Rexie

Granted, the money is good but what other professions have had their salaries capped? Personally, I am uncomfortable with the concept of capping salaries. But if we are going down that path, why not hospital CEOs? Why not accountants? Why target nurse? And now that this door has been opened, where will it lead?

Apparently it has happened in Massachusetts: https://www.mass.gov/regulations/101-CMR-34500-rates-for-temporary-nursing-services

I agree. It's a pretty crappy way to transfer patients I worked at a hospital that switched to a system in which the floor nurses received no report and were expected to monitor the room assignments in epic see when a new patient was added. The ER would then roll the patient to the floor 15 minutes later. We were often caught off guard, especially at change of shift. We were told we could call the ER if we felt we needed additional info but all I ever got was attitude, if the nurse was even still available. Anyway.... a few months after the Joint Commission inspection, that practice was ended and the ER went back to calling report. I hope your hospital eventually goes back to calling report

I've been working on a surgical floor and I am about ready to lose it over the constant interruptions, especially when I'm passing meds. We have an intercom system that the secretary uses to call into the room to tell us that we have a call. She says that all she is allowed to do is answer the phone and contact the nurse. She either is not allowed to ask who is calling or doesn't have the time - I'm still not clear on that. So I can either drop what I'm doing and take the call - sometimes it's a call I've been waiting on - or I can take a chance and leave the caller hanging until I finish what I'm doing, though they'll probably hang up. I was called away from one patient to answer the phone three times in about 10 minutes while trying to give his meds. It's just too many distractions and a med error waiting to happen. I'm not going to change the culture of the floor and so I need to find a way to manage this better. Or to find a new job.

I hate them too. Many patient keep accurate lists in their wallets but a surprising amount don't know or don't care. Calling their pharmacy to verify can be problematic as well because quite a few people use mail order pharmacies and I've found them tough to deal with. Then you have the people who shop more than one pharmacy. Whoever said it can be a "cluster" is spot on.

To my knowledge, I've not made a med error that resulted in harm to a patient. It's only by the grace of a God because every day it is push, push, push, rush, rush, rush. We need better staffing. I agree that patients are sicker than ever. They also seem to be needier. Maybe that's because they tend to be older and less able to do for themselves. Maybe they also have expectations of higher levels of service. Maybe it's because, out of fears of liability, we let them do very little for themselves. Then the Powers That Be blame us when patients become deconditioned. We can't seem to win. It's not just the nurses who are stretched thin. The doctors have been pushed to the limit as well. So are the HUCS, the CNAs, and everybody else involved in patient care. We're all struggling and need to find a way to advocate for each other instead of turning against each other as is too common. I think we're all pretty amazing to accomplish what we do considering how hard we're pushed. We need better staffing. Period. We need to communicate better between staff. I spend too much time cleaning up messes that could have been avoided if hospitalists would just talk to specialists, if pharmacists would just talk to physicians, etc. Everybody is stretched thin so they take shortcuts. Whatever goes wrong, it becomes the nurse's job to fix it. Not enough CNAs? The nurses will just have to cover. The pharmacy tech did not have time to load Pyxis machines on both sides of the floor? That's ok, the nurse can pull from 2 machines for each patient on her med pass. Materials did not have time to stock everything? Well then, the nurse will just have to take time to scavenge or to call every other floor until she gets lucky. Kitchen is out of applesauce for pt to take meds? Get someone to cover your patients while you run to another unit. And so on and so on. We nurses have a lot to do in a limited amount of time. We don't have time to play hunter-gatherer. It adds to our stress levels and is a distraction from patient care. We need to streamline processes instead of adding meaningless extra steps so that we can appear to be doing something. It should not be all about checking off the right boxes and looking good on paper. Too many falls? Why increase staffing when you can add an extra page of documentation and make it all look nice? Because that extra piece of paper will surely keep Mrs Smith from jumping out of bed and falling while the aid has been pulled off the floor to sit with the CIWA and the nurse is toileting another patient. There are far too many instances where we are documenting in duplicate or triplicate. And don't get me started about the interruptions! The doctor calls? Drop everything and come to the phone. Ditto with the lab calling with critical values or pharmacy calling about meds. Patient jumping out of bed? Well, there is no CNA available so put those meds you've poured into your pocket and race down the hall to keep the patient from falling. Family members hunting the nurse down because "Mother needs a cup of water" or they want to speak with the doctor Now. And then the Powers That Be grumble about the lack of critical thinking? We hardly have time to breathe. How many times has a result come back a little bit off and our first thought is " Crap! I don't have time for this! The physician is going give me attitude over this, etc" I really enjoy going over labs and disease processes and putting the pieces together. I like to think I do ok. But I could do better with enough time to think for a minute or two. I have to agree that all too often we're flying by the seat of our pants. I want to leave at the end of the shift feeling like I did right by my patient. I want to make a difference, even now. Those days are becoming all to rare and it huts my heart to settle for the knowledge that they're just all still alive. I truly believe that the business school types do not care (because I can't believe that they don't know) how close to the edge we come. I would like to think that if they only knew, they would find a way to make it better. When one of their loved ones is admitted, we're made aware who they are and they're treated well, insulated from the dysfunctional system they've created. I honestly don't know how we reach them when all they care about is the bottom line and their own compensation (including bonuses). All I know is that it makes me wonder how much longer I can work like this.

