carolCCRN

OMG I must share this. This AM a pt on out unit died (elderly, metastatic CA) and it took awhile for the family to get here so 2hrs later they were still at the bedside. The attending MD's office was notified of the death @0915 but no one had spoken to him directly and at 1030 Dr Attending came up to the unit and slipped into the pt's room before anyone realized it. He proceeded to perform an ASSESSMENT (stethoscope to the chest and all) and update the family on pt status and PLAN OF CARE. That's when the pt's sister leaned in and said "She's dead.":eek:

www.ihi.org has info on the SBAR. You have to register, but it's free.

The SBAR communication tool is excellent for helping you organize your thoughts and keep to the point. I believe an actual SBAR form can be downloaded off the internet, but I'm sorry, I don't know of a website offhand. S - Situation- what's the main problem? B - Background - events of hospitalization, relevant to the present A - Assessment - include vitals, physical assessment R - Recommendations - what do you think the pt needs? I've found that MDs like the facts without alot of extras, and this communication tool keeps me on track. With practice, you'll get more comfortable with it.

You stick to your guns on this one! It is absolutely unsafe for you and the patients for all the reasons stated above. If you don't stand up, nobody will. Best of luck, and be brave!

Wow, what you describe is a HOT MESS. No wonder the staff complains. I've been doing our schedule for 8 years and we've pretty much been doing self-scheduling. We staff for 20 beds (ICU unit, RN/Pt ratio 1:2) and the schedule is opened for self-scheduling 6 weeks before the start of that schedule, and final 2 weeks before the start of that schedule. Any shift that isn't staffed with 10 RNs is open for extras/OT. Self-scheduling, however, does not mean staff gets whatever they want. I can't have 15 RNs working on Wed and 3 on Fri. Adjustments have to be made. We don't have set schedules, but we do take special consideration for school or on a case-by-case basis. I think the staff is by-and-large happy with the way we do things because I really try to mess everybody over equally. It forces them to take responsibility for their own time, for finding solutions to their scheduling conflicts, and looking to each other as a team. I believe in rewarding performance and flexibility as opposed to longevity but I know others feel differently. On a daily basis, if our census doesn't support 10 RNs, we have to give LOW (lack-of work) for which they can either use banked PTO or sign up for another shift - bumping extras/OT and supplemental(PT) staff. It is what it is. We cancel in 4hr increments. If I call you off at 5am (for 7a-11a) I may call you in @ 11, but I would NEVER make someone work 7a-11a, call them off 11-3, and call them back in 3-7. That just bites. Overtime gets cancelled first, then supplemental (PT), then extras (non-OT), then regular staff. Holiday time is another matter. We have 3 holiday rotations (Thanksgiving, Christmas, New Years and other minor and hard to fill holidays like Memorial Day, 4th of July, Labor Day) each RN is assigned to a group. They stay in that group until they quit or die. If they are in the Thanksgiving rotation this year, they do Christmas next year, and New Years the next. Holidays are always stressful, but no so much for me now, because the staff knows well in advance what they'll be working, and they take the responibility of working out issues with their buddies. The schedule is not set in stone, and deals can always be made. Empathize with the staff while keeping your eye on the needs of the unit. Sometimes you will need a Margarita. God bless and good luck!

Taking that first job is scary at best. Best of luck to you! I went to ICU as a new grad even though I was strongly discouraged by nursing school faculty - been there for 10yrs now. I wouldn't even stop at HR (my HR dept is less than helpful), but contact the managers of departments you are interested in, request a meeting, and ask what you've got to do to get a job there. ER is tough on a new grad, but many ERs have "holding" units where they might be willing to take a chance on a motivated new grad. Go get 'em!

At my facility, we have a point system that awards so many points for an absence, more points for an absence on a holiday, etc. Once a staff member gets to a certain number, he/she gets a warning. If the behavior continues, the corrective action continues up to termination. Of course, it only works if the NM has the guts to fire somebody--and mine does! Alot of my co-workers have "the hook-up" at other facilities for extra hours, but there's not too much calling-in over here because of it. People with trully chronic health problems are strongly encouraged to file for FMLA.

