Share Policies That Have Not Saved One Life

[Emergent]

(But may have contributed to a few deaths by sucking time and energy from us)

I'll name a few:

1) Care Plans

2) Charting pain scales before and after meds

3) Laminating paper bulletins 

[Ioreth, BSN, RN]

I keep thinking of more: 

Charting in the room. The patient won't shut up and let me do my work!

Bedside shift report. Yes, I know this is a touchy subject. "I want to be included in what is said about me". But really... there are family issues, results the physician hasn't told the patient, etc. Sometimes I just want the noc nurse to just tell it to me straight "this guy is noncompliant with..." or "this lady is dying but is in denial about her condition and family is fighting over her" rather than dance around it because we're being good nurses and doing the whole handoff at the bedside.

No labeled frozen dinners in the staff fridge over 1 week old.

No shelf-stable food in the lockers.

Everyone must take a 30-minute uninterrupted lunch break and 3 10 minute breaks and clock out precisely no later than 1937 with no late meds or cares and all charting complete. Sure... then give me a normal patient load and adequate CNA coverage. They used to track this, then they used it against us in annual performance reviews. Now everyone just lies and clocks out on time then stays off the clock to finish charting.

[Corpsman2OncRN, BSN, RN]

7 hours ago, Ioreth said:

One more!

Physicians must put in an order for a CPAP, and the patient cannot use their own device but must use a hospital-provided device (policy in place long before COVID). 

If the patient has a dx of OSA and has used a CPAP for years, we have to get a verbal or written order from the physician. Patients also hate that we can't use their own CPAP that their surgeon or intake told them to bring.  Would love to see a policy that CPAP use for known OSA is a nurse-driven protocol. Most of noc shift will put the order as a verbal and not ever call the physician, but this is less than legal per policy.

ugh, that sucks! I have sleep apnea and would be miserable if I couldn't use my own machine and mask. I love when the patients bring their own from home and use it independently, less work for me!

My contribution:

Not taping papers to the wall (we just had a visit from the Joint Commission fairy and this was a big deal...nevermind the fact that we've had multiple falls in the past two months; get that tape off the wall!)

[Ioreth, BSN, RN]

That tape reminds me of another courtesy of the fire department's inspection this month. 

Nothing can be taped to the doors unless it is laminated. Bare paper is a fire hazard.

[BetterTomorrowThanToday]

All WHITE uniforms for licensed nurse staff. 

(while these look very fetching, are a complete PITA or something... nevermind). 
NO LIVES ARE SAVED!! ?

[ladedah1, BSN, RN]

Having to write some long annotation describing the events leading up to and any efforts to dissuade a pt who decided to leave AMA.  It seems like 9 out of 10 AMA's are people with some kind of addiction who are coping poorly with withdrawal (alcohol, drugs, cigarettes)... trust me, if there was something I could say to make them see reason and stay for treatment, they wouldn't be leaving AMA.

Conversely, best policy ever:

Pts who leave AMA just to get outside and smoke a cigarette have to go back through the whole ED process if they want to be readmitted... and, most likely, will end up in some other room on some other unit ?

[Leader25, ASN, BSN, RN]

Oh yes "sucking time and energy"

the policy that only BSN grads can do fingerstick.

I guess humiliation is their specialty.

[Leader25, ASN, BSN, RN]

Only the residents may use the recliners.

You must share your  tiny locker with 3 people.

Nothing under the sink cabinet Joint commision is coming.

Free coffee only for doctors.

No lock on nurses toilet,(so any parent,leaving lochia smeared seat,bloody  handle faucet,stranger,can get in there)oh there is no money for a lock.(even utility room has a lock)

I could go on

 

[nursej22, MSN, RN]

This is fast becoming my favorite thread! 

[Ioreth, BSN, RN]

Fall Risk Screening and Skin Breakdown Screening (I forget the actual name of the tools at the moment) that have to be done every 12 hours

I assess their fall risk by assessing their strength, compliancy, and how they move; not this stupid tool that I generally don't fill out until late in the shift. The skin I assess by looking at the patient and how often they shift their weight. I'm sure these tools are useful for the inexperienced, but for those of us that have been doing this for a while, it is a waste of time.

[amoLucia]

On ‎7‎/‎17‎/‎2021 at 12:58 AM, BetterTomorrowThanToday said:

All WHITE uniforms for licensed nurse staff. 

(while these look very fetching, are a complete PITA or something... nevermind). 
NO LIVES ARE SAVED!! ?

Hey! Where did his come from? Seriously ...

[RN1987]

LOL, who's got time for care plan nonsense?  Some facilities have sheets of paper in patient rooms to initial to prove that staff were in the room each hour. No time alloted for that nonsense either, same with the whiteboards.  Bedside shift reports are useless as well.

[Hannahbanana, BSN, MSN]

I’m with you on a lot of these things, except for the nursing plan of care.
 

You wouldn’t think much of an attending physician (or resident) who didn’t diagnose an admission and document a plan of medical care. Without that, the next shift of residents or covering just wings it because there’s no plan? Or wastes time reassessing the basics and reviewing everything that came before to see what should happen next, because there’s no plan? Or some diagnostic or intervention doesn’t  happen, because there’s no plan?

Yet for some reason it’s OK for nursing to be like that, flitting from task to task, shift to shift, without an overall plan for nursing care during this admission? 

If your beef is with the idiot administration who believed the IT salesman and bought an alleged “nursing care plan” software package that had more to do c capturing costs and covering asses, without allowing actual professional nurses to evaluate it as a plan of care program for user-friendliness and actual usefulness for planning nursing care for this admission, I’m with you 100%. 

But surely, there has to be enough critical thinking involved for you to differentiate that from an actual plan based on a professional nurse assessment of the individual. Not a canned plan based on a medical diagnosis alone, but a real incisive look at this individual’s actual unique needs in addition to the expected ones. Saying “care plans are a waste of time” is worlds away from saying what needs to be said: “We can’t do our best work with this useless structure imposed on us. We need a better answer.” 

As one of my favorite nurse rabble-rousers once put it, nobody’s going to give you power. You have to seize power.