nurseshepherd

Our small OB/MOBA unit does team nursing, but only on nights. We take report on everyone, the charge nurse makes assignments, but if someone needs something the nurse at the desk takes care of it whether it is her patient or not. Same thing when we get an outpatient in, one nurse writes while the other nurse does the hands-on part of the assessment so we are done very quickly and efficiently. Our day shift does the opposite, spending 5 minutes to find 'that patient's nurse' in order to refill their water pitcher or some other task that would take just a minute of their time. Team nursing works and keeps individuals from feeling too overwhelmed, IMHO.

When I worked as a tech in nursing school, there were some horrible nurses who were verbally abusive to techs who didn't stand up for themselves. I was not a timid person, but nursing was a career change and I was unsure of myself. These seasoned nurses knew more than me, I realized that, but they lost the very essence of being a nurse somewhere along the way and became merely technicians performing tasks. They had no compassion at all, and it made the 2 shifts a week something to dread. Yes, there were some good nurses, and they were the ones who made up for these sad individuals. I needed the experience to strengthen my clinical skills, and the money was a Godsend. All but one of these nurses straightened up after the first 6 months, but only after a controlled verbal confrontation where I let them know their behavior and attitude were unprofessional and would not be tolerated any longer. When it was time to interview with the VP of nursing for job placement, I told her I would work any unit except the one with the hateful nurse. Without elaborating or naming anyone, I told her the experience had been a trial by fire that I wouldn't wish on anyone. She was shocked, evidently no one else said anything about the hospital's nursing staff before. Speak up, but do it to the supervisors and in a calm and professional manner. Learn this now as a tech, it is a skill you will need the rest of your nursing career!

The idea and practice is sound, according to studies that have been done showing improved patient satisfaction, reduced pain levels, etc. The problem comes in when nurses have too many patients and not enough help to do hourly rounds, address needs (pain medication, food, drink, blanket, pillow, etc.), and chart without feeling overwhelmed. Right now I work in a small unit and with 2 - 4 patients and the hourly rounding from 7 - 11p takes up all my time, but it is doable. When we first started hourly rounds a couple years ago, most of us would just keep our notes in our pocket and jot down what we did, then we would chart everything at the 11p full assessment. Now we have computers at the bedside which makes it easy and convenient to jot down a note and that pleases management because they don't like having to explain 4 - 5 hour old charting when the JCAHO comes to survey our hospital. I personally cannot fathom working on some of the med/surg units (like in our system) and trying to do hourly rounds on the 8 - 12 patients they usually have each shift, it has to be nightmarish!

Our facility is proud to support the continuing educational efforts of it's employees. However, some of our folks interpret this as permission to do most (if not all) of thier school work on the clock regardless of patient load. The charge nurse needs to bring them back to the reality that they are there and being paid to work, and their patients are counting on them. Night shifts are great for folks going back to school because there is often down time after finishing 11p rounds, but they don't need to depend on that time to get assignments done. As an instructor I was given that excuse more than once!

Thanks to all who have replied. Interesting that many included administrative cutbacks; to date we have not seen that at our not-for-profit hospital system. Our local nursing programs are still taking as many students as they have desks for and I worry about those getting out in the next year or two expecting (and needing) to find a job in the current climate. Thanks again!:)

Our area hospital system (rural TN) has cut all nurses and non management employees to 32 hours a week, allowing those with personal time to use it to make up the hours. They have also cut all education and travel funds, reduced each departments budget by 10%, and have instituted a hiring freeze. Departments with secretaries and techs will not replace any who leave (increasing the workload on nursing staff) and our PRN nurses are not being utilized unless absolutely necessary. Additionally, if the department census does not support the number of staff scheduled, nurses are sent home low census (using even more personal time if they have it or try to get by on 20 hours that week). What is going on in your area and are you rural or urban?

Management has not mentioned anything but we are in the rural South so I doubt seriously it would be an issue here. Agree with PP, micromanagment!

I work with several women on herbals but they are going to a local MD who was an internist until the stress of the hospital led him to partner with a local herbalist and they have a thriving alternative medicine practice. So far I haven't heard of any untoward outcomes.:wink2:

Our hospital has a policy that all positions have to be formally posted, even though they already have it promised to someone. That could have been what happened with the posting.

Sounds like a really good unit! We run into this quite a bit with 'change-of-shift' deliveries and it is funny how different it is depending on whether it is AM or PM. If it is at 6:45 AM, some of the day folks will stall around because they have to get report and sometimes act annoyed that there is anything left undone, anything. However if it is 6:45 PM, they are yelling at us to come in and take over so they can get out on time, finish their charting, whatever, and they don't mind leaving a laundry list of stuff they couldn't get to.

We need a lot more like this!!!

I agree with the PP that simply asking politely and keeping the visitors informed works well with most folks. As far as having people at bedside during procedures, that really depends. In OB we almost alway insist on having the woman come back sans partner so we can discuss health care issues one-on-one. It is amazing how many women tell their partners they quit smoking but really haven't, have herpes and haven't informed their partner, have taken drugs and their partner is clueless, etc. We also need to discuss her relationship to see if there are issues with domestic violence and provide her with resources without the partner at bedside. One issue we run into quite often is family members who are CERTAIN they are wanted in the room for everything and if you haven't asked the patient while you have them alone you won't find out until it is too late that she only wanted her partner in the room and not the whole clan.

During nursing school I thought I wouldn't have any money worries once I graduated because I would make so much more than I had before. A hard lesson was learned about the financial backlash of nursing school (when you keep robbing Peter to pay Paul, Peter eventually gets wise) so I spent the better part of the first year trying to get myself out of debt and put a little in savings. My first RN check was awesome though, it was 3 times what I had been used to making and the idea of being paid that well for doing what I loved was just the best feeling. For motivation I kept a copy of the house plans I intended to build after graduation in the front of my notebook and every time things got rough I would flip to it. Find your motivation, tough it out. God bless.:wink2:

I try to keep an unstructured PRN job to help with situations like that and for addition income when I have a project or financial need. Working in another area of nursing is always a challenge and helps you grow as a health care professional. Having said that, my primary issue is the hourly rate and safe working conditions. Good luck to you and God bless.:wink2:

'Buzzing' a fetus in utero in order to get it to move/turn is an example of noxious stimulation (uses a device similar to an artificial larynx) which does not hurt the baby but certainly gets a reaction which is the goal. Sternal rubs usually do hurt and I would put them in the painful stimuli category......