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Where I work, we chart by exception. We have a shift assessment that is entered in the computer, each body system can by wnl, or abnormals checked. If you chart wnl, it shows you what you mean ex. under neuro wnl, a/ox3, perla, etc. I then do a progress note in the computer that supplements my shift assessment because some things are easier to narrate ex. wound descriptions, while there are multiple screens that I could go through checking, I just think it is easier to describe with words. I do chart by exception with most other things. I often chart things like an iv site as unremarkable. I was taught that that means it isn't red, painful, swollen, outdtd, cold to touch etc. and and it alleviates the chance of you accidently omitting one of those words. I work on a med surg unit, sometimes I have 10 patients to start and with discharges and admissions by the end of twelve hours I have taken care of 12-14 patients or more. I think that if I wasn't able to chart by exception I would sleep over some nights to finish. I do progress notes throughout the day for anything that happens, patient going off floor for test, patient complaints, calls/discussions with md's, discussions/teaching with patients & families, etc. If there is nothing to chart in 12 hours except their assessment (not likely), I would chart a note halfway through the shift that the patients assessment is unchanged. There is alot of information regarding charting by exception, but if you can imagine 4 years down the road when you may need to refer to your notes and explain them to an attorney, chart with that in mind. In other words I would rather have someone ask me, what I meant by "unremarkable", as opposed to someone ask me since I charted that an iv site was not red, not swollen, not warm or cold to touch, not outdtd, did I ask if it was painful....and then have to answer of course I did, because I always do. We all know if we didn't chart it, we didn't do it. I think many may say that you can't chart worrying about a lawsuit, but having seen people go through it, I say it is the only way to chart.

What is it?

At the hospital where I work we track the time it takes for patients to be moved from the ed to the floors. I am on a med-surg floor and our time last month was

Hey, what about New Jersey? It is a great place to live, I am talking Central/South. We have the shore, We have mountains, We have beautiful change of season, We have Bruce Springsteen!!!! LOL! I would be interested to hear what your search says about NJ though, we really need you here!!! Best of Luck!

Thank you for the reply. I don't know anything about any of this, just throwing around ideas in my head. Thinking of contacting an attorney for some legal advise about the different options, ie. incorporating or not.

I have recently been throwing around the idea of starting my own business. I guess it would be similar to an Agency, but different in that I would want to contract with hospitals to provide nurses but their part of the contract would hold them to a safe patient ratio. In NJ, our staff nurses are making approx $22/hr, we are working with Agency RN's that are making $40/hr. I started thinking, what is their agency billing for them? I considered quitting and going to work for an agency, but now I think it sounds alot more empowering to be my own agency. If anyone has any thoughts, or advice I would love to hear it.

Med-Surg nurses are beginning to realize their value, so for starters you may want to pay them what they are worth. Of course the chances of that are slim to nil, the only other thing that I would be concerned with that would encourage me to make a move is nurse-patient ratio. Most nurses that left the hospital settings in the past will site that as a big problem. Good Luck

I worked as a CNA as I was going through Nursing school, I found it invaluable. It helped me to begin to feel comfortable being in the healthcare setting, and comfortable around sick people. I am sure it helped in ways I am unaware of as well. Lastly, I don't think the "tough" work will discourage you, if you discourage that easy you will find it very difficult to get through your schooling, let alone being a nurse! Good Luck!

Great ideas everyone! I am a Diploma (Hospital program) RN. I got a great education, and I am a spectacular bedside nurse, if I do say so myself. Higher education is an option that I am interested in, but I don't think that is the answer to joining us all as professionals. The argument that if we had entry level BSN requirements we could all join as professionals is lame. We would probably all argue about what BSN progam is better! I think it is important that we all join to make nursing better for all nurses. How we are going to do that, I have no idea!

Great ideas everyone! I am a Diploma (Hospital program) RN. I got a great education, and I am a spectacular bedside nurse, if I do say so myself. Higher education is an option that I am interested in, but I don't think that is the answer to joining us all as professionals. The argument that if we had entry level BSN requirements we could all join as professionals is lame. We would probably all argue about what BSN progam is better! I think it is important that we all join to make nursing better for all nurses. How we are going to do that, I have no idea!

