Doing too much for your patients? - page 2

by Virgo_RN

2,220 Views | 25 Comments

I'm beginning to feel that one of the reasons I struggle so hard to get my documentation done is that I am doing too much for my patients. For example, I did not get two of my systems assessments charted until after my shift had... Read More


  1. 0
    Quote from NancyNurse08
    I was lucky enough tonight to be working with an aide with a team attitude. She was proactive, anticipating patient needs, and responsive, answering call lights and assisting patients with their requests. Instead of waiting for me to ask her to do things, she would ask me if I needed her to do X,Y, or Z. What a difference that made!

    My patients weren't as heavy tonight either. That made a big difference too.
    Yes, I have the same problem. Truthfully, it's easier to just change the person rather than try to track down the aide and wonder all night if the patient was changed. Some just don't care. I know which ones I'll find wandering the halls trying to look busy and which ones I can count on.

    Some techs really won't do it if you don't tell them to directly. Others are self-directed and know what to do before you do.

    I make sure that at the beginning of the shift, I write the tech's cell phone number down and make sure that she has mine. If I call her and tell her what needs to be done for a patient and it still doesn't get done, I'll eventually get exasperated enough to mention it to the Charge Nurse.

    I've had to suggest or support a write-up of only a couple of techs who simply didn't want to do their job.

    I went home and I slept better knowing that the patient got changed and the work got done, even if it made me late to do it.
  2. 0
    Personally I would put my foot down on the aide to aide reporting.

    I fully support aides offering to inform other aides for the next shift, however there are little nuiances (watch BP if pt gets up to walk, empty foley frequently pt is on lasix tonight) that I like to get directly to my aides, and they appreciate it.

    I use a little half sheet chart I designed and I incorporate the normal things they need to know (activity, diet, VSS/Accuchecks) and then I add little details such as a turn schedule etc.

    I usually give it to them and then point out a few things. This cuts some time on giving a full report, they can look it over when they have a second, instead of when I have a second.

    I believe delegating like this not only covers your butt legally, but also creates a bridge between aide and nurse, making them more responsive when you call for help in a room, and most times more respectful between them and yourself.

    Teamwork is really a key to nursing, and knowing when to say I can't get that right now, but we will take care of you.

    Tait
  3. 0
    Aide to aide reporting is policy on my unit. Nurse to aide reporting, however, there is a lot of ambiguity as to whose responsibility it is. Is it the nurses' responsibility to seek out the aide and give them report, or vice versa? When I was an aide, my understanding was that it was my responsibility to check in with each nurse at the beginning of my shift. But now as a nurse, I'm not seeing aides do this. There are a lot of things that I did as an aide that other aides don't seem to do.
  4. 0
    Quote from NancyNurse08
    Aide to aide reporting is policy on my unit. Nurse to aide reporting, however, there is a lot of ambiguity as to whose responsibility it is. Is it the nurses' responsibility to seek out the aide and give them report, or vice versa? When I was an aide, my understanding was that it was my responsibility to check in with each nurse at the beginning of my shift. But now as a nurse, I'm not seeing aides do this. There are a lot of things that I did as an aide that other aides don't seem to do.
    From my stand point it is my responsibility to make sure my patients are delegated correctly for my nursing practice. Policy or no policy it is my liscense on the line when that person gets a bedsore because A Aide told B Aide that "we don't really have to turn him since he slides back to that side anyway".

    Also like I said, it builds relationships. Just let them know, "hey here I am and this is what needs to be done."

    Tait
  5. 0
    I know I've been retired 5 years now, but this reads like a normal and typical day to me.
    Patient care and pt needs ALWAYS overode any charting etc.
    Afterall, the reason we're there is the patient.

