wickeddiazrn

The people on here who are complaining about the JC I believe have issues with how their administration is handling the visit. Patient safety is a huge issue. Keeping our care driven by EBP and not just random ideas is so Important. In my 20 years of nursing I have never had an issue with a JC visit. They wanted to see the events then ask process and review questions. I have heard of facilities acting confrontational to the JC during the visit, and yeah I could see that causing some strife for everyone. All facilities should be in a constant state of preparing for a JC or CMS visit. That is what keeps places at the top of their game. Keep in mind that regulations and standards do not prevent you from having a bad day with poor through put. Instead of complaining or blaming someone about the delay in admission, why not look at your facilities process? What if that charge nurse had been involved in a patient emergency? What if she had already taken an admit or transfer and simply could not take the patient? What plan of action does your facility have in place to work through this? Then again keep in mind even with a plan in place things happen. As far as your person with an attitude even though they were possibly stressed out of their mind, that does not excuse being rude. Unfortunately some of those people work in healthcare. If you truly do not like or agree with how this is handled why not get involved at at a closer level with keeping up with the JC standards?

You can negotiate, but in today's current market you may loose some of the assignments. I always worked with 10 or so agencies and then picked the one that was offering the better package. You should also take into consideration how floating happens and how the agency will back you if you are told to float to a unit that is out of your practice area. I am a critical care open heart nurse and one place tried to float me to NICU! I flat out refused and my agency backed me up. I have seen RN's that were not so fortunate. Good luck with your travels!

It does not matter what her role or title is. She could have been a family member or a visitor. No photos should ever be taken especially without consent. The only exception to this is for would care progress documentation, or education if you have the person or family members consent to take a picture. Where I work family cannot even take a picture of their family members as patients when they are not awake, alert and oriented. If I am not wrong, I believe many places have even banned or limited videos of child birthing.

You can so long as you do not release patient information. I have nurses text me to please come to the floor they have a question about something, or my director will text me if I am out rounding as opposed to paging overhead. But yes patient protected information is a HIPPA compliance issue if you send it via non-secure channels of communication.

That is completely unprofessional, and I am sure taking pictures is against P & P, not to mention she just opened a potential HIPPA violation. I believe that smartphones have a place while practicing nursing, but it must be done in a professional manner. I am personally against any P & P that is as limited to say "no cell phones on the floor at work". I am a professional and I know I can use my smartphone in a professional manner. All of my nursing references are on my phone, calculator and I have access to online information. I recently moved into Risk Management where I work and I can have access to my work email while away from my desk with my phone. That allows me to roam around the hospital and check with the staff about issues, as opposed to being stuck at a desk all day. I will agree monitoring is needed with the use of phones. I also teach and I once had a student text me that she was going to be late for clinical. Not a good choice of communication and not acceptable. We also had an issue with nurses texting pictures of EKG's to cardiologist to read. That was not a smart idea. Not only HIPPA and against P & P, but really how well can you read a 12 lead on an iPhone. I know they have great resolution but they are so small. I would have either said something to her.

Nursing is very important, but we are part of a team, part of a bigger picture. I love being a nurse and very proud of what I do. The fact is that we are part of a team, but unfortunately many hospitals fail to promote teamwork. Each department constantly bickers and complains about the other and they never come up with a solution to fix the problem. If you think the patients do not hear that or see that then you are mistaken. They do, and yes these days the patients can pick and choose where they want to go. In reality without patients a hospital will not stay open. In addition, it is not just poor management that is at fault. We have all worked with those nurses that when you see them come into work, you think it's going to be a long day. They either grip constantly, are mad all the time, or just flat out lazy. Many of the changes that we want to see in our working environment have to start with us through actions, not just constant complaining. For the record I have seen admin come in during bad weather. I worked in Nebraska for year as a travel RN, and was very impressed that at one hospital I worked at one person from admin always made it in during inclement weather.

So you believe the hospital runs only on nursing power? Many other department support nurses and allow us to perform our jobs. Without all parts of the hospital we could not care for our patients. We do not work in a black hole. Try to run a hospital without a lab, or housekeeping, or IT now days. It just will not happen. That includes CEO's and administration. Yes, some of the CEO's and other admin staff basically suck, but not all of them.

I agree. Never sign something that you do not agree with. In addition, I would check your facilities P & P or your HR rules and regs on what your signature on a discipline action infers. Do not just relay on what your manger, director, or the HR director says in infers, always check. In reality, they may not know. If you are being told that you need to improve or if you are being told you committed an error that should be listed out and very clear as to what, when, where, and what the event caused. Red flags should also come up if you are never offered to be re-educate, or if your manager does not want to support you in improving the process change if indeed you did mess up or need to improve. These plans should be very clear with due dates, and who will be responsible for what. A good manager/director will want to spend time investing in staff to improve outcomes and get to the matters at hand. A good manager/Director will not just look for write up opportunities.

