As a new nurse in the 1980s, my patient load was probably three to four patients, which is what it is currently in pediatrics, but the patients were not as sick as they are now. There's been a definite change over time to a higher acuity [sicker] patient, requiring more technology, more paperwork, more intensive monitoring. If you had a patient assignment in the past, you might have one sick patient and several patients on the mend. But that has changed.
And so what you used to do is try to get everything done you possibly could, make sure everybody was comfortable and safe, and then you would run and take your meal break and ask somebody to listen out. Essentially, your patients would not get care while you were gone.
Whereas now, with the ratio law in effect at all times, the employer provides additional nursing care for breaks so that I can say, "OK, this child needs pain medication, can you give it and I can go to dinner?" That's a huge difference for a family, to not have to wait to get care.
I [used to] go home and be falling asleep and would wake myself up thinking, "Oh my God! Did I do such and such? Did I tell the next nurse about this or that?" Because you're so rushed you would be continually questioning, "Did I get everything done, was everybody safe?"
I didn't consider leaving the profession, but I know a lot of nurses did. I know a lot of nurses told me they wouldn't tell their sons or daughters to become a nurse. But I was one of the people who chose to work hard to get regulations and to make improvements in my collective bargaining agreements so that I could stay a nurse.
Because I like being a nurse, I want to provide patient care, I want to be a patient advocate.
RN, 59, intensive care unit nurse at UC San Diego Medical Center; nurse for 32 years
There are all kinds of complicated procedures and technology that the nurse is responsible for monitoring that didn't exist 10 years ago. A lot of patients are on continuous dialysis with machines. A lot of labs and drugs have to be given on an hourly basis. There are very critical IV drips, and you're titrating the drugs up and down based on the patients' clinical picture, and there is constant bedside decision-making with each patient.
We also have [many more] patients who are on isolation precautions [because of infectious diseases] than we used to, which means gowning and gloving every time you walk into their room. That's very time-consuming, but very, very necessary. There is a much greater risk factor for people who work in healthcare now and it makes the care more complicated. There are a lot of things that have changed over the years that make the delivery of care a lot more complicated.
I still enjoy what I do. I think people who go into nursing don't go into it for the money but go into it for a sense of altruism and wanting to help and be in a caring profession. But it's a very high-stress, physically, intellectually and emotionally demanding job, and that's why I think the ratios are so critical, so that when people go to work they are reassured that they won't have more than five patients, or more than two in the ICU. That may be a heavy load, but it's better than it used to be.