A question about hospital nurses

[RoughCollie]

I really would like to know what is happening to nurses.  All of them were nice, and all of them were competent. They were always working and rushing around, not sitting around chatting.  There were nurse's aides assigned to each inpatient, too.  They were always working and rushing around, too.

 

I was never so busy in my life.  A lot of the time, I had to find a nurse when my son's dressing change or medications were due.  Several times I prevented the nurses from giving Stephen the wrong pain meds (I had had the doctor, via the nursing staff, change to another med).  More than a few times, I had to make sure the dose was correct -- the nurse was about to give him one pill instead of two. I had to hunt down a nurse when the IV thing beeped.  Even though no one but staff is allowed in the nutrition room, one nurse let me get his juices and jello from there instead of bugging the staff.  There is much more, but why belabor the point?

 

There were a couple of social workers there, and I had to do a lot of talking to get my son a visiting nurse, an extra day in the hospital, and an ambulance transport home.  All of this was a no-brainer -- we have good insurance and it was obvious that he needs those things.  When I asked about equipment we will need, though, they did get an occupational therapist lined up to come over here and handle that -- otherwise the insurance won't pay.  They also suggested a gel mattress that the insurance will pay for since my son will be basically bedridden for many months, up to a year or longer.

 

I left the hospital today right before the ambulance arrived -- DH stayed with our son and rode home in the ambulance with him.  By that time, I'd spent 2.5 days at the hospital, spent most of my time either taking care of Stephen or trying to get someone else to, and I had had it! If he had stayed one more night, I doubt I could have remained polite and friendly and thankful, I was so frustrated.

 

I don't see how the nurses stay in good moods throughout their shifts.  It must be so frustrating to have to keep track of a zillion details for each patient and be continuously interrupted no matter what they are doing. 

 

But the healthcare system ... what the heck is going on?  I wouldn't advise anyone to be a nurse, ever, based on what we experienced in the last few days, and based on my prior experiences as an inpatient in hospitals in Boston and western PA over the last dozen years.

 

Honestly, I think every patient would greatly benefit from having a family member stay with him or her every minute they are in the hospital.  I don't think that should be the case, though.

 

My son needs continuous care 24/7 and now it is up to me.  The difficulty of the situation is compounded because he cannot sit, he cannot lie on his back, he cannot take a shower or bath. He stands up to eat because it is nearly impossible to eat when he is lying on his stomach or on is one available side. Those darned drains will be in for 3 weeks, at least. 

 

What happens to people who don't have a SAHM to do this for them?

 

I remember what nurses were like in the good old days.  Patients who couldn't take a shower got bed baths by the nurse.  If their backs hurt, they got a back rub.  Now there is hardly any direct patient care.  Nurses hand the patients a basin, soap, towel and washcloth and tell them to wash themselves.  If they can't, they don't get washed.  Sheets don't get changed during a hospital stay -- cloth bed pads get removed and changed if they are dirty or a patient or his family member/advocate asks for it to be done.  People who have to lie flat on their stomachs used to be fed by a nurse -- not any more.  Nursing, I guess, used to include TLC.

 

From my point of view, nursing has turned into taking vital signs, dispensing meds, and changing dressings.  They must do more -- they are certainly busy -- but what is it?

 

I left that hospital feeling sorry for the nurses and aides, and for the patients.

 

Insight would be helpful to me.  I have no clue what is going on.

 

Thanks,

RC

 

 

 

 

 

 

 

 

[VeganCupcake]

I am not 100% sure, but I think each nurse has a lot more patients that s/he is responsible for than in the past.

 

I now feel sort of guilty for the nurses' time I took up when I had my twins earlier this year.

[stripe]

When I had one of my kids and was staying after the delivery, the RN came infrequently. There was an LVN who did a few things and some sort of technician who took blood pressure, temperatures, and pain assessment, whom I saw a fair amount. I had the next child in another hospital (same town) and mostly saw RNs as I recall. In fact, I don't really recall the parade of other medical people.

 

I think nurses are super organized. Well, I mean, good nurses, not scary bad ones.

 

I had two different nurses last week, who were both very conforting to me over the phone. So I don't know. Everything seems so busy in every aspect of life these days; that doesn't help.

 

I think it requires an enormous amount of work to make up for a concerned family member. Every time I go to the doctor, I feel like I am telling the nurse/doctor something relevant from past medical history that they should know about.

[Paige]

I don't think it's like that everywhere. My DD was in the hospital for a week and the nurses were very attentive. Maybe it depends on the unit and how busy they are? Or maybe it depends on the doctor in charge? She was in a specialized unit that probably has lower nurse to patient ratios than some general units would have. The nurses helped her to the restroom when she was able to stand, they washed her hair at the bedside for us when she was unable to get out of bed, and she got all the equipment she needed without anyone needing to ask. The only time I had trouble was when we had a couple floating nurses who weren't familiar with the unit or with the type of surgery DD had and her doctor's protocol. 

 

My own hospital stays have not been so pleasant, but I just stayed at regular local hospitals. DD was in a nice one. Prestige counts.

 

 

 

[Freckles]

I'm an RN BSN. Let me nutshell it for you. Super high acuity of patients and unsafe nurse to patient ratios in most states. As a hospital RN I was in charge of at least six patients with high acuity on a team with an LVN and a shared CNA. My responsibilities included all full body assessments, meds/IV pushes that the LVN wasn't allowed to give, treatments, discharge teaching, new patient assessments, patient education, new doctor's orders, covering other pt's for nurses smoke breaks or lunches, and charting. I never sat down, I never peed, I rarely ate. I quit being a nurse seven years ago. I am now an elementary teacher. I was taught all of the nursing techniques of days gone by. back rubs, bed baths, linen changes. There is no time for the RN to do these things unless there is blood/body fluids all over the sheets and no one to help. I could go on, but I'll get too worked up over my wasted degree. This was my experience. Other nurses will have happier anecdotes I'm sure.

