Chaya 7,772 Views
Joined Mar 5, '03 - from 'Bosstown metro area'.
He has '15' year(s) of experience and specializes in 'Rehab, Med Surg, Home Care'.
Posts: 1,129 (19% Liked)
Ah, yes, that change of shift dump. I do get it, really. I understand totally that it is necessary to free up space for incoming patients. However-and this should be a HUGE factor with the current emphasis on accountability, continuity of care, and prevention of
re-admissions; change of shift admissions specifically create those black holes where there may be significant time lags before an oncoming caregiver is identified. Report may be called to the floor to and from off-going staff who are no longer available for clarification. Critical ( as in Sentinel Event level) information is omitted ( in my experience omitted details have included patient with wound evac device, insulin pumps, life threatening med allergives and numerous patients needing imminent warfarin dosing). You get the idea. When I worked med- surg and we had those meetings about reducing errors and improving continuity of care between care levels I always raised this issue; not because of the inconvenience factor but because it creates a particular point of vulnerability in terms of the increased number of opportunities for errors in the system (as in, "falling thru the cracks"). Ideally, don't create the situations that allow these "cracks"!
Thank you for reminding us what the spirit of Christmas is really about as well as the kind of gifts we should be focussing on. And thank you for the difference you have made over the years both to your patients and to your many allnurses friends who you may never meet in person. Your story brought tears to my eyes.
Never use the "Q" word(Quiet) on nights! It's guaranteed to make all H*ll break out!
Burst stoma bags always occur 5 minutes before you are due to give report.
If you swap shift with someone,it will be a busy night and your original shift will be uneventful.
That bag of fluids which was not running well will suddenly run through when you are on your break.
The doctor wants an answer which is in the careplan,the careplan is in an office where the phone doesn't work!So you either leg it for the careplan leaving the doc hanging or chance phoning back when you just know he will be elsewhere.
So-just a thought but shouldn't whoever the medical caregiver, whether PA or MD, have received/ had reported to them the most vital and timely info such as, for instance the patient received IV medication during the night to correct cardiac rhythm?...
I loved hands-on nursing. However, at one of my last positions, one of the questions posed in the written self-evaluation portion of our yearly evaluations was "what are your career goals and what do you plan to be doing in 5 years. Ambition was valued perhaps more than technique, good bedside manner or staying current with new nursing practice. This was a med/ surg position at a magnet hospital; many of the nurses there were just starting their careers and there was an almost condescending attitude toward those who chose to remain at bedside instead of moving on to become educators, administrators or at leasT advance practitioners.
I wish you the best. You sound like a caring, responsible caregiver. Hang in there.
You would think by now I would know better than to even think there was nothing left that could surprise me...
The other name I see used for "they" is "TPTB" or "The Powers That Be", meaning those who actually hold and wield the power to make those decision and take those actions that impact our policies and resources to care for our patients.
I am heartened to hear from so many nurses who have not forgotten what it's like on the clinical side and genuinely struggle to balance budgetary prioroties with excellent patient-and staff-care. There need to be more of you.Please keep on fighting for our patients AND those of us still in the trenches with them, Quixotic though it may seem at the present.
I'm so sorry for what you and your family went through and that your experience with hospice, instead of easing some of the difficulties and pain of your family's last hours together made them that much more difficult.
It is heart wrenching to read your words and I'm sure even more difficult for you to relive these hours in sharing them with us but know that your story will stay with your many allnurses friends and remind each of us to see the situation thru our patients's/ family's eyes and go that extra mile.
May you find peace.
I became a nurse at 50. For me, it was easier to study than it would have been in my 20's because I was steadier; more focused and less distractable in general than when I was younger. I found I was better able to handle it emotionally after a lifetime of working in a variety of positions with coworkers having a wide range in temperment and personalities. I had also seen and weathered many life events and crisises in my life and those of family members and close friends and I came to believe that nursing was a good fit for me in terms of skills and outlook at this point in my life. Physically, it was more endurance than brute strength; although I did work with many obese patients that required extensive assistance with personal care we were well trained in body mechanics, had mechanical lifts and followed a strict policy of having 2 or more caregivers assisting with transferring, boosts, etc. I also had to become used to 12 hour shifts (but found working fewer days less stressful); had to invest in really good orthotic arch supports and shoes, and keep healthy.
Good luck if you do make the decision to go ahead; it can be crazy at times but I've found it very satisfying-and never boring!
See, now I thought it was going to go something like "you'll have to do a fingerstick, and his glucose will be high, and you'll have to get the lab to verify it, and you'll need to call the MD for extra insulin coverage, etc, etc...
Who would use a place that fired them as a reference?
"If it wasn't written down, it wasn't done." You can't be expected to read minds re: what previous doses were actually given but not recorded accurately (not to mention how future doses of warfarin are based on knowing accurately what dose received caused a given response). If you have a med discrepancy the only safe option is the one you chose; notify the MD for any change in the order since prescribing is NOT in your scope of practice.
"If it wasn't written down, it wasn't done". (I'm guessing you've heard this a time or two). I don't know about your nursing curriculum, but mine did not include psychic divination of patient care delivered on previous shifts but not recorded. You had no way to know what doses were actually given; plus to further complicate the issue, future doses of warfarin would be based on how well the assumedly correct dose regulated coagulation. Even if you had been able to verify that the actual dose being given differed from the recorded dose, this is a med discrepancy and your only safe option was the one you chose, to present the situation with as much info as you could obtain to the covering MD for evaluation (not in your scope of practice as an RN.
Once I came to that realization, I became fine with putting 70 percent to 80 percent of my efforts into providing the care.
I know the aforementioned statement may have sounded terrible to some readers, but hear me out. 70 percent is still passing. 80 percent is still passing. In addition, when I didn't put my all into the job, it led to self-preservation since I didn't burn out or take the negative aspects of the job home with me.
Some would say, "I don't want a nurse caring for me or my family who gives less than 100 percent!" However, that outlook is unrealistic because no stranger in healthcare cares about you or your loved ones as much as you.
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