Shortcuts

The Nurse who cannot prioritize his/her work will be strongly criticized. The main thing is to keep the main thing the main thing. I set aside charting and have even answered "no" when someone asks for a snack, etc. till I get caught up. Ask for help from other nurses and be available for them. If necessary, go back to Maslow's and determine what your priorities are from that. The best thing is to plan ahead at the beginning of the shift and get done all the nick-picking things when things are at a lull. Don't put off tasks or they may build up on you.

Thank you for your helpful reply. Im keeping all this in mind at work.....And thanks for reminding of Maslows pyramid,very helpful.

Planning ahead is, of course, great. Prioritizing is a must... however, what makes floor nursing (med-surg in particular) so challenging is that for which you can never plan. Stay loose and flexible: don't be rigid in your plan for the day. Here's a few things I've learned along the way that have helped me.

1. Beds don't have to be changed to the mattress every single day. Change what needs it.

2. Don't fudge on vitals: they're often your first sign of something bad coming.

3. Let those who can, do. Delegate to other staff as appropriate and available, let your patients do for themselves what they can.

4. Your patients will forgive you much if you get them their trays while they're still warm (hot is probably impossible =)!

5. Always find time to medicate for pain.

6. When you have a pt go bad, let your other pts know, as appropriate, that you have a situation that will require your full attention for awhile and that you will provide for them in the best way you are able. I've found most people to be very understanding.

7. When at all possible, answer your call lights quickly. If often saves several minutes worth of complaining about how nobody ever comes when they call!!

There will be days from... heck. No way to totally avoid them. The best way to make it through is to develop your method of delivering care and stick to it. You learn thru experience safe time-saving methods. Learn from your mistakes and move on.

Enjoy your career,

Tracy

I have never felt comfortable about short cuts in any nursing duty. If you are a good worker you will soon discover how to best organize your time with priorities first. If you get behind, ask for help. If there is no help, then your sup failed to staff properly. Personally, the facts are that many do take short cuts out of fear that they will lose their job or be reprimanded. The sup has one objective, get as much work out of as little staff as possible, it always comes down to a dollar. Just remember, if you make a costly mistake because you're forced to rush, you may lose your license, but you're sup simply goes through root cause analysis to write up new policies to prevent the event from occuring again.

One thing I never take shortcuts with is passing meds. I made a med error many many years ago of giving Digoxin and Lasix (both IV push) to the wrong new admission (I had 2 at once in ICU while working charge and both docs yelling orders at me). I realized the error as soon as I had given the second med, and started bawling like a baby. The doc (whose pt. I'd given the meds to) took me aside into a conference room and let me cry for a few minutes; then told me to snap out of it because my patients and staff needed me. He also said that I'd probably never make an error like that again, and I haven't because I still remember how awful it felt to know I could have killed that patient. So (the moral of the story is) don't take shortcuts with meds. Always follow the 5 R's: Right patient; right med; right route; right time; right order.

You were asking for shortcuts regarding getting meds out on time etc...most hospitals have a 1/2 hour to hour before or after rule that you can give meds early or late. I like to start to give my meds as soon as possible, so at our hospital, I can give it 1/2 hour before. I go into the medroom and start getting everything prepared 1 hour before so they are all ready. I also use the papercups and write the patient room number on the bottom of them and load them all up at the same time. On my brains I put in red the names of the meds only, and check them with all the rights when I am putting them in the cup. Then I double check my list in the patient's room, with the room number on the cup and the meds inside the cup. This seems to work well for me and I have never made any med errors to date. Also, if you are really in a jam, charge nurses can be asked to help and give meds for you. They are often there to keep the unit flowing and can sometimes help if they are not too innundated. I also find that if I offer to help other nurses whenever possible, they are much more willing to help me when my time of need comes around...hope some of this helps!!

Hi! It would be helpful to know what area of nursing you work in.

There are so many different regs for different areas of nursing. In LTC where I work......we have an hour grace to get the meds out.....because your assignment can be anywhere from 20 - 40 residents......and many are on anywhere from 8 - 17 meds:eek:

The state regs for LTC are so strict.......refusing to give a snack when asked for one, for example, if witnessed, would be considered "neglect".....seriously. Food trays must be passed within a certain time frame, and all people in a room must eat at the same time, so if one of them needs fed....someone has to stop and feed in that room (if you're short on CNA's the nurse must assist!) If you fall behind on a med pass on 40 residents, you are seriously in trouble for the rest of the day!! (Also during this pass you have to stop and suction trachs, hang feedings, change IV bags.......not a lot of takers for LTC these days!!) We are also not allowed to "pre-pour" which is a huge no no. At any time a state inspector or even a Pharmacy inspector can come in and unlock your cart and check it. They've been in several times shortly after 7am.......you just never know when it will be. As far as shortcuts.......heavy sigh......not many. I just go as fast as I SAFELY can......limit chit chat without being rude, promise to come back later.....etc. It makes you feel so bad to pull a little hand off you who is asking you to stay and talk because you don't have time:o

It always makes me wonder when I'm on with someone who does a pass that takes me over an hour and they do it in 20 minutes.......then you find unopened med boxes that you stocked 2 days ago.....STILL unopened! They come back with a list of B/P's.....and there is only one cuff on the floor and I had it the entire time......heavy sigh.......the most common "shortcuts" are obvious to the trained eye....... ;)

LC...your last paragraph,where you begin "it always makes me wonder.." sounds like you might work at the same hospital I do.