This is a great place to post this. I am a Quality Risk Manager and sorta new at the position. I have always been involved in policy and procedures, best practice, and patient safety, so some of the things that I am doing stayed the same. Something new to me is I am involved in monitoring our eSRM (reporting system). I am expected to investigate, track trends, and look for areas or improvement. Having been a bedside nurse for 20 years I also look for opportunities for education for the nurses. Many times if the same areas are reported on then it may be that the nurses were not educated correctly. I am not big on punishing but rather looking into why and then educating, at least until you know more and then at times you have no choice. Fortunately, the organization that I work for supports me in this and the administration culture open to education and not just discipline. Networking is a big help in this position. Many other facilities may have already experienced or gone through a situation that you may find your facility dealing with. Other places will share P & P with you and suggestions as to what worked and what did not work. I would reach out to your quality director or CNO at your facility. ASHRM is an organization that you could look into. They have webinar's, and a website where you can educate yourself on the areas that you need help with. For example I am also very involved in legal actions or possible legal actions against our facility. This is very new to me and the ASHRM has good information on this. good luck! ~Kris

Are you using Clinical Practice Guidelines to drive your measures? These would assist you with your measures. We have a EBP coordinator that monitors these on all the patient's but the bedside RN's are expected to monitor and keep the information straight. We also use "cheat sheets" on each of the groups. So for example we have a color paper that has all the SCIP measures on it and the nurses can use it to see what else they need to do or chart for the patients. It goes in the chart but not in the medical record. We also have checked all of our order sets against the CPG's to make sure that the orders are in keeping with the measures. Good luck. ~Kris

Please do not judge all administration by a few bad examples. I would hope someone would not judge nursing based off of a few bad nurses. Hospitals are kept going by all departments, not just nursing. Nursing just happens to be the largest work force in a hospital. And for the record when I went into administration I technically took a pay cut. I am salaried and can no longer make any overtime. As a beds side nurse for 20 years I regularly worked overtime. In addition, admin flexes off if the census drops to help with budget. Like I said, not all CEO's CNO's etc. are out to get everyone. Some are very very supportive of bedside nurses. ~Kris

This is frustrating. I have recently accepted a position as a risk manager at my facility. First thing, if these are being "written up" in an actually reporting format that your facility uses to track and monitor trends etc, that information is very confidential. Please be careful when posting "actual notes". Our eSRM system cannot be printed. When I do trend and have to present information to committees, to help with changing a process, I have to make sure that the information is very watered down. In fact no one can remove note or minutes from those meetings. I keep a record of the minutes only. Have you talked to your manager about this face to face and in a professional maner? Just because someone is in a management position it does not mean they have the best communication skills. He/She may be very uncomfortable aproaching people face to face or one-on -one. I agree that the drink at the station, I would have just walked up to you and had a nice discussion about it. In addition, Iagree that the rules should apply to her also. I always come across the reports that you can read are just being petty. I review them, look to see if maybe it could be a problem or why did the person report it, and then many times close it out. I can still go back in at another time and run reports to see if something is really becoming a problem. The fact that you feel that "you" are being written up and not the "action" is a big alert for me that the culture at your facility may need to be re-educated as to why reporting is important. Many of the saftey process that are inplace currently came from tracking errors. As far as the union, it depends on the union and the leaders of that union. I have seen great ones and poor ones. The great ones comminicate for the nurse with the management and have frequent meetings throughout the year. They do not only meet when there is a problem. They frequently discuss things in terms of patients and safety. Yes, they also support the nurses, but they also have a eye on the management/hospital side. Remember, if a hospital goes under due to financial reasons or saftey issues the nurses are out of a job too. I am curious did anyone "write up" or report the fact that you have a patient that should have been at a higher level of care? That is what needs to be addressed. That is a big patient safety issue. I hope things get better for you and that you find a way to get management to listen to you. You may want to speak to your Quality Director or Risk Manager if you feel like after you speak to your manager that things will not change. ~Kris

Leave it at home. Safest thing. If you do wear it what ever you do, do not pin it to your uniform. That is the best way for it to get lost. Do not forget that if it is raised up much at all you can scratch your patients skin even through gloves. Especially if they have frail skin.

To cover break and meals many California hospitals have a "float" or "cover" nurse that is qualified to cover the patients and they work a full 12 hrs shift. In addition, many of the Charge RN's cover for break and meals too. California while having controlled staffing ratios is not without problems. I would have to look up the study but when California was compared to other non-union, non-ratio (nursing to patient) mandated states, their (California) did not have better patient safety outcomes. I have worked outside of california without the ratio laws and in California with the ratio laws and the only improvement I could see was that, as a nurse I could only be given so many patients in California. Sadly at times acuities are not taken into consideration, and wait times in the ED's are ever increasing. As far as making your patients "break ready" that is a great idea on paper. In real life that does not work. You can try but you are attempting to control something that you can at best hope to safely manage. In addition, what about the nurse covering your "break ready" patients? What is their patients are fresh post-ops, or being discharged, or taking a turn for the worse? The best thing for patient safety is communication, and understanding that a blanket law or ruling is not a fix for every hospital or situation that nurses will find themselves in. We have to be flexible and recognize that what may work at one time or in one situation or in one particular unit, may not work outside of that particular situation or place. Being creative and open to changes and trying new ideas is what will work. ~Kris :)