What Would You Change?? - page 2
If you could change one thing about the ER that you work in to make it a better place, what would it be?... Read More
Sep 6, '06A pelvic room not used as a patient room, but just available for the neverending series of pelvic exams that need to be done, (but get put on hold until the person in one of the pelvic rooms is discharged, or we play musical beds until everyone has rotated through).
NO beds in the hallways! :uhoh21:
Having the same staffing ratio around the clock. Why is it that nights have as many patients as days, but only 2/3 the nurses (if that), only one sec., one tech and NO transporter!
Get rid of the massive amount of paperwork to justify restraints, bad enough we have to use them in the first place.
No carpeting, ick
Sep 8, '06#1 Make hallways from one area to another match up. I feel like I am running the grand prix some days weaving around corners etc.
#2 Make doorways/halls wider
The people who design hospitals are not the ones who work in them for sure or else there would be better designed rooms, halls, doorways etc.
Sep 8, '06Quote from CNANancy2006I told my husband this last year when he landed his current administrating job. It only makes sense to ask for input (and USE it) from the people who are working there, about renovations.The people who design hospitals are not the ones who work in them for sure or else there would be better designed rooms, halls, doorways etc.
Sep 12, '06Wow, lots of great responses here and I can identify with all of these.
But the number one thing on my list that absolutely burns me is the holding admitted patients in the ER thing. I don't have access to the actual numbers, but a significant portion of the shifts I work, the only reason the ER is actually busy is because a large number of our ER beds are tied up with "Admit Holds" waiting on an available room upstairs.
Sep 13, '06mandatory 12 hour (no lunch break) shifts for all management people who have a nursing degree. I think they need to do this at least 1-2 times per month
Sep 13, '06"mandatory 12 hour (no lunch break) shifts for all management people who have a nursing degree. I think they need to do this at least 1-2 times per month"
Ditto on the above. Actually we should have ALL administrative staff shadow us for a day. Especially a day (like I had yesterday) where you don't get the opportunity to go to the bathroom or even get a Diet Pepsi. If I have one more person, tell me "just go," I'll scream!
I would also like to have security personnel who are not retired. If you want to be hospital security, especially in the ER, you need to be under the age of 60!
Also, I hate to ask for too much, but if we could have housekeeping swing through more than once a day, it would be a God send.
Sep 13, '06and if they are unwilling to send housekeeping through the er more than once a day (at 6 am mind you) get bigger trashcans.....
does management realize how big a bedpan or a vomit bucket is? they take up alot of room in a trashcan.
Sep 14, '06Quote from erdianeI love this one....great idea. And I would add the 12 hour shift they work must be walking in our shoes in the ER. Perhaps they could work as a tech in the ER pushing stretchers for those 12 hours.mandatory 12 hour (no lunch break) shifts for all management people who have a nursing degree. I think they need to do this at least 1-2 times per month
Sep 20, '06All I want is to be able to eat and pee once during my 12 hours. Just once, and I swear I will eat fast.
Sep 20, '06Quote from Jennifer, RNAmen! The longest I have gone is 9 hours without peeing. I am sure this will have repercussions later on in life :-)All I want is to be able to eat and pee once during my 12 hours. Just once, and I swear I will eat fast.
No Mandatory overtime!
A well-staffed ER!
Sep 25, '06I know one thing that I would love to change but it would be impossible, is to make the primary care physicians to stop telling their patients,:angryfire "if you're not feeling any better go to the ED". Sure it's different if the patient is short of breath, continued chest pain, conditions that are life-threatening etc. etc. etc.. That's different! But you get the ones that come in let's say, one example: with pain to their left wrist, from a fight :smiley_abthe were in at school yesterday, and Mom says," I called my doctor and told him about it and he said go to the ER". Granted, we do take an x-ray and 99.9% of the time there is no fracture, and send them home but the instructions to take ibuprofen and instructions on R.I.C.E.
How about changing the "Floating nurse" to "Keep going Nurse"... the keep going seems to be self-explanatory, and the floating title has a need to be explained to some nurses, at least where I work.
Oct 1, '06Quote from jojotooI have been working in our ED now about 5 months. I really like it although still nervous with very critical pts. But I worked med surg for 3 years prior and there was allways this clash between the floors and ED. You really do not know what it's like until you've worked in each area. I understood ED very busy and you allways take in pts no matter what but had no clue how it felt untill I started down there. And wow did it open my eyes. Unless I was right in the middle of something on med surg I'd take report from Ed. Our ED now states the floors should treat ED report and taking the pt as OR pt's are treated. OR they take or send immediately just the nature so if there is a bed we need to take pt's upstairs was the point and I had to admitt the attitude to take OR stuff was more urgent than Ed pts.Not having to fight with the floors to get them to take admissions.
