Nursing today....How the system sets us up for failure.

I have been a nurse for the last 10 years. In that time I've worked in the areas of Med/Surg, Oncology, Pediatrics, Long term care, and Medicare. Each year I've watched as the laws have changed making it harder and harder to do the job. I've watched as State and Federal laws are contradicted by corporate policies, rendering that law ineffective, and I've watched as good nurses have lost their license because some rule had changed and they didn't know about it.

Recently a local news station had an expose' about abuse and neglect in nursing homes. In that time frame they talked about alcohol and drug addiction being rampit among nurses, and nurses who steal from patients. What should have made me feel sad for the victims, only made me feel like raging at the news station. In 10 yrs of nursing I have only seen 1 case of intended abuse/neglect. I've seen 1 case of theft of narcotics, and 2 cases of staff showing up under the influence.

I currently work in long term care, and most of our residents have some form of dementia. What we, the staff, face every day is caring for ppl who are one step away from some form of phsycosis. The system as it's set up now, makes it impossible to take care of residents who are acting troublesome. I'll give you an example.

Recently we had a resident who was acting violently towards other residents. throwing things at them in the dinning room when he didn't like what they had to say or what they were doing. The law says we can not isolate residents as a means of disepline, it's considered abuse. We can not medicate as a means of restraint, we can not use restraints of any kind. So, as a way to deal with this situation we talked with the family and the resident in question and had them sign an agreement that the behavior would stop. That lasted a day because even though the family did try to get through to the man, he suffers from demetia and doesn't remember anything from one day to the next. After this happened several times and the doctor played around with his meds attempting to find a combination that would solve the problem. The management finally told the family that they would need to look for another place for him to live. Well that bombed out, because with his violent background no other facility wanted to take him on. The last time I saw him he threw a table knife at another resident at his table, and when the staff went to remove him from the dinning room they found another knife in his pocket. At that point our DON ordered that he be sent to the ER for an emergancy Phsyc evaluation, then told us that no matter what we were not to take him back. A short time later we received a call from the ER saying, "Hey you can't just dump him here like this!" Our DON showed some backbone and refused to take him back, telling the ER nurse that we had done everything we could for him and therefore could no longer meet his needs.

Of course the family was furious and have been making all kinds of threats. There's been talk of a law suit, and I have no doubt that in the end this decision will cost our facility thousands. But what do you do in this situation?

I can give you hundreds of senarios just like this where one individual consumes the time a nurse has on the floor and others get neglected in the process. However, it's not the family or that resident that will pay the cost, it's the nurse, because while the nurse is spending her time trying to calm this kind of person down, others needs are not gettin met, the families of those ppl get upset too, and blame the nurse.

I have 35 residents on my shift. If I'm in the middle of inserting a catheter and someone falls I'm in trouble. If I finish what I'm doing the person on the floor has to wait, and if they have an injury the family screams neglect. If I don't finish what I'm doing and instead go to the fallen person then the family of the person I left screams neglect because their loved one is now suffering. It's an endless cycle of you're damned if you do and damned if you don't. I've been bitten, scratched, and punched. I've been urinated on, and had feces thrown at me. I've been called every name in the book and had my breasts, crotch, and butt grabbed more times then I care to mention. This happens when you try to clean confused residents up and they don't understand what you're doing. You don't have to do anything to insite their rage, if they don't get it, you're in trouble.

I'd just like to know when someone is going to stand up for us! The nurses who are out here doing the best we can under impossible odds!

damn, that sucks, and i feel that way about other stuff too.

(Snip) this, im starting something. im so sick and tired of the (Snip) in this country.


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[edit on 21-3-2008 by asala]

it's unfortunate that our laws have been amended to the point that they no longer work to protect anyone. Nursing isn't the only profession that is under this kind of chaos. The police have the same frustrations to deal with. The rules are so contradictory that it's almost impossible to catch the bad guy.

