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Of course its wrong and unsafe not to be trained on equipment. Ask for training and to have super users. The device company has educators or sales people to train you. Having worked for Baxter IV for 17 years the company will have education available to ensure correct use. The worst thing for patients and manufacturers is misuse of equipment. You can also call companies 800 line to get information, they have folks waiting to speak to you usually 24/7 depending on the equipment. Please report, label problem and take malfunctioning equipment out of use to the attention of proper department. The department should report problem to FDA. Uncomfortable asking for help? Look up TeamStepps CUS for safety on google or YouTube. Chris

people I am from NYC where people respect boundaries (its crowded) and a french Canadian descent the non touchers. To Touch or not to touch is a cultural habit which should be respected from both sides of the patient clinician relationship. I do hug patients in dire conditions its rare but I ask them, I sense you need a hug because words are not enough. For those of you who feel hugging is mandatory I guess you never worked in NYC during the aids crisis. We are clinicians not martyrs.

Hey folks legally you do not have to give a reason its called HIPPA. On the lighter side, one night when I was in charge someone called in to be off because they needed to have their hamster checked for diabetes! Really?

Stay the course. report to your manager behaviors that are bullying if she doesnt do any thing look for another job where you are appreciated. There are ALOT of miserable people in healthcare that you can not fix. Look up read Malcom Bladwell which is required reading for most MBA programs. After the tippiong pt he wrote a book called Blink which was evidenced based research that folks who did things with frequency always out did the scholars with out practice. Look up quote from Eleanor Roosevelt "you have to give your permission for someone to offend you she said it much better

Nurses have academic degrees, techs do not. As a critical care nurse, who is Not really good at IV sticks (I always have CLs) I am better than most at ABGs because I have done so many and this is why I applaud all my lab tachs who can hit a vein I cant see or find because I dont do it even on a regular basis. I let them know how much I value their skill because I do. it allows me to do what I do best. Put your self in their place. They know you know so much more for them and they know how much more we make. But the reality is their skill is so important in helping me have the time to my job. We are a team; let them know how you value them.... you will be surprised at your new relationship!

According to CDC and manufacturers prefilled syringes are Single Use which means One Time Use, not single patient. If its a TLC triple lumen cath it needs 3 separate prefilled flushes. Once a prefilled syring is used it is NEVER recapped and reused; it hits the needle box. Leave it on an alcohol wipe on a dirty table... gross. Visualize this, you have a TLC. each port has its own probability to be contaminated by any number of microbes ( inadvertant touch contamination usually transfers Candida Albicans and Staph Aureus. Lets say they have mainly been using only one line for IVs solutions and the outside of the hub has normal hand flora of the above.( Good reason to use gloves when you touch patients; this is is normal hand flora and it is not alleviated by hand washing only reduced) If you were using the same syringe to flush: First you flush 3 mls into the used hub( ok maybe you have really clean hands but can you trust the other 10 people who held this hub in their hands ) The flush now has the above flora on the inner hub, now use this same syringe to flush the other 2 lumens with the remainder of the flush and you have transferred the perfect storm of a line infection, CLABSI which kills about 100,000 folks a year. For those who are trying to be frugal, the cost of a prefilled to the hospital is 0.18-0.30 cents depending on what purchasing contract they have. The charge to the patient is for internal accounting purposes, CMS and insurance companies pay a flat fee based on the diagnosis( DRG) Its price fixed, one rate for a diagnosis and they dont care how many flushes you use or dont use. Well actually they do, if you cause a CLABSI in their patient CMS aint paying for you to fix bad practice. HAI hospital acquired infections are now mandated to be published "transparency in healthcare" The major insurers will follow suit in the next few years. So if you want to really want to "help your hospital to be accountable please splurge on prefilled syringes; you may be saving a life! And yes Scrub the HUB! You may think your practice is pristeen ( you are not) but there are others who have left their microbes before you! Think about it!

please objectively report this immediately reporting the actions non actions but don't report what you feel like she is lazy that is subjective. Also remember we are not only accountable for what we do but equally or more importantantly what we dont do.

