Do you cut corners in your daily nursing practice? - page 6
Do you cut corners in your daily nursing practice? Or do you do everything according to the 'book'. Do you police yourself in your everyday care of a patient, what do I mean by police yourself? I... Read More
Dec 9, '12I don't do thank you notes. Rarely do. No AIDET for me. Sometimes, I skip a hourly round (gasp!).
Turning doesn't always happen q 2 because I'm not doing it on my own (I've got a back to protect!) and I can't always find someone to help me.
I waste a lot of IV fluids (if I'm in your room and there is 150 ml's left and I know I won't be back for a while because I'm getting an admission, I'm hanging the next bag NOW).
Sometimes, I don't wear gloves when I give people mosquito bites (aka insulin shots).
Hand-washing, alcoholing, and gowning for isolation are corners I don't cut.
Dec 9, '12Quote from BrandonLPNThe end.You were clearly in the right in the situation you descirved there,.
There was "no way" someone who is no weight bearing on one side and has an immobilizer on the other side can be transferred correctly by one person unless that person is slinging them over their shoulder.
And that's the situation I was talking about.
Dec 9, '12I suppose that we all cut a corner or two during the course of our care over the span of a career.
Keep in mind, however, that what we practice over and over becomes habit.
Do not practice bad nursing over time if you do not want to be a bad nurse.
Dec 9, '12I always try to do everything exactly right. However, I am human and sometimes fail. I do reflect back on the care I gave each of my patients and look for ways I could have done better. I always alcohol swab ports. Change CVC line dressings, foleys with sterile technique. I take a lot longer with my patients than some of the other nurses I work with do. But it works out for me because I would rather take care of my patients than spend work time on facebook.
There are some shifts where all you can do is keep them alive, but fortunately not so many. I am lucky to work in a place that is usually well enoughed staffed that things can be done in a timely manner. I love the ICU. I consider myself a work in progress and am always looking for ways to improve my patient care and outcomes.
Dec 9, '12Quote from woohPerfect nurses do not have bodily functions.But you might touch something and not know it! You never know when you'll be in a patient room and lose control of your bodily functions, and you have to be wearing full isolation gear just in case!!!!!!!
Dec 9, '12Cutting corners is exactly why I am leaving my current position. I spoke to my manager to tell her why I was leaving. I was noticing that the culmative effect of everyone HAVING to cut corners is impacting LEVEL AND QUALITY care. She said she disagrees....how the hell would she know, she never gets off her FAT *** and works the floor so would have no idea. FED UP.COM therefore I am going elsewhere!
Dec 9, '12Quote from eatmysoxRNDoesn't your place have alcohol gel? I'm pretty anal about this, b/c with kids in particular, they get stuff so sick--just too easy to spread stuff from fomites and so forth. It will rip your hands apart to scrub every time, but not to use gel properly. Now for changing diapers and things like that, yes, I do still do the hand scrubbing. . .which is probably why my hands look they belong on a 100 year old. Same thing with dressings, yes, even if I am using gloves. There is just too much crap floating around and too much resistance.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.
And if the soap is not antibacterial, you are supposed to dry after and f/u with alcohol gel, rubbing vigorously.
Dec 9, '12i think there are times when you have to. It never makes you feel good to cut corners or not be able to get to something, but in my last job at a SNF I had 40 patients (given that half of them were ICF). they all had at least one treatment that needed to be done; lotion, topical creams, small dressing changes, large dressing changes and all of that. out of those 40 patients 13 were diabetic and i had to check all of their blood sugars in my 8 hours shift twice and administer insulin to about 10 of them. I also had a trach patinet that had trach care once a shift and suctioning 3 times a shift, he was also a tube feed and we had one other pt who was a tube feed as well. on top of that i did the large dressing changes and treatments and i did all my charting. If everything went perfect i could get it all done. If something happened, like a patient fell, or someone coded or needed to be sent to the ED or the house dr came in and wrote 20 orders for different patients or patients were on IV fluids then i was screwed. at that point i would have to cut corners or "skip" certain things..... mostly it would be things like anti-itch cream or barrier cream (which its required that a nurse to apply if it contains zinc) or the small things. I never skipped the big things like dressings, meds, or such, but sometimes i wasnt even able to chart on all my patients that i needed to chart on! i felt guilty about that all the time, but in the end we are put in the position that we have no other choice! i could ask for help 1000 times and never get it, i could try to stay 3 hrs past shift but still couldn't finish
Dec 9, '12To answer the question though, where direct writing is still required, in trying to get everything done, or as the shift gets later and later, my handwriting goes more and more down the toilet. Yes I see some nurses print or write with perfect penmanship. I envy that, but as long as the writing is legible enough to hold up in court, I feel like other things are of greater priority. Plus, unless I write very slowly, I cannot print like some of these nurses. Lord knows I have tried. I'd be there forever.
IDK, I think it's kind of tough to cut corners in intensive care units. They are very anal-retentive environments, and mostly there is a reason for that. Now if the crap really hits the fan, well, the hygienic aspects may become core only--it depends. I hate to miss that too; b/c if you have ever been a patient, you know how much it makes you feel better to be as clean as possible--although nothing beats a good shower.
I have had times when drainage canisters were not empty--only b/c we only had to dump them a zillion times already, and other things of higher priority got in the way. Guess what? Mostly other critical care nurses will still @#$%^ at you about it, even it was a war zone. Depends upon the nurse-person, but I kid you not.
When you work on the floor, well, you can't always be as anal as you can in the unit. There are just too many patients with too many needs, and you can only divide yourself so far before you risk jeopardizing higher priority functions.
Mostly what I find is the documentation isn't as nice and pretty. Like I said. . .if it's legible, that is what counts the most.
Dec 9, '12Quote from FLmedIn my first five months, I didn't either.I have been a RN for almost 5 months, and I can honestly say that I've never cut corners. What you have written here makes a lot of sense though. Perhaps I might need to look at my current practice and reevaluate things. I'm sooo incredibly burned out right now.
Dec 9, '12Thank you for this reminders, it helps that we need to read this more to better serve our patients.
Dec 9, '12We have a new-grad nurse on our busy med-surg floor who doesn't cut any corners. She does the most thorough assessments, creates awesome, and loves to educate her patients. And her technique is flawless... I could give lots of examples; once I even saw her scrubbing a brand new heparin vial for 30 seconds before drawing out the medication into the needle.
Unfortunately, she can barely handle more than 4 patients. She doesn't have time to reconcile the medical administration sheets (we are required to audit all of the orders in the chart every night for the day shift). Once she got a new admission and didn't have time to do even one assessment during the remaining 8 hours of her shift - nothing was documented but the vital signs. Sometimes she even forgets to check on her patients.
She is either going to burn out, kill someone, or learn what corners she can safely cut.
Dec 9, '12I am leaving my current position of direct care because I am finding myself cutting corners. I don't want to be that kind of nurse. My excuse is that I am burned out from patient care. As soon as I recognized I was starting bad habits, I started looking for a desk job. I found one and hopefully now I can sleep at night.