RN "Super Union" - Page 8
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Dec 29, '09 by herring_RNoriginally posted by herring_rn
here are a few select quotes and the conclusion:
"rns must exercise independent judgment at all times."
"at issue here is will the professions (medicine and nursing) control
technology or will technology control the professions?"
"unfettered use of technology will have a chilling effect on the rn’s ability to advocate for her or his patient."
conclusion: rns have the right and the duty to act as patient advocates, and therefore must have the ability to override any decision, solution, recommendation made by any computer software, system, tool which in the rns’ professional judgment is against the interest and wishes of the patient.
Quote from onekidneynursethe purpose of the attached article is to educate and motivate rns to advocate exclusivly for the best interests and wishes of our patients.having the ability and using it are 2 very different things.Last edit by herring_RN on Apr 16, '11lindarn likes this. -
Dec 29, '09 by misplaced1Wow I have been watching what was happening with the Unions and have been pro union but I think that what I just read scares me. No doubt that people dont want to be treated like machines but this statement I just read seems anti-technology to me. This is the same thing that factory workers tried - with very poor results
I dont think we will educate ourselves out of jobs but we sure could push corporations that want to use more technology to hire non nurses to do the jobs nurses have traditionally done if we are going to deny technology. It does not take an RN to have compassion and any human that desires to can deliver "therapeutic touch".
I suspect the hospitals of the future will have FEWER patients. Why admit someone that can stay home and take care of themselves, or have a family member take care of them. With technology this should be possible in the not so ditant future for many people that would normally be admitted. One of the big questions in my mind when I started down this path was why isnt more of the care of patients done at home? It would be a huge cost saver, no AC to pay, etc etc. Technology could be used to aid in monitoring. I suspect some of it is that the nursing homes and hospitals are fighting the good fight not wanting to let go of the peice of pie they are now enjoying. But, there are begining to be programs that are sidestepping this and helping people for instance get out of nurinsg homes and get home health care. How long can we continue to warehouse people given the high cost of healthcare and knowing that in many cases there are better ways to care for them that will allow them a higher standard of living and that are more cost effective?minirn likes this. - GuideDec 29, '09 by herring_RNI am very glad that many thousands of us worked to achive safe staffing ratios because the "evidence based" patint classification softwar did NOT allow sufficient staff to care for patients.
No matter what we filled out as the acuity on our telemetry unit we got 8 patients on days and 12 on nights. The secret proprietary software told us how many patients we could care for.
Now by law it is the professional judgment of the RN who assessed the patient.
WE were able to override the software that called for a critical care nurse to care for two patients. One needed multiple drips, CRRT, IABP, was awake and trying to get out of bed. Easily reoriented but could NOT be left alone.
I never left that patient while the charge nurse cared for the other patient the technology assigned to me until another RN arrived.
No we cannot rely on such tchnology. And my charge nurse stepped up to the plate and refused to let tchnology think for her.
And proprietary staffing software that doesn't let nurses know how staffing is decided is just wrong.
It is not anti technology. It is to have us think critically and have the courage to advocate in the exclusive interest of our patient.Last edit by herring_RN on Dec 29, '09 - Dec 29, '09 by OnekidneynurseQuote from herring_RNWishes? My patients "wish" for bananas, french fries, and ice cream. What kind of advocate would I be if I gave them those things. My surgical patient's wished for 3 day long naps, no CDBT. What kind of advocate would I have been then if I'd gone with their wishes?The purpose of the attached article is to educate and motivate RNs to advocate exclusivly for the best interests and wishes of our patients.
- Dec 29, '09 by OnekidneynurseQuote from misplaced1We may be able to slow the inevitable by working with management instead of against it. via Unions. We need to be partners and having every single issue become a mountain instead of a hill will not do that.Wow I have been watching what was happening with the Unions and have been pro union but I think that what I just read scares me. No doubt that people dont want to be treated like machines but this statement I just read seems anti-technology to me. This is the same thing that factory workers tried - with very poor results
I dont think we will educate ourselves out of jobs but we sure could push corporations that want to use more technology to hire non nurses to do the jobs nurses have traditionally done if we are going to deny technology. It does not take an RN to have compassion and any human that desires to can deliver "therapeutic touch".
