-So every time you have an agitated, possibly dangerous patient, you either have to waste time getting a witness to verify the waste in the Pyxis, then draw up a microscopic dose, which usually seems to be about as effective as fighting a four-alarm fire with a teaspoon, or pull out the whole thing and waste later, and then get written up for violating policy.
Or why drug companies put pills and tabs in blister packs that are so sharp you could perform surgery with them?
Or why every floor only has ONE flipping set of keys to the narc cabinet?
-So, now when you have the drug-seeker with the egg timer whining for his Lortab, you have to have roll-call to find out who's got them. Usually it's someone on the preceeding shift and they have them in their car, and then you have to wait for them to bring them back. That is, of course, unless the sup is feeling magnanimous and comes to unlock the narc cabinet for you. Of course, by that time, Mr. Abdominal Pain NOS is practically in DT's because he's had to wait ten minutes.
Or why IV poles always have a bum wheel?
Or why the lab always takes the CBC machine down for maintenence at 10 in the morning?
Or why the sickest patients are the ones you never hear a peep from, yet the ones that are probably better off than you are always the ones that whine and carry on fit to make you hold your ears?
You guessed it, I'm on another one of my tangents. Nursing's great Unsolved Mysteries. I'd love to hear some of yours.
I did, got written up for violating p/p. Every time, no matter wht the situation was. That was my initial question. It makes no sense. While I'm waiting for someone to come waste with me, someone else could be seriously hurt, but God forbid I do something out of sync.
It was an emergency! Can't that rule be overlooked during emergencies!
~ birds suddenly appear every time you are near? (kidding, but really...who wants to hang around a person surrounded by birds all of the time?)
~ physicians cannot communicate with one another? (surgical resident gives me a phone order to contact cardiologist about diagnostic study result, then after i talk to cardiologist, i have to call surgical resident back).
~ no one ever dates primary iv tubing? (does that mean no one ever changes it? sometimes i think so.)
~ all of the orders for low beds are filled at 2 am when the patients are finally sleeping but the patients must be put in the beds asap because the bed delivery man is complaining to our manager that we aren't doing it right away and because day shift will have a very large cow about it if it's left one second past 0700? (i know for patient safety, the bed must be utilized, but this is always the one night the patient isn't trying to get out of bed and is accepting limits!)
~that cutie pie resident who flirts with you for months on end and always makes it a point to sit next to you and talk to you and only you turns out to have a girlfriend? (uh, this is...hypothetical :))
~the nurse before you reports that the patient hasn't had a bowel movement in four days, and when you check the chart, you discover that no one ever initilized the constipation protocol even though the patient in question has no contraindications? (or there is no documentation of the last time the patient had a bm?)
~ the vast majority of the population still has no clue what a nurse's scope of practice entails? (or thinks we're not "smart enough" to be doctors).
~ the meanest, dirtiest, grossest, most foul patients always have a significant other and children yet i can't get that hot sailor to call me back? (i think about more than boys, i promise!)
~ people think we'll believe them when they say "i was walking around the house naked and forgot i had an empty grey poupon jar on my kitchen chair so i sat on it and that's why i need to go to the or to have it removed"? (and why grey poop-on?)
~ just when you think your night can't get any worse because you've been running around like crazy and no you won't catch up by shift change, you realize you forgot to put on your deodorant? (or the tech you're working with did).
oh yeah, i hate being the middle person for everything. like i;m not busy enough i have to chase around doctors, pharmacists, techs, to relay messages.
Not to put a damper on the mood BUT regarding the not changing IV sites on the prescribed "expiration date"-
Actually, more and more research is supporting leaving healthy IV sites in longer...no standard change date but rather using a validated phlebitis rating scale to assess the patient's site and use this assessment to decide whether to resite the IV rather than an expiration date. Many factors dictate how long an IV site can remain healthy, not time alone. I believe this practice is based more on tradition than evidence and results in wasted resources and time. Of course the issue becomes the fact that hospital policy is what it is...but perhaps it needs to be changed rather than that healthy IV site...My WHY has to do with precisely this...
WHY are we wasting our precious time doing useless tasks-
-bowel sounds on patients with absolutely NO bowel issues or symptoms (evidence shows they are a useless assessment, basically-esp. on a person devoid of distension or other symptoms)
-blood glucose checks that nurses blindly keep checking...even though the pt has had normal results everytime, is not diabetic ...and is still getting poked QID for 2 weeks and no one asks WHY!
-weighing a demented MRSA positive pt daily because we are worried he is not eating enough...takes 2 staff, a disposable sling for the lift-scale (don't have scales built into the beds so have to hoist the person up on a lift q moring to weigh him)...not dialysis, not CHF...just to see if he is eating...heard of a calorie count, labs, weigh once a WEEK?
-pt on IV fluids for "hydration" and is already tolerating tube feeds...heard of water? We can put that in the tube too.
-intake and output on everybody whether it makes any sense or not.
Why do we complain about workload but don't question if the tasks we are doing are making any difference? We need not blindly accept MD orders or policy...I say question everything and ask WHY
Why does Dr X have a STANDING ORDER for something he's going to yell at me for actually doing (and what ELSE does he expect me to do for a post op appy who hasn't voided for SIXTEEN hours, even though he's only 28)?
Why does plastics never sign out their patients to the doctor on call for them when they leave on vacation? And why does their answering service not KNOW who is on call for them...ever?
If you are going to write parameters for a) blood sugars, b) urine output, c) heart rate, d) anything else objective, why does it only fall OUTSIDE the parameter at 0200, and why do you yell at me for calling you about it (and why do you write for me to CHECK it at 0200 in the first place)?
Why wont the one resident realize that the pt has the right to refuse that darn MRI? This is a whole story in itself.
Why can't the resident assess his own patient or read the chart during rounds?
Why, when I am in charge do patients code?
Why does CT in the ER try to delay a CT on a pt who went from localizing to decerebrate posturing, what this isn't a emergency? Glad we had a good resident on who went and told them what they were going to do and CT done and EVD placed, but pupils blew anyway.
Why is it when a pt has expressed wishes that family/DPOA wont follow them?
and more importantly how is it you can spend 30 minutes organizing all the iv lines, art line, swan ect.... go get a cup of coffee and they are tangled and braided again and it has only been 10 minutes and the patient is chemically paralized and did not do it.
You can always take out the 2mg vial and then waste it later in the pyxis. That's what I do. Screw standing there waiting for someone to waste the other mg.
I keep it in my med cart and 9 times out of 10, I end up using the other 1 mg before the end of the shift. If not, then I get someone to witness the waste.
meadow85
168 Posts
It was an emergency! Can't that rule be overlooked during emergencies!