The issue with team nursing, is that the focus ends up being on the work to be done (task orientated), rather than the patient, and we all know the need of each patients can be quite complex, more than the simple act of attending to a task. I feel you can still work as a team but that each nurse has overall responsibility for a smaller group of patient's.
If you caught The View yesterday, you saw Joy Behar ask of Miss Colorado (Miss America contestant) and nurse, "Why does she have a doctor's stethoscope around her neck?"
Oh, yes, we know them. The throngs of visitors, family members, and guests who flock to comfort our patients. This is just for fun. See if you can name some of our favorite guests.
1. The good Samaritan who brings your post-surgical NPO except ice patient some pungent tacos because the patient said he felt hungry. Patient eats three bites and begins vomiting epically. The visitor, big-eyed and instantly remorseful, tells you, "But he said he was getting really hungry and you guys weren't bringing him anything!" At least three places in the room, including the door, say "NPO x Ice". There will be Phenergan. Visitor bolts because of the smell and leaves the wrappers in the garbage.
2. The PCA pump spouse who watches the clock and pushes the PCA button every ten minutes, even if her husband is asleep. She tells me she doesn't want him to wake up in pain. Luckily, with the help of Narcan and some skilled critical assistance folks, the husband gets to see his wife's face again. No matter how many times you educate...
3. To my young patient's friend: I can see you care about your buddy's comfort and worry that we aren't giving him his choice dose of powerful narcotics. There are reasons. He is constipated, he is experiencing AMS, and a zillion other things. While it's kind of you to bring supplementary meds and slip them to your friend, it kind of messes up his breathing and living. Please don't visit again.
4. I like meeting my patient's relatives, but if I have already met 20 and answered the same 400 questions, I'm going to nicely ask you to start talking to my patient or to each other. Maybe bring a tape recorder when the doctor comes in if the patient agrees. I want you all on the same page.
5. Speaking of relatives, I know the hospital can be noisy, cold, annoying, and frightening. Should your facility permit, I have no problem with one of your relatives staying overnight. Just a foreword--the couches don't get any more comfortable, we will be coming in the room to do annoying procedures like vital signs and medication administration, the room will either be too hot or too cold, the patient down the hall may yell, there may not be 4 pillows readily available, and the TV does not have HBO. Plan accordingly.
6. We love kids. We just don't love it with young children decide to bounce on Grandpa and bust his stitches. Unfortunately, the care providers prefer that catheter bags, oxygen devices, JP drains, bed controls, suction canisters, computers, IV pumps/poles, and just about any cool thing be left to the appropriate hospital care provider. We hate to be a bummer. Oh yes, and the gloves. The gloves won't hurt you, but if you pull the entire box on the floor, it costs the hospital money and we don't want that.
7. Dear overzealous advocate for your sick loved one: I am proud of you for standing up for your friend/family member who isn't feeling 100%. I am happy to report complaints to my supervisor and if I can rectify the problem, by golly, I will. I can not help the shows on TV, the food, the lack of closet space, the consistency of the sheets, the brand of orange juice the hospital provides, the absence of a beauty salon, cafeteria hours, erratic doctor's rounds timing, or the size of your room. I will give you some paper to write those things down for my supervisor or let you talk with my charge nurse. I know I will get bad patient ratings for not correcting all these problems. Next time I will learn.
8. Please, guys. Don't ask me about labs. I want to tell you. I can't tell you. I'm sorry.
9. Shift change is a bad time to call about an update on patient condition. Try to call 2 hours before or two hours after shift change. If before shift change, the last shift nurse can give you the low-down. If you call a few hours after shift change, I will have a good handle on your loved one's status. Otherwise, it might be messy and I won't get a chance to thoroughly evaluate my patient.
10. If you are a visitor and if you curse, threaten, hit, or disturb my patient in any way, you will be leaving. Same goes for me and my colleagues. This is a place for healing.
11. Family drama is not conducive to healing. If grievances must be aired, please have quiet, non disruptive discussions. Screaming profanities is not therapeutic and everyone will be asked to leave.
12. I like help, don't get me wrong. But, uh, no matter how strong you are, certain patients require certain strategies to move about, pivot to the commode, whatever. The patient might wind up caught up in any number of tubing, fall, reopen a wound, etc. I like your go-getter attitude, but I'd prefer to help you get the hang of things. I like my patients unharmed.
13. We all make mistakes. Usually they are minor. It is painful, not fatal, if I accidentally blow an IV on MawMaw's floss veins. Don't call me names, don't assume I am just poking around for kicks. I'll get help if my technique fails. Twice is a good number before I ask another colleague.