I understand that ppl get hurt when there is not enough rules, but doesn't it seem like the State and Federal departments, that are making the rules, should maybe consult the corporations that are running the show and get on the same page? Their not the one's doing the job but they are the ones paying the bill when the facility gets sued so you would think the corps would take an interest in the law making.

reply to post by enchantress62


I know exactly where you are coming from. I'm not a nurse but I have been a CNA for the last three years. I once had a man shove me into a wall and punch me because I stopped his wheel chair and backed him up a bit to keep his catheter bag and tube from getting tangled in the wheelchair wheels. The only instance I can recall where a family tried to claim neglect was when a resident didn't have a cup of water in his room. Of course the fact that he hadn't been in his room in hours and his water was in the tv room with him didn't matter to them.

They bind you with so many rules it's practically impossible to do your job right. Can't let the residents hit each other or you, but you can't restrain them, take them to a different room, etc. I've been saying for months that the powers that be need to come work as a nurse or CNA for awhile so they might actually understand what we go through on a daily basis instead of dictating rules and regulations for circumstances they will never be in and will probably never even see.

Originally posted by Jenna
reply to post by enchantress62

 

I know exactly where you are coming from. I'm not a nurse but I have been a CNA for the last three years.

You guys have it even worse then we do. You're more hands on and therefore get assaulted more often, and you're the first one's to hear the families complaints. I feel so bad for the CNA's that I work with. The other day we had a resident bite a CNA so hard that it left a bruise and teeth prints on her arm, and she's five months pregnant.

In another facility I worked at a CNA was attacked by, a very big alert and oriented man, who sprained her arm by twisting it. It took five ppl to pull him off her and when the wife was notified she complained to the administrator that the CNA must of said something to set him off. I couldn't believe it, but the administrator and DON refused to pay her workmans comp because of the wife's complaints. The girl had to sue them to get medical attention, and to make matters worse they made her work the shifts she was scheduled for or she would loose her job. I watched her work in tears with her arm the size of a soccer ball.

I got into nursing to be of help to my fellow man, but the whole profession has been quite a shock to me!

reply to post by enchantress62


Hey there. I too am in the healthcare industry. I work as a cytogenetics tech and also as a morgue deiner. You think nursing is bad? Try the labs. they are out of control. WAY OVERWORKED AND UNDERPAID!!! At least you guys have increased your wages by a ton over the last few years. As a lab tech, specifically histology, for over 12 years, I never cracked the 40K a year range. Histology is like carpentry....it is a skilled trade.
I just recently transferred to the genetics department because I couldn't deal with surgical pathology anymore. Thank god I have the morgue work behind me because I think I am going to go to the Medical Examiner's office pretty soon.
Anyways, what it all boils down to is this. Unless you are an administrator, supervisor, or specialty doctor, you get the shaft in healthcare. Any way you look at it, all others are doomed in the field. We are overworked slaves that initially want to work for the patient, but our governing bodies make it so unmotivating that we end up losing sight of why we got into the profession in the first place.

I feel your pain, sister. I've been doing bedside care for almost 28 years and things have really changed since I started. I've done mostly ICU (CCU, NICU, etc.) but have tried psych, prison nursing, private duty, long term care. Even got into legal nurse consulting (which I still do on occasions). You show me anyone's charting and I can show you where they're lying. It's simply not physically possible to do all the things that got charted as done.

