Safety and work environment

Callorado5 · Feb 1, 2009

Good day everyone,

Just wanted some advice from anyone who is willing to give it. :spin: I just recently moved from Orlando, Florida where I worked for a large hospital system with 7 affliated campuses. I started working there as a new grad in the ED and the work environment there was pretty up to date as far as computerized charting, ED protocols, patient safety, good teamwork, nurse managers who care etc. My conundrum is I recently moved to California following my husband's job transfer, and I started working at an area hospital in Santa Monica. The hospital has just recently opened a new "hospital" near the old one which they will occupy at the end of the year. Till then I am working in the old ED. I have noticed a few things that have been red flags for me that I have tried talking to nurses on staff about and the nurse educator. Particularly these are the things as follows:

1. Most of the time no pregnancy exams are routinely ordered for females of child bearing age even though they are going for xrays, are receiving narcotic medication, going for CT exams, etc.

2. At my old hospital in Florida we used DIAL A FLOW extensions at the end of primary and piggybacked tubing to regulate flow we did not use roller clamps to regulate flow of IVF, abx, etc. According to my old facility policies and research done by several nursing journals this type of system is most effective for patient safety, decreases the incidence of roller clamp being bumped and the medication, fluid being rapidly infused, greater control of flow rate, etc.

3. No report being given on patients who are triaged in by the triage RN; "states she is to busy" and needs to get back. I have gone in where a few of my patients have been SOB and later vented or placed on CPAP, and the only reason I knew they were there is because another coworker told me or I walked by the room

4. No STEMI kit - this is an easily instituted solution, to a big problem I see at this hospital. I had a Code Stemi with a fellow nurse and from running back and forth to get ASA, Nitro, Plavix, Heparin etc. and calling pharmacy for integrilin a ludicrous amount of time is wasted. Their reasoning is pt will be charged for all meds in Stemi kit; it is better to just pull them from the Omnicell. When your goal for balloon time is 90 minutes this is absurd.

5. ED protocols are nonexistent in triage. I was with the triage nurse last week and a hypotensive pt with 1st BP taken was 80/40 and 2nd taken was 77/42 - triage nurse said we don't start lines and give bolus here - we wait till we have them in the room - this lady was sitting out there in the waiting room for 15 minutes before she got a bed :eek: No allergy bands placed on patients. Patients who are having SI being left in rooms with clothes and belongings in place . . . . no removal of these things immediately.

6. Narrative charting - this is a big one for me; because you need to include everything - there is no charting by exception. There is no computerized charting either.

7. Pediatric patients IVF, meds being adminstered by gravity flow using a roller clamp; this was a big NO NO the last place I was employed - all peds were placed on a pump irregardless if a bolus, med etc. d/t possible fluid overload etc.

8. No drug guides, IV drip books in place "everything is in the computer" or on the "Braun pump" - Drug drip book no longer used because a RN used it erroneously before. I never have had time before to sign in and look up multiple drug dosages via computer found only at the front of the ED; when my attention needs to be focused on vented patient, on multiple drips who needs 1:1 care (Luckily I do have some IV drug guide books I have bought and brought with me to help me with this issue)

These are just some of my issues with this institution. I am seriously considering going to a larger hospital system with more resources like KP or UCLA. The big pluses are the teamwork atmosphere "depending on whose working", shift worked and the short commute from my home. I really want this to work, but I am having serious doubts. I have been working there for about a month now and have talked to the educator about possibly making some changes i.e. STEMI kit, dial a flow, but the basic response I receive is "it's not in the budget" Am I to critical?

Any advice would be welcomed.

Thanks.