Lets be hypothetical

alansmith52 · Sep 1, 2002

I know this feeling. I used to work at nursing home and could never get it all done. they expected us to sign that we had even when we didn't... I left.

ohbet · Sep 1, 2002

Thanks alansmith52,

But lets say,hypothetically,that quitting is not an option.

nursecheryl · Sep 1, 2002

Than hypothetically you'd have to change things with administration. If it is your duty do to the treatment and it dosen't get done than you have not followed a doctors order, in that case md needs to be notified and this must be documented. As a nurse it is your responsibility. If you can't get things changed with the management to get more help then the only other option is to get another job. Believe me this is always an option. I would not stay at a place that puts my licence or the lives of my patients at risk. Lets say hypothetically it is your child, husband or sibling/parent who missed the treatment...what would you expect that nurse to do about this problem. Just hypothetically of course. Tell your administrator they do not have enough staff to get things done in writing, be sure the doctor in charge of your unit is notified and if all else fails you must quit

Brownms46 · Sep 1, 2002

I think would then stay and do them. Why? Because if you can't get all your txs done during the 8 hrs of your shift..why should the next nurse be expected to get them done during their shift?? If it's just one or two tx...ok. But not anymore than that. But then again.... if it's just one or two tx...then I see no reason why the they couldn't be done before that person left!

I rarely ever pass on something for the next nurse to do. I only do so...if after I go to do them...and they say no...they will do it. Or if I'm waiting on something that isn't available yet...and I can't do it! Even if I get a new order...I will try and get it done..before I leave. I guesss I just feel guilty about leaving anything for someone else.. :cool:

Jenny P · Sep 1, 2002

Ohbet, I HATE the excuse that they can't "afford" another nurse to do teatments, etc. YOU CHARGE THEM for the overtime; and every other nurse who is staying over should also! That is time-and-1/2-pay; instead of them paying all of you time and 1/2; they should be able to afford to pay someone to work 4 hour shifts to do treatments. There are nurses out there who love to do 4 hour shifts! If people are staying and finishing their treatments and not charging the facility for the work they are doing; then they are their own victims! I've "donated" many hours in my life doing the "finishing up" on my shift; it is a sure way NOT to get the help you need, because the facility has all of these people working for free.

Nurse Ratched, RN · Sep 1, 2002

Let's say one is staying OT on the clock to do the tx's. No problem, and the facility is paying anyway and should look at the OT as reason to pay someone else straight time. As Jenny said, if one is staying off the clock because the facility won't pay, then one is setting up herself for having to continue to do it. If there are treatments that there is no way on God's green Earth are going to get done in a normal shift simply because of the sheer volume of work, then _repeated_ documentation to that effect must be submitted to the administration, with copies kept by the nurse. The options should be submitted as well: (1) you can continue to pay one person OT who is quickly burning out or (2) hire someone else. At that point it becomes incumbent upon the facility to insure that there is sufficient staffing to provide for the patient's needs that they claim to be able to meet.

I am confident that the hypothetical person is as organized as possible and is just horrendously overburdened. Management can claim ignorance of that fact until formal and frequent objections are made.

A person in such a situation might also enlist the aid of the MD's, who would no doubt be very interested to know that management is not providing adequate nursing staff to meet their patient's needs. Sometimes the big wheels have to squeak in order for anything to happen. Doctors at one facility where I worked managed to force staffing matrix changes when they saw that nurses were running top speed and still not able to meet all their patients' basic needs.

I do feel for you. We are each of us only human, with no more than two arms if we're lucky.

ohbet · Sep 2, 2002

Thank you so much for those help ful replies.Would the documentation be done on an incident report? or would it be done just writing free hand what is happening?

sharann, BSN, RN · Sep 2, 2002

Why don't we hypothetically say there is a continueum of care in nursing. Then hypothetically say , oh why not, why don't we just have one shift do everything. Then the next shift can just stay at home. No one can do it all in 8 or 12 hours (given standard staffing nowadays). Lets do our work, but not tear eachother up. Isn't there a supervisor who can do that for us?