[Freckles]

You say you had to find nurses when your son's meds/treatments were due. I don't doubt it, but I wanted to add that on a surgical unit it was acceptable for us to give meds/treatments within 30 minutes of their due time.

[ChrisB]

...

Honestly, I think every patient would greatly benefit from having a family member stay with him or her every minute they are in the hospital.  I don't think that should be the case, though.

...

Thanks,

RC

 

A few years back my nephew, who was 13 or 14 at the time, was in the hospital for several days.  My sister strongly believed that a family member needed to be with him around the clock to be his patient advocate.  Too many times one doctor specialist would contradict another's prescriptions, med recommendations, treatment, etc., and then the nurses had their own way of doing things that contradicted the doctor's.  It's frustrating so say the least.

[sewingmama]

When I was in hospital for a week I saw a nurse twice a day for about 2 minutes each time. Once when they weighed me and once when they gave me meds. They didn't change my sheets even though I had night sweats, they didn't check to see if I was able to shower (I was very, very sick with pneumonia and could hardly move, they didn't check whether I ate anything ( and I didn't because the food was gross and I had no appetite and then the weighing nurse would get annoyed cause I lost more weight).

 

I mean I understand they are busy...I worked in a nursing home and there are never enough nurses to cover everyone to do the little more then the very basics. We also hated to send our residents to hospital...especially if they had dementia because the nurses would not feed them and they wouldn't eat for a week.

 

Really, truly, nurses are just run off their feet and with budget cuts there just aren't enough of them to go around. I liked nursing and thought about getting a proper degree but it wore me out in five years and I would never do it again.

[Frances]

A recent article in the Wall Street Journal discussed what some hospitals are doing to try to address some of these problems:

 

http://online.wsj.com/articles/nurses-shift-aiming-for-more-time-with-patients-1405984193

[RoughCollie]

You say you had to find nurses when your son's meds/treatments were due. I don't doubt it, but I wanted to add that on a surgical unit it was acceptable for us to give meds/treatments within 30 minutes of their due time.

 

He was supposed to get his 2 percocet every 4-6 hours for pain.  By the time it had been 6 hours, he was in pain (level 7/10).  They flat refused to give him pain meds until the 6 hours were up.  Then they would offer him morphine instead, which we never did figure out because he was fine if they gave him percocet on time.  The last time he was offered morphine was a few hours before he left the hospital.

 

I talked to everyone about pain management.  They seemed to have no clue.  Instead, they would tell Stephen that he would have to live with the pain.  Nonsense!  This is 2014, not the Dark Ages.

 

He couldn't move himself and was in a lot of pain (back and legs) from not having his position changed in 12 hours.  I couldn't move him either because I didn't know how to do it without causing damage.

 

He repeatedly asked to have his bed laid flat.  The nurses kept telling us that it was already flat, when clearly it was not (the head was raised).  Finally, 24 hours later, someone lifted the mattress and found an oxygen tank under it that was preventing the bed from lying flat. When they removed the oxygen tank, they unplugged the nurse call button.

 

He kept asked to stand because of the lying in the same position problems ... and they couldn't figure out how to get him out of bed, so they ignored the request.  His brother came in and told the nurses how to get him out of bed.  It was the only way to do it, and they couldn't figure it out. This from the nurse's own mouths in response to DS1 -- we couldn't figure it out so we didn't let him out of bed.

 

It is extremely important that his dressings be changed every 6 hours, no later.  Impressed on us by the 2 surgeons over and over, and in the doctor's orders.  If he gets any infection, he'll be back in the hospital to do this surgery again, and already they anticipate 3-4 more rounds of the same surgery during the coming year. 

 

Also important for everyone to wash their hands before they put on the medical gloves.  I had to remind them to do that.  Every time.  You see, they are risking contamination of the gloves on the outside when they pick them up with unwashed hands -- then do wound care.

[Pawz4me]

It's been many years since I've known a nurse to do things like change sheets or help a patient bathe or eat.  Those are all duties of CNAs.  Nurses now mainly administer medications and do more health management type stuff.  The CNAs are the ones on the front lines of patient care as far as meeting basic needs.  And just like nurses they're spread way too thin in many hospitals.

[Night Elf]

What's bad is that I would have had no idea to do all those things for a loved one in a hospital. I always assume the medical professionals around me know what they are doing. I hope I remember this post if I'm ever in the same position.

[Cindy in FL.]

I think it depends on the nurses and the hospital. We have had phenomenal care some hospitals and almost nonexistent care at others. I am so sorry that you have had to deal with this. I really hope and pray that you are able to get all the help that you will need in taking care of Stephen and that his recovery will go far better than the doctors anticipate.

[kroe1]

Health care cuts have been massive over the past twenty years. Nurse to patient ratios have soared, and charting requirements have escalated to the point that over fifty percent of nurse time is on a computer charting. At the same time, administrative jobs have increased, mostly those that make sure hospitals are in compliance with some government standard. In addition, the number of reports the computer generates to say how great or poor a hospital is mind boggling. Then there are administrative personnel to prepare meetings about reports and to walk around each department all day talking about said reports.

 

Yes, government intervention, insurance and Medicare reimbursement cuts, and fear of litigation have destroyed hospitals and ultimate patient care, in my opinion. Yet, it is called progress, safety protocols, matrix compliance, streamlining, evidenced based algorithms, etc.

 

I am grateful your son had such a compassionate advocate. Yet, as a member of healthcare, I am ashamed he had to have an advocate.

 

I pray you will feel more comfortable taking care of him as he is now at home and that he will recover rapidly.

