Latest Comments by Anna Flaxis

Latest Comments by Anna Flaxis

Anna Flaxis, ASN 20,139 Views

Joined Oct 15, '10. Posts: 2,815 (67% Liked) Likes: 8,394

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  • 2
    Everline and Farawyn like this.

    In a word, no.

  • 0

    You can ask anything you want. Whether you get it is a whole other question.

  • 2
    Maevish and calivianya like this.

    Quote from canigraduate
    Unacceptable: looking in every patient's chart on your unit as a floor nurse when there is no reasonable expectation that you will be providing some sort of care...
    I think this is the crux of the issue. In some small units, there is a reasonable expectation that you will provide care for any/all of the patients in your unit. For instance, in my ER, we provide care for one another's patients routinely, either because the primary RN is in another room, on a break, tied up on the phone coordinating a transfer, or any number of reasons- and we don't have a Charge, because we are so small. When a physician needs something done right this minute, and the primary RN is unavailable, whoever is available jumps in and provides the needed care. Whenever administering a medication or providing an intervention, understanding the rationale and any unique patient characteristics (i.e. whether the patient is opiate naive or on long term opioid therapy, whether the patient is unsteady on their feet at baseline, whether the patient has residual deficits from a previous CVA, etc) is pretty important, in my opinion as a professional ER RN.

    I've caught some medication errors before they happened, because the physician placed an order on the wrong patient (easy to do with Epic, if the physician has the wrong window open, is in a hurry, and does not double check), caught only because the order didn't make sense for that particular patient. Had I not known anything about that patient, the medication would have been administered.

    So, the question is whether this is the case in the original post- that RNs frequently provide care for one another's patients, and so knowing some basics about every patient in the unit is essential. It doesn't sound like this is the case, which I agree would make accessing the charts inappropriate.

    I still think it would behoove the original poster to ask the other RN why they are accessing charts for patients that are not under their care. Is it possible that there was an event in the past, such as a Code Blue that went bad, and this RN thinks it's important to keep tabs on all of the patients for safety purposes?

  • 0

    I think you need to get *all* the nurses trained in NIHSS, but start with the Charge Nurses. This way, you can transfer the pt to the gen med floor, freeing up the tele bed, and at least the CN can do the NIHSS until it is DCd.

  • 27

    I disagree. In a small department where you are each others' backup, I think it's important to be familiar with all of the patients on the unit. In the ED, while I have my assigned patients, I need to know who else is in the department and why they're there, and what the plan of care is, because we back each other up- I may or may not end up doing any care on someone else's patient, but I should be aware of what's going on in case I am needed to do so, especially since we don't have a charge nurse.

    As House Supervisor, I don't actually provide any care (most of the time), but I do review the charts to know who is in the hospital, why they are in the hospital, what the plan of care is, any issues or concerns, that core measures are being met, and what the discharge plan is. I also review charts of ED patients to be on the lookout for potential admits.

    So, there are reasons that are perfectly legitimate and not violations of HIPAA for someone not directly providing care to be in the patient's chart.

    Maevish, rather than being passive aggressive and dropping hints, have you directly asked your co-worker why they are reviewing the chart?

  • 5

    Yes, aside from getting what legal assistance you are able, were I in your situation, I would change my name, move to a different location, and eschew social media. Sorry you're going through this!

  • 0

    This is actually very puzzling to me. First, where in the world the nurse found 15 pillows, and second, what the rationale for this action could possibly be? The only thing I can think is that perhaps the nurse thought that the sensory perception of the pillows around the patient might help calm them, like swaddling a baby sort of? Just a thought.

  • 76
    RNHop, bbd613, Nurse Cookie Swirl, and 73 others like this.

    You're being thrown under the bus.

  • 0

    It will get better. ;-)

  • 3

    Quote from TNT_RN09
    Cardizem gtt on a regular med surg floor???[emoji15]
    It's a telemetry unit. And Cardizem is not that difficult. It's totally doable on a tele unit.

  • 10

    Thank you for elaborating. This is very helpful.

    Pancreatitis can be one of the more painful conditions, requiring astronomical doses of opioids just to make the discomfort tolerable. This patient may have even benefitted from a PCA (Patient Controlled Analgesia).

    It sounds to me like your unit/facility could benefit from implementing an Acute Pain Protocol of some sort. This way, the doctor could just order the protocol, which gives the nurses a lot of flexibility within a set of parameters to figure out what works best for the patient. It's a win-win. The doctors will receive fewer pain related pages, the nurses will have more tools in their toolbox, and the patients' need for pain control will be addressed. Do you have a unit based practice council, or could you bring this up to your manager for consideration?

