell the next nurse about this or that?" Because you're so rushed you would be continually questioning, "Did I get everything done, was everybody safe?"

It's scary as hell. Come to England and have no control over how many patients you have and end up with 12 or 17 or 35 people to look after. People who probably need a one to one to get the kind of care they imagine that hospitals provide. See how that fucks with your serenity................Anne

"There are all kinds of complicated procedures and technology that the nurse is responsible for monitoring that didn't exist 10 years ago. A lot of patients are on continuous dialysis with machines. A lot of labs and drugs have to be given on an hourly basis. There are very critical IV drips, and you're titrating the drugs up and down based on the patients' clinical picture, and there is constant bedside decision-making with each patient.We also have [many more] patients who are on isolation precautions [because of infectious diseases] than we used to, which means gowning and gloving every time you walk into their room. That's very time-consuming, but very, very necessary. There is a much greater risk factor for people who work in healthcare now and it makes the care more complicated. There are a lot of things that have changed over the years that make the delivery of care a lot more complicated."

This is also the case in the UK, and these prehistoric long retired dinosaurs refuse to understand this fact. We now have more untrained staff now in proportion to trained staff. That means that there are very few people on the ward who can actually deal with this very complicated stuff. They are overwhelmed with it all. The patient loads that the RN's are forced to take on are horrendous. The nurses may have no control but they are still liable. The total care elderly patients are mixed in with acutely unwell medical patients. One acutely ill medical patient can keep a nurse on her toes for hours, constantly. But she still has 10 other total care elderly patients. Patients such as this really do need one to one care to have their dignity maintained and remain clean, hydrated etc. They do. They need that.

I walk away from a 90 year old dementia patient for 5 minutes to check on my bleeding patient and the 90 year old ends up covered head to toe in feces, and falls out of bed trying to help himself. Multiply this scenario by 10 and that is my normal patient load. This is the indignity of old age. Nurses did not create and can not cure old age. The families of these patients and the hospital managers do not want to lend a hand or pay for more of us. No one cares either...............................Anne

Reading a straightforward feature article about nursing is like taking in a breath of fresh air. The author of this article talked to nurses who have been nursing a long time, and are currently nursing.


Ad nauseam said...

When I was a baby doctor I remember patients going into hospital "for tests". They were basically well, mobile and self caring and pootled round the wards - even helping out if they could. They used to fill their time going to the hospital hairdresser so they would look good on the ward round! Now if you are even remotely well enough you are booted out, with everything done as an outpatient. The wards are full of dependant, sick patients with complex needs and multiple problems, acute and chronic, and none of this is taken into account in terms of staffing. Keep on spelling this stuff out to people Anne.

Nurse Anne said...

Thank you ad nauseam. Thank you.

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