    I know this doesn't give you the answers you're seeking or the advice on how to time manage more effectively. I'm just sharing with you that this was quite common and par for the course when I was still working.
  6. 0
    Am I understanding that when report is given, it's not given to the entire incoming shift?
    Do you not all receive report together, at the same time? The team as a group hearing the handover?
  7. 0
    Quote from Angie O'Plasty, RN
    Yes, I have the same problem. Truthfully, it's easier to just change the person rather than try to track down the aide and wonder all night if the patient was changed. Some just don't care. I know which ones I'll find wandering the halls trying to look busy and which ones I can count on.

    I went home and I slept better knowing that the patient got changed and the work got done, even if it made me late to do it.
    Angie, can you help me understand something please?
    Is it not normal practise for nurses in the US to attend to patient care?
    I read posts whereby people mention aides doing this, that and the other, in relation to patient care. It seems to me that nurses are absolved from actually doing hands on patient care in many instances. I'm a bit confused as to just what the role of the nurse is in the US, in many instances. Does it not also encompass direct patient care as well as drug administration, charting etc etc?
    Thanks in advance and hoping you might be able to enlighten me.
  8. 0
    Quote from Grace Oz
    Angie, can you help me understand something please?
    Is it not normal practise for nurses in the US to attend to patient care?
    I read posts whereby people mention aides doing this, that and the other, in relation to patient care. It seems to me that nurses are absolved from actually doing hands on patient care in many instances. I'm a bit confused as to just what the role of the nurse is in the US, in many instances. Does it not also encompass direct patient care as well as drug administration, charting etc etc?
    Thanks in advance and hoping you might be able to enlighten me.
    Hi Grace,
    Often, we nurses are so overburdened that it's difficult to get a lot of hands-on nursing care done.

    In my hospital, the nurse's job is to assess the patients, dress wounds, interpret labs, report to docs, take off orders, check orders for accuracy, pass medications, and document. Some nurses have additional duties such as completing the NIHSS scale on stroke patients. RNs sometimes have to "cover" LPNs, who have a more limited scope of practice.

    CNAs are usually given task-oriented things like toileting and changing patients, doing fingersticks and vital signs.

    Some units use primary care nursing. No techs at all, just the nurse doing everything for the patients. I liked doing primary care because I knew what had been done for my patients and what needed to be done. I also felt that the patients got better, more professional care, to be perfectly honest. We had less patients to care for so it was doable.

    My current unit (and Nancy's) uses a team nursing model, which can be very effective if everyone does his/her job, but as Nancy can attest, if you have to work with a tech who's not doing her job, you wind up doing the work of two. With team nursing, there are less nurses and more patients. For instance, in the primary model, I'd have 5-6 patients but on the team model, I'd get up to 10 patients with a tech.

    I hope that helped answer your question. Somewhere around here awhile back, I seem to recall an excellent thread about what each nurse did all shift long that was extremely enlightening, but I cannot find it. If I can find it, I'll PM you with the link.

    Also, as far as handover goes in the hospital, it's pretty much general chaos. A general handoff would be too time-consuming, so each nurse gives a private verbal to the oncoming nurse. Techs are supposed to report to techs, as their assignments differ from ours. I always try to catch my tech early in the shift and get specific about what we need to do -- for instance, one patient might need a stool for CDiff, and the tech can collect and send it, while another might need ortho BP's, which also would be a tech duty.
    Last edit by Angie O'Plasty, RN on Jan 14, '08
  9. 0
    [QUOTE][Some units use primary care nursing. No techs at all, just the nurse doing everything for the patients. I liked doing primary care because I knew what had been done for my patients and what needed to be done. I also felt that the patients got better, more professional care, to be perfectly honest. We had less patients to care for so it was doable./QUOTE]

    This is the kind of nursing I'm accustomed to!

    Thanks for your reply, Angie. I now have a better understanding of how things work "up/over!"
  10. 0
    Quote from Tait
    Also like I said, it builds relationships. Just let them know, "hey here I am and this is what needs to be done."
    Tait
    When I see the aide, I do this. However, there are many times where one can search the entire 65 bed unit for the aide and not find them.


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