sunshineCCRN

darn right! :angryfire

we do not have a patient-free charge nurse and it is an issue (16 beds). our charge gives group report and briefly outlines all the patients on the unit. the whole staff listens and makes assignments out together (~15min). this is very good because when trouble happens, your coworkers know how to help you and what you need. also, no one can complain about their assignment. report is 1 on 1. we still have paper charts, so we basically go through the entire flowsheet. there is also another sheet that highlights the pt's history, what happened over the hospital stay, code status, etc. we will go over orders and do a "quick peek" if the pt is critical or has a weird drain or dressing change, etc. our kardexes are never updated and don't have the info we need on them. they might as well go in the garbage. it would be nice to have a column somewhere to write down things that are pending (ie it's PMs, and we want to make a note to ask tomorrow about a wound care consult, or maybe there are blood cultures pending that the next shift should look out for). the nurses are pretty good about these things, but it would be nice to have it written down, since you can't always trust that it will be passed on. report on 2 pts takes 30-45min.

it wasn't me, so i don't know all the facts, but yes, half the hospital administration was involved. thanks for your post, i feel a little better if i ever have to take one of his patients again. (legally, doesn't matter--just sounds like a pretty juvenile thing to do...) this doc (an attending) is, uh, well-known for sometimes being exactly that.

our open hearts have closing films just before they come to ICU. we confirm swan placement by waveforms and CXR if there is a question (usually anesthesia is right there anyway). every patient receiving a central line (IJ or SC) should have an immediate confirmation of placement--why isn't this done in the OR prior to surgery? Scary! our central lines from the cath lab or radiology are confirmed with fluoro, all others get a CXR. our nursing policy covers CXRs for line placement-no order needed. if you can draw blood and flush from all ports, and the med is stat, i would not hold a treatment. i agree with pinoy: an order would have covered her, but CXRs are always good.

We had a physician who refused to cosign a verbal order taken on night shift. This MD absolutely gave the verbal order, but since a bad outcome happened, he claimed "I never ordered that" the next day. What is the legal ramification for nurses? He gave the order, and now doesn't want to take responsibility for it.

You did a good job with him. Good thing you recognized a problem and acted--now you have a valuable experience that will probably come in handy sooner than you think!

i joined aacn. i find their Critical Care Nurse magazine really helpful. the Society of Critical Care Medicine has published guidelines for treating certain patients (end of life, neuromuscular blockade, sepsis, etc) which are the gold standard in critical care. definitely check those out. they should be free. Guidelines ps-nurses can join sccm, too.

oooh, reminds me of my psych clinicals! If they say something awful, ask (nicely, of course), "I'm sorry, what did you say?" (Makes them realize how rude they just were!) Then try to get to why they were rude: "So you're upset because [the patient isn't going to their stat CT with contrast right now]?" Then justify your actions in a non-threatening way: "Are you familiar with [our protocol for oral contrast administration]?" You kill more flies with honey, and patients lives can depend on solid communication between disciplines. BUT if they're completely out of line (cursing, threatening, making personal remarks) then, "This unit has a zero tolerance policy for disrespectful behavior, and I will not listen to this. You can come find me when you're ready to talk." In my book, every instance of workplace verbal abuse should be written up. For every one time it's documented, it's probably actually happened at least 10 times that much. No one should be treated like that.

I am completely anal at work, whether it's about washing hands or labeling/untangling IVs or having clean, disinfected counters. However, I do NOT understand why some nurses live to terrorize other nurses when the issue does not affect patient safety or quality of care. I hate messes just as much as the next person, but that's my problem and my standard for myself; I have no authority to make the last nurse feel awful, especially if they're new. I don't know any other profession where it is acceptable for coworkers to get in each others' business to the same extent as nursing does. Just my opinion.

our hospital tells our CNSs and managers that they shouldn't perform bedside care! i don't think that's ok for your manager to renew the CCRN if she didn't perfom all the requirements. why would anyone be motivated to get their CCRN if it doesn't mean anything? i guess that's a different issue, though. as a staff nurse, you can't really do anything about it beside ask her yourself and be prepared for the consequences.

I like the "mandatory" specialty nurse idea. The problem is, we have such low volume of certain patients that there's little chance for an inexperienced person to become an expert. Does your unit actually call them in on their days off when you get one of those patients? Sounds interesting....

We can give it peripherally where I work, but if I have a free port on a central line, I'll use that. Think of all those outpatient procedures that use a profpofol gtt! I doubt anyone would start a central line for those! :chuckle I always wondered about propofol's compatibility with TPN. I feel like there's too many ingredients in TPN to know if the two are truly incompatible--and it would be nearly impossible to detect a precipitate.

What kind of locked pumps allow for fentanyl and benzos? I've only seen MS, dilaudid and demerol run at a basal rate on those PCA pumps--I didn't think they made compatible containers for benzos and fentanyl.... Our regular infusion pumps have a locking mechanism, but that wouldn't stop someone from tapping the infusion bag...

Yeah, she COULD....

Thank goodness we don't have traumas. I guess it's just different in a small hospital. There have been nights when I'm the ONLY person in the house who can take a CVVH/IABP/CABG patient. So it ends up being me and a select few who are always taking patients we don't have much experience with. And oftentimes we don't have anyone else on the shift to pose a question to, unless we call the eICU...which isn't always helpful depending on their nurse's expertise. There are days when I want to say no because it could be more than I can handle, but there is no other option. Not to mention our surgeons are very difficult to work with. Some make it obvious that our hospital takes a back seat to the main one. So when a patient bleeds out at 3am....it's either "why did you let him bleed?" or "get an H/H in 3 hours and don't call me until then". Grrr.... I guess I'm starting to whine now.... where is my cheese?