Do you cut corners in your daily nursing practice?

[TheCommuter, BSN, RN]

Sorry, but I am forced to cut corners in my current position. I can provide quality care when I have 6 or 7 patients. However, when I have 10, 11, or even 12 patients on a severely short-staffed night, cutting corners is the only way I can humanly get it all done.

I will be leaving the bedside in a week and a half for various reasons, including the chronic short-staffing at my current place of employment. Even though I know we need nurses at the bedside, I'm running into a brick wall with the crappy conditions at the bedside.

I will become a 'paperwork nurse' with one of those 'desk jobs' so that I am no longer placed in the position of cutting corners.

[wooh, BSN, RN]

I can cut corners on each patient, or I can cut entire patients. The more patients I get, the bigger the corners have to be.

[eatmysoxRN, ASN, RN]

I'd be a handless nurse if I washed my hands every time I entered and before I exited a room, and I feel it isn't cutting corners when I'm hitting restart on an iv pump and don't wash my hands before and after that. I never leave pills untaken. I always take measures to reduce harm such as swabbing ports with alcohol and providing Foley care with each diaper change. However, some policies were created by people who don't work bedside.

[imintrouble, BSN, RN]

All of the above, plus I feel like you're asking if I'm perfect.

[dudette10, MSN, RN]

Ask yourself when you are tempted to cut a corner, would you approve or condone this if it was your relative or meaningful other?

Funny you should say that because I do ask myself when I'm tempted to cut a corner. The answer though is, yes, I still cut corners.

Just one example: At my workplace, we are required to chart two head-to-toes per shift. I do a full hands-on assessment at the beginning of shift, but the second one? Well, if I can't figure out if anything has changed in six hours when I've been in that room at a minimum of three times, my assessment skills and powers of observation suck.

[redhead_NURSE98!, ADN, BSN]

On my floor there is a nurse who was charge from 7-3 for years, never touched a patient, never helped out, rarely processed discharge papers. In fact I'm not real sure what she did exactly. This past year due to so many nurse complaints, they took her off charge and put her on the floor from 7-3, then whoever is charge takes her patients from 3-7. When she first started this all the other charge nurses were up in arms from taking her patients at 3. They said she left things undone, didn't give 1500 meds, etc. After taking her patients a few times though, I realized that it's because she is a good nurse, and very thorough on the things that she does get done. Besides, why should she have to accomplish all the tasks expected in a 12 hour shift, in 8 hours?

Of course, now her patients spend from 3-7 complaining to me about her attitude... can't fix that. Some of it is just that they don't like what they are hearing (such as a 27 year old lap chole being told she doesn't need to have the BSC and she needs to get up and go the ten feet to the bathroom, or the panc patient who can't seem to grasp why he can't have a ham sandwich).

[thelema13]

Of course I cut corners, only way to survive as an RN.

I cannot give you all of your medication information when I discharge you. I give the main points, but there is something to be said for self-awareness. It is also the patient's responsibility to read directions.

Sometimes I don't finish the fluid bolus on a DC'd patient so I can clear the room for another sick one.

Using nursing judgment, critical thinking skills and autonomy are our greatest tools. In a perfect world we could do everything by the book, but in reality, we are all overworked and understaffed.

[turnforthenurse, MSN, NP]

I cut corners. I think all nurses cut at least some corners. I feel like you have to.

I have left pills untaken before, but they were things like Os-cal. I have taken care of terminally ill patients and patients with literally a bunch of pills...some patients stating it is painful for them to swallow. and they will take some and ask if they can take the others in a little bit. I personally don't see a problem and will leave them at the bedside. Now if it is a controlled substance, I make sure they take that med before leaving the room.

Do I cover EVERY side effect of a medication? No, just the important ones. Same with during discharge teaching. I provide written materials regarding new medications for the patient and highlight the important things, but that's about it.

I wash my hands with patient contact, but as eatmysoxRN said I don't always wash them if I am going in to fix an IV pump alarm or to sign an hourly rounding form.

I do not ask the patient what they are allergic to EVERY TIME they get a medication. I do not ask for their birthdate. We have medication/arm band scanning at my facility. If I am giving a med that for whatever reason won't scan, then I check the MAR, double and triple check the medication, ask the patient their name and DOB and have the RN also check the medication and sign off as a witness on it.

I make sure I always swab IV ports with alcohol and do sterile procedures with sterile technique (central line dressing changes, foley cath insertion...etc).

[CloudySue]

Wow, OP, do YOU do all of that? Every time? Because if you have an employer that allows you time to do all that within your shift, I want to come and work with you in this wonderful place.

[MN-Nurse, ASN, RN]

Interesting survey. Let's see how I do:

Do you cut corners in your daily nursing practice? Or do you do everything according to the ‘book’.

I am the very embodiment of perfection in everything I do. OK, is this a serious question?

