nursemaa

gotcha. i do understand that scripting is difficult for most of us to accept. i always ask "is there anything else i can do for you", but the "i have the time" part does sound a little weird. i do have some scripts that i use, such as "how can i help you", "i'm going to give you some privacy" etc, but if it doesn't sound natural and genuine, we end up sounding a little stupid. it seemed like some were saying that they don't approve of hourly rounding because patients need to rest, they don't have time, etc. it just worries me that some nurses think it's ok not to check on patients hourly.

Hourly rounding is not really a new concept- it was considered standard practice when I entered nursing in the late 70's. If a patient is sick enough to be in the hospital, someone should be checking on him/her hourly. And, it is just good patient care to see if they are comfortable, need to go to the bathroom or use the bedpan, or see if they need help to reposition every hour or so. So I don't see why nurses are fighting this idea- if we are sitting around instead of checking our patients, we are not making sure their needs are met and that they are safe. Just my opinion.

The problem with discipline is, the person standing by the cup, or angio, or whatever else may not be the one who left it there. It's hard for me to tell exactly who is responsible for the mess. I too feel like "mom"- always picking up after everyone, often having to nag them about documentation, customer service, etc...and these are professionals! sigh....

Proactively notifying manager of busy shift/multiple codes, any attempts to diffuse angry patients or just heads up in case problems later reported very helpful for Mgr to have facts at hand in dealing with issue next shift /day. Speaking as a manager, this is extemely helpful- then I can visit the patient and try to do some damage control before they go home. Every patient thinks their needs are the most important...sigh

American Heritage New Dictionary of Cultural Literacy, Third Edition empathy [(em-puh-thee)] Identifying oneself completely with an object or person, sometimes even to the point of responding physically, as when, watching a baseball player swing at a pitch, one feels one's own muscles flex. So you showed great empathy for your patient- you could almost feel the same feelings she had- good job! Empathy helps us advocate for our patients, as opposed to sympathy, which is merely feeling sorry for them.

Most places have this policy- if it isn't workers comp or FMLA, it counts. They usually have a limit on how many times you can call off before disciplinary action is taken. If you have a chronic health problem, it's a good idea to get intermittent FMLA to cover the absences.

Probably referring to a matrix system of staffing. You take your hours per pt day (theoretically based on average acuity), and use that to determine how many staff members you need for each census point, or number of pts. There's a formula for that, can't remember it off the top of my head. A chart is usually made up that tells you "for 20 pts, you need ___ staff, for 21 pts, you need ___ staff", and so on. It's not a new system but I suspect more hospitals are using it....helps keep you within budget by not "overstaffing", and keeps your productivity reasonable by not "understaffing". But it doesn't take into account situations like having more high acuity pts than usual, or high turnover of pts ( you know, those shifts where you discharge a bazillion pts and get a bazillion more in....). So a manager has to decide whether to go above the matrix in those situations, and take the heat if he/she does.

Usually they discuss things like attendance, attiude, teamwork, dependability to complete assignments, and any other issues (good or bad) that we want the other manager to know. Some places award the job based on seniority (the manager doesn't get to choose), and some places allow the manager to select the best candidate from all of the bidders. My hospital is union and it's all about seniority, so even if I think someone is a good fit for the job and the team, I have to take whoever has the most time in, even if they are not as desireable as other candidates.

Hmm...seems strange that they would only hold one meeting, and penalize those who are on sick leave or vacation, or may not know about it. Are you sure you didn't misunderstand? I've known of places that marked you down on evals or something if you didn't complete mandatory activities, but have never heard of a penalty as severe as 3 days suspension without pay. Ideally, a meeting like this should be scheduled more than once, and at different times of the day...but if you have many employees (I have 65) working a variety of shifts and days, it's tough to do. So you end up having the meeting a couple of times and try to get as many staff there as possible. Mandatory things should be available in a variety of formats, like "read and sign" packets, online, and face-to-face meetings.

On behalf of all of us managers on this board....THANK YOU ! We really do just as much work as the staff do, it's just different work. We're all part of the team, we just have different roles.

33 bed med surg unit: typical staffing when full is 5 RN, 2 LPN (days and nights), with 4 NA on days, 2 NA on eves and 1-2 NA on nights. Sometimes go with 3 RNs and 3 LPNs if there aren't 5 RNs available. LPNs do assessments, PO meds etc. RN only can do admissions, IVs and orders.

All of the above statements make sense. I think you have greatly misunderstood me. I definitely do listen to my staff. Many great ideas and solutions to problems have arisen out of those hallway and coffee break conversations. I don't discount the tremendous value of getting out there and talking to and mostly listening to my staff- they are great idea generators. I spend enormous amounts of my day talking with them and getting feedback about various things. I also completely understand those who just want to do their thing and go home- I've been there, especially when my kids were little. And I have lately come to the realization that most staff just don't care for meetings- OK, I can live with that. It's just that I guess I see so many opportunities to get involved in projects and committees that are really trying to do worthwhile things, it's hard for me to understand not wanting to be involved- but that's me. I'm the same way at church, my kid's clubs etc. I just got the feeling that you think all managers are is a bunch of pencil and paper-pushers, and that you felt that the reason we want staff to sit on committees is to get them to do our work. I wanted you to know that we're not all like that, some of us really support and believe in our staff and are not trying to push our work off on them- we just want their input. You're right, committees aren't the only way to get that. I know I care very much about my staff and their working conditions and do whatever I can to help and support them. I also believe that you don't have to be in management to be a leader, and to generate great ideas. One more thing...I don't disrespect them or feel that they aren't there for me. It's not about me, it's about nurses at all levels working together to improve and sustain quality care and to have a voice in our organizations. OK, just one more thing- I appreciate your positive comments about management in the post you quoted. It's nice when staff recognize the good managers and don't lump us all together. Now I'll shut up. : )

I can't speak for any others, but for me it's not a matter of asking them to do my job. It's simply that I really do believe that when the team works together on a project or problem, the outcome is usually better than if one person (me) decides everything. Staff complain when they don't have a say in decision-making, but then don't want to be part of it. So they send conflicting messages to management. You seem to be really angry about management in general- please believe that we aren't all slackers, or uncaring, or whatever it is that you think. Some of us (many that I know of) really care about our units and what happens with our staff. I feel bad that your experiences have made you feel this way.

