i started a list of the things that bother me about my job/unit. this is only a portion of what i have. i apologize about length, but i did cut a lot out! it's a shame the way they treat us (and the pts). although this list makes it seem as though the unit is full of imcompetent rns/pcts, this is not actually the case. we, for the most part, have a great, caring group that gets along well. our pt load/acuity is unbearable and we are not given the opportunity to provide the quality care we can and want to. we are now considering writing to the ceo of whole system...maybe that will help i think i'll have a new job lined up first though
every time an employee complains about ratio and acuity manager replies we have our "buddy" to help when we need it. our "buddy" watches our pts when we go to lunch (if we are lucky enough to have one). we are supposed to pull other nurses away from their own pts and responsibilities when they are just as busy as we are! on unit there is no time for teamwork. not because we don't want to help our coworkers, but because we do not have time. we don't really have time to take care of our own pts properly.
it is really sad and discouraging to hear the ceo of the hospital, when lack of quality care due to poor rn-pt ratios is brought up, reply in regards of comparing our hospital with others in the area, not in that we we strive to better than, but that we (our ratios) are "comparable." really? now i understand... management does not strive to provide the "excellent" care that is so often pushed down our throats (or even better care at that)...but only wants to be "just as good" or (in other words) mediocre. this unacceptable response also leads one to assume this management does not (in reality) really want to hear what employees have to say, but instead will only look at numbers on paper. well, this does, in fact, trickle down to this unit manager (in particular)...as our pts are only looked at as numbers on paper and their individual needs are not considered when shift staffing & assignments are made. if this is the response this health system wants from a ceo, then i really don't want to hear about or see any signs regarding this "hospital of choice" crap...say it how it really is. "xxx medical center...mediocre (at best)!"
things seen regularly, reported by many and never addressed.....
trach care is routinely not done.
dressing changes are routinely not done.
frequently orders are signed off by unit secretary and rn but not completed, verbally passed on in report or documented.
frequently events that occur are not documented.
routinely documentation not completed
occasionally consults are not notified.
2+ pedal pulses documented on pt with bilateral bka (by numerous rns)
patients routinely not turned every 2 hours.
iv saline locks and picc lines routinely not flushed every 8 hours.
g tube not flushed regularly, g tube dressings not changed regularly, ng and g tube sites not routinely checked for placement/residual before use.
twin packs, syringes, lancets, etc. frequently found in patient beds, on window sill, bedside tables, floor, etc.
daily weights are routinely not done for 2-3 days.
input and output is routinely not accurate or not completed for 3-4 days.
white boards in patient rooms are routinely not updated for 24-36 hours instead of every shift.
patient on oxygen with oxygen not connected to wall.
scds/ted hose not on for days after md order written.
do not use, dnr and swallow precaution wrist bands frequently not on patients.
picc line dressing changes not done after 1st 24hrs as written in policy and procedures
iv catheter not changed after 3 days as written in policy and procedures
iv tubing not properly changed no sticker put on and signed when initiated, iv fluids have no sticker on them
urine, stool and sputum specimens not colected for days after being ordered
canisters filled with discharged pt's body fluid still in room when new pt admitted
name of previous pts (one time a pt that had died and another the new pt knew the d/c'd one) still above bed/closet when new pt admitted
pt belongings found in room after pt discharged, pt belongings lost, pt belonging list not completed upon admisssion
numerous incompetent telemetry technicians, tele strips frequently posted in the wrong charts, frequently tele tech does not call for long period of time when pt off monitor. a pt can be gone for an hour without recieving a call, rns have recieved calls from monitor tech hour or more after change occured
one rn is repeatedly complained about by patients, other rns and even mds. rn extremely unsafe, scary to patients and families, but remains on unit.
unable to find working equipment in emergency situations: blood pressure cuffs, oxygen saturation monitors, suction equipment, oxygen tanks, backboard, oxygen tubing, oxygen masks, etc.
some rns leave notes on chart for md for a change in patient condition (e.g. "blood clots in urine", "vomiting blood", "patient temperature 102.6 last night") instead of notifying md of change in patient status. some mds have discussed this with director but it has not been passed on to rns.
some night rns do not call in critical values to mds. this is routinely reported to manager and no disciplinary action is taken.
no behavioral sitters allowed. if family can't sit with patient, use restraints. this is wrong on so many levels. it goes against evrything we were ever taught in nursing school. it also goes against all current research. also, this new "policy" has been put in place to save money and is in direct conflict with the hospital's stated philosophy of blah, blah and blah of the whole person.
pts with c diff have been cohorted with non c diff patients.
patients with chest pain have notified their pct and pct has never told the rn.
manager bad mouths staff to other departments when staff try to transfer to other departments.
no disinfectant containers in or just outside each room as in most other hospitals. must walk around nurses station to (hopefully) find the only container on the unit.
often no gowns and other contact/airborne equipment directly outside of pt room and/or possibly on unit
every other department knows what a horrible unit this is. ask any of them, especially the ones that come to our unit such as pt, ot, dietary, speech, etc. they all see the chaos. ask the poor souls that have been floated for a shift from other units. ask our own rns and pcts that have been floated to other units how much worse our ratios, acuity and resulting lack of teamwork is.
some pcts are rude to patient, family and staff and the issue is not addressed by department management.
some pcts refuse to complete required and assigned tasks
some pcts found napping and nurse's station, in empty rooms, in locker room and in break room (not during their break).
one pct on a saturday with 28 patients is not safe...manager was aware.
important pt information often left out during report such as pt previously intubated, procedures done or planned.
rn tells charge he/she is "drowning," & need to catch up before getting an admission...then get a new admit before can turn around
charge rn are not supposed to have pts, but most of the time do
occasionally rn or pct leaves shift early with no one covering his or her patients and no report given to the next shift on their patients. manager is aware.
6 months nursing experience does not a preceptor make!
