typical

I spent 4 hours getting home the night CT got a blizzard the week of halloween in 2011 and knocked out power to half the state for 10 days. My car got stuck 4 times, and I had to reroute numerous times due to downed power lines, downed trees and abandoned tractor trailers. My normal commute was 30 minutes. I left work at 730p and didn't get home until close to midnight. No one in the hospital made rounds that night asking or encouraging us to spend the night. No one offered clean scrubs, toiletries, or a quiet, private place to sleep. No one offered us free dinner if we stayed. So thinking my option was a row of chairs lined up and some linen from the linen cart...I said to heck with it. I'm from new england, I can drive in the snow tonight, and I'll drive in the snow to get back here tomorrow..... But after my 4 hour commute home I was literally shaken. What if I was going a little faster and that 100 year old tree I watched crash down on the road had landed on my car? What if I stepped on a live wire covered with snow one of the 4 times I climbed out of my car to assess how stuck I was? I looked out my window that next day at 4am and saw that the roads still weren't plowed. I called the local police and state police. I asked if they could send someone to drive me to work. The answer..."sorry kid, we're trying like hell to get our own people here, we can't worry about you". My boyfriend worked a night shift at a closer hospital, got there the night before, before the conditions got so terrible. He wasn't available to help me get in either. So I called in. I apologized, but the chances of me making it back to my hospital that day were little to none. I wasn't risking getting abandoned in my car in 5 feet of snow someplace where civil services weren't functioning. Did I feel guilty? Oh god yes. I do NOT call in. I don't do that to my coworkers. But I really stuck it to them that day. Some of those poor souls worked 20 hour shifts because no one could get back to work the next day. And so...I got written up. And ya know what...I didn't give a crap. If getting your staff to show up during storms is so important, then maybe the hospitals need to start investing in some heavy duty snow transportation vehicles for shuttle service. I don't fancy becoming a patient trying to show up to take care of one!

Thanks so much! That seems like the right thing to do from an infection control standpoint. We recently had a whole debacle around supply drawers in patient rooms....the end result was that the infection control department told us they had to go. I feel like it's the same rationale with code carts. If you're touching the contents with gloved hands, everything inside needs to be turned over for the next patient. Since my hospital thought that wasn't a cost savvy practice, they just said get rid of the drawers all together. Why should there be a different standard for the code cart? If anything, hands inside the code cart are 100x more contaminated with the nasties than plain old gloved hands on a medical floor doing day to day patient care!

I've been to certain hospitals where the nurses leave a tape recorded report, other places where they leave a note on the kardex....all in lieu of verbal nurse to nurse report. I wasn't a fan of either method. However, my old hospital did not give us report from the ER and it really was not that bad. It forced the floor nurses to look the patient up and read the ER docs note, the ER nurses note, labs, radiology reports, vitals trends etc. If the nurse was prudent enough to do this, she was perfectly prepared to accept that patient when he/she arrived to the floor. Expecting the ER nurse to call repeatedly, holding the patient until the floor nurse can take a verbal report is not what's best for the patient in some of the bigger, higher volume hospitals. It really is not about the money. It's about getting the patient out of the ER where they are getting bare minimal medical attention, into a bed, into a room where there is privacy, and among a team of nurses who specialize in their diagnosis.

Do you know if they turn over ALL of the stock inside the drawers accessed?

My current hospital is beginning to implement standardized report format. We're definitely getting push back from ER because our standardized format is essentially a head to toe. I have trouble commiserating with them though. I've worked both high volume ER and floor. When I worked ER I performed a summarized head to toe on every single patient (mini neuro, heart, lungs, pulses), a focused related to the complaint and then additional assessments depending on the patients age, general health and co-morbidities. i.e. if I had a 91 year old who fell and broke her hip...darn right i rolled her over and assessed her skin. How long was she down for? How long does she sit at home? I feel like nurses are getting lax with reports and assessments in general....it's not just a single department or single specialty issue. I don't think that a nurse should be reciting the chart to the nurse taking over....but he/she should be able to recite their own assessment so that the oncoming nurse knows if there are changes.

I used to work at a large teaching hospital in the northeast who did not give report for patients being admitted from the ER. You only got report if the patient was being admitted to a step down or ICU. Otherwise, the RN was simply told the patient's name. He/She then could look the patient up, read the ER nurses and doctors notes, history, read radiology reports etc etc. It really wasn't that bad. On occasion the patient would need to be transferred on the monitor, in which case the ER nurse did the transport and would often give a quick bedside report...or I would go down to the ER and touch base with the nurse before doing the transport myself. I'd like to add that I worked on a ridiculously busy neuro trauma unit and never had a problem with finding the extra 10 minutes it took me to go downstairs and get the patient myself. The ER not only appreciated it (because regardless of how busy I was, they were managing a volume of 120,000 annually, and were ALWAYS busier than me). The practice gave me an opportunity to get a quick blurb from the ER nurse, and assured I knew my patient was appropriate for my unit before formally accepting them.

Hello There, I've noticed of late that my current hospital doesn't have a standard operating procedure for where the code cart goes and who has access to it during a code. Instead, I notice during codes that everyone in the room seems to have their hands in the drawers (gloved hands!). My previous hospital had very strict rules about the code cart...and strong rationales for those rules: Cart was parked outside of room (keep space around bed clear, gives med nurse or pharm space and noise reduction to calculate and draw meds) Defibrillator placed on end of bed (keep environment free of wires that staff can walk into or trip on, reduce risk of leads being pulled off patient or risk of defibrillator falling on floor) A person or persons not touching the patient passed off meds and equipment to a nurse pushing meds or doing procedures (reduce risk of contaminating inside of code cart and it's contents with bodily fluids) Everyone I talk to in my hospital seems to have a different idea of how a code should be set up. So we're going to develop a team to work on standardizing the environment. Does anyone out there work someplace where there is a standard in place?? I'd love to hear what your hospital is doing if you feel like it is effective and works. Thanks!