avado

I been a nurse for twenty years now in same facility. I always know social interactions have been painful for me and over the years it's becoming more apparent that I have to mask and mimic other co workers to be successful. So I know that I am undiagnosed. I have been called a squirrel or on the spectrum by my co workers including bullied and marginalized. I started to deviate for my own well being to rise and received my PCCN and CEN. Still my facility chooses clueless extroverted people and therefore I watched my type males especially never finished their probation period. I have never had a performance evaluation besides that's how bad my facility is. With your gifts that we have is that we drive and guide others of our knowledge including policy, we become that resource nurse or charge nurse. Unfortunately, we should be a part of staffing education especially inclusive diversity. I stick around to write occurrence reports because I am secretly driving change with the knowledge I have. I am done with the bullying and marginalized I am okay who likes clicks away. I wear a badge pin SNL character Molly Katherine Gallagher to break the ice and encourage others to wear Elon Musk one to show greatness. Remember there is a sentinel alert called diagnostic overshadowing with patients austism, gender transition, substance abuse that causes harm. Maybe education to staff and awareness is what your manager needs have in her PIP. Hang in there!!

Is the norm with the EHR that nurses verify CPOE meds only, ancillary or both? Does your HUC triage phone calls during med pass times? Do you have a system down to prevent distractions? I am trying to improve a process that causes failure or delay of care. As an Example, I receive phone calls from Radiology "when is a good time for me to come do the Xray on your pt?" Speech therapist calls wants to know how their lungs sounds are? Lab, " did the md want the labs today or tomorrow, we just drew it this morning?" This usually happens in the morning when arrive get short report and immediately start med pass. I believe this needs to stop! We have developed a Unit Based council, where they are questioning me, Why? Really? Our HUC are trained CNA who just push Ancillary orders and tell us when they see Medication orders for us to verify. They do not tell us what Ancillary orders so its a guessing game or distraction to constantly reviewing orders especially stat or get a lovely surprise lab or radiology phone call. Again this is another process improvement that I am going to bring up to Unit based council. Does anyone have processes they liked to share? I am all ears!

Thank you and appreciate your response.

I have been a nurse for twenty years and was offended that the newer nurses looked at an old ancient vague policy regarding TPN infusion to look for dressing changes wrote an CPOE order that drsg should be changed every three days regards to that policy!! Our (new) Central line policy is every 5-7 days to prevent CLASBI but since it didn't say anything about TPN they over chose the TPN one instead?! I have emailed this issue to Education, Coordinator, and our Manager. There has been no reply! I will be contacting our quality department, and Infection control nurse shortly. It is one nurse who writes (freely) nursing orders for ADLs for patients including do not give patient meal tray unless up in the chair. It's sad because I am starting to see erthyema under the CHG PICC dressing now. Any policy to share?

I am quite aware of ARDS and YES I have done vents but when the family member has "Hope" that resting the lungs will help their mother who has severe CHF? IS a poor message! I knew she would be dead in no time flat. We are suppose to be the advocates for the patient and the family especially when they are not allowed at the bedside. Please have that sincere talk regards to wishes and status. Yes, no-one perfect. Now reading all the remarks attacking experience or now "causing conspiracy" due show why nurses do leave the field. Nothing new.

Thank you for speaking up. Distant family member who was on bi-pap doing well and got off but then had a set back. Second, daughter was told she was getting vented "to let her lungs rest" right then I knew it was a lie to the family. They should of been truthful that this is last effort and that the mortality is high. Yes, I am a 20+ experienced nurse in ED/telemetry/ICU. My humbled opinion.

What is your gear for Isolation patients? Do you have disposable stethoscopes? One mask/goggles to use for each patient? Currently, I have one n95 mask for each isolation patient and goggles/shield that I leave in ante rooms. I dispose of my gown/gloves after each encounter. Clean my shoes with bleach or sometimes use covers. I really hate the disposable stethoscopes we have. Does your facility have normal simple stethoscopes that are left in the room and are cleaned or all disposable? We haven't had a positive one yet but they are rule outs awaiting test results that can take up to two days. Thanks!

Don't forget the crushing chest pain from over-eating edibles!!

I have seen in a teen would was extremely thin and developed all the clinical signs in C.H.S as example needing to take hot showers, tiger balm, smokes a bowl a/day, retching, and losing weight with no relief inpatient. CT scan showed the secondary diagnosis of Superior Mesenteric Artery Syndrome. Basically compression from loss of fat stores. Pt was transferred to get stented in larger facility.

I would love to fill this out!! Lets say a nurse adn, been in the same organization for 30+ plus years was able to convince administration, hospital board, few doctors, and rumor mongering the staff that she felt bullied. Was able to get the board to fire away her manager, director of nursing, and risk management by tricking staff with letter wanting a certain doctor back who was on her team. Has now volunteered to be interim director and now being protected by the union. New administration of course, that are giving her a second chance. I seriously, got bullied by an MD, and she doesn't want me to fill out an occurrence report but she will use the mds that helped her become this wonderful leader to bully that doctor. All bypassing, policy etc.... So if I complain in any way.... occurrence report, compliance line,... the new CEO, I am looked on as bully....

