TaylorMaidRn

Hmmm....well we are a small rural hospital...no social worker, no case manager either. We have administrators only from 8-5 M-F.

Started with 120, graduated 20.

Any hospitals out there have a policy regarding an individual being hospitalized and a minor child staying with them alone in the hospital room? Our hospital does not have a policy on this, but I feel uneasy about letting this child stay alone in the room with the patient here in the hospital, especially when she is requesting narcotic pain medicine. I do not feel right about giving her the narcs with the child there in her care, and her speech is already slurred and she is very drowsy from narcs she received in ER pta. Any input? Thanks in advance!

Nursing attorney and self-report ASAP

First, I believe you absolutely did the right thing. Do not let this situation deter you from advocating for the patient! Like the others have posted, I would definitely get a second opinion from another nurse before calling the doctor, and then charting that you did so, including their name and title. Second, when your nurse manager returns, I would ask for a sit-down with them to clarify if you were moved because of the phone call, and what would be the best way to handle the situation in the future. If you were moved as punishment, chances are they'll be forced to admit you did exactly as you should have done.

I love seeing non-clinical personnel make decisions for a hospital on what would be best for their patients regarding nurse-patient ratios! Makes perfect sense?

"Sooo, cutting back on our caffeine, are we?"

I am licensed and keep one in my car. Workplace violence is not unheard of in the hospital setting. Where I work, we have no security, and our rural county has only 2 sheriffs deputies and 1-2 police officers on duty during the night. These officers cover a radius that would take over an hour to cross. Response times aren't that quick. I doubt I will ever have to use it during my career, but its a comfort knowing that its there, should the need arise.

Well, more information would be helpful, but just based on info given, a 24 hour urine cortisol and/or 8am cortisol draw to rule out/explore Cushing's would not be unreasonable.

We usually use our nursing judgment and we normally get the patient triaged and to a bed quickly. However, there are times when we have an ICU/critical patient that it takes both nurses or all three nurses to get stabilized and ready for transport to an ICU 30 mins away. My problem with the system is that they not only want them triaged immediately, but also placed in a bed immediately. "Door to doctor in 10 minutes". How they have remedied that is to take one small exam room and cram 10 chairs in there and have us treat ESI 4 or 5s in that room. No privacy at all. They also require us to radio the doctor on a walkie talkie and have him examine the patient right there in the triage room. We have only 1 doctor who works 24 hr shifts, 2 nurses from 7a-7p and 2 from 7p-7a, and a midshift from 10-10. No aide, no clerk, no housekeeping, we do our on blood draws, ekg's, respiratory, bed baths, trauma and critical care, etc. Before this policy, truly emergent patients went straight back to a bed and were triaged and treated in the bed, all other patients were triaged and roomed immediately and treated as well, unless a bed was not avail, then they were triaged and placed back in the waiting room to wait for a bed (esi 4s or 5s), but a nurse also checked them every 15 mins.

The only code team we have are the ER nurses (2-3 total depending on what time of day). This new triage policy was put into place to increase press ganey scores. The idea behind it was to reduce LWBS and increase patient satisfaction.

Rural emergency room, new triaging system...1 RN triages every patient that comes through the door AS SOON AS THEY COME IN THE DOOR, and the remaining 1-2 RNs (no other support staff) treat all of the patients in the ER. (We can have up to 18 at a time). Safe or Not?

Marie.rn- yes, this was her first TPN treatment, she was originally supposed to receive it in the hospital, however, she requested to the dr that she be able to do it at home and go back to work so that she could keep her medical insurance which covered her son who was on a transplant waiting list (all this according to info sent from hospital). I had not accepted my schedule for the day, this was the disagreement and the reason I left and they fully knew this was the reason I was quitting when I walked out. I try to learn as much as I can and update my education when I come across any new skills that I will need to be able to perform, however, up til this day, the agency had a policy not to accept TPN patients, so I did not seek any instruction on it before hand. The agency had just decided to accept this patient because they were desperate for money/having problems meeting payroll. They did not warn us ahead of time so that we could prepare by educating ourselves on this skill. As far as getting another nurse to help me, only one other in the field staff had any experience in this and she probably would have helped me, except that her schedule wouldn't allow..she was scheduled to see patients an hour away from our location. The nursing supervisors had experience with tpn but refused to help. The agency KNEW I didn't have any experience with TPN because they keep a skills checklist in our file, AND I told everyone who could hear me that date that I was inexperienced with this. Since this has occured and I am not currently employed, I have logged many hours reviewing material on TPN therapy.

Thank you all! I'm currently looking into the malpractice insurance and wondering why I didn't get it as soon as I step foot in the nursing field! Thanks for all the info!

Thank you all for your responses and advice...I appreciate it greatly! I have made an appointment with an attorney who represents nurses in these predicaments to aid me in how best to go foward, and already feel a little relief. It just dumbfounds me that 3 days after I quit, I went in to finish paperwork/make corrections and the administrator asked me to please come back, told me I was an "excellent nurse", and then told me if I ever changed my mind, that I always had a job waiting with them and then they turn around and do this!?! Insanity!