quote:

Originally posted by striperkid:
I'm going through this now with my Mom. Only difference is I have NO medical experience so I'm behind the eight ball.

You might not have any medical experience, but you've known your mom your whole life! If something seems off, or different, or outright wrong, speak up!! Even if you can't "put your finger on it," tell the staff of your concerns. If they don't allay your concerns, politely escalate the case. Many hospitals have different set ups, but ask for a charge nurse, an assistant nurse manager (ANM), the nurse manager, or the house supervisor. Many hospitals also ha a "rapid response team " to assess a sudden change in a patient's condition. Some even have the patient or family to activate the RRT themselves! Also, don't forget to involve the doctor in your concerns.

First, let me say how sorry I am for your mom and you for having to go through that MCF.

Many years ago our daughter was in a car wreck where she got hit head on by a drunk driver. She was in emergency room and was slowly dying of lack of oxygen, and internal bleeding. Her "doctor" was doing NOTHING. Fortunately for us, the ER head nurse called in another doctor who checked, then he and the nurse came to see us in the waiting room. Essentially, they asked for our permission to treat our daughter. We agreed and they jumped in and saved her life.

Turns out the first "doctor" was from one of those middle eastern countries and was up on charges from a previous MCF in which the patient had died.

Not to mention some of the "care" my grandson received when he was at Walter Reed! Both times!! The work done by those "experts" when he was shot in the face had to be completely removed and redone by the real doctors at Ft Bragg.[/QUOTE]

att types....The V.A. hospitals have become the slum of the American medical world. MOST V.A. hospitals have GREAT NURSES, and a few good doctors.

I will not get into my past battles with the V.A.... But it needs a 100% make over.

https://www.theblaze.com/news/...-licenses-since-2002

mom is gone now, but she was a nurses aid for 29 years in a Vets hospital.

they asked her to take a few courses and become a nurse for additional pay , she refused them twice.

when she was asked why she refused, she told the head of the Hospital " I've worked with 20 nurses for 13 years and only 4 of them was worth the money that you paid them , I don't want to be one of those people"

They have a very tough job with lots of stress and responsibility.

Most can not do all aspects well.
Like gun sales people,
Some are great at customer service, but don't know anything about product knowledge.
some know everything about the guns , but nothing about tact, manners or courtesy .

others are just , well shelf stockers.

I'm not ancient by any stretch of the imagination but I've been around a bit. Like every profession in life there are good and bad and they're in every unit in the hospital. ER and ICU are some of the most demanding areas for nurses. I'm glad your mother is improving. It's just like physicians that depend upon imaging and labs to make a diagnosis rather than some use of history and physical examination. I'm guilty of generalized statements which gets me in trouble sometimes such as "the ER physician abdominal exam aka CT scan". I'm a surgeon specializing in trauma/critical care and still do a fair bit of general surgery so I spend quite a bit of time in both units.
I've noticed a scary trend of late though in regards to nursing. In this area we are seeing a rapid turnover of ICU nurses as they must work 2 years of ICU before applying for CRNA school. I firmly believe in advancing professionally if possible but this is creating a constant turnover in ICU nurses. When they really start to hit their prime they ask me for a letter or recommendation. Not all of them get it as some aren't deserving but most do because they know if I agree to write them a letter it will be a good letter. I miss the old battleaxes that I trusted from my days of residency. I knew if they called and said there was a problem I needed to get there immediately whereas a lot of the new nurses dedicate as much time as possible to facebook and other such forms of entertainment rather than critical care and half the time don't know what's going on with their patients nor do they care. It's truly a shame and unfortunately I don't believe there's an end in sight.

There's a reason that hospitals/medical errors kill more people than guns do.

