Support systems

[KTB]

Hi! I am looking for input on the support systems in place in other small community hospitals. I have had a rough weekend because we have had a high census with many sick calls and failing support systems. On Friday at 3:30 pm, we had a fresh post-op hip replacement and a chest pain admission literally sitting in the hallway because their room had just been vacated by 2 patients and there was no housekeeping staff on. So, the CNA and I quickly stripped the room, scrubbed and mopped it and made the beds while the patient's families looked on. An hour later, another admission came and when I went to bring her to her room, found that the room had never been cleaned from the discharge on day shift. So, again, I stripped, mopped and made the bed while the patient laid on the stretcher in the hallway. I overheard the family say, "gee, the RN's even have to do the housekeeping around here". It was very embarrasing. We usually have housekeeping on evenings but when there is a sick call, there is no one to replace her so it is assumed that nursing will pick up the slack. We have just implemented a new computer order entry system that has many problems. The lab called last night and said there were many errors that were put in by the day shift, such as duplicate orders. This is probably the computer's fault but it is hard to tell. The lab insisted that it is nursing's responsibility to fix there errors so I spent 45 minutes doing that last night, time I could have been spending with my patients and documenting. Then, the last straw was when I went to give the IV Rocephin to a 7 week old with pneumonia. I found the powdered filled vials in the med drawer with absolutely no instructions/guidance on how to mix it and no diluent. So, that took an additional 25 minutes to find out how to mix it, calculate the dose, and give the drug. Had pharmacy been doing their job, all I would have needed to do was a quick calculation to make sure it was the right dose. We don't have any formal transport program so when a patient needs to go to radiology, CT scan, etc. it is up to nursing to transport which sometimes can take them off the floor for 30 minutes or more. I have just had a lousy weekend and needed to "vent"! Thanks for listening/reading!

[JC74]

Sounds to me like there are problems with some of the other departments besides nursing and they should be covering thier own call in's. I can understand every now and then nursing having to clean a room but when you are busy and census is high, it should not be the nurses who are taking care of patients responsibility. First of all, ask yourself who's in charge of Housekeeping? If someone from that department calls off, it sounds to me that the department manager should be out there helping and covering a shift, after all thier probably on a salary and not hourly basis. It makes me sick when department heads gripe and complain about problems on the floor and they never come out and see whats going on, cause they only get it second hand.

Another question I have, is who is in charge on your shift and what are thier responsibilities? If your facility is anything like most, 3-11 is usually one of the busiest shifts. Youv'e got Docs coming and going, new orders, admits, discharges and transfers ect...

It also sounds like you don't have any Medication resources in your work area and if thats the case, someone higher than you needs to know about it and take care of the problem and make those resources available. I've run into a problem recently with "new" medications that are not in the nursing drug reference books or the PDR and our Pharmacy will stock the drug with no information on it. How am I to know if it's an antibiotic from an antipsychotic? Well, when the pharmacist on call gets a telephone call at 2 or 3 am, hopefully they'll think twice about leaving a med with no information on the floor.

Everyone has a job to do just like you and need to be made accountable. You should not be expected to do everyones job for them and if you don't make it known to the person in charge, you'll get stuck with a difficult situation again.

[pjh]

KTB

Hi I read your message and want you to know your not alone. I'm a RN in a small hosp.I work 3-11shift so I do every dept. except surg.I do all my own treatments, blood and wound care.I mix and give all my own meds.When I work ER I have to go hunt the drug and find the correct dosage and way to give it.that backs us up. I get no extra pay for diff. depts. worked. This is the only hosp. in this small area, many have left and come back becuz of the long drive they got tired of. We all need our jobs so noone says anything.Some days were swamped and the next we have to take low census, so we cant really complain.and if your from the area and have land and family you dont want to move. I'm not so I'm thinking of doing some traveling nursing with a 3yr.old along. What else do I do?? Anyways your not alone. [email protected]