Youda · Sep 2, 2002

I agree that if something isn't done, a doctor's order was not followed, and then you must call the physician and document it into the legal records (including who you notified, the time, and their response, and WHY it wasn't done - and be careful with that one, because you can't document that you were tired or didn't have time). But, if you had do all that paperwork for each missed treatment, then you had time just to do the treatment. Stay over and finish the treatments and charge your facility the overtime. It's the best way to protect your license and your patients.

Now, here's one option you may not have considered. When a doctor writes an order for a treatment, s/he generally says to do it QD, BID or whatever. The MD only specifies the frequency within a 24-hour period. It is the NURSE who notes the order who, arbitrarily, assigns the times to do that. Sometimes that depends on a facility's policy, such as all QD orders will be done on the day shift at 08:00, or whatever.

The point is that you could go to your admin or DON and let her know that you are having trouble getting everything done and could she, please, redistribute some of the treatments so that more fall on the other shifts, including the night shift. (Don't expect this to be a popular idea with the other shifts, though, if you are working somewhere where the oncoming nurse is unwilling to pick-up where you left off.)

Another option is to delegate the task to someone else, if possible.

Another option is to organize better. Have your CNAs (assuming this is LTC) know who gets treatments and make it a rule that right after breakfast, or whenever, they are to lay these people down, make sure they are clean and dry, so you can whip down the halls and do them as quickly and efficiently as possible. If it is a particularly hectic day or facility, let your office manager know that you will not be available to take calls or be interrupted for the next _________- (timeframe).

Maybe some of those ideas will help.

Good luck! :)

Nurse Ratched, RN · Sep 2, 2002

Sharann, I don't think anyone was tearing up Ohbet. Again, the limitations of the medium may have us coming across as harsh without intention. We have all been there. The problem is that she has too much work to be done by one person in a single shift. I'm betting that the same exists on other shifts as well. In one of the examples given, if there are BID dressing changes to be done, it seems reasonable that a certain amount of time should elapse between dressing changes, thereby making passing it to the next shift unreasonable (or risk it only getting done once per day, which is not what is supposed to be happening.)

Ohbet - where to document is a good question. Technically, if something is not done for whatever reason, it should go under an incident report. However, those don't really capture the scope of the problem, and a freehand objection might be more appropriate. I would suspect that a detailing of the tasks expected for that shift (hard numbers - 10 dressing changes, med passes on x people, charting on x people, whatever) would be most useful. Ideally, everyone who is similarly unable to complete everything (presumably everyone) would do the same. You may have to be prepared for the fact that others who are not completing tasks may simply be signing them off, as happened in alansmith's facility. Administration doesn't like to hear this sort of thing. Maybe they'll respond, and maybe they'll just invite you to go somewhere where the work load is more conducive. I don't know. I also don't know your circumstances or why perhaps different employment may not be an option right now. Whenever we take a stand, we must be prepared that someone is not going to like it, and that someone is probably the person who has the ability to change things and chooses not to.

It all comes down to choices. Management CAN hire a treatment nurse; they simply choose to spend the money elsewhere. We can leave a situation; it may simply be more comfortable to stay, and that's perfectly understandable, too. We all know you are working as hard as you can.

nimbex, RN · Sep 2, 2002

nurse ratched raises some excellent point and suggestions to ponder. We keep revamping time flow studies or hours per patient day, AKA acuity. Although gererally imperfect, this is used as an indicator to score the patients to determine staffing... staffing per this acuity isn't written in stone..as it has flaws.

long story short.. does your facility have some way to measure hours of patient care per nurse? This is a great first step.. when each and every day the basic treatments cannot be performed..

Which leads to second point... you ARE responsible for treatments not done, if the second shift does not complete it.

We do 24 hr. chart checks (this is acute care). Any care not done, should go on an incident report. My report asks for contributing factors, short staffing, lack of experience many other varriables are on it. Goes to performance improvement where they monitor and make suggestions to admin. never a disciplinary measure unless a med error, which only results in verbal counceling, discussion and attempts to prevent in future.

We've all been where you are... doesn't make it easier on you... hurts to hear it's occurring. Let us know what you decide to do... For the patients safety and your licensure safety... it can't continue