    As far as dealing with the (understandably upset) family members, I have a basic spiel that works well for me. First, I offer reassurance that controlling the patient's pain is important to me, and that I will do everything I am able. I explain that I cannot give medications without a doctor's order, and that I am making it a priority to obtain that order. I explain that these are very powerful medications, and that for the patient's safety, I have to be careful not to give too much, because I don't want to kill them. I explain that often, it takes more than one dose to get an acceptable result, and that we have to work together to figure out how much of what drug is going to work without harming the patient. I let them know that some conditions are so painful that it is not possible to eliminate the pain completely- that I could give them enough Dilaudid (or Morphine or Fentanyl or whatever) to kill an elephant and they still might have some pain, and that the goal is to get the pain to a level that they can tolerate- not to eliminate it completely. I might ask "If we could cut your pain in half, would that be an acceptable result for you?", and I make a plan together with the patient and their concerned family to do that. Since I work in the ER, the doctor is right there and so I don't have to page and wait for a response, but I have worked inpatient in the past, and I would explain this to the patient and family: "I am going to page the doctor to find out what else we can try, and it's going to take a little time for him/her to return my call and give me the orders. I can't give you anything until that happens, but I can offer _____________ (warm compress, ice pack, dim the lights, whatever) while you wait".

    If they *still* follow me out of the room and shoot daggers at me, well then, I tried. But usually, when I make myself their ally and ask for them to participate in the plan like we're a team, they calm right down. They're just concerned for their family member, as they should be.

  • 26

    My gut instinct is to tell you that it comes with the territory.

    But thinking about it more, I have to say I don't have enough information.

    Are you treating acute pain or chronic pain, or acute on chronic? What was ordered? When you notified the physician, did you receive new orders? What was their response? What did the family members do that was intimidating to you? How did you respond?

    And, it's "hostile". "Hostel" is a type of lodging.

  • 1
    Christy1019 likes this.

    Don't focus on your preceptor. ​Focus on what you were taught vs. correct procedure. Focus on the processes, not the person. Good luck!

  • 3
    chare, RainMom, and Vanilla101 like this.

    I'll bet you never forget to clamp the saline when running blood ever again!

    Had that not happened, the safest thing for the patient would have been to just run in the unit without interruption. Many blood administration sets are made to handle multiple units, and CDC guidelines are to change the set within 24 hours of initiation. The 4 hour/2 unit policy seems to be pretty standard for most facilities, but I'm having a hard time finding the evidence to support this.

    I'd be willing to bet that not EVERY nurse is gossiping about you. As others have stated, this will blow over when something more interesting to talk about comes along- and it will. In the meantime, I commend your integrity and humility, keep up the good work, and make a mental note of who gossips and who doesn't.

  • 10

    Sounds like a rough night.

    My first piece of advice is to familiarize yourself with your facility's Policies and Procedures- where they are located (most places these days, it's on the company's intranet) and how to search them to find what you need. It might also serve you well to have a nursing procedure manual (Lippincott's, Mosby's, etc.) handy at work. This way, when you need to do a procedure that you don't know how to do, you can look it up in your facility's P&P and/or refer to your procedure manual.

    Second, you might have to be specific when asking for help from your co-workers. Ask them to do a specific task, such as "Can you pass meds in rooms 10 and 11 while I start an IV in 12 so I can get her back on her Cardizem gtt and start her blood transfusion?". A co-worker could see that you're struggling, but not think of a specific way to help you unless you ask.

    Lastly, and I saved this for last because it's probably obvious to you, triage your care. What is the thing that's going to kill your patient the quickest if it doesn't get done? The patient requiring a Cardizem gtt and a blood transfusion who has no IV access would be #1, right? A Foley irrigation can wait if the Foley is draining. Obviously, if there are clots blocking the catheter, it needs to be tended to sooner rather than later. But if it's draining and the patient is not experiencing bladder distention, it can wait a little bit. Routine meds are important, but you do have a window of time in which to complete this- it does not have to be at the exact scheduled time. Many facilities give you a two hour window- an hour before and an hour after the scheduled time- in which to complete this. And while it is important to keep patients with incontinence clean and dry in order to prevent skin breakdown and preserve dignity, you do have some time. If the patient is able to help by rolling side to side in the bed or lifting their hips so briefs can be changed, then one staff person can safely provide incontinence care. If the incontinent patient is truly dependent and unable to assist by rolling side to side or lifting their hips, then yes, someone needs to help the CNA, but it doesn't have to be you if you are busy starting an IV and hanging blood. A co-worker can help, or the CNA can wait until you are available.

    You will learn to be more efficient as you gain experience. For instance, since you have to wait until the blood bank has the blood ready before you can hang it, you can do other things while you're waiting, such as the Foley irrigation, or passing meds to a patient or two. While you're in the room for the first 15 minutes of the transfusion monitoring for s/s of adverse reaction, you can be catching up on your charting, or you can give the patient's routine meds a little early (if within your facility's acceptable time frame), or researching Foley irrigation procedure (if you haven't gotten to that yet), etc.

    I can honestly tell you that it will get better, but I'd be lying if I said that you won't have any more rough nights. Nursing is hard, and being a new grad is overwhelming and terrifying. The first year is tough-with-a-capital-T. But if you stick with it, keep trying, learn from your mistakes, and just keep showing up, one day you will look back and see how far you've come, and you will be the experienced nurse mentoring the new grads.


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