Anytime a family member is in the hospital we make sure to have someone with them to ask important questions and watch what is being put in the IV, etc. My wife caught them putting something other than what the doctor ordered in my IV onetime. Don't know what would have happened, but am thankful I didn't have to find out...

quote:

Originally posted by armedmd:
I'm not ancient by any stretch of the imagination but I've been around a bit. Like every profession in life there are good and bad and they're in every unit in the hospital. ER and ICU are some of the most demanding areas for nurses. I'm glad your mother is improving. It's just like physicians that depend upon imaging and labs to make a diagnosis rather than some use of history and physical examination. I'm guilty of generalized statements which gets me in trouble sometimes such as "the ER physician abdominal exam aka CT scan". I'm a surgeon specializing in trauma/critical care and still do a fair bit of general surgery so I spend quite a bit of time in both units.
I've noticed a scary trend of late though in regards to nursing. In this area we are seeing a rapid turnover of ICU nurses as they must work 2 years of ICU before applying for CRNA school. I firmly believe in advancing professionally if possible but this is creating a constant turnover in ICU nurses. When they really start to hit their prime they ask me for a letter or recommendation. Not all of them get it as some aren't deserving but most do because they know if I agree to write them a letter it will be a good letter. I miss the old battleaxes that I trusted from my days of residency. I knew if they called and said there was a problem I needed to get there immediately whereas a lot of the new nurses dedicate as much time as possible to facebook and other such forms of entertainment rather than critical care and half the time don't know what's going on with their patients nor do they care. It's truly a shame and unfortunately I don't believe there's an end in sight.

There’s a reason for that. Kids these days are told you can do anything. They are cottled and all expect to be rich by the time they are 30. Nursing is no longer looked on as a career but as a stepping stone. Like police nurses take on a shit ton of responsibility for not a lot of pay. When I was in Pittsburgh where UPMC has a monopoly and set the nursing pay scales, nurses started out at like $21 an hour with a bachelors in the ICU. The people at the genuis bar at the Apple store made like $18 an hour. Who in their right mind would want to take on that much responsibility for such little pay innthe long run. In many areas of the country nursing no longer affords a liveable wage especially when school loans are involved. I bet if nursing salaries were increased you would have more retention in the units. It’s akin to the primary care shortage. Family docs make less money and are a dying breed.

This is my favorite meme:



But in reality we over image everything in the ER for multiple reasons. We are now indoctrinated into a culture of defensive medicine. Everything is a potential lawsuit. Couple that with increased patient loads and diminishing resources and that is what you get. For instance last night I worked at one of our free standing ER’s. So there is no real hospital support. All we have is X-ray, Ultrasound, CT, a basic lab, and a nursing staff. No respiratory therapy, no onsite consultations, no MRI, no social work, etc... I think yesterday we saw 121 patients at a site that is two Provider run. That means one doc and one mid level at any given time. The city is completely out of beds and we were boarding 5 admissions in our ED on top of the other 16 regular beds and 5 fast track beds. At no given time was the waiting room less than 20 deep. I had one STEMI, a couple of TIA’s, a few bad Flu’s and 2 surgical belly’s. I saw 36 patients in 10 hours. That’s 3.6 patients per hour where the national accepted average is 2.5 per hour. That’s 36 notes I have to write by the end of my shift because I don’t get paid to stay late and chart. At any given time I am managing 10-11 patients, waiting on labs, CT’s, consults to call back, etc... it unfortunately doesn’t leave much time for actual 1:1 patient interaction so exams get abridged. I would love to take 10+ minutes with each patient but in reality it’s not really feesable. It’s a sad state of affairs. This flu season is particularly bad which is really straining the system.

Thanks for the sock meme. Stolen, for my rads.

Another thing I’ve recently started to notice, in addition to the “stepping stone” mentality nurses these days have as Dusty78 mentioned, is that nursing these days unfortunately has morphed from critical thinking career to a task-oriented job. Nurses, just like doctors and other ancillary therapists/technicians/aids, are being loaded up with an ever increasing amount of work and responsibility without additional support. Nurses are being forced to take on a higher patient:nurse ratio along with “hourly rounding”. Think about it: if a nurse has six patients and is diligent, she has to check in on a patient ever ten minutes for an entire 12 hour shift.

