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?

This person is creating a hostile work situation for you and your employer is required by federal law to protect you from it. Whether it means finding other placement for that patient or paying you to stay off while he's there, they must respond to a complaint of hostile work environment. Report it to Human Resources, immediately. Document every comment he makes, has made, etc, date and time and give those the HR as well. With the fact that he has already injured you there is a good case for relocating him to a different facility (yes, there is one somewhere, all patients like this in the state/country are not in your facility). If you do not get an acceptable (to you) response rapidly, report your employer to the Labor Relations Board and file suit. Do not mess around and get hurt again, take care of this now. Yes, in your job there is always a possibility of being hurt, but this man has already done so and is threatening again. He must be stopped. If putting him in 24 hour lockdown is the only way to maintain your safety, then insist that it be done until another arrangement can be made to transfer him elsewhere. I know that your employer is not responsible for this person's behavior (and I'm sure you don't want to cause trouble for them), but they are responsible for protecting their employees from such people, and they have no excuse for not doing something, he has done it once and is giving plenty of warning of a repeat.

Hem/Onc AR On salary, but it breaks down to about $37.91/hr. 8-4 M-F, I work every 5th weekend and an occasional holiday. State job, so lots of holidays, vac, and sick time.

Sorry, but just wanting to wash your hands of it is one of the reasons such behavior has been allowed to continue in the work place for so long. Report it. Actually, you can report it anonymously to your corporate compliance officer. Cite the JACHO ruling and state that this is such a problem on that unit that several nurses, including yourself have either left or are considering doing so, and patients have been exposed to the bad behavior as well. Say that you don't wish to make trouble, but you still have some loyalty to the hospital and since compliance is concerned with maintaining JACHO accreditation you felt they should be made aware of the situation as it needs investigating.

your nm had better re-think her actions in cases like this, as she is responsible for such on her unit. 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 further 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.

While most nurses prefer 12 hr shifts for their convenience, more than one study has shown that the rate of errors increases in the last four hours of a 12 hr shift. But then there have also been studies that show that for every patient over 4 that an RN is responsible for the chances of dying increase by 7 percent. And if your nurse is responsible for 8 or more pts your chance of dying increases by 31 percent, or almost one third. So the rate of deaths, whether influenced by error or not, can be correlated more readily with the number of patients for whom you are responsible than the hours worked.

Not completely on point, but very informative anyway, see the article "Care and Chaos on the Night Nursing Shift In a Search for Purpose, An Editor Changes Careers; 'He's Asking for You Again'"from the May 24, 2007 edition of the Wall Street Journal.

I have made many changes in my career, some great, some not so great, but I'm glad for all of them. Every one added something to my resume, my career, and my life. Don't know who said it, but there is a quote that goes something like, "At the end of your years you will alway regret more the things you didn't do." Life should be an adventure, so hold your nose and jump in at the deep end!

Perhaps it's time to stop choosing our battles so carefully. Doing so hasn't made any great changes in the nursing culture as far as I can see. No MD would allow a nurse to get by with critiquing the way he does his job, so why should nurses?? We are educated professionals who deserve to be treated better, but until we force the issue it won't happen.

Normally I would say just get the guy a cup of coffee, but since he makes a point of being rude to nurses, in this case I would have just said, "I don't know, you need to check with your waitress."

You said it. Adding to your comments...loving your job still doesn't make it a calling, anymore than an architect that loves his job or an engineer that loves his. And no one would even consider calling them unethical for accepting a paycheck. And if the paycheck is not a priority there are lots of other ways out there to help people such as Habitat for Humanity, where everyone is a volunteer. But don't denigrate those of us who have to make a living. I am a college-educated PROFESSIONAL and I do my job well, but I do it for the paycheck.