I once got my butt chewed because I charted that I did not turn a patient every 2 hours as is the policy (and standard of care). I tried explaining why it was impossible to comply and the supervisor assured me that everyone else had been able to do it (according to their charting) for the past 3 months. The patient was 950 pounds, had undergone a gastric bypass, developed complications and came to ICU when she was down to 850 pounds. According to policy we are not allowed to lift/turn more than 50 pounds per person without assistance. There were only 4 nurses working in ICU. If all of us go to turn a patient the most we can collectively lift/turn is 200 pounds (per policy). If we do not comply with policy and wind up hurting ourselves, we are not covered by workers comp. According to their rules it would take 18 people (all the nurses available on 3 units) to be able to turn this woman every 2 hours. I guarantee you that 18 nurses did not stop what they were doing to go to another floor and turn this woman every 2 hours.
She also had an order for daily weights and the only way we could comply was if we got several people to roll her bed down to the loading docks and weigh her there. Also never happened. The daily weights were faithfully recorded on the chart every day.
Nurses are resorting to "pencil-whipping" their documentation to show that they are "good nurses" when, in fact, the rules are set up to make it impossible to be a good nurse. I think most nurses are good nurses and go above and beyond at a furious pace all day long, sacrificing their family time and own health to be able to care for hostile and demanding strangers. We are totally unappreciated or recognized for our work.
When the Murrah bldg. was bombed our pastor wanted to honor the "heroes" and asked for all the cops and firefighters to stand up and be recognized for their efforts that day. I stood up and the pastor said, "I didn't know you were a firefighter, or are you on the police force?" I said, "No, I'm a nurse. The only rescue worker that died that day was a nurse who left her family to drive to our state and help. I think she's a hero." He sputtered for a bit then said, "oh and nurses, you stand up too."
When a cop shows up at a gun fight and saves the day, he's a hero. When a firefighter runs into a burning building and drags out an old lady, he's a hero. But when a nurse runs into a room with a G.I. bleeder who's just blown like Mt. Saint Helens, spewing infective body fluids all over the place and develops Hepatitis B for her efforts, well that's just all in a days work. We don't get hazardous duty pay or combat pay even though we frequently earn it. (Not dissing cops or firefighters--would just like equal recognition).
I better quit here or I'll have to post it in the rant section.

First of all I want to thank all the nurses and CNAs. I appreciate all of you. You are indeed unsung heros. I've watched my good friend and my daughter's boyfriend work long hours and go literally weeks without a day off. It's not fair or right and puts them in harms way oh so many times. What will happen to the RN at that hospital when she makes a mistake on meds; not due to her incompetence but due to exhaustion? How will she be able to live with it? I say a prayer for them daily. My job is bad enough I don't want theirs. So once again Thank you.

Don't worry . . . it is not just the health industry.

I work at a public school. The kids are horrible, and nothing can be done to them. Everyone's child is an innocent angel. I have a few parents that are normal, though, and realize that their kids are not perfect angels. They basically tell teh school to do what we have to do. I like them

Thank you all for your input. I'm glad to see that I'm not the only one who feels this way, and I'm not the only one who's not handling it well. lol To me this is like the giant pink elephant in the room that no one is talking about. There is no way that patients are getting the kind of care they need with our current system, and nurses are dropping like flies with there own health issues, from the stress of the job. In the last six months we've lost 3 nurses to heart attacks. One of them was a 30 year old pregnant woman, and it's only going to get worse as we baby boomers come of age. I'm 45 years old. I used to be a very outgoing extroverted kind of person, but in the last few years I've become depressed, reclusive, and prone to antisocial behaviors. A year ago I picked up smoking and when ppl ask me why I don't quit I laugh and tell them, "It's the only thing that keeps me sane!" I don't mean to sound flippant but I'm a take action kind of person only I don't know what action can be taken to solve this problem. I thought about writing an article and submitting it to the New York times, or USA today, just to see what America thinks of this issue. What stops me is that even if ppl wake up, nothing will be done about it. They'll sympathize for awhile, but nothing will really change. The healthcare industry is the one of the largest providers of employment in the world today, but to be a part of it is like selling yourself into slavery! What can be done to change that though? That's the burning question in my mind.