[Annie Elle]

I'm a RN and left the hospital setting for these reasons. I felt like my care was paperwork driven and I didn't have time to get a patient a glass of water if he asked for it, very frustrating. Hospital administrators have no clue what happens on the floor and yet continue to add more meaningless paperwork that is redundant and time consuming. As long as everything looks good on paper, hospital administrators do not care what is actually occurring on patient floors. Healthcare in this country is a big hot mess and I don't see things changing any time soon.

 

I am now working for a non profit community hospice and I love it. I now have to time to use my critical thinking skills and truly care for my patients and their families.

[Alice]

I'm an RN BSN. Let me nutshell it for you. Super high acuity of patients and unsafe nurse to patient ratios in most states. As a hospital RN I was in charge of at least six patients with high acuity on a team with an LVN and a shared CNA. My responsibilities included all full body assessments, meds/IV pushes that the LVN wasn't allowed to give, treatments, discharge teaching, new patient assessments, patient education, new doctor's orders, covering other pt's for nurses smoke breaks or lunches, and charting. I never sat down, I never peed, I rarely ate. I quit being a nurse seven years ago. I am now an elementary teacher. I was taught all of the nursing techniques of days gone by. back rubs, bed baths, linen changes. There is no time for the RN to do these things unless there is blood/body fluids all over the sheets and no one to help. I could go on, but I'll get too worked up over my wasted degree. This was my experience. Other nurses will have happier anecdotes I'm sure.

 

 

Health care cuts have been massive over the past twenty years. Nurse to patient ratios have soared, and charting requirements have escalated to the point that over fifty percent of nurse time is on a computer charting. At the same time, administrative jobs have increased, mostly those that make sure hospitals are in compliance with some government standard. In addition, the number of reports the computer generates to say how great or poor a hospital is mind boggling. Then there are administrative personnel to prepare meetings about reports and to walk around each department all day talking about said reports.

 

Yes, government intervention, insurance and Medicare reimbursement cuts, and fear of litigation have destroyed hospitals and ultimate patient care, in my opinion. Yet, it is called progress, safety protocols, matrix compliance, streamlining, evidenced based algorithms, etc.

 

I am grateful your son had such a compassionate advocate. Yet, as a member of healthcare, I am ashamed he had to have an advocate.

 

I pray you will feel more comfortable taking care of him as he is now at home and that he will recover rapidly.

 

I think both of these are true. I'm not a nurse but what I see is..

*Increasing number of patients that nurses are responsible for. 

*Higher acuity of patients. Insurance is driving people getting out of hospitals earlier, which means that patients that would have been in an ICU/Intermediate Care setting are on the floor and those who used to be on the floor are at home. 

*More and more paperwork. The amount of charting is crazy and interferes with time actually doing patient care. 

 

In general our medical system has gone to a system that places value on procedures/interventions over thinking/caring/healing. By value I mean how a hospital and the staff gets paid. Value is given to those things that can be documented and are more objective (vital signs, giving meds) but not to those that can't (taking the time to figure out how to get a patient out of bed). There is also an increase in regulations and paperwork. If you've ever been on a unit when JHACO is coming it's ridiculous. The entire staff is focused on ticking off a sheet of regulations that may or may not make sense for that unit but that if are not done will result in fines  for the hospital. I'm not anti-regulation but it's spawned a whole industry that also sucks away time and money from direct patient care.

 

I think another factor is that we've gone more and more to specialist care. This even applies to nurses. The nurses may not have known how to get your son out of bed because that's now more typically done by the PT/OT at your hospital. Not excusing them, just that may have been a factor. Or the nurses no longer do things like baths, which are done by CNAs, but if your unit doesn't have a CNA that day (not uncommon) than it might not happen. 

[kewb]

My opinion:

Too many patients per nurse.

Too many people who go into nursing for the schedule and/or that is where the jobs are. Not because they feel called to it.

Not enough respect for what they do from other medical professionals and patients.

 

When my father was in the hospital a number of years ago his room was across from the break room. I can't tell you how many times someone would pop open that door to find someone/ask a question and they would then have a 10 minute conversation in the doorway thus disturbing my father who we were trying to keep comfortable as he lay there waiting to die. My dh went out there and politely asked them to please close the door as the noise was disturbing my father. The staff was quite huffy about it. I get it, you are taking the first break you had all day but you are disturbing a patient. The extra 2 steps inside to close the door was all that was needed.

 

My sister or I had to hunt down a nurse every time our father needed something. This is not the nurses fault, as I stated earlier, understaffed and overworked, but I felt for people who did not have a family member or friend to assist them because those people had to lay there and wait until someone had a free minute.

[JFSinIL]

I spent over two weeks, first in intensive care, then a regular room, before moving to rehab for two weeks, earlier this summer. Always there was a nurse and an assistant nurse available. I think you just ended up at an understaffed hospital. The nurse was in charge of meds (and wheeled a portable cart with meds and a computer from room to room) while the not-RN did sponge baths, etc.

 

 

 

Will insurance pay for visiting nurse at home to help with dressings, etc.? Certainly sounds justified!

[Valley Girl]

 

 

I talked to everyone about pain management.  They seemed to have no clue.  Instead, they would tell Stephen that he would have to live with the pain.  Nonsense!  This is 2014, not the Dark Ages.

 

He couldn't move himself and was in a lot of pain (back and legs) from not having his position changed in 12 hours.  I couldn't move him either because I didn't know how to do it without causing damage.

 

...

 

He kept asked to stand because of the lying in the same position problems ... and they couldn't figure out how to get him out of bed, so they ignored the request.  His brother came in and told the nurses how to get him out of bed.  It was the only way to do it, and they couldn't figure it out. This from the nurse's own mouths in response to DS1 -- we couldn't figure it out so we didn't let him out of bed.