I suspect the hospitals of the future will have FEWER patients. Why admit someone that can stay home and take care of themselves, or have a family member take care of them. With technology this should be possible in the not so ditant future for many people that would normally be admitted. One of the big questions in my mind when I started down this path was why isnt more of the care of patients done at home? It would be a huge cost saver, no AC to pay, etc etc. Technology could be used to aid in monitoring. I suspect some of it is that the nursing homes and hospitals are fighting the good fight not wanting to let go of the peice of pie they are now enjoying. But, there are begining to be programs that are sidestepping this and helping people for instance get out of nurinsg homes and get home health care. How long can we continue to warehouse people given the high cost of healthcare and knowing that in many cases there are better ways to care for them that will allow them a higher standard of living and that are more cost effective?
Nursing is the highest cost factor in many hospitals and in order for those hospitals to survive they need to control costs . All of them. Facts. Pipe dreams are not facts. Should we work for peanuts. NO but we do have to be proactive one nurse at a time. We need to take care of ourselves so we can take care of each other. - GuideDec 29, '09 by herring_RNQuote from OnekidneynurseIt is a condition of my license as a registered nurse in the State of California. Notice that best interest comes before wishes?Wishes? My patients "wish" for bananas, french fries, and ice cream. What kind of advocate would I be if I gave them those things. My surgical patient's wished for 3 day long naps, no CDBT. What kind of advocate would I have been then if I'd gone with their wishes?
I will NOT allow my lung cancer patient with an advance directive for DNR to be intubated.STANDARDS OF COMPETENT PERFORMANCE
A registered nurse shall be considered to be competent when he/she consistently demonstrates the ability to transfer scientific knowledge from social, biological and physical sciences in applying the nursing process, as follows:
(1) Formulates a nursing diagnosis through observation of the client's physical condition and behavior, and through interpretation of information obtained from the client and others, including the health team.
(2) Formulates a care plan, in collaboration with the client, which ensures that direct and indirect nursing care services provide for the client's safety, comfort, hygiene, and protection, and for disease prevention and restorative measures.
(3) Performs skills essential to the kind of nursing action to be taken, explains the health treatment to the client and family and teaches the client and family how to care for the client's health needs.
(4) Delegates tasks to subordinates based on the legal scopes of practice of the subordinates and on the preparation and capability needed in the tasks to be delegated, and effectively supervises nursing care being given by subordinates.
(5) Evaluates the effectiveness of the care plan through observation of the client's physical condition and behavior, signs and symptoms of illness, and reactions to treatment and through communication with the client and the health team members, and modifies the plan as needed.
(6) Acts as the client's advocate, as circumstances require by initiating action to improve health care or to change decisions or activities which are against the interests or wishes of the client, and by giving the client the opportunity to make informed decisions about health care before it is provided.
http://www.rn.ca.gov/pdfs/regulations/npr-i-20.pdf
I will not send a patient to surgery who does not understand the consent.
I will do all I can to provide the best possible care for my patient.
And pray I recognize when circumstances require that I ACT on behalf of my patient.
And when my patients don't like their therapeutic diet I take the time to listen, to educate, and obtain a dietary consultation.Last edit by herring_RN on Dec 30, '09 - Dec 30, '09 by OnekidneynurseQuote from herring_RNYou needed all that to agree with me? I never went over a surgical consent with a patient. That's the surgeon's duty. I've had surgeon's ask me to get a consent signed and I refused every time. I will go back into the room and ask the patient if that is their signature.It is a condition of my license as a registered nurse in the State of California. Notice that best interest comes before wishes?
I will NOT allow my lung cancer patient with an advance directive for DNR to be intubated.
I will not send a patient to surgery who does not understand the consent.
I will do all I can to provide the best possible care for my patient.
And pray I recognize when circumstances require that I ACT on behalf of my patient.
And when my patients don't like their therapeutic diet I take the time to listen, to educate, and obtain a dietary consultation.
Please tell me how you know someone understands anything? Many of them can parrot what they've heard but that doesn't mean they understand. If English is not their first language do you get an interpreter. And how do you know the interpreter knows what he/she is talking about? - GuideDec 30, '09 by herring_RNoriginally posted by onekidneynurse
wishes? my patients "wish" for bananas, french fries, and ice cream. what kind of advocate would i be if i gave them those things. my surgical patient's wished for 3 day long naps, no cdbt. what kind of advocate would i have been then if i'd gone with their wishes?Quote from herring_rnit is a condition of my license as a registered nurse in the state of california. notice that best interest comes before wishes?standards of competent performance
a registered nurse shall be considered to be competent when he/she consistently demonstrates the ability to transfer scientific knowledge from social, biological and physical sciences in applying the nursing process, as follows:
(1) formulates a nursing diagnosis through observation of the client's physical condition and behavior, and through interpretation of information obtained from the client and others, including the health team.
