Why does only nursing have to put the patients first? - page 3
Caution, rant ahead: So the other day I'm in a tiff with radiology because they want me to transport a patient that (per policy and per good nursing judgement) I'm not required to accompany and I... Read More
Jun 13, '11Occupation: RN On Call--Hospice Specialty: hospice/onc/tele/m-s/endo/outpt ; From: US ; Joined: Mar '10; Posts: 534; Likes: 749One reason why i now do hospice is because i CAN MAKE ancillaries do their jobs: Can make the chaplain visit a family that is not coping well even though i am still present, can tell the HHA to come back in the room to clean up a bm if i am in the midst of a discussion with a family member, can call the on call answering service and have them call the courier to send meds to a pt's home that i have requested locally, can request the social worker to visit even though i just left the patient (yes, the manager will send the MSW out right away), can put a pt on ICC and tell the scheduler to rush it because pt is imminent. Other than endoscopy and outpatient surgery, this is the only job where i get to be allowed to insist other folks do their job. When i was working med-surg tele, even as charge nurse-- no way, i was required to do everything for everyone and often heard "the patient comes first" from the MD, dietician, housekeeping, management, CNAs, LVNs, PT/OT, Lab, pharmacy. Acute care is an absolute nightmare. Nowhere is the nurse dumped on more.
Jun 13, '11Joined: May '02; Posts: 4,581; Likes: 4,883Quote from cursedandblessed"that's certainly a valid concern, doctor - i think this is something you need to follow up with the department. why didn't i get it done? if only i had the ability to make everyone else do as good a job as i do..."don't forget they are also responsible for the patient who had an order for the dietician written 6 days ago, it's now monday, the dietician hasn't bothered to show up, but it's still the nurses fault. and don't forget the dietician's don't work on the weekends and why is the nurse upset--well the doc screeched at her because the dietician hasn't bothered to show, pt is ready to be discharged and probably won't hear a thing the dietician has said.
Jun 13, '11Specialty: 3 year(s) of experience in ICU ; Joined: Jan '10; Posts: 19; Likes: 47Ahh the many reasons that after a mere 3 years at bedside I have begun to loathe almost everything about working bedside, and cant wait until I'm done with grad school to get the hell away. I'm sorry, but I dont get paid enough to do my job and make sure that everyone else is doing theirs, and then be the one accountable if something wasnt done...
Jun 13, '11Specialty: CVICU, Obs/Gyn, Derm, NICU ; Joined: Feb '04; Posts: 727; Likes: 1,315Quote from RocktheBoatUmmm .... but that's the plan of many others too. There aren't enough jobs to accommodate everyone who gets a masters and doesn't want to work bedside. I work with many staff nurses with masters degrees.Ahh the many reasons that after a mere 3 years at bedside I have begun to loathe almost everything about working bedside, and cant wait until I'm done with grad school to get the hell away. I'm sorry, but I dont get paid enough to do my job and make sure that everyone else is doing theirs, and then be the one accountable if something wasnt done...
It helps to have a coping plan for dealing with bedside meanwhile
Jun 13, '11Specialty: CVICU, Obs/Gyn, Derm, NICU ; Joined: Feb '04; Posts: 727; Likes: 1,315Quote from talaxandraWe are 24/7 and many others aren't .... that's part of the reason for this trouble."That's certainly a valid concern, doctor - I think this is something you need to follow up with the department. Why didn't I get it done? If only I had the ability to make everyone else do as good a job as I do..."
We are cordinating /doing /chasing up care and work for others who are not there.
I think nursing needs to start insisting others pull their weight during their 'off' hours. We are a 24/7 operation and I would like to see many of the others start working Sat and Sun day hours.
Jun 14, '11Joined: Jan '11; Posts: 1,825; Likes: 2,419Quote from woohCan't wait to get out of nursing and put myself first. You are right about it all. The 4 am labs , the mile long trips to pharmacy. etc... Somehow it is always a nursing responsibility or nursing's fault if something is not done.Caution, rant ahead:
So the other day I'm in a tiff with radiology because they want me to transport a patient that (per policy and per good nursing judgement) I'm not required to accompany and I can't accomodate them because well, I have other patients that I need to attend to. So they call my charge nurse who tells me that we all have to work together and put the patient first. Well if they really wanted to put the patient first, as in my other less stable patients, then they wouldn't insist on me leaving my other less stable patients to accompany a perfectly stable patient. Heck, there's no reason this couldn't have been done bedside, so if THEY truly wanted to put the patient first, they'd bring themselves on up to my floor and do it at the bedside.
I'm just soooo tired of everytime I stick up for myself, I'm accused of not putting the patient first. But other departments don't fully staff on weekends, because the patient can wait until Monday. We do labs at 4am for the MD's convenience, even though it wakes up the patients. I don't have a medication, pharmacy expects me to run halfway across the hospital for it, because most of them are at lunch. After I've searched all the boxes THEY might have accidently put it in. Heck, housekeeping won't even clean the IV poles. But the other departments, and even our fellow nurses, expect us to drop everything in a split second for the convenience of another department in the name of the patient being first. And if we dare say, "Hey, that other department could do x,y,z instead of me dropping everything, ignoring my other patients, and leaving an hour late, then getting called to the principal's office for my incremental overtime" then we as nurses aren't being team players. But do you see the other departments being team players on the weekend? Nope, they aren't there. Are they being team players at 7pm when we want to go home? Nope, they left on time at 5pm.
If nobody else wants to do it, it's the nurse's job. Not "if nobody else CAN do it." Not "if nobody else is QUALIFIED to do it." Plain, flat out, if nobody else WANTS to do it. And we as nurses are expected to suck it up in the name of the patient first. Because if we don't do it, the patient suffers. How about, "If housekeeping/radiology/respiratory/MD/pharmacy/customerservice/cafeteria/whoever doesn't do it, the patient suffers"???????? Why not lay the guilt trip on someone other than nursing for a change???
