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Bri1231

Bri1231 BSN, RN

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Bri1231 has 20 years experience as a BSN, RN.

Bri1231's Latest Activity

  1. Bri1231

    Why Nurses Are Leaving the Bedside In Droves

    Whether this is off topic now or not I will stick my two cents worth in. I have jumped around different areas of nursing, a little stint in the ED, a little one in the Cath Lab etc etc etc. I have throughout my nursing career remained mostly a med surg floor nurse for one reason. I became a nurse to care for people not for job security. It never even entered my mind even though it is an added bonus. I have trained nursing students that quickly went into administration roles, management etc so in other words, they never wanted to provide any hands on patient care. And you can always tell the ones that just want to jump to the top for status reasons. In saying that, I have also met the one or two who still to this day will gown up and put a pair of gloves on to help a patient. Rare, but happens. I think when I went into nursing in 1998 nurses became nurses because they wanted to NURSE! Now there are too many who take nursing as an option because they just want job security and it's a career choice that means I will never struggle to work, in some capacity. An old work colleague openly told me once. Oh I hate patient care and I hated dealing with their families. I hate being a nurse but when I'm on a date or at a social gathering I say I'm ER Nurse, not oh I work in retail. True story!! Nursing now attracts the wrong type of people, some end up being the best caring nurses ever when they didn't even think they would. Others strive to get to the top so they don't have to touch a patient. It's sad.
  2. Bri1231

    Patient report

    As promised here is a quick update on the new report system. All nursing staff RN/CNA in patient report at the start of the shift and report starts with Safety brief Patients at clinical risk ( unstable/VS issue) Patients at risk of developing pressure ulcers Patients with NGT in situ and exact placement as measured before the end of the shift Patients with chest drains in situ Patients with Central Lines in situ Any other relevent concerns to highlight. Then the patient report for every patient on the unit is handed off to the entire oncoming shift by the charge nurse. It is all done in around fifteen minutes give or take. At 12pm there is a post MDT patient review update for RNs only then we update our CNAs with anything relevent to their input in regards to patient care. So far so good. No issues. All going very smooth. Everyone knows all the patients on the unit and any relevent specific issues to be mindful of. Does anyone on here have anything to add or take away? Thanks :)
  3. Bri1231

    Using medical terminology as a nurse

    This is why you must always document Urine red, ? Hematuria, await further testing. Or just document nothing at all until you have strip tested it. But there is nothing wrong with writing ? Hematuria.
  4. Bri1231

    Patient report

    Thank you for the reply. First of all I am not taking this personally I have come on here to get advice from everyone to figure out a better way to deal with patient report and I am taking all of the advice on board. I refer to the CNA making a serious error part. This you have read wrong. I stated that I have not had any serious errors with a patient thanks to a CNAs quick thinking. In other words the CNA picked up on a clinical issue and reported it back to myself and I was able to act. This is what I meant. There is no legal scope for thinking! I otherwise may have walked into disaster in a patients room on a few occasions. Beacause I spend way less time with a patient that assistants do. It is a hard one because as some people have decided to point out we have scope, legalities, RN assessment. Twenty years later you know I could write a book on all of this with my eyes closed. I will bring this all back to the original point. More places than not have provided a FULL PATIENT REPORT to RN and CNA at the START of a shift. The places that did, teamwork was better, patient care was better and there where less issues. The places that provided a need to know report at the START of each shift. Well, the shift could be scatty to say the least. Especially in my current hospital. You mention NAs standing around while nurses discuss x, y, z. For example I would not call my CNAs and say I just need to tell you that the doctor called and changed this patients orders, or the lab called and reported, whatever it may be. I am specifically talking about the beginning of a shift. In order for patients to have appropriate, holistic based care from the entire 'NURSING' team. The RN and CNA must have the full report. Anything after that first intital report is a need to know basis I totally agree. Hopefully the trial will work I will keep you all updated and please anymore advice or suggestions please let me know. I really do take it all on board. It is what nursing is about. We all have to chip in to make things better.
  5. Bri1231

