the hospital is never going to be clean enough. i am tidying patient rooms on "clutter rounds" and wiping down the computers daily and meticulously recording it on a paper log. because i have to. or else there will be "corrective action".
i am now responsible for IM notices and some other government mandated mumbo jumbo about people refusing to be discharged. if i don't give them out, there will also be "corrective action".
it's not quiet enough and patients don't feel that they are being listened to enough, and the call lights aren't being answered soon enough and patients aren't receiving help as fast as they would like, and communications with the care team are dismal, and also the HCAPS and the report cards are not at the median line and we are in yellow and red or something like that.
our aides are dissatisfied because they are not getting lunches and they are complaining. and instead of getting more aides so they don't each have to care for 16 patients, nurses need to stop delegating so much stuff. except for last month, in which we were told to delegate because we are punching out too late and it costs money.
and then there are the cultural competence online modules and the ever-popular "de-escalation training". this will be mandatory. well, only if you want a raise next year, that is.
and also i need to complete the advanced nursing pathway because we need 4 people to do it by next year. not to worry, this involves only 20 hours of continuing education. and a poster project to a group. and a research study. and that i precept 100 hours this semester.
which i do, by the way.
i precept: one on one with a student nurse and then for weeklong stretches with new grads. i'm charge nurse, which we do while taking a full patient assignment. i field questions from the new nurses, and am a resource person. all the nurses on my shift are new, by the way. with the exception of one other nurse, everyone has been on the floor for less than a year.
and then there are the nursing students, 4 different groups on 4 different days every week this semester. we are responsible for teaching them too.
i head a council, for which i am supposed to attend a monthly house-wide meeting. then i am to run 3 floor meetings monthly. then i meet with the heads of the other councils monthly. there must be typed minutes that are approved a week before for all of this. and projects. no one wants to do projects, however, so i do most of them myself.
and then there is the bedside shift report, which is not getting done and we should all be ashamed of ourselves.
and the hourly rounding, we have to do that too, or the Studer group says all our patients will fall and die.
and we all must attend the mandatory interdisciplinary rounds. well mandatory for nursing, i guess, but not for the physician representatives. they couldn't possibly be bothered to come and discuss their patients, because they're busy.
and i clearly have all the time in the world.
it's too much, too much for my brain to even hold and definitely too much to expect from a person. because those are just the "extras" in my mind. i also have to assess, medicate, monitor, and nurture 4-5 patents too. to maintain tubes, to suction trachs, to change dressings and ambulate and bolus and make sure that there is enough urine and that the blood pressure isn't too high and that trauma isn't about to wreck kidneys with IV anti-inflammatories. and then i need to keep track of all that data by charting the assessments, fall risks, braden scales, IVs, wounds, pain assessments and reassessments, neuro checks, CIWA scales, and sitter scores. oh and do care plans and patient education too.
i can't do it all, but it is all "an expectation". and failing to do any of the above comes with "corrective action" and "negative consequences".
i don't care about half this stuff, and i care probably twice as much as most people on the floor.
so what do you do when you can't do it all?
the best you can, i guess.
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