Quote from imperial
Curious, what do you mean they 'are not staff friendly'...
My main focus is on education of staff who provide care to patients. I have been reading at the www.dialysisethics.org
site many survey results (posted here, I believe) and am astonished at the mistakes that take place. I have mentioned already my concerns with the experience requirement of new proposed language in the ESRD regs, of only six months. This is frightening, especially, since I have seen posts at this board stating dialysis is a serious business.
I know of many patients in FMC units who basically are 'not' satisfied, but due to location/convenience, it is not reasonable for them to switch units. They are not allowed to question anything staff does. This is not okay. At the beginning, patients are told they are part of the team, however, once you provide input as to your care, you are cut off.
I know of one story where the district educator was doing training in one unit. However, this educator did not even wash those nasty hands inbetween patients, or touching machines. Additionally, taking the apron and touching the paitent's machine just brings all those contaminated areas on the apron to the machine. Obviously the educator had not one thread of cognizant awareness to infection control. So, how can one expect staff to perform appropriate tasks when the educator isn't. yes, an FMC unit, but I am sure this happens all over. And, yes, I know there are wonderful great sincere nursing staff out there.
I don't know which FMC clinics you are referring to, but that certainly is not the case where I am (re asking questions, genuinely being ENCOURAGED to ask, and to participate in their care).
I'm sure there are good and not so good clinics and educators everywhere, not that it justifies this particular educator's negligence.
We are careful to wash our hands and change gloves between patients, I can assure you,, but as far as the aprons go, that suggestion is a FIRST.. no we do NOT don new aprons between patients, as we are CONTINUOUSLY running to and from machines... they alarm constantly. We monitor vital signs q half hour, and go from patient to patient and machine to machine to monitor them.
During turnover it is chaotic.. we are swamped. We each have four patients, HOWEVER.. if a coworker is tied up with a bleeder or one who is hypotensive, another staffmember goes to her aid and helps with her other patients if she is not too tied up herself. When I say nonstop on the move between patients and machines, I mean exactly that. To think that we will stop and remove aprons between patients during this chaotic time is absurd. We would never get ANYTHING done, as we would be spending all our time exchanging aprons.. and just as soon as you have one on, you need to run to the next patient in distress... there is just no way. It is NOT feesible, or even do-able.
It is hard enough washing hands between patients when things get wild, and they DO get wild, believe me.. But, yes, we DO wash our hands between patients, absolutely. Another reason we intalled the etoh-gel dispensers, because there are times when these emergencies cannot wait for you to stand at the sink washing to the tune of Happy Birthday... when someone is bleeding all over the floor, you must be ready to jump right in there.
What you are suggesting is ideal, yes.. but would require that a staffmember have no more than one patient apiece.. two max. That way all this "perfection" could be done, but not when you have four patients, or a roomfull of patients.. as hte aptients are all in one room, and we run around this room like a guinea pic on a treadwheel ) and everything going on with them at the same time, perhaps even taking on a couple more when a coworker has her hands full with a patient crises (or two).
And you will NEVER see the day when a staff member is given only one or two patients.. just ain't gonna happen.
If our apron is soiled, certainly, it is removed and a new one put on.. but not just going from machine to machine because the minute you turn your head, you are needed right back at the first patient's machine for something else.
I would like to ask you this... have you ever worked at a dilaysis unit (chronic outpatient) ? You might want to do that for several months... (not just spend a day looking about)..get in there and see what is REALLY entailed, and do it yourself. Then come back here and tell me how you think all these ideal methods could best be implemented.
They all look GREAT on paper. But it is far from realistic. There is SO much more involved than just putting a patient on and taking them off after four hours. You have to work it to understand what I mean.
Yes, we are cognizant of infection control, and we do our very best to prevent cross contamination... but with as many patients as we have and the constant running between them to addresse their needs or answer the machine alarms, replace the acid and bicarb (which also require aprons and ppe) we'd have no time to get to the patient if we were to be constantly changing gowns or washing our hands every second.
Again... I say increase the staff so we can even more competently care for our patients.. but not expect us to be able to do all that is required of us in a given amount of hours in the day with all the things that go on at any given time. We are continuously pressured to not acquire ANY overtime and yet we have no control over a patients' rides being late, the transport service not showing up to pick said patient up.. patients having to hold their sites longer than usual.. hypotensive situations.. you name it. Everything always looks so good on paper.. but these many situations are never taken into account.
Sorry for the long rant... but I SO feel that it is not the staff who should be further burdoned and attacked... speak to the company SUITS, and demand better staffing for the improvements you seek. We all want the same here.. better care for our patients. But we can only give and do so much... our heads are already spinning from the minute we arrive at 0400 until we leave 12 or 13 hours later.
But the company administrators don't want to hear it. They will NOT increase the staff... remember.. it's all about the $$. :stone
End of rant.