smk1

We were taught that if a mention in the patients chart or record was made of an incident report being filed then the incident report became "discoverable" and could be asked for by the attorneys. So if a patient fell, you don't document in the chart that an incident report was written. You write what you want to say in the progress notes and don't mention any other reports being written. I always wondered about it though...

Patients with extremely active psych issues. Sorry just not my cup of tea, I feel for them though and hope I never have to go through what they go through, but I don't have the patience needed to deal with a 12 hour shift of psych issues 3 days/week.

It is a joint commision standard that they be signed within 48 hours. The hospital needs to come down hard on the providers who are not in compliance to fix the issue. This is NOT a nursing responsibility. Yet we get emails all the time about "our" compliance. At some point providers have to be responsible for their own paper work. I probably sound a bit cranky on the subject, but it is irritating that somehow hunting providers down to fulfill their job requirements is becoming a function of my nursing practice. Not cool.

People who insist upon gathering every last relative known to man around there bedside and people are still comeing up to visit at 2 am. If you are really sick then you need rest. Visitors need to roll out.

You've gotten some good advice and opinions here. Without us being there to see the situation, we can't accurately make a judgement call. If you have questions regarding a new diagnosis the best thing to do is talk with the PCP and your father. If you are really concerned that this is a result of improper nursing practice, then you know where you need to go from there. Good luck in your studies.

I sleep the first day off then wake up in the evening (I'm a night shift gal) and start laundry and cleaning). THe next day I usually go out to lunch with a friend and run some errands, swim in the pool watch some tv and relax. We also like to take small day trips or weekend trips when possible so we head to the beach or to visit family pretty often.

Check your BON because this policy may be against the law. Blood is still and informed consent procedure and in my state requires the provider to explain the procedure and risks and obtain consent. People were getting lax about this policy in my area and we had a timely reminder about the legalities of it. In any case, the bloodless medicine centers are great resources. EPO would take time to work and if you haven't stopped the bleed anyway is not going to do a whole lot.

We have visitors who are constantly walking into the nurses station and it bugs me to no end. No one walks behind the counter at a bank or a gorcery store, it is the same principle. THere is sensitive information in the nursing station and you have no business coming in there. Also I am happy to get you (the visitor) a cup of coffee when I have the time, but constant refills, warm blankets and extra pillows with snacks starts to be a bit much. If I can only find a couple of extra folding chairs, then I am sorry that is all I have. I don't have a half an hour to run around searching high and low for that sort of thing. 20 people don't need to be holding a party in a room with a sick patient at midnight anyway. I also can't keep reheating all of your KFC and pizza hut food because you want to snack on it every 45 minutes. Enough is enough!

Don't be afraid to say you don't know something. I told my manager how thankful I was to have internet access at work, because their have been quite a few times where I receive a patient who is having a procedure that I know nothing about and need to read a quick excerpt to see where I need to focus my attention, or how to explain something to the patient if they have questions.

Basic understanding of how to talk to providers. We never took orders in NS so we were out of the loop in that arena. The first time I called a doc when I started my job a few months ago, I was SOOO nervous, and he just wanted me to tell him what I wanted. So always have a recommendation in mind, and then learn that with some providers you will have to be a bit assertive because they do not look over their labs or imaging results (shocking I know), and infiltrates, low potassium, etc... will be missed if you aren't very thorough. Try to look through your chart and organize your issues on a piece of paper with vitals before you call so that you aren't calling every 10 minutes. Bundle your calls to the extent possible. A blood pressure of 88/58 is not always a cause to panic! Assess your patient first, look at the trends.

I'm a clinical decision unit nurse so I kind of fall in the middle of the ER and the floors. Can kind of see both sides. From the perspective of someone who admits patients from the ER in large volumes nightly, I can say that it is a huge benefit if you can get the actual nurse who took care of the patient to give you report. It isn't always possible, but a LOT of potential problems can be nipped in the bud before they blossom into a full scale issue simply by having this communication. At the same time if I am in the middle of admitting 2-3 patients in the last hour I may not be able to take the next report when the nurse calls, and I get that she is busy and if that means that now someone else will have to give report when I call her back, then I have to deal with it and ask more questions to get the info I need for safe patient care. 99% of the patients come up with an AC iv start. I can deal with that because I understand why, what I do not get is the nurse who doesn't put and adapter on the EMS IV start so that it is compatible with our needleless luerlock devices. Yeah I can do it upstairs, and I am one who always flushes IV sites during assessment to make sure they work, but it frustrates me to no end that others do not. Not good nursing practice. Also don't question me if I say that the unit is full. I am not lying to you, feel free to come up and look if you like. (this last rant is mainly for doctors who think they are the only ones admitting patients to the unit, and can't understand why we have no available beds if they have only admitted 2 patients so far.)

Here is another example of the system setting you up by promising the world, but not providing the resources to deliver. We have one pharmacist that works in the central inpatient pharmacy at night for the whole hospital. ONE! so when I send down orders on my new admit it can take quite awhile for these orders to arrive in the pyxis and computer system for me to sign off. When I am admitting a patient I am supposed to talk about their "rights" some of which are to have their pain treated adequately and their medications delivered in a safe and timely manner. How timely is it when a patient arrived at 11 pm and the medication orders do not show up until 2 am? Now I can override certain things such as certain amounts of dilaudid/morphine or acetaminophen, but not Toradol or oral ibuprofen and other meds or many of the antiemetics (i can override zofran but not anything else). But a patient who wants to get their regularly scheduled medications that they have not taken yet today before they go to sleep could be waiting hours for that to happen, depending on how busy the pharmacy is. Now this isn't my fault but because all the other departments are the "unseen" machinery that makes a hospital run, when they aren't able to get the job done in a timely manner, be it housekeeping, dietary, pharmacy etc..., it reflects on nursing because we are the staff members that coordinate the care of the patient. It's not my fault ,but it reflects negatively on my practice. Not a fun aspect of the job.

Perhaps I have missed something, but I don't see anyone stating that they don't make an effort, are not polite and do not smile. These are things that we are in control of and probably the vast majority of us do with regularity. However if I am running interference between a patient with runs of v-tach and another with symptomatic SVT, I cannot immediately drop what I am doing to get fresh water for your flowers or grab another blanket out of the warmer because the one I got you 20 minutes ago is no longer toasty. Doesn't mean that I wouldn't like to to those things, it means that I simply don't have the extra time to do those things at the moment, now if we had a CNA or tech or "concierge" services (meaning not a nurse) then perhaps that could be done ASAP. But, we aren't staffed for that. This is the problem.

The problem is when they promise the moon and create a phony sense of what the patient can expect and fail to pay for the staff to deliver on those promises. What good is a beautiful rose garden on a terrace if the patient in room 2 requires someone to take her in a wheelchair out to see it and no one is ever available to do it? What good is "telling" someone they have round the clock room service when the staff aren't provided to actually accomodate these promises? I have excellent customer service skills, I am new, bright eyed and busy tailed and gung ho, ready to make a difference... and even I can tell that the promises made are pretty empty.

The biggest misconception seems to be the ones that the hospitals themselves promote. The hospital decorates the place like a hotel, we have valet parking, everything is about customer service, we are supposed to write down patient requests and wishes for their care and follow it etc... Now the hospital does not staff for this in any way. so if I have a 5 patient load and the pampered lady down in room 1 is on the call light for someone to adjust her pillows and get her coffee and find a way to take away any scrap of discomfort she is having while in the hospital, I don't have time to deal with her requests when room 2 is having pain, room 3 is have runs of SVT, and room 4 is nauseated.