nytenurse2

Nurses within my facility use the Modified Early Warning System (MEWS) to avert further decline in patient conditions. The system has increased calls to the rapid response team (RRT), reduced the "code blue" incidences, and contributed to a significant reduction in mortality. While we have made leaps and bounds in the right direction, the MEWS scoring system does not take into consideration the baseline condition (i.e. vital signs, etc.) of the patient. The system has also taken away from the clinical judgment of the floor nurse. For example a 95 y/o patient admitted with unresponsiveness and hypernatremia scored a 3 in the emergency department and a 4 upon arrival to the floor. The score of 4 deployed the RRT only minutes after the patient arrived to the floor. Another example, a MEWS score initiated the RRT in a case where the patient was tachycardic related to a fever that she had upon admission. She already had orders for blood cultures, fluids, Tylenol, antibiotics, etc. My questions: (1) are you aware of the MEWS being used in palliative/comfort care patients, (2) how is the MEWS used in patients with DNR status, (3) how is the patient's baseline condition taken into consideration? We have ICU nurses being pulled from the sickest patients in the hospital to respond to MEWS scores that are unchanged from the baseline, floor nurses are in fear of being written up if they do not request the RRT , physicians are being told they cannot write an order to override the MEWS score, and clinical judgment is being overlooked. Any input would be appreciated. Thank you.

Nursing school is hard work, the assignments are difficult, the math calculations are challenging, and the clinicals are unpredictable. Welcome to nursing school! You have made an astute assessment of your "current" skills and abilities . . . that WILL improve with time. Those of us who are nurses understand Benner's theory of novice-to-expert. Students come to the bedside with a variety of learning styles and life experiences. To lack confidence at this early stage is normal. You WILL become more confident with time. So what can you do in the meantime? 1. Talk with your instructor - share your struggles and ask for help. Instructors usually have extra work sheets available for practice. 2. Think about getting a job in the healthcare field to help build your confidence. If you are unable to do so, look for summer internships or a PRN job. 3. Get a mentor - this could be a senior nursing student or a practicing nurse who understands your struggles. 4. Get out of your comfort zone . . . not just during clinicals but routinely. Volunteer to be one of the SNA officers, raise your hand in class, facilitate a study group, anything that allows you to become more confident. 5. Surround yourself with positive people and adopt positive talk when communicating with yourself or others. ~ Unknown

Hi, I really liked your survey. That salary question threw me. Are you including nurses outside of the UK in your study? I am working on my Doctorate in Health Administration. Good luck to you! Nytenurse2