mcleanl

Hello All, I have had a day to mull over everything. I still feel that it is completely ridiculous to call someone at home regarding an unchecked box. This in NO way impedes patient care. I also stand by what I said, if 100 percent compliance is the goal then someone should be doing a chart audit before I leave. It is interesting......the responses you get from nurses on here. Some people chose to jump on the not charted/not done band wagon, some were feeling I was lucky to have someone audit my charting to prevent a lawsuit and others jumped all over compliance. I think someone actually questioned whether or not I was telling the truth about the number of times this has occurred or if I actually left more boxes unchecked than I admitted to. Very interesting responses. I am a Registered Nurse in the ICU for 20 years, I take care of very sick patients and I forgot to check a box. I find it demeaning and irritating that someone would call my house to tell me that I forgot to check a box. I find it demeaning and irritating that someone would tell me, and the staff that I work with, that management will allow us to get away with 2 offenses but on the 3rd offense we must return to the hospital to correct out mistake. I dislike punitive management.....I find it very ineffective and offensive. We are Registered Nurses......we should be treated with respect, not like "naughty" school children. If the goal is 100% compliance, let's figure out a way to get there. So, there were some good responses. I plan to use some of the suggestions that were mentioned here, since I will be bringing this up at the next staff meeting. 1- self auditing..... If they can run an audit.....they can teach me how to run my own audit. When time permits, I'll run my own audit. 2- Leaving emails and giving x number of days to resolve the issue. Altra, I am not sure what to make of the quote below. Are you suggesting that I lack insight into the nature of my offense? If so.......is smacks of superiority. Just another issue some nurses have.

Thanks Monkeybug!!!!!

Actually Altra ..............what I am understanding is that we aren't documenting for better patient care but to satisfy TJC. As a nurse......I find that very satisfying (yes, I am being sarcastic). There are two camps of people........one camp that can admit how ridiculous this all is and the other that seems to believe that has some sort of deep level of importance. I promise you, my patient outcome will not change based on this one box. If reimbursement is the issue.....and I sense that it might be........someone should be auditing me before I leave........so I can leave and rest my weary bones at the end of my 12 and a half hour shift. Sure, If box checking is where it is at and what it is all about........no problem. I could actually reduce the amount of energy I spend on patient care and really focus my time on the box checking.

Thanks all, I plan to bring all this up in the next staff meeting. If the documentation is that important......I mean to the point where if one single box is not checked, then someone should come in starting at 6pm to audit, so it can be done before I leave. It is not as though all we do all day is sit around checking boxes. People having to return to work after 12hours to check a box.....I think this is all overkill. I hate the idea of someone calling my house with such trivial issues....and yes......it is a trivial issue. In the whole scheme of everything that I did yesterday.......checking the family notification box is on the very bottom my list. The other point that I would like to make to all the auditors out there........approach is everything. If you sound like your salivating because you found someone didn't check a box or if you sound like you enjoy calling people to tell them that their box checking skills aren't up to par...........you are going to get on peoples nerves!!!!!!!! If you absolutely have to call me, please say something like........"I can't believe I have to call you for this, I know you ran your butt off today BUT.........this box has to be filled out....."

Ok......I just got a call from the night charge nurse. She audits the restraint charting somewhere around 2000hrs. She called to tell me that I didn't check the box (in EPIC) that states I notified the family regarding the restraints. Every other bleepin' box was checked except that one..........she called me to tell me that I had missed that one box. FYI.....this lady was maxed on pressors, rapid Afib, intubated and lined today and started in CRRT....wasn't like I was sitting on butt all day. She apparently will call you up to 2 times and on the 3rd time if your restraint documentation isn't perfect........you have to come back in to fix it. I work 12 and half hr shifts. Some staff members have been called as late as 2200hrs. Can this even be legal???? I feel totally harassed. I was always under the impression that my documentation was mine....done under my license. If I failed to complete everything, than it was my license at risk and that it would also show up on my evaluation. Can management really call you for such small infractions?

Transplant!!! I agree that the learning experience will be incredible. Just as an aside......ortho floors are very heavy...and the work is physically difficult.

I suspect the OP is referring to the "college of nurses." It is a equivalent to the US's BON.

I've seen it used for bedside procedures (in adults) along with versed but never in drip form. I was taught to minimize stimulation and talking near the patient while ketamine is in use to prevent flashbacks/psychosis.

This is a good question. I actually had a vascular pt, several years ago that occluded his graft and needed to go to the OR stat. He was intubated, SR on the monitor. We packed him up to go the OR, placed him on the portable monitor/vent and started out the door when I happened to notice that his rhythm looked slightly different......it was PEA. Our monitor didn't pick it up and the pt didn't have an A-line. He potentially could have made it to the OR without any of us noticing!

Not sure about the diagnosis, but in my world cyclical vomiting gets an NGT.....

Trish....hugs to you. Your post did make me giggle when you wrote "Hamilton (not a fan). I grew up there and it was often referred to as "the mistake by the lake." Good luck with your search, TO and the burbs......that is where my heart longs to be!

"Manchildren"....................:lol2::lol2::lol2::lol2:.........I never knew there was a name for this, but I know exactly what you are talking about!!!!

