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View Poll Results: Do we do too much?
Yes, we do too much. We should stick to health issues. 7 35.00%
No, we don't do enough. A person's health is affected by their lifestyle. 8 40.00%
I think what we do is just right. 5 25.00%
Multiple Choice Poll. Voters: 20. You may not vote on this poll

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Old 11-28-2007, 02:55 AM
Mr Ian
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My answer to the question is -
It's not my problem.

But I'm not talking to the patient when I say that. I'm talking to the policy makers, the insurance companies, the bureaucrats, the administrator.. etc..etc...

I took on the role of nurse to help people. Not just treat an illness. If I wanted to do that I'd have studied medicine.
If the hospital/service doesn't have a protocol to manage the stuff I deem clinically necessary then they can go deal with it in a forum somewhere after I've done it. If I'm getting too much 'social health' (or other) issues that I can't even deal with the essential clinical stuff, then I bang on someone's desk until they give me someone or some way to get it done.

The hospital is not there for the insurance company; not the nursing board or council; not the politicians and it's not there to give some administrator a cushy life.
I'm not about to help them avoid making decisions or providing service because we decide for them based on their non-clinical needs. Not until they start coming to the floor and helping me deal with my patients.

If I deem it necessary in the interests of the person then I do it to the extent of my ability and resources (and I can be pretty resourceful!).
My responsibility is to the people who need my services and to them alone.
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Old 11-28-2007, 03:00 AM
Mr Ian
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If I was posting on an administrators forum as an administrator or if I was a politician, my answer would have been completely different.

But I'm not.

So it isn't.
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Old 11-28-2007, 03:54 AM
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Well interestingly Ian I am now one of the 'administrators' or managers that you speak. I work in the area of the health system that holds the money and whose job it is to make sure that money is spent in the most effective way. Effective does relate to cost, but it also means best, appropriate and evidence based. Having said that, I am also a nurse. Ok so any contact I have with patients is coincidental these days but it is my job as a clinician employed as a manager to keep the focus on patients.

while technically it is the problem of the manager or administrator if the health care system is providing social as well as health care, but it is down to us as nurses to make sure that we know the difference. As a district nurse I worked with someone who took her patient's clothes home to wash. The lady had no relatives and in her view no one to do the washing, therefore in her eyes she was providing a necessary service. However, not withstanding the infection control issues, this was not appropriate behaviour. There were people in social services whose job it was to assess and ensure that social needs could be met (all be it at a financial cost to the patient) and what is more doing patient's washing is not the job of a nurse. No manager told her to do what she did, but sometimes people need to be needed and for that reason it is difficult to legislate that people won't do things they are not supposed to do.
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Old 11-30-2007, 05:26 AM
Mr Ian
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Absolutely Julie, and I have moved to a more considered understanding over the years that each role has its responsibilities.
Health care is a business, I make no mistake. It is also one of the top three or four issues of politicians (more often in UK and Aus than US); not because politicians care about our health as much as they care about what gets them votes.
But perhaps necessarily so, as votes reflect the peoples choice.

The whole structure is a game of balance; the wants of the mass of the people; the needs of the individual.
Unfortunately, boards and committees and administrating staff, as you identify, only meet with patients coincidentally from their positions.
Nurses, however, ought be seeing them 90% of the time they are at work. (Tho this 90% is in much contention with the anti-litigious paperwork required nowadays).
It is not easy for a nurse to see a patient with a need and simply walk away from their ordeal muttering to themselves about maintaining budgets and keeping the professional boundaries. Nurses simply do what the job requires them to do. In mental health the boundaries of 'nursing care' are much more smudged such as when a CPN (community psychiatric nurse) sees old Jo who hasn't got enough food for the week in his cupboard. I know many a CPN who will tend such needs under the consideration that addressing a minor issue now can prevent a major issue in a week. And trying to get it done thru submitting paperwork to another agency just doesn't happen in timely or purposeful fashion. Such diligence is oft found at the shop floor; sometimes just because it saves the nurse who knows in 3 days they'll be getting an urgent call to attend if they don't do a simple task now. But always it is done because the social issue is linked to the mental health issue. Nursing is part preventative and to not address it would be like the surgical registrar not treating the infection and waiting for the gangrene to set in because amputation is his job. Even when the CPN later raises their issues, it becomes subsumed by other issues that seem to take priority. Meanwhile, CPN is just happy to know that Jo is well and will eat tonight - and doesn't really give a stuff about someone else's policy need 3 floors up.
The failings I believe are not that nurses cross from health to social (or other) boundaries. Neither do I believe they are from ministerially led decision-makers. The problem comes when you try to marry the two together - two different needs bases; two different roles and most definitely two different daily experiences at work.
The service(s) are not flexible enough to meet the unique and emergent needs of the individual; the management is too defined in terms of it's administrative role and restricted in it's latitude to move away from the generalised and profession/task-specific policies even where a need is identified. This is no different to the issues facing nursing when, eg, 'health & safety' teams define 'how' the job is to be done.

Open and transparent practice management that welcomes the issues from, and considers them at, service delivery levels can support health care staff to resolve them in terms of their needs, and the balance of issues of service structure and service cost can be passed up the line to be raised as a point of concern that may or may not need further address. A management that simply tells you "You shouldn't do that" or one that says "I'll get back to you on that" and takes the issue further up the administration ladder; until 6 or so other nursing service issues emerge, or the medical or governmental team issues take priority, will lose the responsiveness to the issues that the service delivery staff require. For those issues that make it through the administrative barriers you can only hope the actual reality of the problem isn't already lost amidst the bureaucracy.
If I had that kind of service administration response, then I wouldn't need to be banging on your desk
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Old 12-10-2007, 01:39 PM
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Default It gets frustrating...

In the ED we see every end of this spectrum. Sometimes it feels like we have become too hardened, because I can discharge some to the street, and have it not bother me; other patients, it really bugs me...

I think we do as much as we can, for as many as we can, but with the healthcare industry in the shape it is, and the political climate what it is, we can't fix everybody or everything.
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Old 12-13-2007, 06:44 AM
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I don't think it's so much about whether we do enough or not, but rather shifting our focus to a health promotion/illness prevention model. I feel the training of RNs has grown much bigger than bedside nursing to include holistic care of individuals and populations. We underestimate our ability to, as the pole states, do more.
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Old 12-13-2007, 07:29 AM
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I agree NurseSean. The focus of the RN has changed since the start of nursing. As more is discovered about health it is becoming the role of the nurse to be health promoter not just hand madden. So we are doing too much for our patients by taking the recovery off them (by doing everything for them), and I have heard a patient being told that this was a hospital not a hotel.

I have had a few pts who could be considered a handful, many were capable of their own care but were not willing to do it themselves. These people generaly got left to the bottom of our list as we cared for the patients who needed assistance. I have also had patents who were aware of their limitations and would ask for specific things, like 'I'm going for my shower now, can you help we with my iliostomy when I come out, I'll buzz when I'm ready' This meant that I had time to check on my other patients and to just keep an eye out for the bell. When I did go back in, she had all she suppliers layed out, with the tape already cut. It was just a matter of lining everything up for her and help her with the taping. I was done in 2min.

So are we doing too much. It all depend on the circumstances, we are there to promote recovery and health, not to wait on a pt hand and foot. I have seen nurses after 2 days of waiting on the same patent and being there when the doctor has told the patient that they can transfer by themselves; have to tell the patient that they were not going to get another bed bath and if they required assistance in the shower one of the student nurses (male) would be willing to help, the patent suddenly was able to do everything themselves.
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Old 01-20-2014, 11:21 AM
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i think we are just doing enough. Not much though.
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