Do you police yourself in your everyday care of a patient, what do I mean by police yourself? I mean always follow the correct procedures no matter how busy you are, and when tempted to deviate never vary because you know it is wrong and that errors do often occur.

I police myself, whatever that means according to your strangely framed question.

When you are in a patient room alone, by this I mean no other staff member watching you or a patient who is oblivious. Do you behave as though you were being scrutinized?

Yes. (Finally a question I understand.)

Do you manage that patient care the right way, because it is the correct way.

My way is always the correct way, silly. (See my first response.)

Do you manage your hygiene, the correct procedure for changing IV fluids, remaining clean/sterile when changing dressings?

Um...Yes. Yes. Yes. I think you need to do a "fill in the circle" type thing because it is hard to tell when you are done asking a question.

Do you always wear gloves, do you change your gloves between procedures, do you wash your hands.

Let's see...No. Yes. Yes. (You don't always have to wear gloves).

Or do you occasionally forget to wash hands, not follow guidelines for procedures. Cut corners because you think nobody is looking, even though you know it is wrong but do it anyway?

No. No. No. (I think someone is doing some projecting here.....)

Do you reflect on your care after every shift? Reflection is old fashioned now, but after every event I do reflect on how I managed that situation, and if I could have done it better.

No. Jeez how in hades do you reflect on every event?

Often a corner is cut, nothing bad occurs so the next time you give yourself permission to do it again because you tried it once and it was OK. Soon the corner cutting becomes a habit and you no longer remember that you are cutting corners because it is part of your daily practice.

Your honor, is there a question here?

The reason I ask you, is because there are professional health care staff who do cut corners on a regular basis.

Name names, senator.

We do see frequent mistakes made because we don’t take our time.

You got a worm in your pocket?

Medications mistakes being common

Sentence fragment.

So many are made, but I wonder how many are actually happening and caught, and how many are never caught?

478 are actually happening and caught. 15 are never caught.

How many of you will go into a room, ask the patient her name, check her name band and then ask what she is allergic to? Every time you give that same patient her medication.

Whoever does that will eventually get slapped in the face by everyone around him or her.

Do you tell the patient what medications she is receiving? Do you discuss the side effects or check if the patient actually understands what meds she is receiving and why?

Sometimes, and always with medications new to the patient.

Do you watch every patient take the meds you gave them? Or do you give them the pot and walk away?

Don't bogart that pot, Tonto. Around here we share the pot.

Remember when you sign the MAR you are saying the 5 R’s are correct, but you are also saying you saw the patient take the meds you gave her?

Do I remember this? I suppose I remember this.

How many times have you been into a room and seen a pot of medication sitting on the side!

Pot doesn't last long in the open around my patients.

Do you always do a head to toe check, or do you skip some parts of it?

I often do focused assessments when proper, and I never skip the proper parts of the correct assessments at the perfect times.

You know that these things I mention occur on a daily basis and often go unchecked until a major disaster occurs.

You know you wanna leave me, but I refuse to let you go.

Often causing patients an injury, we have an obligation to provide each patient with high quality care always.

I don't often cause patients an injury, but when I do, it's Dos Equis.

Ask yourself when you are tempted to cut a corner, would you approve or condone this if it was your relative or meaningful other?

Myself is annoyed with me and refusing to answer.

When a mistake happens, it is often something that could have been avoided but it is something which will live with you for a very long time.

Sounds like you've been talking to my exes.

I am not your judge, I am not your conscience and I am only playing devil advocate.

Whew.

Please please please do not cut corners because in the long run you may have cost somebody a lot more time, than you spared.

WHY DIDN'T YOU JUST SAY THAT TO BEGIN WITH??? SHEESH!

[NurseDirtyBird]

Part of nursing, nowadays and especially in LTC where I work, is knowing how to cut corners safely. Occasionally you have a patient who says, "I'm sorry, I just can't take any more of these pills right now, can you just leave them and I'll take them in a few minutes?" As long as it's not controlled, and they are A&O, I'll do it. There are people who are fully capable of operating their own HHN. I'll prepare it for them, and they'll do it when they're ready. I don't always pop in with meds and the most convenient time for the pt.

It's impossible to wash in and out of every single room every single time. If I wash when leaving one room and go right into the next room without touching anything, my hands are still clean. I always wear gloves when indicated.

Sterile procedures are one thing you can't cut corners on. If you do, you're risking serious infection.

Floor nurses where I work are only required to do focused assessments, the Charges do the head to toes. But if I saw a bruise or scab yesterday and it was fine, there's not going to be any real change in it today.

Safety checks on meds become habit after a while, and I can do them in my sleep (and I have in dreams!). It takes me zero extra time because it's so ingrained.

I try to work by the book as much as I can. But it is IMPOSSIBLE to do so 100% of the time for anyone. If you are someone who works completely by the book all the time, I can guarantee you are off the book because your meds are late and you're waking people up in the middle of the night for their afternoon dressing changes.