Nurses lost in care

recently had a conversation with someone regarding the nursing shortage. She asked me what I thought were contributing factors to this delimma. As I rolled the tape back into my 22 years of nursing I thought about this question, seriously, for the first time in my career. As I am thinking back to the scrambled answer I gave her, I laugh. Why did I not have the answer to this important question? Afterall, since I have been working the nursing shortage has always been an issue. So why could I not find the answer? I have had plenty of time to observe this, think about it, and reason the different problems. Well, I have thought about it now. The answer to the problem has not intruded into my space because I have never wondered about a solution. I have just worked my hours, done the best job I could, and resolved to the fact there will never be enough help. Why? Because nurses can offer more help to their patients than themselves. We have orders to follow, written specifically, designed for each patient. We have policies to follow to honor our hospital quidelines and JCAH standards of care. We know what medicines are due each hour and what they are indicated for. Every minute of every hour is consumed with what needs to be done. What isn't planned for? A patient who suddenly stops breathing. A code is called. Appropriate people arrive and work to remedy this problem, save a life, or determine efforts should be stopped. During this, time stands still. The nurse is still responsible to continue care for the other patients and yet the demands of the one patient is most important, life threatening. The same amount of work still needs to be done, but must be delayed while determining priority. The work was mapped out at the beginning of the shift. What wasn't planned for? The sudden onset of being 2-4 hours behind. It all happens within minutes. In a few short minutes the nurse is behind. Then a patient vomits all over the bed. Minutes to change a bed. The patient really needs another bath to feel clean and comfortable. Minutes to hours. New orders are being placed on her clipboard for other patients. She hasn't even finished rounds on all her patients and it is 9am. Her 8am meds aren't finished and she has stat meds to be given. Many nurses can adapt, regroup, realize the important stuff, keep adjusting her level of care, but quite honestly, some cannot. Nursing is the ability to give care, compassion, and quality assessment to each patient; however, if the nurse does not possess organizational skills and the ability to find a system that works, care and compassion do not happen. If a nurse is stuggling with the basics of care, how can she excel? The nursing shortage is a result of poor planning on the ratio of nurse per patient. We have it all backwards. Our hospitals need to be looking at the number of nurses each day, instead of the number of patients. Hospitals are too concerned about the financial aspect and should be more concerned with employee support, satisfaction, and offering benefits. On a low patient census day, employees are asked to go home. Why not offer the chance to have a day when the work isn't so demanding. Catch up on organization of the floor, brain storm ways to better serve the patient, have a floor lunch where everyone may get the chance to enjoy their 30 minutes rather than choke food down. Because nursing is such a structured job with no flexibility, why not offer 2hr, 4hr, 6 hr shifts. This could open doors for help when a 40 hour person is sinking at 9am. Offer incentives. Pedicures, manicures, facials, shopping sprees. Money talks but an act of service done for someone who devotes their life to serving others is an act of setting the example. Lavish, vogue nursing stations where employees feel comfort when their shift has been too rough. Providing so much positive reinforcement, that nurses feel a committment based on the way they are treated. Nursing is a priviledge. I love what I do and have never wondered about my career choice. What I do wonder about is the calling to give to our patients the excellent care they deserve and realizing every minute of everyday there will a crisis, a delay, and unplanned bump in the road. What a difference it would make if nurses felt their hospital's calling was to provide such excellent support for the staff that every crisis could be handled, but not at the expense of the nurse. Hospitals need to empower their nurses by giving them resources to solve staffing problems. What is not working? Telling a floor nurse, "we're sorry there is nothing we can do." We teach our children to ask for help. We teach nurses to help themselves.