Wednesday, July 14, 2010

Nurses Aids or No Nurse Aids

No, Fainting is Not OK

I thought it was wonderful that at this hospital there were no nurse’s aids. Not because I don’t think nurses aids are a good thing, but because the registered nurse did everything for the patient and got to know the patient well. Better chance of good outcomes when less people are involved – or so I thought. The nurse is more responsible to her five patients because it is just her and her patient. She must tend to every detail and be more aware.

Accept what happens when one patient needs extra assistance. As in the case when a patient needs to stand up after being in bed for almost three full days? The nurse told us that she needed other nurses to help. One nurse will change the bedding while two other nurses will help her out of bed.

As we waited and waited, the three nurses finally came in. Now I’m realizing that as many as fourteen other patients don’t have any nursing available at all. Even if one of these nurses was a charge nurse, and was only there to help anyways, that still leaves nine patients (our nurse’s four other patients and the helping nurse’s five patients) with no nursing care.

As one nurse scrambled to make the bed – with my help, two other nurses helped the patient and then needed to spend time with her standing, cleaning getting acclimated to being out of bed. As time was ticking away, patient’s somewhere very possibly, weren’t getting their medications notes weren’t being written up and someone’s water may be empty. Patients very easily could have been neglected. Then, when the nurses went back to work, after about 15 minutes, I’m sure they now had much more to do.

If this happens for two patients a day, and since this patient had to get up another time later and walk, how much lost patient care time is there? It may add up to hours in a day.

I shouldn’t be surprised than that on two occasions, the patient under my watch fainted. Unfortunately, the second time was as she was preparing to go home. This caused additional blood work, testing and costs. It became apparent that the patient was probably just dehydrated and, after days on her back with only standing and walking slightly two times a day, she became lightheaded.

How could this have been missed by the overworked nurses? Very easily. Should I have done something differently? Absolutely! After the first time the patient fainted, the nurse’s reaction was that it can be expected. Because of the lack of mobility, the nurses explained she may feel faint. But I know the bed was tilted for awhile so the blood would not rush all at once. Fainting should have been taken more seriously by me, her advocate as well as the nurses the first time. I should have insisted someone check her for dehydration (although not being a medical professional I don’t need to know what the problem is, I do need to make sure the problem – and fainting is a problem, is addressed) Nurses should have informed the doctor and everyone should have said “no, fainting is not ok” but an aid may have been better able to pick this up and spend more time recognizing this. If this patient was hurt in the fall, at a cost to the hospital, I'm sure changes would be made.


Doug said...

Good question - I think there should be additional staff for the reasons you point out and more - the staff are asking for each other's help all shift long - and two thirds of the patients go without attention - the number of Failure to Rescue come to mind - Plus, the nurses cover for each other when one goes to lunch and takes other breaks - and if there is a code on their unit, they may all respond - sometimes they are called off the unit entirely to help with a code - Medication can be delayed, pain not addressed, IV's infiltrate, blood administration reactions -falls - the list goes on and on - the few dollars to add either aids, LVN's and RN's are well worth the investment to prevent medical error and to improve the general quality of care. This is not the place to economize.

Anonymous said...

Hi! I stumbled on your blog today and happened to read your post. Whew! Being a nurse is always that hectic huh. Personally I believe that men and women in nursing scrubs must always be flexible and of course always ready though we have 12 hours and more of lack of sleep. Quite demanding for a work that needs a lot of caring and loving and a whole lot of "ing".:)

nurseebooks said...

I learned to value the help of nursing aids. They are extra eyes and ears. They do the routine things like vital signs, trips to the bathroom, and tooth brushing so necessary for patient comfort. An experienced aid can also tell you when a patient is having problems that are not obvious. The aid can free up the nurse for higher levels of care for many patients.