Dec 26, 2009, 04:50 AM
From my perspective in a rural hospital:
1) absolutely more staffing -- and don't just give us more nurses to take away telemetry techs, ICU techs, lab techs, etc. Look at the manhours required, and fill them by putting the appropriate person in the job, not just having nursing do everything including EVS.
2) If you have an ER, have a "fast track" -- that is, a 24 hr non emergency care room so that when you get the "cold sniffles n/v/d" group, you send them there, and keep the ER beds open for the folks with MI/CVA/HTN emergency/trauma. We're not going to fix people coming to the ER for nothing (and by that, I mean things that the average person would treat with OTC meds), so let's give them a place to go that's not an ER bed. I see a LOT of ER nurse burn out because they can't work on a really sick person due to all the non sick people who are pitching a fit about an earache.
3) Assign patients by acuity, not by open bed space or 'balancing the load across the shift'. If I've already got 2 terminal patients who will probably pass within my shift (or absolutely within the next), a screaming off the chain schizophrenic who the family wanted to have Christmas without Dad, so let's check Dad in with a complaint of "seizures", a possible new onset NSTEMI, please don't give me a person who comes in with the worst coag lab values I have ever seen because the poor demented thing couldn't remember if he took his Coumadin, so he took it again...and again...and again and is getting a gallon of FFPs. Aside from just the logistics of trying to look after really critically ill people who could have died in a heartbeat not to mention a crazy person screaming obsenities and attacking the staff that I couldn't calm down after enough Ativan/Haldol/Seroquel to calm an erupting volcano, it's emotionally taxing when you're watching two people die on Christmas Eve. And yes, that was how I spent night before last. Wouldn't it have made more sense to give one of my really critical people to someone who had self care patients, instead of me having people with neuro checks q2, restraint protocols, seizure protocols, flight risk, and a guy going into respiratory failure? I've had a day off, and I still feel worn out.
4) If I'm busting my butt for you (see #3), don't give me a bunch of BS about not clocking out on time because one of my patients was bleeding to death at the time. That's a great way to get me to never clock back in. And if I had left on time, you'd have jumped my tail about "leaving day shift in the lurch." Passive aggressive behavior should be grounds for immediate termination. And I don't mean the "you're fired" kind of termination, either.
5) If you can't give raises, give time off. Make me feel like you appreciate what we do, not stand up in a meeting and say, "any time you're not happy, remember we'll have new grads coming at the end of the semester." And yes, the person who was told that in response to question about patient safety in the ICU did quit. Wonder if they were surprised?
6) This can be a rewarding job, or a completely horrible one, based off what's gone on your prior shift. If you've had a new just off orientation 2 weeks nurse who had a bad shift (patient death, high acuity, just a bad, bad shift), give him or her a break and don't give them the most tore up people on the floor. I've seen a lot of new nurses burn out because people just kept pilling bad patients, bad families, bad docs on them, while they see the rest of the shift lounging in the nurse's station, and they don't get help and support. Don't give them a free ride, but you know if someone's had a crappy couple of shifts -- give them a break.
Finally...treat each other with the same respect and compassion we are expected to give the patients. If you want to have nurses, work as hard to keep them happy as you expect us to do to keep the patients happy. That's not too much to ask for, is it?
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