Do you cut corners in your daily nursing practice? - page 2

Do you cut corners in your daily nursing practice? Or do you do everything according to the 'book'. Do you police yourself in your everyday care of a patient, what do I mean by police yourself? I... Read More

  1. Visit  Despareux} profile page
    3
    I figured cutting corners was part of the package deal when it comes to nursing judgement; and policies were put in place as guidelines to help promote good nursing judgement. Eh, what do I know.
    Orange Tree, KitkatPRN, and brownbook like this.
  2. Get the hottest topics every week!

    Subscribe to our free Nursing Insights newsletter.

  3. Visit  tokmom} profile page
    2
    This is too long to answer correctly, but yes, there are days I cut corners. I might give quick d/c instrxns on meds, but I always put in information for them to read at home. In the fantasy world, I would do teach back for every single med.

    We scan our meds, and no, I don't always check for allergies with the pt. It's written on top of the emar and I can see it there.

    The handwashing thing I do every single time and I'm shocked at those that are answering they do not. I will even gel in and out, to silence a pump. I will wash/gel before going into a room to touch a pt, even if I just came out of a room next door and washed/gel'd. I might know I washed my hands, but the pt that I'm going to touch in the other room doesn't know that I did.
    Think about it. Another nurse comes out their room and goes into yours to silence a pump. That particular nurse might not have washed their hands and haven't done it all day. God knows what is on their fingers! They come in your room and touch your pump. You, thinking your hands are clean, touch the same buttons. Since you only touched one spot on the pump, and nothing else, you walk away and don't clean your hands. See where this is going?
    Last edit by tokmom on Dec 8, '12
    Intentional and anotherone like this.
  4. Visit  MunoRN} profile page
    4
    I remember a shift last spring where I had time to do everything "by the book", good times. Other than that occasional shift, most of Hospital Nursing is the art of cutting corners as responsibly as possible, if there is such a thing. Nurses earn their keep by figuring out how to squeeze 16 hours worth of work into 12.
  5. Visit  Kdrenee} profile page
    6
    Quote from MN-Nurse
    Interesting survey. Let's see how I do:

    Do you cut corners in your daily nursing practice? Or do you do everything according to the ‘book’.

    I am the very embodiment of perfection in everything I do. OK, is this a serious question?

    Do you police yourself in your everyday care of a patient, what do I mean by police yourself? I mean always follow the correct procedures no matter how busy you are, and when tempted to deviate never vary because you know it is wrong and that errors do often occur.

    I police myself, whatever that means according to your strangely framed question.

    When you are in a patient room alone, by this I mean no other staff member watching you or a patient who is oblivious. Do you behave as though you were being scrutinized?

    Yes. (Finally a question I understand.)

    Do you manage that patient care the right way, because it is the correct way.

    My way is always the correct way, silly. (See my first response.)

    Do you manage your hygiene, the correct procedure for changing IV fluids, remaining clean/sterile when changing dressings?

    Um...Yes. Yes. Yes. I think you need to do a "fill in the circle" type thing because it is hard to tell when you are done asking a question.

    Do you always wear gloves, do you change your gloves between procedures, do you wash your hands.

    Let's see...No. Yes. Yes. (You don't always have to wear gloves).

    Or do you occasionally forget to wash hands, not follow guidelines for procedures. Cut corners because you think nobody is looking, even though you know it is wrong but do it anyway?

    No. No. No. (I think someone is doing some projecting here.....)

    Do you reflect on your care after every shift? Reflection is old fashioned now, but after every event I do reflect on how I managed that situation, and if I could have done it better.

    No. Jeez how in hades do you reflect on every event?

    Often a corner is cut, nothing bad occurs so the next time you give yourself permission to do it again because you tried it once and it was OK. Soon the corner cutting becomes a habit and you no longer remember that you are cutting corners because it is part of your daily practice.

    Your honor, is there a question here?

    The reason I ask you, is because there are professional health care staff who do cut corners on a regular basis.

    Name names, senator.

