The real reason nurses are leaving
From the Boston Globe comes this opinion piece on part-of-what-is-wrong with the hospital system:
“Ask any bedside nurse what the worst part of the job is, and chances are they won’t even mention bodily fluids or patients’ insults. The answer I hear most often is the same as mine: “charting.”
Accurate, timely charting of nearly every patient interaction, assessment, and intervention is mandatory. Arguably, it’s the requirement that matters most to the hospital administration. I’m not being critical here — I get it. Insurance companies pay the bills. They demand documentation. It’s part of the job, and we do it, grudgingly.
I’ve learned most hospitals ignore these essential limits on nurse-to-patient ratios. Legally (except in California), they get away with doing so. We can argue about the reasons such as budget shortfalls, staffing crises, “it’s a pandemic!” Concerns over unsafe staffing ratios have been voiced for decades. They are likely to remain until hospitals are forced, either by law or by finances. Until hospitals accept that nurses are not bottomless pits of cheerful productivity.
We’re expected to complete more tasks in less time. But a patient who just had a hip replaced can’t be made to walk faster to her commode. An IV antibiotic that needs to be administered over five minutes can’t be administered in two. Good, safe patient care is time-intensive. Reduce the time, and it’s neither good nor safe.
“The problem is, nurses just take the path of least resistance,” my manager said to me recently. We were discussing my safety concerns about the unit. Safety policies and procedures are often designed by nonclinical staff and ignore the realities of patient care. Some are so cumbersome they are impossible to execute. As a result, they get bypassed or curtailed. I had suggested a particular workflow be changed to accommodate practical constraints. It would increase safety, because staff would be able to implement it.
My manager disagreed. Hospital policy, she explained, is based on best practice. Nurses need to figure out a way to follow it. Then she smiled, like we had an understanding, and thanked me for my input. I smiled back. What more was there to say? She finalized my resignation a few minutes later, while my anger was still fresh.
I hear a lot of people blaming the mass nurse exodus on “burnout,” but I think that misses the point. Even in the midst of a pandemic, I loved my job. What I couldn’t stand was the constant administrative pressure to accomplish the maximum number of tasks in the minimum amount of time and the fundamental lie that I should be able to do so without compromising my patients’ safety — and my own.”
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Dan,
Great find. Thanks for this bite of reality.
Little confused by the “charting” thing. Yeah, I get it is used to bill insurance companies, but it is mainly for the attending physician to insure the treatment is being carried out. From my week in the hospital this January that became very apparent to me. Also, from what I saw, the vast amount of “charting” was done via bar code for meds, etc., and electronically for BP, etc.
Dan?
the situation the nurse describes is very, very common. probably nursing is a worse than usual example because the job itself is too hard to do well when your boss is an idiot. sorry for the shorthand..a very common type of boss. [what i was trying to say is that there are jobs a person can do even when their boss is an idiot, but these are jobs that are not intrinsically (mentally) hard, and most people can adapt to mindless bullying if they can ignore it and still get the job done, if not as well as they might have done it if left alone, or paid reasonably for their work.] I don’t know if nurses have an effective union. that would likely bring in another level of nonsense, but at least they’d have a fighting chance.
EMike
I think the point was that the charting..bar code or electronic or not…is an added layer of time on top of a job that doesn’t leave enough time to do it well.
Maybe a little like playing baseball and having to write a detailed play by play at the same time. Except of course any good manager could see that there is a lot of time between pitches that the players are not doing anything. And what are those guys sitting on the bench doing? Couldn’t we have them stitching up old uniforms or something?
Cob,
As long as there have been hospitals there has been charting.
EMichael
probably not.
but the point is not that there is charting, but that it is a task loaded onto nn already overworked staff.
“Probably not”.
Yeah, no. Not even up for debate. You think the providers had no idea of what medications, diet, test results, etc. their patients had? “C’Mon, Man!”
EMichael
hospitals have been around since before writing.
Ok, we’re done.
EM
I think the real issue being the number of patients assigned to a nurse. The admin is trying to do more with less. The bloodsuckers would come through each morning and draw blood. They were always in a hurry. My left arm was a mass of bruises and it became very painful.
I am not sure why the hurry. After my second week, I found a couple of them who could really draw blood without damaging my arms. After 3-1/2 weeks I was out of there. Even their manager stabbed me through the vein.
I think you’ve got it with the shortage. When I went in they put the IV right in the inside of the elbow. 10 times a day the tubes would get tangled and set off the alarms, not to mention wake me up. Usually waited 15 minutes or so before a nurse came in and fixed them. Then one nurse said this is ridiculous, that should be in the back of your hand, they’re just cutting corners. Never got tangled up again.
EM
It is called Labor efficiency. One nurse “should be” able to handle so many patients. For me with almost nonexistent platelets till I was dosed with Rituxan, it was an issue. One tech got a surprise when he did not get the cap on right.
They do not look at workload per patient. I am a nothing to handle and the guy two rooms over needs constant monitoring.
I was being wheeled into surgery and they had this super long IV in me. I could only think of it getting snagged in the wheels of the cart so I grabbed it. It did get snagged. The nurse fixed it and the surgeon got mad. Tech issue.
EMichael
I understand “we’re done,” but I think it is interesting how much what you agree with something depends on who said it.
I said “overworked.” run said “number of patients assigned to a nurse.”
They mean the same thing.
Christ. Yeah, my comment was about “overworked”. Actually it was because of the incredible nonsensical idiocy contained in “hospitals have been around since before writing.”
Please, I’ll read you thoughts on Social Security all day long, but nothing else.
EMike
first, i am trying to spare you from having to read my thoughts.
second, try thinking about how long there have been hospitals and how long there has been general literacy.
don’t take my word for it.
Why would I waste my time on something so totally irrelevant to the actual topic?
EM
why did you bring it up then? “As long as there have been hospitals there has been charting.”
one reason for wasting your time thinking about someting irrelevant is that sometimes you find out it is relevant. but i thnk I was the one telling you that it was irrelevant.
the “actual topic” was the stresses of nursing. you and I and run all agreed it was too much work or shortage of nurses..which i said are the same thing, charting being “merely” one of the more annoying aspects of the stress of too much work.
of course another reason for thinking, is that it’s good practice (practice as in practising the piano, not as in pattern and practice, or even “medical practice”) .and sometimes leads to unexpected insight
if you had managed to form mental images of what hospitals were like in the Civil War, and then in 1812, and then in the middle ages, and then in Rome and Greece, and perhaps in Sumer, or the stone age…. you might have begun to ask yourself what do you mean by hospital, and then maybe what does the person you are arguing with mean by hospital. and along the way, you might have had to ask what does “writing” mean, or anyway, what did he mean by “writing”. before the invention of writing by anyone anywhere in the world? or just befoe the routine writing up of records in hospitals?
after this you might have concluded that I was wrong, but maybe not “incredible nonsensical idiocy” or at least gotten to the point where you could resist the urge to stop your own thinking by saying things like that.