Is anyone able to tell me what the typical day is like for a nurse manager? Some floors seem to have nurse managers that are present for rounds and are out on the floor quite a bit, even answering call lights. Other floors seem to have managers that you rarely ever see - the charge nurse attends rounds and you rarely see the manager out on the floor. And some are in between. In my own experience, people usually think that people in different positions from theirs don't work very hard but they have no idea. So, I'm simply curious and have to think that our managers are busy but are doing things that we floor nurses don't know about. Is their time spent in endless meeting? Generating reports? I'm sure the powers that be keep them busy but doing what?

So long as I can pay my bills and have a little left over, I'd go for the better work environment. If not, I'd do what I had to do and keep looking for a position that would meet my financial needs and was a tolerable environment.

A family member has cancer and needed a unit of blood. The nurse in the infusion center intended to run it over an hour, though she had to slow the rate a bit due to a rise in blood pressure. It probably took 2 hours. On the floors I work, we typically infuse blood over 3-4 hours. It never occurred to me to run it faster but now I can't help but think, if the patient could tolerate it, it would be so much easier to run it faster. Which leads me to ask: how fast do you normally infuse a unit of blood and how well do your patients tolerate it?

On the floors I work, when a pt is being admitted, the home medications are to be reviewed in the ED by a med tech and then reviewed again my the RN as part of the admission process. Is this the most common method? We seem to run into a lot of problems where the first med rec is not done or not done correctly. Also, if the patient has a list, they too often send it home with family because they think it is no longer needed. Meanwhile, the doctors may be writing orders based on this information which may or may not be correct. It makes us floor nurses crazy. Another question I have is that if a patient comes in for a scheduled surgery that morning, we are still expected to verify their home medications when they come to the floor as a post op. I can't imagine how a post op patient, who is feeling pretty lousy and full of pain medication, is able to give a reliable account of medications they take at home. Is this common practice? It makes no sense to me.

I agree that the pt has a right to know everything about their care but there are certain things that they do not need to hear from nursing. The worst examples have been times when there was a question of cancer but we're waiting on radiology reports or lab results (or for the physician to speak with the pt). If the physician hasn't already shared this with the pt, bedside report is the wrong time for the pt to learn this kind of news. And I've seen it happen. My favorite bedside report is when we've covered the basics, discussed the plan for the day (as far as we know it) and update the white boards. I never want to wake a sleeping pt - they get little enough sleep as it is. And I never want to have to use a script. I've pushed back hard on that in the past and hopefully will never have to use one. It's insulting to the pt and to the staff.

