Rules for Med-Surge

whitecap1 · Jan 22, 2007

I just want patients to know that sometimes we come in and ask you to do funny things...squeeze my fingers, lift your leg, look this way, that way, whatever. Just know that this is part of our assessment. We know nothing is wrong with your legs, but it is part of your neuro assessment, or whatever. Please just follow the instructions. Don't say...."I came in with diabetes...do you even know what you are doing?? Nothing is wrong with my eyes, legs, head, etc."

Oh...and I know that it is funny putting a number to your pain. but you still have to give me a number. You can also explain that "well, its not really a number, it is just bothering me a little when I move" That is good to know and I will keep that in mind....but I still need a number to put into the computer. Thank you!

General E. Speaking, RN, RN · Jan 22, 2007

Please describe your pain. Burning, dull, pressure, heavy, sharp, throbbing, etc... "It hurts" isn't an option on my paperwork! (though I have written that in quotes when the patient can't be specific)

freestylepnoi · Jan 25, 2007

Second, on the be specific in what you need, I feel when patients say I need to speak to a nurse and finding out after I get in the room that all you wanted was a glass of milk, socks, etc that really makes our job difficult, believe me if I didn't have 10 things happening at all at once, I'd do it myself, but most of the time, the CNA can easily accomodate those type of requests.

Do not wait too long to ask for pain medicine, I feel like the faster we can manage the pain (or earlier) it saves patients needless pain later on. Another one, is if there are things you need or want, let us know, true story, pt. ask for some juice, i came into the room gave them juice, and then she requested a fork,brought her a fork before I can even step out the room, she wanted extra towels, I do my best to keep a smile, nod my head and say "no, its ok, ill get it" but many people can understand that it does get you just a little agitated.

Last but not least be patient, we can't just appear the second you need us (unless its an emergency)

RNsRWe, ASN, RN · Jan 26, 2007

Please don't complain to the supervisor that you were kept waiting with a call light on for twenty minutes, when it was five.

When we are working with your roommate, please be patient, your turn is next. Or, conversely, if we've been working with YOU frequently throughout the shift and your roommate finally needs something, don't be a total hog on their time. They have rights, too.

OH! And speaking of roommates: if you are NOT in a private room, please don't squeeze every last person you know on Earth into the room during visiting hours. Be mindful of the fact that the person on the other side of the curtain (that one of your visitor's kids keeps playing with) is sick or hurt and needs time to rest, too.

arizonanurse · Jan 26, 2007

1. Put your light on when you're in pain. Don't worry about bothering me, it's my job. Don't wait till it gets so bad that nothing can get it under control.

2. If I ask you to put your light on if you throw up, PLEASE PUT YOUR LIGHT ON WHEN YOU THROW UP. Do not wait till the doctor gets in and tell him you've been throwing up all morning. I'd rather hear about it from you than from the doctor who wants to know why the heck nothing was done earlier.

3. If you're a patient's mother and I ask you to let me know when your baby has a diarrhea diaper so I can look at it, PLEASE do so. I know you're only trying to be considerate by changing it yourself, but I really honestly do need to see it.

4. If you're on a clear liquid or NPO diet, please follow it.

5. Watch your IV site periodically, and if it starts swelling up, put your light on. (It's REALLY nice when patients do this - I caught a Vanco infiltration very early this way.)

6. If you see a little 1 cm air bubble in your IV tubing, you don't need to freak out - it's fine.

7. Be patient if we can't get to you right away - but if it's been awhile, put your light on again. We do forget sometimes.

8. Write down your list of questions for the doc so you remember to ask him everything when he comes in.

9. I don't know when the doctor will get here. No really, I honestly don't.

10. See # 9

irishnurse67 · Jan 29, 2007

1. If you are able to wipe your bum, raise the HOB, feed yourself, etc, please don't be surprised if I politely decline to do these things for you.

2. Family members, please see #1. While I'm at it, I know it's my job, but if you see me running around like a chicken w/it's head cut off, I'd be ever so grateful if you assisted w/easy things like pillow fluffing and water fetching, etc.

3. If you are up ad lib, easily moving around the rm, please don't climb in bed and then ring for a boost.

4. Please use the call light instead of hollering into the hall if you are A&O.

5. Please don't ask me to fetch snacks for your guests.

6. No, I don't have time to give you a massage and if I did, I'd use that rare opportunity to actually take a lunch.

7. If Grammy wants to keep her underwear on under her johnny, I"m going to let her do it, even if you don't like it.

8. If your mother codes, don't tell me during the code that you just can't believe she hasn't been washed yet. You won't like my response to you.

