SarahK73

Our policy is that anyone on a heparin or insulin drip need to have a dedicated line and a second line for atbx.

JACHO standards for med-rec apply for ER patients as well. They have a obligation to ensure they have a complete list of medications, to the best of their ability (just like us on the floor). Our ER has a home medication list that the use on their ER patients. This is signed by the physcian admitting them so it validates them as orders. When we recieve them on the floor we simply review them to be sure they did not forget something or if ER was not able to get it all such as a dosage we then finish it for the physcian to review on first rounds. ER needs to do their part, we are all busy!

UGGH!! I hate workers comp situations, there is nothing stickier. You should absolutely get your HR involved, she should have a work comp caseworker that you can be in contact with. I would set up a meeting with your HR so you know exactly what the policies are and so you stay within the rules. Unless you have a work restriction that states those specific requests are required to meet her disability, you do not have any policies allowing set schedules and you are not allowing other staff to use set scheduling.. You should be able to give her fair notice of what the policies are for the schedule and let her know that you will not be able to accomdate her "requests". You allow her to decide if she is wanting to stay and continue working with the schedule as you post it or you will not be able to meet her needs. The kicker is though that is she is disabled due to a injury occuring at work you facility will have to pay for her one way or another, so some facilities may choose to keep them on in atleast some capacity. If you are not able to meet her needs maybe there would be a different department that would be able to accomdate her. Good Luck!

i am a clinical manager for a 30 bed medical-surgical unit in a 140 bed hospital. i am responsible for 75 employees. the questions... 1) how are you accountable for the clinical practice of nursing and the delivery of patient care? i am responsible to hire, staff and schedule the appropriate staff needed for our unit based on census, staffing ratios and acuity. i help to coach staff and round on patients daily to ensure we are meeting their needs. i am responsible to be a resource for staff as well as handle any difficult situations that may arise and facilitate the communication with the other disciplines. 2) how are you accountable for managing human, fiscal, and other resouces needed to manage clinical nursing practice and patient care? i report to a director and am held to standards set by my facility and director for maintaining our resources within budget. i have adjust staffing to keep it in line with the units needs and still be productive. i have to authorize the purchasing of any equipment or supplies for the unit, as well as evaluate the need for and cost /benefit of any new items. 3) how do you facilitate the development of licensed and unlicensed personnel? i address any concerns that arise with staff wether professionally or personally to coach them and allow them to work to the best of their ability. i complete all evaluations as well as disciplines and terminations. i help address learning needs by ensuring adequate education is provided to the staff based on the needs. i plan, conduct and evaluate regular staff meetings. 4) how do you ensure institutional compliance with professional, regulatory, and governmental standards of care? i keep current and familiar with our hospital policies, national patient safety goals and with current jacho standards. i have support to keep up-to-date with our quality department and director. we conduct routine tracers that takes us from door to discharge for a patient to identify any potential issues with meeting the standards. 5) what and how do you contribute to strategic planning? each unit/ deparment is required to complete one action plan that is specific to our unit and how we can contribute to the hospital strtegic plan. we do not create the stratigic plan for our hospital. we do complete yearly process improvement goals that are specific to our own unit. 6) how do you facilitate cooperative and collaborative relationships among disciplines and departments? i participate in our bi-weekly interdisciplinary care team meetings. i am the go-between from our unit to other departments to help address any concerns, evaluate and improve our processes that work together.

I manage what used to be a 20 bed that is now a 30 bed med-surg unit. Our staffing matrix is 1:5 but we have been short staff so my night shift has been taking 1:6 occassionally with nurses aides to help at a 1:7 days and 1:10 night ratio. We are just finishing budget and I am asking for increase from 9.8 to 10.0 ppd. My biggest problem right now is the huge amount of admission/discharge/transfer activity that occurs on a daily basis. The extra hours I want to put towards a charge nurse with no patients for M-F 8 hours a day. I recently met with somone from Missouri that said her ratios are 1:8-10 for a med-surg floor which seems outragous to me. What is everyone doing for charge nurses do yours count in the matrix and do they take patients? Sarah

The purpose for the RRT team is to get your experience at the bedside and I know on my night shift it is VERY green! We are in a 130 bed hospital with ave census of 90-95 and have resp therapist and nursing supervisor 24 hours a day. We have those two along with a ICU nurse respond to our RRT calls. Our first difficulties that we had to overcome were 1. Staff not wanting to call it for fear of looking stupid and being sure those who responded did not question or chide staff for calling it. We set the expecation right away that it was a learning expereince and giving anyone a hard time about calling it would not be tolerated. 2. People wanted to turn it into a code team. It is not a code team it is a team to help identify and address a situation before it becomes the code. We had to teach our ICU staff and supervisors to help and teach, not to take over. Otherwise the less experienced staff never learn how to recognize or handle the situation if they encounter it again. Once we got those areas addressed we saw a HUGE decrease in codes outside of ER and ICU, or mortality dropped significantly and my new grad nurses are so much more comfortable and are learning more then trying to figure it out on their own.