1. Many couples have met at work- not unusual, not necessarily unprofessional. 2. If he's married, then he's a pig and she should dump him, but unless I'm a close friend who can talk to her about it, it's really none of my business. 3. The patients may ask how long they've been married simply because when they make rounds, they are so comfortable with each other- no big deal unless they're making out in the patient rooms or something. I had a patient ask if an orderly and I were married...there was nothing going on between us, but we'd worked together so long and had a good friendship so we probably acted like an old married couple sometimes. 4. As long as she is taking good care of her patients and is getting her work done, then who she's dating is again none of my business. 5. I am way too busy at work to pay much attention to who is dating who- I hate "office gossip" and won't participate. 6. We all say we should leave our personal lives out of the workplace, but we don't really do that. We talk with each other about our kids, our husbands, our family life, and many other personal things. I'd need more information to form an opinion- is she a good nurse, is it interfering with her work, are they showing public displays of affection, is patient care being compromised, etc. Just my thoughts.

One thing I'm not crazy about in regards to unions is that you lose some flexibility and control. For instance, where I work the posted job always is awarded by seniority- the manager can't choose the best candidate. So sometimes the person who gets the job isn't a good "fit" with the team, or isn't the best clinician, and it can created some angst when you're trying to create or maintain a good team.

We had to do breast exams but not pelvic exams. The teacher stood by and watched- it was disgusting. We wrote to the dean to complain about that and several other things- the teacher was removed from teaching that class.

I use this method too. We don't usually have any trouble, except occasionally everyone wants the same day off so there's no nurse on the schedule! I then give that day off according to seniority, making sure we have our complement of nurses scheduled that day.

Thanks, good ideas. I have shared with them the financial and patient-outcome ramifications of mislabeling. The clear box idea sounds interesting. The labels print pretty quickly after the order is entered, so unless it's a stat I think they should not draw until they have the label in their hand.

Labeling at the bedside is the best way to prevent errors. I've found though that many nurses draw the blood, stick the tubes in their pocket and carry them around until the lab printer produces the label- VERY bad practice on several levels!! I hate to start writing people up for something like this, but I'm not sure what else to do as just discussing it with them doesn't seem to work!

My mother died a couple of weeks ago. Before she got the morphine, she had been in terrible pain and frantic because she couldn't breathe. The morphine allowed her to rest and slip away quietly. So yes, I belive in it- it was terrible to see her so anxious and in pain. Yes, it slowed her respirations but did not cause her death- just made it peaceful. I work in med-surg, have been a nurse for 25 years, have an MSN. No guilt.

I totally agree! Many times our patient sat surveys come back with comments like "the nurse acted as if I was bothering her". A great nurse understands that the patients are the reason we're there, and does not feel "bothered" when they ask for something! A great nurse sees the bigger picture, and always demonstrates a kind, caring attitude toward her patients. A great nurse cares about her coworkers, and is always willing to help when needed. A great nurse stays calm and focused when the unit is going crazy. And of course, clinical expertise is important too.

Because C Dif results in sometimes rather explosive diarrhea, the spores from the bacteria can heavily infect the whole environment. It is not safe to have these patients share a room with another patient, because it's almost impossible for the non-infected patient to avoid the spores from the bacteria. If you find C Dif after admission, the non-infected roomate should be moved to a private room (moving the infected patient won't help because the environment is already contaminated). Many places put any patient with diarrhea on contact precautions until C dif is either confirmed or ruled out by sending several specimens to lab. Masks aren't necessary because the spores aren't airborne; it's mostly spread hand-to-mouth. Gowns and gloves, along with strict handwashing and thorough cleaning of the environment post-discharge will protect staff and other patients.

Amen!! For the record, I always pay people who come in on their own time for meetings, but that doesn't seem to help either. I post minutes in a notebook for them to read...some do, some don't.

Wow...was this patient oriented? I was punched in the chest once by a very confused patient. While it certainly hurt me, I wasn't angry because he really was out of it. But if the patient was coherent, I would have definitely called security to deal with him!

I don't make staff meetings mandatory, but I do post minutes and everyone is responsible and accountable for the content. Staff who come in on their time off for staff meetings or any mandatory activity are paid for their time. Some inservices have to be mandatory, like new equipment and JCAHO requirements. We schedule several sessions at different times of the day. Sometimes we do traveling "road shows", going around to the units to demonstrate new equipment etc. We do alot of online training, and read-and-sign, to try and avoid so many meetings. All jobs have certain requirements including training sessions. If it is an expectation for my job, I make the time to do it. If your employer requires certain training, it's their responsibility to provide it during times that are convenient for everyone, or provide alternatives like computer modules and read-and-sign. If that's done, then it's the employee's responsibility to complete it. Talk to your staff development people about the needs of the off-shift and part-time staff.