Kate RN

In our hospital the OB unit uses provided scrubs that are laundered by the facility. So in that department it is easy to tell who is a nurse. In other units we wear our own scrubs and in whatever color we like. btw I have seen some black scrubs that looked very professional and I liked it. It is difficult for pateints to know who is who as the other departments are also wearing whatever color scrubs they like- housekeeping, radiology, lab, even kitchen folks. Maintenance and volunteers are color coded. and the surgery folks wear provided scrubs so they are too. We talked about "color coding a couple of years ago and that was not well recieved. It was not the battle we needed to fight at the time- I was on the Practice Board- so it was dropped. Now I am reading "Nursing- Against the Odds" by Suzanne Gordon. She criticizes Nursing for not Looking professional in our pajamas, and that we do not stand out as nurses because of what I describe above. I am not done with the book yet- but again I am wondering where we should be going with our "uniform" as a profession. What are all of you thinking??

We do have the same expectations for getting the patient ready. It simply helps the flow. but we use checklists for orientation and socialization to get the new to the dept nurses up to speed with what can be done before the MD actually sees the pt.

I am not staff development. I have been on the Nurse Practice Board for the last 3 years- which is a new thing for our hospital and a very good thing for Nursing. I am a staff nurse and have no intentions of changing that. Do include yourself on any self governing nursing body that meets in your facility. Your role will be to help facilitate their work. Being there will help you to understand the goals of that group in the requests that are generated by their work. Rest assured they will have requests. I totally empathize with the post wanting to know how to reach all 3 shifts. When you figure that out please share. There is not a perfect time that we can find so poll the learners and do the best you can without burning yourself out.( do not come in at 0300 to teach as that will be the night of multiple CODEs.) Do put the dates of classes out as far ahead of time as you can so that the staff can schedule themselves and their daycare issues around the classes. Self learning packets go over well here, but not everything can be taught in the same formats. I will be watching to see what else comes out here. We will all benefit from wisdom shared and it makes Nursing in general stronger.

I am not sure what this model looks like. We chart by exception. This means that if a system is normal or not indicated by their complaint we do not chart about it in our assessment. So in the case of a laceration I may not check lung sounds unless they are wheezing and it looks like the reason the pt fell and cut themselves. Is that what you are looking for? We are also computerized so the format is driven by the software. We were the first ones live on this program so we have had a lot of opportunity to have input on what it does. As much as this process was painful there were good things about being the 'pilot' I hope this helps.:Melody:

When we took the tests as Juniors in high school that are supposed to tell you what you would be good at- the results said I should take a technical desk job- like a secretary. I laughed at that- I cannot sit still for 30 minutes much less 9 to 5. I knew I wanted to help people.(stupid thing is kids in my freshman year gave me a hard time for choosing a major for this reason- what did they know? and glad I did not listen) I thought I should be a PT. When I get to college I was babysitting for a PT and read through some of the course books on their shelf. I realized that they sort of "hit and run"- and that they cause an amount of discomfort while they are at it. - this was my perception, I love the PTs I work with now. - I did not want to burn enough midnight oil to earn the 4.0 I would have needed to get into the PT program either. So I went through the course book a few times and realized that Nursing is what I needed. NO regrets about the choice. The reward is in the thank you's pts and their familes give. It has also been quite nice to get a job easily every time we have moved. I have had paychecks from 7 different hodpitals in 17 years in 3 states. The flexiblity and the payscale do not come with every profession.

this is another tangent of this topic. We are all in danger of patients and families anger. Our facility just gave us excellent inservices on de-escalation. This includes not being in this guys room alone once he starts to show frustration and anger. Get out of the room- even if it feels rude. It would appear it could not have made him more angry. and to always keep your palms down whenyou are tlking to some one that is upset. This was emphasized several times through the 2 hour class. This is a topic that NEEDS to be taught to students- and has not been. It is now part of our organization's orietation. and it is not limited to nurse staff. Yeah- this is an adult, and he should be held accountable for his actions. I have been punched by a patient- I did not bruise and did not require Xrays. The pt was confused though. His father- who was 70 at the time- helped tackle the man who had been roaming the halls in his undies. I did not even think to file charges. The administration was more than alarmed that it had happened and they still use it as an example of what we need to prevent. If I had been bruised and bloody I doubt my husband would have let it go without police intervention.

The only solution to all this that I have been able to come up with is to educate people that are not all that sick. We have a standard of asking almost everyone that comes through our facility if they have written their wishes down.( I am in the ED now) I know that many nurses ask and do not spend any time talking about it. Not me. If I think it is in way relevant to the pt- if they are older and/or have a bunch of children- I tell them that is very imprtant to think about what they would or would not want done and then TALK to their families- give them permission to say "no" to further treatments and tests. I tell them that it is too hard to decide not to do everything when your parent is very ill and that is enough to cope with at that time. I sya that we will do whatever they want - but we need to know it is what they want and I tell them talking about it is still more important than documenting it- the people can pay a lawyer,,, I have seen too many children come flying back from out of state saying "I just talked to him/her and he/she sounded fine- so do everything." and just be ding-danged if we do not 'save' them sometimes only to have them come back in a couple of months and finally die of the same thing, and we were doing 'everything' again. Because of this phenomenon I teach.

