dream'n, BSN, RN 8,531 Views
Joined Aug 28, '06.
Posts: 814 (55% Liked)
what i see is ageism rearing its ugly head.
I think that its up to the boss to police other nurse's behavior. It's not hurting you when they come in early, so why would you get involved?
I think it's quite different to research a patient you will be caring for and poking around a chart out of curiosity. Actually I know it's different; BUT it may not be acceptable. Research actually might be ok, but in my hospital charting off the clock has now become a big no-no.
I am one of those nurses who have trouble getting out on time and I am in that age range. My problems are compounded by being an 8 hrs. nurse who often has to wait for a nurse to float from another floor. I see nurses who have time to hide in the med room and spend time on their phones. Probably because I am on the floor answering their call lights. My notes also provide real information about how the patient is doing; getting better, worse, need for education, encouragement, etc. The majority of notes I read from other nurses is a copied goal of preventing falls and not one single original word about the patient. Doctors have called me after reading my notes to discuss the patient's treatment.
There have been times I am halfway through my shift and read part of a doctor's note and discover an important part of the patient's history.
I do agree that there should be some kind of change to prevent overtime, but nurses trying to prepare for good patient care are not degrading nurses. Charting after the shift and clocking out is not good.
I guess I need to hide out in my patients rooms more until my charting is done and hope no one falls when I ignore the call lights for a bit longer. I should also let my manager know about my assignment last weekend giving me patients on every corner of the unit. That did not help with time management.
Quote from Asystole RN
Who cares about someone's feelings when LIVES are on the line? The pursuit of organ donation should be aggressive and persistent. We owe that much to those who are dying and to the families to know what their feelings may cost.
Organ donation is serious and should be treated as such, their tears will dry but dead is forever. Maybe their loved one's death will mean that others may live.
Feelings v. Life
The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.
So Yes, I am CERTAIN the preceptor went outside her scope.
also it was not prescribed yet either.
I agree completely with most of the other posters. A tool is one more thing that would need to be done on an already full to-do list... actually those big task lists are a big part of the problem. As others have brilliantly said, it puts the RN's eyes onto a computer/worksheet and takes them off the patients. It is no substitute for the RN laying eyes and hands on that patient. Plunking a RR onto an extra worksheet sheet ("extra" because it has already been documented on the VS flowsheet) is a task...noting the character of respirations, noting the patient's mental status, noting the "look" they have on their face is nursing assessment. Plunking a HR and BP on an extra worksheet is a task...noting at the color and temperature of their skin, and noting the patient's mental status is nursing assessment.
A couple side stories: a while back I had a patient who was on trach dome all day, who had been guppy breathing but never *looked* like he was breathing comfortably. He was also minimally verbal so difficult to assess his mental status. I arrived for my 2nd shift with him. The previous day he would give me these big vacuous smiles whenever I talked to him...like he didn't necessarily understand me but was trying to be social. Well I go to assess him, and immediately feel something is off. His breathing doesn't look comfortable, but as the previous nurse said "it never did." But he had this expression on his face that reminded me of a dead fish, and he made no eye contact. The dr. came in and I said I really think he needs to go back on the vent. Something was off. MD ordered an ABG "to confirm," and his pCO2 came back in the mid 60s. It wasn't his RR or any other quantifiable number that told me something was off; it was his look and mental status.
Another time while orienting in my former LTACH, we went to assess this one patient. Her HR and BP were a bit higher/lower respectively than her baseline but not terrible, but she was flushed and confused. She was becoming septic and we got her transferred into the ICU pretty quickly. Again, our clues were not worksheet-quantifiable numbers...turns out her WBCs were elevated, but labs weren't resulted for a couple more hours. So based on the info we had at the time, our clues were her mental status and the look/feel of her skin.
I really don't see a substitute for nursing assessment; and proper RN : pt ratios, elimination of extraneous charting, elimination of customer service tasks, etc. that allow the time and focus to perform said assessments.
