razzledazzle2428

Hi everyone, I'm looking to get some insight from other med-surg units regarding how you handle charge nurse shift handoff. Not bedside handoff, just charge nurse handoff. I currently work on a 48-bed medical-surgical unit where our charge nurses (two during the day and one at night) are free charges (no patient assignment). In our current format at shift change, we give a brief report on essentially every patient on the unit. As we go, we give additional focus to discharges, admissions, and any issues. As you can imagine, this can make report quite long (>1 hour is not uncommon) and, at times, feel redundant-especially since much of the information is already available in the EMR. I'm exploring ways to improve efficiency while still maintaining safety and situational awareness. One of the biggest things that I have become convinced of in the last few years both as a bedside and charge nurse is that longer report is absolutely not necessarily better report. I honestly have come to feel that as much as 2/3 of the time I have spent in charge report is redundant time going over excessive details that are never relevant during the shift. Even when I do need to know details about a patient, the report from charge report is usually not enough information anyway, and I end up having to talk to the primary nurse and/or dive through the chart for more information anyway. I have been asking myself more and more, if I have to do all that whenever I need relevant information, why I am I spending an hour at the beginning and end of every shift trying to do a brief report on everyone? I've been reading about more exception-based or operational handoff models, where the focus is more on: Unit census and staffing High-risk or "watch list" patients Admissions and anticipated discharges Safety concerns or recent events Operational/unit issues They would focus on these rather than going patient-by-patient. However, most actual research or organizational recommendations focus on administrative-style handoffs for directors and managers. I can find almost nothing specific to charge nurse handoff, and the little that I can find is almost always focused on an ICU setting. So I would like to put it out there here to see if I could get some feedback very specific to a Med-Surg Setting, how do you all handle these sorts of things in practice? Do you give report on every patient, or use a more focused approach? If you've moved away from full patient-by-patient report, what does your structure look like? Have you implemented any kind of charge nurse log, dashboard, or written handoff tool? How long does your charge report typically take? If any of you moved away from a full patient-by-patient report, did you encounter resistance? I'd really appreciate hearing what has (or hasn't) worked for your med/surg units. I'm especially interested in what's been sustainable long-term. If anyone knows of any research related to this topic, or have alternative handoff templates, I would appreciate information on them. Thanks in advance for sharing your experiences!

Interestingly, I decided to come back and revisit this old post I started, now that 2.5 years have past. I have spent that time on a Med/surg floor, and have now become a charge nurse as welll and frequently work in a mentorship role to new nurses. I have also begun a part-time DNP program, one that also has several fluff classes. I was hoping that in that experience, I would find some validation of the utility of the time I spent on BSN degree. My overall opinion at this point? Not really. I'll be honest, even after working a few years and taking on mentorship and leadership roles, I find myself still disagreeing with this. Interestingly, the hospital where I work originally was following the trend of requiring BSNs for all nurses by a certain date and only allowing BSNs into certain departments, but due to pandemic staffing shortages, did away with it. They even allowed LPNs to come back to med-surg and rehab floors. We have seen no difference in our outcomes as a result of this. As far as interventional radiology? Slapping "BSN-only" on those is completely arbitrary. Nothing in my BSN program remotely increased my qualifications for interventional radiology. The few useful research, public health, education, and leadership principles I was taught in my class could have been taught in a week or two. They somehow stretched it out to 10 classes over three semesters with fluff assignments and papers that were frequently just slight variations on the previous assignments. During this time we had so many new grads come through, all with shiny new BSN degrees. Those new grads have been getting eaten alive. Sure, they can write papers, they can sure do APA format, but that has not done a thing to stop them from dropping like flies. We are barely retaining any of our new grads, despite attempts to mentor them and despite having a nurse residency program. What they lack is clinical skill and experience. As I and other charges have spent time in our charge office with new grads that are bawling their eyes out and on the verge of leaving the field within the first year because they feel so unprepared, I have a very difficult time supporting the idea that all that time spent writing perfect APA papers would not have been better spent on more clinical time and experience. As I've gone further into my career and understood more of the history of nursing research, more and more I am convinced that the BSN is simply another example of credential inflation. It is another example of how the nursing field has an inferiority complex (that it just needs to get over) about its standing as an academic field, so we have to find more ways to add alphabet soup to the end of our names so we look more academic and respectable. I've seen more nurses go straight into leadership with very little floor experience because they are "BSN-prepared" where they proceed to repeatedly screw us over because they do not even understand how the basic workflow of our floor really works. To date, I'm surprised that despite current emphasis on evidence-based practice, we are pushing for a degree approach that really lacks sound evidence to back it. I'm aware that there were a few studies that showed better outcomes in certain areas such as cardiac outcomes, but all of them were observational studies done at urban hospitals that were first to push for more BSNs, had better staffing ratios, more experinced overall staff, and more resources compared to the hospitals with lower BSN staff that generally are smaller, more rural, have fewer resources, and have more staffing issues. There were dozens of other factors that likely contributed to the outcome rates. The reality is that there has been no high quality evidence that shows the BSN to actually be a causative factor for better patient outcomes. The simple fact is the BSN needs to change. By all means, continue to teach some research, leadership and education skill, but compact it into a few classes instead of stretching it out to 10 fluff ones, and then spend the rest of that time improving clinical skill. That is what is actually needed right now.

