Nursing: Old versus New

A couple of days ago, I promised to tell you the tale of the beaurocrats. The world of nursing is a great example of where the number crunchers and bean counters have overwhelmed the world of medicine and driven this noble, caring profession into a squirrel cage rat race doing more secretary work than patient care.



Let's take a look at "old nursing" vs "new nursing".



Old Nursing: Bring meds to patient, bring dinner, spend 10 min talking with patient and learning what they're scared of, a little about their family, spend time teaching about the next day's test. Pt's upset and nervous, you give a back rub to help them relax. Total time spent with patient: 50 min. Total time on paperwork: 10 min.



New Nursing: Run meds in, confirm patient ID with armband (because you really haven't had a chance to get to know them all. Spend 10 minutes on computer documenting you gave the meds, and did so with all of the appropriate safeguards. Nurse's aide brings in dinner. You run in to glance at tray to estimate how much they ate. Spend 10 more minutes documenting how much patient ate. Nurse's aide repostions patient. You spend 10 minutes documenting frequent repositioning of patient. Drop off a brochure with patient about tomorrow's procedure. Spend 10 minutes documenting you gave patient brochure. Nurse's aide lets you know the patient is anxious. You talk to patient for 2 minutes to confirm this. Call the doctor, get order for sedative, give to patient. Spend 20 minutes documenting anxiousness, call, and meds. Total time with patient: 10 min. Total time documenting: 50 min.



And on and on and on and on and on and on and on it gooooooooeeeeeeeesssssss.



How did we get here?

The beauracrats came along with "a better way"



"Healthcare is a disaster" "Our system is Failing" "Too many errors" "Systems will make it all better"



Beauracrates, with no knowledge of healthcare, nursing, medicine, or just simply caring for another human being decided they could do it better. And to acheive that, you must have DATA. So now, instead of caring for the patient, the nurses create data. This proves what good care they are giving. Of course, even as the beaurocrates were making healthcare better, they were already upsetting the balance of personel within the system. With all this DATA coming in, it was necessary to hire people to collect the DATA, and people to store the DATA, and people to analyze the DATA, and even more people to supervise the people who process the DATA, and pretty soon there were 5 and 6 people for every one person actually, physically, caring for the patient. Current estimates now are for 20+ people in healthcare who never actually provide care to the patient, either directly or indirectly, for every one person who provides actual, hands on care to patients. Recent estimates suggests that for every dollar the consumer spends on healthcare, about 17 cents reaches the doctor. Another 10 to 15 cents go to nurses and other allied health care salaries. More goes to administration, bean counters, and a host of others whose jobs is to file claims, check claims, scour the charts to make sure they are in compliance with a dozen different regulatory agencies, make sure everything is signed, dated, and complete. But, do you know where a little over half of your dollar goes? The insurance company. And is health care any better? I doubt it. Now that we document the living hell out of everything, our nurses spend less time than ever with the patients, leaving more and more of the patient care to "nurse extenders," aka, nurses' aides or "patient care technicians," basically someone who does all the hands on work like checking vital signs, feeding, bathing, bedding, bedpans, call lights, etc, leaving the nurse free to pass meds, run IV's, and, least we forget, DOCUMENT. Don't get me wrong, I work with a host of wonderful, caring, dedicated nurse extenders. But they lack the training to recognize subtle signs and changes in a patient headed for trouble, and so the call to the doctor warning of trouble is often that much more delayed. Too many times, I've rounded in the morning, looked at the flowsheet (the list of vitals, ins&outs, etc), asked the nurse why I wasn't notified of an obvious change or trend, and she had not even seen the flowsheet. This isn't evil people. It's good people, caring people, who've had their job defined and redefined, and redefined again, by people who've never provided patient care before. (The lawyers are part of this, but that's a whole other day. Gotta stay focused)
Ok, it's getting late, and I've rambled on again. Tomorrow, tales of trauma past, just for the fun of it.
Good night.