I read through these posts and I think that all of you are doing the same thing.... Finding one piece of information to use against an entire idea. It is no different to crucify those who believe in the MNM for their ideals than to crucify the ANA for not doing enough. I would bet the ideals and purpose of the ANA are similar to those of the MNM, and both are right. I think membership in the ANA is something that we should all do, because it will give the ANA the power and voice that it needs to make changes. The ANA is attempting changes for advanced practice because I would bet that they are the people that join, it makes sense. The MNM is attempting changes for bedside nurses, because we (I am a bedside diploma rn), don't join our National Organization. Eventually, MNM will be a national organization, and I dare say it, you may need dues, and you will attempt change focusing on the desires of your members. The infighting among people with different ideas should be expected, it is how new and better ideas are formed. The personal attacks and insults could be left out though, I think you discredit yourself when you make personal insults, I also think the excuse of cost to join a professioanl organization is played out. If a change is going to happen ever, it will cost us. To march will cost people something as well. I believe in both organizations, I come to this site whenever I can, I get great information, I copy alot of the articles and bring them to work and hang them on our bulletin boards. I will March, and I will continue to believe that membership in a professional organization by all in our profession will create change. I actually think that eventually we will have a meeting of the minds in our profession and change will happen, possibly by all of us being in the same organization, maybe it will be called Million Nurses Association. You know what they say "a rose by any other name...".

I read through these posts and I think that all of you are doing the same thing.... Finding one piece of information to use against an entire idea. It is no different to crucify those who believe in the MNM for their ideals than to crucify the ANA for not doing enough. I would bet the ideals and purpose of the ANA are similar to those of the MNM, and both are right. I think membership in the ANA is something that we should all do, because it will give the ANA the power and voice that it needs to make changes. The ANA is attempting changes for advanced practice because I would bet that they are the people that join, it makes sense. The MNM is attempting changes for bedside nurses, because we (I am a bedside diploma rn), don't join our National Organization. Eventually, MNM will be a national organization, and I dare say it, you may need dues, and you will attempt change focusing on the desires of your members. The infighting among people with different ideas should be expected, it is how new and better ideas are formed. The personal attacks and insults could be left out though, I think you discredit yourself when you make personal insults, I also think the excuse of cost to join a professioanl organization is played out. If a change is going to happen ever, it will cost us. To march will cost people something as well. I believe in both organizations, I come to this site whenever I can, I get great information, I copy alot of the articles and bring them to work and hang them on our bulletin boards. I will March, and I will continue to believe that membership in a professional organization by all in our profession will create change. I actually think that eventually we will have a meeting of the minds in our profession and change will happen, possibly by all of us being in the same organization, maybe it will be called Million Nurses Association. You know what they say "a rose by any other name...".

As far as to join or not to join the ANA, I once asked an MD why he joined the AMA. His answer was that "It is expected, as PROFESSIONALS, to join our National Organization.". It really made me think about opinions that I had about the ANA, including, what the ANA could do for me. If we want to be treated like professionals we have to start acting like we are. Membership in a professional organization is something that we should all consider, and maybe consider what we could do for the ANA with our involvement. I can't remember the exact figure, but there are upwards of 2 million professional nurses in this country, and we have very little power, because we have no group to represent us. Unlike the AMA. Just food for thought.

I tried, it says the pages are currently unavailable for viewing. Sorry.

I worked the 7A to 3P shift before we switched to 12 hour shifts. The 8 hour shift was always so busy I ususally left 4-4:30 in the afternoon. My theory is at that point why not stay a short while longer and get an extra 2 days off. With only 2 reports in a 24 hour period there is much less chance of something being lost in reporting, especially on a med surg floor where the ratio is 1 nurse to 8-10 patients. Also, I think the benefit to the patient is continuity of care. I think our hospital had one big benefit, 3 12 hour shifts equals 36 hours, 4 free hours before you start earning time and a half, compared to 5 8 hour shifts you earn time and a half for all time over and above your shift. I like the 12's, I wouldn't work five 8's again.

I am looking for anyone that works at or knows of this hospital. Recently, the hospital I work at implemented a program that according to them works very well in Baptist Hospital. It is called Quinton-Studor (excuse the spelling). The admin at our hospital believes it is the answer to our problems of short staffing and overall decline in the quality of our work environment. Of course, any answer that doesn't involve spending money or hiring nurses seems to be what they prefer to try and try, and try. Anyway in the kick-off for this program we were told that at Baptist Hospital once they implemented THIS program the call bells don't go off and they actually have RN's on a waiting list to work there! In case any of you are wondering, it is a program of zero tolerance for not following key points about Attitude, Accountability, Public Etiquette and the like. Just curious if whis program made the difference, or did they implement other programs re: recruitment and retention of nurses and staffing ratios etc. Any input would be greatly appreciated.