I am fed up with our interim manager. She is basically a wall. When I asked there is no policy or a failed order set with issues for patient safety, the answer why don't you make that policy for me? She is directing staff to work on projects that need to be done that have been neglected over the years. She pretty much just goes to meetings and probably takes the kudos. If anything, involving a physician issue on med reconcillation, she puts it back on our plate to tell the MD. It is hard to do since she doesn't want us to write occurrence reports but to solve it ourselves. I really don't have the energy. If you do write an occurrence report especially about a doctor you get the third degree. WTH.

I know that often our pyxis if your finger and height doesn't match up you can pull up the person or med next to it. I really do have to slow down. Last month, I had tylenol liq ud mixed in Ibuprofen liq ud. Luckily, I have experience that machines are not perfect and that we are the last stop! Too bad, that nurse did not print up the order to carry down as a double check.

yes and no its something that could be used but in reality the patient died and my occurrence report was simple but the message to the manager to look into it went too far.

Seriously, we had no policy except another department policy that is over 7 years old. That is how messed up it is where I work. Yes, I have taken my lumps from my annoying write up. I usually write up on process problems like med reconcillation or safety issues. Union is pretty deep with the manager they are best friends, trust me they talk. Its a flash back high school. All I requested from the union is who changed the policy and an apology from my manager. I shouldn't be discouraged now for fear of retaliation.

Good question.. not to make waves I guess. Why can't it be simple and used as a study? It shouldn't deter anyone. Its just sad.

It was guessed as sepsis. i was not present for RR but was told my manager the day out of surgery something was amissed and two other people verified what I was seeing. I just come back to find out and RR was not reported as we have new one year grads as charge nurse now. Our manager is a temporary who has never been this position before. Yes, I should of questioned the doctor but gave a report to oncoming rn that this is a different device and best I could explain how to assess it and use it and left that message to my manager about it. It was just not ordinary device that could mistaken for other things but placed differently. I can't say much, it just bothers me why i am feeling the heat. Because of this device, it was added to an old policy in another department since we do not have one. So this manager threw this in my face that its been in this other department policy for over 7 years. Yes, policies have rarely been updated that one hasn't been updated over 7 years! I really enjoyed the different font when I looked it up...

Manager knew of device, the OCR was simple, pt came in for observation status, had a rapid response, transfer to ICU then DNR within 3 days.

Yes, it is a fine line. I appreciate your thoughts.

Pt was an observation from a minor surgery that needed rapid response and later died from possible sepsis within three days. No medical doctor following? It was simple occurrence report complication from a surgery that needed to make facility aware. Are facilities not to report a complication? This is a small hospital where I work with not even a compliance line set up. There is more to it because something was used for the surgery that was not normal, an "off label use" which they changed a policy to okay for off label use. It was set up for failure due to that! Manager said that device was normal...not in my 18 years..

Well, This has been bugging me. I wrote an occurrence report for a rapid response and then patient died within a short time frame after a procedure. My manager told me that I was in the wrong for writing it and that MD doesn't want me to take care of his patients and also somehow another surgeon chimed in about "my conduct" during this review! Its a long story, but is that a JUST culture? Feels like retaliation to me for something our unit and MD could learn from? Does it make them look bad at higher up? A policy was changed to make me look bad too. I am trying to see if union can help me but doesn't look promising. PS our "manager" never been in this position before so she is trying to "make peace" for "my error" of reporting.UGH!

I know, we have been ignoring it! I am making it with aware with new upper management. There is no co-sign just stop what you are doing and read the medication order and if it looks good?!

What does a real hospital do when a nurse takes a verbal or telephone order? Our process is to read back the order and place into computer entry, our hospital wants us to stop what we are doing and find another nurse to double check what you put in?! This won't fly in an ED. Our doctors are slowly learning to put orders in. I am talking about 50% so far. Our computer system does not make anything user friendly. Appreciate anything!

Hi All, Let you know our education department posts flyers for classes and our manager does the same for staff meetings. Attendance is poor. I would like to find out what kind of special phone app or private calendar to accessed from home of upcoming events that your hospital might use? I would like to deliver an option to our education and IT departments. As I said it is mostly flyers and an email only accessed at work. :)

Is this Bedside Reporting done on an acute care floor with nurse ratio 1:5 or ICUs? I would cringe too if the Interrogator had all FIVE of my patients! Our Nurse Executive wants us to start doing Bedside but we are so spread out in distance & mixture of patients. I can see it Fail fast..

Thank you dudette and calivanya. I voiced my frustration to the IT computer person(previous RN) since my manager is swamped to reply. Yes we have a nursing order screen that we can scroll thru but like i said it is huge and time consuming. Basically, I need to do what Calivianya does and call the doctor at 0300 to dc items off the nursing order and maybe the doctor will learn not to overkill us with those huge order sets. Our QI sucks they drive our manager crazy and do not see what the nurses are going thru. They are for the administration to make sure the hospital gets their dollar. My two cents...