neurotraumaRN

"Sleeping on duty is technically not a violation of the NPA. However, if a nurse is sleeping she is neglecting the patient's in her care. So the violation is negligence. If a nurse is on break and has reported and someone accepted the responsibility of watching that nurse's patients then the nurse is not negligent. It may be against the facility policy for a nurse to sleep at any time while on duty and if this is the case it would be an employment issue." This is from the NC BON.

In my unit, you get a one hour unpaid break for lunch. You are allowed to leave the hospital to eat and if so, you clock out and then back in. If I stay in the breakroom, and decide to take a short nap, I could face disciplinary action for sleeping? Yet the ones that leave the hospital completely are not penalized? That doesn't make sense. To me, unpaid break=off the clock, employers shouldn't be able to dictate what you do. (And I'm in NC....maybe I'll email the board and ask!)

administering them each separately? you would be there all day! they are going to get mixed up in the stomach anyway, so what's the point of that? (depending on the amount of meds, you may also end up with a lot of flush in the stomach!!) i'd never heard that before, we always just mix them all together unless there is a specific contraindication. anyone else?

Hi everyone, Sorry this is long, but here goes.... I'm an ICU nurse wondering how everyone out there does their acuity system. The reason I ask is that I had a situation at work that I feel was very unsafe, yet management was aware of it and I don't really know where to go or what to do from here. My first day that week I was assigned to two patients, they were doing a procedure on Patient A when I first got there and while I was getting report. About 15 minutes after report ended Patient A coded - we got him back pretty quickly but after that I was hanging multiple drips, etc, busy with all the post code activities. Finally the charge nurse starts doing the assessments for Patient B and gets her squared away, she is off to the OR so I don't have to worry about her for the moment. Patient A meanwhile is consuming every bit of my energy. He has literally 14 IV pumps going - sedation meds, 3 vasopressors, insulin, maintenance fluids, replacement fluids (losing a lot from his abd drain), K/Mag/Ca/Phos supps, abx, etc. I'm pushing bicarb and he is also getting liter after liter of fluid on the warmer. He has a swan and I'm doing Q1 hr wedge readings. He also has 4 chest tubes to keep track of and now his kidneys start shutting down, so they consult renal - they start CVVHD later that day. I'm also dealing with family since of course they are distraught that he has taken such a turn for the worse. Luckily at this point my charge nurse decides that when Patient B comes back from the OR they are going to put her in a different room. She is also pretty sick, beginning stages of ARDS and making lots of vent changes on her. Anyway charge nurse tells me that she'll keep my other bed open but if an admit comes, that she'll care for it, so I will be one on one with Patient A. Whew. The thing about this unit is that they literally NEVER 1:1 their patients. So I get there the next day, and I am told BY THE NIGHT MANAGER my assignment is Patient A and Patient C, a stable vented patient. I say "Is Patient A more stable?" She says no. I ask why Patient A is not singled, she repeats "the assignment is Patient A and Patient C." This is where I don't know what to do. I don't think switching my assigment will help because ultimately someone will have that assignment, and at least I already know Patient A. Plus I have had him for a few days now and have bonded with his family, etc. So I get report and the night shift nurse had that same assignment, tells me basically "yeah it sucks, but they don't 1:1 people here." My question is WHY THE HECK NOT? Both the day and night managers were aware of this patient's acuity and he is still doubled. He is still a full code and he has so many hourly things to do you barely have time to finish them before the next hour is here. I am just so frustrated by the mentality that the other nurses have - they just say "well this is just how we do it here." They say "we all just help each other out." Sure, so if something happened to Patient C, you're all going to come to court with me and say "Well we all work as a team here"? That is unacceptable to me. I have been at this hospital for about 8 months now. I have 5 years of ICU experience in teaching hospitals. The hospital I used to work at would 1:1 sick patients based on an acuity system - Level I, II, III, etc. Here they don't have that. Each nurse is assigned to two patients, period, end of story. They don't have any flexibility in their staffing at all - 11 bed unit, 6 nurses each day. One to do charge and take one patient, everyone else is doubled. I know that in another unit, they double two CVVHD patients together, so I know it's not just my unit. Did I mention this is a Magnet Hospital? Ha! What should I do? Sit down with my manager and raise my concerns again? Go to risk management? Can anyone offer any advice or words of wisdom? I just don't know how to even change things since no one seems to think it's a problem but me and a few others - most of them just accept that this is how it is.