I'm not suggesting that errors of any kind should be overlooked. The original question asked if we saw an INCREASE in employer intolerance of nurse errors, and my answer is "Yes". Minor infractions that were once seen as educational opportunities are now being dealt with as progressive corrective action which starts as a verbal warning and progresses to termination. Now, if a nurse is so lax that he or she can't correct problem behavior and/or practice issues, then they should be let go. I give my best to the patients and staff on my unit every day that I work. As good as I think I am, and as tough as my exterior may appear, it pulled the rug out from under me to have to sign a verbal warning and know it was going in my file. In MY file. ME. Now, I can speculate that administration is putting on the pressure because of the medicare issue, but I can certainly say that the atmosphere around here lately is punitive whatever the cause and it's not pleasant.

Wow, I thought I was just being paranoid. We just implemented a new computer charting program, and I swear it just makes it easier for management to find mistakes - mostly documentation lapses. WE EXPECT 100% COMPLIANCE AND ANY LESS IS UNACCEPTABLE!!! I've seen more "corrective action" in the months since Go-Live than I ever have. I'm not excusing poor nursing care, but after I've worked all night and done the best I could, I don't care to have a meeting with my manager because I forgot to chart a dressing change that I labelled, initialled and dated! I know, I know, "if it isn't charted, it isn't done".

AMEN, llg! Most people spend more than they make, and creditors are more than happy to extend loans to nurses. I don't want to be a wet blanket, but I have so many nurse friends who are working overtime to dig themselves out of trouble they've gotten into. Enjoy yourself and take advantage of the retirement or savings plan your employer offers. I wish I had done it sooner.

I've got to "ditto" the necessary evil of the note graveyard. There is so much new info that comes out daily that has to be implemented YESTERDAY!!!! that it's hard to get the word out one-on-one. And, no, not everyone checks their mailboxes ever. And, yes, sometimes the staff does act like children. Recently we had to take an RN off the schedule until she had her CPR card renewed-- despite expiration notices posted for all staff months ahead of time, and personal reminders. It's hard to be a Nurse Manager (I'm not one and never want to go there) and if she's good to you in other ways, try to cut her some slack.

I think at the top of my list would be better communication with the MDs. We have some MDs who hide for family members and have to be beaten before they'll talk to anyone. Sure, sometimes the report is going to be "Same", but the stress level of these people is so high, that a word would help. Really, I don't want to talk to some of the family, myself, but not everything is all about me. Our visiting hours are pretty strict, too. Our unit was just built 1 yr ago, and when it was in the planning stages, administration asked the nurses for suggestions. Knowing that they really like the idea of open visitation, we asked for: Bigger rooms- didn't get Visitor shower/bathroom- didn't get visitor waiting/conference room-didn't get(waiting room and bathroom are on another floor) So, now, even WHEN we open up visitation, we don't have much to offer the visitors (A TOILET!). It's a shame, because I believe opening visitation would encourage trust between the families and the medical staff.

I went to ICU straight out of nursing school and have been there ever since. I was so lucky to have a few coworkers who liked to teach and didn't mind answering my questions, because ICU is so intense- no pun intended- and you have to be ready for anything (hence the OCD). Some nurses see new RNs as a liabitity, so instead of helping them grow, they abuse them (ignore, neglect, verbally mistreat) which sounds like what's happening to you. I'm so sorry for your bad experience, but be encouraged that Nursing offers a huge variety of possibilities for your career. You need to figure out how to best use your talents---and it may not be in the unit you're in.

On my unit, we try really hard to support the family members by preparing the body (Yes, sometimes a bath and linen change) and the room (removing medical equipment, placing chairs and tissue boxes) so that one who wish to can spend a few private moments with their loved one. I work in a busy ICU, but my co-workers and I always make time for this (takes us maybe 5-10 min) and it seems to comfort the family.

Nursing school for me seems like such a long time ago. I learned to "stay under the radar" and say "Yes, Ma'am" alot because right or wrong, instructors wield a lot of power (and some of them really like it). You know you were right to address your pt's concerns immediately, and you should continue to do so. It keeps you and the pt safe. Now, you may want to practice a little phrase I've used often- "I hadn't considered that." It buys you a little time after the unexpected slam to catch you breath. I never saw a student win an argument with an instructor, so look at this as an opportunity to learn not to take it personally. Most of the time when someone lashes out like that, it's about them, anyway.