Nursing as maid of all trades

jnette, ASN, EMT-I · Aug 27, 2005

Gosh... don't even get me started.

The things that are delegated to nurses anymore is truly absurd !

Instead of having someone resposnsible for inventory, and stocking.. WE have to meet the delivery truck (even if it's after we are done for the day, after a long, HARD day that began at 0400!) and once he "delivers" (meaning just unloading it in the basement).. WE have to count the inventory, then begin stacking, sorting, piling, and carrying all this HEAVY stuff around to it's proper place (much of which is upstairs). :stone

And I'm referring to 35# boxes of saline, heavy bags of dry bicarb mix,.. I could go on forever. A whole truckload of inventory, and WE get to put it all away ! Every other week. Not to mention pumping the acid from the barrels (55 gallon drums) outside into the holding tanks in the basement... even if it's zero degrees outside and a blizzard. :rolleyes:

Always more and more being thrown at the nursing staff in order to save the COMPANY $$ from having to hire a person more appropriate for the job.

VERY, VERY annoying, discouraging, and frustrating. As if we don't have ENOUGH to do already and no time to do it all ! :angryfire

papawjohn · Aug 27, 2005

Hey Canoehead

First of all, 'not thinking of leaving'? Man, I sure would be. But if you feel like you gotta....could I make a few observations?

I've been in the very same place. One very slow couple of days between Christmas and NYears, I rearranged all the emergency drugs in my CCU. Very logical--most often used in top drawer, down to drips that we seldom used back in the supply closet.

I proudlly showed it off to my manager when she came back after the holidays. That's when I learned about the "Pharmacy-Nursing Committee"--you can fill in the rest of the picture; all the meds went right back where they 'belonged'.

If you're gonna change things where you work, you're going to have to stand up and be a bit of a leader. Decide which ONE THING you need to change. I might suggest that accurate vital signs are kinda basic to what we do. But you've gotta prioritize on two bases: What's important to do? and What can be done? One important determinant of likely future success is whether the MDs are behind you. If you can document inaccurate VSigns from specific machines (Thermometers, Sphigs--gush, do we still use that word--BPCuff). That shouldn't be hard: Sit a few nurses and CNAs and WardClerks down, they become BP Pt 1, BP Pt 2, Pt 3, etc; uses BP Machine 1 on all of them, then BP Machine 2, etc. Document. If you've proven one machine is off, go to your Manager. Keep working with the Manager as long as possible. Be willing to do your own research on best machines, industry standards, prices, etc. You'll probably end up working with a 'VitalSignsCommittee' and the purchasing people. You'll have put in lots of time (most of it unpaid) and possibly gotten a reputation as a really competent, caring and professional Nurse (from those who like you for what you did) or a pushy and bitchy Nurse (by those who don't--and someone will).

All that just to get accurate VSigns!! Ain't it grand!! You see why I'd be thinking of my next job. But you can be a better person than...

Grumpy Ol' Papaw John

PS: Of course, you COULD end up getting really well acquainted with a Medical-Equipt Company and end up getting a fabulous job offer. Hey, it happens!

Papaw

**canoehead, BSN, RN** · Aug 28, 2005

OK, now the moniters aren't working...we can hook the patient up to the crash cart, which has no alarms, or to the moniter that intermittently, an without beeping, goes into a fit of artifact, becoming useless. Since there is no central monitering we don't know this has happened unless we walk in. Very inconvienent for my last patient who was having bouts of asystole lasting up to 8 seconds, with LOC, (but the doc claims she's stable) and ONE RN for the unit who cannot sit in there. I got the visitor to holler out when it happened- embarassing to be working like that.

UM Review RN, ASN, RN · Aug 28, 2005

OK, now the moniters aren't working...we can hook the patient up to the crash cart, which has no alarms, or to the moniter that intermittently, an without beeping, goes into a fit of artifact, becoming useless. Since there is no central monitering we don't know this has happened unless we walk in. Very inconvienent for my last patient who was having bouts of asystole lasting up to 8 seconds, with LOC, (but the doc claims she's stable) and ONE RN for the unit who cannot sit in there. I got the visitor to holler out when it happened- embarassing to be working like that.

