eegrnbsn

My hospital also does not split up isolation assignments. We are a med/surg/oncology floor. Our floor is split off into "pods" of 4 rooms (all our rooms are private). The other day my "pod" of 4 rooms had a c.diff pt., next door was a MDRO--urine+blood, and next door to that was neutropenic fever--wbc ~0.2. Seriously I could not make this up! I was assigned to all these pts. The point is, as other people have made, that there should not be an issue if proper isolation (or reverse isolation) procedures are in place and are being followed each and every time (not just by nursing staff-by MDs, dietary, housekeeping, PT/OT, lab, etc.). Our isolation pts. and neutropenic pts. alike have their own vital sign machine (dynamap) that stays in their room the entire stay so as not to pass infection to other pts. We use the disposable stethoscopes for the same reason. Of course gown, gloves, mask when appropriate, and HANDWASHING go without saying. The neutropenic patients: mask for all staff and visitors, no flowers/fresh fruits or veggies, handwashingx1000. We have an infectious control nurse who is seriously insane, and she does not have a problem with this. And our neutropenic patients are not getting sick.

Yeah I used to say the same thing. Now for the past month our small 32 bed medsurg/ortho unit is experiencing such low census (last Sunday when I left my shift there were 8 pts. on the floor) that they are calling 2-3 nurses off every single shift, and the "rotation" is going through the turns at least once per week. I haven't worked a full work week in over a month and all of our PTO hours are used up. So now when we get called off we just get the "on-call" pay ($2.50/hr) to sit by the phone for our entire 12 hr. shift and wait for them to call us, which they never do, because there's only 8 patients on the floor!! And we don't get any other pay, since our PTO bank is dried up. Heaven forbid you wanted to take a paid vacation sometime in the near future... So gift from the heavens...not so much any more :-/

This is how it works on my floor, except the charge nurse takes a FULL pt. load, not "one less pt." Exactly as you described, it's "ok, who wants charge today?" And that nurse carries the "charge" phone and makes assignments and assigns admits. You get an extra $1.00/hr. that shift. :-/

Just got a hospital-wide email from my employer stating that all staff are required (underlined in the email) to get a flu vaccine this year. It went on to say that those with egg-allergy or "conscientious objectors" (direct quote--but they put it in quotes! as if that was a fictitious term to them) may have to wear a mask at all times during flu-season, they said "details are forthcoming." I know this has been discussed during previous flu seasons. My confusion lies here: last year, my employer was not enforcing the flu vaccine with such vengeance as I see now. I never got the vaccine last year, and no one came after me, made me wear a mask, or even so much asked me if I had gotten one or not. No one even kept track. I would think that with all the hype about the Avian Flu last year, that they would have been strict about vaccinating employees then. Why this year, all of a sudden, are they trying to bully employees in to getting it? It was my understanding that this flu season is not predicted to be as bad as last year? Thoughts? Ugh, just add this to the list of things that never fail to amuse me about the company I work for...

I hate this! All the time the patients will put their call light on "I need to see my nurse." When I go in there "What do you need?" The patient says "I can't find the TV remote." or "I need my dinner warmed up." Really? These are the people who won't tell the secretaries what they need over the call bell system, just "I need to see my nurse." Do they really think I am the only person who can help them with these things and/or I am not busy with anything else!?

Every MWF each RN has to sit down with these 2 board members on the case management review team--the real "High Ups" (one is an RN and one is an MD, neither of them practicing any longer except on this review board) and "talk with them about our folks" --direct quote. Their job is essentially to get the patients out of the hospital the second they are ready and not a moment after. So they come after the nurses to "get the scoop" (another direct quote) about why the patients are here and "why haven't they been discharged yet." Each nurse has to sit down with these people individually and get hounded with questions..takes about 15 min. at least..RIGHT in the middle of your day..and if you say you're too busy to sit down and discuss with them you get in trouble. The thing that gets me is, every single question they ask you, can be found in the chart. If they just LOOKED IN THE CHART THEMSELVES. And the real clencher is, half the time, these board review members know more about the patient than we do! Example: RN: so Mr. Smith is 65 and here with diverticulitis. He's on day 2 of antibiotics. Board member 1: Which antibiotics? RN: cipro and...hmm I am not positive about the other one because he only recieves it on night shift Board member 2: It's flagyl. Board member 1: and did he come from home or from assissted living? and where is he going to go after discharge? and has he had his pneumonia vaccine? RN: he came from home but I don't know if he'll go back there after discharge or to assisted living. I don't know off the top of my head if he's had the vaccine but on admission the screening form was filled out so I'm sure it's fine. Board member 2: Well his daughter wants him to go to assisted living after discharge and the case manager is already working on it. ARE YOU KIDDING ME!? #1: If you want to know this pt diagnosis, which antibiotics, and his vaccine status, look in the freaking chart. #2: I never understand how Board Member 2 knows all these things about the patients..and if she does, WHY is Board Member 1 sitting here asking me the questions that they already know the answers to!?! and #3 Isn't this entire converstation more suited for the case management team..not the RN anyway? And this discussion happens for EVERY patient we have. EVERY Mon. Wed. and Fri. right in the middle of our workday....usually around 10:30AM If that isn't a waste of time, I don't know what is. And yes I realize that was an insanely long rant..but I literally think that is my biggest administrative pet peeve in the entire world...once again the nurses are supposed to do and know everything, and don't worry, we have plenty of time to do it, and with a smile on our face to! :-)

