Some days I trudge in to the bedside and I wonder what happened. I don’t want to go forth with a pessimistic attitude as that’s totally against my nature, and I try to put my best foot forward hoping for a better day, but the fact is bedside nursing is changing. I’m supposed to change with it, but that isn’t always easy. There’s more I’d like to see stay the same than there is that I’m celebratory about its evolution, and as it stands most days I hardly recognize nursing anymore.
If seems like every week that I return there’s a better way to get the same job done, yet it somehow manages to take at least ten minutes longer. Usually more. Most required tasks in any given day seem to orbit around the best possible way to achieve reimbursement. I understand Medicare requirements are forcing everyone’s hand; it just seems like all our hands are so busy proving what they’re doing that it can’t possibly be done well. In other words I spent a large part of my time documenting my care rather than performing my care as thoroughly as I would like.
I nurse in a world of fingerprint access, multiple, ever-changing passwords, and required scanning with scanners that don’t work. You can’t just grab what you need; you have to charge what you need, after trying to access a system that won’t recognize your credentials that is.
The focus now is on keeping the customer happy, which is somehow skewed from what it used to be, which was keeping the patient healthy and alive. The measure of one’s success is in a satisfaction score rather than the job completed in the best interest of personal health and wellness. Achievement of goals coincides with the number of inpatient days, but not simply because we desire patients to get better. I mean, that’s still important, but so is getting paid.
So we focus a lot on checking boxes that research tells us will make folks better rather than getting down to the nitty gritty of just making them better. And I’m all for research, I’m all for guidelines gained from years of knowledge, but when we spend so much time dotting the i’s on our care tracks, we might miss crossing the t’s on our honest to goodness interventions.
We take away a nurse’s ability to make judgement calls based on years of experience. We snatch their ability to quickly obtain a lifesaving medication. My question is do we take that privilege of pulling medicines for safety sake or because we’re missing too many fiscal charges? I’d bet money on the latter.
The thing is I love actual nursing care. I love talking to my patients, performing skills, and providing education to help them feel better (not just so they won’t be readmitted within 30 days). I find such satisfaction from a job well done, but a lot of times lately I spend more time wondering, what did I forget? I spend so much time navigating documentation requirements and learning new rules that I miss out on just calming my patient’s fears. I get so flustered trying to work through new medication administration records that I worry I’m not giving the medications I need to give.
And it’s not like I’m a dinosaur. At least I don’t think I am. I’ve only been nursing for about twelve years, but seeing all the changes in healthcare makes it look like many decades have passed.
Hospitals aren’t to blame, really. They’re being held to new standards themselves, and both our hands are being forced.
It’s not that I’m against progress, or even that I hate change. I’m glad we know more now than we did yesterday, and I’m thankful medicine is always evolving and learning from its mistakes, but I’ve never felt so lost in it all. I guess many days it just seems more like a business of profit rather than a business of heart. We’re losing sight of why we do what we do and just struggling to do it at all. It’s exhausting and devastating to those nurses who love the actual patient care piece of healthcare. Sadly that piece of the pie seems to get smaller each year.
It’s hard enough being a nurse where you try to care for people at their weakest and most vulnerable moments. It’s difficult in itself to keep up with technology and medical advances. All the other stuff is simply a straw, and flustered nurses are the camel’s back.
So why do I do it? Why not just throw in the towel? Well, here’s one reason. I live in a rural area, and it didn’t surprise me when I saw a patient on our unit I had cared for before. In fact, we had known each other around town, and I felt my heart break at the situation. At one point I stood at the bedside, the patient unresponsive, and I explained different aspects of the disease process and expectations to the family. I realized as I spoke they were finding a measure of relief and comfort from my words, even if it was a small one. My time at the bedside helped someone that day, and though I may feel like I don’t get enough moments there, if any speck of the day that I am present has a positive aspect on my patient then it is not in vain.
Nursing is changing. So much so that I hardly recognize it some days. But one thing remains, and that is a nurse’s heart. That calling to care outshines much of the frustration I face. Some days that is hard to see, but then a rewarding patient/family encounter centers me once again, and I come back another day to fight my way through the red tape.
Chrissy says
YES!!! The motto where I work in a geriatric setting is “The Best Care”. I felt like we were lying today. We are so concerned about staff to patient ratio because our census is low that we don’t take into account sundowning, acuity, or type of staff, i.e. newbie vs. experienced or even orientee (as one of the numbers!).
It is a highlight of my day when I can converse with a resident, or just take time to listen. I overheard an aide asking a resident how old she was. She’s over a hundred years old, but her response was, “Oh, I’m in my fifties,” and she fully believes it in spite of her frailties.
Joy says
Thank you for saying what we have difficulty expressing! God bless you as you work in the battle field of healthcare.
Laura says
I’m not a nurse but I hope to be one day. My son has been in the hospital quite a few times in his short eleven months of life,once being at only a week old, and I can’t even begin to express my love and gratitude for our nurses. The ones who took the extra seconds they didn’t have to give me a reassuring smile, the one who sat in the room with me, feeding my son so I could sleep for a couple hours after being awake for several, worrying over my son. It’s part of what has made me want to be a nurse.
brieann.rn@gmail.com says
I’m sure you’ll be a great one!