I have worked in one facility that used the automatic deductions but the problem then became that there were several people who were abusing the "No Lunch" button when they clocked out. I have to watch for trends during payroll, as well as those who like to clock in 1 min early to get a extra 15 mins of pay. The other facility I worked at had a very strict policy that if you did not clock in and out correctly you were given a warning and written disciplines for every 3 time clock adjustments. I only had to give a few warnings and 1 or 2 disciplines and they figured out very quickly how to do it correctly. Sarah

As a nurse manager in a med-surg unit I am saying AMEN to all of the above. I find it hard to entice new nurses who are seeking the glory and thrill of ICU and the warm fuzzies of Maternal-child. We do absolutely need to reflect our ratios to give the nurses the time they need to care for their patients. I admently disagree with one post that you do not use your critical thinking. You are using it constantly. You could have anything and everything in one day! I am amazed when we have a ICU nurse who "HAS TO" float down, and is shell shocked at what we do. Sometimes I get the impression they think our patients are not that hard (or we are not that smart), when in reality we have some very sick patients and have to juggle multiple things at once. They are usually ready to run back to their one or two patients. Med-Surg is a speciality!

I like you made the big jump from a long term care facility to a busy Med-surg unit in the hospital. I thought I was a great nurse and was confident in my 13 years of experience. Nothing really prepared me for the change in acute care. I was terrified because I felt like I was a brand new grad, in fact I wanted everyone to think I was a brand new grad! I realized with a little help that my expectations of myself were much more harsh then those around me. IV's were my down fall as well, I could not get any of them! I was to the point that I didnt want to even try. My manager at the time gave me the opportunity to go to pre-op in our Short Stay Surgery for a couple of days where they put IV's all day long. Once I quit psyching myself out I got better. The thing about Med-Surg that even the veterns will tell you it is always changing, you will always have new things to learn and no one knows it all!

Call me old fashioned but I still like verbal report. The idea of getting report on a telephone sounds like a problem with meeting national safety goals related to hand-offs. We enourage and use SBAR as well for our reports. S (Situation) B ( Background) A (Assessment) R (Recomendations) I want the staff to be able to ask questions and with so many new nurses I want our staff to help teach eachother. We are trying in our hospital to go to Bedside Reporting. We want the two nurses to go together into the patients room and give report at the bedside. It is intended to include the patient, make sure everything is good such as the room is safe, IVs running correctly, dressings done, etc. It avoids the "he said / she said" when there are problems.

When I was hired we had 2 units that were both med-surg but one was ortho and the other oncology/dialysis. One clinical manager was covering both units. We split them, each of us taking one. It was a difficult, rocky transition. The manager I was working with is great and everyone loved her, I of course was the unknown. Our greatest difficulty was staff wanting to go to the old manager rather then me. With the support of our Director and my co-manager we made it a firm rule that we would always direct staff to the their manager and the three of us met regularly to be sure we were on the same page. The staff will try to divide and conquer, so there needs to be a united front. We also started to have our monthly meetings that we would rotate, odd months was a joint meeting with both units together we would go over items that were pertienet to both. The even months were just our unit to go over our specific concerns that applied to our individual units. We also made a "Spirit Club" with reps from both units that helped plan fun activities for both units to socialize. We also made sure that we stanardized everything we could so staff could easily float from one to the other without difficulty. Hope that helps, good luck!

When I was DON I always kept my "Survey Ready Binder" with all the info that I would need when Surveyors walked in. I tried to update it every week atleast. You should be able to go to your states State Survey Guidlines and get copies of the state specific form that they will want. I was in LTC as a DON for 6 years, I finally decided to move on but I stayed for as long as I did becuase I had a wonderful ADON who was truely my right hand man. You need to be able to count on eachother for support becuase you rarely have anyone else.

When I am going through the hiring process I always ask if there are any scheduling concerns coming up. If I know about prearranged plans upfront it is not a problem with me. In fact I am probably more flexible right off the bat then later on, becuase during orienation I am not counting you as "productive hours" but when you are on your own taking patients I have to replace you. Sarah

I have done the method of throwing something away if it is out, it only took one maybe two times before they got the picture. I have even had a couple of people leave keys on the counter and I snagged them. It was a couple of hours before they had the guts to come to me to say they lost them, but they remembered. I still found the best was to get the staff involved. I would periodically come at change of shift and have the charge nurses from both days and nights make rounds with me and fix what needed fixed. Soon the nurses got tired of doing it and put a little more pressure on eachother to keep things where they belonged.

I had a mentor tell me when I first started in management to give it 2 years before would feel like I knew what I was doing. She ended up being right. 6 months is a little soon but life is to short to be unhappy.