reply to post by enchantress62


How to fix the problem? We nurses (and health care providers in general) are "fix it" kind of people. We see a problem and jump right in to solve it. I remember when we used to have time to talk with our patients, hold their hand, comfort them. Those days ran out the door when DRG's came into play. For those of you who don't know, DRG stands for Diagnosis Related Groups. It's something the insurance companies came up with that said, "you have this illness? you have x amount of time to get over it". We were wheeling people out the door of the hospital even though they were literally green and puking the whole way out. Doctors were lying through their teeth, making up new diagnoses to be able to keep these people who so obviously were not ready to go but all the media reported was about the "fraud" perpetrated by healthcare. Technically, yes, it was fraud, but which is the bigger criminal action? Throwing sick people out of the hospital because the insurance companies are now in the business of practicing medicine without a license or trying to find a way to help those sick people?
I took to smoking because it was the only way to get a break. If you're sitting in the break room, someone will come in there and say, "can you help me clean this guy up?...you're just sitting there doing nothing." If you smoke, you have to leave the floor and can get away for 5 minutes. Better pee and eat your lunch during that time, too, or you may never get another chance.
A lot of people think that socialized medicine, (translate: free bubble up and rainbow stew) will solve the healthcare "crisis". That will be the day I throw my retirement plans out the window and go work at Taco Bell. *shudders* We didn't have a healthcare crisis until the DRG's, medicare changes and, don't forget, Hillary Ramrod Clinton telling us that "it's none of the American people's business what we're doing behind closed doors regarding their healthcare."
I believe that there is a conspiracy in the healthcare industry because there is an unthinkable solution to the problem. We have to be made to accept it. We have the median age of the population increasing and the majority of people are at an age where they need some sort of constant care. We have a large base of young people with AIDS; we have insurance companies going bankrupt; we have a nursing shortage. What one stroke of the pen will solve all those problems? Let the people die.
The problem is created so that the solution can be offered.
When I get treated like a slave at work and scolded like a recalcitrant child instead of the profession adult I am, I tell my bosses that I can have a job before I get out of the parking lot. How quickly can they get an experienced, qualified, English-speaking nurse to replace me? That usually buys me another couple days of reprieve before the abuse starts again.
Is it too late to go to truck-driving school?

Originally posted by whitewave
reply to post by enchantress62

 

Is it too late to go to truck-driving school?

I feel your pain my friend! I come home at the end of the night and have to elevate my feet and lay on a heating pad just to get my body to work right again. That's not to mention the large amounts of Ibuprophen I take so the pain in my back and joints will go away. 10 years ago when I started in nursing I had a job with a 401K, life insurance, PTO (paid time off) and a 6% shift differential for working nights. Today I have none of those things, and after taxes I make less money then I did back then.

How to fix the issue?

1) Reform the liability laws for medical malpractice. Thus cutting down on the sheer amount of redundant documentation nurses have to do. For a 1 hour transport I have to spend 2-3 hours filling out the paperwork.

2) Curtail and severly limit the power of JACHO. They alone are responsable for so much of the needless crap that gets in the way of direct patient care.

3) Institute reasonable and MANDATORY staffing ratios for all facets of nursing.

many fo these things can be acieved by organizing. The Union that represent my hospital is set up and run by the nurses. From the president on down they all have to be nurses working at the facility. Collective bargaining has so much more to offer.

reply to post by enchantress62


Hi enchantress,

I am also a nurse but retired quite awhile ago. I've worked ICU, CCU, Peds, OBGYN and just about everything including the Psych Unit. I went into nursing because I wanted to help sick and injured people. My sister and I went to the same college, except she studied Computer Repair. I should have too. She made a whole lot more money than me and had no problems with a computer dying on her. Even back then all the CCU nurses smoked. We still had the heavy work-load, stress, and not enough help. I did meds and treatments in a nursing home on the night shift too. It was a 120 bed home and just about all needed treatments or meds of some sort. Restraints orders at that time were prn. You could use wrist, chest, or ankle restraints if needed. If a patient was in danger of falling out of bed usually a chest restraint was applied. It was a vest-like and the ties criss-crossed in the back. The patient was left with plenty of turning space and the ties were attached under the bed. I worked there for two years and no patient ever fell out of bed or were injured, due to the restraints. I could have never did all those meds, treatments, catheters, injections, & suctioning ect...without some patients being restrained. I had the best NA's and they were willing to help me anytime. The restraints were applied carefully and lovingly. No bruises or marks were ever left and were only applied for the patients or nurses protection. If you don't have this option now days the nurses job is impossible!