14. I do love family stories, and I'd love to hear them all, but a floor nurse is on the go 24/7. I'm not ignoring you.
15. Please let the patient talk if he/she can.
16. There's generally a reason I ask patients' families to call me should something happen. Please don't unhook an IV, remove a mask, or any other 500 things without assistance. Some things could turn out bad.
17. Do not sneak alcohol to my patient.
18. Please do not paint my patient's nails, dye her hair, or otherwise alter her appearance unless it's been run by the doctor or me. The polish irritates other patients' lungs and dying hair is messy. No make-up... it's a no-no for surgeries. Please don't clip toenails, wax, or beautify without first checking with your nurse. Some hair styling tools may burn patients and hospital beds.
19. For those randy, lonely spouses missing their lover in the hospital: NO. Your time will come.
20. Visitors, never assume you know what's in a random cup.
21. No strippers. I don't know why I have to include this.
22. But I must say, on the whole, a good friend or family member helps brighten my patient's day. Please watch to see if my patient looks tired or in pain, because he/she may need a break. Your love, support, and comfort help beyond what I can do sometimes.
So the other night I was called to assess an unresponsive patient on our locked psych unit. I arrived to find him to look perfectly fine and have perfect vital signs. We checked and he wasn't hypoglycemic (the most common cause of unresponsiveness calls). He didn't react in any way to a hard sternal rub. I was wracking my brain trying to think what could be causing his unresponsiveness.
I should add that this patient is well known to the rapid response team. He knows each of us by name and face and we have dealt with him many times, but this was the first time he had been found unresponsive.
I was standing at his bedside and had just paged the on call physician from my RRT cell phone when a code blue was paged overhead.
On hearing the overhead code announcement my unresponsive patient popped his eyes open and said:
"PMFB, it sounds like you have something more important to do."
I took off for the code thinking "You SOB" and I didn't mean shortness of breath.
i think all nursing school prospects should have to work as aides first.. i have been an aide for 3.5 years and just passed my nclex.. i could get a job in the ED here where i work but i wont because i want the expirience of floor nursing first..
Please don't forget that Med-Surg is a specialty and that we need new nurses to know the basics just like any other specialty! I think this "phenomenon" has been happening everywhere because more and more of the nursing schools are expecting the student's first employer to teach them the basic skills instead. Couple that with children growing up thinking that they're all special snowflakes and we end up being the ones to have to burst the bubbles...AKA...NETY.
Your article basically only discussed how CC's are more flexible and cost effective. To me that translates into cheap tuition = low quality training. Plus your link mentioned only community colleges in general, it said NOTHING about nursing programs at community colleges. My link has ONLY nursing schools. I'd put my BSN program against your community college any day, I don't care which community college you're talking about, class by class and clinical rotation by clinical rotation, and my program would blow any out of the water, with hands-on experiences (didn't need my professor by my side to do things), with total clinical hours, amount of science required, etc. Did your nursing school have a cadaver lab? Did your nursing school have a high-fidelity sim lab? I took the exact same anatomy, physiology, pathophysiology, microbiology, organic chem, biochem as the pre-med and pre-dental students were required to take before ever being accepted into my nursing program. Like I said, I'd put my program against any community college's program ANY day.
I could barely set up an IV when I started, but I also caught two strokes (one pt was tPa'd) pneumonia (because I was the only nurse who had had the patient before during his stay), and prevented a more experienced nurse from giving a med the patient was allergic to (and because I did it quietly, she thanked me) within the first 6 months.
While I am not downplaying the need to learn skills, they are easily and quickly taught. Medicine is see one, do one, teach one, and nursing could be the same. The other day, a newer nurse asked me to help her deaccess a port, as she had never done it. I verbally told her the supplies and steps, then walked her through it on the patient. Boom, she's ready to do it on her own. Assessment and monitoring for deterioration (pathophys, s/s, etc.) is much more important.
"Who opens your pack of crackers / holds your cup while you drink / feeds you / moves your blankets an inch this or that way / holds your penis while you urinate / turns the lights on or off / changes the channel for you AT HOME?!?
This is for those patients who seem to think just because they are in the hospital, you must do every little cotton-picking thing for them when they are full well and able to do it themselves!!!!!!
Just once I'd love to say to them "Are your hands/arms broken?
Adding to my last post--when you take off a patient's socks and you see all of their flakes of skin dispersing through the air. i feel like I'm breathing it in and its getting in my hair, on my scrubs, etc...yuck!!!
