emoening

We have been dealing with this issue on my unit forever. We have a staff meeting next week to talk about this so I would love to bring some suggestions with me. On our unit, we do NOT staff by acuity whatsoever. We staff by location. Our unit (med-surg / ortho) is 2 long hallways with groups of 4 rooms we call "pods". Our ratio is 6:1 so the rationale is to keep the nurse in 1-2 pods so he/she doesn't have to walk all over the place. However, our unit is rarely full, so half the time your 6 pts. may be spread out amongst 3-4 pods anyway, so you end up walking the entire hallway. To me, this system is insane. You may be kept in 1 pod, but every single one of those pts. in the pod is a total care, or a new post-op hip, etc. Additionally, our hospital is so small we don't have a peds unit so guess where they bring the peds pts? To us. This is also not factored into our assignment, it still goes by room location. I have had assignments where I have had 2 postop hips, a 6 month old with pneumonia, a postop spinal fusion, a confused woman setting off the bed alarm every 5 min, and a complete total care..but it was "fair" because they were all in the same 2 pods. I've also had assignments where all 6 of my pts. were self-care and stable, but another nurse is sinking, because "it goes by pods." And the real clencher is the night shift nurses make up our (day shift) assignments at the end of their shift. Not the charge nurse. No, our charge nurse is just whoever is working on the floor that day who happens to have the most experience, she still takes a full pt. load just like everyone else, the only difference is she carries the "charge phone." Okay I realize I got off on a little rant there, but I could use some serious suggestions to bring to this meeting next week because something has got to change. We NEED to start assigning by acuity, I can't understand why our clinical lead / nurse manager doesn't understand this. I would much rather walk a little more than do what we're doing now!!

Our original assignments always include an extra room or so (unless we're full of course). That way new admits can rotate. Our max is 6 pts. If someone already has 6, they will not get an admit. The nurses who have only 5 pts. would get the first admits. If everyone has the same amt. of pts. (rare occurance) the admits will start at the top and work their way down. At any rate it's still ALWAYS rotated, never will one nurse get 2 admits back to back without any other nurse getting one. Sometimes it works where one nurses will have the same 6 pts. all day and never get a new admit, where the other nurses will discharge several and then get several back. Our charge nurses are great about taking admits, where if everyone else is drowning, they will take back to back to back admits until we're caught up. I think this is a great system but it only works because A.) our charge nurses are awesome, fair, and are more than willing to help out. and B.) all of us staff nurses are very team-oriented, and even if I have 5 pts. and someone else has 4 and is about to get an admit, but still can't handle it, I'll take it if I can (making me have 6 and someone else 4). We are all very helpful toward one another and will make it work whatever the circumstance, even if that last new admit has 3 nurses doing things for them, just as long as it all gets done.

Our CBI bags are 3,000cc. We have a flow sheet that had columns for: bag#, amt. in (which is always 3,000), total amt. out, and urine output. So let's say bag #1 has just finished going in, and you empty 3,800 out of the foley bag. The Urine would be 800, because you know the CBI bag was 3,000cc, so anything after 3,000 out is urine. Let's say you're running at a brisk rate and you have to empty before a full bag is in. You just keep a running tally of how much you empty, and once a full bag has gone in, you subtract 3,000 from the total amt. you've emptied. So in essense, your actual urine is always: what you empty from foley minus 3,000. Let's say a full bag has gone in, but you only empty 2,800. Then the pt. didn't put any urine out for that bag, and you're in the negative (-200). As far as it being "continuous" and not being able to stop it to empty, there is no harm in clamping momentarily to empty the foley and then unclamping..that should take all of about 1 min. and then it's right back on. I hope that would not too confusing to explain..it makes sense in my head lol!

I don't know how it's "supposed" to be done, but on my floor, us nurses obtain the consent 99% of the time. There is 1 surgeon who actually signs the consent and fills in the blanks so the nurse just has to get the pt. to sign and then the nurse witnesses. But other than him, every other surgeon in the hospital does not do his own consents. Like someone else had said, when the pt. is put into the computer for a procedure, an OR packet prints out (including a consent form). Then we nurses fill in the blanks (MD's name, pt's name, procedure) then get the pt. to sign, then we sign as witness. Now that I'm actually sitting down to think about...we probably shouldn't do that. It really IS the MD's responsibility to get the consent, but I think it's one of those things that "should" happen in a perfect world, but never would in the real world.

which port did you try pulling back fluid out of? the irrigation port or the drainage port? The irrigation port. The drainage port was patent as urine was flowing out of it.