9. If you develop cellulitis after admitting that you shot up w/a dirty needle and then you ask me why it happened, don't report me to administration when I say, "Because you shot up w/a dirty needle."

10. I won't revolve my schedule around your numerous, lenghtly phone calls.

11. If a dsg change is due at 1000, it may happen anytime between 0900 and 1100 and that's okay.

12. If you are practically obtundant and have a low BP, don't get mad when I don't give you Dilaudid.

13. No, you can't go out and smoke.

14. Yes, I do need to take your hep lock out when you are discharged.

15. If someone is SOB, don't get mad when I tend to him first and then reposistion your father who wouldn't be here in the first place if you hadn't neglected him so severely.

16. It's not my fault that you didn't fill out the medicaid paperwork that the welfare office periodically sends you. This is why the pharmacy didn't give you your scripts for "free." BTW, we're hurting for CNAS here and the training is free and the job comes w/full bennies! (hint, hint)

17. If you just had surgery, it's important, to me at least, that you ambulate. I will help you and give you as much dope as I can, but I have to be sure you walk. I have to listen to your lungs and heart and belly and ask you about your gas. I'm sorry that the nurses keep doing it. I've explained what a DVT is and what pneumonia is and what an illeus is. I don't want you to get these things.

18. Please don't get mad when your HS meds are given to you an hour later than usual if you refuse to know what your meds are. I need to call your pharmacy, wife, etc and that takes time. This goes for A&O pts, of course.

19. I know it's not your fault that we're short-staffed, but it isn't mine, either. I have to prioritize and sometimes that means my pts won't get the full spa treatment. You will , however, get the care you need.

20. If you are chatting on your cell that has every feature imaginable dressed in head to toe Hilfiger and then your kids come in w/private school uniforms w/your wife who brags about how she could never be a working mom while talking about the new house and Hummer you bought, don't tell me to hurry up b/c your insurance pays my salary. I will also find this is ironic when I see that medicaid is paying your bill.

21. If your chest is bruised and your nose is red from a code (caused by your OD), don't complain, just thank me for saving your sorry ass.

22. To all of the intelligent, kind pts out there who appreciate nurses and treat us w/respect. I tank you. I'm glad that patients like that are in the majority.

christvs, DNP, RN, NP · Jan 30, 2007

Please be specific. "I need to see my nurse" sometimes means "I want another carton of milk or I dropped my straw" There are usually techs nearby who can help while I am on the phone with a MD or administering pain meds for another.
I have to prioritize. I cannot be in 4 places at one time. If someone has chest pain or another emergency, they will come before your need to have your arm wrapped for a shower.
I really don't know when the doctor is coming. I can give you an idea of when they usually round, but my magic 8 ball doesn't work at the hospital. (If it gets really late in the day, or if my patient need something- I will call.) However, I will NOT call the doctor at 0745 to find out when they will be arriving.
Remember when your doctor says you can be discharged, he/she still has other patient's to see, he/she has to take the chart and dictate, write the Rx, etc. I am the last one in line to get the chart so it will be a little while before I actually get to do your discharge paperwork. I still have other patients to care for. Their needs are just as important as yours.
I am acutely aware of customer service and try to address all my patient's needs in a timely manner, however, nursing duties will always come first with me.
some of these sound heartless (gulp)

Oh my Gosh, everything said here was perfect!! These are my biggest pet peeves as well! Well said. :)

