There is a crisis brewing in nursing homes. Although I applaud the recent interest in the needs of the infirm elderly I must ask, "Who will actually be at the bedside caring for the sick and aged?" It probably will not be a licensed nurse. Nurses are being driven from the bedside by increased paperwork, increased pressures, and the low level of recognition for the work they do.
Nurses have little patient contact anymore. I am a registered nurse working in a nursing home. Here is how my time is spent. It is reported that Mrs R. has an elevated temperature. I go to the bedside to assess the situation. After just a couple of minutes, I am back at the nurses' station. I must call the physician and the pharmacy. Appropriate information must be written on the patient's chart, in the medication treatment and pharmacy order books, and in the 24-hour log. I will have to make out a telephone order slip and possibly a lab slip. There Is a patient care plan to be filled out as well as an infection control report. For every five minutes spent at the bedside I must spend an hour at the desk with paperwork and telephone calls. Sometime during that period I quickly slip back to Mrs R.'s room to give her some medication and squeeze her hand. I am the only licensed nurse on duly for 30 patients. I come in early, stay late, do not take breaks, and eat my lunch at the nurses' station. I work here because I like our elderly residents and want to see that they receive good care.
Along with all the demands for detailed documentation of every aspect of nursing care, the nurse has increasing responsibility for the actions of everyone involved in health care, from the physician to the nurse assistant. Now with time so fractured, a nurse must worry about the growing possibility of being sued for any real or imagined misstep in health care.
The person at the bedside is most often a nurse assistant. He or she can hardly give adequate care when responsible for large numbers of patients, a great many of whom are confused, incontinent, and helpless. The work is often backbreaking and depressing. The assistant usually has minimal health education and training, and salaries are low There are few benefits and little regard for an important job that few people would choose to do.
State regulations have admirable objectives in mind, but it seems that in practice the state's evaluators of nursing homes focus as much on the paperwork as on actual care patients receive. There is no praise for what is right in patient care, only criticism for every fault. The state has yet to address satisfactorily the central issue - that to give good care, there must be appropriate staffing at the bedside. In closing, I ask, when nurses seek greener pastures, who is going to take care of you when you are old and can no longer take care of yourself?