I work on a general med-surg floor and consistently have post-op TURP patients with 3 way foleys and CBI. Yesterday I encountered a situation I've never experienced before of probably 50 CBI pt's I've had. This gentleman had a 3way foley with CBI set up, and the urologist came in at 0830 with orders to stop CBI, but restart for clotty or bloody urine. So I clamped off the CBI but kept all tubing connected just in case I needed to restart. Sure enough by 1400 the pt. put out 1000cc of bright red urine. So I open up the CBI clamp to restart...and nothing. Will not flow in. I irrigate the foley--nothing. Pull back with a 60cc syringe to check for clots--nothing. Flushed the CBI tubing into the garbage to see if the tubing was patent--it was. Pt. not c/o any pain, bladder soft and nondistended. Had charge nurse come in, who trouble shooted basically just as I did with no success. We ended up asking every nurse on the floor who all said they had no idea and had never had this problem. First instinct is to think there is a clot..but urine was still flowing out (1L in 5 hrs.) so I would think if it was a clot, there would be an obstruction in flow of urine, but there wasn't. Ended up calling MD who just said "keep the CBI clamped, put a new 3way foley at bedside, and I'll be in later." (Assuming he's going to switch out the foleys...but why?) Ended up leaving my shift and he still hadn't come in, so I don't know how it turned out! Anyone ever had this or can come up with any ideas why this happened?

I had a patient's son WALK IN TO ANOTHER PATIENT'S ROOM while I was in there emptying a JP Drain to tell me "I can't figure out how to work the controls on Dad's bed." Umm are you kidding me?

at my current hospital: Dr. Sharp -- cardiologist Dr. Love -- head physician of OB/GYN

I wanted to get everyone's take on this. Yesterday at work I got out of report at 7:30am and began to make my rounds on my 6 patients. At 8:15 one of my patient's physicians called me and said he was taking my patient to the OR in 45 minutes for a urinary stent and to have him ready. This entailed printing out his OR packet, getting the consent signed, pre-op checklist, and giving him the CHG bath. He said the procedure would take about an hour and he would have him back by about 10:30. I was just finished wiping him down with the CHG wipes when the transporter arrived to come get the patient. About 2 hours later my patient had not returned, and I was told by the house supervisor that something had happened in the OR and the patient would be going to ICU after the procedure. Later that afternoon when the patient had arrived on the ICU, the nurse taking him over called me, I was assuming to get report. Instead, she chewed me out over the phone, and told me she was filing an incident report against me, because she received the patient and chart from the OR and my charting had not been done for the day. I told her that the patient was taken from me at 9am, and I assumed he would be back to me by 10:30, when I would catch up on my charting. She told me, that is not an excuse, and it is an incident report if you do any charting after the fact, that you have to chart as something is happening. I told her I would be more than happy to come down to the ICU and do my charting for the 2 hours I had the patient, but there is no way I could have known he would end up in the ICU and wouldn't be able to finish my charting when he came back. She said fine, but that she would still be filing the report. I told my charge nurse about what happened and asked if I was in the wrong, or what I should have done differently. She said no I was not in the wrong, and that I couldn't have done anything different. She also said we are not expected to chart everything immediately, that is literally impossible. On my floor, it is the norm rather than the exception to start your charting around noon or so, once you've assessed all your patients, done all your AM meds, taken off MD orders, etc. So my questions are: do you think this was a ligitimate incedent report? And how many of you do your charting immediately? Or do you actually "do" everything first, and then sit down and chart later?

Re: May 2009 Graduates!!! Do you have a job yet? kingkn-- I am working at Hilton Head Hospital in Hilton Head Island, SC. On a med-surg floor.

OMG tell me about it. I graduate in 6 weeks and I cannot seem to get myself to do ANYTHING. I have worked overly hard the passed four years, overachiever-type, and maintained a 3.95 GPA. But now..I just don't want to do it. I can't bring myself to study for HESI, and every time before clinical I just pray for an easy patient assignment so I don't have to think. Oh well..it will be over soon I guess

I was actually feel pretty lucky, I applied to only one hospital that I really wanted to work at, in South Carolina (I go to school in Ohio) and I got the job after one interview. They told me I can start as soon as I pass my boards as they are holding a position open for me. And until I take my boards I can work in that hospital as an aide. They start at 21.50 which I was a little disappointed in. They have a "relocation" bonus since I am moving from a different state. They also pay full tuition reimbursement to get your Master's if you continue to work fulltime while you're going to school. Overall I am really happy I got the job so easily but honestly I was expecting a higher pay rate. Good luck everybody.