 

It is extremely important that his dressings be changed every 6 hours, no later.  Impressed on us by the 2 surgeons over and over, and in the doctor's orders.  If he gets any infection, he'll be back in the hospital to do this surgery again, and already they anticipate 3-4 more rounds of the same surgery during the coming year. 

 

Also important for everyone to wash their hands before they put on the medical gloves.  I had to remind them to do that.  Every time.  You see, they are risking contamination of the gloves on the outside when they pick them up with unwashed hands -- then do wound care.

 I edited your quote here. I've also had to hunt down nurses for a family member in pain and run interference, so I hear you. (It was obvious the nurses were very busy--not their fault.) That said, I would report this to whoever is in charge in the hospital. Ignoring a reasonable patient request because you "don't know"? Find out! Skipping basic cleanliness before providing wound care? No way! Not acceptable! I don't care how busy they are. You don't put the patient at risk. No wonder people come home with hospital-acquired infections. I get that nurses are swamped and most are doing their level best to provide good patient care in difficult conditions. But nothing will change--including unreasonable nurse to patient ratios--until this kind of stuff gets reported and documented and publicized. Your poor son.

 

[T'smom]

I just had a c-section a few months ago and my nurses were very attentive. It may be different in the maternity ward though. I did have one particularly weird experience. My doctor had told me in the morning that my days goals should include walking around the unit three times and taking a shower. (This was my third c/s, so I was not unfamiliar with this.) I had heard/read several places that walking around as soon as possible speeds along the healing process. My nurse came in and when I told her I wanted to go walk, she acted like that was ridiculous. She told me none of her patients were up and walking when I was. I told her my doctor had told me to. She says "oh yeah, it really does help with healing. I had a hip operation last year and there was another girl who was having the same thing done. My husband made me get up and walk and I recovered a lot faster than she did." What on earth?!? She knows the best thing is to get up and walk and she is actively encouraging her patients not to do it?!?! I had to argue with her to let me go. She was the nicest person though. Very attentive and helpful.

[Twigs]

:grouphug:  :grouphug:  :grouphug:

[Mimm]

I was in the hospital in November for four days following a c-section. I felt pretty well taken care of but I did have to be on top of asking for my meds. I kept track of when I was allowed to have something, and paged a nurse asking for it. They were pretty prompt once I asked. But I had my husband there the entire time so it's possible that nurses kind of rely on family to help out and give extra help to people who don't have family. I had a friend who had a baby in that same hospital and her husband had to be home with the kids the entire weekend and the hospital didn't have a nursery so she felt a bit overwhelmed. I don't know if the nurses did more for her.

 

Nurses are just crazy busy. The paperwork involved is just intense. My mother worked in a nursing home for a long time and more than half her time was devoted to charting. Which meant that less than half her time was involved in patient care. Every single thing they did with the patient needed to be charted. Now she works as an in home nurse to a medically fragile child who needs 24 hour nursing care. She is more satisfied with her job and feels like she interacts with and cares for her patient more, though she still has to chart every little thing.

[Mimm]

Oh I will say that when I wanted a pacifier for my baby, the nurse did what she could to hunt one down and my hospital and just become "baby friendly" (pro-breastfeeding) so they didn't have pacifiers readily available anymore. They did end up finding one to give me. And they sent me a lactation consultant and supported breastfeeding, but also didn't fuss at me at all about feeding formula and gave me as much formula as I asked for. So I felt like they were really nice and supportive. Just busy.

[PinkTulip]

This is a very timely thread for me - my son is having major surgery next week and will be in the hospital for 5 days and then need 24/7 care for about 3 weeks after. I intend to basically just live at the hospital while he is there, notebook in hand, taking notes on what the Dr. says and making sure pain meds are given properly and on time (it will be a very painful procedure and recovery).

[AimeeM]

I feel blessed, after reading this thread. If anything, our nurses were TOO involved, lol. I mean, at the time it was moderately annoying, but looking back, I'm grateful.

 

When DS5 was hospitalized for about a month (lung/vascular surgery, the readmitted with complications), the nurses were not only competent about his pain medication, but I can (fuzzily) remember one particular overnight shift nurse coming in and rocking/singing him back to sleep, trying to soothe him so that I could get some rest. I can remember them patiently sitting with us for quite a long time, helping us get him to take his medications orally so that we could go home - teaching us such tricks as chasing it with a syringe of clear soda, etc. They chatted with us, soothed us, helped wipe him down, and knew all the tricks when we had a concern but an on-call doctor wasn't listening or responding - they knew which were the more receptive doctors, and told us when they would be on shift, etc. When we couldn't bear to leave Nico, for whatever reason, they would make sure we had little luxuries that made our time easier - favorite sodas, etc.

 

I'm forever grateful for the quality of our nursing staff. Different hospital, but same experience when I gave birth to both boys - maternity ward nurses were just as kind, just as attentive, just as friendly, etc. No problems helping me shower after c-section, etc, and if they were busy, they found someone else to do it (CNA maybe?).

[VeteranMom]

I started working in hospitals in 1991.  Hillarycare had just started and I was seeing the changes.  Patients became much sicker and the hospital administration and the doctors started having conflict over how long the patients could stay in the hospital.  All of the sudden there was something new to keep track of- the patient "pathway" was created.  God forbid the doctors keep a patient a day past the pathway.  The minute a patient showed any sign of being mobile, they were out the door.  Doctors were no longer able to call the shots on length of patient stays.  Nurses still had the same number of patients, though.  When I started working in the hospital as an RN in 1995, it was common for me to have 8 post-op patients with only half a nurse aid to help me.  I look back at that and can't believe I tolerated such working conditions.  Also, I feel sorry for some of my patients.  There were nights when a couple of patients weren't doing well and that left the other 6 on their own- except for when I had to give them pills.  I know I saved lives, but I made mistakes (never killed anyone).  How can a person be tugged in a million different directions and not make mistakes?  Nursing is a career where multi-tasking can be taken to the extreme.  I know that things have not changed for the nurses in that private hospital where I first started working.   

