Comments on: What Could Be Wrong with the IOM Committee on the Future of Nursing? http://suzannecgordon.com/what-could-be-wrong-with-the-iom-committee-on-the-future-of-nursing/ Fri, 03 May 2013 12:21:36 +0000 hourly 1 http://wordpress.org/?v=3.4.2 By: Amy http://suzannecgordon.com/what-could-be-wrong-with-the-iom-committee-on-the-future-of-nursing/#comment-94 Amy Wed, 26 Aug 2009 14:57:28 +0000 http://www.suzannegordon.com/?p=151#comment-94 As a staff nurse on a busy general surgery floor, I can tell you that the need to discharge patients more quickly has become a more "urgent" issue from our supervisors, who have had it handed down to them from their supervisors. Women who have mastectomies are now discharged the next day. People can have complex vascular bypasses/repairs of their aorta and be out in only 2 days! Of course, with the vascular patients, you spend the first 12-16 hours after their surgery doing hourly neurovascular checks (which requires an RN) and also hourly vital signs. Sometimes, I come in the day those patients are discharged, and think to myself, "but all of that work that I did, now I have to start over with another patient!". You can see how nurses can easily get burned out. Not only that, but in the last 3 years, I have seen an increasing number of patients "bounce-back" i.e., return to our floor because they have developed a complication which could have been prevented with a little more time to teach them how to prevent it, or they come back simply because they were never really ready to go home in the first place! So then the patients return for another 3-5 day stay, when maybe, they could have just stayed an extra day in the first place, the return stay could have been prevented! Add up those costs! As a staff nurse on a busy general surgery floor, I can tell you that the need to discharge patients more quickly has become a more “urgent” issue from our supervisors, who have had it handed down to them from their supervisors. Women who have mastectomies are now discharged the next day. People can have complex vascular bypasses/repairs of their aorta and be out in only 2 days! Of course, with the vascular patients, you spend the first 12-16 hours after their surgery doing hourly neurovascular checks (which requires an RN) and also hourly vital signs. Sometimes, I come in the day those patients are discharged, and think to myself, “but all of that work that I did, now I have to start over with another patient!”. You can see how nurses can easily get burned out. Not only that, but in the last 3 years, I have seen an increasing number of patients “bounce-back” i.e., return to our floor because they have developed a complication which could have been prevented with a little more time to teach them how to prevent it, or they come back simply because they were never really ready to go home in the first place! So then the patients return for another 3-5 day stay, when maybe, they could have just stayed an extra day in the first place, the return stay could have been prevented! Add up those costs!

]]> By: Suzanne http://suzannecgordon.com/what-could-be-wrong-with-the-iom-committee-on-the-future-of-nursing/#comment-93 Suzanne Fri, 14 Aug 2009 20:09:32 +0000 http://www.suzannegordon.com/?p=151#comment-93 Wow, these are great comments. I especially like the one about the computerized bed system. Yes computers are great, but the real question is, in what context are they used and what imperatives and mission do they serve. Lorettajo Kapinos and the other nurses I talk to highlight what seems to be one of the main imperatives of too many hospitals today -- get the patient out. The question too many administrators and managers seem to be asking or seem to be forced to ask is, as she says, "why is the patient still here?" The response seems obvious -- because the patient is sick. The real question that should be asked is "What can we do for the patient while he/she is here?" Wow, these are great comments. I especially like the one about the computerized bed system. Yes computers are great, but the real question is, in what context are they used and what imperatives and mission do they serve. Lorettajo Kapinos and the other nurses I talk to highlight what seems to be one of the main imperatives of too many hospitals today — get the patient out. The question too many administrators and managers seem to be asking or seem to be forced to ask is, as she says, “why is the patient still here?” The response seems obvious — because the patient is sick. The real question that should be asked is “What can we do for the patient while he/she is here?”

