sfn2008

I am a retired Travel Nurse (2008) and in my travels I came across a schedule for 12 hour shift nurses. It was brillient. Every nurse knew months in advance what days she/he was to work. Nurses were possitioned in one of four shift slots. Team 1 day shift and team 2 day shift.Team 1 night shift and team 2 night shift There was a 14 day repeatable schedule for each team. Each schedule started on a Monday. first week two days ON two days OFF three days ON second week two days OFF two days ON three days OFF Never work more than three days in a row. Always have two days off between your shifts. Know months in advance what days you are scheduled. If you are absent for sickness or other reasons a Per Diem staff steps in. Also end of year Holidays would need to be considered so one year you get two of the three holidays off, and the next year you get only one of the holidays off. Question: how many hospitals are using this schedule method? What are the pitfalls of this type of scheduling?

The big IF. But it doesn't look like that is going to happen any time soon. California is definatly more progressive ... but even that is not going to be good enough in the long run. Too many people are focused on hourly wages and not patient care load or quality of care. We can't turn out enough new nurses to fill the need and nursing employers are burning them out faster than even the new rurses can be replaced. The Original Poster got fired because she would not accept an assignment that she KNEW was unsafe. So nurses are taught in school how to TRY and keep patients safe and keep their licenses, but in reality we seem to be trained in vain. If we don't dance to the tune that our employer can financially afford to play, then we are unemployed. Anyone want to take a stab at predicting the future when we get socialized medicine in the USA? Does UK employ Travel nurses at the extent that they are use in the USA? Just wondering. (OK, sorry I am babbeling and thinking out loud... maybe I'll be kinder to the almighty dollar tomorrow.)

nursing school taught nurses to use the nursing process to assess and treat people with health issues under md orders. we were taught that patient safety is one of the highest priorities. protect patients from falls, medication adverse reactions, protect them from md's that give wrong orders and even protect them from themselves at times. the bon (board of nursing) gave us a license to practice what we were taught in school. our license can be lost if we do not follow what we have been taught. if a patient under our care is harmed, we are at risk of loosing the credentials that allow us to earn a living. employers give money to put nurses education and skills to use. employers are in the business of staying in business. our employers need nurses to stay in business. some employers abuse nurses and ask that they work under conditions that are not safe for the patients that they are responsible in protecting. if there is a conflict between patient safety and staffing ratios, the nurse is placed in a dilemma. should they continue to keep the patient at risk and do the best they can under the circumstances? should they leave the patients in one facility and seek another job in the hopes that another facility will be better? should they leave the education and experience that they have acquired and find employment in another field? should they sit back, collect a paycheck, raise their kids, mind their business, wait for someone else to fix the problem and retire when the time comes? lots of questions. few answers

As much as a Union could or couldn't help, that is not the answer. Nurses need the legislation. California is trying to get something going, and granted it is possobly because California Nurses Association and it's bargining power... BUT we need legislation to protect nurses JOBS. Nurses are taught in school how to protect a patient. Nurses are taught how to protect their license from being removed by the BON. Nursing jobs need to be protected.

Any ideas on how to get such legislation?

You are sooooooooooo Right!

Telephone Installer. One of the first females to pass Pole Climbing School.

What people? Who? The nurses at allnurses? The BON? The community where your hospital is located? WHOM are you expecting to stand up and take notice? Hospitals have a Board of Directors. Do nurses attend the meetings? As an employee of a hospital I have never attended a Board Meeting, but maybe I should have.

During a Code all concern and attention is on reviving the patient. I think it makes a difference if the Code is called in the ED, the ICU or the Floor. In many of the hospitals that I have worked someone from the chaplain's office responded to the code specifically to address the NEEDS of the family. I agree with the abirobs post, too much going on for family to witness. I have sat with family members during a Code with the ability to support them in their time of HOPE for a successful recessitation. Families need someone to pay attention to their feelings during a crisis, and inside a room where a patient is being Coded, it is the patient that has the focus of the team. I agree that family should be taken somewhere where the focus can be on their grief, anxiety and hope.

It has always been my thoughts that we do not have a shortage of nurses. We have a shortage of nurses that are willing to work under the conditions that are being presented. Change the conditions and I wouldn't be surprised if you saw nurses come out of the woodwork to go back into a field that they love. Travel Nurses work under a contract. Union Nurses work under a contract. I have always wondered why nurses can't get themselves an "agent" and draw up a contract and hold the managers to it. If Baseball players and Football players can have an Agent and a Contract on an individual basis, why can't Nurses?

A nurse recruiter recently told me that termination under these cercumstances should be referred to as "ethical differences". In other words you and your employer disputed what was "safe nursing practice". This seems to be a reasonable explination if you are terminated or you quit. In essance, you quit when the facility required you to take an assignment that you assessed as being unsafe.

I disagree. I don't identify with the control issues. I feel we should identify and meet NEEDS. Let me ask, how many times would you have liked to just sit and TALK to your patient because you knew that that is what they NEEDED, but you couldn't because you had to pass meds or fill out paperwork? And when you have been able to squeeze in the time to just hug or comfort a patient, hasn't that felt like validation for why you became a nurse? To me nursing is about patient education, (Granted in a LTC that is not might not be appropriate for ALL the patients, but maybe for SOME), quality of care, critical thinking skills and assessment skills. As a nurse I would want my time to be freed up to do more of where our expertise (sp) lies..