What I would wonder is how many patients were assigned to your ds's nurse.  Was it a private hospital or a city, state, or university run facility?  Private hospitals are the worst for staffing.  When I interviewed for my last hospital job, I asked how many patients I would take care of on any given night.  I was told up to 8 by the private hospital.  I was told up to 6 at the city hospital.  I went with the city hospital job.  Being that your son was on a peds floor, I would say that anything more than 4 patients is too much to care for. 

I know enough about hospitals to not leave a loved one alone there- ever.  

I left nursing about 5 years ago.  During my career, I worked in rehab, ambulatory surgery, family practice, med/surg, and home health care.  I served 5 years in the Air Force.  I liked every job not related to working in the hospital.  The atmosphere in the hospital will destroy a nurse- mentally and physically.  The burnout rate is high.  Between patient and family complaints and some doctors who are a*sholes, it's not a good place for someone who really cares.  Nurses are notorious for not looking out for each other, too.  There is a saying that nurses "eat their young".  It's very true. 

I hope your ds can recover soon and that you get some support.  I'd wonder about some home health care?  A home health RN might be able to get you guys settled.  I hope you'll find that things calm down once you return to your own environment.  :grouphug:          

[swellmomma]

At the children's hospital the nurses are good and do things like they used to but I still strongly believe a family member needs to be there at all times.  My other experiences with nurses has been either like yours or worse.  I still recall nursezilla when I had my 2nd and then when I went to have 3rd at a completely different hospital she was on the ward, and I made it clear the minute I walked in she was never allowed near me or my baby, her actions nearly cost my daughter her life 4 years earlier.  When I worked in a hospital it was the PCAs that did all linen changes, fed patients, gave the TLC, etc  We only had 1 nurse on the ward at a time, she dispensed the meds, took vitals and did paperwork all shift while the hoard of PCAs took care of patients (4 of us per wing-there was 3 wings).  When I had my youngest, it was a nurse that told the dr I was not in labor and sent me home (she told the dr over the phone I just had an irritable uterus-yeah because after 4 kids I don't know what labor feels like, especially when my water broke 2 days before)  3 hours later a different hospital had me in an ambulance with a wonderful nurse delivering my daughter on the side of the road.  The nurse from the 2nd hospital offered to come with me because I was alone, this was a preemie delivery, and it was merely an ambulance transport company so they had no experience with delivering babies.  I am so very grateful she did that.  After delivery they finished transporting me to the 1st hospital that sent me home and the nurse that came with me made sure they took good care of me and babe and informed them of what happened so first nurse that sent me home was investigated and then the ambulance service drove her back to her hospital.  That nurse really went above and beyond what most can do/will do these days.  I think the vast majority of nurses want to do more for their patients, and that is why they went into nursing but they simply are over loaded with cases that prevent them from putting as much focus on individual patients than they would like.

[J-rap]

I'm really sorry about your experience with understaffed hospitals.  Are hospitals just trying to save money?  We haven't had much hospital experience except for my husband, and his was very good, for the most part.  He was in a hospital for 3.5 months, and they did so much for him, including making sure the food he was eating looked good enough and sometimes calling the hospital kitchen to order something different!  I was there for at least 12 hour/day every day, but really had to do nothing at all except be with him.  It's scary to think that nurses might be missing something important because hospitals are understaffed and nurses are overworked.

 

I will say that when my husband was still in neuro-ICU at a different hospital  (hell on earth -- not because of the staff but because of the terrible events and outcomes), the nurses all went on strike for several days.  So, I guess there were issues going on.  The hospital was prepared and had trained nurses from a different state coming in immediately to take their places, but it also happened to be when my husband almost died.  I continue to think that what happened would have been caught earlier if the regular nurses were still there, because they would have seen the subtle changes sooner.

 

Nurses are so important.

[cjzimmer1]

I have always heard news stories about how bad hospitals but I've always discounted them as hype because the most serious "flaw" I've ever encountered is that when a nurse removed an IV she forgot to close the tube from the pump and so when it was removed from hand started spraying stuff all over the room.  The nurses around here never seem rushed, the check in hourly with the patients asking if they can get you a drink or a warm blanket (and a snack on the maternity ward), check if you need help and are just amazing.  A friend had a child in the local children's hospital and they have someone who goes around with an iPad and plays games with the children (I suspect she might be a social worker/metal health professional because she chats with them about how they are feeling etc while they play games together).  I so sorry to hear that this isn't the case everywhere and the you and your son had such a rough time.

[Andani]

I think it depends on the nurses and the hospital. We have had phenomenal care some hospitals and almost nonexistent care at others. I am so sorry that you have had to deal with this. I really hope and pray that you are able to get all the help that you will need in taking care of Stephen and that his recovery will go far better than the doctors anticipate.

 

My thoughts exactly!

[stripe]

When my father was in the hospital a number of years ago his room was across from the break room.

I had this, too, after one birth. I heard two ladies discussing how awful their supervisor was!

 

I was totally sick of having people walk in without a proper knock in one hospital. To the point that the billing coordinator walked in about 20 seconds before the nurse was going to check my post-delivery recovery area (if you know what I mean!), and another time a pediatrician on rounds walked in while I was in my underwear. I switched to a larger, teaching hospital that actually (!) had curtains and where people waited instead of knocking on their way in.

