[tntrn]

Okay, and this reminds me of our floating to other units. At out place, OB nurses who have been OB nurses for 15-35 years are getting floated to med-surg, where we don't know the meds, don't know the docs, don't know the treatments, and they think we are competent to give safe nursing care. I think not. And I also think that if some horrible event would happen when one of our nurses was floating that the administration would not stand behind her/him for even one second.

[gonzo1]

At one hospital I worked at they didn't even own seizure pads in the ER. They taped blankets to the rails. How cheap and stupid is that? This is simply a case of the nurse didn't follow procedure. But we don't know the whole story. Or their side of it.
So many times a patient of mine has come back to ER room from xray etc and the returning person left bed high in air, rails down etc. I always try to get in to the room as soon as possible, but if something bad is going on this could be missed.
Hospitals say they don't want to use agency, but I think they are lying. Agency works great for them.
They may pay a little higher hourly rate, but the don't have the burdon of paying for vacations, benefits, sick time etc. In the end they save money. And it is a way for them to save money by not having to pay staff on slow days, and weeding out nurses they don't like.
Don't you think it is cute the way hospitals try to hide their use of agency nurses. They give you their hospital badges so people won't know they use a lot of agency.
Also, most agency nurses are well trained now. You wouldn't believe how many tests I had to take to go agency. Then every hospital I go to makes me take more tests.
In my opinion hospitals don't want staff nurses, they want rent a nurses. And I am a rent a nurse that is also on staff somewhere, so I see both sides

[angelique777]

First I feel horrible for the family and person that this happen too my deepest condolences for them .

From a nursing point view only I believe this is not an agency issue at all.
I did not read all your post cause it a busy day today. However I disagree with this report. First since I was not present cant judge if that nurse did or did not check that patient. What I do know is there has been times that I have had to fight to get a one to one on a patient I consider a fall risk. Checking a pt frequently does not mean you will not miss it if that patient decides to suddenly get out of bed right after you checked him and went into another room.

The safest way to monitor a fall risk patient is to have a one to one. Periodic awareness may be ok sometimes but if some one is a true fall risk you need a one to one person.

Now they say this occured in an ER and I dont work the ER but I do know it can get crazy down there depending on how many people the nurse is monitoring.

I dont think this is an agency issue I think its a hospital issue. I think they should provide one to one observation on patients who are serious fall risk cause I believe it the safest measure periodic awareness is good but from experience with how busy it can get on my unit I just dont find periodic awareness safe practice. I also feel the hospital makes unrealist demands on nurses a lot of times they do not provide us the auxillary support we need and we are doing everything from cleaning the floor cause now housing keeping wont clean up with out us cleaning first. They leave us without PCT to work on the floor. One charge nurse sent PCT to break at 10pm PCT still had not completed taking VS or FS. When she came back at 11pm she sent her to cover another PCT. Now the nurses are with out a PCt for 2hrs.So we doing everything and that night my patient where very sick and had 2 patient unstable...........I again have to say thank the Lord nothing has happen to me but the potencial for it to happen lies ever present over my head.......



What happens when your other patient become unstable do you really expect me to rely on PCT to monitor my periodic patient. A lot of times the PCT are on break and your other nurses are busy and then your other patient becomes unstable. IT can get crazy. I had to put those fall risk patient sometimes in a recliner so that everyone can help watch them cause it can get that crazy.

I thank the Lord every day nothing has happen to me as of yet. The only patient that has fallen of my patient was a pt who was AXOX3 and I told him to not get out of bed with out calling me cause his BP was low and I worried he may fall. I told him several times to call me.

In the morning he decided he was a grown man and did not need to call me to go to the bath room and he fell smack down in his face I felt horrible but the first thing he said to me was I am so sorry I did not listen to you. I am glad he said that in front of his family b/c they came to the job asking how he ended up on the floor and where all upset.

However he said that I told him several times not to get out of bed with out calling. He was not a confused person or elderly. Pt sometimes patient are just plain stubborn.

Had a co-worker also have AXOX3 patient steady on his feet just fall gettting out of bed. It can happen its awful.......

If this nurse neglected this person completely knowing he was a fall risk then thats awful but suppose they gave her this fall risk person and then had her covering 10 other people in ER. There has to be more to this story.........definitely do not think this is an agency issue..

[student1000]

My computer has crashed 3 times so I am just going to agree with most of what everyone has said. Basically it is nursing 101 to check these things out but again as Gonzo1 said things happen once you leave the patient even if everything was in its proper position when you checked.

Off topic: At the very bottom of the article it talks about a link to an article about how you know longer get massages and all the niceties that used to come with being in the hospital. Sorry I can't find the link. I just know this is a big pet peeve of people who are nurses (luckily as a student I haven't experienced much of it).

