Elijah Strong RN
The Hospital is turning into the Hotel. Due to changes in the way medicare is reimbursing hospitals, many hospitals have begun implementing huge changes in attempt to boost patient satisfaction and hospital revenue.
The big problem is that the Bedside Nurse is the one who has to implement these changes since the bedside nurse is the one with that patient more than anyone else. Suddenly, making sure that patient and family experience is as pleasant as possible is more important than making sure that patient leaves the hospital and never comes back.
Historically, the hospital was not a pleasant place. Much like prison, none of the guests come because they wanted to. They are all guests out of necessity. Up until the 70’s and 80’s, nurses had the reputation of being some of the gruffish, physically strongest, women around. They are the original “no nonsense ” girls. These Nurses used to clean blood and stool off of humans with their bare hands. These Nurses were the ultimate patient advocates. They not only knew what was best for these patients, they pushed these patients hard. They stood up to doctors and ignorant family members in the name of the patient.
They didn’t take no for an answer. “No ma’am, you’re not laying in bed for the whole day. You are getting up to the chair to have breakfast. Later we will walk around the Unit, and when we get back you will show me how to change your own dressings, so that I can make sure you are Safe to Return home.” These days, with increasing work loads for the bedside nurse, a patient in the hospital is lucky if a nurse says more than a few words to them.
Charting has gotten incredibly detailed and complex over the years with the increases in legal issues surrounding the hospital. That means that nurses today are being forced to spend more and more time behind a computer screen instead of at the bedside to benefit the patient. The role did not change however, just more tasks are added to it. Not only are you expected to act as a patient advocate, social worker, confidante, and customer service representative for your prospective hospital, but nurses are still responsible for all aspects of patient care on top of insane amounts of charting that you are expected to do before the end of your shift every day.
Calling the amount of charting insane is an understatement. Add this to scheduled and prn(as needed) medication administrations, and scheduled tasks such as preparing a patient for surgery, bathing a patient, and dressing changes. In this new environment of placing a high importance on the perception of patient satisfaction has pushed the compassionate nurses away from the bedside, out of the hospital or higher up the ladder, the only two options for a Registered Nurse outside of finding a new career.
So who is left to take care of the people you love? Some of the most compassionate nurses that I have ever met used to stay two to three hours after their 13 hour days in order to finish their work. Essentially to finish charting. Needless to say, these same nurses did not stay bedside at the hospital very long. No normal person could work those hours and under as much stress as bedside nurses today face. So how do some nurses leave on time every single shift?
Some nurses thrive in the chaos that is the hospital bedside. These nurses have learned to sacrifice certain aspects of patient care in order to have a much less stressful and productive workday, preserving their sanity to be able to return to work again after sleeping only four to five hours. Even the best nurses may have to take shortcuts at times. As much as real-time charting is being pushed to the standard, there will always be times when the do-first-chart-later approach has to be adopted.. The increasing workload of the bedside nurse has led to the bedside nurse having to care for more patients with more needs than the nurse can realistically meet in one 12 hour shift, and ultimately patient care suffers.
Here is a hypothetical situation that might happen a lot more than you think. Bedside Nurse(let’s call her BN for short) starts her day at 0700 with 7 patients. After getting report and starting her assessment, she may or may not realize that the first patient she visited during her initial assessment is covered in poop. Say this patient (lets call her Granny) is sleeping really well and BN checked on everyone so she continues her busy morning routine because BN knows that if she doesn’t stay on schedule that she’s gonna at work for an extra two hours finishing up her work. 0800-0900 BN finishes her rushed charting, and from 0900-1000 she is giving medications. From 1000-1100 BN uses this time do perform complicated dressing changes and document those as well.
This means that it could be 2-4 hours on many units before the nurse has a chance to notice that Granny is now confused from the urinary tract infection she obtained from sitting in stool for a few hours. This is why the role of family at the bedside is very important, even though this a complex situation as well. Say Granny starts to get septic, who knows how long it will be until anyone has time to notice the change in status. Now, imagine this is your Granny. This happens everyday, and could be avoided if the bedside nurse is given a more manageable set of tasks.
Sadly hospitals are a multi-million dollar industry and many large corporations lose sight of the genuine duties and responsibilities of the bedside nurse. This means that nurses in non-union states will continue to see a decrease in pay, and an increase in workload. Patient satisfaction may increase but at the expense of long-term patient outcomes, and the overall compassion of the bedside nurse today.