gypsyd8, MSN 9,161 Views
Joined Nov 28, '07.
Posts: 278 (63% Liked)
Stupid new nurse question.. Why do you need a 10cc for a picc? Is that just what fits??
This is really a very interesting subject, and it all hinges on how you define nursing. Actually, I used to develop these types of systems as a consultant & it paid very well.
Most 'acuity systems' are simply laundry lists of tasks -- like the one outlined by a previous poster. These tasks certainly add to the workload, but they don't completely reflect the work of nursing.
Workload and Intensity are actually 2 separate issues when it comes to staffing. You can have a 'high task' patient (comatose) but most of the the work could be handled by a nurse assistant. On the other hand, you could have a new diabetic - completely ambulatory and self care, but with extremely high teaching and emotional support needs - high intensity - that requires a LOT of RN time.
Of course, acuity systems also fail to account for the ADT 'noise' (admissions, discharges & transfers) that are very time consuming. We all know you can start & end the shift with 4 patients, but the ones you ended up with are not the ones you started with!
All in all, I don't think that there is any task list that can replace good old nursing judgement. I am a proponent of 'prototype' acuity systems that consider both workload and acuity. But they need to be coupled with additonal workload attached to the ADT.
It's no wonder that so many hospitals have just given up and rely on ratios.
I hate the pledge (Nightingale and of Allegiance) because both feel like indoctrination and mindless subservience.
When I was a school teacher, I never made my students stand during the morning pledge recitations (both to Texas, which recently added under God as well, or to the USA) unless it was something they felt personally compelled to do. I myself never stood. I don't have to prove my patriotism to anyone.
During my LVN pinning, we weren't told about the Nightingale pledge recitation until pinning rehearsal, and I was beyond pissed. I recited it because I felt pressured to do so and because I'd already been overruled in terms of venue when the ceremony was held in a church. I had to listen to an invocation and a benediction, standing in a Christian church, and recite something I found personally offensive. Recitation of this pledge is just one more in a multitude of ways southern education continues to skirt the separation of church and state.
I'd be classified as a Millennial according to this piece since I was born in '81. I feel older than the typical person who belongs to the Millennial cohort due to being in my mid-30s, but anyhow...
Although I'm very computer-literate, I didn't grow up with a computer in the household. I'm also a team player, but far from enthusiastic about the concept of work. I also lack any morsel of dedication to the workplace itself. Let me rephrase that: I will never be loyal to an employer.
You see, I was 20 years old when Enron collapsed in 2001. The masses of upper middle-aged Enron employees who lost their retirement savings due to misconduct from upper management did not benefit from their profound loyalty to the company. That news story had an impact on me.
I am a team player, but work is not the most important aspect of my life. It never will be. I will never give my all to a workplace, only to be steamrolled in the end.
The day started out normally enough: come into work, get my assignment, and start preparing my OR. I didn’t need to move in right away; while we normally move patients into the OR around 0700, my patient wouldn’t be moving in until 0800. And so, when the trauma code was called overhead at 0654, I was called upon to scope out the trauma bay.
I headed down to the ER, expecting the usual car accident, stabbing, or shooting. Well, it was a car accident all right, but certainly not the usual. A young woman, on her way to work, struck head on by a drunk driver. Yes, before 7a.m. But the heartbreaking part was that this woman arrived with the CPR device compressing away, her obviously pregnant belly bouncing in sync with the compressions. The baby was in obvious distress, and there was no time for transfer to the OR or to wait for an OB to arrive from maternity, four floors away. The trauma surgeon did an emergency C-section, right there in the trauma bay. Suddenly, we had not one but two trauma patients. And both were coding.
Baby boy was intubated and gradually his color improved, although respiratory function, heart rate, and pulse ox remained well below norm. He was sent to a nearby children’s hospital NICU, with many crossing their fingers and saying a prayer that he would make it.
We never did get mom back. We tried drugs, we tried external pacing, we tried every trick in the book. All without success. We did what we could to get her incision closed and cleaned up for family to see.
We all heard the husband/father arrive. The wails as he was told his wife didn’t make it, the sobs as he was walked into the trauma bay and sank to his knees. Every single person in that trauma bay was crying right along with him, even those known as the crusty old battle-axes who have never openly shed a tear.
I’ve cried over patient situations and deaths before, but always privately and usually in my shower at home after a hard day at work. But this was a situation where I couldn’t hold it together, and I was certainly not alone. This was one of those traumas that will likely haunt many involved for the years to come.
Many healthcare employees are involved in events in the workplace that can lead to traumatic stress brought about by strong emotional responses (Vaithiligam, Jain, & Davies, 2008). In light of these events, hospitals should provide support to involved employees. Many offer an Employee Assistance Program (EAP), but is an EAP always enough? Employees may be reluctant to contact the EAP if they fear their employer will find out they have sought mental health help.
