Edward,IL

I have an additional question/comment. We have always been told and adhere to very strict narcotics counts and accountability via documentation, having a witness watch and document wasted meds, counting narcastics between shifts, etc. I've heard that these strict rules only apply to nurses. MD's stock meds in their offices, pharmacists stock narcotics in drug stores. My understsnding is that they are not required to have a witness when they waste expired meds or have to have near the documentation that nurse require. Is this true? Edward, IL

Good answer. There is an illustrated lesson and very thorough explanation in the Springhouse Publications text I have. It's about twenty years old now, but is very good at explaining this and measuring central venous pressure using a penlight shining on the patient's neck with the HOB at 45 degrees. Just my opinion, Edward, IL

Many states are following the fine example of CA in introducing legislation to guarantee minimum safe nurse-patient ratios. The one I like the best is the state of Nevada, with specfic numbers for all areas, documentation requirements of shift-by shift assignments and hefty fines for failure of management to comply. Check them out on the internet. Edward, IL

I've had Crohn's Disease for 34 years, since age 10 y/o. Quite an experience going through high school, college, nursing school twice (ADN, BSN). It can be done. It is never easy. Most signifigantly, check out a web site for a group called PARA. In 1992, a microorganism called Mycobacterium avium paratuberculosis (MAP) was discovered. This bug is believed to cause Johnnes disease in cattle, hogs, deer, sheep. This is a wasting disease (It is essentially Crohn's disease in animals). Bottom line: There is a strong assumption now that this microorganism causes Crohn's disease in people. This will be difficult to validate because of politics within the domain of drug research. However, I have been taking Rifabutin and Clariththromycin now for two (2) years and have seen a real improvement in symptoms. Many patient's with less severe disease history have been able to go off of all other meds. Research this on the internet. PM me if you have any further questions. Edward, IL

Missy, the Professional Nurse is not the wife of the M.D. If you want education at the doctoral level, please look into degree programs that grant the PhD in Nursing or the DNSc, rather than marrying someone with a professional degree. DO NOT date anyone from that other discipline. You never know where they've been or who they've been with. Besides, nurses shouldn't fraternize with subordinates. Just my opinion, Edward, IL

You are best to keep separated from surgeons. 1) The general consent for admission and treatment gets the patient inthe hospital door and gives consent for ROUTINE nursing and medical care without fear of a charge of battery. With this consent, for example, you can ask the patient to disrobe so that you can perform a physical exam, collect urine, feed the patient, etc. 2) Any additional procedure (endo, minor surgery, chemotherapy, blood products) that may remotely involve risks to patient or be considered by anyone to be beyond the realm of ROUTINE should have the consent of the patient BY THE PERSON WHO IS GOING TO DO THE PROCEDURE. The patient always has the right to refuse any or all of medical treatment. During the course of even routine care, I always explain to patient prior to their care what I am going to be doing to allow them the chance to say 'no". This has always served me well. Make the MD's get their own consents signed! Just my humble opinion, Edward, IL

JMHO 1) Ratings of hospitals can be done by anyone. Popular magazines are not considered the most reliable. Only about 1.0% of the 5,000 hospitals in the U.S. have Magnet Hospital Status (This recognition being the earned from the American Academy of Nursing's accreditation program). 2) Peds at U.of C. may be okay. They have a collective bargaining agreemnet with INA that does at least help decrease the shenanigan's played by those management people. Just my opinion. Edward, IL

I went through a buy-out several years ago, successfully. When the hospital is sold, so ends your relationship with the Sisters of Mercy and Mercy Hospital. Finalize that relationship by going on COBRA for health insurance, get your 403(b) or other retirement funds rolled over into your own personal account and take a little time off to decide your next move. If you lie where I think youlive, there are plenty of employers around. Just tell the people at work that you think that this would be a good time in your career to take a break. A new employer won't look disfavorably on this as it is a natural time to break a relationship with an employer. Keep in touch with your co-workers and in a few weeks, see if you really want to go back there. Like someone else said, interview at least 5 different places. The ones represented by the state affiliates of the ANA in your area have some decent contracts, although the working conditions in any hospital are bleak these days. Also, you may want to consider working part-time at a couple of different facilities. DO NOT SIGN A NO-COMPETE AGREEMENT OR ANY AGREEMENT WITH A BINDING NON_COMPETE CLAUSE unless it is quite limited and your attorney goes over it. Some companies these days are really awful. Your new employer is NOT the Sisters of Mercy (although they will want to lead you to believe that they are the Little Brothers of the Poor). Stay cool. Take your time. COBRA benefits last for 18 months. Good luck, Edward, IL.