NurseCherlove · Feb 3, 2007

1. If you are able to wipe your bum, raise the HOB, feed yourself, etc, please don't be surprised if I politely decline to do these things for you.
2. Family members, please see #1. While I'm at it, I know it's my job, but if you see me running around like a chicken w/it's head cut off, I'd be ever so grateful if you assisted w/easy things like pillow fluffing and water fetching, etc.
3. If you are up ad lib, easily moving around the rm, please don't climb in bed and then ring for a boost.
4. Please use the call light instead of hollering into the hall if you are A&O.
5. Please don't ask me to fetch snacks for your guests.
6. No, I don't have time to give you a massage and if I did, I'd use that rare opportunity to actually take a lunch.
7. If Grammy wants to keep her underwear on under her johnny, I"m going to let her do it, even if you don't like it.
8. If your mother codes, don't tell me during the code that you just can't believe she hasn't been washed yet. You won't like my response to you.
9. If you develop cellulitis after admitting that you shot up w/a dirty needle and then you ask me why it happened, don't report me to administration when I say, "Because you shot up w/a dirty needle."
10. I won't revolve my schedule around your numerous, lenghtly phone calls.
11. If a dsg change is due at 1000, it may happen anytime between 0900 and 1100 and that's okay.
12. If you are practically obtundant and have a low BP, don't get mad when I don't give you Dilaudid.
13. No, you can't go out and smoke.
14. Yes, I do need to take your hep lock out when you are discharged.
15. If someone is SOB, don't get mad when I tend to him first and then reposistion your father who wouldn't be here in the first place if you hadn't neglected him so severely.
16. It's not my fault that you didn't fill out the medicaid paperwork that the welfare office periodically sends you. This is why the pharmacy didn't give you your scripts for "free." BTW, we're hurting for CNAS here and the training is free and the job comes w/full bennies! (hint, hint)
17. If you just had surgery, it's important, to me at least, that you ambulate. I will help you and give you as much dope as I can, but I have to be sure you walk. I have to listen to your lungs and heart and belly and ask you about your gas. I'm sorry that the nurses keep doing it. I've explained what a DVT is and what pneumonia is and what an illeus is. I don't want you to get these things.
18. Please don't get mad when your HS meds are given to you an hour later than usual if you refuse to know what your meds are. I need to call your pharmacy, wife, etc and that takes time. This goes for A&O pts, of course.
19. I know it's not your fault that we're short-staffed, but it isn't mine, either. I have to prioritize and sometimes that means my pts won't get the full spa treatment. You will , however, get the care you need.
20. If you are chatting on your cell that has every feature imaginable dressed in head to toe Hilfiger and then your kids come in w/private school uniforms w/your wife who brags about how she could never be a working mom while talking about the new house and Hummer you bought, don't tell me to hurry up b/c your insurance pays my salary. I will also find this is ironic when I see that medicaid is paying your bill.
21. If your chest is bruised and your nose is red from a code (caused by your OD), don't complain, just thank me for saving your sorry ass.
22. To all of the intelligent, kind pts out there who appreciate nurses and treat us w/respect. I tank you. I'm glad that patients like that are in the majority.

YES, YES, YES!!! Too true!!!! And to add to those....

1) So why are you telling me that you need a laxative or that you're having some new symptom your forgot to mention to me this morning when the doctor just left your room? Do you not know that a doctor is the one who has to order your meds and I am the one who will administer them to you? You just cost yourself probably an extra 30 minutes to an hour or more before you will receive the needed med, as I will call the MD (and wait for the call back) and the secretary will take off the order (I will not be going out of my way to do this - I have other things to do) AFTER I give these other 3 people their pain meds.

2) To the rude family members/friends....Do you not see that I am trying to listen to your loved one's heart & lung sounds? Do you think that I am able to pick up subtle abnormalities with your constant, inconsiderate yakking, especially when you are directing questions/comments to your loved one so that they feel the need to answer as I continue to try and listen?

3) To the patients who do not realize (or care) that nurses are very busy...when I come into the room to do your assessment, I expect you to get off the phone right then, as I do not have time to stand there and watch you 'wrap things up'. HANG UP AND CALL THEM BACK RUDEBOY/GIRL! What else do you have to do today other than watch TV - I have plenty more to do other than watch you talk on the phone!

4) To the MDs who lack consideration for nurses...please do not order dilaudid q 2-3 hours for those patients who are pretty much established clock watchers - have your not heard of PCA?

5) Also MDs, for patients with significant dysphagia with resulting aspiration pneumonia, how about changing those po meds over to an appropriate IV substitute? Do you just want to have to stop in your busy day to call me back for something you should have already thought of?

6) And back again to the family members...don't call me, trying to pump me for specific information about the patient. I will let you know if there is a significant change in status; otherwise, talk to the MD about test results, what they mean, etc.

7) For the stable, A&O patient, please don't keep yakking at me just because you're bored and like to talk after you just heard me answer my spectalink and tell the person on the other end that I'll be right there.

OK, I think that's all for now - hee hee.

linzz · Oct 21, 2007

If I am charting in the hallway computer station, please don't try to read what I am charting. I will see to your request but instead of hunting me down, you could have just used your call bell.:angryfire

Fiona59 · Oct 31, 2007

When you see two nurses doing a narcotics count on the med carts in the hallway, unless your relative is coding or bleeding out don't ask them for a glass of ice chips. Use your call bell or go to the nursing station.