I'd rate that as more than inconvenient. I'd rate that as dangerous for the patient and a liability to your licensure. You can bet that I'd be taking that one so far up that chain of command that they'd spit! :angryfire

UM Review RN, ASN, RN · Aug 28, 2005

bouts of asystole lasting up to 8 seconds, with LOC, (but the doc claims she's stable

Also, I'd take this over the doc's head to the medical director, the guy is dangerous too.

William_SRNA · Aug 28, 2005

This is so typical everywhere you go and the state of nursing today. I am so glad to be done with bedisde nursing.

RT dept, maintenance dept and materials dictate what we keep in our crash cart and where we put everything. Doesn't matter that the nurses who work in the dept all agree that items we use most often should be easier to access. Their order sheet is listed like so, and thats how they want the supplies stored. And why should they go to the trouble of changing their sheet because the nurses want to change something?

Our thermometers are routinely 2-3 degrees off, we have only one that is accurate. We steal BP cuffs from another unit, and pharmacy crabs that our narcotic count is sometimes not in temporal order, but the Pyxis has been sitting unprogrammed for months.

Yes, the NM is aware of all this, yes she promises to do something about it, but the lag time between promises and action means there is more building up (for me) than is getting solved. I'm trying to look at it as a challenge- how much can I get done safely without optimum equipment, but it is wearing on me.

I LOVE the people I work with, I'm not thinking of leaving, but does anyone have a different mind set to approach this from? Of course, a little co-venting is great to hear too!

SeekUrBliss · Aug 28, 2005

OK, now the moniters aren't working...we can hook the patient up to the crash cart, which has no alarms, or to the moniter that intermittently, an without beeping, goes into a fit of artifact, becoming useless. Since there is no central monitering we don't know this has happened unless we walk in. Very inconvienent for my last patient who was having bouts of asystole lasting up to 8 seconds, with LOC, (but the doc claims she's stable) and ONE RN for the unit who cannot sit in there. I got the visitor to holler out when it happened- embarassing to be working like that.

Sounds like a VERY unsafe place! It's sad that type thing goes on way too often.

Peace

BETSRN · Aug 28, 2005

I am so often (almost continually) frustrated at work by all the people that feel they can delegate to nursing or dictate how we do our thing. One of our docs treats us as "her" nurses, and refers to us as such to patients. If equipment is in the room she will write an order for us to pull it from the drawers, and leave rather than get it out herself. She is BUSY you know!
RT dept, maintenance dept and materials dictate what we keep in our crash cart and where we put everything. Doesn't matter that the nurses who work in the dept all agree that items we use most often should be easier to access. Their order sheet is listed like so, and thats how they want the supplies stored. And why should they go to the trouble of changing their sheet because the nurses want to change something?
Our thermometers are routinely 2-3 degrees off, we have only one that is accurate. We steal BP cuffs from another unit, and pharmacy crabs that our narcotic count is sometimes not in temporal order, but the Pyxis has been sitting unprogrammed for months.
Yes, the NM is aware of all this, yes she promises to do something about it, but the lag time between promises and action means there is more building up (for me) than is getting solved. I'm trying to look at it as a challenge- how much can I get done safely without optimum equipment, but it is wearing on me.
I LOVE the people I work with, I'm not thinking of leaving, but does anyone have a different mind set to approach this from? Of course, a little co-venting is great to hear too!

First off, we keep our stuff wherever we want it and ti is convenient for us. Second, if your thermometers are off, send them to the Biomed department and have them repained. WE write all problems in the appropriate repair book and they are checked daily by those departments.

Why is your Pyxis unprogrammed? I would take all of these issues to Risk Management and have them do a risk assessment on your unit. Things might improve. It also seems to me that you have a totally ineffective manager.

I also would stay clear of this doc and the next time she treats you in the manner you have described, I would pull her aside and speak to her about her actions. Noting will be done unless you nurses make some noise.

pickledpepperRN · Aug 28, 2005

I wouls probably write my resignation honestly.