We got a small soft cooler. It's actually pretty nice. TPTB provided ice cream sundaes that nobody knew about until after we'd returned from lunch. Typical. Last year, if I recall, we got nothing

I was just thinking about this yesterday. I make a point of taking my lunch break every day and if I don't get my lunch break, I will write "no lunch" when I sign out at the end of my shift. Even so, I often feel bad about taking lunch and return early. Even though I won't attempt to go to lunch until my patients are settled, I know that anything could happen and I worry about the nurse who is coving my patients in addition to her own. I wonder if other nurses feel this way too?

My manager has told us how much she appreciates and values us. Whatever she can do for us, she has. This seems mostly related to scheduling issues, though. As far a the upper managaement goes, absolutely not. They've cut back holidays, vacation accrual rates, etc. And then they had the audacity to send out an email that pretty much told us that the low wages we earn are pretty much the norm for our area so that's it. (Which is not true. Other hospitals in the area are known to pay better). My wonderful manager is the reason I stay for now but if the right position opens up elsewhere, I'm gone.

The hospital where I work requires us to wear a mask if we do not receive a flu vaccine, no matter the reason. One of the respiratory therapists told me that certain masks will cause a build up of co2. Has anyone else heard this?

The idea of nursing being just a job has kept me sane (less crazy?). Last summer I posted about being tired of being angry all the time. I was burning out big time. It has helped me detach and by doing so, I am actually a better nurse. I have to confess that deep down, I still want to change to world one person at a time. But by fighting that impulse to try too hard and take too much to heart, I find that I have less stress and more energy to apply to the actual care of my patients. I really appreciated that article and have bookmarked it. I plan on reading it from time to time to help keep my priorities in clearer focus.

On most floors that I work on, if there is a huddle, it goes really quickly. We talk about fall risks, concerns, and whatever management has decided we need to improve. Later, there is another meeting which is also attended by case managers and the physicians and NPs where barriers to discharge are discussed. It is a good opportunity to bring up any concerns with the doctors/NPs. My favorite floor has a team leader who will speak with each nurse individually to ask if there is anyone we're concerned about. It takes much less time than having a group huddle. It might be easier for the team leader as well - trying to get all of us together during the morning med pass is a challenge.

I used to absolutely hate when the ER nurse calling report would tell me "this isn't my patient, I'm just helping out" and proceed to read from the SBAR. I can do that myself! But after working at a hospital in which the ER does not call report, I appreciate any type of person to person handoff. The charge nurse is supposed to monitor the boards and patient is supposed to be transported a half hour after showing up on the tracker. In theory, this gives the floor nurse time to look up the SBAR and to call for any clarification necessary. I've called for clarification and gotten a snotty attitude. I also had a patient just get rolled up to the floor without any warning. I think it's unsafe. At the places I work that call report, I'm usually stressed but manage to get the stressed ER nurse to grumble along with me and we sort of blow off some steam together. Once they realized I'm not out to give them a hard time, they usually give a pretty good report. Every now and then, you get somebody difficult that you have to force to give you an acceptable report, asking them questions when you know they're trying to rush you off the phone but they're the exception. We're all stretched too thin way too often and it helps when we can remember that we're in this together.

I bought the crockpot liners at the supermarket though I don't use them often. I do all the prep the night before and take it out of the fridge and dump into the crockpot. I mostly do this so my husband will eat something besides popcorn and ice cream for dinner There is no way I cook other than maybe a grilled cheese sandwich or popping mozzarella sticks in the oven. I try to eat light because I tend to go to bed not too long after eating. If there's a crock pot dinner waiting or my husband has grilled or brought home a rotisserie chicken, I have a small portion. A glass of wine and some cheese and crackers is good, too. And I try my best not to stress binge on any and all the junk food in the house. Eating well after working 12's a real challenge.

