Difficulties in Patient Care and Identification

Nurses General Nursing

Published

As a nursing prospect and student, I was wondering what the common issues with identifying rooms and patients are in the workplace.

From a psychological stand point humans are innate to missing cues in high stress situations. Stress causes anxiety which can cause mistakes and confusion. To overcome these anxieties, devices like notes, or psychological reminders can be implemented. However, in a data heavy and personalized environment it is very common to miss information or misinterpret information. Especially in distinguishing a patient.

In such a high paced and dynamic environment where time and service is key, what makes it hard in identifying patient rooms? What makes it hard to distinguish the medical precautions that are to be taken when entering a patient's room? What indicators, or visual cues make it easier in distinguishing specific patient rooms?

Chris, perhaps your time would be better spent by addressing coworkers at your 'institution,' not by trying to convince us that we are also in a stressed-out brain fog. We are experienced nurses who simply do not agree with you. We have enough to do taking care of seriously ill patients. We do not need any clues visual or otherwise to remind us how to find our patients' rooms.

I liked your post and I agree with the gist of it. Sadly, Chris addressing nurses at that institution is not going to be able to effect real feedback. Just a fact. If that place is taking these kinds of measures, you can be sure that the staff has already been informed how to toe the line with regard to all of this. They know what is expected. He will never get the truth.

I am not sure what line we're supposed to toe or what his actual question is.

LOL. I understand. Have you been in a place where this kind of thing (non-nursing team of "experts" is tasked with solving made-up nursing problems) is happening?

The line to toe is that one must not speak about reality. If he is there, I am confident the nurses have already figured this out.

Specializes in Operating Room.
I created this thread to help with a process decision at my employing institution. I'm trying to lower the stress of nurses and optimize the flow of our floor's workflow. Thus, I'm focusing on cues that can ease the stress on the minds through lowering the amount of information needed to be remembered or known by caring physicians.

I'm not sure if I even understand what you are asking because quite honestly it doesn't make any sense?

But if it hasn't already been asked, why don't you just talk to the nurses on the floor in which you are trying to "optimize the workflow" on? They would have the best insight into what would work best from them since THEY work there and WE don't. Every unit is different and we don't know what you already do/don't know and how it would impact their work environment.

I'll answer your questions about the precaution signs, or as you referred to as "cues"

I'm wondering how often those visual cues added to a nurse or doctor's experience.

I mean, I see the sign every time I go into the room, so I would say it added to the experience every time?

In your experiences, did you pay attention to those cues? Did they accomplish their goal?

Did I pay attention to the precautions sign? Yeah.. they are hard to miss and it is an important aspect of my job as a RN to follow the precaution guidelines and don appropriate PPE and perform appropriate hand hygiene.

If they did not accomplish their goal, what limited the cues' success?

If precaution signage has been unsuccessful at your institution and health care staff are unable to follow a simple sign, then I think someone from infection control as well as management on the unit need to be involved because this isn't rocket science, you put a sign on the door notifying staff of the precautions to take and the appropriate measures which follow (PPE, hand hygiene, etc).

After reading more comments I have to agree with the general consensus that increased staffing would decrease stress. There are numerous publications related to this as well. I am unsure if you are focusing on just precaution signs or overall workflow? Either way, every unit is different and if you really want to know what would help the staff in your institution you have to ask THEM.

It is interesting however that it appears your hospital asked staff what would help and they responded with better staffing, which was subsequently shot down and instead their response is to pay someone else with no nursing experience or even general patient care experience to develop solutions for unidentified problems. I mean this with the most respect but it is quite obvious you don't understand the role of a nurse, what nurses do during their shifts, etc. To actually think that creating "technology" to improve identification of patient's rooms and precautions would decrease our stress shows just how little you know about what we do and how we do it; and that is just frustrating, annoying, and kind of hilarious. But this consistent trend in healthcare of having individuals create policies/etc that impact jobs they don't actually do or understand is truly wasteful, inappropriate, unproductive, asinine, and ridiculous. Consider how your job might be impacted if a group of nurses were brought in to develop policies/procedures relating to your duties and workflow.

Specializes in OR, Nursing Professional Development.
LOL. I understand. Have you been in a place where this kind of thing (non-nursing team of "experts" is tasked with solving made-up nursing problems) is happening?

Had it happen in my OR. Almost completely destroyed the department.

They decided to cut back on supplies kept in the building- had a patient on the table, opened the only arterial graft in the size the patient needed, and then when it got contaminated had to debate going with another size or taking the time to run to a neighboring facility and picking up one of their grafts, meaning a longer clamp time on a freaking aorta and non-perfused kidneys for a longer time. Sure, the hospital decreased supplies on hand by nearly $1,000,000, but at what cost?

Then they decided that we were overstaffed and shouldn't fill vacant positions. How well did that work? One person calling off meant that we had to shut down an OR and reshuffle cases and staff. Vacations were denied way more than they were approved. People got so fed up that when the vacation was denied, they'd wait and call off anyway. If the even still worked there and hadn't bailed for better working conditions.

Yep, genius people knowing absolutely nothing about what they're making decisions on is a recipe for disaster. The management eventually ended up admitting they messed up, but it was far too late by then.

I really couldn't understand what this thread was about until several posts in. Makes me long for the "I'm seeing a lot of tall nurses" post!

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Brownbook, thank you for your detailed response.