]]> By: Lorettajo Kapinos http://suzannecgordon.com/what-could-be-wrong-with-the-iom-committee-on-the-future-of-nursing/#comment-92 Lorettajo Kapinos Thu, 13 Aug 2009 03:21:39 +0000 http://www.suzannegordon.com/?p=151#comment-92 I am an ER nurse in a large level one trauma center. We have recently been implementing computerization in stages. I have to say that I felt very supported regarding this process. There were so many trained hands around to provide technical help that we were nearly tripping over each other. I never felt left alone to figure out my own way, making the transition seamless and easy. It has now been over a year. I always give myself a year to adjust to change, figuring that angst has more to do with transition than the actual change itself. And I have to say that I feel more like a bank teller than a nurse, especially in triage. I even try to joke about it with my patients when I have to wait for the system to reboot. Our bed management and tracking system has also made me feel less like a nurse. Too many times a day I hear, "Why is that patient still here?" And I feel the need to defend myself, yet again. I am tired of running against the clock that ticks faster than I can think. Don't get me wrong. I love technology. At home, I use my blackberry for a phone, listen to podcasts on my iPod and read books on my Kindle. My laptop has become my best friend. Is my life at home easier? No, but I can say it is enriched. At work? Not so much. Technology feels more and more like a burden I don't want to bear. I feel so old when I say nursing is moving a direction I don't want to go. I've been a nurse for 12 years-wanted it since I was 13 years old. And now, I just don't know. It's so impersonal and overwhelming. And now, after reading this blog, I understand why I am so miserable. Thank you Suzanne for your insight, Loretta I am an ER nurse in a large level one trauma center. We have recently been implementing computerization in stages. I have to say that I felt very supported regarding this process. There were so many trained hands around to provide technical help that we were nearly tripping over each other. I never felt left alone to figure out my own way, making the transition seamless and easy.

It has now been over a year. I always give myself a year to adjust to change, figuring that angst has more to do with transition than the actual change itself. And I have to say that I feel more like a bank teller than a nurse, especially in triage. I even try to joke about it with my patients when I have to wait for the system to reboot.

Our bed management and tracking system has also made me feel less like a nurse. Too many times a day I hear, “Why is that patient still here?” And I feel the need to defend myself, yet again. I am tired of running against the clock that ticks faster than I can think.

Don’t get me wrong. I love technology. At home, I use my blackberry for a phone, listen to podcasts on my iPod and read books on my Kindle. My laptop has become my best friend. Is my life at home easier? No, but I can say it is enriched. At work? Not so much. Technology feels more and more like a burden I don’t want to bear.

I feel so old when I say nursing is moving a direction I don’t want to go. I’ve been a nurse for 12 years-wanted it since I was 13 years old. And now, I just don’t know. It’s so impersonal and overwhelming. And now, after reading this blog, I understand why I am so miserable.

Thank you Suzanne for your insight,
Loretta

]]> By: T.C. http://suzannecgordon.com/what-could-be-wrong-with-the-iom-committee-on-the-future-of-nursing/#comment-91 T.C. Wed, 12 Aug 2009 16:49:58 +0000 http://www.suzannegordon.com/?p=151#comment-91 Suzanne: As an advanced practice RN (CNS) I was involved in setting up a stroke program for a large HMO. Many of my recommendations involved un-popular ideas such as making all newly admitted stroke patients a 1:3 RN to patient ratio. My rational was based on the workload (numerous studies; CT, MRI, MRA, CTA, vascular ultrasound, etc). These numerous studies mean that each RN must go with each patient to many locations in the hospital. What we call "road trips." When each RN must transport patients 4 to 8 times a day, there is little time left for doing all the other work such as medications, charting, teaching, and on and on. The bottom line, RN's were very stressed, and patients did not get the care and attention to detail they needed. As a result, "patient satisfaction scores dropped." This got the attention of senior leadership, but they still didn't see that the problem was the RN not having enough time to do the job right. They wanted to know what was "wrong with the RN's?" Did I mention that we also had 7 different RN managers in two years for the new stroke unit? No consistent leadership. Suzanne:
As an advanced practice RN (CNS) I was involved in setting up a stroke program for a large HMO. Many of my recommendations involved un-popular ideas such as making all newly admitted stroke patients a 1:3 RN to patient ratio. My rational was based on the workload (numerous studies; CT, MRI, MRA, CTA, vascular ultrasound, etc). These numerous studies mean that each RN must go with each patient to many locations in the hospital. What we call “road trips.” When each RN must transport patients 4 to 8 times a day, there is little time left for doing all the other work such as medications, charting, teaching, and on and on. The bottom line, RN’s were very stressed, and patients did not get the care and attention to detail they needed. As a result, “patient satisfaction scores dropped.” This got the attention of senior leadership, but they still didn’t see that the problem was the RN not having enough time to do the job right. They wanted to know what was “wrong with the RN’s?” Did I mention that we also had 7 different RN managers in two years for the new stroke unit? No consistent leadership.