I've only heard scary things about this place and the parent company. The INA doesn't have a collective bargainign relationship with Advocate, as far as I know. In your locale, collective bargaining through INA is available at U. of C., U. of I., Cook County Hospital, Providence Hospital (which I think is part of Cook CO. now), Reed Mnetal Health. Check out INA's website for more info. I wouldn't feel particularly safe working inside any hospital these days without a good contract. Just my opinion, Edward, IL

I've found changing jobs whenever you feel it necessary. Move to a new area, learn what you can, then move on. I also think working two or more jobs part-time helps. If one job is getting bad, you only have to deal with it two days a week. Chances are, things on your other job are going okay and can provide you with some positive experiences. Don't put all of your professional eggs in one basket. Edward, IL

I worked in a large university teaching hospital until 10 years ago. Dietary was awful. 1) Cockroaches coming outof the food cart when meals were delivered to floor. 2) No requests taken after 8:00pm because they closed an dwent home at 8:30 PM 3) They did leave the keys to the kitchen with the Nursing House supervisor/adinistrstor on-call. That meant that the nursing sup.was making sandwiches at midnight. 4) It got worse when they gave the dietary contract to ARA services. 5) My last few years there we finally just subverted the system and called the take-out Chinese restaurant in our area. They deliver to the ER regularly. We had to pay out of pocket for this, but they never hasseled us, the food was good and we didn't have to be so embarrassed in front of our patients. One more reason why I left hospital nursing. Edward

Thank you, Karen. Correct answer! The articles mentioned above and the authors are the real authorities on this. Anyone interested in this VERY important topic should visit the NANDA web site (and links to NIC, NOC and NDEC. Consider becoming a member of NANDA (I think it's still Edward.

This certainly is an interesting thread. a few more thoughts: 1) We have often times said "Nurses handle too much information in too short a time to be able to keep track of it". We do process ALOT of information during an 8-hour shift providing care to as many as 10 patient's. Computers won't ever capture it all, but can perhaps help us record at least 75-90% of what we do. Many of the computer/acuity systems out there were developed by non-nurses and are not a good fit. People outside of nursing often times see nursing as just task-oientd rather than the complex set of clinical judgements being made within the context of the nursing process. The best classification system I've seen to date (and use every day in practice) is the Nursing Intervention Classification(NIC) developed at the University of Iowa, McCloskey Joanne C., and Bulecheck, Gloria M. This is research based and gives labels for nursing and corresponding (mutually exclusive) numeric codes that can be used to track patient consumption of nursing resources. This is a universal system that can be used by all nurses in all settings. Take a look at this and select the nursing interventions that you use with your specific patient populations. You may find that there are perhaps 20-30 most common to your unit. This becomes your focus for beginning to keep data on nursing resource utlization. After tracking patients in this way for say 6-12 mos, you have some fairly meaningful data that gives a less fuzzy picture of what you are doing ith your nursing resources. The minute details such as I.V. starts, dressing changes, feeding a patient, safety surveillance, etc fit nicely as activities under the label headings. This allows for the individualization of the patient's careplan and continuity of care. Take the information gleaned from say 50-100 patient care plans and throw it into the hopper and see what aggregate data you have. This gives an answer to those pesky administrators when they walk on the unit asking "What have you girls been doing all day?" 2) An accompanying volume (when you are ready to take the next step) is the NursingOutcomesClassification(NOC),,Johnson, Marion, and Maas, Meridean. This is a separate but well-fitting system to measure those outcomes and be able to really evaluate how well you are doing (or perhaps provide the information you need to support your claim that you need more staff on the night shift!) We all have to begin somewhere, each nurse and each unit is unique. This gives us a common language across settings that makes conversation much more sensible. I suggest everyone get thee volumes and begin using them immediatey in all nursing settings. If you haven't yet had coffee and are a little slow to start, at least visit their web-sites. Start at NANDA and follow their links to NIC and NOC This is some really exciting stuff going on in nursing these days and can improve your mood. Let me know what do you think. Edward.

Wake up and smell the fiduciary coffee, ya'll. This is the BIG picture of hospital charges. 1) Any department headed by a man gets to bill directly for their services (lab, x-ray, resp. therapy, pharmacy, physical therapy) Departments headed by women (nursing, dietary, housekeeping are thrown in with the room rate. This serves a couple of purposes. One, by structuring the accounting system this way, administration can say, "boy, you nurses are an expensive part of the overhead. This keeps the girls own at heel and feeling guilty that they are paid for what they should do willingly as part of their womanly duty. Two, if nursing costs were to be unbundled, that would put a value on Nursing professional services, and give value to the work nurses do. Three. In-patient hospitalization with the monitoring and care provided by nurses is the only reason that people are admitted. They would otherwise be seen as out-patients in their doctors office or have their procedure or diagnostic test done in ambulatory care. Four. Hospitals are not expensive to run, they just sort of serve as a giant money laundering operation. Large instituitions are usually built with tax-advantaged bonds, government money,etc. Operational costs are not that much. Did you know that city governments often times will not charge property taxes or even a water or sewer bill? It's politically advantageous to have a hospital in your city or allow one to expand to "create jobs" (horrible low-paying service jobs that only someone REALLY desperate for work would take!) Five. Consider this. The standarddaily room rate is about 1800-200 dollars. I could take a patient to a VERY nice hotel for Six. An excellent book on this subject that chronicles all of the many ways that nurse can be financially exploited is titled Hospitals, Paternalism and the Role of the Nurse, by JoAnne Ashley, published c. 1975. If you are going to work in a hospital, at least know to what degree that you're being taken advantage of.

The Infusion Nurses Society has published standards of care. These are the professional standards that all nurses in the USA can be held accountable for (attorneys know this and will bring this to court. It's an easy case for them as the standards are very clear in black and white. Interestingly, anyone (including MD's) administering IV fluids can and will be held to these standards. Get a copy of the IV Nurses Society Standards of Practice and get your institutions policies up to date.