Shortcuts

[ohbet]

It would be helpful for me to know,when your jamming at work and unexpected crises comes up on the floor,then you start falling behind,lets say falling behind with meds, what shortcuts do you take to catch up?

[RNPD]

Donna-thanks for the further info re possibly delayed onsets and peaks in the elderly/compromised patient. I didn't know that but it is valuable info.

As for that unsafe nurse-you did what you could, and have nothing to feel guilty about. I have seen several instances in my career where the hospitals cover for unsafe, dangerous practioners-docs and nurses. I don't understand it, but I continue to report incidents as they occur, even if I doubt anything will be done. If you keep documentaion, no one can accuse you of a cover-up after the fact when the dangerous nurse makes a mistake too serious to ignore!

Just as well to not be working there any longer. It is a shame that someone obviously unsafe is allowed to continue practicing, but you did all you can do.

Good job with the heplock incident. All too often, some nurses wait for the last minute or the next shift, often to the detriment of the patient. You sound like a truly caring nurse and patient advocate!

[Jenny P]

Donna, did you consider telling the State Board of Nursing or the Department of Health about this nurse? If she is as unsafe as you say and the management of the facility won't do anything, the patients are at risk with her there and it wouldn't hurt to report her. I would be worried about the patients lives with someone like that on staff at any place I had worked at.

[IluvMyPtsPeriod]

Hi Jenny....Yes I had considered it, and about a week ago I did in fact report her! Thank you for the confirmation. The last thing any nurse wants to ever have to do is report another nurse....but to be honest with you, this girl is not a nurse in my book. She does not care about anyone but herself.

I have to tell you that this has truly been a bad situation.

Donna

[Mijourney]

Hi. I feel that another way of managing your workload competently is to engage friends or family, if possible, in assisting with patient care. Far too often, we let friends and family "visit" instead of interact. Yes, we are very busy, but nurses are responsible for seeing to it that patients, families, or friends, if allowed, are active in the patients plan of care. Instead of calling the nurse to pour that cup of water, why can't the family, if able, get it? Is it possible that the family can help the patient put on a fresh gown if it's not complicated? What about changing linen on a bed if passed initial supervision by a nurse?

In home health, I've seen amazing things done by some of my caregivers. They have delighted me with their interest and participation in patient care. These caregivers are keenly aware of their primary responsibility and accountabiliy to their loved ones.

[jamistlc]

Originally posted by purplemania

The Nurse who cannot prioritize his/her work will be strongly criticized. The main thing is to keep the main thing the main thing. I set aside charting and have even answered "no" when someone asks for a snack, etc. till I get caught up. Ask for help from other nurses and be available for them. If necessary, go back to Maslow's and determine what your priorities are from that. The best thing is to plan ahead at the beginning of the shift and get done all the nick-picking things when things are at a lull. Don't put off tasks or they may build up on you.

Thats the way to do it! I agree!:)

Peace,

Jami

Have a Blessed Day!

[LPN_mn]

I am also an agency nurse and see lots of negligent things that LTC nurses do. I was working at a nursing home in MN. I went into work the evening shift and was told at report that Mr. John Doe had been given some MOM and had a very bad allergic reaction. The worse thing was that the man had a iliostomy. I am still trying to figure out why the nurse gave an iliostomy resident a laxative. Maybe someone can help me out here. In the same facility they had a man dying of cancer and was giving him .50ml of roxanol even though he could have up to 1ml. The man was having this amount every hour. On my shift I gave him the 1ml. every hour and the nurses coming in on the day shift were very upset that as an agency nurse I took it upon myself to increase the amount of pain med that was being administered. But I bet that is the best noc sleep he had before he died.

[drBerry]

Regarding use of a hep-loc. I thought they were a great idea until I was admitted as a patient recently. I had 3 inserted, all (despite flushing) developed clots and infection at site of insertion. I asked to have it removed and the nurse on duty refused and said she would not have patients on her floor without one. So I had to remove it myself with assistance of an older experienced nurse.

[medsurgrnco, BSN, RN]

I read your post as wanting to know what shortcuts nurses take when the unexpected crisis situation happens that causes you to fall way behind. The only shortcut I will take with meds is to get all or several pts' meds out at the same time - but I put them in separate plastic bags and check them with the MARS and pt nameband before giving them to pts. When I am jammed, I know I am more likely to make a med error so I slow down when giving meds. Ask the charge nurse, other nurses, and the CNAs for assistance - sometimes being specific with task(s) you would like them to do works better than a general request. I shortcut assessments by not turning pts to look at the backside if I have had the pt before so I can be reasonably certain I won't miss anything. And I let pts know that I had a crisis situation with a pt so I need to rush, so they are less likely to want to talk or ask for some item. I am briefer in my documentation and in my report to the oncoming nurse. I also typically postpone documentation till I feel caught up, so if a crisis situation happens my documentation gets postponed further but hasn't caused me to fall further behind initially. Hope this helps.

[lpnflorida]

This is my short cut,however it is not a medication short cut. Coming out of report I first look at my MAR, I have my own work sheet which I have used forever on which is listed rm/ pt name. blank space ( in this space I use a series of things like check marks ,stars etc. which indicate to me what aspect of my charting I have completed) then each and every hour has a space, followed by blank space of prn med, or things to recall. I put a big M in the appropriate hour for med due, or feeding etc.... this is my shortcut for the entire day. It allows me at a glance to know what I am doing each and every hour, new med order I write it in on my one piece work sheet,, as patient condition changes my priorities will change, but I can glance at my board and let someone else know to give such and such med if I am tied up with an emergency. I also before I also on first rounds/assessment make a mental note what items I need to bring back into the room with later so that I will not have to be making multiple trips back and forth, wasting my time and frustrating myself.. These are my short cuts, which are nothing more than organization skills which work for me. Develop what organization works for you.

While my marks for charting might sound stupid at first. Again at a glance I look and see for each and everyone of my pts that I either have already, or have not charted my assessment, the teaching note, updated care plan, etc. I also do not wait to chart prn meds I do them as I go, another time saver for me.

As I see and interact with patient I will jot a small note on my PCP ( patient care profile/ otherwise not unlike cardex for those of you who have a different set up) that allows me to give accurate reports to doctors and on coming staff.