Is this unusual?

[Spritenurse1210]

At my hospital the following changes have been made:

Nurses are to do report on patients at the bedside, and use "key words" such as "Thank you for letting me take care of you, We want to make sure you are satisfied with your care ect.

The docs have been complaining that the nurses are calling too much. We are only to call on the even hours (at night only by the way) for non emergent issues such as critical lab results, blood sugars ect.

Is it like this anywhere else?

[klone, MSN, RN]

What is "rounding with intent"?

Or specifically, what does the "with intent" part mean?

I can tell you, in the unit I work, if we rounded hourly during the night, customer satisfaction scores would go WAY down.

[Up2nogood RN, RN]

What is "rounding with intent"?

Or specifically, what does the "with intent" part mean?

I can tell you, in the unit I work, if we rounded hourly during the night, customer satisfaction scores would go WAY down.

The 3 P's. We are to specifically ask if they have to use the restroom, positioning, and if they need pain meds or if they think their pain is being managed to their liking. That can open up a big ol can of worms right there.

We aren't supposed to just pop our heads in at night to make sure they're still in bed vs the floor and still breathing but really wake them up. Do we do that at night? Um, no.

Some of the crazy ideas management comes up with. I think they should get a taste of their own medicine and be a patient for 24 hrs

[BluegrassRN]

I round hourly, and it's an expectation on our unit that everyone checks their patients at least once an hour.

I warn patients when I assess them that I will be peeking in on them hourly during the night. I tell them "I try really hard not to wake you up, but I just want to eyeball you, to make sure you aren't sprawled out on the floor, and that you look comfortable in bed. If you start having any chest pain, shortness of breath, upset stomach, or you need help to the bathroom, or you need anything at all, I don't want you to wait until I make a round, just hit your call light and let me know." That little spiel pretty much covers all my bases: letting them know that I'm checking on them and why, telling them when to call, and pre-excusing any disruptions that my checking on them may cause.

If a patient comments on it, it's to tell me they are happy to know that someone is checking on them. A lot of patients say something like "I'm glad to know you're going to be in here often, because I don't think anyone came in all night last night to check on me." Of course they did; but if you don't tell people you're doing it, they don't know. Typically people don't wake up when i peek in; in the last 5 years I've only had one pt that I can think of specifically request I do less frequent rounds as it was disturbing them.

[MelEpiRN]

The notion that doctors are being called too often is absurd. When you go to med school, that's what you sign up for. It's inexcusable they limit the timeframe you can call them.

To be honest, you could always anonymously report your facility to The Joint Commission or the state. They'll put a stop to that crap real fast.

[OBplease]

I have a friend who after being on pit. for about 15 hours, then turned off when she was fully dilated and told NOT to push and left like that at about 4am because, "we are not supposed to call the doctor before 5am unless it's an emergency". Not sure if it was related or not but she ended up with a severe uterine hemorrhage, which was stopped just short of an emergent hysterectomy.

[beewink]

"I can and I will" is the tagline at a previous employer. Gag me.

[Asystole RN]

What the eff?

I hope this is unusual, particularly with regards to the second request. This is how I would handle this: "I'm sorry, Mrs. Smith, that your pain medication isn't sufficient/you need a sleeping pill/mylanta/stool softener. Unfortunately our administration only allows us to call the physicians on the hour every two hours. You'll have to wait one hour and 40 minutes before I am allowed to call. If you feel this is poor care, here are the phone numbers of my unit director and our hospital CEO, and you are welcome to call them at *any time* to discuss this. Shall I dial the number for you?"

And I would start looking for another job, in a hospital that doesn't think it's a kindergarten.

Missed this part I guess.

for non emergent issues

I would consider patient comfort/pain issues emergent.

[BluegrassRN]

Anything that I call for in the middle of the night is an emergent issue. You know? I mean, the OP listed critical labs, blood sugars, etc. So I have a potassium of 6.5 that I'm going to wait to call? I have a blood sugar of 700, but I'm not calling it for another hour or two, because I can only call on the dot at even hours? No effing way.

Honestly I'd call it anyway (including for pain control), and crab crab crab at work. I'd certainly be reporting it to Joint and anyone else who would listen (including my buddy who reports on health care issues in the local newspaper). And I'd look for another job.

[OCNRN63, RN]

Welcome to Stepford Medical Center. Have a pleasant stay.

[nurse2033, MSN, RN]

Yet another example of corporate BS. Don't get me started...

Don't ever hesitate to call a doc. If you are concerned then call. Far better to p*** off someone than let a patient be compromised. They get pad for call, a lot more than we do, and at least they were sleeping in the first place.

[caliotter3]

What the eff?

I hope this is unusual, particularly with regards to the second request. This is how I would handle this: "I'm sorry, Mrs. Smith, that your pain medication isn't sufficient/you need a sleeping pill/mylanta/stool softener. Unfortunately our administration only allows us to call the physicians on the hour every two hours. You'll have to wait one hour and 40 minutes before I am allowed to call. If you feel this is poor care, here are the phone numbers of my unit director and our hospital CEO, and you are welcome to call them at *any time* to discuss this. Shall I dial the number for you?"

And I would start looking for another job, in a hospital that doesn't think it's a kindergarten.

This is excellent advice which I would follow if I were in your position (and was reasonably sure of a new job).

[meandragonbrett]

Some of these hospitals are off the chain.