[gentlegiver]

Originally Posted by marie-francoise

I wonder if this common "mistake" is actually a result of too few nurses stretched thin "failing" to be able to pick up on subtle signs of patient failure"...

http://www.msnbc.msn.com/id/24002334

They can't expect nurses to be miracle workers, esp when they have too much charting and too many patients.

I sent a pt out to the ER, SAT's mid 50's, Bp very low, rash that suddenly appeared. I called the Dr, he agreed that the pt needed to be sent out, possible reaction to new med just ordered and given for the first time. I contacted the family who met the pt at the ER. The daughter came back to the LTC facility and placed a complaint against me. Her complaint was that I didn't catch the problem and fix it before it started!

[herring_RN]

Originally Posted by pinoy_guy

lordy.

this is how it is in my hospital too.

the current trend is for the charge nurse to have here own patient load...and through a devious "game plan" of assigning "partners" the hospital is getting away with understaffing.

each nurse is partnered with another nurse, and labelled as "teamwork" and "encouraged to ask for help from your partner."

problem is, all the nurses on the floor have full plates, and it's very hard to ask for help from your "partner" as he/she has a full plate too.

this made me realize the precariousness of the nurses' position.

admin is covering its behind with nice-sounding phrases like "but they had a partner! he/she did not know when to ask for help!"

fact is, if a patient goes south, even if you recognize it early, sometimes there's very little you can do, especially if your other patients are always on the call light, or if their relatives are constantly hounding you to give pain medication (even if the patient is obtunded with pain medications).

this is why I'm advocating laws that require these admin people to work the floors 6 months of each year, so they cannot continue to ignore the problem.

as things stand, the hospitals are winning large by betting/playing with the nurses' licenses.

if the admin people have to risk their licenses too, I doubt they'll be instituting these lopsided policies.



this is how I feel too.

sad.

The problem is that some of them are no longer competent.
The shift supervisor asked me to go to the ER to help with an acute MI. I told her i was already assigned two patients. She told me she would "look after" my patients until the late call registry RN arrived.
I gave her report on two patients on ventilators. One was alert and oriented. She had been given Lasiz and had an extra bedpan. I told her that if the call light went on more that loikly the patient needed the bedpans emptied.
The other patient was unresponsive and dependent on Dopamine. I told her to watch the A-line and increae the drip as needed. She said she understood. (Of course there was more to my report)

After about an hour I transported my patient to the unit. This supervisor was sitting at the desk teading a tabloid "newspaper".
The call light was on and the patient was frantic in a wet bed.
The a-line of the other patient was alarming with hypotension.

She said, "There are always so many beeps and buzzes in ICU so I tune them out."

Fine except when they are your patient!

maybe theuy should shadow an RN for a shift every other month. A willing nurse who will explain what is being done. Whe can
think aloud" so they can reaquaint themselves with the nursing process.

[MAISY, RN-ER]

While experience certainly plays a huge part of this, location of beds can be critical!

One shift I had a young woman who was pregnant and spotting-I mean two spots(one pad)! She had some abdominal discomfort, but was mainly afraid for her pregnancy. My assignment was on our long hallway, the full length of the ER-of course she was at the end. I assessed her got her info-went to the other end of the hall to chart. Within 10minutes, a fellow nurse was walking by her room and noticed blood on the floor. SHE WAS BLEEDING OUT! I had already placed a line and fluids-THANK GOD! She was sent to OR within 10 minutes from that point.

I couldn't have guessed that would've happened based on my assessment. She was 1 of 5 patients (I thought the least worrisome), and young and healthy. By her presence, my co-worker saved her life. Our patient's lives and our licenses are placed in precarious positions daily with the uncertainty of our "very human bodies" In this case location, made all the difference.

While I see HIPAA as a positive in many situations, I believe the ward-like atmosphere promotes a better outcome for the patients and the nurses. People can be observed in a smaller space. Walls and private rooms with doors are making very dangerous situations! How can you rescue if you can't see?

The other thing lacking is common sense from some of our charge nurses or just plain worship of the green instead of worrying about those we are caring for. Recently I had a patient with afib, chf, swollen legs, hx aortic dissection, tons of cardiac and renal-placed in an unmonitored room for sob. WHAT? I advised no meds would be given, or anything performed until he was out of the hallway. They found him a room! That is the difference perhaps between a newbie and and "older-somewhat newbie". I will not risk either of us!

Anyway, I believe people are doing what they can. We need to stick together and make the change, or we will be the ones gasping for air in a few years. Don't know about any of you, but when Jack Kevorkian is looking better than the hospital...something needs to be done.

