Do you cut corners in your daily nursing practice? - page 3
by madwife2002 23,430 Views | 109 Comments Senior Moderator
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 mean always follow the correct... Read More
- 0Dec 8, '12 by OnlybyHisgraceRNDo 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.
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.
Do you manage your hygiene, the correct procedure for changing IV fluids, remaining clean/sterile when changing dressings?
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.
We do see frequent mistakes made because we don’t take our time.
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?
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.
Often causing patients an injury, we have an obligation to provide each patient with high quality care always.
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.
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.
- 12Dec 8, '12 by lemur00There'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.
- 8Dec 8, '12 by echoRNC711Seriously???......
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!!
- 13Dec 8, '12 by JZ_RNIf 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.
- 15Dec 8, '12 by echoRNC711OK 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.
- 13Dec 8, '12 by RNperdiemYes 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.
- 2Dec 8, '12 by Ntheboat2I don't always wash my hands when I take off gloves. I'll pull them off and throw them in any trash can I can find while I'm running to do the next task. Washing before putting on gloves and then after is a bit overkill IMO...especially if you're going to wash again before you go into another room. Technically, if you do things the "right way" and the rooms are 3 feet apart then you would take off your gloves, wash your hands, wait for them to dry, and then wash them AGAIN because the last time counted as the washing that was supposed to be done after removing gloves and not the washing before entering a patient's room, yes? That's just goofy.
- 4Dec 8, '12 by madwife2002 Senior ModeratorMy article was designed to get you thinking, it is not about persecution of the nurse.
I can feel your blood boiling, but you have to think about how easy it is to make a mistake
As nurses we are poor communicators and we have poor managers or hierarchy, the expectations from companies we work for, are that we can manage and cope.
If we all stood together, vocalized our disgust and inability to manage, we might be able to make changes
Unfortunately there are expectations and governing bodies are checking our care and are quick to judge.
New changes from medicare and medicaid, mean payment for performance, money is taken away instead of given so we will see more stringent measures in place. These government bodies think if they hold money back that it will force health care facilities to improve their care, but I do not believe this will happen. It will just cut jobs and those left behind will have to work harder with less resources
I want to live in a world where we are free to practice without worry or looking over our shoulder but sadly I do not live in this world.
- 2Dec 8, '12 by tokmomQuote from Ntheboat2Put yourself in the other pt's room that is three feet away. A nurse walks in the room and doesn't wash her hands. Are you going to A) Ask her to wash her hands because you, the patient, did not see it?I don't always wash my hands when I take off gloves. I'll pull them off and throw them in any trash can I can find while I'm running to do the next task. Washing before putting on gloves and then after is a bit overkill IMO...especially if you're going to wash again before you go into another room. Technically, if you do things the "right way" and the rooms are 3 feet apart then you would take off your gloves, wash your hands, wait for them to dry, and then wash them AGAIN because the last time counted as the washing that was supposed to be done after removing gloves and not the washing before entering a patient's room, yes? That's just goofy.
B) Assume she did and say nothing? C) Say nothing because you don't want to offend her?
Nobody is touching me without washing once they enter the room. I don't care if the washed their hands 3 feet away. If it's not done in front of me, nobody is touching myself or my kids.
- 5Dec 8, '12 by Ntheboat2Right....so you're going to throw your gloves into the trash and then wash your hands outside the door and stand there while they dry so you can walk in the room and immediately wash them again?
Or...you're going to throw your gloves away and then wash them outside the door/as you walk into the room? Or throw your gloves away and use the dispenser inside the room? Either way...it's the same thing.
I've not seen a person yet who throws their gloves away, washes their hands while they stand outside the room and then walks into the room where they'll immediately be washed again.