In a school orientation today, the USPHS (United States Public Health Service Commissioned corps) was mentioned as a possibility when they were reviewing different career options, as well as something that could help us pay off our loans if we were interested in it after graduation. It piqued my interest and I am trying to learn more about them. I have been to the USPHS website, and while it explains overall what they do, it doesn't have a ton of detail. I searched here on allnurses to see if anyone here had worked for USPHS to get an idea of what the job is like and if they recommend it. I only found a few forums talking specifically about USPHS, and all of them were >10 years old. Is there anyone on here who has worked for USPHS within the last 2-3 years who could tell me about their job? And if you would recommend it to other nurses? Pros and cons?

Hello All. I wanted to ask if anyone here knows of a case where someone has made a nursing union succeed in a right-to-work state. I work in Idaho, where just like in most right-to-work states, large corporations thrive due to their ability to run roughshod over their employees with the full support of the state government. For me, the question isn't whether or not I want a union, I 100% want one. I am fed up with increasing ratios, increasing workload, and retaliation against anyone who speaks up about patient safety concerns. I am not the only one who wishes we could organize. Even many of the more political moderates like myself as well as conservative coworkers I have are even starting to express support for the idea. Unfortunately, I just don't see how we can succeed with one. It is a right to work state, so anyone can choose not to be a part of it. I work on med/Surg, and our floor almost without exception wants unionization, as well as PCU, ICU, and ER (in short, all the floors that are getting progressively more screwed each year). Our L&D, postpartum, and pediatrics floors oppose it since they all have pretty posh conditions on their floor d/t having such high reimbursement, and they think that the hospital will gouge their floor to meet our demands (which I have to admit is a likely valid fear). I would say that on our Med/Surg, PCU, ICU, and ER, I would make an informal guess that about 75-80% would support unionization, while in the other mentioned departments about the same percentage are opposed. Much as we would love to have one, I just worry about it causing a lot of ugly infighting and hostility that I just don't know if I have the stomach for. Most of the stories I hear about successful nurses unions come from states like California, new York, and other similar ones that have stronger union protection laws. Does anyone know here about any examples of nurses that have had successful unions in right to work states? Or does someone knowledgeable on the subject think that we have a chance given what I've explained above? As much as I want one, if we simply have no chance I don't want to start the fight.

