explorereb96

A patient with ICP would most likely be in the ICU. I don't know many ICU's that utilize PCTs and if they do those PCTs are specially trained AND take report with us nurses. Either way, with the knowledge of this person with ICP should not be placed in Trendelenburg, the nurse should make it a point to tell anyone (family, other nurses, PCTs etc). Most of the newer beds also have HOB locks on them also to prevent inadvertent unsafe positioning. Raising the foot of the bed is not necessarily lowering the head of the bed either. We could also place a sign at the head of the bed on the wall. "Do Not Place Patient in Trendelenberg, keep HOB at 45 degrees at all times." Safe repositioning of a patient needs to go both ways...safe for the patient and safe for the nurses.

Our hospital literally has NO tools. We have NO Hoyer lift. The only slideboard we have is for transfer. so we have Chux pads and a draw sheet and beds that can go into Trendelenburg. So if a patient slides down to the end of the bed, and is 200 lbs or more, those are the tools we have.

you answered your own question. IF you have the staff to "lift" a patient over 200 lbs without sliding them, more power to you. We all aren't so lucky.

Well to be fair common sense cannot be taught. You either have it or you don't. You can teach ways to aquire common sense and critical thinking but I believe experience is the only real teacher. It's simple physics. I am sorry for the patient, but when you are only given 2 staff to "lift" these patients over 200 lbs. It's either get pulled up and risking a little shear or they can't be pulled up until there is someone else available to help. I have been bedside for 38 years and still need my back to work for me at least another 10.

In our EMR (Cerner) on admission, there is a Suicide risk assessment area in which we fill out. OK fine, but do we really have to chart the suicide risk assessment on every patient every shift? It seems ridiculous to me. Yes, if we identify someone who is at risk (of depression, anxiety, psych issues I can see it), but to ask a patient these questions every 12 hours and chart on it every 12 hours for the duration of their stay is silly. I can also see if there is a change in demeanor or condition. Our hospital (and the only one in our system of hospitals to implement it) wants us to do just that. Is this a thing? TIA for your honest feelings on this and your experience with this.

Well I think for at least 6 months we should ALL do it and do it like they want us to, When it starts costing them exorbitant amounts of money in overtime they will b*tch about it. Then we can all chime in together to say, "well, lets just INVESTIGATE just where all this overtime is coming from...." The only thing they understand is money. Once WE as nurses understand that those bean counters really don't care about anything else....just the bottom line, we can find a way to make it hurt enough where they push legislation against certain regulatory processes. We can protest all we want, but if we don't hit em in the pocketbook, they won't listen. They are the only ones with the power to try to make change in regulation.

Octreotide ugghh I'll stick to Sandostatin

It sounds pessimistic but I have never completely trusted anyone. Sounds like you need to brush up on Labor Law and harassment. They don't deserve your tears. Start by going into HR and asking that the write up be rescinded, that you felt pressured into signing something you did not agree with and that now you feel that they have "created a hostile work environment." That is legal speak for, "I am not going to take this harassment and will take it to the labor board if I have to." Believe me, you will earn mad respect from then on in. I have seen this as a new trend lately. They will pick on the newer nurses, ones that they feel will believe anything. They will "feel you out"......if you signed this then what else can they convince you that they have power over? HR and management can always TELL you that this and that is "hospital policy" but does it coincide with State and Federal Labor Laws? Hospital policy NEVER trumps state or federal laws. When they hear the lingo of Dept of Labor they generally A.) leave you alone or B.) shake in their shoes because fines are heavy and it leaves a mark on the record of the employer. It helps other employees too because if this is a trend, the Dept of Labor (either state or federal) will have record of it and be more inclined to investigate it thourghly. The more employees that walk away hurt, with their tails between their legs, the worse it is for eveyone.

