ladybyrd

Worked in rehab for over 12 years with no injury, 'cept the usual aches and pains that go away after a good nite's rest. Our secret: USE CONSISTANT TRANSFER TECHNIQUES FOR EACH PATIENT! My biggest suggestion: go to the gym with the patient and watch PT teaches that patient for a couple transfers. While many techniques are the same, sometimes techniques have to be revised for patients specific disabilities. Transfers for quads are totally different than stroke patients. However, left stroke patients and right stroke patients can have different cognitive abilities and their techniques and cuing can be different, even though they both have had "a stroke" ------------------------------------------------------------------------------ RATIONALE: To learn a new technique, you first have to learn "the rules" then the variations on those rules. Remember what it was like in Nursing school when you first learned how to give an injection? It was a new skill that you had never done before, and there were certain key safety elements to master before you could be successful. Did you have different clinical instructors who used different cues and conflicting instructions, or were you taught the "right way" to do it FIRST...then learn how to adapt the technique for different situations (ie obese patients, emaciated patients, children, combative patients) If nursing uses a different approach than therapy does, or each nurse says "do it this way" or "that way" the patient will learn inconsistant techniques. Instead of promoting independence and mastry of technique, the patient may learn sloppy habits which can lead to falls when they are in an unsupervised or unstructured environment. If you can continue to help teach the patient to do the transfers using the same constant approach that therapy is using, the patient is more likely to do the bulk of the "work" of the transfer which will keep both you and the patient from getting hurt!

Similar thing happened to acquaintance who was a fairly new nurse. The narcotic count was off, and due to his inconsistant documentation (due to understaffing and overwork) there was no way to *prove* he either did or did'nt do "the drug-misdeed". He was told by board of nursing that if he pleaded "guilty" he could go to drug rehab, and if he followed all their rules for rehab and aftercare and follow all the restrictions on his license, he would be treated as a "recovering addict" and could maintain his license and continue to work. However, if he continued to deny that he did the deed, and pleaded "not guilty", he would loose his license permanently and could be prosecuted, even though his "only crime" was shoddy charting practices NOT misappropriating narcotics. He said he would NEVER plead "guilty" for something he didnt do, and if it meant he couldnt practice nursing, it was THEIR loss, not his. He now working in the construction field. Follow up: several months later, the REAL culprit (a co-worker) was apprehended and admitted that they had "done the deed" and taken the drugs, and further that to cover their tracks, they had let this unfortunate man "take the fall" rather than fess up and admit that the man was an excellent nurse and was only guilty of "not charting as well as he should".

Never take one to work that you wouldnt mind loosing!!! Had a friend who took her "top of the line" to work... had it less than a week before it came up missing Whether it was borrowed,lost, or just plain stolen was never determined. However, since she couldnt afford a second "top of the line", she settled for what she could replace if it came up missing again!!

The feeling among the most of the staff has been: "keep an eye over your shoulder, and your back to the wall"...Recently, I spoke to a former middle manager, who said our perseptions are correct and that she couldnt take the control from up above anymore, so she left. In simple terms, the top people are "obsessive coumpulsive controlers" & the middle management's response to this control is to attempt to control the staff even more! Now with this "new system" going into effect, its as though 'BIG BROTHER' will be clocking in with you and watching your every move...waiting for you to screw up and then OUT you go!!! Living in a dictatorship that (honestly) calls itself a dictatorship is "easier" than living in one that (dishonestly) calls itself a democracy, but exibits ultimate control at every turn...then says "you" are the one with trust issues!!

To those of you who currently use these devices, a few questions: Does your hospital/floor have "standards" for minimum or maximum time in a patients room? Does that minimum/maximum standard change for shifts? IE: you would naturally spend more time in a patients room that needed a procedure or personal care,(day shift) and less time if they were sleeping had no iv or meds. (night shift) How long do you have to be "IN" the pts room before it registers that you were there? Do staff members "leave their badge in a patients room" for a few minutes extra time off for a smoke break? (asking this question as unfortunately, I actually work with several people who would do that!)

