Sunday, April 30, 2006

Nursing Morale Issues

As I sit here trying to think of an appropriate entry for Grand Rounds, I can't help but remember a conversation with a fellow nurse co-worker about morale. This last week was horrendous for most of the staff nurses due to to acuity and bed availability. Patients are sicker and the ratios (while better than they have been) are higher.
Recently, I was sitting at the desk entering my assessments into the computer at 9pm, one of the charge nurses asked why "some" nurses can't seem to enter their assessments until later in the shift. I glanced up and said "do you really want to know some of the reasons?" "Let me count the ways!"
I actually spend time with my patients talking to them and their families. I'm not out at the desk doing crossword puzzles or going downstairs an hour after I get to work to go get breakfast. I don't go smoke every hour or go into a room to catch a nap during my lunch break. Often, I am doing public relations damage control due to complaints related to care.

I round with the doctors. Not many nurses take the time to get a thorough report from the offgoing shift and have a list of issues that need to be taken care of. I don't have to call the doctors in the office and make the office wait times even longer by interrupting unless it's an emergent issue.

I often walk into some real sh*tstorms in the morning due to nurses who don't know or care enough to take care of business. An inexperienced nurse told me years ago that she had called her charge nurse 5 times during the shift to report a problem regarding a patient's urine output. I asked if she had called the doctor... She said no... I explained that the doctor doesn't care how many times you called your charge nurse, but that you didn't call him! The lawyers won't either..
Doctors make a big deal out of being called in the middle of the night, but in an emergency.. you better call because they want to know what's going on and if something bad happens, you had better make sure that you did everything you could for the patient... That includes possibly making a doctor mad.... Your license is on the line....

I make several trips looking for adequate equipment to do my job. While I'm on the hunt for equipment, I answer other people's call lights, get patients up on the bedside commode or bedpan, get water, and answer family questions. While this amounts to regular nursing care, I would like to take care of MY patients... I can't sit back and watch someone else's patient fall trying to get up to the commode because they have waited too long for someone to help.

It's hard to maintain good morale when teamwork isn't there. The charge nurses don't come when you need help or when they do it's superficial. I understand about things that can delay charge nurses due to being a standby charge nurse myself. I also understand the need for maintaining "the bottom line". We need to pay the techs better so that they will feel appreciated for the hard work that they do.

Families can make things easier by not standing by the door and staring at us when we are taking care of other situations. It's not going to make me move any faster and other patients that are more acute are taking up my attention at the moment. You won't find me sitting at the desk while there are issues going on. I know that the doctor said that you were going home but the order hasn't made it to the desk because he's rounding on three other halls before your chart gets to the main desk. Odds are... he's not the primary doc and he can't write the discharge order anyway. You have to wait for him to see you and I'm not calling his office to see when he's coming. He saw you yesterday and he'll be here today.

If you are having a procedure, expect not to eat for SEVERAL hours and don't expect to be discharged as soon as you get back to the room. You have to wait for the results to be read and I can't speed the process. Threatening to walk out won't help either. Don't curse at the staff because you are not happy while waiting for results.

I really do love my job. It's hard to do sometimes in a timely manner. There are some days when everything flows well and I get to take proper care of my patients. You leave work with a sense of satisfaction that you helped someone get better. You may have actually saved a life. It's really worth it when you hear a patient ask..

"Are you working again tomorrow?"

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