Nurses need a workspace where they can think critically, and chart to avoid med error

**canoehead, BSN, RN** · Jun 7, 2008

JCAHO has a rule that the med area be free of distractions but in, oh, six hospitals I have worked in the rule was NEVER enforced. It's more likely that the med carts are in the middle of everything to "facilitate communication."

UM Review RN, ASN, RN · Jun 7, 2008

How we're expected to be able to concentrate to chart, pass meds, and think critically with all the distraction is beyond me.

I'm supposed to tune everything out that's going on around me so I can concentrate to get meds up, yet if the cell phone rings or if a patient call light goes off, I'm expected to be right there too.

It's a real Catch-22, isn't it.

We have to give report standing in the hallway in front of each patient's rooms. What a racket at change of shift!

locolorenzo22, BSN, RN · Jun 7, 2008

Crazy....

I am a FIRM believer in computerized charting...when the hospital went to it last year it was a real pain...now, I don't know how we ever got along without it. There's a lot of things to chart, but I know that I can find things somewhere in there.....

NeosynephRN · Jun 7, 2008

Oh...my unit is set up so nice, we do not have this problem. Every two rooms have their own nurses station, with 2 computers. Each room has a pass through cupboard, that you can access from the pt room or the nurses desk. This contains a locked inner cabinet that we keep all the meds in. Also has our commonly used items. 10, 5 cc syringes. Insulin needles, 2x2's 4x4's trach sponges, restraints and just a whole bunch of stuff. We have 2 med rooms on opposite ends of the unit, never busy, two fridges for meds, and 2 pyxis machines if we need a STAT med. It really helps keep the unit calmer and quieter.

registerednutrn, BSN, RN · Jun 7, 2008

It is very difficult to chart (especially paper charting) when you can not find a place to sit and think. The last job I was at sounds similar to where you are except we did not have a med room we had a pyxis machine in each hallway. I was difficult to prepare medications because coworkers, drs and family would just walk up to and start talking to you and since it is difficult to put a dr or family off you so got distracted. The job I currently work at had to different sections. In the old section we have what we call rosies which are computer work spaces that we can take to the patients bedside. We go into the patients room shut the door and prepare meds, chart the patients assessment and attend to all the patients needs right there. In the new section each room has a computer work station right in the room at the patients beside. This gives you the opportunity to give your patient you undivided attention. As far as having to wear a sash while giving meds I think that is stupid. People can see you are giving meds and should respect that you need to put you full attention on that and leave you alone. I also feel that you should be provided a please to sit and chart. At my old job I would pull a bedside table out of an empty room and sat at the end of the hall to chart which is less crazy than the desk sometimes and generally put me closer to my patients

ICRN2008, BSN, RN · Jun 7, 2008

My old unit had three desks with two chairs and two computers each in addition to the nurses station. The physicians had their own area with computers. We also had computers on wheels that we could use if we wanted. However, during high-volume times when all of the specialty services were on the floor, it still became very difficult to find a seat. Fortunately, that was short-lived. There were various places on our floor that we could go to "hide out" when we needed to write our notes. We were paged for all call lights, so we didn't have to worry about physically being at the nurses station in order to know that one of our patients was calling or beeping. Our med room was locked so that only nurses, pharmacy techs and pharmacists could get into it. Overall, it was a nice set-up that I didn't appreciate until I saw the struggles that other facilities have with lack of space.

P.S. Unless each nurse has his or her own sash or they could be cleaned between each use, those would be considered an infection control hazard. I wonder what the Joint Commission would have to say about that? Studies have shown that the cloth covers of stethoscopes and cloth lanyards (for ID tags) can act as fomites and contain everything from MRSA to VRE.

racing-mom4, BSN, RN · Jun 7, 2008

This is exactly why I am a huge fan of job shadowing...I was offered a job on a busy post op cardiac tele floor of a major heart hospital, but did a 4 hour job shadow. Seeing 1st hand the tiny nurses station with charts overhead and 2 computers for 3 nurses at this tiny station--the monitors beeping to your left, the Med cart to the right, the BP cuffs and thermometers and acu check machine above the charts --so that meant the CNA always saying "scuse me" and reaching over your head to grab equipment. It gave me a huge headache and I was only there 4 hours.

I now work at a new hospital with HUGE nursing stations, they are bigger than my bedroom with huge counter tops , more cabinets and drawers than we could ever fill. Ample room and great lighting. Our mgmt asked what nurses wanted and actually listened---the nursing staff was a huge part of the bldg plans. Then after we moved in and we found glitches or things that didnt flow, they actually corrected by installing more lighting or a half wall.

Proper logistics of a floor plan makes a huge difference in the quality of work you can provide, we may not think so until we have a good working floor plan, but the difference is amazing...we didnt know how bad we had it till we got it right.

SoundofMusic · Jun 7, 2008

This is my greatest pet peeve at work is the space issue. We literally fight to save our spaces and seats at work -- but when a doc comes and sits down where you were sitting -- forget it. There goes your chart, your notes, your brain, your plan.

And don't forget those attention seeking co-workers who only seem to add to the noise level with their incessant chatter of anything and nothing related to the work at hand. I swear some of them did not get enough attention as children, as loud as they talk and joke in the NS. It's a wonder we can think through any of it. And this includes our unit managers! They are some of the loudest! :angryfire

We can have up to it seems 25-30 people in an area the size of a hotel room. Then what makes it really special is when at least half of the computers and phones in any location go down at ANY time on day shift.