"...when you have a cna who spends a total of 75 min in patients rooms in a 12 hour shift you have good reason to be looking into this..." I agree that this system can be benificial for dealing with "problem employees". However, for arguments sake, lets say you work night shift, have several "well patients" who only have a few IVPB meds and dont require more than mimimal care... You have several who require "more than their fair share" and are in their rooms more than you are out and barely sit down the night. The confused patient who is on the call light every 10 minutes (because they mistake the nurse button for the TV button) needs restraints to keep their IV and foley intact (and all that "new monitoring" that goes along with it these days); One patient is a suction prn and "turn q2" and although you have suctioned him as needed, you only turned him 4 times in your 12 hours instead of the usual 6, You have been in with someone who is bleeding and needs your 1:1 monitoring; have restarted 3 iv's Been on the phone with 5 separate family members of one patient who dont understand why you cant give them a detailed explanation of their loved ones condition... Also you have been on the phone with 3 doctors and the lab trying arrange the details of the transfusion as the lab has had a difficult time getting the 2 units of rare blood type so you have been using the volume expanders till you can arrange for their ultimate transfer to ICU. Additionally, the "mystery meat" served in the cafeteria has been at war with your GI system and you have been answering the "shouts of nature" between your other duties. Normally, we accomplish what we can... HOWEVER, 2.5 weeks later, your new nurse manager (and the worse one you have ever had in your 15 years as a med-surg nurse) has just returned rested and refreshed from her 2 week vacation) returns to review the new "NURSE TRACKER"... She calls you into her office to ask for a detailed explanation for why your "perfomrmance sheet" for the nite looks like you spent an exorbitant amount of time with a couple patients, ignored others and were at the nurses station or using your moblie phone much more than any other nurse that nite. And most outrageous of all: in the bathroom 6 times once for 10 minutes!! Suddently instead of the focus being on all that you accomplished...it turns to WHY: "the q15 minute checks wern't done on the patient with restraints" (thankfully she fell asleep watching the test pattern on the TV) "turned the patient 4 times not 6"....(didnt matter you suctioned him 8 times...and he was in a different position everytime you were in the room) "you spent only 1 minutes every 3 hours in 3 rooms"...(you stuck your head in, acertained they were sleeping peacefully, the iv was running, hung their piggy back and emptied the urinal...and got it all acomplished in less than 1.5 munutes!!) "those bathroom breaks"...(thank gawd that stress incontinence forces you to wear pads...it made the cleanup easier, but needing your stomache pumped and washing panties at work was definatly NOT what you planned when you wolfed your meal in 10 minutes...) Well, you get the idea...

The hospital I work for has changed our classification to "associates" and "partners in healthcare". They are redoing our evaluations to reflect "objective criteria" for evaluations rather than the current "subjective criteria". They have instituted a new computer charting system, which only the RN/LPN's can chart patient care and education. We must also chart all of the care given by the CNA/tech's. The system is very labor intensive to learn & use. It took me 20 minutes to chart 12 vital signs and I/0's for 6 patients; 30 minutes to do an admission on a new patient. (I could do ALL this in about 20 minutes on the paper system) The hospital will soon be installing a "tracking system" for employees which is a device attached to your name tag that sends information to a centralized display (like "telemetry" cardiac monitors). They will be able to see where the staff is, how much time is spent in each location and who you are with (ie multiple employees are in a patients room providing care vs in the lounge) They will be providing a "quality service satisfaction guarantee" to patients. It has not been fully explained to the staff, but it seems to be that if a patient has to wait longer than "x minutes" for anything, they will recieve a financial renumeration by the hospital. The administrators are saying all of these changes "will improve health care delivery" by allowing "location of staff" and "quick communication patient needs to the appropriate staff member" and "monitor the documentation of care" Two references about electronic monitoring: http://www.graduateresearch.com/buswell.htm http://www.light1998.com/faceit/Tracking.htm If you work in a hospital that uses these electronic system, what is your experience with them? MY OPINION: the potential for the employers to abuse exists when they reduce professional nursing to a "time and location study" and they "do the monday morning quarterbacking" system of evaluating your whereabouts and time your every move. WHATS YOUR OPINION?