Please Start!

Prescribers: Please start entering your orders in a timely fashion or making it clear if you want me to enter it for you. I hate when at 10am we discuss putting my patient on an antibiotic and at noon still no orders are entered. Did you change your mind? Forget? Assume I would enter it as a verbal? Just not get to it yet? I hate to keep having to page you when I know you're having a busy day!

Also, please explain to the patient what new orders you're entering, so at 9pm it's not a surprise when they're getting Lovenox for the first time or when they try and order lunch it's not a surprise that they're now on a clear liquid diet.

Aids: Please start checking the hats in the bathroom and commodes each time you're in the room. I do this also. It will cut down call light use, improve compliance with I&O's, and it's embarrassing for the patient to need to ask for their hats to be emptied.

Sistrmoon,

It's not efficient at alllllllll. It's a hot mess in fact. Admitted patients in the ER = no bueno for anyone. Suspect this is just the tip of the iceberg

Please start reading the descriptions of the assessment components. A patient on a telemetry monitor does NOT have "abnormal cardiac" issues!

Please start respecting MY time. When I come in for my shift, I don't ask questions I can find the answers to in the chart specifically so you can clock out on time and be with your family. Do the same for me.

Please start to realize that if you are getting the SAME patients for your 2nd and 3rd shift of the week, you do not need the minutiae of what brought the patient into the hospital in the first place, that hasn't changed. However I will be more than beyond happy to tell you ANYTHING that has changed in the patient's condition during my shift.

I work day shift Cardiac Tele, ratio 4/1. We pull ALL meds for entire shift from Pyxis with a few exceptions (Vanco, Amiodarone maintenance dose, Flagyl, Protonix gtt)

Amiodarone loading & first 6 hour gtt, Cardizem gtt, Dopamine gtt, heparin gtt, antibiotic mini bags... And all PO meds are our responsibility to pull. We pull one patients meds at a time from the Pyxis so other staff can have a turn. We have 2 Pyxis dispensers on both of our Cardiac floors. At first it was a huge PITA, but have since adjusted and like not having to wait 60-90 minutes for pharmacy to deliver missing doses.

Please start remembering that propofol tubing needs changed AT LEAST every 12 hours, not just on night shift. I hate coming back and seeing my initials on the propofol tubing that I hung the night before. And don't tell me that you've never been told, that's a lie.

PLEASE do oral care! Vented patients need it at least every 2 hours. A/O a few times a day depending on dentition, diet, O2 use, etc.

PLEASE moisturize after a bath. CHG baths are very drying and can irritate skin if not rinsed well and followed by a moisturizer.

PLEASE do not get offended when I ask you to help turn a patient for a skin check before you leave. I'm not trying to accuse you of not turning our patient, I simply want to see their skin early in the shift to monitor for changes.

PLEASE clean up after yourselves in all areas. Patient rooms, staff break room, nutrition rooms, med rooms, etc. And if a trash can ANYWHERE needs emptying, just do it!

Lots more, but these are all from the past 2 shifts.

Please at least TRY to start changing central line dressings when they are due. On day shift you have so much more support staff to help. I probably won't be able to do it until after midnight (after my assessments, nighttime med pass, and getting slammed with admissions). Can you see why patients complain that they don't sleep?? If you don't have time, I get it. Some nurses never even try.

Please start checking your orders. There is no excuse for not knowing that the patient should be on cardiac monitoring, have IVF running, blood transfusion ordered, ect... All orders that were really missed by repeat offenders.

Please start addressing issues on day shift with the patients doctors when they are actually there, or call them before they are off call!! When you tell me at 1900 that the patient hasn't had a BM in 7 days and needs intervention, I now have to call an on call physician who is going to be ticked that the attending wasn't notified in the day time. Same thing goes for "clarification" orders. Don't tell me, "we need to clarify this order that Dr. Unclear put in", when you know Dr. Unclear is off call now and I am going to have to call the on call physician who does not know the patient.

There are so many more...

Please start:

Explaining to patient that PRN means as needed. Not "due" .

Why am I always looking like the bad guy for assessing pain and its a zero, yet the patient says well, I am due for my pain meds.

Legally, I have to give it within the parameters ordered by the physician, so zero on the redundant scale gets no meds..

Please explain that PRN means the patient has to request the medication....

we have white boards in our rooms that we are required to write down when the next dose of pain meds is "due" and we catch hell if we don't. It is almost an expectation that the pts will get their PRNs on a "schedule"

Start figuring out how to do your own IVs, lab draws because you've been here almost as long as I have. I hate that you don't even try because your answer of "i don't really know" when I ask how their veins are betrays that fact. You don't have to stick them if you look and you can't get it but at least look...

Aides...start documenting the things you do. If you don't document, it's not done. If you say you emptied a foley/hat but it's not in the system and you can't remember when I ask, it's difficult to pull a figure out of the air.

Dear Manager, praise us sometimes because we're really trying and working our butts off. Don't always give us the bad news of how our customer service sucks and we need to do better when you know we're so short-staffed it's a wonder we even get basic things done...

Please start putting the sequentials, venodynes, flexipulses, or ALPs, or whatever they are called on your unit, on your patients.

It is a core measure. Charting it but not actually putting them on is just wrong.

Music in my heart,

I will start ordering the 0900 meds. I work nights in a busy ER with loads and loads of boarders sometimes and a pyxis full of nothing but emergency meds. You know, I had never thought about doing it and had never been asked. I can't wait to surprise my day nurses with this =)

The only reason that I'm so cognizant of it is that I, too, work nights but will occasionally hang around in the morning for a few hours and have thus been on the receiving end.

Kudos to you for helping out your phasors... (those folks whose work schedule is 180° out of phase with your own.

Have you gotten any feedback yet?