I worked the Psych Unit once when I was attacked. A REALLY BIG Psychotic fellow was admitted. He fought off 6 cops and sent them flying! I was sitting at the desk when he came up to me. He wanted a cigarette. I said, sorry sir you are only allowed 1 cigarette per hour and you just had one. (bad move) The BIG GUY got 'a little' upset and yelled, " GIVE ME A GD CIGARETTE %ITCH! Again, because of the 'rules' I repeated your're only allowed 1 cigarette per hour sir. There was a wall phone just above my head. The guy grabs the phone's handset and wraps the cord around my neck. He threatens to strangle me, if I don't give him a cigarette! Since I was the only one in the locked Psych Unit with this guy I gave him a WHOLE DAMN CARTON of cigarettes & Screw the rules!

I didn't get in trouble for that incident. There should have been an orderly in the unit with me. That guy could have easily broke my neck. He took the cigarettes back to his room and smoked up a storm!
I've also worked on board an ambulance. What really gripes me is the nurses who re-used needles at the Endoscopy Centers in Las Vegas! Because of doctors orders. They knowingly subjected the patients to HIV or Hepatitis. They should have just told the doctor owner, "NO WAY WILL I RE-USE A NEEDLE TO SAVE YOU 15 cents!!! I can't understand for the life of me why the nurses went ahead and re-used needles. Why didn't they just refuse, quit working there and report the doctor's practice?

I'm willing to write letters to help out.

reply to post by MountainStar


Wow! Just Wow! Getting hurt on the job is expected these days. Patients know you're not gonna slap the fire out of them for their abuse and so they just pour it on. One nurse I worked with lost an eye due to patient abuse/violence.
Fred T has some good ideas. Several reform ideas have been suggested but management doesn't want to incur the cost. Since I work for the state it literally takes an act of congress to get changes enacted. State workers in Oklahoma are the 50th rank in the national pay scale yet our representatives are in 6th place for pay. We should be getting our first raise in 5 years this year but we are just going to be giving it to the insurance company for our "benefits". A 5% pay increase is proposed for our raise and coincidentally enough, a 5% hike in our insurance premiums is also proposed.
Nursing is a predominantly female populated profession. When men started getting into nursing the rates went up. Glad for the raise, whatever the reason but I believe that women, generally speaking, are more willing to put up with abusive practices than are men. With that said, let me hazard a prediction: as more men get into the field of nursing, changes will occur that should improve the lot of us all.
I once saw a doctor rip a phone out of the wall and throw it across the nurses station at a nurse who had the audacity to make a suggestion regarding a patients' care. She ran out crying. (didn't hit her) The same doctor threw a chart at a male nurse a few weeks later for asking for clarification on an order and the male nurse pinned him to the wall and threatened to beat the sass out of him. That doctor no longer throws things at anyone-male or female. So our lot has already improved with the addition of males.

I live in a right to work state. Arizona to be more specific. it's a republican right to work state. What that means is that there is no union. A company can fire you without explanation, or for any reason they want as long as it's not about discrimination, which is a joke, cause all they have to do is say, "Your fired" No explanation necessary, and you have to prove that it's about discrimination if you think you can. There's no job security here, and even though you can walk across the street and get another job, that place will be just as bad, or worse. I was offered $28 an hour to work in one place, $26 to work in another, but I took the job that offered $22 because it's an older facility, has a good reputation for being supportive of their staff. I can't complain cause my patient ratio is the best I've ever had, and although the benefits and pay suck, the corp. who runs it seems to really care and they are as supportive as they can be.

The fact is though, being in this profession is a lot like being in an abusive relationship. The ever changing game keeps you off balance and living in fear. You want to get out, but then you think of how much time, energy, and money you've put into this career and what a waste it will be to just walk away. When we moved here last year, I took some time to explore my options. I found nothing else that would pay me a similar wage that didn't require going back to school. I spent $15,000 on my education, much of which I'm still paying on, to work for even less and still have to pay that payment.......well it keeps me locked into nursing.

I would love to work for a company that has a Union but a few years back when I worked for the hospital the Union tried to come in. The hospital sent a letter to all employees saying, "If you are caught talking to anyone afiliated with the Union you'll be fired without notice. I was told at that time that in Arizona we're not allowed to strike. We're considered a service profession and ppl can't live without us, so we can't strike!