[smudge]

RN for the last 20 years here. 18 of which has been hospital based. I have worked everywhere from Recovery to ICU to Medical patients. When I first started, charting was done on paper, now it all has to be computer based as per Obamacare. Even now, when you go to the doc, they barely look at you as they are all focused on the screen. Anyway, paper charting was so much easier. You could look at the whole days events at a glance on one side or the other. With computers there are too many screens to scroll through. 

Nursing is the biggest financial expenditure in a hospital so it is also a thorn in the side of administration. So they try and get away with as few RNs as they can. 

Patients are sicker now than they used to be, pushing sicker patients to the floors, and even to Home Health. 

Pain meds are usually ordered "PRN" which means As Needed. The staff will not automatically bring you the pills with this kind of order, you have to ask for it.

Last Winter when DH was in the hospital after back surgery, the staff on the post op floor had recently instituted a "bedside report" protocol. Supposedly this led to greater patient satisfaction, but I sure didn't see it. For an hour to hour and a half the RN and aide were near impossible to get a hold of so poor DH would get behind on his pain meds. So that was irritating.

Interestingly, it seems these days (over when I first started) there are so many more managers and assistant managers. Hospitals are extremely top heavy.

(working in a University medical center)

[Murphy101]

Honestly, I think every patient would greatly benefit from having a family member stay with him or her every minute they are in the hospital. I don't think that should be the case, though.

I have been adamant about this for almost my entire adult life. People treat me like I'm silly for it and it really angers me. I've seen some horrible stuff in hospitals and had some awful care myself.

 

Whether it should be the case or not, it is and I strongly advise it for every single person I know and I volunteer to give them breaks so they don't have to leave people alone either.

[mrsrevmeg]

I think it varies from one hospital to another, and sometimes from one unit to another. When my mother was the hospital for over a month (cancer surgery followed by a heart attack), most of her nurses were phenomenal. There was one unit that I was not impressed by, but other than that the nurses and CNAs were amazing. In another hospital, my grandfather received care that was much like what the OP is describing about her son AND they try to discharge patients on Fridays (whether they need it or not) A friend of mine is the head nurse in one unit of that hospital now. She was bragging one day about discharging a certain number of patients on Facebook and I had to stop myself from asking her how may would be back by Monday, in worse condition because of it.

[kiwik]

I am in NZ but I think, nurses are overworked, therefore if there is a family member there they tend to assume if they are needed that person will come and get them. This is particularly the case with parents staying with young kids where the parent does most of the care. I got heaps of attention when my first child was born because I had a c-section and was alone but if I had had a partner there they would have left my care to him while he was there.

 

I found I had to ask for my pain meds though (I got paracetomol which is about half the strength of yours every 4 hours). A nurse friend told me they wait as long as possible unless you ask to minimise your dosage and to assess your pain levels.

 

It also depends a lot on when you go to hospital. Flu season is a lot harder for everyone as the hospitals are busier and there are likely to be people of sick who are covered by people who require more assistance or not covered at all.

[Stratford]

OP, a lot of what you have described needs to be reported, particularly the medication and hand hygiene issues.  Those problems are more likely to be corrected if a manager is aware.  My hospital has a "care line" that you can call if you have concerns or complaints, yours probably has something similar?  

 

I'm sorry you had such a stressful experience and I hope your son is doing well at home.  As an RN, I feel terrible when I hear stories like yours.  

[school17777]

I was in two hospitals Friday and Saturday with my step-father. The nurses and doctors were very attentive and always right there. At the second hospital, the doctor was in sight and available the whole time. It may have been because his situation was life and death though.

[shawthorne44]

I have been adamant about this for almost my entire adult life. People treat me like I'm silly for it and it really angers me. I've seen some horrible stuff in hospitals and had some awful care myself.

 

Whether it should be the case or not, it is and I strongly advise it for every single person I know and I volunteer to give them breaks so they don't have to leave people alone either.

 

I agree with you.  The thing is, things can happen even with attentive nurses.  

 

I was a teenager after stomach surgery I was given Demurral without the anti-nausea medicine.  Which meant I threw up, which meant I was in pain, which meant I got more Demurral, (repeat many times)  Even my pain-filled sleep-deprived recovering-from-surgery brain eventually figured out that the problem was the Demurral.  A family member would have figured it out many cycles before then.  My aunt is an RN.  She said that doctors often speak in short-hand.  The doc likes said "Give her X amount of Demurral" assuming that the RN would know that Y amount of the anti-nausea medicine went with it.      There are other examples.  

 

I also firmly believe that I and my loved ones need to get OUT of the hospitals as quickly as possible.  For self-preservation, not money.  I think in the future we will look back at hospitals of this time period the same way today we look at hospitals when the doctors would do an autopsy and then deliver a baby with the dead persons blood still on their hands and clothes.  

[LizzyBee]

Two of my sisters are hospital nurses.  There have been layoffs to cut costs.  There are rules about patient/nurse ratios, but they are not always followed.

[LizzyBee]

I have been adamant about this for almost my entire adult life. People treat me like I'm silly for it and it really angers me. I've seen some horrible stuff in hospitals and had some awful care myself.

 

Whether it should be the case or not, it is and I strongly advise it for every single person I know and I volunteer to give them breaks so they don't have to leave people alone either.

 

Someone always stayed with my Dad when he had alzheimers and had several hospitalizations.  The nurses always seemed glad for the extra help to keep him safe, ring for a nurse when needed, etc.

 

When I was in the hospital after my leukemia diagnosis, we were in a different part of the country, but no-one seemed surprised that I had family members spending the nights with me.  One of my nurse sisters spent the first night, and again, the nurse on duty seemed grateful for the help.

[Big Buckin' Longhorn]

I firmly believe that everyone in a hospital should have a 24/7 advocate with them. 