    We do see frequent mistakes made because we don’t take our time.

    You got a worm in your pocket?

    Medications mistakes being common

    Sentence fragment.

    So many are made, but I wonder how many are actually happening and caught, and how many are never caught?

    478 are actually happening and caught. 15 are never caught.

    How many of you will go into a room, ask the patient her name, check her name band and then ask what she is allergic to? Every time you give that same patient her medication.

    Whoever does that will eventually get slapped in the face by everyone around him or her.

    Do you tell the patient what medications she is receiving? Do you discuss the side effects or check if the patient actually understands what meds she is receiving and why?

    Sometimes, and always with medications new to the patient.

    Do you watch every patient take the meds you gave them? Or do you give them the pot and walk away?

    Don't bogart that pot, Tonto. Around here we share the pot.

    Remember when you sign the MAR you are saying the 5 R’s are correct, but you are also saying you saw the patient take the meds you gave her?

    Do I remember this? I suppose I remember this.

    How many times have you been into a room and seen a pot of medication sitting on the side!

    Pot doesn't last long in the open around my patients.

    Do you always do a head to toe check, or do you skip some parts of it?

    I often do focused assessments when proper, and I never skip the proper parts of the correct assessments at the perfect times.

    You know that these things I mention occur on a daily basis and often go unchecked until a major disaster occurs.

    You know you wanna leave me, but I refuse to let you go.

    Often causing patients an injury, we have an obligation to provide each patient with high quality care always.

    I don't often cause patients an injury, but when I do, it's Dos Equis.

    Ask yourself when you are tempted to cut a corner, would you approve or condone this if it was your relative or meaningful other?

    Myself is annoyed with me and refusing to answer.

    When a mistake happens, it is often something that could have been avoided but it is something which will live with you for a very long time.

    Sounds like you've been talking to my exes.

    I am not your judge, I am not your conscience and I am only playing devil advocate.

    Whew.

    Please please please do not cut corners because in the long run you may have cost somebody a lot more time, than you spared.

    WHY DIDN'T YOU JUST SAY THAT TO BEGIN WITH??? SHEESH!
    YOU ARE AWESOME. I literally LOL'd for 10 minutes after reading this!
    NutmeggeRN, SleeepyRN, MN-Nurse, and 3 others like this.
  6. Visit  wooh} profile page
    11
    Quote from MunoRN
    I remember a shift last spring where I had time to do everything "by the book", good times.
    I remember a shift a few years ago, I think about 7, that I was able to do the most exquisite documentation. I was kind of sad nobody sued, I really wanted to see it up on the big screen.
    SleeepyRN, mazy, sharonp30, and 8 others like this.
  7. Visit  tokmom} profile page
    1
    Quote from wooh
    I remember a shift a few years ago, I think about 7, that I was able to do the most exquisite documentation. I was kind of sad nobody sued, I really wanted to see it up on the big screen.

    LOL, that is so true. I had one troublesome pt that I charted with amazing detail. Nothing happened, thankfully, but the prosecuting attorney would have had a difficult time picking it apart.
    As much as I did not want to be named in a lawsuit, I was a bit disappointed it went to the archives without anyone looking at it.
    wooh likes this.
  8. Visit  BiohazardBetty} profile page
    0
    Quote from wooh
    I remember a shift a few years ago, I think about 7, that I was able to do the most exquisite documentation. I was kind of sad nobody sued, I really wanted to see it up on the big screen.
    LOL love it!
  9. Visit  OnlybyHisgraceRN} profile page
    0
    Do you cut corners in your daily nursing practice? Or do you do everything according to the ‘book’.

    Yes, I do cut corners not because I want to but often there are not enough time in a shift and sometimes other things take priority. For instance, I didn't have time to gown up when I was responding to a code and a pt. had MRSA in the nares.

    Do you police yourself in your everyday care of a patient, what do I mean by police yourself? I mean always follow the correct procedures no matter how busy you are, and when tempted to deviate never vary because you know it is wrong and that errors do often occur.
    See above.