[santhony44]

Originally Posted by banditrn

I worked PRN at our hospital for three of the years I worked there. During that time, I watched them using some agency nurses. The ones we had were good, but I knew from talking to them that the hospital was paying a lot of money to get them.

So, I went to our unit director and told her I'd sign a 3 or 6 month contract with them - during that contract period, I'd work the same amount of hours that I did before I went PRN, and they wouldn't have to pay me for 'low-census' like they did with the agency nurses. All I wanted was $2 and hour more than I was making then. They'd have saved a LOT of money doing that. The unit director was excited about it, so she went straight to the Dept. Head, who came right down to talk to me about it - she liked it all, except she said they couldn't possibly pay me more money - even tho they were paying the agency a whole lot more.

So I told them to forget it, I'd just stay PRN.

I think this is a fine example of the kind of managerial insanity that has us in this whole "shortage of bedside nurses" situation in the first place.

I believe that most facilities could solve most of their problems if they were just willing to encourage their employees to think and act creatively. (And to let go of just a wee bit more $$$- but your example would have saved that facility money!)

Instead, too many management people can't see past the end of their own noses and end up cutting off those noses to spite their faces, anyway.

I think staff retention centers around two things: not hiring adequate staff, and not taking care of the small petty irritants that just drive people insane after a while.

How about some creative leadership that will work on that? Creative staffing could include offering free refresher courses to those who have been away from the bedside a while, to include a good thorough orientation. It could also include offering creative shift options, including 4-hour shifts to fill in gaps.

Bandit, your facility could have taken your idea and run with it. I'd bet that other nurses would have been willing to do the same thing.

I'd have given you a bonus for thinking of it in the first place! Instead, I'll bet neither you nor your Unit Director made any more creative suggestions after being slapped down for this one.

Pity.

Oh, and I'm sorry to steal the OP's thread. I agree with the other posters, the fact that this was an agency nurse is probably irrelevant, and we don't know all the facts anyway.

Yes, I've recently had a creative idea slapped down, myself.

[dzd&cnfsd]

I couldn't agree more. You said it so well. I want out of nursing for these very reasons, but I'll have to do it a little while longer to be able to go back to school.

[JessieRN]

I really wish we could hear the nurse's POV. I know personally I have went to a patients room to find the bed up to the ceiling, or side rails down-when I know that is not how I as the nurse left it. So many people go in and out of rooms, any one could have let the side rail down.

And we don't know what staffing was like. Since they are using agency nurses, I would think it is very low staffed. So, she was probably running hard. Even if you are checking on a patient frequently, every five minutes, they can still fall out of bed in that short span you are out of the room. Even with bed rails up. And if they expected her to take other patients, she couldn't be expected to stay at that one patients bedside.

We dont' know the whole story, but it really sounds like someone is trying to take this bad situation, and make a scapegoat and example out of a nurse that was probably trying to do a good job.

[kstec]

Okay I realize that agency nurses may not know the facilities, but I would think seizure precautions would just come naturally to a nurse, agency or not. I just graduated from LPN school 18 months ago, but I can still hear my instructor saying always keep the patient from getting hurt when they are having a seizure. I don't even know how the agency would be to blame, except for the quality of nurses that they employ. I know we all make mistakes, but some things should just come second nature. I think that might be why nursing focuses so much on critical thinking and thinking outside the box. What everyone may not see, we as nurses have to see and respond too. I'm not passing judgement because I'm learning something new everyday, but if and when I ever do something like that, please kick me in the a$$.

[pickledpepperRN]

Many agency nurses are excellent.
But I know a few who have burned bridges for various reasons and cannot get a staff position in the area.

[BrokenRNheart]

I don't think this should stand out as an agency thing.

This goes back to why there was an agency nurse in there to begin with. Having the agency nurse there wasn't going to change the problem. My best bet would be that they had staffing issues and as usual there was more work than could be done safely. Nice scapegoat to flop this on a nurse and more-so an agency nurse.

So the spotlight falls on an agency nurse when it should fall on what the truth is....why can't they keep staff? Why did they need an agency nurse?

I'm sure conditions were unsafe and un-manageable and any experienced nurse would probably agree. It seems to me that most ICU's and emergency rooms are used to agency nurses and are regularly staffed with agency nurses and doctors. For a reason.

As a matter of fact, my most recent experience was a floor that I supplemented on last week and the only people that were actually working and doing patient care were the agency nurses. The regular staff had sat up at the desk and socialized for 12 hours and ignored lights. Half of the staff was float and agency and I can take a good guess as to why. Would any one here want to work side by side with regular staff like that? I'm sure all the good nurses left.