 

I know it is not possible for every family, and I feel immense sympathy for those who are not able to make that happen.  When anyone in my immediate family (children, spouse, parents, siblings) are in the hospital, all of us get together to move heaven and earth to make sure one of us can be with them at all times.  It's just a necessity. 

 

This is one of the reasons I decided to stay home with my son.  He has several medical conditions and has been in the hospital many, many times.  I consider it 100% in my job description to camp up there with him when he is hospitalized, even now that he is beyond legal adult age. 

 

We have good hospitals here.  All of the medical staff, including the nurses seem to be doing everything then can to make our stay as comfortable as possible, but it's just the nature of things.  They have multiple patients to keep track of, and I only have one member of my family in the hospital, so I will be the one who is more attentive. 

 

I don't consider asking about medications, treatment plans, reminding about treatment changes, etc. . .  to be a deficit in the medical staff's protocol, I consider it to be the responsibility of the patient advocate (me).  We've just had too many hospitable experiences to leave a family member's health up to chance. 

 

 

[QueenCat]

I think it depends on the nurses and the hospital. We have had phenomenal care some hospitals and almost nonexistent care at others. I am so sorry that you have had to deal with this. I really hope and pray that you are able to get all the help that you will need in taking care of Stephen and that his recovery will go far better than the doctors anticipate.

 

I've seen that......... ds had a procedure and was in for a few days at one of the more revered hospitals around us, and got excellent care. Dh had a procedure a couple of years earlier and we had to really stay on top of things.

[jenslp]

I'm not a nurse but I work in a hospital and two of the issues I've seen are:  There are a ton more documentation requirements than there used to be and that takes a tremendous amount of a nurse's time so that instead of being with a patient they have to sit and type a bunch of stuff up on the computer; the laws have changed several times about how many nurses and aids there have to be per number of patients, and now the hospitals will just staff at the lowest possible level so that the aids and nurses have a lot of people to take care of all at once.  These are the 2 biggest issues I've personally seen affect the care at a lot of hospitals. 

[Joules]

I had a family member in the hospital for 3 weeks and it was so hard to be there for that long and ensure she got proper care. I can't even list all of the things that went wrong. I learned quite a bit during that time.

 

They do spend a good bit of time charting, but the charts don't seem to actually have enough information to care for a patient properly. After two days, I realized someone needed to be there at every shift change (7am and 7pm) to explain to the new nurse what surgeries she had had and what we were doing. Nearly 40 shift changes and over 20 different nurses. (I cried with joy when I had a repeat nurse that I could just update.).

 

Paperwork is done at the beginning and end of the shift with the current nurse and relief nurse together. There is practically no care for patients between 6 and 8, so plan pain meds accordingly. If I was able to be relieved I always arrived back before 6 and didn't leave until after rounds 14 hours later.

 

The nurses have way too many patients. If it seems like your family member is ignored, it may be because they know you are there and they are spending more time tending to patients who are on their own. I'd say over 75% of the nurses appreciated the family members' help. A few resented us and made that 12 hours hellish.

 

And pack a cooler. There is no way to talk to doctors except during rounds (at completely random times). If you pop to the vending machine or cafe while the patient sleeps, the docs will appear and disappear during that time. They will not wait for family even if the patient is asleep or unconcious, so your questions will not be answered and you can't explain problems or request med changes.

 

I think there needs to be a new business concept that provides "nurse advocates" to patients when the family members need a break. You could be in contact by phone, but at least be able to tend to kids and pets and rest a bit. After a week, I would have paid SO much $$$ for a reliable, trustworthy, independent advocate. Something for enterprising nurses or former nurses to think about!

[melmichigan]

He was supposed to get his 2 percocet every 4-6 hours for pain.  By the time it had been 6 hours, he was in pain (level 7/10).  They flat refused to give him pain meds until the 6 hours were up.  Then they would offer him morphine instead, which we never did figure out because he was fine if they gave him percocet on time.  The last time he was offered morphine was a few hours before he left the hospital.

Just to clarify:  a nurse cannot give two Percocet more than every six hours around the clock.  It's toxic to the liver.   If he needed more for pain then he needed to take the morphine.  If people choose to take more Tylenol then prescribed on their own then they are taking the risk, but a nurse won't give it.  It's also against the doctor's orders as part of a standing order in most hospitals.  They weren't being mean or neglectful but it does sound like they should have explained it to your son a little better.

 

Patient care will depend on the hospital and the individual nurses.

[simplemom]

Pain meds that are ordered every 4-6 hours are meant to be as needed and aren't meant to be automatically given. And like above, Percocet can't be given above a certain number of pills in a 24 hour period due to too high Tylenol dosage. The MDs order that way so if there is an increased pain for a spell it can be given every 4 hours at times, but isn't meant to be needed every 4 hours around the clock. Just every 4-6 hours when pain is the greatest. Morphine was probably given in between for pain control to prevent giving more than allotted amount of Percocet given in a 24 hour period.

 

Also, if a patient has scheduled meds for a specific time, the nurse can't be committed to be giving that med at that exact time. There is a 30 minute window either way, but if it isn't vital as a timed medicine, the nurse may have to delay a dose longer if she is dealing with a more critical situation in another room.

 

I haven't worked in the hospital for 4 years, but the nurse stress is worse every year. I used to be able to get a med , give it, and initial that I gave it on the med record. Now to give a med, the nurse has to put a screen name and password into a machine, wait for the machine to open, sometimes count the remaining meds in the drawer before it will allow you to leave the machine (narcotics mostly for this), find a rolling computer to take the med in the room with you, sign onto the computer with a different screen log in and password than is used on the main med dispenser, scan the patient armband and find the med that can be given on the computer screen, then click a box on the computer screen after the patient takes the med.