    When you are in a patient room alone, by this I mean no other staff member watching you or a patient who is oblivious. Do you behave as though you were being scrutinized?
    I try my best to do everything as if my manager was there in front of me. However, I've seen the best of the best of nurses fall short at the bed side.
    Do you manage that patient care the right way, because it is the correct way.
    Yes.

    Do you manage your hygiene, the correct procedure for changing IV fluids, remaining clean/sterile when changing dressings?
    Yes.

    Do you always wear gloves, do you change your gloves between procedures, do you wash your hands.
    Yes. When my gloves are visibly dirty, I wash my hands and change them. Other times I use Purell.

    Or do you occasionally forget to wash hands, not follow guidelines for procedures. Cut corners because you think nobody is looking, even though you know it is wrong but do it anyway?
    I don't forget not to wash my hands or cut corners because I think no body is looking, it is because, once again other things take priority.

    Do you reflect on your care after every shift? Reflection is old fashioned now, but after every event I do reflect on how I managed that situation, and if I could have done it better.
    You betcha I do! This is the only way to grow as a nurse.

    Often a corner is cut, nothing bad occurs so the next time you give yourself permission to do it again because you tried it once and it was OK. Soon the corner cutting becomes a habit and you no longer remember that you are cutting corners because it is part of your daily practice.
    I agree, however due to staffing ratios', never ending documentation and other things the only way to survive a shift is cutting corners. I do things such as swiping an iv port 15-30 sec and etc. should never be not done.

    The reason I ask you, is because there are professional health care staff who do cut corners on a regular basis.
    Agreed.
    We do see frequent mistakes made because we don’t take our time.
    Agreed.

    Medications mistakes being common

    So many are made, but I wonder how many are actually happening and caught, and how many are never caught?
    Alot, I suppose.

    How many of you will go into a room, ask the patient her name, check her name band and then ask what she is allergic to? Every time you give that same patient her medication.
    I've done LTC, and half the residents don't remember the name, neither do they have ID bands. In ICU half the patients intubated and sedated.

    Do you tell the patient what medications she is receiving? Do you discuss the side effects or check if the patient actually understands what meds she is receiving and why?
    For my AOx3 patients, yes I do. However, I don't volunteer alot of information because then I 'll get asked a trillion more questions. I know its' wrong, but once again time management is a priority. I generally tell the patient why there are receiving the med, and go over major adverse effects. IE. Nitro paste my cause severe headache.

    Do you watch every patient take the meds you gave them? Or do you give them the pot and walk away?
    Yes, every single time.

    Remember when you sign the MAR you are saying the 5 R’s are correct, but you are also saying you saw the patient take the meds you gave her?
    Agreed.

    How many times have you been into a room and seen a pot of medication sitting on the side!
    ONce too many.

    Do you always do a head to toe check, or do you skip some parts of it?
    When I arrive I do a complete head to toe. Then after that, every time I walk in the room I take time to assess, and I do more of a focused assessment through my day. In the ICU we had to do three head to toe assessments. If I just listened to your lungs less than 10 minutes before your head to toe is due, yes I am going to skip that part.

    You know that these things I mention occur on a daily basis and often go unchecked until a major disaster occurs.
    I agree.

    Often causing patients an injury, we have an obligation to provide each patient with high quality care always.
    Agree.
    Ask yourself when you are tempted to cut a corner, would you approve or condone this if it was your relative or meaningful other?
    Yes, once again I walked a mile in that nurses' shoes.

    When a mistake happens, it is often something that could have been avoided but it is something which will live with you for a very long time.
    Agreed.

    I am not your judge, I am not your conscience and I am only playing devil advocate.

    Please please please do not cut corners because in the long run you may have cost somebody a lot more time, than you spared.
  10. Visit  lemur00} profile page
    12
    There's a reason "Work to Rule" is an effective labour resistance technique if followed consistently. Employers have policies and best practice guidelines primarily for show. They claim to be committed to such standards, but in reality no unit I have ever worked on has been staffed adequately to be able to follow them. That creates a win/win situation for them. When the standards aren't met and mistakes made, they can blame staff for not following them. If they are met and staff isn't getting all the work done they can blame staff for being slow, because others can get the work done (by cutting corners). In addition, following the policy isn't always the appropriate choice (this is why nurses are expected to use clinical judgement).