Not having to hold admissions in the ER for a couple of days.
It's no excuse but a lot of it is both sides are extremely busy, understaffed. But ultimately I think one huge factor is time management. I've gotten way better but many do not have it. I found the more experienced nurses I mean 20+ had it and I was floundering. But after a while with our turnover increasing draumatically a lot of my coworkers even myself it became a challenge to get everything done and having to deal with an admission comming in could be overkill and I know of many who would put it off.
Now our new critcal beds the pt's from ED are not allowed to come up b/c not lack of beds...no staff. So it strains the ED staff b/c we do not take admissions it's ED and it is incredibly frustrating and it's not the nurses fault.
A lot staff including Ed managers keeps saying can't they (floors) take an extra pt and I feel so torn b/c you want the pt's up there to make room for others but it's dangerous if not enough staff upstairs to even care for the pts. So then it's this war between one another with no respect b/c well you don't take the pt so you're screwing my liscense. It's just a mess and I really feel management feeds off this crap.
Now that I'm in the ED, I can't BELIEVE how many times I call for report and 9/10 x I get let me have your extension I'll call or so and so call you back. I totally get it's busy. Just how come certain busy med surg floors I can give report quickly but some of our telemetry floors I can't and it's same people all the time. I think it's b/c in our telemetry it's not uncommon for several admissions, get admission begining of shift and discharging at the end. Now our critical areas have had at times no manager and in 10 years our ICU had 10 different managers so I think staff have become complacent WITH getting busier.
But my experience comming from med surg floor...I would freak with just bp of 160/80. An ED nurse call report and I'd hound does MD know? I cringe now thinking about all the stuff that would frustrate me. So my priorities were different. And a peds nures I know had several issues she felt the ED would downplay critical cases just to get pts upstairs. Now look at me freaking over bp 160/80 could it be maybe not as critical as she thought but still lots work and followup? I don't know. She says Ed only worries about immediate needs and no one else. Now that is Ed nature but I don't think totally like that. I think it depends on the nurse. With Ed you may not experience something for an entire year then take care of someone and looking for someone with experience to ask ?s (but I do like how this makes ED so much different). The peds nurse complaints was that ED nurses with especiall infants drew blood from IV line and would clot off the line. I was originally taught to not stick an infant multiple times or make sure it's good first time. But I asked around and found out no you do not sacrifice a line on infant for blood draw b/c you can allways get a heel stick so only draw blood from line if it's very good. It freaks me b/c I didnt' know that! I'm really annoyed my ED educator was gone 2nd week into my orientation and had none for my entire orientation. Got a new educator my last few weeks of orientation. I'm not stupid, I ask ?s but I still wish more direction. I've seen a lot during orientation, active MIs, mult trauma with transfers, DKA ect.
But maybe management needs to find out all the complaints each side has and devise more edu on it. Just talking with the peds nurse helped me a lot just for I don't work with kids every day. I also found out Rocephin Im very painful especially in kids and lidocaine with it can help. I had no idea!
But especially ICU holds in the ED while interesting can be so time consuming. I took care one ICu pt, DKA and AWESOME experience but I had no time with other pts! It's not fair.
Another thing...with ED our #s of pts in are consitent so a required #staff remains, whether we have it all the times that's another issue but on our reg floors if certain pt census they'd take a nurse off. So then admissions would fly through and you still have the workload originally b/c even though census is low you still have the same pt load compacted now with a high # of admissions. Then supervisor would find another nurse after nurses already drowning and the entire thing totally ineffetive. Not to mention one holiday a nurse was allowed go home. Then admissions and pt's in ED a lot and had not enough staff upstairs b/c that nurse was let go then there was no replacement or way to get that nurse back. Then they were ED hold. It's disgusting!!!!!
Sorry I'm really going off here but honestly each side has there own issues but I have to admitt in the ED you really have no clue what's comming in so those pts do need to leave they can't hang out in the ED b/c we need our staff for all the pts comming in. Floor nurses I don't think it fully hits b/c they are in their own area and only worried about that which maybe is absolutely correct but it does create this discord between both sides and management should do more to fix it.