 

If the nurse gets called to another room for something that can't wait, she has to leave her charting screen on the computer, log out if that patient chart, and log into the new patient chart and do whatever needs to be done for that patient and chart it on the computer, then later come back to the other patient screen to finish charting what was interrupted. If the nurse forgets to chart one thing on one patient, she can be written up for it, even though she may have spent most of her shift handling an emergency, doing CPR, on the phone with family about a loss, and multiple other things.

 

On the floor I used to work on, they have laid off the housekeepers, medical receptionists that answer phones and keep charts updated, and several aides. The nurses are doing these things in addition to everything else. OB floors used to staff better because the lawsuit time for OB malpractice is usually 18-21 years. Now they have OB nurses doing the room cleaning between patients in addition to everything else.

 

I used to be able to just double check and change IV fluids or antibiotics as needed. Before leaving my nursing job, I had to input a long patient ID number into the machine, and manually put in the IV fluid type, any additives, etc....before I could start a simple drip. This is time consuming.

 

Some meds and procedures require 2 RNs to check before giving, like insulin. I am glad for this, but if patients can't find one RN when needed, imagine what it is like for one RN to find a 2nd RN that is available to double check meds when giving. I've been delayed giving meds just waiting for someone to double check certain meds.

 

This thread has got me 2nd guessing whether or not to return to nursing again. But please, give RNs grace. I think this thread isn't bashing RNs, just bashing the hospital staffing and overall system of how things are run. Thank you for distinguishing between the two! And like someone said above, report problems to management, only put in a good word for the nurse and say that you observe it is staffing/too much work in the nurse that is creating the problem.

 

Of course, working in a hospital for over 10 years, I will admit that there are some terrible nurses who are just lazy. Report them for that as well, because those nurses are a burden to hard working ones.

[shawthorne44]

I wonder if there is a market for hired Patient Advocates?  Seems like Simplemom would make an excellent one.  It would probably be expensive.  The other_person sleeping arrangements seem to be universally sucky.  I'd only sleep on one for love or a lot of money.  

[simplemom]

I have actually stayed with elderly friends in the hospital at night to give their families a break. Before marriage and children, I worked 3 night shifts/week, so if a dear friend were in the hospital and the family needed a break, I would just take a book to read and stay till early am morning nursing rounds. Haven't thought of doing that for pay! I wouldn't charge a friend though. Maybe I can add patient advocate to the list of possible "jobs for introverts after homeschooling" thread that got me to thinking whether or not to keep my nursing license active. There are paid doulas now that are trained to assist a laboring mom and speak up for her during the hospital labor process if that mom needs an advocate to labor more slowly and naturally than the doctors want and/or if the mom doesn't understand all the things happening during labor, can explain all the things happening that the nurse doesn't have time to explain. I miss being able to just get wet cloths, extra pillows, and ice chips for moms in labor...helping them through the labor process with a paper chart at the bedside to write in the major events and changes, to just quickly grab a pain or nausea med when needed and sit to wait to help her until it helped. Now as a nurse I can't even be In the room that long, and if so, I have to stop and use the computer for everything I say and do for the patient and every thing the patient does in response, which takes longer than actually doing what needs to be done.

 

Vent over! I am glad that some have shared that there are places, like the small Catholic private hospital described previously, where staffing is protected and patient satisfaction (not the dollar signs) is the highest priority. It is difficult with the new health care hurdles, more red tape, and patients are very sick. Someone mentioned receiving good care with a nurse only assigned to a few patients, this was probably a higher level of care (between critical and stable) than is typical on a general hospital floor.

[ElizabethB]

It varies from hospital to hospital and state to state. Also, different sections within the hospitals.

 

They do save the best nurses for things like pediatric hematology/oncology, we have never had a bad nurse when we have been in the pediatric hematology/oncology department. (The pediatric oncology patients and families have enough on their plates without good nursing and good nurse to patient ratios.)

 

We have been to hospitals in about 7 different states. It does vary widely in both quality of care and time to be seen in the ER.

[RoughCollie]

Of course, working in a hospital for over 10 years, I will admit that there are some terrible nurses who are just lazy. Report them for that as well, because those nurses are a burden to hard working ones.

 

The only nurse I didn't meet was on shift when DS1 spent the night at the hospital instead of me. Stephen told me yesterday that that nurse seemed "stoned". I'm pretty sure Stephen was  the "stoned" one since he was on morphine and rapping Tupaq songs at 1:30 AM.  The next morning when I got there, Stephen started singing.  This is notable because even when he was a young boy and in the kids' choir at church, he only mouthed the words.  It was the first time I've heard Stephen sing in over a decade!  Besides, if there had been a problem with the nurse, DS1 would have reported it and then told me about it.

 

I met all the other nurses and they were great.  Just overworked.  There were computers in every room, and hallway computer stations every few rooms.  The nursing station had at least one person there most of the time, and there were never groups of nurses hanging around chatting.  Everyone seemed to be going on high speed all the time.

 

Every nurse was friendly, cheerful, and polite all the time.  The only complaint I heard from a nurse was when the night nurse told me that the "powers that be" want all the nurses to go back to wearing all white uniforms, like they used to.  The reason is that people complain they can't tell the nurses from the aides.  Yet hanging from the bottom of every name tag, prominently displayed, is another tag with RN written in big letters.  So yeah, telling nurses from aides is a piece of cake.

 

We only saw aides once, aside from them coming to introduce themselves at the beginning of their shifts.  I bet they were glad I was there, because they were always running around, busy as can be, too.

 

I am definitely not complaining about the nurses.

 

I checked with DS1 about the allegedly stoned nurse.  "He was really nice, really together.  He took the time to explain everything to me as he was doing it. He was definitely not stoned.  Stephen was, though.  He was on morphine, you know, and rapping."