Doing diabetic teaching on a 350 pound frequent flyer while she washes down a stack of pancakes and syrup with orange juice. Just drag me away in a straightjacket please.
Simple. You can't "abandon" patients for whom you not have taken report and assumed care for.
That is the bottom line. That and she is so FOS that it's insane. Don't give in.
The issue with team nursing, is that the focus ends up being on the work to be done (task orientated), rather than the patient, and we all know the need of each patients can be quite complex, more than the simple act of attending to a task. I feel you can still work as a team but that each nurse has overall responsibility for a smaller group of patient's.
Attachment 19422
Party foul!!!
While these mindless twits sit around sipping coffee and gossiping we're actually working to make a difference....
Ah, yes, The View. Proving once again that women can also be knuckle-dragging troglodytes.
If you caught The View yesterday, you saw Joy Behar ask of Miss Colorado (Miss America contestant) and nurse, "Why does she have a doctor's stethoscope around her neck?"
Our friends at Gomer Blog couldn't resist.
Littmann to Produce Separate Doctor and Nurse Stethoscopes Thanks to “The View” | GomerBlog
I think I'll order one custom-made with assless chaps.
Oh, yes, we know them. The throngs of visitors, family members, and guests who flock to comfort our patients. This is just for fun. See if you can name some of our favorite guests.
1. The good Samaritan who brings your post-surgical NPO except ice patient some pungent tacos because the patient said he felt hungry. Patient eats three bites and begins vomiting epically. The visitor, big-eyed and instantly remorseful, tells you, "But he said he was getting really hungry and you guys weren't bringing him anything!" At least three places in the room, including the door, say "NPO x Ice". There will be Phenergan. Visitor bolts because of the smell and leaves the wrappers in the garbage.
2. The PCA pump spouse who watches the clock and pushes the PCA button every ten minutes, even if her husband is asleep. She tells me she doesn't want him to wake up in pain. Luckily, with the help of Narcan and some skilled critical assistance folks, the husband gets to see his wife's face again. No matter how many times you educate...
3. To my young patient's friend: I can see you care about your buddy's comfort and worry that we aren't giving him his choice dose of powerful narcotics. There are reasons. He is constipated, he is experiencing AMS, and a zillion other things. While it's kind of you to bring supplementary meds and slip them to your friend, it kind of messes up his breathing and living. Please don't visit again.
4. I like meeting my patient's relatives, but if I have already met 20 and answered the same 400 questions, I'm going to nicely ask you to start talking to my patient or to each other. Maybe bring a tape recorder when the doctor comes in if the patient agrees. I want you all on the same page.
5. Speaking of relatives, I know the hospital can be noisy, cold, annoying, and frightening. Should your facility permit, I have no problem with one of your relatives staying overnight. Just a foreword--the couches don't get any more comfortable, we will be coming in the room to do annoying procedures like vital signs and medication administration, the room will either be too hot or too cold, the patient down the hall may yell, there may not be 4 pillows readily available, and the TV does not have HBO. Plan accordingly.
6. We love kids. We just don't love it with young children decide to bounce on Grandpa and bust his stitches. Unfortunately, the care providers prefer that catheter bags, oxygen devices, JP drains, bed controls, suction canisters, computers, IV pumps/poles, and just about any cool thing be left to the appropriate hospital care provider. We hate to be a bummer. Oh yes, and the gloves. The gloves won't hurt you, but if you pull the entire box on the floor, it costs the hospital money and we don't want that.
7. Dear overzealous advocate for your sick loved one: I am proud of you for standing up for your friend/family member who isn't feeling 100%. I am happy to report complaints to my supervisor and if I can rectify the problem, by golly, I will. I can not help the shows on TV, the food, the lack of closet space, the consistency of the sheets, the brand of orange juice the hospital provides, the absence of a beauty salon, cafeteria hours, erratic doctor's rounds timing, or the size of your room. I will give you some paper to write those things down for my supervisor or let you talk with my charge nurse. I know I will get bad patient ratings for not correcting all these problems. Next time I will learn.
8. Please, guys. Don't ask me about labs. I want to tell you. I can't tell you. I'm sorry.
9. Shift change is a bad time to call about an update on patient condition. Try to call 2 hours before or two hours after shift change. If before shift change, the last shift nurse can give you the low-down. If you call a few hours after shift change, I will have a good handle on your loved one's status. Otherwise, it might be messy and I won't get a chance to thoroughly evaluate my patient.
