willie2001

Hi everyone! I haven't posted here for a long time. mostly lurking. I work in a rural hospital. I have been an RN for 16 years. I am interested to know if there are others out there working in rural hospitals that have become Critical Access Hospitals. It seems to be the current trend and the main reason is for Medicare reimbursement. There are a lot of hoops to jump through in order to become a Critical Access Hospital. I don't know all the ins and outs of it, but I do know that Medicare reimbursement for such facilities is 101% which sounds great. Almost too good to be true. I want to know the downside. I guess my main concern is if there is any effect on nursing postions. I would like to here from others about this and if the work environment is effected and do people get layed off etc. Any feedback will be greatly appreciated! Deb

We recently had one of these "employee satisfaction" surveys. We recently got the overall results. Only slightly more that half of the total number of employees participated, but supposedly it was enough to make "general assumptions" about the overall quality of the "work environment. I was among the almost half that chose not to participate. Of course there was a positive spin put on the results. My only assumption from all of this is that almost half of the employees are ambivalent enough not even to bother and waste their time, because we have been around long enough to know that the only thing that will result is more commitees and meetings. Very little, if anything will be accomplished. The whole process was skewed from the beginning and is set up to make things look better that they really are. :zzzzz

I just got done having my yearly eval. and am getting a 3.5% pay increase. The whole system is rigged against the employee. As someone previously stated, you would have to walk on water to get any more. I don't even know why they bother because you're going to get the same whether you are a great nurse or a mediocre nurse. I suppose I should be grateful that I got the 3.5%, but somehow I can't help but feel insulted and depressed about it.

I have never seen an Ativan or alcohol drip in my hospital. We have had insulin drips, Amiodarone infusions, Cardizem drips and dopamine drips on med surg. The dopamine and Cardizem are only allowed if the drips are low dose and are not being titrated. This weekend one of our IM docs ordered a nitro drip at 10 mcg/min. on a 90 yo. DNR patient. The patient had chronic intermittent angina, and the 10mcg seemed to keep him comfortable. I don't know why the doc didn't just order nitro paste or something else besides the IV nitro. This is the only time I have ever seen nitro on the med surg unit. I really didn't have a problem with it under the circumstances but I hope this particular doc doesn't try to make a habit of it.

I rarely write an incident report, but I sure did today and it was on a physician. He admitted a renal failure patient several days ago. The patient had been doing CAPD several times a day for some time, assisted by her husband. She developed an infection and had been prescribed an antibiotic to be administered in one dialysis exchange per day. The husband had been doing this at home. When the patient was admitted to the hospital there were no orders written for this treatment. I was taking care of this patient yesterday and found out from the patient's daughter that the patient's husband has been administering the medication to his wife in the hospital. No order, no dosage, nothing. Evidently other nurses who had taken care of her knew of this, but did not call the doctor on it to find out what was going on. I called the doctor and his comment to me was "oh I know about that", but he also was unable to be specific with me about the dosage, etc. I called dialysis and got the whole thing straightened out by talking with them. I then wrote the appropriate order and nursing staff are administering the medication. I discussed this incident with my nurse manager and she also felt that an incident report was appropriate in this case. I wrote up the doc because I felt he was the one who dropped the ball in the first place:rolleyes:

What are some of your opinions on the routine suctioning(ie:q 2-3hrs) of patients on ventilators? Do you routinely suction because it is "policy" or do you only suction when needed. We are having a mild ongoing controversey at my hospital about this, and I would like some of your thoughts. Thanks for any insight any of you can offer.

If it is a really critical need (determined by nurse manager) we get $10.00 more an hour plus the over time if applicable. Sometimes I will be asked to work extra and be offered the $10.00 and sometimes the extra money is not offered. Whether I accept to work just depends on my state of mind at the time. Sometimes I say I will work but only for the extra money. If they don't want to pay extra then I won't work extra.

We have had to time clock now for several years; the kind you swipe your badge through. I have to be at work at 7:00AM. If I swipe at 7:01, I am late and written up accordingly. I'm ordinarily not late, but I cut it close, usually clocking in a 7:58 or 7:59.

I agree that med/surg can be a dumping ground. I work in a rural hospital and our unit does the out patient blood transfusions that come from LTC, oncology, clinic , etc. Sometimes we know they're coming to us and sometimes we get a call from the doctor that the patient is on there way to us from the clinic. Who cares if we don't have a bed and have to scramble for a place to put the patient. Occasionally, we have an admission just show up at the nurses station. No call to see if we have a bed, no orders etc. It's maddening some days and it always seems to happen on days when we're tearing our hair out busy in the first place. The other day a PIA patient showed up to be admitted out of the blue. The doc never called for a bed, just sent orders with patient. The woman wasn't even sick, but supposedly she was dehydrated from vomiting for 2 days. The first thing she wanted was food. The orders said NPO so we explained that to her and she got mad. She was mad that we had to start an IV because she was dehydrated and needed the fluids. She just didn't know why we had to do these things. This particular patient is notorious for being a PIA and I am convinced that the doc sent her be admitted because he was busy and didn't want to deal with her in the office. So what if we were busy with really sick and needy patients and had to scramble around for a bed for this patient who never should have been admitted in the first place. She ended up leaving AMA the next day. Does that tell you how "sick" she was.

I agree that good hand washing and proper site preparation are the key to preventing infected peripheral IV sites. At my institution, we place tape under the opsite (chevron under the wings, keeping the tape as far as possible from the actual site). Often, I will wipe the site with betadine and/or alcohol before placing the opsite. I'm not saying that we never see an infected site, but it is very rare.

It's too bad that you're are being more or less forced in to a postition that you don't want. In my facility we have shift "supervisors". She is not only responsible for med/surg, but is often called to ER if they're swamped and must go to OB when there is a delivery. If there is a problem in ICU, she is expected to be on hand. She is pulled in all directions. I am an RN with 12 years of experience in ICU and Med/surg. I have been "unofficially"approached on several occasions about becoming a supervisor. To me, the extra 25-50 cents/hr more is not worth the tremendous responsibility and hassle. Just let me go to work and take care of my patients in the very best way that I can.

:) I have removed JP drains on several occasions and have never had a problem. However, on one occasion, upon inspecting the tube after removal,it did not look as long as it should and the end of the tube didn't look right to me. I did not let on to the patient the panic I was feeling. I called the surgeon and he informed me that he had shortened the drain himself prior to placing it in the operative site. I wished he had told me that before I removed the drain!

We used to give verbal report but it always took too long. We have been taping report now for several years and report goes alot smoother. If the oncoming nurse has questions, she can get together with the previous nurse after report. We tape at0700, 1500, and 2300. We do have some 12 hour shift nurses. The oncoming nurse usually takes a verbal report when she comes on at 1900. We've found that the nurses coming in a 1900 have a hard time getting settled in (gabbing, chatting,etc) and often wouldn't even start listening to a tape until 1920 or later. It's faster at 1900 to give verbal. :)

I read someone's post about garlic breath. We have one doc who most always reeks of garlic. Some days you can smell him coming 20 feet away. He is well groomed and neat in every other respect.

:) I work in a small rural hospital with 26-28 bed med/surg unit. If OB is closed or low census we do have OB nurses that work on Med/surg. If things start popping in OB, the OB nurse will be pulled to OB and the rest of us absorb her patients. We have some OB nurses that absolutely refuse to work on MS and vice-versa. No one is allowed to come in and just sit and play games.