Kayartea

It is way too many. That is why we are trying to get it streamlined. As for why it's this way, who knows? We're a University Hospital and the process has just grown. Every new initiative has meant adding to the process, but no one ever seems to consider downsizing it.

I'm currently working in Care Management and part of what I do is assist with transfers from other hospitals. Our current arrangement for accepting patients is very cumbersome, involving 3 departments and the ADON, plus the accepting MD. I'm researching how other hospitals manage this in an effort to streamline the process and would appreciate any information on the methods currently in use at other hospitals. If anyone can help with their process for transferring patients from outside, from the time the transferring MD calls through all the steps taken until the patient is en route I'd really appreciate it.

You can also remind them that embarrassing things (some very similar) happen to people who aren't sick and it's not their fault either. Mostly it helps to just be matter of fact about it.

When I was a nursing student one of my patients was wearing a Texas Rig catheter and, as is usual with those (they need to make some of the Rhode Island sized), was having difficulty keeping it in place. I got the idea that we could use the spray adhesive to help. After spraying the area, it was taking too long to dry enough to reapply the rig so I started blowing on it. Imagine my instructors face upon opening the door and finding my patient in the chair with me kneeling in front of him huffing away like someone trying cool their soup! One of my buddies in the same class (Oh, that poor instructor! We were so young, dumb, and awkward) walked into her patient's room on our very first hospital clinical day only to find the patient sitting up ready to vomit. My friend panicked and ran over to the patient with her hands out. The patient promptly vomited into her hands. And she just as promptly vomited all over the patient, right as the instructor walked into the room.

Putterers - people who work all the time, but never seem to be able to get anything done. Obsessors - people who make the job 50 times harder than necessary for themselves and all the rest of us if given a chance. If one form will work, they create three for us to fill out. And they always seem to be the ones on all the committees.

Trying reason on a patient in "Status Dramaticus" works just about as well as it does on a two year old in the middle of a temper tantrum. (Come to think of it, they are very similar.)

* Cardiac patients with MUH (messed up heart), PBS (pretty bad shape), PCL (pre-code looking), or HIBGIA (had it before, got it again). * Stroke patients - "Charlie Carrots". CCFCCP (Coo Coo for Cocoa Puffs) to describe their mental state. * Trauma patients - CATS (cut all to ****), FDWB (fell down, went boom), TBC (total body crunch), or "Hamburger helper". * Car crash - NV2VI ("negative vehicle to vehicle interface") or TDS ("terminal deceleration syndrome"). * HAZMAT teams - "glow worms". * Persons with altered mental states as a result of drug use - "pharmaceutically enhanced". * Gunshot wounds to the head are "Trans-occipital implants". * The homeless are - "urban outdoorsman". * Endotracheal intubation - "PVC challenge". * Recently deceased or dying persons - TBTT ("to be toe-tagged"), ART (assuming room temperature), CC (cancel Christmas), or RFDN (ready for dirt nap). * Handbag positive for the little old lady who insists on keeping it in the bed with her. * P cubed = piss poor protoplasm, P5T = piss poor protoplasm poorly put together * FF (Frequent Flyer) Homeless person in no acute distress - 3 hots and a cot seeker

Well, yes, and no. Doctors admit patients to the hospital for the nursing care. If it's something that can be taken care of solely by the physician it's done in the office, not the hospital. Nurses are the reason patients are admitted.

One of my favorites was when one of our brand new foreign fellows charted in the H&P "complains of of frequency ass burning micturation". Of course, he meant associated with burning micturation. It's amazing how much fun the absence of a punctuation mark can engender in tired nurses.

Push through legislation to allow billing for nursing care. As long as paying for nurses is lumped in with the bed charge we will continue to be seen as the most expensive, most troublesome department and as not contributing to the bottom line. Nurses are the reason patients are admitted to hospital (face it, they see less of the MD while inpatient than in an office visit and nurses operate most of the specialty equipment that is the reason for admission), but no one who is not a nurse really recognizes the vital job we perform. Until nurses or hospitals can bill for our work we will never be recognized as the educated professionals we are, or treated as professionals either.

In general, I don't think nurses make bad patients, but they do make the worst family members.

Maybe we should track the cost of blankets and pillows and sodas to families? Much of the cost is in the dissatisfaction expressed by nurses and the plans of so many to leave the field as soon as they are able. I was rounding the other day with one of our new docs, a German, who has not been here long. We had to see a patient who's husband had been really obnoxious and had interfered in her care. Of course, we aren't allowed to throw him out as she has said he makes her decisions and it would be such poor customer service. So, he had a problem with the plnned course of treatment and gets up in the doc's face and says, "I'm an ex-SEAL and ex-CIA and I used to kill people for a living!" Our doc, with a perfectly straight face, didn't miss a beat when he replied, "Really. I still do. Zo, now zis is what we gonna do for your wife...if this doesn't suit you we can transfer her elsewhere." I think I'm in love... (Kidding!) Patient family members like that and all administration thinks about is customer service.

Sorry, but I disagree. Patient Safety was involved. Any time a nurse is too upset to do the job, or another nurse has to stretch to cover for an upset nurse, all of the patients being cared for are affected. Just because there were no major errors or deaths directly attributable to this incident doe not mean patients were not at increased risk.

more than just reportingit you need to fill out a patient safety net (or whatever your hospital uses for reporting sentinal event and patient safety issues). the joint commission has issued an alert on bad behavior among health care professionals and announced that effective january 1, 2009 a code of conduct that defines acceptable and unacceptable behaviors will be required to address rude language and hostile behavior, intimidating and disruptive behaviors, verbal outbursts, refusing to perform assigned tasks or exhibiting uncooperative attitudes during routine activities all potentially leading to poor patient outcomes, patient satisfaction, errors that impact safety all of which do matter. they go on to say individuals in ‘positions of power’ who display behaviors like impatience with questions asked or the tone of voice is condescending along with the message when questions are asked undermine team effectiveness and can compromise safety and are overt and passive behaviors that are unprofessional and should not be tolerated. they go on to include refusal to answer questions, return phone calls or pages and the list of those involved in this behavior include administrators, support staff, pharmacists, therapists, physicians and nurses and both genders. the announcement does state that intimidating and disruptive behaviors are such a serious issue that, in addition to addressing it in the new standards will also be in the new sentinel event alert. their behavior interfered with your ability to do your job for the day and thus put your patients at risk, which is the joint commission's point. anything reported in patient safety net must be addressed by tptb and is reviewed by risk management. this kind of behavior needs to be looked at in this way, it is too easy for their dept. head to allow them to pass it off as joking, "boys will be boys, you know." that's how this behavior has been allowed to proliferate for so long. we now have the means to address it and the backing of the joint commission, and we need to use it. i know that things are better than they used to be, but we still have a ways to go, and this is a tool to use to achieve progress in being treated like professionals.

Are you actually thinking that acting like that will improve care?