    Patient report

    Do I get paid to take charge of the unit on some shifts. No. So it is like I never bring who gets paid to do what into nursing. When I do take charge I give out the assignments and then I take one patient from each nurse and charge and have four patients. Personal choice but do I get paid for that. No. Now I will give you a true scenario. Patient coded and everyone went to attend same code. No one canceled the code alert so it continued to ring. At the same time a sitter was assisting a patient to the bathroom and in that bathroom the patient collapsed. She pulled the coder and no one responded fast. She made the decision to perform CPR immediately. Same sitter was a RN who left practice years earlier due to stress and workload to raise a family and help care for her mother. Was having a break from nursing proper. Now imagine if she had performed CPR on a patient with a DNR. Or did not perform at all. She saved that patients life. See. Not all sitters are just sitters and you would be very surprised at some of their backgrounds. So I will continue to included all of my CNAs in pretty much every aspect of patient care. I will of course not bother saying oh this patient needs labs because of whatever reason. But you learn lessons in this job. Scope can be kicked to the sidewalk if it is justified. And you know what. Twenty years and I have yet to have a serious error with a patient thanks to a CNAs quick thinking which I always always thank them for. I value them so much. They provide nursing care. Just not at a level that we do. So as of next week there is a four week trial of patient report to include CNAs. And I welcome that with open arms.
  6. Bri1231

    Useless Shift Report Information

    Oh those nurses who go on and on and on so much that I actually after patient number three have many times had to read up on the remaining patients myself because I started to loose interest and scrolled on the latest updates on Pretty Little Liars. And it is always the same nurse. I kid you not I have heard This patient likes their water at a tepid temperature not too cold not too warm, is not too fussed on the hospital food so a friend of his brings in food on a Mondaaaaaay and Wednesdaaaaaay and his wife brings it in on Tuesdaaaaay Thursdaaaaaay Saturday and Sundaaaaaaay. I do not really care as long as he eats. I can chase that up myself. This patient told me the most interesting story about his worklife. One of his cousins worked at the shipyard and one day he decided that he.......blah blah blah. This patient does not like how he feels when he has opitates so I contacted the doctor and I could not get hold of him. So I then explained to the patient that I would try again and the patient said ok. So at 2am I contacted the doctor again...... All I want to hear is patient can not tolerate opiates so orders changed. Another one was not even relevent to patients The hand off started like this Oh my god have you all heard about * Claire*, one of the CNAs told me what happened so I went onto google searched her name and up came the news story. If you all want to read it it is on the local news. I can send it to your whatsapp. I was so shocked. I always knew there was something about her. One day I was working with her and...... This story continued forever! I could write a book. Save the gos for the nurses station. I do not want a kids storybook read to me. Thanks.
  7. Bri1231

    Using medical terminology as a nurse

    Ugh......the neverending debate over what can you chart at night. How many ways can you write it. Lol. I continue to write what I have always written. 2am. Patient appears to be asleep. No clinical concerns to report at this time. I keep my charting super short This I have written for 20 years. Have yet to have a problem. I say yet!
  8. Bri1231

    Using medical terminology as a nurse

    Ah ha ha ha ha I love these ideas!
  9. Bri1231

    NHS Apprenticeships

    What kind of idiotic stuff is that?!
  10. Bri1231

    Patient report

    And on the sitter one......at what point does HIPPA stop you from telling the perfectly competent sitter from another floor whether the patient is DNR or not. She actually did not know. That is so bad beyond belief. Yes it should have been up on the patient board but she said she was unsure and did not want to ask because CNAs are just dismissed as an annoyance here. I guess it just is a bad culture. For me it is do I move or help change it?
  11. Bri1231

    Patient report

    You are totally right. What I see here is a communication issue amongst all staff groups. It actually is quite bad here. The reason I ask about this issue is because in a previous setting the patient report sheet was updated by each nurse for each of their assignments towards the end of the shift. When the next shift came on the charge nurse did hand off in a room with ALL staff present even down to Physical Therapists. There was literally not one single issue that I mentioned above because all patient related information was handed over to the next shift. Even the PTs knew well we can do this today with this patient and maybe leave the other patient until tomorrow or late afternoon for whatever reason. They could also plan their time properly. Then there was a get together at 12pm for post morning updates. Literally everyone knew what the other was doing and all patient needs where met. I would then just update the CNAs with brief, relevent information as needed. Patients where happy, staff where happy. No clinical issues really and never a HIPPA violation. We all know and abide HIPPA law and anyone that does not suffers the consequences. My point is that no one provided care without a full hand off and there where no problems. Previous department to that it was the charge nurse dealt out assignments then the RN that you where taking over from did a direct patient report to both RN and CNA. Again there where minimal issues and not much chasing up. Now when I go way back when to the days of taped reports. CNAs did not sit in. We listened and then filled in a report sheet for each CNA. I soon learned that I was not giving enough information and I stared to do so. Taking the lead from a seasoned travelling nurse. I guess I have worked in so many different areas / hospitals I have seen many different ways of handing off information and the best one was when the charge nurse handed over the entire unit. To everyone. That also cut out RN mistakes when you had to step in and help out on another RNs assignment for whatever reason at short notice. You already knew the deal. So I guess I have gone from a safe effective patient report to basically a super fragmented one. And I never take anyones comments as arguing. I take everyones comments as a helpful viewpoint
  12. Bri1231

