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  1. But I don't have the time. As you so clearly explained, 1/3 of my time is charting. This, after patient safety and care, is an incredibly high priority for me. If it's not charted then it's not done. If I'm called before the BON or brought to court, my charting is what I rely on. As for reimbursement? I need to chart that I called the doc about scds/vte prophylaxis so we don't have a core measure fall out. Now I better not forget to document that I've applied those SCD's! Charting actually probably takes up more than 1/3 of my time. So I now have 8 of 12 hours to do patient care, since 4 hours is charting. I have 5-6 patients, that's a max of 96 minutes per patient for the entire shift (if I have 5 patients, less if I have six). I have medications to administer, orders to review, doctors to call, and I have to pee at some point. Everything I do I need to double check. SAFETY is the number one priority. Hourly rounding? Patients need to sleep? I need to eat lunch? Patient unexpectedly codes? Where do I have time for all of this?? 96 minutes MAX for each patient out of 12 hours, not including the unexpected or a bathroom break/lunch break for myself. Think about that for a while. 1.5 hours total a shift. Do the math. You (administration in general) are asking us to do more and more, but are in denial about the TIME we have to do it. Find a solution. Adding more responsibility and tasks without more tools and resources is NOT the answer. A cheerleader pep talk with buzzwords is insulting, and truly shows how out of touch you are with what WE do in twelve hours. Any good nurse or halfway decent person understands kindness and compassion, and will use that when interacting with people/patients. I don't have the time to go above and beyond. I give 100%, but literally can't give more than that. Added this after thinking more- OP article said a lot about what nurses need to do and what customers/patients need from us. What will YOU do (as an administrator) to help ME do this? What do NURSES need? You said "like it or not" customer service model is here. So... What are you going to do to help? This pep talk isn't working. Find a new solution.
  2. Hospitals will never pay enough to have a nurse to patient ratio that would allow the nurse to actually be able to do their job at the high standard we are held to. Such a ratio would be so ridiculous that administrators would laugh. Last week I somehow ended up having only 4 patients on my med surg night shift. Usually we have 5-6. At around 02:00, I was taking an elderly post op patient to the restroom who kept apologizing, "I am so sorry you have to help me, I don't want to be a bother, I know you are busy". As I reassured the patient that I had the time, was not busy, and was doing my job ("this is what I am here for"), I had a realization- I actually DIDN'T have anything else to do for once! No patients waiting for pain medication, antibiotics to hang, no assessments to chart, no one else ringing... I was completely caught up. It was a wonderful moment because I was able to truly attend to this patient without having to rush with fifteen other things on my mind. I can't remember least time I have said, "is there anything else you need? I have the time!" without having been lying through my teeth. I said it to this patient, I meant it, and I left that room feeling fabulous. That night I did my job and in my heart knew I did it well. 1:4 as a standard would never happen on med surg, ever. I won't list all of the examples for which "patient satisfaction recovery" is impossible. At least 1/5 of my patients are completely impossible to satisfy, with unrealistic expectations. These could be the drug seekers (for whom the only dose of narcotics to satisfy them would also be lethal), the manipulative personalities (admitted each month), or the CEO's daughter (VIP's), ect... There are always going to be patients who you can't please, no matter how above and beyond you try. Kiss their press ganey goodbye as soon as their room is assigned to your unit. Some of our press ganey results are completely laughable and ridiculous. I will share one- poor ratings, and the expectation that "we need to invent wireless pulse oximetry monitoring and oxygen tubing, because in this day and age with technology it's unacceptable to have all these lines and wires attached". WIRELESS oxygen tubing!!! I would be a billionaire if I could figure that one out. This whole topic is depressing. The only real solution is better staffing, to the point that it's a fools dream. I am going to continue to do what I do- which is to truly give 100%, to the point that there is nothing left in me. Any administrator needs to work four weeks on the floor (now, not ten years ago) before I would believe any single thing they say about "customer service". You are paid a lot more than me, you are certainly higher educated than I am, but you are ignorant of what I have to do on any given shift for twelve hours. Research all you want and put together an article with lots of action phrases and cheerleader optimism, but it means nothing to me unless you have worked the floor recently.
  3. Karou

    It's A Whole Different World Down Here...

    LOVE this post!!! I can't like it enough.
  4. Karou

    IV starts in arm with a DVT

    I wouldn't say an upper extremity DVT is rare, but I definitely don't see them as often as a leg thrombosis. Is it really that common that yall get dialysis patients with a upper extremity fistula one side, and a upper extremity DVT on the other? Does your facility have a policy in this? We do, and as soon as the DVT is discovered/known, IV access is removed (if it was already there), and that extremity is made a no stick/no BP. If a patient is like the one you described then then I have seen IV's placed in the foot, EJ, or physician places a central line. I have seen less than a handful of patients who have that exact scenario though. If the other arm is limited due to mastectomy (w/lymph node removal) or CVA, the physician will order that arm to be used.
  5. Karou

    IV starts in arm with a DVT

    No, a known DVT in an upper extremity is a contraindication for IV access. Once a DVT is discovered we have to remove any IV access (PIV or PICC). The arm already has a DVT and is at risk for further neurovascular compromise. You should not to anything else to that extremity that could cause neurovascular damage- so no IV's, blood draws, or blood pressures. That is what I have been taught and that's the policy where I work.
  6. Karou

    Is this real? Vein light

    It's real but can be a pain to use. The machine is huge and heavy, difficult to move around. It is nice that it's hands free when you are inserting so you can keep the light on and have two hands to insert the IV. I have gotten difficult sticks that I know I couldn't have gotten otherwise because I have used the vein finder. It takes practice also. Overall... It can be helpful. It's the best vein finding tool we have used on my unit, aside from the ultrasound (which we aren't trained on/don't have and have to call ED or ICU to do).
  7. Are you a nurse? What setting are you in? Of all the people who have commented on this post, you seem to be the only one who interpreted it this way. That's interesting. Have you had a negative experience with death in the acute care hospital setting before? I ask you... What is the harm in the lie? What are the benefits?
  8. My hospital does inpatient satisfaction surveys weekly that they post for staff to see. They also do a survey after the patient discharges. Any staff with positive mentions get acknowledged. This is factored in when employee of the month is awarded. So they are constantly telling us how we are "performing" as a unit and giving "positive recognition". If a patient has a complaint then the supervisor visits them to discuss it and patient advocate gets involved. I am lucky because my manager is actually very supportive of our staff and will stand behind us (when reasonable). One thing we constantly rate low on is noise level. They recently implemented those noise traffic lights at the nurses station. We also rank low on room size but that can't be fixed. It is interesting to me how vastly those scores can range weekly. We might be 90% positive one week and 1% the next on the same topic. Oh well. You can't satisfy everyone. Some patients requests/complaints are just plain unreasonable.