True, there are many that NEED a professional to administer medication and deliver treatments. And there is definatly a need to protect one patient from the medication or treatment of another. I agree to this. My question was "what is the percentage of those that don't NEED the professional" for the med administration or treatment. Over the years I have encountered patients that are more than capiable (sp) of administering their own medication while admitted to an acute care or long term care facility. Good grief, there are patients that are fully able to walk to a PIXIS-type machine and have their medication drawer open for them. My point is that unless we start to find some better ways of doing some of the tasks that have been "traditionally" assigned to nurses, we are not going to have anyone at our own bedside when the time comes.

A young Dialysis patient was "stuck" in an acute care setting because there was a LONG delay in his ability to get follow up care. He had been on our unit for over 3 weeks and was going "stir crazy". One day while I was quietly speaking to a family member outside the door of my patient this young man passed by and said "This is the best nurse on the floor". that made my day. Another time one of my patients told his RN daughter that was on maternity leave, "when you go back to work I want you to be just like ******" (meaning me). WOW! What a compliment. It is good to be validated if you are doing something right. God knows we are sure "raked over the coals" if we make a mistake.

:redbeathe

This sounds interesting. Other than your run-in, how is it working?

Where do I find this kind of a law? You said that the coroner "overrules" . .. my question is.. when I die if I wanted to practice an Irish tradition of having a "Wake", is this now against the law?

not knowing the unit patient:nurse ratio, the hospital often has an ideal ratio... but ask to speak to one of the nurses that works on the shift you are being assigned. they are asking for a traveler so that the don't have to work the regular staff outside of what they consider safe patient ratios. on a week-end "anything goes" hospital would staff for a 1:4 or 1:6 and ends up with 1:8 or 1:10.. working on new units with minimal orientation i don't know what it is like now that "everyone and their brother" is traveling these days, but this is what travel nurses do.. they are expected to know patient care and learn on the cuff each hospital's routine. some hospitals are more prepared than others with orientation. some are mandated by state law. if you feel comfortable in your patient care skills, that is the important part. if you are not, the regular staff will chew you up and spit you out. and with possibly a new computer documentation system, this is a given. and it is so frustrating to try and find or enter lab work on a new system. all the more reason to be nice to the other staff who will need to help you a lot in the first weeks. possibly being given the difficult patients no one else wants, until the charge nurse or nurse making the assignment gets to know what you can do, you are going to have to take the patient load that is the most stable. this might mean an old stroke or a dnr with lots of adl needs.. this isn't because you are being dumped on.. it is because registry and travelers need to show what they can do before they are trusted with someone that could be harmed or neglected by a nurse that is incompetent. the staff don't know what you can do until you show them. in the beginning it might be hard, but so was your first 2 years in nursing.. right? possibly minimal help from regular staff. management has brought in a traveler so that their regular staff will not have a higher patient/staff ratio. if you have the attitude that you are there to pick up the slack and help them, they might treat you better than if you think that you deserve to be treated a certain way. some hospitals might envy or even resent travelers because of the difference in pay and benefits.. but if you represent yourself as there to help them so that they can give safe patient care, they will be more willing to help you with the admit or a patient that is crashing. are travel rns generally treated better than agency rns? i have done both agency and traveler. it depends on the hospital. some small community hospitals are better than teaching hospitals.. personally i prefer the small community hospital that has attending md's rather than residents.. but "to each his own" as they say. agency nurses are sometimes used for only one day but a traveler is there for 13 weeks. the staff knows that you are there to help them for a long enough time for them to make it worth their while to try and be nice. if you are agency you can say "don't send me back there again" to your agency. if you are a traveler you can't do that. has anyone started a travel assignment where the hospital has decided they don't want you? never never never leave home without a signed contract! your contract might have a clause that allows the hospital to "test run" you for a few weeks, but after that they (and you) are "usually" on the hook. there are extenuating circumstances in every situation, of course, but on the whole the agency that sent you as a traveler will have a contract with the hospital that spells out these kinds of things. and.... picking your travel agency is important. i used ppr in florida and they were great. the telephone interview is crucial. have your questions written down before the call. document the answers and don't be shy if you have to speak to the nurse manager in the first few weeks to "clarify" the promises that you were given when you accepted the assignment. things like hours worked, shift rotation, patient ratio, overtime, floating, etc. good luck

Even if nurses KNOW that a small air bubble will not be a problem, some patients and their families can FREAK... I learned a trick years ago and it might help.. Take the tubing and wrap it around your pen and "walk the bubble" up the tubing. As long as you have an open valve and the ability for fluid above the bubble to move, keep twisting the tubing around the pen until the bubble goes back in the bag.

You have described 1. Hypotension, (Alteration in perfussion:redbeathe) 2. Altered LOC, :zzzzz 3. Adverse Effect to a Medication I am even thinking with what you have described, 4. Altered Respiratory Status might have been present. Good Luck

How many people in these LTC's actually NEED a nurse to do the med pass? How many patients in the hospital NEED a professional to do a task that they do for themselves at home (and very well I might add). What do you think the percentage is of patients that actually need nurses to hand them their routine meds? OK, I am thinking outside the box again. But.. hey.. we have a nursing shortage for a reason... technology is out there making the Super Market check out fast and efficient.. but who is out there trying to keep nurses at the bedside? Passing medication is not what makes me a Registered Nurse. RN's go to College to learn critical THINKING skills.. and yet our day is filled with tasks that many of our patients can actually handle better than we can. Are there any places in the world that THINK OUTSIDE THE BOX?

get copies of everything that is documented about the practice. you are doing your job the way you were taught. but, it may be that your preceptor did not follow up with a policy or proceedure. your intelligence tells you that to put quality patient care first, you need to be prepared. so get someone to write a policy and proceedure that will allow nurses to give quality care.

Funny AND Educational. We need more like this.