(2) formulates a care plan, in collaboration with the client, which ensures that direct and indirect nursing care services provide for the client's safety, comfort, hygiene, and protection, and for disease prevention and restorative measures.
(3) performs skills essential to the kind of nursing action to be taken, explains the health treatment to the client and family and teaches the client and family how to care for the client's health needs.
(4) delegates tasks to subordinates based on the legal scopes of practice of the subordinates and on the preparation and capability needed in the tasks to be delegated, and effectively supervises nursing care being given by subordinates.
(5) evaluates the effectiveness of the care plan through observation of the client's physical condition and behavior, signs and symptoms of illness, and reactions to treatment and through communication with the client and the health team members, and modifies the plan as needed.
(6) acts as the client's advocate, as circumstances require by initiating action to improve health care or to change decisions or activities which are against the interests or wishes of the client, and by giving the client the opportunity to make informed decisions about health care before it is provided.
http://www.rn.ca.gov/pdfs/regulations/npr-i-20.pdf
Quote from herring_rni will not allow my lung cancer patient with an advance directive for dnr to be intubated.
i will not send a patient to surgery who does not understand the consent.
i will do all i can to provide the best possible care for my patient.
and pray i recognize when circumstances require that i act on behalf of my patient.
and when my patients don't like their therapeutic diet i take the time to listen, to educate, and obtain a dietary consultation.Quote from onekidneynursei was not agreeing with you. i was explaining the word "wishes" in my states nursing practice act.you needed all that to agree with me? i never went over a surgical consent with a patient. that's the surgeon's duty. i've had surgeon's ask me to get a consent signed and i refused every time. i will go back into the room and ask the patient if that is their signature.
please tell me how you know someone understands anything? many of them can parrot what they've heard but that doesn't mean they understand. if english is not their first language do you get an interpreter. and how do you know the interpreter knows what he/she is talking about?
hospital policy requires i witness the signing of the consent.
working nights there is often a doctors order to get a consent. if the exact wording is not in the written order i call the doctor and read it back. sometimes a secretary has prepared the consent.
if the patient has any questions or misunderstanding i contact the doctor to come talk with the patient.
ps: we have excellent tested interpreters. i always have an interpreter when assessing a patient and anytime there is a need. we don't think it is appropriate for a young family member to translate.
and of course before they sign a consent they are asked if there are any questions. our physicians write (well type) extensive progress notes regarding what the patient was told and questions answered. but even then sometimes a patient forgets to ask a question so the doctor has to return to the hospital to answer.Last edit by herring_RN on Dec 30, '09 - Dec 31, '09 by OnekidneynurseQuote from herring_RNAs I said witnessing a consent and explaining it to the patient are 2 very different things. I am not operating on the patient I am not explaining the risks or procedure. EVER.I was not agreeing with you. I was explaining the word "WISHES" in my states Nursing Practice Act.
Hospital policy requires I WITNESS the signing of the consent.
Working nights there is often a doctors order to get a consent. If the exact wording is not in the written order I call the doctor and read it back. Sometimes a secretary has prepared the consent.
If the patient has any questions or misunderstanding I contact the doctor to come talk with the patient.
PS: We have excellent tested interpreters. I always have an interpreter when assessing a patient and anytime there is a need. We don't think it is appropriate for a young family member to translate.
And of course before they sign a consent they are asked if there are any questions. Our physicians write (well type) extensive progress notes regarding what the patient was told and questions answered. But even then sometimes a patient forgets to ask a question so the doctor has to return to the hospital to answer.
What happens when you go home and the surgeon never came in to talk with that patient. Where would your liability be with that scenario. You go right ahead and get consents for surgery signed. I won't be doing that.
Who assesses the interpreter? Do you have staff who speak both languages so they can assess the medical knowledge of the interpreter. Often it's just someone who's been in the US for a couple of years. NO medical knowledge at all.lindarn likes this.
