windynights

I am very curious why you would single me out with a description that feels like I've been assaulted, just to read it?

What really scares me about this, is that you have so few staff. Our nursing station is always full of staff...sometimes difficult to find a chair to sit in, to do charting. My attention would go to beefing up the staffing, rather than enclosing the nurses station. I work on an acute unit, with 30 beds, and we often have patients from jail. Potentially assaultive patients are the norm for us. But I'd be more uncomfortable with an enclosed nurses station than one that's open. I want to hear what's going on. That being said, I don't think anyone is wrong for having the preference to enclose the nurses station. Personal preference. And it must not be a JCAHO requirement, because we've had the open station for eons, and are always accredited. I'm grateful to have the numbers of licensed staff, who are well trained in managing assaultive behavior, on my unit. From what I've heard from other psych nurses, our staffing is to be envied.

If you are fearful of working in a psychiatric facility with an open nurses station, how do you feel about being out of the nurses station, interacting with the patients? I don't understand how you could be uncomfortable in the nurses station and not uncomfortable being in the milieu with the patients.

If the ratio is lowered, wouldn't that mean that the hospital could not take more admissions, if the ratio wasn't met? I'm speculating here, and would like to know what other hospitals are doing when they're out of compliance now. If the hospital is violating State law by being out of compliance, shouldn't they defer admissions? Doesn't mean the patients needing admission would be served, but might mean the nurses weren't exhausting themselves working with ratios beyond their capabilities. Our hospital is "self-reporting," meaning that they inform the State daily about whether the current ratios are met. Most of the time we're out of compliance...but because we're "self-reporting" we get away with it. I think the State doesn't investigate unless there's a "sentinel event." And any of us could file a complaint with the State, that would bring some presence to bear in our hospitals. But the complaints should be accompanied by data about events in which patients or staff were injured/harmed in some way. Your point about there not being enough nurses is valid. Didn't mean to take away from that. We rarely meet the ratios on our unit, and lowering the ratios wouldn't change that....unless nurses who aren't working now, would be attracted to return to nursing if they were assured their workload would lessen.

If the ratio is lowered, wouldn't that mean that the hospital could not take more admissions, if the ratio wasn't met? I'm speculating here, and would like to know what other hospitals are doing when they're out of compliance now. If the hospital is violating State law by being out of compliance, shouldn't they defer admissions? Doesn't mean the patients needing admission would be served, but might mean the nurses weren't exhausting themselves working with ratios beyond their capabilities. Our hospital is "self-reporting," meaning that they inform the State daily about whether the current ratios are met. Most of the time we're out of compliance...but because we're "self-reporting" we get away with it. I think the State doesn't investigate unless there's a "sentinel event." And any of us could file a complaint with the State, that would bring some presence to bear in our hospitals. But the complaints should be accompanied by data about events in which patients or staff were injured/harmed in some way. Your point about there not being enough nurses is valid. Didn't mean to take away from that. We rarely meet the ratios on our unit, and lowering the ratios wouldn't change that....unless nurses who aren't working now, would be attracted to return to nursing if they were assured their workload would lessen.

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Our patients take their voluntary time outs in their own rooms, which are not seclusion rooms and have no locks on the doors. They're either secluded or they're not. We have no involuntary time-outs. Didn't mean to imply that in my earlier message. We offer patients voluntary time-outs...and progress to seclusion if they are uncooperative and a risk for hurting themselves and/or others.

Our facility uses Voluntary time outs, and does not consider them to be seclusions. We view them as a way to avoid having to seclude patients. We explain to the patients that we are trying to help them to avoid seclusion, and want them to voluntarily remain in their room to help them gain control of their behaviors. If they do not agree, or are unable to follow direction...and their behaviors are such that they might hurt themselves or others, then they are secluded. Time outs, and 1:1 staffing, and short-hall restrictions (where the patient can not go outside certain areas), are viewed as attempts by staff to avoid seclusion. We chart to the time outs as being voluntary...and maintain good communication with the patients, to insure they feel they are involved in the decision to time out in their rooms. We view it as a way to educate the patients, as to how they can maintain good behavioral control

Our paranoid patients have, for the most part, been willing to carry their ID bands (with bar codes) in their pockets, and bring them out when there's a need for staff to see (or scan) the ID. For the extremely paranoid patients, we keep the ID bands near the computer, to scan when administering meds. Because of hospital policy, we have to have an order from the MD for this.

Thanks for your reply. I'm not worried. I am interested, and would like to see what others have to say about what JCAHO looked at, in their hospitals.

What has been the focus of JCAHO in your hospital this year? Just wondering if all the prep is worth the energy, especially when it takes away from patient care. Our nursing director keeps pouring out things we have to do, in order to be prepared for the upcoming JCAHO visit. I'm new enough to the experience, to question why we don't just do things as we normally do, and see what JCAHO thinks of us with our normal way of doing things. Comments?