    Patient report

    I second what that tech said! It is so true. I think that my concern is at least there is some kind of hand off to the techs/CNAs on your unit. As there are here. But some units basically give less than basic to literally nothing for a whole half hour. It is unsafe to me. I always give the CNAs who are working alongside me a FULL patient handover before the morning care rounds start. So they have the bigger picture, know their patients and can provide good care based on the entire picture.
  13. Bri1231

    Patient report

    Patient mobilzed out of bed when they have a low BP which was checked by the RN, not reported to the CNA and therefore not reported to the incoming CNA. CNA gets patient out of bed. Disaster. Patient has had a physio assessment and it has been advised to use a hoist to chair transfer only. Patient taken out of bed with no hoist. On an emergency ortho / surgical admissions unit patients offered diet and fluids at 8.00am. Patient NPO. Not written above bed by RN. So in a way that is the RNs fault. On same said unit the morning CNAs leave at 7.45am as the day staff come on duty. RNs take report until around 8.15am. So an entire half hour where patients are left with CNAs who have no clue about the patients. Which equaled to a patient with a #NOF being mobilized out of bed for breakfast. That is a few of many witnessed issues. Not only that but the way I see it is many CNAs are so in the know with basic knowledge of a range of diagnosis. Which leads them to provide better care to patients and report more valuable stuff back to me! In this system they are given no medical/social history whatsoever and they are providing care to patients. This morning when I came on duty I was walking around my assignments and I asked one of the CNAs who was sitting for a patient how was your night. She said all good apart from the fact I literally have no idea why this patient is here. The information given to her was Assistance ×2 to mobilize Can have full diet and fluids My point is there are a whole range off issues from medical history to a patients current social history. A staff member walks into a patients room and says Hi, I am your CNA for the day. The patient is feeling down, stressed , and generally in a super bad mood. Distressed. The CNA opens the blinds and says oh lets have a good day today everyday should be a good day all bouncy and cheerful, which is nice, but the CNA has no clue that two months ago this patient lost her husband in a crash and is now facing being homeless with two kids. All caregivers from RN to CNA should know the whole story to be able to give appropriate, holistic, patient centered care.
  14. Bri1231

    Using medical terminology as a nurse

    I would have, always do, and will continue to chart hematuria when I see it. It to start with is NOT a diagnosis as previously pointed out and you could I guess write Self voided 250mls urine. Rose color. No clots ? Hematuria. Then await further testing i.e your dip. Simple as that. You did nothing wrong
  15. Bri1231

    Patient report

    I need some advice before I decide to go to the powers that be. I moved to a new hospital at the start of the year. I do a lot of agency so I am able to see how things are done on multiple units. One thing that struck me the most, is that a lot of units do not include CNAs in the patient hand off. So literally there is a whole workforce looking after patients that literally have no clue what is going on with them apart from Dietary requirements Mobility Cognitive issues Continence needs And that is pretty much it. There is so much more going on with patients than just this and CNAs spend the most time with them. This information is provided by ANOTHER CNA Things get missed!!! It is the first facility ever where I have worked where you do not give CNAs a full detailed patient report. I find it super unsafe. I can already list range of issues that I have witnessed with this system. How does your facility hand off?
  16. Bri1231

    NHS Apprenticeships

    I think these two things will be left for band 5s. Specifically the charge part. There needs to be those set boundaries. I am super happy that the ones who have progressed into this role have done so, otherwise some of them may have remained at band 2 forever, scared to go to university full time or not given the chance too. They have put themselves through a very tough gruelling two years and now, here they are :). There is a place for band 4s to shine in the nursing workforce and that is exactly what they are doing. I love working alongside this new role. And long may it continue.
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