As I said before -- administration wants 100% excellent ratings -- why can't they provide a 100% excellent work environment??

That set up with the computers outside the pt's rooms sounds heavenly.

charlitsweb · Jun 7, 2008

Oh...my unit is set up so nice, we do not have this problem. Every two rooms have their own nurses station, with 2 computers. Each room has a pass through cupboard, that you can access from the pt room or the nurses desk. This contains a locked inner cabinet that we keep all the meds in. Also has our commonly used items. 10, 5 cc syringes. Insulin needles, 2x2's 4x4's trach sponges, restraints and just a whole bunch of stuff. We have 2 med rooms on opposite ends of the unit, never busy, two fridges for meds, and 2 pyxis machines if we need a STAT med. It really helps keep the unit calmer and quieter.

Hi,

Where do you work?

Ii have been asking for drop down tables that you can lock for a bout 5 years. I am always looking for my notes, my glasses, a chart.

The distractions on our floor are phenomenal.

In addition to no space to chart we carry tele pagers as we have no tele tech, they go off all the time, We carry very archaic HUGE cell phones that are difficult to wear. Then on top of this, a badge, a pen, a stethoscope, other equipment, and now they want us to wear sashes. ( even after a huge scabies outbreak)

I am sure it will be easier with computerized charting - as long as they give us enough computers.

I personally purchased little plastic boxes that go on the walls of each room with supplies, 2X2 flushes, alcohol, tape, electrodes, iv caps etc.

I personally purchased an IV start kit - otherwise we are running over the entire floor looking for supplies which are located in all 4 corners.

The irony is that we have an enormous dirty utility room where abouto 1/8 of the space is used.

I am simply asking for 5 drop down tables. One for every 2.25 rooms. One for each RN to be able to go to when things get hectic so she/he can think about their patients critically.

I do bring use a bedside table and find a chair and extricate myself from the crowd. But you can guarantee that if I have to answer a call light, I will come back and PT or discharge planning, or another nurse will be sitting there.

Does anybody else work in an organized environment

Pediatric Critical Care Columnist · Jun 7, 2008

The unit where I work is small, cluttered, overcrowded and noisy too. Our nurses' station is not considered a work space for the nursing staff; in general the only nurse who is expected to use it is the charge nurse/unit manager. There are two computers at the nurses' station, as well as our central monitor, the fax machine, the pharmacy scanner, all the paper documents that make up our charts (no computerized charting here!), 3 phones and the telelift station. Our PACS montors for radiology are on a desk outside the nurses' station along with another computer and phone. Our Pyxis is on the other side of the wall surrounding the nurses' station, opposite to the PACS desk. Next to it is the central line insertion cart and the sternotomy cart. Opposite them are the fridge for dialysate, TPN and other fridge meds, a countertop, the drug manuals, storage for rarely used items and a sink. This corridor is used as a shortcut from one side of the unit to the other, and for transferring patients in and out. Takes some maneuvering to get a stretcher through there but we do it. The nurse at Bed 5, closest to the Pyxis, is constantly called upon to check meds and waste narcotics... and often has a really sick patient into the bargain. Our respiratory therapists have an area roughly the same size as the nurses' station where they have thier gas analyser, spare parts, a phone and a computer. That area is behind the med prep area.

We have a 15 bed ICU that routinely contains 18 patients. We have 7 single patient rooms and 8 open bed spaces. 2 of the single rooms ALWAYS have 2 patients in them... each with their monitor, pump tree and 15 pumps, ventilator, supply cart, and sundry other items. We squeeze in chairs for two sets of parents and two nurses and sometimes even a rocking chair. There are two overbed tables for holding and working on charts and a counter/cabinet arrangement that runs along one wall for the sink and storage. It's incredibly crowded. Now they've converted a storage room into a patient care room except that it's not as big as any of the other single rooms. There's no clock, no storage, no networked monitor (we're using a transport monitor on an overbed table), no fridge, no drug manual, no curtains, no door... but they want to put two kids in there. Infection control and the fire marshall are constantly patroling the unit because we're violating codes left and right.

As I said above, our charts sit on an overbed table near the patient's bed... accessible to anyone who wants to peruse it. Or take it away to a quiet place! We do our charting on a clipboard. It holds our flowsheet, nurses' notes, Kardex, micro flow sheet, lab flowsheet, MARs, QI checklist and any other pieces of paper deemed important to the patient's care. After rounds each day the nurse puts yesterday's paperwork into the chart. It's a system that is cumbersome and risky at best. So I totally sympathize with the OP!

I read an article in a nursing journal that talked about how a med-surg ward went about making the area around the Pyxis an interruption-free zone. They put a tape rectangle on the floor and made sure everyone who worked in the unit understood that anyone standing inside the tape was to be left alone. Sort of like a "cone of silence". Their efficiency went way up and their med errors went way down. Simple enough, don't you think?

SoundofMusic · Jun 7, 2008

I read an article in a nursing journal that talked about how a med-surg ward went about making the area around the Pyxis an interruption-free zone. They put a tape rectangle on the floor and made sure everyone who worked in the unit understood that anyone standing inside the tape was to be left alone. Sort of like a "cone of silence". Their efficiency went way up and their med errors went way down. Simple enough, don't you think?

If you can, please post this article so I can take it into my unit. I have had nurses come up to chat, or literally come up and make comments: Get out of the way, or, Are you done yet? Or, whatever. People get in a rush and expect you to "hurry up" so they can do their meds and so you get hurried -- and it's bad.