Question for fellow R.N.s, and a whine

[CathyA]

Tonight my DH and I were talking about how incompetent so many people are in their jobs. DH is having major problems with a company he is doing business with because they are just plain stupid and have no sense.
Anyhow......DH has been getting haircuts from this lady who has been a friend of the family for years and years. I think next one will be his last. She is turning 90.
But she told him about something that happened to her. For some reason, she hasn't been able to urinate, so she's been having to be catheterized. The last home health nurse that came, put in the catheter and left. Well, she put it in the lady's vagina and inflated the balloon. First of all, it was incompetent of her to do this. Second of all.........didn't she wonder why no urine came out???
Geez. Can't people be competent any more???

[SteveinMN]

I'm not a nurse, but I have almost direct experience in this area. A member of my family requires catheterization among other home-health visits. At least out here, the R.N.s who do this are essentially paid piecework. If they troop out to someone's house and they can't see them, they don't get paid for that visit. Not like they're getting paid what hospital-floor R.N.s are making, either. Many times these nurses are given only the most cursory patient history. And like every business in America, the pressure is on to do more with fewer people. So the visit is quick. The nurse doesn't want to hang around long enough to see if your haircutter is producing urine. She will ... or she won't. My family member is lucky in that he has PCAs who have been trained in how to change the cath or he'd have to wait until a nurse could be sent out in a day or two...

None of this defends incompetence. But it may provide an idea why the whole thing seems so ... un-medical.

[CathyA]

I understand what you're saying Steve..........but that's exactly what concerns me. Where's the quality in any of this? And urine is made constantly and should always come out of a catheter immediately...........especially if the person needs to have the catheter to void at all. Its a medical emergency if urine can't get out in a certain amount of time.
I think home health care, unfortunately, is one of those jobs where people who might not be hired anywhere else, might easily get hired here. I know it must be a very hard job, since going into the homes can be a challenge. I just keep seeing quality going down everywhere, in every job of every kind, and its very disconcerting.

[Tammy]

This cost cutting pressure is a national trend in many areas. The result is lots of overworked people, while simultaneously there are lots of unemployed. It's all or nothing, both of which are hard to live with.

Still doesn't excuse this nurse. I am one .... And I just worked a 12 hour shift with no break. I ate lunch during a meeting. I ate dinner while on the phone. Neither was a complete meal. No one told me I couldn't take breaks .... In fact if I ask I'm told I must. But there was no time. It's the sad reality at times. Some nurses cope by skimping on patient care. I can't do it .... But I understand why it happens. It's a system problem ...

[SteveinMN]

I understand what you're saying Steve..........but that's exactly what concerns me. Where's the quality in any of this? And urine is made constantly and should always come out of a catheter immediately
A dehydrated patient likely will not be generating urine (BTDT). But, again, it does not excuse this nurse's incompetence.

As for the quality, apparently at the moment, it is judged to be sufficient by the majority. Between the people who don't want to spend another penny on anything that does not benefit them directly and the not-unexpected consequences of turning over medical care to huge for-profit corporations, we are getting what we're willing to pay for. I just heard on the TV news that America ranks 51st in the world in life expectancy -- despite being 1st in the world for how much we spend on medical care as a percentage of GNP. Any businessperson would look at that and wonder what we're wasting the money on and where the money could be spent more effectively. Yet the party of business doesn't want it and the party of the rest of us seems cowed at the prospect of re-engineering an obviously-failing system.

[KayLR]

Not a nurse, just reading this....Cathy, I hope someone's head rolled over this. How stupid! Your poor hairdresser!

[pinkytoe]

Two years ago, I was hospitalized for severe anemia and blood loss and had to be transfused. It took going through four different nurses to successfully insert the "thingy" in my wrist to do so. By the fourth nurse, I was a nervous wreck - she was the chief ER nurse and quite a bit older than the others. I now have a deep fear of ever going to a hospital again because the whole experience felt more like torture than help. I think across the board, people aren't as competent in many fields as they once were. I don't know why though.

[Miss Cellane]

Nursing is like any other profession--there are good nurses and poor nurses. There are nurses who are fantastic at some things, and not so good at others, like in Pinkytoe's transfusion story.

My nephew was born with a multitude of medical issues. He spend 6 months in NICU and when he finally came home, he had a trach and needed a ventilator most of the day. He also had 18 hours a day of home nursing care. Eight hours during the day, and eight hours overnight, so my brother and sister-in-law could get some sleep.

Early one morning, my brother and SIL were woken up by all of Nephew's alarms going off. They ran into his bedroom to discover he wasn't breathing--and that his night nurse had no idea even how to begin resuscitating him. Fortunately, SIL is a doctor and at that point had several months of caring for Nephew and she knew what to do.

But that's one home nurse, out of the 25 or so they've had over 13 years. Most of the nurses have been absolutely wonderful and have gone above and beyond their job descriptions in taking care of my nephew. He wouldn't be alive today without them.

There needs to be a system to weed out the incompetent. There also needs to be adequate training. There needs to be adequate time to do each job correctly and carefully. Even in hospitals, nurses may have more patients than they can care for in the time they have.

[CathyA]

I've always worked in an E.R. and Critical Care. Maybe I'm used to more competence there.
Yes, the cut backs (at least back when I was working) were crazy. Even in the ICU, right after I quit, they were having former housekeeping people starting IVs and the R.N.s had to start serving food trays. Can you believe that?
Oh, by the way Pinkytoe...........sometimes people are just really hard to start IVs on. And if you were several dehydrated......that would definitely factor into it too.
I'm sorry you had to go through that.
When I was working, they would let us nurses do arterial sticks but not venous. Go figure.

[Amaranth]

Wow, what a difficult situation. Cathy it might be worth it for your friend to see a different doctor to see if they can't change things so she can urinate normally. But in the meanwhile she might want to get trained so she can catherize herself safely.