If I were you I would check the policy of the hospital where you are working. You may find there isn't one, in which case you should bring that to the attention of the Managers or if you have a Professional Practice Team, or someone that can start the process of forming a policy. Also, do you report off to the dialysis nurse? That would be an important difference, if you don't, which in my hospital we don't, than I would say you are just as responsible as if the patient was still in your unit. Also, I would say, if a patient is having any type of abnormal tele monitoring it certainly doesn't seem like a monitor tech giving that info to a unit secretary via phone sounds sufficient. You could probably use this experience to benefit your patients and other staff nurses by improving quality of care. I would follow it up, ask around, contact risk management, ask them. The policy of your hospital will be what is most important as far as your responsibility. But if your name is on that chart, you are responsible.

Sorry to say, but if you are dealing with Psych patients one of the risks is violence. I would say always protect yourself and the staff. Always remember, keep yourself between the patient and the door, use a buddy system if you need to. Block arms and legs even if they are not moving. And remember, if someone bites you, push toward the bite, don't pull away. Keep the room clear of anything that can be thrown or used to hit you with. At least keep these things out of reach. If the patient is that dangerous, you should be able to get security to stay in the room, or restrain the patient. Explain to the family that it is in the patients best interest as they could hurt themselves trying to hurt you. If that doesn't work, explain that you can not allow the patient to endanger the staff, or other patients for all you know. Also, you need to speak with the Manager of the floor, everyone should be on the same page as to exactly what to do if a patient becomes violent or hits the staff. Good Luck.

After reading all the posts and considering the original question I am struck by how amazing we nurses are. Most nurses are really unhappy with the healthcare system of today, we work like dogs to say the least. Ours is a job as physical as it is mental. I know nurses, who have literally had to pull over on their way to or from work so they could vomit because of the stress of either what they were facing or what they were leaving. The key point is after they vomit, they continue on to work. Politics, forget it, I often think that the hospital I work in is similar to adult high school. It is definately beneficial to ride the tide of popular managerial opinion, and never tell a Manager the impossibly obvious idea that "You can't run a Hospital without Nurses, why do you keep trying?" Been there done that, it doesn't go over well. However, commit to going to work and doing your job the best you can and you will be fine. As for the job, there is nothing like it. Keep a gratitude journal, you will find joy in a single touch, or a mili-second of eye contact with one of your patients that can sum up everything you and they are doing. You will earn respect from peers if you are true to your patients and yourself and them. My job makes me crazy at times, it enrages me, and it enlightens me. I would not change it for the world.

I replied to the article as well. I mentioned that a new grad perspective and sign on bonuses were not the way to go. I stated and I hope I was right that most RN's would be more interested in improved conditions and general professional respect from the Hospital's than a sign on bonus. I also brought up that they should consider all the elderly that come to the hospital with no family and no one to be their voice. I said they should research the amount of lay offs over the last years that hospitals did that caused RN's to leave our profession in droves. I said they should consider the real evil in our health care system is the INSURANCE COMPANIES, who have taken the money of these people for years and years and their employers and now set up criteria and rules and squeeze the hospitals. I basically said the problem is worth alot more than what seemed to be a 5 minute blip. I suggested that they visit one of the many Nursing Bulletin Boards to get a feel for what we think about this shortage. Hopefully, if they get enough response they will do a follow up piece. One more thing, have the reporter follow a staff nurse on a med-surg unit with no notice. Have them just walk in to the hospital and request to do a follow up to the story. Ask specifically for med-surg floors, where my experience tells me they are always short. If the hospital refuses, they should be able to draw some sort of conclusion from that!!!

The hospital that I work in we give verbal report, most of us go through our patient rooms and eyeball the patients before report. A quick they are breathing, lines in, lines out, dsg check look. I have worked where report was taped, and I have done walking rounds. I don't like taped because I don't have the oppurtunity to ask questions easily, walking rounds takes quite a while in my opinion, even though we have incorporated the concept into our routine. Also, with taping, taking report from nurse's with heavy accents is difficult, it is easier to understand them face to face.