I never would have thought this question would generate so much talk. Depending on the day and the department usually I get my own v/s. and prefer to. Occasionally there is someone assigned who has done the first set. and sometimes I even find out about it before I start taking them myself.and I prefer to get the B/P manually. I think it is faster and I know it is more comfortable for the patient. I also trust my ears more than the machine most of the time. I work most of the time in the ED. and day and night shifts. It is on the med/surg unit that occ my v/s are done for me. It is nice to have help. There is a printout that automatically comes with oiur machine. They stick that on the front of the chart as well as documenting them on the graphic. This does seem to work. K

At the end of it all I must say that I believe that the majority really have pain. But some have learned strange ways to cope with their issues. Some that we have met have other things going on besides their pain. Some probably do not have pain. But the sad thing besides the crappy attitude we have adapted becasue of feeling abused is that these patients do not get the services they truly need. They do not follow up with pain clinics on schedule like we contract with them. They do not get the counseling they need to help with the social issues they are trying to escape with my drugs by lying to me and my doc. Their true needs are not adequetly adressed and this also feeds into our frustration- whether we name it or not. When this patient leaves we do not necessarily feel like we solved anything. - sometimes I do- sometimes I really feel like it is a person with a headache they cannot control themselves and we just got "her" over the bump so that the headache can be controlled at home. These people seldom leave with a zero pain rating- just enough better to feel like they have control. They are happy -so we are too. These do not always get or request narcs either. If is was an easy topic it would not have generated almost 10 pages of discussion. If my crystal ball worked so I could see what pain is real that would be the best! And I agree that the fakers that inspire our doubt deserve a special hell. Telling the difference I imagine falls into assesment skills. We are trying to figure out what our patient really needs. Maybe it is not really drugs- maybe it is counseling. and maybe it is drugs and then it is sad when we cannot let the patient be an active part of the care planning team- because we have "learned" to question motives. K

I am looking forinput to help with our scheduling as well. We ahve had a sort of self scheduling in place for some time. There had been block schedules before that,a nd before I came to work here. So the ones that have been here that long do not want to go back. However we are not being successful with the self scheduling model either. People do not move once they have filled things in. It goes by senority which is fine but then the same people get moved around to accommadate holes in the schedule- or staff mix issues so that not all inexperienced or new to us nurses are staffed on the same day. There is so much frustration. There has been a vote to change the current model. I am having trouble finding information about either block schedules and how they are being set up- or really anything other than software to do any of it. I do not think we really want to give control to a program either. Any kind of input is going to be a good thing. To make it more interesting we have a mix of 8 and 12 hour shifts- and the resulting 4 hour left over shifts- and some every other and some every 3rd weekend. Thanks

I am looking forinput to help with our scheduling as well. We ahve had a sort of self scheduling in place for some time. There had been block schedules before that,a nd before I came to work here. So the ones that have been here that long do not want to go back. However we are not being successful with the self scheduling model either. People do not move once they have filled things in. It goes by senority which is fine but then the same people get moved around to accommadate holes in the schedule- or staff mix issues so that not all inexperienced or new to us nurses are staffed on the same day. There is so much frustration. There has been a vote to change the current model. I am having trouble finding information about either block schedules and how they are being set up- or really anything other than software to do any of it. I do not think we really want to give control to a program either. Any kind of input is going to be a good thing. To make it more interesting we have a mix of 8 and 12 hour shifts- and the resulting 4 hour left over shifts- and some every other and some every 3rd weekend. Thanks

I see that no one answered you initially. We are wanting to change our staffing method and block is what we think we want to try. What did you end up with, and how is it working. We have a smaller staff, there are less than 20 of us in the ED , work the same kinds of shifts (8,10, 12) , but we are not a contract hospital so what we agree upon among ourselves is most likely exactly the way it will be done. Our manager has said as much. This is an earned attitude though. And a good thing. Please let us know what happened! (Fact is I found this bulletin Board because of this thread. I will return for other things but this is why I came.)K

We have seen the whole spectrum of migraine complaints. But the sure sign there is a problem folks is this- if they get their shot and scoot immediately to the bathroom- to huff the air freshener- then we know there is a problem. Yep we did catch one. This Pt no longer gets narcotics in our dept. We spent time on the net and found that air freshener somehow makes the high better. Yeah whatever. We really try to believe what our patients tell us about their pain. and treat according to their complaints. I hate that patients like this affect the care of those who would never dream of abusing us. K

Customer Service has been a major focus for us, especially in our ED that just finished major reconstrustion. We have not found a magic formula either. Our surveys go out to everyone before their bill. I have been known to respond to thank you's on discharge with a "your welcome- my name is Kate so you can fill our survey out when it comes" they usually think that is funny. Advice from management has been to make sure to ask if there is anything else they need. This gives them the feeling we have time for them- even if we do not. On the floor we are trying out a plan- to spend 5 minutes sitting with the patient discussing goals for the day. The study we read says patients will percieve it as much longer than 5 minutes and that it has positive impacts oin the surveys. As far as why we care about the survey results- we are piloting a model of Shared Success. If they survey results and the net income of the organization are at predeterimed levels at year end we all get a bonus check in ratio to our pay level. Not such a bad deal if it works.