Nursing is a profession and to be successful at any profession you need to have a balance between IQ intelligent quotient and EQ emotional quotient. Its about having empathy (which requires engagement) not sympathy which denotes a degree of superiority over another. Its the difference between being "cared for" and "cared about" According to press ganey the pollsters patients want to be cared about. Nursing is also a science. If you havent read up of Florence Nightengale please do so. She set about establishing nursing as a science and speaks of the rightious with disdain. She also felt women were too emotional to be effective in medicine (too much EQ!) Here's a great example of the problem with healthcare: On my unit people are asked to come up with WOW moments with patients and they are posted on a white board to share with staff. The other day the night nurse asked a patient what would really make him happy, he asked for one of those disgusting pancake egg sanwhiches from mickey ds which we have at our hospital. The nurse bought him 2 of the sandwiches so she would be extra special and of course he enjoyed both. The day nurse who is telling me this story explains that this pt is a IDDM and while the night nurse got mention for the deed she was left with the chore/task of managing his BS which was 459 in addition to some patient education.

Please do not TELL your patients what to do unless they are mentally impaired. Be their advocate explain WHY we are doing what we do and its research based not hospital policy. Involve them in their care by allowing them to coordinate schedule with you. Engage them with clinical information; get their feedback. Speak with them about their care and plan of care, not at them or to them. When you discuss /collaborate with them with relaxed body language, seated if possible. Ask them is a good time for them to discuss, would they like their significant other there. And please ask them how they would like to be addressed or called.

If blood does not return easily without additional pull the line needs to be declotted once it has been checked for position and kinking. Forced blood drawing does hemolyze cells which releases intercellular folks like Mr K+ into the Serum count.

yes you must know your drip rates to double check RX label and doctors order which may be wrong. You also need to know nl dose ranges for which indication eg hi dose/ low dose Dopamine. having been a CC nurse for 15 years I cant tell you how many times I have assisted a fatigued doctor or one with bad hand writing the correct dose. most hopitals have flow charts for this created by RX. And many drugs are mcg or mg by KG, thats 3 opps for error if any one are wrong or omitted (very common) Also be aware that with IV pumps you cannot count the drops in the drip chamber beause it is a "volume set"which pulls fluids 5-10 mls, depending on the cassette,company used. These pumps depending on the manufacturer are 98-99.999% accurate versus "volume controller" pumps typically used for tube feedings or less critical administration which have an electric eye which counts drops and which you can see and also count. Their accuracy is usually about 90% and they are a heck of alot cheaper Old Baxter (travenol) sales chic

As a new clincal educator on a neuro/spine surg unit for the past year with extensive infection control experience, I was aghast that our nurses practice was to return used surgical wound ice paks for refreezing to save money! Their practice is to put ice paks which had been on a patients wound back to the med freezer with a patient label and put in a flimsy baggie. Because of the flimsy bags they fall out and come in contact with other used and new clean ice paks. I have had the freezer terminally cleaned out with sani wipes and posted a sign on the freezer that ice paks are single use only and reported to management. Since then I have found new USED ice paks repeatedly I asked my manager to consult with infection control who unfortunately advised the practice was ok if they got a separate freezer (there are no meds in freezer only the refrigerator) Point understood but does not resolve problem that we have contaminated paks in contact with other contaminated paks and new ice paks. So I suggested to my manager she discuss it chief neuro spine surgeon since they have had quite a few readmits of spine cases with infections. She has yet to do this. Even if the ice paks stayed in the cheap baggie (which they dont because as they refreeze the weight is greater than the strength of the flimsy slide lock) the density of the plastic is not sufficient to prevent bacterial transfer from object to object. I have further plans to address this including transferring to another position where management understands patient safety and I dont have to explain it. What processes do you all have to report and mitigate patient harm?

No because of potential for splashing and it would require sani wipe cleansing before used again.

Categorize them by what they do and their worst side effect eg Antihypertensives: ARB,ACE etc. Try to learn by categories no one can remember all drugs. The average experienced nurse knows 70-80 drugs well; the average experienced MD knows 33! Thats what PDRs are for ! Also remember to always refer to recent editions because new adverse drug alerts are reported every day.

For the past year I have asked that our ice paks for spinal surgery wounds be one time use. Nurses routinely take the warm ice paks put a patient label on it and put it in a flimsy baggie and return it to freezer to refreeze to save money. The outcome is the paks come out of the baggie and come in contact with other patients ice paks as well as new ones. I have repeatedly reported this to management and made a sign "Ice paks single use only" which is still on the refrigerator but routinely disregarded. The manager just got rid of a new set and I recommended she get guidance from infection control nurse, who suggested we get a separate freezer since this is also our med freezer!? My last recomendation is to ask the neurosurgeons who are having a number of readmissions with infected wounds Any suggestions?