10. If you are a visitor and if you curse, threaten, hit, or disturb my patient in any way, you will be leaving. Same goes for me and my colleagues. This is a place for healing.
11. Family drama is not conducive to healing. If grievances must be aired, please have quiet, non disruptive discussions. Screaming profanities is not therapeutic and everyone will be asked to leave.
12. I like help, don't get me wrong. But, uh, no matter how strong you are, certain patients require certain strategies to move about, pivot to the commode, whatever. The patient might wind up caught up in any number of tubing, fall, reopen a wound, etc. I like your go-getter attitude, but I'd prefer to help you get the hang of things. I like my patients unharmed.
13. We all make mistakes. Usually they are minor. It is painful, not fatal, if I accidentally blow an IV on MawMaw's floss veins. Don't call me names, don't assume I am just poking around for kicks. I'll get help if my technique fails. Twice is a good number before I ask another colleague.
14. I do love family stories, and I'd love to hear them all, but a floor nurse is on the go 24/7. I'm not ignoring you.
15. Please let the patient talk if he/she can.
16. There's generally a reason I ask patients' families to call me should something happen. Please don't unhook an IV, remove a mask, or any other 500 things without assistance. Some things could turn out bad.
17. Do not sneak alcohol to my patient.
18. Please do not paint my patient's nails, dye her hair, or otherwise alter her appearance unless it's been run by the doctor or me. The polish irritates other patients' lungs and dying hair is messy. No make-up... it's a no-no for surgeries. Please don't clip toenails, wax, or beautify without first checking with your nurse. Some hair styling tools may burn patients and hospital beds.
19. For those randy, lonely spouses missing their lover in the hospital: NO. Your time will come.
20. Visitors, never assume you know what's in a random cup.
21. No strippers. I don't know why I have to include this.
22. But I must say, on the whole, a good friend or family member helps brighten my patient's day. Please watch to see if my patient looks tired or in pain, because he/she may need a break. Your love, support, and comfort help beyond what I can do sometimes.
Ya'll got some "guest" goodies?
So the other night I was called to assess an unresponsive patient on our locked psych unit. I arrived to find him to look perfectly fine and have perfect vital signs. We checked and he wasn't hypoglycemic (the most common cause of unresponsiveness calls). He didn't react in any way to a hard sternal rub. I was wracking my brain trying to think what could be causing his unresponsiveness.
I should add that this patient is well known to the rapid response team. He knows each of us by name and face and we have dealt with him many times, but this was the first time he had been found unresponsive.
I was standing at his bedside and had just paged the on call physician from my RRT cell phone when a code blue was paged overhead.
On hearing the overhead code announcement my unresponsive patient popped his eyes open and said:
"PMFB, it sounds like you have something more important to do."
I took off for the code thinking "You SOB" and I didn't mean shortness of breath.
Please don't forget that Med-Surg is a specialty and that we need new nurses to know the basics just like any other specialty! I think this "phenomenon" has been happening everywhere because more and more of the nursing schools are expecting the student's first employer to teach them the basic skills instead. Couple that with children growing up thinking that they're all special snowflakes and we end up being the ones to have to burst the bubbles...AKA...NETY.
I could barely set up an IV when I started, but I also caught two strokes (one pt was tPa'd) pneumonia (because I was the only nurse who had had the patient before during his stay), and prevented a more experienced nurse from giving a med the patient was allergic to (and because I did it quietly, she thanked me) within the first 6 months.
While I am not downplaying the need to learn skills, they are easily and quickly taught. Medicine is see one, do one, teach one, and nursing could be the same. The other day, a newer nurse asked me to help her deaccess a port, as she had never done it. I verbally told her the supplies and steps, then walked her through it on the patient. Boom, she's ready to do it on her own. Assessment and monitoring for deterioration (pathophys, s/s, etc.) is much more important.
"Who opens your pack of crackers / holds your cup while you drink / feeds you / moves your blankets an inch this or that way / holds your penis while you urinate / turns the lights on or off / changes the channel for you AT HOME?!?
This is for those patients who seem to think just because they are in the hospital, you must do every little cotton-picking thing for them when they are full well and able to do it themselves!!!!!!
Just once I'd love to say to them "Are your hands/arms broken?
Drives me nuts!!!
Adding to my last post--when you take off a patient's socks and you see all of their flakes of skin dispersing through the air. i feel like I'm breathing it in and its getting in my hair, on my scrubs, etc...yuck!!!
Doing diabetic teaching on a 350 pound frequent flyer while she washes down a stack of pancakes and syrup with orange juice. Just drag me away in a straightjacket please.