If I decided to stay, or in the interim, DOCUMENT!

I mean I would write an incident report every day I could not take accurate vital signs and monitor cardiac rhythms with both a working alarm AND a competent human observing those rhythms at all times.

I addition to the detailed daily incident report would be a duplicate memo to appropriate management all the way up the chain to the CEO (or whatever (s)he is called). Especially the medical director of the unit and of the facility.

Then I would report to the state department that licenses the facility.

AND, if no action to the medical and nursing boards. If my manager has too much to do or is thwarted in attempts fo fix things I would encourage him or her to sign the documentation. Everyone who agrees should sign it, especially licensed healthcare providers.

I've done this twice about 25 years apart at hospitals where I worked registry. One was called Imperial Hospital in the South Bay area of LA. I reported to all officials at the hospital and the state. Even my husband thought I was exagerating. Then we saw the place exposed as a MediCal mill on Sixty Minutes. MDs were faking surgeries and billing the government. I didn't know WHY but knew that place was unsafe. That was 1975.

At our once excellent county facility, Martin Luthor King hospital it was much as you describe regarding equipment. Also there was extreme unsafe staffing, dishonesty, and racism. This was earlier this century.

Sadly my reports didn't save either hospital. At MLK there were wonderful physicians, nurses, clerks, and so on. BUT curruption was in play too. (go to latimes.com then search "hospitals")

I got out as did many other nurses. We still have our license.

elthia · Aug 28, 2005

I am so often (almost continually) frustrated at work by all the people that feel they can delegate to nursing or dictate how we do our thing. One of our docs treats us as "her" nurses, and refers to us as such to patients. If equipment is in the room she will write an order for us to pull it from the drawers, and leave rather than get it out herself. She is BUSY you know!
RT dept, maintenance dept and materials dictate what we keep in our crash cart and where we put everything. Doesn't matter that the nurses who work in the dept all agree that items we use most often should be easier to access. Their order sheet is listed like so, and thats how they want the supplies stored. And why should they go to the trouble of changing their sheet because the nurses want to change something?
Our thermometers are routinely 2-3 degrees off, we have only one that is accurate. We steal BP cuffs from another unit, and pharmacy crabs that our narcotic count is sometimes not in temporal order, but the Pyxis has been sitting unprogrammed for months.
Yes, the NM is aware of all this, yes she promises to do something about it, but the lag time between promises and action means there is more building up (for me) than is getting solved. I'm trying to look at it as a challenge- how much can I get done safely without optimum equipment, but it is wearing on me.
I LOVE the people I work with, I'm not thinking of leaving, but does anyone have a different mind set to approach this from? Of course, a little co-venting is great to hear too!

Sounds like my workplace. Except that usually we can't get into the pyxis because our biometrics is off and the stupid thing won't read my fingerprint, or the patient med list hasn't been uploaded to the pyxis by pharmacy so you can't remove the med. :angryfire (our pyxis won't let you remove a med that hasn't been prescribed to that patient, there is an emergency override, but the emergency override will only let you remove the meds you would need in a code like situation. Works great for preventing med errors, but tell that to the patient who has to wait 2 hours to get the med because the pharmacy hasn't put the med in.)

It's horribly frustrating trying to provide care and a safe environment when you don't have the tools to do so.

**canoehead, BSN, RN** · Aug 28, 2005

Thank you guys, I needed some back up on this. It seems like people have put up with this for so long that they don't notice anymore. There is no PI program in place either, but JCAHO is due anytime, so hopefully a shake up will change things.

I hate the part where I have to make do with what little we have and other depts just dump on us, leave us all their work with the statement that "we are a team, it's not just one person's job." In that spirit I have emptied garbage, gone to pharmacy, and then be told by the security guard that watching the psych pt was not a security issue unless he did something threatening. And the people that work their butts off to help end up getting dumped on.

Luckily I have a vacation coming soon, I will take my tired self and my bad attitude on a long trip away from here.