The Big Picture

     While most days, I absolutely hate my job, there are days that I try to look at the bright side of my job: forming trusting, therapeutic relationships with my patients.
     I find it hard not to have compassion for my patients. Most of the people that I work with, be it RNs, LPNs, CCAs or physicians, seem to have little to no compassion for their patients. For example, there is a gentleman with a chronic illness that is well known to the unit. In my year on the unit, he has had multiple lengthy admissions. As a result of this, I have gotten to know him and his wife well. He is a very well educated gentleman who is now in the end stages of his illness and beginning to suffer great pain. This is a man who took great pride in his independence- even though he was slow at his ADLs, he could accomplish them on his own. Now, he requires assistance with standing, bathing, toileting and ambulating to his bedside chair. Even the simplest of tasks are now becoming a chore for him. He is deeply apologetic for "wasting our time" because he "knows that we are busy". Is that what patients think? That they are wasting our time when they genuinely require assistance? Is this what nursing care has become? When the gentleman with the chronic illness rings for assistance, most of the staff rolls their eyes and mutter some form of "they need to get him out of here" under their breaths. One even said  "his wife just needs to take him home to die." He is a 2 person assist and I just find it so disrespectful that when we are in there helping him, when the other person is standing there with their hands on their hips or sighing or rambling on endlessly about their stupid weekend partying plans like I actually care. And you know what REALLY makes me mad? When staff are texting or looking at their cell phones at patient's bedsides!
     I understand that yes, we are all tired. It's been a long shift, it's been insanely busy on the unit this past few weeks and we are all run off our feet- and yes, most of us are burned out and a little snippy at times. But that does not give us the excuse to disrespect our patients or act unprofessionally.
    I am now off on vacation for 2 weeks (hello Turks and Caicos!) and I can't help but worry about this man. His condition is declining and I even wonder if he will be alive when I return. 
     Now while this gentleman only rings when he really needs something and is genuinely thankful, there is a gentleman who has been on the unit since the summer, fully continent, who is content just to lie in his own piss until we change him. He will just urinate or take a dump in his pad, then ring for us to come clean him. No attempt (or desire) to get up to the bathroom, a commode or even a bedpan. Now that is upsetting. And he needs to be the one that should be trying to go home. He is content being waited on hand and foot and he has now come to expect it.
     I guess when it comes down to it, I am just frustrated with work. Frustrated with the management not taking our concerns into consideration - and the health and care of the patients is being affected. Patients are having falls because there are not enough bed alarms for confused patients (or enough staff to look after these patients/bells), staff morale is the lowest of anywhere I have ever worked, and a lot of people are burned out.
     At the end of the day, I try to look at the positive things, like the care I have provided for my patients. While I don't always have the time to spend as much time with patients as I would like to, I do try to chat with my patients every shift. You know, just talk. Some of the staff I work with seem to get a little pissy about that, but you know what? Too bad. I am the one who has to answer for the care I provide. And when it comes down to it, I am happy with the basic care I give to my patients. While sometimes I feel guilty that I couldn't be there to stop that confused patient from falling out of bed, or just spend a bit more time with that dying patient's family, I try to look at the bright side. In all the darkness, there is a bright side.

Frustration.

     I write this the day after two of the busiest shifts I have worked in my 8+ months in the nursing field. Nothing is more frustrating. 
     Not only did we have five discharges on my first day shift, we also had three admissions from Emerge- within an hour and a half of each other and of course, within two hours of the end of shift. It is unbelievably frustrating to feel like you can't get all of your work done, to rush through it and not do a good job- just having the goal of "getting it done." Like, it is now 1600h and while you're trying to get charts done from 0800h, you are "interrupted"* constantly answering phones, talking to family members, outrageously high blood glucose readings, IV meds, answering call bells to get patients off of commodes... it makes it impossible to get your work done. I'm sure other nurses sympathize with my frustration- as doing these things is part of our role in providing care, but you know what I mean. I can probably count on both hands the times I have gotten out of work "on time" since I have worked there. It is not uncommon for me to bank a half hour+ of overtime after shift change and OT for missed meal breaks each shift.
     In our Canadian health care system, there is too much paperwork. After hearing from my American nurse friends, it appears that your "paper-trails" are even longer (although you guys are using technology we could only long for.. we don't even have Unit Dose in our hospital district or any form of electronic charting.) I mean, the amount of charting in a shift is foolish- charting the same thing in 50 different places.
    The unit I work on is constantly battling sick-calls.. burned out and overworked nurses. Being understaffed and working short is not uncommon in a shift. For day shifts: 26 patients- we have 2 RNs, 3 LPNs and 1 CCA to look after them. Then an IMCU- where we have 1 RN for 4 acutely ill patients (mostly cardiac in nature). The work load is impossible and management who while hearing our concerns, refuse to change the way things are done. While bringing up all of the overtime that is worked, they refuse to hire more nurses- stating "it's not in the budget" (but neither is all of the overtime they are forced to pay out!)
    How can we change this? They were always telling us in school "you can be the change!" but I don't see how this is possible. What do you guys think? Has anyone had a similar experience and found something that has worked?


* - Not that discussing care with family members is an "interruption" or an inconvenience, but you catch my drift.

Daily Deduction # 1

My deduction of the day/shift: if you, the patient, can wash your face and hands or feed yourself, you can wash your critter. I am not washing it for you. K? Thanks.