My facility goes beyond the EAP and provides critical incident debriefings when deemed warranted or if staff request a debriefing. The most recent was after a sudden onslaught of more than a dozen heroin overdoses that led to poor survival rates and several becoming organ donors. I am sure there will be one to follow today’s events.
Debriefing allows those involved in a traumatic event to process it, vent emotions, and address potential physical or emotion harm that may result from the experience (Davis, 2013; Vaithiligam, Jain, & Davies, 2008). A timely debriefing that occurs within 72 hours of the precipitating event can reduce short- and long-term crisis reactions and psychological trauma (Davis, 2013). Healthcare employees can greatly benefit from the option to attend a critical incident debriefing. Does your facility provide this crucial support?
Student Advantage is not a "federal" program. At least here in Michigan everybody uses Certified Background which uses their own certified labs like Quest. Unfortunately, this factor alone will not solve the problem. Even moving across the country may not solve the matter because the OP will have to answer all these ubiquitous "name ALL the colleges you'd ever attended" and the likes.
If OP is absolutely adamant about eventually doing nursing, one workable (though long) way is to get entry level non-nursing degree or certificate. The choice is wide from commercial CNA or MA schools to undergrad in PT, OT, speech, laboratory and the like. Most of these degrees require clinicals, but many, especially for-profit schools, have ridiculously lax requirements. After going that and working for a while the OP will be able to start "direct networking" in order to personally convince a school that the whatever could be dug up from the past can be safely overlooked. If not successful, the OP will get real work experience and exposure to dozens of other health care occupations not less interesting and less restrictive than nursing.
IMHO, the situation like described is a pretty good illustration why MJ must be legalized and accepted yesterday. I do not (and physically cannot) use it, but seeing a talented young woman whose life was won in years-long battle against cancer doing social work (which she hates quietly) instead of nursing (which she dreams of) ONLY because she literally has choice between Marinol every day and TPN for unknown length of time is heartbreaking. It is just so plain wrong.
I have no idea so nothing helpful.
I don't get how nursing students can get hammered on alcohol but kicked out for any amount of marijuana. Well I get that one is legal and the other is not, it's just non sensical.
FWIW: you have put your stuff out there on the world-wide internet. It does no good to place paramaters around what you do and don't want to hear. You will get it all. If you don't care to have all types of comments, take your post down.
IMO, it's not even "your job" to make them healthy; for some people that's an impossible, unattainable goal (and there's only so much we can do to undo the damage people have done to themselves). Our job is to provide nursing care, end of story. Happiness and health are up to the individuals.
I think your professors meant was this: "Students who are too cerebral lose touch with the fact that a bedside nurse's job is to perform tasks. You can know all the information in the book, but ultimately, your job is to execute orders."
Thank you all for the responses and the support!!!! I know that many places are like this. I believe it that it is the rule rather than the exception right now and it scares me how many of you are experiencing the same things. I am involved the the state nurses association, the ENA, Nurses for Change and several other groups. I want to improve things but it is a daunting task. I have considered becoming an administrator but I love bedside nursing and I don't want to become the thing I despise.....
I do agree with most of the other commenters that this is not an isolated incident, my hospital is going through exactly what your have described. Sadly my facility was one that was known as one of the best places to work in my city and now is experiencing identical "symptoms" that yours is. I don't know if you will find it comforting or infuriating to know this is not isolated right now but many hospitals around the US are facing these issues as they try and find ways to cut money to increase profit and merge with larger organizations to find a way to stay in competition with the "mega corps" in our industry.
I also look believe in being a change and am glad you are trying as well so here are a few of my suggestions.
1. Do you have a Shared Leadership Committee in your unit or hospital? If yes get involved! These committees can make a difference in small ways that may not make your staffing issues go a way but may make life better for your nurses, if not see if you can get one started in your unit. I joined mine and found that we can influence small things that make our work better like reorganizing our stock room, we took inventory on what we run out of the most and made our management aware of how much this slows us down. We now are double stocked in these items.
2. Get political. Seriously mandatory patient ratios have been enacted in some states and it has helped. I'm sure there nursing organizations in your city and state are lobbying for them. In fact there is a large lobby day in D.C. coming up over this issue. Get involved, even if it is by encouraging nurses around you to add their signatures to a petition or write to your representative one more voice in this fight is one more voice raised. Nothing is going to happen if we as nurses sit and complain to each other. When the View pissed off all the nurses over the infamous stethoscope comment the united front of all the nurses in the US was powerful. Imagine what we could do if we had the same response in regards to climbing patient loads and unsafe work conditions?