Gaylarn4.....I'm not sure this is a "human" trait as much as it is a cultural one.

There is a direct correlation between the brain and the heart and we see this frequently with neuro patient's with high ICP's........see Cushing's reflex. Large head bleeds can cause brain herniation and brain hernation is almost always fatal........and everything fatal ends up in cardiac arrest.

This is crazy.....back in the late 90's I remember a phase anesthesia went through where they were doing "trans tracheal blocks?" Does anyone else remember these? The patients were fully awake a small gauge needle was essentially stuck in their neck "to freeze them" then the patients were tubed.....most of them kicking and screaming. It was one of the worst things I have ever witnessed.

Not to be negative but in this economy it might be the specialty that picks you! That being said......SICU....and always in a teaching hospital!!!!! Pro: teaching hospitals tend to get the juicest cases -rounding with the residents and the attendings....you will learn a ton -ICU nurses get a decent amount of respect. -in teaching hospitals there is always a resident around and in the ICU's they almost never leave the floor -you will do invasive monitoring, CRRT, Vents, IABP, VADS.......I could go on for days with the equipment that you will learn to use -drugs, drips, drains and dressings...oh boy! -your nursing colleguagues will have your back when the poop hits the fan......I have never been in a crisis without a handful of nurses in my room helping Cons......you will rarely get a sit down lunch!

Hahaha.....this made me laugh. I usually refer to doctors orders as "suggestions".........since some of them really aren't all that wise to follow!

Most people don't record the MAP....unless you are in the ICU. We tend to look at MAPs in various situations like calculating CPP's and closely watching BP's MAP is particularly helpful with low bloodpressures....... so if you have a pt with a bp of 92/59, you know that your MAP is higher than 60. MAP is comprised of diastolic x2 + systolic divided by 3. In this insistance if you have call parameters for systolic If you have a bp of 100/32.....now you have a MAP of 54. Now you vitals organs may not be perfusing even though your systolic is at 100. Like every patient....low people tolerance to BP vary. So check the BP, assess the patient and call the doctor as needed. If the BP is low....knowing the MAP can be useful in deciding treatment.

I agree with the power and control theory! Nurses are an odd bunch.....we have very little power/control or autonomy. We are subject to the orders of physicians and the policies and protocols of our place of employment. I personally feel that the low levels of autonomy and feelings of powerlessness lead to aggression.......that aggression manifests itself through lateral violence. Nurses spend a lot of time criticizing other nurses......look around this forum and you can see it first hand. You don't really see that with doctors. Nurses judge each other very harshly...."I would never do that," or "I have never made a medication error." Or we make a HUGE deal out of a nurses error.....somehow it makes us feel better about ourselves. The whole thing is a shame.....but I am not sure how it can be fixed. I think it really is important to acknowledge that tearing others down really has more to do with how we feel about ourselves.

I took 2 breaks...the first one, I was off for 2 years and the second break, I was out for 2 and a half years. I just started back in Feb. The breaks were nice and it was great to be home with the kids....getting back to the bedside really reminds me how much I need to get an advanced degree!

Hopefully, if you were the nurse manager you would get both sides of the story. One thing I am glad is that the OP discussed her concerns with the RN in question. That to me shows a high level of integrity. It is okay to nudge people when you feel stuff isn't going right....."hey, let's not forget we need to deal respectfully with human bodies."

I never said it was okay.......I am merely saying, please do what you do and do it well, encourage others to do it well.......but it was another example of one nurse judging another.......and I feel it is unneccessary. We as nurses spend so much time judging what other nurses do.....the OP could have easily written a reminder to remember to use care when taking care of people post-mortem. ....my spell check isn't working...my apologies for sp. mistakes

I too always try and be respectful....but some people deal with situations differently. I have seen really great nurses joke inappropriatly (even done it myself a time or two) during stressful situations. You may not know the full extent of the story......this nurse may have issues dealing with dead bodies, or she may hve spent every minute of her last three shifts trying to keep this patient alive and just couldn't spend another moment in this room. The possibilities are limitless........ Give the best possible care when you can and encourage great nursing but try not to second guess another nurse.

income tax myth #2: your tax bracket is the tax rate you pay if you're in the 25% tax bracket, you're entire income is not subject to 25% tax--that's just the highest rate that's applied to your top range of income. a "tax bracket" is a range of income that's taxed at a certain rate. each bracket gets assigned a progressively higher rate, which means that the first dollars you earn are taxed the least and the last dollars you earn are taxed the most. there are six tax brackets for 2010: 10%, 15%, 25%, 28%, 33%, and 35%. if you're in the 25% tax bracket, you're entire income is not subject to 25% tax--that's just the highest rate that's applied to your top range of income. the actual amount of tax you pay can be used to calculate your effective or average tax rate, which is always lower than your tax bracket rate. simply divide the amount of tax you pay by your income. for example, if you're a single taxpayer and make $35,000 in 2010, you're in the 25% tax bracket--but your effective tax rate is just 14%. at moneychimp.com you can use the federal tax brackets calculator to find out how much tax you really pay based on your income and tax filing status. (depending on where you live you may also have to pay state income tax, which raises your effective tax rate.)

Ummm........I don't work on your unit and I am not really sure why I would be a liability if I did...so how does that make me in the wrong business?