gypsyd8, MSN 12,632 Views
Joined: Nov 28, '07;
Posts: 282 (62% Liked)
; Likes: 625
When 12 hour shifts first came in, I was *told* that I would work them, not asked, and sent to nights from my evening shift. That was my first experience, and it was awful. I eventually ended up on another unit where the manager tried to accommodate everyone's wishes and staff accordingly, 8s and 12s. Following that I worked in a number of places and eventually accustomed myself to 12 hour shifts but have never really liked them. I think overlapping 10s, which I saw in one hospital, would be ideal for everyone, but hospitals seem to be reluctant to try those, as they are reluctant/resistant to any "new" thing.
Ruby was right about 8 hour shifts rarely being just 8 hours. I worked 7-3, and to get all you need to get done in that time frame is almost impossible. I would almost always stay late to get most of it done.
12's are hard, but 8's are harder. With 12's, you might actually leave at 12.5hrs (full charting, everything done) and enjoy what few hours you have to live and then sleep for the next shift. With 8's, you're looking at anywhere from 10-11 hrs once you're done charting and making sure you're not dumping on the next shift. And you basically end up working near-12's for 4-5 days straight, instead of 12's for 3 days.
I second this, in particular the need for far more research. I detested 12-hour shifts and didn't start doing them until I was 50. Then went to 10s, which I preferred. But what about SaltySarcastisSally's comment about more days of daycare needed if there are only 8-hour shifts? That's problematic for some. Most younger nurses I've spoken with prefer 12s, which I understand. I've "heard" hospitals prefer 12s b/c it's easier to staff those shifts. From experience I can say it was harder to fill a 12-hour shift when there was a sick call. No easy answers but better research and replicated studies would help.
I agree with MunoRN. More (and better) research is needed. I find it odd that the OP says, "I believe flexible scheduling could achieve cost-cutting goals, patient safety goals, and boost nurse morale, as well," while citing no evidence for this -- or for many other statements in the article. And yet, the author espouses the importance of focusing on and using "the evidence."
Almost everyone ignores the evidence when it says something they don't want to hear. Management ignores the part where nurses say what they want when what nurses want is expensive. Staff ignores the parts that say they should get enough sleep, exercise, eat right, don't work too many hours in a week, etc. when they want the extra pay and/or want to live a lifestyle that is unhealthy. Both sides ignore the inconvenient evidence and only focus on evidence that supports their desires.
The evidence definitely matters, the bigger question is what the evidence actually is. Shift lengths greater than 13 hours are clearly associated with an increased risk of errors, near errors, and other adverse effects of fatigue, however there isn't conclusive evidence that a 12 hour shift schedule produces more risk and fatigue overall particularly in settings where 24-7 staffing is required. The most cited 'evidence' against 12 hour shifts comes from a Geiger-Brown that supposedly found "3 times" the risk of errors in 12 hour shifts, although a closer reading of the study shows this figured on a "per shift" basis which of course is not an equal opportunity for error, when corrected for an equal amount of time (errors per hour for instance), the risk is actually slightly less for a 12 hour shift schedule.
Honestly, if they took away 12 hr shifts at the hospital, I wouldn't work there. Going to 8s mean two more days of daycare a week and I've done 8s in LTC, you are NEVER there for just 8 hours. More like 10 hrs 5 days a week, extra time you aren't paid for because admin c/o OT so you clock out just to put another 2 hrs in. I suspect the same would happen in acute care since state mandated ratios are a very nice idea that will likely never be implemented. I do think however that night shift workers should be paid for more than a few extra $$/hr because of the toll it can take on your health.
Where is the North American research showing that the method shown in the video is a safe way for lay people to store and use epinephrine? Was the method approved by any pharmacists?
There are a greater number of things that can go wrong though...1. Contamination, 2. The whole set is less sturdy...the auto injector is designed to be held to your thigh but can take a hit if a panicked person uses it, a pre fill you do yourself probably won't. 3. Needle size, depth, etc..also damage...
there is a reason why auto injectors are so popular. They work well. They are easy to use. They are safe in your purse or pocket..even for kids.
With the concessions being made in the face of the backlash, I feel that others out there are already moving to produce other products. A quick scroll through Google shows dozens of auto injectors for sale at about 40.00 that can be pre filled with any med...and are much safer to carry around.
As a person who has used epi pen and the draw your own method...when in the middle of an attack ( allergy to shellfish) there is no calm and safe time to think about how to do the steps for filling a dose, and in a pre filled case, readying a needle. This is why the auto injectors are so useful and why they are recommended. When you are struggling to breath, there is very little going through your head other than...OMG I can't breath! To expect a lay person to complete an injection, in those circumstances, is asking a lot. IMHO the manufacturers of Epipen, should be regulated, or another competitor found. However that needs to be done. The auto injector is used so widely because it works and saves lives.
Pre filled syringes are ok provided you follow certain precautions
The stability and sterility of epinephrine prefilled syringe. - PubMed - NCBI
Hope these articles help to clarify this issue
As I said, our EMT basics now draw up and administer epi 1:1000 as a matter of course. Having pre filled syringes in the household requires care just as being and insulin dependent diabetic requires caution around children.
The only comment I would add would be to include the date of filling of the syringe so that it doesn't lay around too long prior to use
Many if my pts have their families pre fill their insulin because they can't see the syringe and the click pens are too expensive. While not in use in the heartcare setting, home use is another venue.
If I were you I would pull the video until my malpractice insurer had assessed the video for liability concerns and my lawyer had assessed if the image of Epipen on the video is copyright infringement.
Safety concerns that I had with the video are; storing a pre-loaded syringe in a toothbrush holder is a safety hazard if a young child gets their hands on it. There was no discussion about chemical stability and deterioration with exposure to air or light or what it looks like if it has deteriorated or expired and should not be used.
Suggest you show the video to your malpractice insurance provider to see if they have any concerns regarding liability. I missed some of the instructions because the audio was difficult to hear during the demo.
Mylan has agreed to waive the copay for nearly everyone for whom EpiPen is prescribed. This looks like it could be a recipe for disaster if a mistake is made, and a legal liability to you for suggesting it can replace an EpiPen.
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