I had abandoned this blog for a while, but I really need an outlet to express my frustrations with the state of the nursing profession. I will not get into details of where I work, but let's just say it's a community hospital that is fairly small, but we have access to most specialties, and if not, a patient can be seen for almost any problem within an hour's drive.
I work as an NP doing hospital rounds, so am writing lots of orders, admitting and discharging patients, and everything in between. One day this week, I went into work to be faced with 4 complaining (rightly so) nurses, who started their shift on a busy med/surg floor with an assignment of ten patients each. This is a floor that has a lot of elderly patients who require total care, and these nurses have two CNAs to help answer call lights, feed patients, take them to the rest room, bathe them, etc...I wanted to scream for them. Patients were frustrated, nurses were frustrated, and CNAs were just in survival mode.
This is not a new problem for this facility; when I graduated from RN school, my first job was at this same facility (over 15 years ago). I must say nothing has changed. I am so disappointed in healthcare at this point in my career. I do not work for the facility, but my company is contracted to work there as hospitalists, and our patients are at risk. Medication errors are found on every single chart I pull. I report to the supervisor, she tells them "don't do that," and it's the last that's ever heard about it.
Here are some specific examples: I call the pharmacy to see why steroids were not given to an asthma patient the day before (they were not on the medication administration record even though they were for two days before that). The pharmacy reported they never received the original MAR, until 3 days later, which was the day I called about it. This went through 3 nights of "chart checks." Of course the nurses are blaming the person who was supposed to be doing the chart checks, but my response to that was, "if it was done correctly the first time, we wouldn't have to blame anyone for not doing chart checks."
Routinely, if home meds are restarted by the provider in the afternoon, I look at the MAR and 10 pm meds are marked "N/A" meaning "not available." I have asked pharmacy why these meds would not be available and all they can tell me is "the Pyxis is stocked." This is a problem. In my frustration, I told the supervisor about it, and she said she would take care of it. Her way of "taking care of it" was to go to the day shift nurse and tell her to pass it on to night shift that they have to give the meds that are ordered. DUH!
I had a renal failure patient with GFR of 15, on the verge of dialysis, and no labs were drawn (that had been ordered by both me and the nephrologist). The nephrologist came there to see her on a Sunday and no labs on the chart. How embarassing and frustrating that is, and it's happening way too often. The lab could not tell us why they were not drawn.
Sadly, many physicians never know there are medication errors or omissions, because they do not look at the MAR and pay attention (they think they can trust nurses, and they should be able to, but really...no).