I live in a right to work state. Arizona to be more specific. it's a republican right to work state. What that means is that there is no union. A company can fire you without explanation, or for any reason they want as long as it's not about discrimination, which is a joke, cause all they have to do is say, "Your fired" No explanation necessary, and you have to prove that it's about discrimination if you think you can. There's no job security here, and even though you can walk across the street and get another job, that place will be just as bad, or worse. I was offered $28 an hour to work in one place, $26 to work in another, but I took the job that offered $22 because it's an older facility, has a good reputation for being supportive of their staff. I can't complain cause my patient ratio is the best I've ever had, and although the benefits and pay suck, the corp. who runs it seems to really care and they are as supportive as they can be.

The fact is though, being in this profession is a lot like being in an abusive relationship. The ever changing game keeps you off balance and living in fear. You want to get out, but then you think of how much time, energy, and money you've put into this career and what a waste it will be to just walk away. When we moved here last year, I took some time to explore my options. I found nothing else that would pay me a similar wage that didn't require going back to school. I spent $15,000 on my education, much of which I'm still paying on, to work for even less and still have to pay that payment.......well it keeps me locked into nursing.

I would love to work for a company that has a Union but a few years back when I worked for the hospital the Union tried to come in. The hospital sent a letter to all employees saying, "If you are caught talking to anyone afiliated with the Union you'll be fired without notice. I was told at that time that in Arizona we're not allowed to strike. We're considered a service profession and ppl can't live without us, so we can't strike!

I live in a right to work state. Arizona to be more specific. it's a republican right to work state. What that means is that there is no union. A company can fire you without explanation, or for any reason they want as long as it's not about discrimination, which is a joke, cause all they have to do is say, "Your fired" No explanation necessary, and you have to prove that it's about discrimination if you think you can. There's no job security here, and even though you can walk across the street and get another job, that place will be just as bad, or worse. I was offered $28 an hour to work in one place, $26 to work in another, but I took the job that offered $22 because it's an older facility, has a good reputation for being supportive of their staff. I can't complain cause my patient ratio is the best I've ever had, and although the benefits and pay suck, the corp. who runs it seems to really care and they are as supportive as they can be.

The fact is though, being in this profession is a lot like being in an abusive relationship. The ever changing game keeps you off balance and living in fear. You want to get out, but then you think of how much time, energy, and money you've put into this career and what a waste it will be to just walk away. When we moved here last year, I took some time to explore my options. I found nothing else that would pay me a similar wage that didn't require going back to school. I spent $15,000 on my education, much of which I'm still paying on, to work for even less and still have to pay that payment.......well it keeps me locked into nursing.

I would love to work for a company that has a Union but a few years back when I worked for the hospital the Union tried to come in. The hospital sent a letter to all employees saying, "If you are caught talking to anyone afiliated with the Union you'll be fired without notice. I was told at that time that in Arizona we're not allowed to strike. We're considered a service profession and ppl can't live without us, so we can't strike!

i do not mean to sound like a broken record, but all this insanity going on, with understaffed healthcare institutions and abused nurses, i think it's designed from ground up to force eugenics into the mainstream.

make people fed up and desensitized to the point they will agree with killing everyone who does not fulfill the required criteria (think form with checkboxes)....

all that money going nowhere, while the ones keeping everything afloat get spit in the face, i wonder what else the guys in charge are trying to accomplish?!

Originally posted by Long Lance
i do not mean to sound like a broken record, but all this insanity going on, with understaffed healthcare institutions and abused nurses, i think it's designed from ground up to force eugenics into the mainstream.

make people fed up and desensitized to the point they will agree with killing everyone who does not fulfill the required criteria (think form with checkboxes)....

all that money going nowhere, while the ones keeping everything afloat get spit in the face, i wonder what else the guys in charge are trying to accomplish?!

Interesting theory, I don't know anything about "Eugenics" Do you have more information? I think it's time that we all start talking about this, instead of just accepting it as the way things are. I do agree that you become desensitized to it all. When I first started I cried a lot over patients I lost, but now days I don't cry anymore, instead I try to get the body out of the facility as fast as possible. Not because of any noble reason either, just the work involved slows down everything else I have to do. God! I hate that all the humanity is gone out of nursing today!