Jun 14, '11Joined: Jan '11; Posts: 1,825; Likes: 2,419Quote from Nurse_HagathaMakes me sick. Everything is our fault. Tv doesn't work, lab can't get blood, meds aren't there, 2 diff med groups are looking for you at the same time while you are in another pt's room (how dare you not be available ), pt is short on weekends, no cnas, dietary deleivered the wrong tray or worse pt doesn't like their meal(tooo bad!).I wanted to puke several months ago at a hospital wide customer service rah rah meeting when people from other departments were sharing heart warming stories about how they saved the day because some ratchety nurse wasn't doing his/her job. HELLO PEOPLE! NURSES CAN ONLY BE STRETCHED SO THIN WHEN THEY'RE TRYING TO DO THEIR JOB AND YOURS TOO!!! I am so sick of being blamed for everything that goes wrong with a patient's stay in the hospital.
This morning, a manipulative patient that I had been dealing with the entire night, was screaming at the top of his lungs for his wheelchair. I was sitting at the desk charting so that I could go home. I like to do that after 13 or so hours with no breaks. The security guy comes up to me with a smug look on his face like I am neglecting my patient, and need to get in there right away and take care of him. I wanted to choke Mr. Security Man. I really did. I just looked at him like, "Go back to your little office sanctuary away from the screaming yelling psycho and enjoy another donut and cup of coffee, and then save this scenario in your mind for the next customer service meeting as an example of another lazy nurse not doing her job."
Jun 15, '11Joined: Dec '09; Posts: 362; Likes: 226If the nurses have all this accountability and responsiblility for other departments, how come they don't act with more authority and confidence instead of the subservient or even passive aggressive attitudes? (no offense).
Jun 15, '11Joined: Oct '00; Posts: 8,729; Likes: 8,412You can be held responsible without any authority at all.
Jun 15, '11Specialty: CVICU, Obs/Gyn, Derm, NICU ; Joined: Feb '04; Posts: 727; Likes: 1,315Quote from dmoney8827Because other influencing factors don't encourage this :If the nurses have all this accountability and responsiblility for other departments, how come they don't act with more authority and confidence instead of the subservient or even passive aggressive attitudes? (no offense).
- Very little restriction on nursing school entry .... employers know they have a ready supply of new nurses
- Many nurses are sole income earners and insurance holders for their families
- There are many qualified nurses from developing countries who can replace them
- Many nurses may be accustomed to worse conditions in prior working lives
- There are dysfunctional dynamics in nursing which wear down nurses self esteem and resolve (see the whistleblower thread)
I wish it were better *sigh*
Jun 15, '11Occupation: Emergency Department Specialty: ER/Ortho-Neuro-Med-Surg ; From: US ; Joined: Sep '04; Posts: 11,171; Likes: 3,262Quote from Medic2RNWhat if the pt. doesn't have a right arm? Or has dialysis shunt on Right arm? Can't do a CTA then?If it's not an 18 in the AC then no dice. Not all patients have those veins to stick.
I understand a lot of it has to do with how fast the dye needs to be injected (hence large bore) and how quickly it hits the lungs (hence specific site placement) before the scan is performed.
Surely these are variables that can be manipulated? Say give an extra 3 seconds before scan if the IV is more distal than the AC or something?
Jun 15, '11Joined: Apr '00; Posts: 24,611; Likes: 35,448Quote from ana tomyare you being serious, or is this a joke?We all ultimitely have to do our jobs.
i can't tell, being online.
i had an acutely ill hospice pt, whose symptoms were not yet managed (or, it was just his time).
he started vomiting lots of blood/mucous while having profuse diarrhea.
no one was around, no one would come when i called, and this guy has his arms outreached to me, with the most desperate look that i've ever seen.
i had to carry him off commode and into bed, gave some quick iv meds and got help stat (all while trying to reassure him in my 'calm' voice.)
in spite of all attempted interventions, this is the way the pt died.
later, i called housekeeping explaining the mess.
head of housekeeping comes into assess room and tells me, that once all blood and feces is removed, he'll send someone in to clean the rest.
had total meltdown and gave him a rather loud earful.
he reports to my don, and she comes into room asking me what happened.
i explained, and she looked at me like i was crazy.
she responded with, "OF COURSE you'd clean his surroundings...he was YOUR pt."
i told her exactly how i felt.
exactly, no barriers.:flmngmd:
it cost me a 2 day suspension, 1 very meaningful warning, and a big, fat demerit in my folder.
my penalty was originally 1 day, but since i refused to apologize to head of housekeeping, it was changed to 2.
when i returned, don just couldn't understand "what happened to you???", and "i've never seen you like this before."
i told her, _____ gave me s**t and i gave it back, x 2.
she wasn't amused (that i was being so obstinate) but let it go.
we both understood ea other at that point.
next time i needed housekeeping, i left the room with a few 'smears' and dared them (suggestively) to bust my chops.
sometimes you have to fight/get our messages across, through unconventional means.
it doesn't help nurses overall, but it does feel better to retaliate...even if it's temporary.
but it did help, with my don saying "it's YOUR pt"...because then, i just felt a bit more maternal...just like an exasperated mother...and this is what you do for your kids.
truthfully, i've always felt a bit possessive about my hospice pts, so it's not a huge transition to make.
it's just how we're treated like door mats, is what bothers me tremendously.
sometimes you just need to learn how to either play the game, or leave.
more than one way to skin a cat...no matter how juvenile.
Jun 15, '11Joined: Feb '07; Posts: 267; Likes: 558Don't leave us hanging - what did you say exactly?