]]> By: Lawrence Fisher http://suzannecgordon.com/what-could-be-wrong-with-the-iom-committee-on-the-future-of-nursing/#comment-90 Lawrence Fisher Wed, 12 Aug 2009 03:13:15 +0000 http://www.suzannegordon.com/?p=151#comment-90 The IOM committee has announced three public meetings that should provide an excellent forum for the expression of concerns: • Future of Nursing Forum: Acute Care October 19, 2009 – Los Angeles, CA • Future of Nursing Forum: Primary Care, Community Health, and Public Health December 3, 2009 – Philadelphia, PA • Future of Nursing Forum: Education February 22, 2010 – Houston, TX This page has contact information for the commission as well as subscription information for the listserv for committee updates. http://www.iom.edu/CMS/28312/64233.aspx Larry The IOM committee has announced three public meetings that should provide an excellent forum for the expression of concerns:

• Future of Nursing Forum: Acute Care
October 19, 2009 – Los Angeles, CA

• Future of Nursing Forum: Primary Care, Community Health, and Public Health
December 3, 2009 – Philadelphia, PA

• Future of Nursing Forum: Education
February 22, 2010 – Houston, TX

This page has contact information for the commission as well as subscription information for the listserv for committee updates.
http://www.iom.edu/CMS/28312/64233.aspx

Larry

]]> By: Suzanne http://suzannecgordon.com/what-could-be-wrong-with-the-iom-committee-on-the-future-of-nursing/#comment-89 Suzanne Mon, 10 Aug 2009 21:19:36 +0000 http://www.suzannegordon.com/?p=151#comment-89 I think your idea is a good one, lobbying is really necessary. the committee should include some kind of staff nurse representation. I'd like to hear from other people on this, please write in. Suzanne I think your idea is a good one, lobbying is really necessary. the committee should include some kind of staff nurse representation. I’d like to hear from other people on this, please write in.
Suzanne

]]> By: Kathyleen Bartholomew http://suzannecgordon.com/what-could-be-wrong-with-the-iom-committee-on-the-future-of-nursing/#comment-88 Kathyleen Bartholomew Mon, 10 Aug 2009 19:55:25 +0000 http://www.suzannegordon.com/?p=151#comment-88 Suzanne, I strongly agree with all of your comments and share your concerns. Working as a staff nurse and also a national speaker buts me in a unique position. As a staff nurse,my workload continues to increase weekly - small additions to the workload e.g. this week we now have to get a key from one pyxiss and then go to another pyxiss for PCA Dilaudid and then return the key! 3 steps for a med that 80% of our post op patients use. Management does not intervene - they don't see the effect. The bottom line is money. Even hand amputees are discharged as shor stay patients in less than 24 hours. Because changes like thse are insidioius and small, and nurses work so hard, they often don't see the cumulative effect of numerous busy-work. That said. Let's lobby now to the IOM to include front-line nurses and managers in this forum - even if it's just recommendations. Appreciate your advocacy! Kathleen Suzanne,
I strongly agree with all of your comments and share your concerns. Working as a staff nurse and also a national speaker buts me in a unique position. As a staff nurse,my workload continues to increase weekly – small additions to the workload e.g. this week we now have to get a key from one pyxiss and then go to another pyxiss for PCA Dilaudid and then return the key! 3 steps for a med that 80% of our post op patients use. Management does not intervene – they don’t see the effect. The bottom line is money. Even hand amputees are discharged as shor stay patients in less than 24 hours. Because changes like thse are insidioius and small, and nurses work so hard, they often don’t see the cumulative effect of numerous busy-work.
That said. Let’s lobby now to the IOM to include front-line nurses and managers in this forum – even if it’s just recommendations.
Appreciate your advocacy! Kathleen

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