Use it or loose it.

  1. I usually work on an alzheimers unit,I enjoy it and am comfortable ,however my nursing skills are diminishing,use or loose it kind of thing.
    So I asked to be rotated to some other floors with a higher acuity to maintain and learn new skills.
    How would you deal with the following hypothetical situation?
    Its 1000,A new patient has to be admitted,there are still schduled meds,28 pts. ,each one with alot of meds , an order to start an IV,and a restart IV , 6 tube feedings that need to be given, and BID treatments that need to be done.
    So what would you do first,then second,etc. and etc.?and keep in mind your a nurse who has worked with alzheimer residents on a Long Term floor for a long time ,so this hypothetical situation is not a piece of cake.
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  2. 11 Comments

  3. by   Vsummer1
    Ummm... 28 patients?
  4. by   ohbet
    Yep.
  5. by   WashYaHands
    1. Go to bathroom, bang head on wall.
    2. Give all meds (rationale: if you dont give them on time you could become part of a research study which inidicates that 75% of your med passes are errors because they were late).
    3. Go to bathroom, bang head on wall.
    4. Tube feedings (people need nutrition, otherwise you'll be having to start more IV's for hydration and have to explain to family members why their loved one hasnt been fed).
    5. Start IV's and restart IV. (appease the doctor Gods).
    6. Go into bathroom, bang head on wall.
    7. Admit patient.
    8. BID treatments.
    9. Explain to supervisor why you had to clock in overtime hours.
    10. Go to bathroom, bang head on wall.

    I don't envy you, Ohbet. Hang in there!

    Linda
  6. by   cactus wren
    Registered: Aug 2001
    Location:
    Posts: 361
    (Post# 4)

    1. Go to bathroom, bang head on wall.
    2. Give all meds (rationale: if you dont give them on time you could become part of a research study which inidicates that 75% of your med passes are errors because they were late).
    3. Go to bathroom, bang head on wall.
    4. Tube feedings (people need nutrition, otherwise you'll be having to start more IV's for hydration and have to explain to family members why their loved one hasnt been fed).
    5. Start IV's and restart IV. (appease the doctor Gods).
    6. Go into bathroom, bang head on wall.
    7. Admit patient.
    8. BID treatments.
    9. Explain to supervisor why you had to clock in overtime hours.
    10. Go to bathroom, bang head on wall.

    I don't envy you, Ohbet. Hang in there!

    Linda



    you hit the nail on the head, couldn`t of said it better....
  7. by   Nurse Ratched
    Originally posted by WashYaHands
    1. Go to bathroom, bang head on wall.
    2. Give all meds (rationale: if you dont give them on time you could become part of a research study which inidicates that 75% of your med passes are errors because they were late).
    3. Go to bathroom, bang head on wall.
    4. Tube feedings (people need nutrition, otherwise you'll be having to start more IV's for hydration and have to explain to family members why their loved one hasnt been fed).
    5. Start IV's and restart IV. (appease the doctor Gods).
    6. Go into bathroom, bang head on wall.
    7. Admit patient.
    8. BID treatments.
    9. Explain to supervisor why you had to clock in overtime hours.
    10. Go to bathroom, bang head on wall.

    I don't envy you, Ohbet. Hang in there!

    Linda
    Where in the queue should we put "Find new job?"

    Holy cow.

    Other than that, I think your prioritizing and rationale are right on track.
  8. by   micro
    1) go to the bathroom,
    2) bang head on wall,
    3) take a deep breath,
    4) go out, do a quick hi and how are you to the admit
    including a quick what is necessary to the admission paperwork and orders, if you cannot delegate this off, come back after the scheduled meds and tf done....(delegate laterally, and upwards)
    5) on the iv orders and the restart iv, is it for continuous fluids or for a saline/heparin lock.....if only for a lock....this goes on the back of your priority list.....
    6) as quickly as possible give the scheduled medications as closely to the time that it is ordered(actually usually it is not in the fact that it is ordered at a specific time, but that a specific time must be listed to give.....and then technically you only have an hour before and after in the legal scheme of things......
    in reality, you know what safe medication administration is.....
    adjust schedule if necessary, but this is for a later time on the priority scale........
    7) ensure tube feedings and hydration.........
    8) attempt to delegate tf's and treatments to someone else.....if not able to.......tf first then treatments..........
    9) know that what "they" are asking you to do is not ideal nursing and not possible to do..........make the adjustments you need to make within your nursing practice........are you comfortable with it in your heart and your vision of your scope of practice........
    Yes= continue on and develop more of your own pattern and style in your day to day.....it can be done.........
    No= finish out your day.....as best you can, talk to your immediate supervisor, give appropriate notice or change back to unit where you came from.......

    and if it is skills that you want to retain or relearn, or learn.....maybe consider changing to a hospital setting/unit.....
    but realize that things are not ideal in the hospital either.........

    do i have any answers, no.....
    do I have survival techniques, yes.......

    28 residents is manageable, unless something/anything happens to throw it out of whack........

    micro
    Last edit by micro on Sep 15, '02
  9. by   ohbet
    Thank you ,thank you and thank you for the feedback,more is good if available,oh yes,new job not possible,as the only other job in this rural area is even more demanding.
  10. by   adrienurse
    I don;t know, that Alzheimer unit's looking better all the time.

    Seriously, this is the way I'm looking at it. Skills can be relearned if you want to relearn them. One learns different, and less tangeable (less recognized as well) skills working on a dementia unit. It is a true subspeciality. If the suits force you to float to another unit and you are caught without the necessary skills-- that is their problem. They need to find someone to work the necessary IVs/traches/respirators etc that knows what they're doing. I'm not going to lose sleep over this.
  11. by   BadBird
    Well I would ask myself what is emergent, are the treatments needed to be given Resp. tx. is anyone short of breath or wheezing. Next would be the med. pass, I would pass all antibiotics and pain meds. What is the new admit diagnosis, anything that can wait or do they just need to be put in the room, vitals taken, is it a monitored unit. Are the IV start and restart for antibiotics now or could that wait. How many of the 28 patients do you have and how many assistants are available. Do the nurses aids take vitals? Are there LPN's that could start the med pass except for the IV's. Do you have anyone to delegate to. If you are stuck with 28 patients OMG that is so unsafe. Ok let's say you have a LPN have her do the med pass then treatments, then tube feeds, You do the IV meds, IV restarts and admission data base then help the LPN finish.
  12. by   globalRN
    I would call and get some help with your load.
    If that is not a possibility:
    ASSESS and then prioritize
    In order to prioritize you also need to assess your new patient's acuity and needs.
    If you do other things while the patient remains unassessed and said patient became compromised and bad turned to worse...not a good scenario.
    Otherwise you have had very sound advice from previous posts..
  13. by   canoehead
    I would go with the airway, breathing, circulation thing- what would kill them, what would make them sicker, and what would be merely uncomfortable if I didn't do it first? Prioritize based on that. But I would also keep in mind items like pain control that if you don't give the pill on a "high" priority basis you will end up spending an hour later starting the IV, titrating pain and nausea meds.

    ...and of course the lady that "needs" her MOM or the call light won't stop ringing, then calls her family claiming neglect
    ...the guy that wants his back rubbed or he can't sleep, wanders all night, falls on his noggin,

    and the paperwork that will bounce right back to you if each hole isn't filled in just right.

    ARGHHH I'm getting a headache.

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