JCAHO: "Behaviors That Undermine A Culture of Safety"

Yes, I had that happen to me. The doctor was standing at the nursing station. I wrote what he said as a verbal order. When the next doctor came asking for clarification of the verbal order, said physcian denied having given an order. then made some comment how he was even really on the case to begin with......did not matter to him that he was on the consult list. Fortunately several other nurses were at the nursing station at the time the original doctor gave his verbal. I simply then wrote a verbal order that dr. signed off case. As on the phone that was pretty much what he said.. grrrrrrrrrrrrrrrrrr. LOved my co-workers at the time, loved that I could confer with them on ,ok now what do I do..lol.. all in a days work

Does anyone think that this kind of harrassing behavior that nurses have to put up with sometimes works its way down to the patients? I don't mean on purpose or to harm people. Do you think that sometimes nurses, CNA's etc. unconsciously transfer their frustrations and angers toward the patients because of what they have to put up with? Can anyone think of any examples?

Well to ask a question you have to start a new topic. Go to user account settings or site help at the top of the allnurses web page. and that should work
Cowgirl2stepup, I have worked in quite a few psych units with psychotic patients and I have seen patients throw water cups and pills but I have never had a patient psychotic or angry throw beverages or food at staff as most times alot of our patients are homeless or been arrested and are hungry and thirsty and even though they are sick they see it as a caring gesture. I realize there are exceptions to every rule and I find as a nurse if a patient is actively posturing or angry I would be talking with the person and bringing them down and would offer food and fluids when they felt more in control and I felt they had control of their behavior. Hope this helps answer your question .

this can be taken a couple of ways ... i'm all for safety in the workplace, but recently it has been used as intimidation towards me from management. i'm a new grad and started two weeks ago at the career i was so happy to start. the facility really cra**ed out on their orientation. i tried talking with the preceptor, the dept. mgr tried to make changes, but the supervisor and charge did things their own way.

so, i pretty much had no supervision or training from anyone and by my 3rd day on the job they wanted me to take two patients on my own.

i didn't think my license and patient safety should be at risk. so, i decided to cut my losses and say i quit to my preceptor in a closed door med room. she followed me down the hall and begged me to stay. i said no. then in a closed door locker room: two overnight nurses were changing and said what's up. i said it's chaos here etc. etc. while i changed and took my bags out of the locker. they defended the situation, of course. the boss talked to me two days later and said during the conversation that they decided not to file an incident report because i was disrupting the workplace. thank you i said .... WOW what kind of cra* is this?

Horizontal violence, mobbing and bullying are threatening our profession. You've provided a great example of how some nurses in management will use the JCAHO "Behaviors" language to perpetuate a self-serving culture that blames the true patient advocate and whistleblower.

Nursing education budgets and direct care RN staffing have been squeezed to accommodate the bottom line financial goals of hospital corporations. You're right, it's not in the best interests of our patients who deserve safe, therapeutic nursing care. You are educated and you should be able to practice the art and science of nursing with the help of expert mentors and preceptors. "Sink or swim" / "trial and error" methods are not professionally appropriate, ethical learning and skill acquisition models.

In this era of market-based, for-profit sale and delivery of health insurance products, a lean and mean industrial model of care has develped. Nurses have been laid off and replaced by less educated, unlicensed staff. Professional skill and judgement is degraded by cookie-cutter "best practice" templates. Many nurses have chosen to flee unsafe, unethical environments rather than risk harming patients and losing their licences. Hospital corporations have escaped accountability for this assault on nursing practice and for creating the onerous working conditions that ushered in the so-called nursing shortage.

I hope you will not leave the nursing profession and that you will seek employment in a facility where the nurses have chosen to organize against such workplace practices. Nurses at the facility where I work organized with the California Nurses' Association/National Nurses Organizing Committee. We have an all RN staff nurse Professional Performance Committee that proactively and collectively acts to create an environment where bedside nursing practice can thrive, in the exclusive interests of the patient. It offers genuine protection for patient and professional advocates. Some larger teaching hospitals offer a little more in the way of new grad internship programs, but public facilities have felt the budget squeeze as well.

Please check out the California Nurses Foundation website for exciting news about nurse mentor/nurse preceptor programs with proven results that help recruit and retain new nursing grads like yourself, and nurses who are new to a specialty. The answers are at hand, and part of the solution is for us to have a national, single-payer health plan. Hospitals, doctors, and nurses should be compensated for providing medically necessary care. Instead of hiring bean counters and collection agencies to demand payment from the multitude of insurers that deny their claims, or limiting access by closing their emergency rooms, hospitals could be hiring more nurses to provide actual care for their patients. Hospitals should be able to ask, "How can we help you?," instead of "What kind of insurance do you have?"

http://www.calnursesfoundation.org/
http://www.guaranteedhealthcare.org/facts

2008rngrad

I am sorry that you were not heard at your employment.

However let me say. Often when orientating new people by day 3 having a team of 6 or 9 patient I would let my new orientee take two patients to focus on giving meds to ,assessing,charting on etc. If she needed guidance I would give it on her two patients. I would check her charting and we would discuss it. As there are so many different areas in our computer charting that needed to be charted I found this a much less overwhelming way for new people to test the waters. They were never truly on their own, they simply had two patients to focus on instead of all 6-8 which I was responsible for . In this way they got hands on as to the charting and giving meds within a 12 hour time period honing their nursing skills along with either learning time management or working on their time management skills.

In this I would continue to educate as to the finer points of nursing on on the types of patients we had.Ask what their goals were for the week and what they would like to accomplish in that week.

The next week, I might give them 3 patients depending on whether they demonstrated ability to care for the original 2. All in all by weeks 8 or 12 depending on whether a new grad or not the goal was for them to be able to handle a team up to 8 patients. With some we could work up an extra patient a week until they were finally up to a semi comfort level of a full team. With some I would have to back off the numbers and start over. Now some required extension of their orientation which was open ended either as requested by the new person or myself.

I do not know if this was what was on the minds of your preceptor or not. I only thought I would share how I do it.

thanks for replying everyone ...

i know i could have handled it differently at the end. i do understand that little by little patient load increases until the new grad can handle it.

my biggest point that was extremely frustrating for me was on days 1 & 2, the preceptor was not doing any teaching and for us to actually take care of patients, i was already doing patient care on my own and i checked in with her. she was always talking and visiting every person that walked by and didn't guide me at all. when i mentioned this, i guess she mentioned to the dept mgr that her load was too much to be able to teach me. the load for the third day was cut in half.

but, that third day i was then assigned a half load on my own and the preceptor got a half load on her own. and then it began, the talk, the discussion, the staff saying to me ... well, 2 months after my orientation i was handling 6 patients .. i don't see a problem with you handling 2 on your own.

well i did ... after three days compared to 5 months .. there's a difference. the peanut gallery didn't have to open their mouths and more or less demean me !