What I Would Love To Send to My Hospital's Inpatient DON
Nursing is a very physically and emotionally demanding profession. Here are some ideas I would love to send to my DON that would make my job a little easier.
This is what needs to be instituted to keep your nurses and patients happy:
Mandated nurse to patient ratios
The suggested ratios are: 1:5 Acute care, 1:4-5 Observation 1:4-5 Surgical acute, 1:4 Heart Care Unit, 1:3 Intermediate Care, 1:6 SubAcute, 1:2 ICU, 1:4 ED. These ratios should not be breached!
Secretaries on the floor to handle non-nursing tasks
They can fill out medical release forms, make copies of advanced directives, stock forms on unit, and pick up old charts and bring them to desk for filing.
Instituting visiting hours and limits to how many visitors at a time
Family members must get special permission to stay the whole day/night. Family members can be great, but they can be detrimental to patients and staff. Some patients want and/or need their rest. Sometimes they don't want visitors. Sometimes family members want to be served by staff. They want drinks and snacks. The hospital has a cafeteria. They can also order guest trays for only $8 a tray. Sometimes family members are so demanding that their family member who is the patient is embarrassed at how they are acting. Staff is very busy. They are not always available to answer questions. There are things that must be done that have time constraints, such as medication administration, documentation of assessments, and hourly rounding documentation. If there were posted visiting hours such as from 1:30-4pm, nurses could be prepared and anticipate family members coming in at that time with questions. Family members expect visiting hours. They ask us what the visiting hours are very frequently.
IV team available to assist the nurses with lab draws/new IV starts
This would be a huge help.
Charge nurses should not have to take patients unless there is a true emergency
Charge nurses are needed to control patient flow, triage admissions and assign them to rooms, handle patient/family concerns, help with lab draws/IV starts, help with admissions, and educate staff. When the charge nurses have patients, they suffer, the staff suffers, and their patients suffer.
No more double documentation!
Aspiration documentation can be done in the daily adult assessment form, and an area for bronchial hygiene can be added in the adult respiratory section. Documentation takes away enough time from our patients and double documentation is a waste of time.
PROVIDERS/Pharmacy in the ED responsible for medication histories
Nurses do not prescribe medications. They are not familiar with all medications and dosing, especially if they are a new graduate nurse. If a patient has an unfamiliar medication and gives the dose incorrectly, it may be a dose that is way off the norm, but a nurse may not recognize the dose as off. Patients come to the unit with incorrect medication histories, and medications are ordered based on this. Wrong times, wrong dosages, or wrong medication! The patient gets annoyed that a PM medication is scheduled for the AM. Then the nurse has to call pharmacy to get it straightened out.
Nurses should not be held responsible for asking providers to order things patients need such as VTE prophylaxis
This is a provider responsibility! Instead of disciplining nurses, providers should be contacted directly. Or there should be a protocol in place that allows nurses to order Teds, SCDs and/or foot pumps given patients do not have vascular compromise in the legs or wounds on the legs.
Anything to add?Last edit by Joe V on Jan 8, '16
About Lev <3, BSN, RN
I'm an acute care nurse at a community hospital on a surgical unit. I have 2 years of CNA experience and 1.5 years of experience as nurse. I enjoy learning new things every day!
Lev <3 has 'A few' year(s) of experience and specializes in 'Emergency Department & Upstairs'. From 'Another planet'; Joined Jun '11; Posts: 2,440; Likes: 4,495.3Jun 15, '14 by francomlWow I didn't realize that this was not standard of care. I guess I have been sheltered working for my institution..... The things I have taken for granted O_o7Jun 15, '14 by Esme12, ASN, BSN, RN Senior ModeratorQuote from francomlHow's the new job?Wow I didn't realize that this was not standard of care. I guess I have been sheltered working for my institution..... The things I have taken for granted O_o
From your posts you DO work at a good facility.....hang on to them they are rare these days.11Jun 15, '14 by maxthecatAgree with everything except the medications: If I am unfamiliar with a medication it is my responsibility to look it up and clarify with the provider/pharmacy if I am still unclear. I don't just give it because it's ordered. I thought this was basic.4Jun 15, '14 by Lev <3, BSN, RNQuote from maxthecatYup that's what I do too! Was talking about taking medication history.Agree with everything except the medications: If I am unfamiliar with a medication it is my responsibility to look it up and clarify with the provider/pharmacy if I am still unclear. I don't just give it because it's ordered. I thought this was basic.4Jun 16, '14 by applesxoranges, ADN, BSN, RN, EMT-PYeah. Patient care ratios can get out of hand at my old facility. It was standard for stepdown to take five patients. Medsurg six pushing seven. ICU was 2 but they could put two intermediate and 1 ICU togegether.
They also need to have a float pool. The old hospital decided to get rid of it and pulled everyone from the ICU. It averaged two pulls a night. It saved the hospital 4 bucks an hour to gig rid of the float pool.
Medication on history is one that is frustrating. It has to be reconciled but no one ever knows the meds.37Jun 16, '14 by woohMy fave is making providers responsible for their own freaking orders. I'm tired of nurses being disciplined for providers not doing the provider's job. Unless one of the providers is Doogie Howser, they're all old enough to not need me babysitting them.0Jun 16, '14 by Lev <3, BSN, RNQuote from applesxorangesThat is dangerous!Yeah. Patient care ratios can get out of hand at my old facility. It was standard for stepdown to take five patients. Medsurg six pushing seven. ICU was 2 but they could put two intermediate and 1 ICU togegether.5Jun 16, '14 by Lev <3, BSN, RNQuote from woohYes yes yes!My fave is making providers responsible for their own freaking orders. I'm tired of nurses being disciplined for providers not doing the provider's job. Unless one of the providers is Doogie Howser, they're all old enough to not need me babysitting them.11Jun 16, '14 by Hygiene Queen, RN GuideQuote from woohUgh.My fave is making providers responsible for their own freaking orders. I'm tired of nurses being disciplined for providers not doing the provider's job. Unless one of the providers is Doogie Howser, they're all old enough to not need me babysitting them.
I have found that, sometimes, Doogie Howser disguises himself as an over middle-aged balding man who is freaking scared of the computer order entry system.
Let the babysitting begin!3Jun 16, '14 by KimberlyRN89, BSN, RNQuote from woohMy facility uses Cerner, and recently the physicians have come on board and now they are responsible for putting in their own orders. It's not going so well :-( Mainly a lot of them are grumbling that they should not have to do it. One even went so far and said "What are the secretaries for?" Sigh.2Jun 17, '14 by NewhospitalRNMy facility also went to Cerner recently. I can't say I like it very much but it beats having to double chart things. The doctors were having nurses put orders in with old system but a few doctors had nurses put in orders with this new system. I am not used to the systems. Tack on 7-8 patients and new system and I think I don't want to be a nurse anymore. I have only worked in hospital med-surg diabetic/telemetry unit for about 6 months but I have been a nurse for a total of 8 years. My experience has been in correctional nursing. I have a new respect for those working In hospitals. And to make matters worse for my family I currently work nights which is not cohesive at all18Jun 17, '14 by ProgressiveActivistI would like to add
Less emphasis on Press Gainey scores and magnet status. Focus on measurable outcomes. Incidence of falls, CLABSIs, CAUTIs, SSIs , readmission rates, VAPS.
A singular focus on customer satisfaction is unethical. What is best for the patient is not always what they want.
Giving the Diabetic keto acidosis patient unlimited meals and hydromorpho en is bad practice. But they are satisfied (so was Michael Jackson)
and keep coming back.Last edit by ProgressiveActivist on Jun 17, '14
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