GoldenRN28
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Technically first day of symptoms are day 0. For healthcare workers, many organizations use the first positive test as day 0. Rapid antigen testing is a good indicator of contagiousness/transmissibility but as we know also unreliable. Returning to work/school on day 6 vs day 10 is a change many providers are uncomfortable with, and because of that we usually use test day to push the isolation out a little longer. Studies have shown that 1 in 3 people are still contagious day 6 vs 1 in 10 on day 10. The new guidelines accept a risk of transmission so that we don’t completely close down with large amounts of cases. Not a fan of the day 6 guidelines. Also not a bad idea to do a rapid antigen before returning, it that’s organization specific. Because where do these day 6 returning staff or students eat lunch (since they are required to mask around others per CDC as they are known to still likely be contagious even if symptoms are improved)? Are they ensured they aren’t in contact with immunocompromised peers?
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100% agree that it’s a risky, unsafe practice. Just offering some perspective on how this practice likely came to be.
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Giving medications within an appropriate timeframe (1h before or after), doing dressing changes, checking vital signs, blood sugars, giving insulin, neb treatments, supervising meals, giving g-tube bolus feeds and writing notes is nearly impossible to do. When I worked 3-11, the evening med pass started at 4. That’s way to soon to give a 9pm Metoprolol. I think there is something to be said for nurse/patient ratios in long term care.
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Root cause of this problem is too many patients to one nurse. I worked in a SNF as a new grad and saw practices like this. No amount of time management can help you safely pass medications on time using blister packs/doing it correctly. you could try to adjust the med schedule to even out the med pass between shifts and still keep dosing frequency safe. This is a huge safety issue currently as receiving meds too early (especially beta-blockers and CCB) can lead to bradycardia and hypotension.