My background is in management information systems and electrical engineering. I primarily work in healthcare systems engineering and process optimization. I have bachelor degrees in software, computer, and electrical engineering. With a specialization in neural networks and artificial intelligence.

I created this thread to help with a process decision at my employing institution. I'm trying to lower the stress of nurses and optimize the flow of our floor's workflow. Thus, I'm focusing on cues that can ease the stress on the minds through lowering the amount of information needed to be remembered or known by caring physicians.

In response to your answers, the numerical room identifiers are like you said, quite rudimentary. However, I am focused on the precautions side of the room identifications. In many hospitals there are still signage and documents that notify nurses and doctors of precautions to take when entering a patient's room. Displaying the precautions is not a HIPAA violation due to the fact that precautions focus on both the patient and staff safety. Thus, I'm wondering how often those visual cues added to a nurse or doctor's experience. In your experiences, did you pay attention to those cues? Did they accomplish their goal? If they did not accomplish their goal, what limited the cues' success?

The best way to optimize work flow and decrease stress is to have adequate staffing. Good luck getting that to happen. As far as people not observing isolation or other precautions, it's not because of inadequate signage. It's because people ignore them. Might be too busy or just feel too important. But until it is strictly enforced by management with consequences for non-compliance, the "cues" won't make a bit of difference.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Here.I.Stand, as for my experience in patient care I've worked in process and systems engineering and development for multiple organizations. As for my knowledge and experience on a floor/unit level, I'm not very familiar with the general consensus among nurses and those staffed on the floor. Thus, why I'm trying to understand the workflow of a unit by reaching out to those who do have more knowledge than me through outlets like forums, and coworkers.

Also, the "brain-fog" possibility came about due to repetitive mistakes by those on the floor at my institution. Whenever questioning others about why those mistakes were made, the main point between those questioned revolved around issues with handling stress and workflow. Due to the issues at hand, and answers to questions, I've found the central issue to be memory and forgetfulness. Which is not a surprise from a psychological stand point. Psychologically, it has been proven that the effects of stress on cortisol levels and the mind do decrease one's ability to remember information.

As a follow-up question, if more staffing is not currently a possibility, what do you believe could resolve issues with stress among patient care staff?

It doesn't matter how you slice and dice it, or how many fancy widgets you invent. If the problem is staffing, then the solution is staff. Brain fog and forgetfulness? That is from fatigue and low blood sugar. From not being able to take proper breaks without falling further behind and delaying time-sensitive interventions.

When there are not enough of us to do what needs to be done, things get missed. When we run for 8 or 10 or 12 or 14 hours without food and fluids, performance starts to suffer. Good luck inventing something that takes the place of adequate staffing.

JKL33, I completely understand your premise. I definitely agree that more employees on a shift would solve a lot of the issues we and many others face in the industry. However, from a business and management perspective, that is not a feasible solution for our current time and environment.

What I'm trying to understand is what causes stress or discomfort on nurses during their shifts. What are issues that cause mental or physical distractions and hindrances?

If you take the extra bonuses that the CEOs and high level management get each year and use it to hire adequate staffing, you will decrease STRESS for nurses and patients, and create a safer working environment. It is illegal to not pay nurses for missed breaks, staying over their shift to finish their work, and not paying for OT. However, this saves healthcare systems a lot of money! Also, the more management cuts from the budget, the less nurses have to work with. These budget cuts are incentivized through bonuses. These are the conditions nurses are working with. These are all factors, which cause stress and cause nurses to constantly run throughout their shift to get everything done. Which leads to errors, reduced focus and decreased efficiency. Same with missing breaks-- brains and bodies need energy and a break during a 12 hour shift-- depriving nurses of this will again cause stress. And all of this without a patient coding, falling, eloping or beating up the staff.

Unfortunately, nurses are seen as a "cost" rather than an income-generating body, like doctors... Improve working conditions and you will reduce stress. This is a problem that has gone on for decades. The answer is clear but healthcare systems prefer to line their pockets, than fix it and invest in one of their most important allies in patient care and safety-- nurses.

Specializes in Transitional Nursing.
Brownbook, thank you for your detailed response.

My background is in management information systems and electrical engineering. I primarily work in healthcare systems engineering and process optimization. I have bachelor degrees in software, computer, and electrical engineering. With a specialization in neural networks and artificial intelligence.

I created this thread to help with a process decision at my employing institution. I'm trying to lower the stress of nurses and optimize the flow of our floor's workflow. Thus, I'm focusing on cues that can ease the stress on the minds through lowering the amount of information needed to be remembered or known by caring physicians.

In response to your answers, the numerical room identifiers are like you said, quite rudimentary. However, I am focused on the precautions side of the room identifications. In many hospitals there are still signage and documents that notify nurses and doctors of precautions to take when entering a patient's room. Displaying the precautions is not a HIPAA violation due to the fact that precautions focus on both the patient and staff safety. Thus, I'm wondering how often those visual cues added to a nurse or doctor's experience. In your experiences, did you pay attention to those cues? Did they accomplish their goal? If they did not accomplish their goal, what limited the cues' success?

For me, it all blends in together and I know that's terrible. Once you see something so many times in a day it begins to lose meaning, IMO. Honestly, I just think about the PTs dx, and if its something like C-Diff, I gown up.

Specializes in Psychiatry, Community, Nurse Manager, hospice.

How are there 45 comments on this thread?

Because somebody's trying to create a new problem we didn't even know we had and make us all feel guilty about that!

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