Well to be fair....if the nurse received bare minimum PPE you can bet that they didn't make ANY available to the other staff at all. The management of that facility is foremost at fault. If that facility was accepting OVID positive patients, they should be ready with all of the precautions in place....extra staff on hand....PPE... and a protocol for when a COVID patient refuses to comply with safety measures. Not only was this poor nurse beaten but that patient exposed a whole bunch of others to the virus by going into the common area...(I'm sure without a mask on). I wish more people would bring on those lawsuits to facilities. It should cost them more to defend those cases than to stop trying to save a little money on PPE or just being too lazy to do the right thing.

gender comes to mind

Excuse me.... but there are plenty of ******** in nursing. I have seen much in my 37 years that warrant worse than being called a *****. She has earned her title and should either wear it proudly or change her crappy attitude. If I was a patient that witnessed that ugliness, she would have a dress down (I'm old military) in front of the whole unit. I would make sure that HR, upper management, heck...the media knows about crappy and unprofessional attitudes in the ER. Like the patient's are secondary for her having her jollies. A new nurse can only learn confidence by being taught well. Yes, you remain firm, and serious. When a new nurse messes up it's OK to get frustrated. But to be mean and nasty for your own selfish satisfaction should be a firable offense, I don't care how good her skillset is.

Your supervisor would be the first person to talk to. Tell them your problem, accept the assignment so she can bear witness. She may have the patient reassigned to another nurse to see if it's "a patient problem" or "a nurse problem." Difficult patients are often difficult people in real life. I am quite sure that there is a family member that is quite aware of this behavior. If there are multiple witnesses to this behavior, you should be fine.

We have SBAR faxed to the floor after bed control and charge agree on the room. Fine, if the SBAR had more than a name on it. And, if the charge nurse actually tells the assigned receiving nurse that the patient is coming. It makes for a cluster*** for everyone, including the ER nurse I call because she/he hasn't written anything but a name. If I want to work ER I would have sought that unit. Now that our unit is a mini ER . I always hear the saying from the ER staff "welcome to our world, we never know what's coming through the door either, it's become a guessing game of what was actually done for a patient downstairs. The point I am trying to make is that from a patient expectation the ER "no one knows anything that wrong with me yet." By the time they get to the floor their expectation is "well they have it somewhat worked out so I should at least have this and that." Amid call lights and our in house patients screaming for attention as an unknown admit comes up with high expectations of having food and drugs available to them as promised by the ER staff. We didn't even know you were coming, what you are here for, or what orders you have. That explanation alone takes time while you are trying to get them in the bed safely. They look at you like you are stupid and some even say so. Sorry, I don't have telepathy maam'. Even with all of this, I don't mind. I just want ONE thing from the ER staff and that is please stop the practice of promising things to these patients things you KNOW damn well we can't provide right away. The explanations to these patients alone take away precious time we can be using to actually get the admits done and our other patients do not have to suffer. It's passing the proverbial buck. Just tell them that even though they are going to the floor, we still have much work to do before they are settled. (example....it's after 730pm, nutritional services are closed...yet ER is promising that the patient can get a hot meal once they get to the floor). One of the other hospitals that is within our area went back to providing report after at least 3 deaths attributed to ER transport bringing up patients, and left them in rooms, on a Cardiac Step Down unit. The nurses in all cases were not even aware they were receiving patients. The charge nurse had a full assignments of their own, no unit secretary, change of shift, all nurses and techs were at bedside shift report. No monitors placed on the patient. Ridiculous. It just seems that it doesn't have to be a circus but they MAKE it that way.

All we get from the ER is an SBAR which really is just basic. The GOOD ER nurses will at least put in their admitting diagnosis, small synopsis of why they came in, their IV site and any fluids rec'd, last vital signs, their monitor info, meds they were given and for what. Sheesh it only takes 5 mins. I am finding that this new way doesn't streamline anything but the ER, it makes the patient's upset and feel as if they are hastily handed off. I also noticed that these nurses aren't able to give a good, solid report since they never practice it. Most of the SBARs I receive now are useful only for the name and age of the patient. not worth the paper faxed up to us. heh why bother, just phone up and tell us I'm getting a 85 year old female to room 240 bed 2. I'll look up the rest.

Learn something new everyday!