healthcare

Nursing care is evaluated and structured from several different agencies and protocols. Nurses are expected to timely document, take all recommended breaks, stay hydrated, care-round every hour, educate on all core measures, keep all family members involved/informed in the plan of care, provide recommendations to doctors, thoroughly assess all six patients, ambulate all six patients twice a day, monitor lab values, among many others, all within a “12-hour” shift. It is often difficult to show compassion, communicate slowly, and provide patient autonomy while all these other measures are being graded.

A nurse once stated at huddle that her goal was to “document as I go.” I and all of the nurses around her could not stop laughing as this was a “quite ambitious” goal to achieve. A typical medpass takes around 10-15 minutes for one patient. Multiply this by 5-6 patients and that results in 50-90 minutes of the morning just ensuring all patients have medications. Documenting on each adds another 60 minutes, all while constantly refreshing the screen for any new orders or urgent patient concerns. Some days all patients are accounted for 4 hours later, and sometimes this is without any documentation.. If it’s not documented, it is not done.

A 12-hr shift is granted two 15 minute breaks and one 30 minute lunch break. Many nurses are lucky to take a full 30 minute lunch and will still get interrupted. It can be lunchtime before I realize that I have not had a sip of water for the past 6 hours, nor have I had the chance to pee.

Care-rounding involves checking the 3 P’s: pain, potty, and positioning, and also any needs at that time. This is expected on each patient every hour.

“Yes, we need to look at your skin.” “No, you cannot get up without us.” The Joint commission is an agency that allows for hospital reimbursement if all quality and core measures are met. This is the greatest concern and the greatest frustration on a medical floor. Upon admission, patients are asked to roll over so nurses can look at their butt, as we must assess for pressure injuries, regardless of the patient age. Patients are also assigned a fall risk scale and placed on a bed/chair alarm so they cannot get up without assistance. Patients are also taught that ambulation is important and getting out of bed will help with recovery; however, this depends on how frequently staff can get into the room. Falls are a major issue, however patients are very much limited by the “restraints” that we are forcing upon them.

“There is no particular time that the doctor will be in.” Many patients wait hours for the doctor to come in and then they are gone within 10 minutes. This leaves the nursing staff to educate the patients on the plan of care, while carrying out any immediate interventions.

Nurses became nurses to help people. The way healthcare is regulated at this time creates a major challenge between helping people and ensuring the chart looks perfect. I value moments to sit down and truly listen to each patient, but these moments are not able to be had every shift. Patients, I assure you that nursing staff are trying their best. There is a lot on our hands .

Until next shift,

Shania