I understand that it is a good thing to be generally educated and be exposed to new ideas, and gain knowledge that will help outside the profession as well as in. But in my opinion, the BSN as it stands achieves neither of these objectives. I would have no problem with them devoting a class or two to advocacy (and frankly, the several classes that I have taken on the subject have required so little work they could easily be compressed into one without any material lost). However, if they are going to require more education, it seems to me that devoting a portion of that required education to address clinical preparation makes more sense than 6 different classes that literally teach the same principles of advocacy in a dozen different ways. Even national nursing organizations have recognized that here in the united states we have a problem with clinically underprepared new nurses. In my opinion, teaching the exact same concept in a dozen different ways and then giving them college credit along with more letters by their name makes them neither a more educated person nor a more capable nurse. There hasn't been a single clinically-related assignment on anything. They seem more worried about our ability to cite APA than our ability to be able to care for a patient correctly (I understand the need for proper formatting for papers as that is standard in college, but my program literally requires us to have an APA citation for each discussion post, discussion responses and each individual answer on worksheets we have done! On worksheets for heavens sakes!). Overall, I understand what your are saying I am supposed to be getting out of this despite the lack of clinical focus, but I don't feel like that purpose is even being accomplished. I would still submit that they need a greater mix of both practical, clinical applications along with general advocacy training. Everything I have experiences so far just seems like fluff to allow hospitals to add more letters to the names of their nurses and pretend they are more qualified.

I just got my RN a couple of months ago and am now finishing up my BSN. I am getting so frustrated with my classes, as so far absolutely nothing has had anything to do with on the floor nursing. Perhaps my struggles come from the fact that I have no interest whatsoever in working in management or participating in research. I love working the floor and have no intention of leaving it, and was hoping to get more in depth information clinical specialties. Everything in the program is about pushing advocacy and trying to get us involved in the politics of healthcare. On top of that, our advocacy lessons are spread over multiple different classes that could easily be compressed into one and cover the same material with ease. All the stuff about advocacy and helping the underserved is all well and good in principle. In practice however, from what I've seen in the facilities where I have done clinicals and worked is that the nurses who try to push for changes get ignored, derided, and if they push to hard for a good idea, just get fired for pushing managements' buttons too much. Even the managers who would like to change things always get rejected by the suits in control, and I have even seen managers get fired for trying to push corporate to change things too much. Besides, in my experience, the nurses are too busy running like crazy to get all the meds and treatments done and the social worker is the one that takes care of all the advocacy and ensuring that underserved populations are connected to necessary resources. I don't have time to sit down with the patients and have in depth chats with them about their issues (much as I might like too), and I have always figured that is why we have social workers to take care of these issues for us anyway. I am normally one who believes it is important to obtain more education, and I agree with those who say that having a bachelor's degree helps put us on a more professional level equal with our colleagues. I just feel that in the final year of my degree that at least some of it should be applicable to my job, especially given how unprepared I felt entering the clinical setting as an ADN grad. If I was in charge of the BSN programs, the first semester classes would be focused on advanced pathophysiology, in depth critical care, management of all the machines in the ICU, how to respond to emergency situations, and focus on so many other aspects of nursing that only got a day or two's worth of coverage in the first couple of years. This would be followed by a second semester that would be essentially a semester long-preceptorship where the nurse would work full time as a preceptor in the hospital, changing to a new wing every few weeks to ensure that there was exposure to various specialties. I feel like something like that would have made me so much more confident in my abilities as a beginning nurse. Thinking about it now, perhaps the frustration with how underprepared I felt entering the clinical setting is partly what is fueling my frustration with the current focus of my classes. At this point however, I am understanding more and more why I have heard so many nurses say that BSN stands for "Bull-S*%# nursing degree. So far I feel like absolutely nothing I have learned will make me any better at my current or future job. I'm still going to keep going. I live in an area where the BSN is required now for hospital employment (or at least, you have to have it within a year of hiring as an RN to keep your job), so I have just accepted at this point that I will have to bite the bullet and get through this. Am I crazy for feeling this way?