babsRN

I'm interested in hearing what the various consequences are out there for medication errors. From ya'lls perspective....how do we hold professionals accountable without creating situations where errors are swept under the rug to avoid punishment? HELP!!!

Great words of wisdom by all who have come before me...my addition would be to remember that it is the charge nurse who sets the culture for the unit for that shift. Much of what is accomplished or not is based on successful trusting relationships. Take the time to compliment your team when they do a good job to your superiors. You will be paid back in diamonds by this staff next time you encounter rocky waters together. All the best...b

Thanks for the responses to my post about keeping a journal. I hope everyone knows not to mention an occurance report in your documentation...then the report could be discoverable by supoena. Be careful out there! b

I have always understood that occurance reports should never be copied. But also I need to mention what our risk manager advises about journal keeping or copying other items related to caring for patients. All of these can become evidence and are discoverable during a lawsuit. Only when they are "work product" can they be excluded. This includes any note taking during meetings about a potential case. I've learned not to take notes, and have refrained from any journal keeping about events of each day. Has anyone else received this type of advice?

You've gotten some great advice already. I can't really top Hoolahan's pointers. Don't be afraid to ask questions. People love to teach, and it is flattering to them that you ask. All of my doctors when faced with staff competency issues say...just ask. I've never worked in a facility(28 years experience, 18-ish in ICU) that didn't offer 90 days orientation...of course if you can come off early great...if not, and it's a good match overall, goals are set and orientation may continue longer. You can do this...don't let anyone tell you otherwise.

I meant demoralizing in this context as having a negative impact on the morale of the employee...basically feeling less than valued and/or worthless as an employee.

I have an issue I really need to get input on. I manage several large telemetry and PCU type areas. Staffing is usually tight...however, once in a while the clouds part and the census in the ICU drops. This means our ICU nurses have to float. Evidently there is an unwritten rule that preceeds me that states that ICU nurses can "bump" the PCU and Tele nurses...causing the PCU/Tele nurse to have to float to med surg areas, while the ICU nurse works on Tele/PCU. While my staff take this like true professionals ...wear a game face and go, for which I'm extremely proud of them for...they end up feeling quite demoralized about the circumstances. I don't blame them. I've attempted but am not getting very far in communicating with the ICU manager about this. Plan to keep trying. I fell terrible about this organizational behavior, I'd love to change it, and I'd also love to hear what you think...how this is handled in your hospital, etc... Thanks bunches! b

All kidding about staffing aside...we've had a pretty successful "watchful eye" program, where the room door, chart, patient armband is all color coded to identify the patient as a high risk for fall. We've have recently tightened the screen we use on admission to kick folks into the program that we were missing in the past. We also use a fair number of sitters to keep restraints(sorry, didn't means to use a bad word) out of the med surg areas. The down side of sitters is that in our facility they come out of your staffing matrix...not good when explaining poor productivity. Also not good when you're tightly staffed to begin with, then pull people off the floor to sit. Let me know if I can be of further help...b

At my facility, the nurse get 2.50/hr for 3-11, 3./hr for 11-7, and and an additional 3.50 for weekend diff, regardless of shift. This rate is pretty standard for this part of Texas. Our PRNs go for 25/hr. Hope this helps...

Kudos to LadyNASDAQ. Our work lives are difficult enough without having to put up with our elders eating our young. My advice to you is to document your experiences in an objective way...using quotes as much as possible rather than how she made you feel. If you can find others to do the same all the better. Take these to your manager, as she can do little without this documentation. If the manager is unwilling you may then consider traveling up the chain of command, but as a courtesy to the manager, make sure she knows you will be doing this. Best of luck...I don't see why some of us continue to not play well together in the sandbox. Another thing to consider as you think this through...perhaps this older nurse feels threatened by a younger nurse...and this is her defense? Just a thought. b

To confirm...side rails are indeed a type of restraint in JCAHO's eyes...hard to swallow when you're an old fart who even two years ago used to shout from roof tops..."Get those side rails up, d*** it!!" . Also interesting twist that "thisnurse" puts into discussion...that by billing the patient's family suggests the facility is unable to meet the needs of the patient. I'll have to chew on that one a while. Thank you thisnurse, I love statements like this that make me think! b

Thanks all for your replies to my dilemma. At my facility we are supposed to tell the families that they will be charged for the sitter time, however, I've not known the hospital to actually bill for this. In many cases the family is not available or not able to come in. Having this expensive coming out of the department adds up fast, and pulls staff from patient care since we're supposed to take it out of the daily hours of care alloted to each patient. There are times when there are up to 3 sitters on the floor, and if the census is low enough...theoretically it could leave one or no staff left to care for the rest of the patients if one is really going to be hard nosed about productivity. I've found some research done on this and will be pulling articles next week after the holiday. Thanks again!

I am in need of ya'lls experience with sitter usage on med-surg areas and telemetry areas. I am manager of about 70-ish total telemetry beds. Half of these are informally considered as step-down ICU beds. Our current nurse patient ratio is about 1:4-6 depending on acuity and shift and all the other usual variables. The patient population is mixed 50/50 medical/surgical, with half being open hearts, s/p MI's, CHF, acute CVA, post interventional caths. My inquiry is this: How does your facility use sitters as a replacement for restraint use? Where do the FTEs come from?...are they paid out of your cost center and therefore a negative impact on your productivity? In my experience, we use alot of sitters...some pay periods in excess of 600-700 hours...with many of these sitters being used to keep patients out of the critical care areas, for example: an OD who otherwise would go to the ICU for 1:1 observation is placed with a sitter in my post interventional area where the n:p ratio is 1:2-3, or the patient who is siezing and without a sitter would be in the ICU. There seems to be an opinion higher up in the organization that these are cute little old folks with oldtimers disease...that if I put mittens on these patients, or close the door to their room so they won't wander that this will fix it. After I stop rambling here I'm going to write a data collection tool to provide meaningful information to convince those above me that their ideas may not meet our needs. I'd love to hear from anyone having similar experiences...thanks!!

I work in a similar setting but with some differences. We have an 10-ish bed area strictly for the recovery of interventional cath pts. The nurse pt. ratio in this area is 2-3 pts per nurse. These nurses handle the line pulls, drips, etc. The other area that is adjacent to this is a 24 bed tele area with a nurse pt ratio of 4-6 pts. per nurse. The nurses rotate through each area, but only a select group are cross trained to work in this post interventional area. Hope this info helps. I too manage this and other areas, and struggle with tryng to keep the ratios safe. :)