When added to the responsibilities of passing out medications; hanging antibiotics; troubleshooting IV pump alarms; answering questions from patients, families, and doctors; making sure labs and imaging are done timely; changing wound dressings; bathing patients; turning/moving/repositioning patients; answering call bells; sitting with and comforting patients as they cry; etc...; it’s not hard to imaging how things slip through the cracks. Mistakes are made and changes in condition are missed because nurses aren’t allowed the time or opportunity to think or recognize when patients are getting worse. They have so much to do by the end of their shift that they rely on their “tasks list” on their computers and on numbers on a screen. It’s no wonder why newer nurses see nursing only as a springboard to “better” careers.

People expect perfection from medical professionals, and rightfully so. People don’t go to the hospital to get hurt, but to be treated. It’s a goal, but unfortunately, with the realities of an aging and growing population and a medical profession that is frantically trying to keep up, that goal seems quite lofty. Sometimes admitting a patient is necessary and unavoidable, but in those other cases, I always ask the question: is treating this patient in the hospital worth the risk of them acquiring an infection from another patient or having a complication from a medical mistake? A hospital has never been a safe place—that’s where we hold the sickest people in our community. It’s also not a hotel where you’re pampered; it’s a place to get the treatment you need.

If you can, stay at the bedside with your loved ones when they’re hospitalized. Be sure to listen and write things down, and write down questions because you’ll likely forget. Politely question things that seem odd to you, and if your concerns are not allayed to your satisfaction, politely escalate your concerns to a manager. Try to be understanding of the realities of healthcare in America. Be helpful and ask a nurse how you can help. Send a thank you note to nurses who have done a great job and send a comment to their supervisors. Nursing is a very demanding profession with lots of responsibilities and when you consider everything above, is an underpaid and underappreciated profession.

Any health care profession is a difficult career path. We are forced to take on life and death responsibility with fewer resources. Not to mention politicians who want to pay us based on our patient satisfaction scores. It’s a wonder anyone wants to make health care a career.

When I graduated nursing school I had no intention of going back to school. I was happy to be an ICU nurse at an urban level 1 trauma center. I learned a ton in that first year. Then it started to wear on me. For about a year and a half I was the only male RN on the unit. We had a period where 8 of the 10 patients on our unit weighed in at more than 350lbs. My female coworkers were all petite little things, so I was expected to stop what I was doing and help with everything everyone else needed. I began to realize that even working out and stying active, I wasn’t going to be able to do ICU nursing when I reached my late 50’s and into my 60’s.

During one particularly bad day, one of the CRNA students pulled me aside after watching one of my interactions with a second year resident of questionable intelligence and even more questionable clinical judgement, and told me I really needed to consider becoming a CRNA. I dismissed the idea at first. However, after another 18 months of precepting one new RN after another, the multitude of social issues and the aforementioned tugging and heaving on people more than twice my own weight, I decided it was time to leave. I’ve been a CRNA for 14 years, and wouldn’t go back to the ICU (or the ER) for anything. That’s not to say it’s all roses here, it’s just a new set of issues. It does pay better though.

Sean

After my 40 years of personal experience with ICU nurses in every hospital in Arizona and Las Vegas I found most to be highly dedicated and patient centric. That's not to say there aren't some burnt out nurses running on empty at the end of their 4th night in a row. Your experience should not have occurred. Perhaps you could have asked to speak with the ICU manager the next day and calmly express your concerns of the prior night.
I've always approached these situations asking the question to management, "What else could I have done to improve the care to my mother?" The manager would have had no other option than look to their staff for evaluation and answers as they couldn't ask you to do the patient care they are responsible for. Liability usually dictates a change.

I hope you mother's condition improved.