At my very small hospital (80 beds) almost all of the nurses are over 50! I feel like the odd one out in my 20's..in fact I think there are maybe only 7 or 8 RNs at my hospital around my age, everyone else is older. There are 2 nurses on my floor (med-surg / ortho) who are 66 and 67, both still working full-time 12 hr shifts (days). And most impressively, one nurse is 70 still working full-time days, 12 hrs shifts. She just celebrated her 50th year as being an RN last month. We threw a huge party for her and the entire hospital came, and there was a front page article in the newspaper about her. :-)

This literally sums up my biggest pet peeves in the world. I complain about this literally every single time I work. I'm glad I'm not the only one! To take it a step further, I have had patient's family members come in to another patient's ROOM to come find me for something. Literally. I have been in room 3 doing a dressing change, passing meds, drawing blood, etc. and all of a sudden I look up and room 2's daughter is IN ROOM 3 (walks right in) and says "dad needs to go to the bathroom." or, "mom is feeling nauseated." SERIOUSLY!?! My response is always the same: I say, "I need you to leave this room immediately. You are violating this patient's privacy by coming in to their room, and I am not available to speak with you right now. I will come see your mom/dad/the patient when I am finished here. If you need something before then, please use the call bell." and then close the door (a little louder than necessary :-) ) I mean seriously. I cannot, for the life of me, think of a situation where a normal human being would think that is an appropriate thing to do. Walk into another patient's room!? Ugh. These people are a piece of work. Thanks for the vent! :-)

Yes, we are out of 2 and 4mg morphine syringes. We had a few 5mg vials left but have used those up so just have 10mg left now. Also short on IV lasix 10mg. The scariest thing now is that we are out of both epinephrine and amps of d50, so much so that we can't even stock the crash carts with them anymore...!!??!? They originally told us these problems would be corrected by the end of June. Clearly....not so much.

I had a patient with a situation I nor any of the nurses or even our MD's have ever encountered before..wanted to get some feedback. Pt. comes to ER with CC of unable to urinate x24hr. Bladder scan shows 400ML urine in bladder. Admitted to our floor. Noc RN attempts foley placement x3. Each time, foley is in urethra, but no urine drainage. RN is positive foley is in correct place..anatomy is by the book. Notifies MD, urologist consulted. Foley is not left in d/t cannot be "positive" it is in correctly? So pt. has no foley at this time. Next day, pt. is voiding sm. amts. at a time (goldenrod-colored urine) 30-50ML at a time..doing so spontaneously. No c/o discomfort or bladder distention. This is a very small hospital and is a wkend and no urologist can come to the hosp until Monday...pt. refuses to get cath attempts again unless by urologist..keep this voiding pattern up all day shift and night shift. Voids 400 on days, 150 on nights, urine is progressively getting darker and more concentrated. Next day, pt. has only voided 30 ML very dark amber urine spontaneously. MD notified poor urine output still. Still no foley. Bladder can shows scan shows 700ML urine in bladder. Convince pt. to allow RN to try foley insertion again. Foley goes right in..drains 25 ML amber urine total for 3 hrs. Pt. ends up getting transferred to larger hosp with urological services. We are all stumped. Issue is clearly not with cath placement..clearly in the bladder b/c it did drain the sm. amt. amber urine (just like she had been voiding). WHAT could be the cause of a pt. who cannot void but 30-50ML at a time, despite over 700ML in bladder, and foley still will not drain urine? My thought (of course I am not a physician...) is that when we are bladder scanning this pt...we are not seeing urine. What if what we're seeing is a mass? What if this pt. has stopped producing urine (the reason for the urine becoming darker) so this is why it is not draining..and a mass is what we're seeing on the bladder scan? Can a bladder scan even show anything besides urine?(ie a mass/tumor?) I don't know. No one really acted on this, for ex. U/S her pelvis, etc...(this pt. does have a hx of uterine CA within the past yr. that she under went chemo and radiation for..) And now I will never know the answer b/c as I said this pt. has been transferred to a larger hospital! Any thoughts?

uh oh..well if so, I hope no one from admin. catches us writing on the boards!