Nanette

When I first read your entry, it sounded like you were down on the director for coming down on this. Where I have worked, we have been dealing w/this for at least 4 years, 2 years ago they lowered the boom and refused to acknowledge orders w/the unapproved abbreviations used. Many Dr and staff knew better but did not want to make the extra effort to change, this moritorium just forced the issue. It takes pharmacy having the support and conviction to do this. I teach a class in basic pharmacology at the Jr college. We started showing the students the unapproved abbreviations, but telling them not to use them. Just wanted them to recogize them. Now we don't even teach them, we figure that if a new nurse does not know what someone wrote, it reinforces to the one who mis-wrote! It just isn't an issue in our 3 hospitals anymore. It's safety, not just someone's whim to make a change

Actually, I did not teach the class last year, the faculty who did had a preplanned activity, she purposely let the discussion focus around Teri S because it was such a hot topic at the time and so rich with issues. I am planning on breaking into groups, I was looking for situations I could make into case studies. I served on an ethics committee for about 10 years when I worked in Acute Care, so I have in patient stories, I wanted to focus on community issues. Thanks for the ideas, I'll try to work up some things on those topics. In the meantime, if anyone out there has a specific situation, I'd love to hear the story!

I am looking for some discussion points for one class on ethics for our community nursing class. Last year we spent the hour talking about Teri Schiabo [sp]. I was wanting to avoid end of life issues to bring an awareness of the variety of ethical issues out there. Could someone share some situations I could make into a scenerio and create some discussion points?? sure would like to benefit from the experience of the experts! thanks nanette

It depends on the state, I imagine. For an RN program you must have your masters, for most LPN programs a Bachelors is OK

Walking rounds can be of great benefit if handled positively, ther e should be nothing wrong with a patient hearing most of what you say about him/her. Granted, there are sometimes you may want to add a PS in the hall, most of the time they are gossip type remarks that could be better off unsaid like 'they were on the light all day'. Even that could have been said in front of the patient in the right way. With family, you need patient permission. I believe JCAHO is looking to encourage pt/family in plan of care and knowledge of care. HIPPA does not forbid it, just how it's done and with who's permission. I do agree that it takes practise and time to get used to, but those tired nurses will cut out extraneous info and staff will get done sooner. At first glance, there is no right or wrong way, but walking rounds are not bad, they work for some. just my thoughts nan

HI You are all over this one! NO, we should not reward poor compliance, YES everyone should be accountable for thier performance. But, unless you have a strong admistrative team and physician leadership, you will not get the docs to comply on thier own. Unforunately, a group that was founded by physicians [surgeons] has no clout or impact on the independent practioner! Do your physicians care if the facility gets a good score? The issue is how do you make them care? We are blessed to have about 1/2 hospital employed docs, so that helps emensly, our phsysician leadership is supportive. We still have to hound the docs, but we are able to tell a doctor if the order is not complete, we will not follow it, we will page you and get another order, write it as a valid order and you will have to sign in next time you come in. You can't believe how many calls we make for incorrect outpatient orders! [or maybe you can!] Yes, it is burdensome for the staff, but the doctors are getting the idea to do it right the first time. We tell the patients the reason for thier delay is the doctor did not write the order completely and we can't honor it. The patients put pressure on the docs too! bottom line is we should not have to chase them around, but who gets the punishment for thier poor performance? we do, so we do what we have to in order to get it correct. nan