JMHO
Maisy

[SanSphinx]

needless deaths are prime examples of the need for more nurses at the bedside.
------------------------------------
SanSphinx

[everydaynurse]

There is another practice out there I think all should know about. A hospital here just got rid of several employees who were close to retirement and had a history of ever having a workmen comp claim, which the supervisors make you fill out. Cheaper to get rid of long term employees and hire new ones. The old employees have too many vacation days accumulated over the years and accumulated sick leave. This makes for loss of productive work hours. Medicine is now run like all of corporations to maximize profits. In other countries across the globe this is not the case. As long as big business can come in and control our health system, things will only get worse and nurses will leave or be pushed out of nursing at the bedside. Join your organizations so they may have a strong lobby in the legislator realm as AMA and others have.

[MAISY, RN-ER]

There are too many specialty organizations. WE need one voice, while ANA may have been the first...I am not sure they are the answer.

They oppose the office of national nurse, and I believe we need one!

If we look at the AMA they are one voice, even though physicians have many specialties. That is secondary, though still important.

No collective power, no results.

Maisy

[everydaynurse]

I hear what you are saying. We are all too busy working all the time to even get together. Hmmm. I work in Kansas and it is a right to work state so not much power here.

[Spidey's mom]

Originally Posted by MAISY, RN-ER

While experience certainly plays a huge part of this, location of beds can be critical!

One shift I had a young woman who was pregnant and spotting-I mean two spots(one pad)! She had some abdominal discomfort, but was mainly afraid for her pregnancy. My assignment was on our long hallway, the full length of the ER-of course she was at the end. I assessed her got her info-went to the other end of the hall to chart. Within 10minutes, a fellow nurse was walking by her room and noticed blood on the floor. SHE WAS BLEEDING OUT! I had already placed a line and fluids-THANK GOD! She was sent to OR within 10 minutes from that point.

I couldn't have guessed that would've happened based on my assessment. She was 1 of 5 patients (I thought the least worrisome), and young and healthy. By her presence, my co-worker saved her life. Our patient's lives and our licenses are placed in precarious positions daily with the uncertainty of our "very human bodies" In this case location, made all the difference.

While I see HIPAA as a positive in many situations, I believe the ward-like atmosphere promotes a better outcome for the patients and the nurses. People can be observed in a smaller space. Walls and private rooms with doors are making very dangerous situations! How can you rescue if you can't see?

The other thing lacking is common sense from some of our charge nurses or just plain worship of the green instead of worrying about those we are caring for. Recently I had a patient with afib, chf, swollen legs, hx aortic dissection, tons of cardiac and renal-placed in an unmonitored room for sob. WHAT? I advised no meds would be given, or anything performed until he was out of the hallway. They found him a room! That is the difference perhaps between a newbie and and "older-somewhat newbie". I will not risk either of us!

Anyway, I believe people are doing what they can. We need to stick together and make the change, or we will be the ones gasping for air in a few years. Don't know about any of you, but when Jack Kevorkian is looking better than the hospital...something needs to be done.

JMHO
Maisy

I do not understand the reasoning behind private rooms in an ER . . . privacy be darned . .

One local hospital is renovating their ER - all private rooms - I would hate to work there (I don't anymore actually).

steph

[herring_RN]

Personally I wouldn't mind just a curtain for privacy in the ER.
But those poor patients being examined and worked up in the hallway.
Docs asking questions that are VERY embarrasing to patients, uncovering them for examination as we walk by for supplies.
Patients are often hortrified.
At least the traditional ER with proper curtains gives a bit of privacy.
Still frightened sick people don't need to listen to each other.

[jjjoy]

Curtains for private exams, discussions, etc but otherwise, I do think it's safer for patients, though perhaps more awkward and embarrassing, to have an more open ward. Heck, if you're feeling well enough to care that much or to pay attention to what's happening to others, perhaps you should be at urgent care or primary care and NOT the ER! Yes, someone might see something that scares them or someone might overhear something about them, but all private rooms leaves so much room for problems to not be quickly noticed and ultimately, I'd rather have the safer environment.

I do think that private rooms also contribute to the harriedness of nurses on other units as well. The difference of having to go into 6 six different rooms instead of 3 (or even just one in the big old wards of the past) to get even just a glimpse of how six different patients are doing takes quite a bit more time. And requests demand a special trip to each room as opposed to a patient being able to mention a request while the nurse or aide is in the room for something else. As a patient, sure, I'd want privacy, especially when myself or another might have bowel probems, an annoying family, or the like. But there are costs & benefits to different set ups and I do think there's a substantial cost to increased privacy.

I like the sliding glass walls with curtains that they have in some ICUs these days. Privacy is available when needed, but the room can be open for easy observation from the nurses' station as well.