Think about it: let's say that an average bedside nurse costs a hospital $500 for a 12 hr shift. That might include wages, insurance, FICA, training etc. If she has 5 patients on a med/surg unit, that's $100 per patient, per day. That's a sliver of the daily cost of hospitalization for a vital part of patient care.
"I have every reason to believe it's gone downhill."
As supporting evidence: The nurse "gave me her number and left."
I'd like to approach this from the other side - unrealistic patient expectations. Staffing is an issue, but there's absolutely nothing to use in his statement. He's demonizing a way to get in touch with the nurse? How often was he checked on? Was it a ratio issue or was any time alone an issue? Side rails? Bed alarms? Cardiac monitors? He could've been near the nurses station with passing eyes on his every five minutes. We simply don't know and to say otherwise is speculation.
Blanket critical statements like American healthcare has gone downhill represent the worst kind of uninformed opinion stated as fact.
I realize this comes across pretty strong and I'd love a chance to talk with him to get more detail. As it stands, this complaint comes across more like the guy I had that got mad at me because he got a normal spoon and not a soup spoon for his soup.
This should be utterly basic information that is not even a question in any nurse's mind anywhere.
We do not have a "need to know" with regard to anything (including presence in a facility) about any patient for whom we have no legal duty/responsibility. If we have some form of responsibility to/for them, that is another matter. If we don't, we have nothing but curiosity, as you note.
Yes of course facilities can see what you are "curious" about. It is 2019 and every nurse should assume all activities in the medical record system are able to be monitored, including your every click and keystroke.
That is incorrect. Being in charge will likely get her pretty far with regard to accessing records unless the information is not being used appropriately or the access of records goes beyond what is necessary for the role.
Being in charge is a responsibility that legitimately includes some review of or use of or knowledge of information about patients who are under the direct care of another RN. Even something completely basic like making fair assignments or assisting newer nurses may involve such information. The law generally allows for activities that facilitate patient care.
This is not difficult. Some activities clearly support the care of the patient and/or other activities directly related to provision of care, and some clearly don't.
A charge nurse has a responsibility for knowing what is going on with all the patients under her charge. That means accessing patient charts to double check that vital signs, I & O, lab draws and treatments have been done and checking the charting for accuracy, timeliness and thoroughness from time to time during the shift. Especially if the nurse is new to the unit or is known to be having difficulties. A charge nurse may also be responsible for chart audits -- ensuring that orders are taken off and carried out appropriately, that meds are given on time, that monitoring and procedures are charted correctly.
Yes, there are audit trails to see who has audited the charts, and as long as you stay in the charts of patients for whom you are responsible, you're good. The charge nurse is responsible for all of the patients.
One more thing while I'm on my soapbox -- the nurse in the room next to you may also access your patient's chart if you've ever asked her to cover you for a break, "drop down a set of vital signs for me," draw a lab or give a med. If she's sitting in her room in the ICU doing some charting and happens to glance up and see your patient in an alarm state, she may also access your patient's chart. Especially if you are busy cleaning up stool in another room, transporting a patient to CT or whatever. If I am in a room next to a new grad fresh off of orientation, you can bet I'll be keeping an eagle eye on the patient(s) and may look into their chart if I see something that needs investigating. You may get pulled into to the office to explain, although I never have. But you'll have a good reason for being in the chart.
It’s good that I read this today. If I had been in their shoes, I might have thought “Well let me just search his name, out of curiosity.” I wouldn’t have gone into what I think of as the “real” chart (that is, I wouldn’t have looked at notes or labs or anything) but certainly might have done a 2-second “see if he was here.” Good frightening reminder to stay in my lane and not go peeking at things!
Yes, totally poor judgment, but you know what gets my goat? Prisoners get expensive treatments for free, hard working, law abiding citizens can't afford treatments and medicines. Hard working mothers and fathers go into debt paying for astronomical copays and out of pocket expenses while the indolent segment of the population gets a free ride.
If these pills were so expensive, like $1000/pill that they had to be kept locked up with the narcs and counted like narcs why didn't the pharmacy bubble pack them? If you have to dump the pills out to count there is a risk of possibly losing pills? And there is no way that I'd ever try to retrieve anything from the sharps container let alone pills to give to a patient.
Agreed with Jed. The BON was in the right. 'Just following orders' isn't an adequate defense when those orders are obviously unethical.
It would have been a more interesting and ambiguous case if the pills had been temporarily irreplaceable rather than merely expensive, which would have made the choice between giving possibly contaminated medicine and not giving medicine at all.
We use telehealth monitors at our hospital during stoke codes to get directly connected to a neurologist.
My guess is this doctor was a specialist that was consulted due to this man’s condition. He could have died before they found out what his prognosis was waiting for a specialist face-to-face.
I see nothing wrong with this!
I greatly disagree that there is anything wrong with this. The patient had been told many times that his condition was very serious, and probably terminal.
The controversy is all about the bull malarkey that surrounds inevitable death in our society, which many refuse to accept.
The messenger is blamed.
The doctor's other choice was to give him false hope. With which I greatly disagree.
We need to start talking about death a whole bunch more than we do.
Otherwise, maybe we just don't do any telemedicine with people who are really sick.
I've got a wild idea. Maybe, considering this man had just hours of time left, the MD did not want to delay his visit whatever amount of time it would have taken for him to physically arrive there. If youve got three hours left, and it takes the specialist just 45 minutes to get to the hospital, well, that's a quarter of the man's remaining life.
Yes, it was not the first time that it was discussed but it makes for a better story.
"The evening video tele-visit was a follow-up to earlier physician visits," Gaskill-Hames said in a written response. "It did not replace previous conversations with patient and family members and was not used in the delivery of the initial diagnosis."
Without knowing all the details this sounds pretty heartless. However, we all know how family can be sometimes and maybe the MD had already been there multiple times with different family answering the same questions over and over. It was the granddaughter that was in the room so maybe the MD had already talked to the pt's son/daughter. And the granddaughter who was distraught immediately whipped out her phone and started recording. I am not sure that would be my first thought if I was getting that horrible news for the first time. Either way sounds like it could have been handled better but we don't know all the details.
There's the headline, and then there's the first sentence of the article:
"Ernest Quintana's family knew he was dying of chronic lung disease when he was taken by ambulance to a hospital, unable to breathe."
I'm not feeling the outrage that so many others seem to be.
I would say that I would absolutely love to work on their unit (express your enthusiasm) however, due to financial reasons you need to obtain a full time position once you graduate. It is a valid reason that won't cause any burned bridges. Ask if you can follow-up closer to graduation to find out if they have a full-time position open then.