    So yeah. Having Everyone follow policy to the letter is usually a complete disaster.
  11. Visit  echoRNC711} profile page
    9
    Seriously???......

    The nurse who last tried this kind of perfection.... has now snapped, is in a four point restraint and is tended by a nurse unburdened by the need for perfection "

    Let's take a reality check. Robots may perform this way but I am very happily human!!
    FineAgain, canoehead, SwansonRN, and 6 others like this.
  12. Visit  JZ_RN} profile page
    14
    If the management weren't cutting corners by understaffing would we have this issue? That's the real question. None of us became nurses to kill ourselves working and be treated like garbage and give poor care. Get real.
  13. Visit  echoRNC711} profile page
    15
    OK blood starting to curdle....I feel a vent coming.

    Let's try something novel, the truth. I have worked on 2 continents nursing for the last couple of decades and I assure you every nurse has cut corners somewhere. Promoting this myth of perfection serves no one. It is not only dishonest to paint the picture of the nurse who is perfect every time it is quite frankly a disservice to the profession. It is attitudes like this that make nurses not fess up when they err when the climate portrays and expects perfection.
    Just look at the poor new nurses. What are we thinking. Not perfect...there's the door. God I would be petrified to be a new nurse in this climate. Zero tolerance. Its just brutal. No one and I mean no one can tell me they do it right everyday.
    So let me start the ball rolling. Forget to wash my hands, yes. Made medication errors yes. Told the pt, yes. Felt the wrath for making that mistake,yes. Next error I got the Dr. to write an order that covered me and I am not ashamed of it. Do I reflect,yes. If it is a stupid rule like the script hospitals have us say, no. I work under my own honor. I do the best that I can. I treat people how I wish to be treated.
    It sets me on fire that a climate has been created not to tell the truth. If I don't do my work I am honest. If I didn't do a dressinsg I admit it. If I don't want to do the next admission I say it. I say what's the truth "I am tired , or I'm feeling lazy, or I'm just too grumpy today "I don't care whose looking because what you see is what you get, a real person. Instead of all this perfection let's try trust. Work on establishing trust that the pt knows you are giving everything you have got.That we begin trusting each other. That management create an environment where trust is valued over making things look good. Lets give the care rather than writing stacks of paper on what we are meant to do. I do not believe that people are doing head to toe assessment because I have seen enough on pts to tell you they weren't looked at . Furthermore nurses on med surg have looked at me ga ga at even the thought of doing it. Your really lucky if the nurse is listening to pt lungs when they are admitted for CHF. Don't take my word ask your pt. Again,lets try some honesty. It is done in units but not on the floors. If anyone tells me "oh no,not me" .Then you are the exception
    We would have less law suits and paperwork if we actually valued forming a trusting relationships with pts. Why, because we miss the most basic thing we don't take the time to listen. People who feel heard ,validated forgive us the mistake of not washing our hands or forgetting an alcohol prep. Why, because they feel cared for.I simply can't take this holier than thou attitude. I absolutely think that when we harm pt,correct it, even sue but trying to make people perfect is just denying our basic humanness We are flawed. So lets just start focusing more on making an environment where people feel safe to tell the truth, room to learn, safe to be yourself without a camera hanging over you. Lets start with the basics give the best care you can. Forgive yourself when you don't and try for bettter tomorrow.
    not.done.yet, SleeepyRN, alotusforyou, and 12 others like this.
  14. Visit  RNperdiem} profile page
    13
    Yes to many things. I also have occasionally yelled at my kids, driven over the speed limit, parked over the 1hr limit, not eaten 5 servings of fruit/veg daily and other innumeralble things.
    I admit to imperfection sometimes.


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

Top