To me, Good Patients are the ones who try to work with us. We're always about talking the patient's health care team. The most important person on that team is the patient himself. His attitude goes a long way in how well he will do. That doesn't mean that I expect him to blindly agree to everything - every test, every treatment, every medication - but if he refuses, to be reasonable and polite about it. Sometimes the patient is right. Sometimes he's wrong and if we're able to explain what we're doing and the reasons why, they'll agree. Sometimes they'll understand why and agree that they should probably go for a test but dammit, they've had enough. I get it. We're all imperfect, but the good patient makes an effort. That doesn't mean they don't have bad moments or days when they're irritable or uncooperative, but overall they're trying. I appreciate that. The bad patient is the one that makes no effort, undermines our effort, is abusive to staff, or totally uncooperative. The patient who is NPO that you catch in the kitchen drinking all the apple juice. The patient who will not put down the phone so you can assess or give meds. The patient who flips out because they have multiple orders for narcotics and benzos and wants them all at once. The patient who refuses all care but wants pain meds. The patient who is on the call button constantly for small things they can do themselves. The patients who act like perverts. The patients who otherwise abuse staff. The patients who sneak off the floor so they can do who knows what. The list is endless. There are difficult patients who aren't bad patients - the confused ones who constantly pull at lines and try to get out of bed. Or are just so sick that you spend most of your time on them, probably neglecting the rest of your assignment. In my experience, I've had only one nurse who was a truly bad patient.

Nurses are generally some of my best patients. I'm sure that I've been a bad patient once or twice, not horrifically bad but whiney. I was sick and I was scared. Sometimes we know too much about all the things that can go wrong, even when the chances are slim. And anyone, even nurses, are not at their best when they're in pain and otherwise feeling lousy.

I mostly like taking care of nurses or people in health care. It usually means that I don't have to translate a lot of things into lay language. It also give them the opportunity to ask questions that a "normal" person might not ask, lab results for example. They're usually my best patients. When I've been on the other side of the bed, I don't announce "I am a nurse!" But if they figure me out, that's ok. I almost feel like it's slightly dishonest to not let them know that I understand more than they think I do. I still expect to be treated like a regular patient. When it's a loved one who is hospitalized, I may or may not let the staff know I'm a nurse. I know some nurses (ok, I'm thinking of one in particular) who are positively obnoxious when her family member was admitted. Not cool. Also, I find it hard not to help out when a family member is the patient. Staff is always busy and it's hard to let that IV pump beep but I do. I will toilet them or straighten up the bed and then stay out of their way.

The trucker who is working through his lunch break is most likely eating while he drives. Due to the nature of the work and not being allowed to eat at the nurses station, nurses who work through lunch are skipping meals altogether. When I worked 8 hours shifts, I would do this regularly. Not that I work 12's, I will pitch a fit to get a meal break because I don't function well going without food for that long. I am not overweight and I pay no attention to BMI, but I have found that my relationship to food has changed since I became a nurse. When I first began, I had to work to keep weight on and now that I'm post menopausal, I have to work to keep it off. I find that the stress of work and the hours make healthy eating a real challenge, which I'm sure is a concern for many occupations.

I totally agree. It doesn't matter how or why you came to be a nurse. All that matters is that you do a good job. I suppose this is true for almost any job but I feel like the patients are vulnerable and relying on us to advocate for them so it is that much more important. Just keep their best interest in mind and the rest should (hopefully) fall I place.

I've always felt bad giving notice but you have to do what's best for you. This dialysis position does not seem like a good fit for you (or anyone!). You do not need your doctor's permission to do what is best for you. You're in pain and you have to opportunity to work a job that will not cause that pain. That's huge. It's up to you to do what is in your own best interest. The dialysis company will use you up and when there is nothing left, let you go and move on to the next nurse. You only get one body. Take good care of it, go back to your old job, and don't look back. Hope you're feeling better quickly