3. Be a resource, become familiar with the laws and policies in your facility and state. Many times we let our organizations get away with doing things because the staff have no idea what is being done is illegal or against policy. By being a resource you can provide that information to your co-workers and allow them to stand up for themselves. Sometimes change has to start by people standing up and saying no way I'm not going to do that and this is why.
I hope this helps. Good luck to you and I hope knowing that you are not alone helps just a little
We had a really mean pt on our oncology unit. I was told she was a very intelligent and articulate woman who was in denial for a long time and who was now trying to blame the medical establishment for her life limiting cancer. She was leaving the unit for daily radiation tx. Lucky for me I never was assigned to her during her two or three brief stays with us. Next door to her was my sweet, simple pt--a frequent flier who had life limiting colon cancer. She was on heavy amounts of Dilauded and was a bit of a scatterbrained to begin with.
She would leave the unit frequently with IV pole in tow to visit the vending machines or people watch in the lobby. Upon returning, My scatter brain sweat-heart pt passed me by at the front desk establishing it would be another hour before she could have her PRN Dilauded/Benedryl combo. She left me and went out of sight down the hall where she settled into the wrong room, sitting on the edge of the bed of the mean pt who started to pitch a fit on the level you've never heard/seen before when she returned with her transport team who had already been yelled at several times for various things. Needless to say they disappeared as soon as they could so she leashed a full fury attack on my sweet pt--throwing racial slurs and just saying the meanest things.
My pt had barely sat down and didn't touch anything, still we remade the bed and obtained a new meal tray. We arranged for a flower delivery. We even wiped all surfaces down with Sani Wipes and called housekeeping to clean the restroom. Mean Lady berated me the whole time to her own nurse who she also treated badly.
While I and the other nurse attempted to do "service recovery" on the mean pt. (and I kindly asked the relief nurse to settle my crying pt into her own room and pull some Ativan early for her based on a phone order I had just obtained), my manager pulled me aside and said she would be writing me up for not preventing my pt from going into the wrong room. That I should have been rounding frequently enough to have noticed my pt was in the wrong room.
So tell me, I asked, how would I know my frequently ambulating/restless pt had settled into the room covered by another nurse? She told me that I should been a good enough nurse to have prevented the situation. Hmmm, I thought to myself, no amount of "good nursing" was going to prevent an honest mistake from happening that was totally unrelated to my nursing care. Am I right?
I started nursing late in life - in my fifties. Prior to that I was a teacher, business woman, and did a lot of other jobs as well. A BN is my fourth degree. I have a BA, BEd, MEd as well so I'm well-educated. While it's true that nasty people are in every profession, I can tell you with certainty that nursing has the highest number of bullies and nasties, period. And by the way, any idea that nurses are well educated is ridiculous. I completed a nursing degree after my other degrees and I know that nurses are NOT well-educated or well informed by any stretch. The introductory liberal arts courses they take are usually something that they sigh about because they "have to" to take them but, "What does this have to do with nursing?" They are not typically curious or enlightened individuals, which is part of the problem. They are in a rush to be middle class, get a secure job and then stay there for life.
I also believe that a lot of Borderline Personality types are attracted to nursing because of the "angel of mercy" aura that allows them to be nasty and kind at the same time. "Borderlines" thrive on drama, are usually paranoid (need to sabotage others), and live in complete denial of their own behavior. They really do believe their own "split" persona - that is, "I'm a nurse so that proves I'm a good person." Actually, I believe that about 50% of nurses are "borderline" Borderlines, and they wreak havoc wherever and whenever they can, but hide it beneath their angel of mercy disguise, (in their own minds). Never in my life have I encountered so many nasty individuals intent on causing problems for others. Think I'm exaggerating? CK out the literature - 60% of new nurses leave their first job because of bullying from their nurse colleagues. The literature is FULL of articles about horizontal violence in nursing. Just google it and you'll get pages on it, and ck out the professional journals. People have done their doctorates on this subject.
I'm laughing because I know y'all are fuming right now since Borderlines have no insight into their own behavior.....
This is absolutely my biggest pet peeve. Medicine is not about numbers. It is about people. If you have never done the job how can you be the administrator? This is the current trend in one of the big Dialysis Companies and it is a huge mistake. It is NOT all about the numbers, it is about giving good care to very sick people. Yes, you have to be financially prudent, but not at the cost of people. I have been a RN ADMIN for 15 years. I know the job and I understand how things work. I can step in as needed and I serve as a resource for the staff. I know how to make the numbers work, but I don't do it at the cost of my nurses nor my patients. No, I do not have a MBA from Stanford, but I do have almost 40 years of being a nurse.
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