The problem is, signs and symptoms of deterioration are many, individual and can be difficult to detect. One cannot reliably detect decrease in urine output over, say, 4 hours unless patient has Foley. Med/surg floors may not have capacity to put every single patient on tele monitor and techs are not typically follow each trace close enough to detect QRS prolongation, for example.
To see, notice, analyze and report signs of changing conditions nurses have to be pulled off screens, papers, spreadsheets, checklists, etc., and back to patients' rooms. They also needed to be relieved from "customer service" scutwork as much as possible, and get more involved in bedside care. Where I work, we have excellent CNAs but I allow them to take my patients' vitals only if I am out of floor because I assess while doing it. I also try not to delegate toileting whenever possible, because it adds a lot to my asessment. And my CNAs know to get me in a second they noticed something - however strange.
Hire more nurses to let them do clinical nursing, and more CNAs to bring water and fluff pillows.
Hire more nurses.
I personally think it is more of a retention and patient ratio numbers game that a checklist just won't solve. The EWS only truly works with frequent VS and I&Os in itself and decreased urine output is a later sign, as you know, but easy to miss without a foley or up to date documentation.
The last time I did CPR (not but a few months ago mind you) I was on a floor at shift change and happened to be the most experienced nurse there between both shifts with everyone else having a year or less experience. I work nightshift so that means all of day shift, including their charge, was that experienced.
Dude straight up just flat lined, no pulse, but by the grace of powers beyond me, I had a pulse back and a fairly stable patient by the time the code team got there because the code was called later than it should because no one except me really new how to call it. Instead of just calling security to overhead page they had been pushing a button on the wall that apparently wasn't working yet as it was a new build floor!
I hope you do find more helpful comments that don't take quite as long to implement for safety!
I agree with the others. Adding more "things" to do won't help.
Step down off the pedestal. ICU nurses should not be paid more.
Medical floors can be just as stressful with less support than the ICU caters to.
Physicians pay scales are structured differently than RN's. Look into how physicians are reimbursed; HR often dominates RN wages with little wiggle room.
Asking three times is just wrong. I am an organ donor, believe in organ donation, have watched organs being harvested. But .... if a family says no, then it is no! To keep coming back, or sending in another more knowledgeable team member to try to get them to change their mind after repeatedly say no, is just wrong. I have had family members be the recipient of organ donation so I understand the need. But the needs of the donating family don't just get shoved to the bottom of the pile. Finally, if a party was thrown for the floor for delivering six sets of organs in one month really happened, then that is downright disgusting. It was disgusting to even type that last sentence thinking it happens.
I agree with you OP. If it was my family member and I'd already said no, I better not see or hear anything else about it. Leave alone in peace to grieve.
Wow, the timing of this thread is shocking!
I'm in California as well and I work hospice. For our hospice patients in SNF, when they die, we have to call that 1-800 number. I've been doing it for years but recently it has gotten more difficult to deal with them. Even if you say the family has said no, they continue to ask you questions that take about 20 minutes to ascertain if the patient would be a candidate.
I had a patient die a couple of days ago. Uterine cancer with mets everywhere. She had a large open necrotic coccyx wound. When she died, I called her family and then started the paperwork as I called the Donor Network. I told the rep the family said no and again, had to answer all the questions. Very detailed, H&P, labs, X-rays, MRI, CT scans, etc.
The rep said the patient qualified for skin donation. I told her the family had already said no to donation - the legal rep of the family. I was told that another specially trained person would be calling back in an hour to talk with the family about donation and I should not talk to the family about the upcoming phone call or anything about donation.
I was appalled. So, OP . . . I totally get your point.
And I am in favor of donation.
But this new way to change people's minds reminds me of Mortuaries and how they prey on the grieving families in order to get them to purchase more expensive caskets.
"Predatory" and "unethical" indeed.
I'm still fuming about it . . .
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