I think the answer to the situation you describe is to have supervisors do random med. pass observances.,the supervisors watch the nurse pass the meds.,then lets see how fast they pass them.

thanks for advice

It is mind boggling for sure!! You know how when you are driving down a road, and up ahead you see a little old lady just stepping off the curb, or you see a kid on a bike on the sidewalk...you start making some kind of contingency plan in your head??? Nurse have to do that on the floor!! See that call light WWaayy over there out of your pts reach...clip it closer, and avoid a fall!! Taking report on a new admit...you hear Tube feed (HOB elevated, drain gauze, 60cc syringe, resids., all should be in your mind), or antibiotics (I need to grab the thermometer...)

Unsafe patients should not be left alone in thier rooms...I recently had a patient who was scheduled to be med flighted the next day across the country to a new LTC facility closer to the rest of the family. He had a history of impulsive behvior, & poor safety awareness....the family paid $16,000 for the flight alone. He came everywherre possible with me the entire weekend until he left...burden yes!! BIG TIME!! But having him fall would have been a disaster with minimal costs of $16,000 for the family! Obviously it is unrealistic to think we can do this all the time.....but nonetheless.....An ounce of prevention!!!

Watch for safety hazards as you work...it takes 10 seconds to place a call light within reach...pick up that blanket on the floor....20 seconds to put slippers on someone who is about to walk to the bathroom barefoot....

P.S. if you suspect someone of not giving meds, or taking short cuts simply out of laziness....you MUST report your suspicions! It sucks I know... Recently I was taking care of a pt. who was a diabetic. He was sched. for QID Fingersticks..6:30 am 11am 4pm, and 9 pm. When I went to check the 11 am blood sugar it was 28!! I remembered the night shift nurse (supervisor) told me that his 6:30 level was high and he got 8 units of Regular Insulin!! I re-checked his blood sugar with another glucometer..it came up 30!! He was completely asymptomatic!! I gave him a large OJ with sugar....called the M.D. and while I awaited her call back I checked the history on the glucometer....the night nurse actually checked his blood sugar at 4:15am Admin. 8 units of regular insulin just about the same time the mans own body would once again increase its production of insulin (to the extent it was able)!! Not to mention that the pt. had NOT eaten anything for 12 hours (he refused his HS snack). I had heard that this nurse sleeps on nights, gets out of her chair once or twice and that is when she does meds, treatments, blood sugars etc... Patients complained all the time that she did not bring pain med, and frequently scolded them.... Her shortcuts were (are) appalling!! I reported her.....she was not even reprimanded, because of the fear of losing a nurse in the midst of the "shortage"!!

NO SHORTCUTS!! Get Organized!! Ask for HELP!!! I have even asked a custodian to help when all the pt. wanted was to have the blind opened or the bedside table pulled closer!! Stay till the job is done, and try to learn how to work together as a team with the shift before and after you to get the job done right!! Nursing is one of the hardest jobs in the world, and one of the most thankless jobs there is...The best gift you can give yourself is to be sure you have done the best possible job for your patients, and that you will have no regrets!!

Hang in there......

Donna

Donna-I feel I must clarify your diabetic scenario-8 units of regular insulin given at 4:15AM would not cause hypoglycemia almost 7 hours later at 11AM, but rather around 6:15 to 8:15 AM, since it peaks in 2 to 4 hours. Didn't the patient eat breakfast? I would suspect that the night nurse actually incorrectly gave NPH or another long acting insulin which begins to peak anywhere from 4 to 12 hours later. Whether or not he ate a bedtime snack would make no difference if his blood sugar was high at 4:15 AM and he was given insulin and then a meal. However, not eating within a half hour of regular insulin administration WOULD make a huge difference, especially if he had been fasting. So as I see it the night nurse made several errors: 1) doing blood sugar at the wrong time, leading to 2) administration of insulin at the wrong time; 3) the likely administration of the wrong type of insulin for coverage (must ALWAYS be regular and given just prior to a meal); 4) not giving a meal within one half hour of insulin administration.

I hope you wrote her up-super or not!

As an aside, i also have seen patients with B/Ss so low you think they should be dead! Isn't the human body an amazing machine at times!

Thanks for the info...I hear you! And thanks for the refresher on insuling onsets / peaks. However I spoke to a friend of mine after the incident who is an endrocrinologist because I was, like you trying to make sense of the matter....and she suggested the same scenario that you mention, but also stated that often times in the elderly compromised patient, insulin onset and peak times have been known to change, usually increasing the length of time for each. She even mentioned that this has been the cause of some cases of insulin overdose. Scary Huh??

In any case.....you are right. This patient had not eaten for at least 12 hours prior, and he ate less than 5% of breakfast.

This nurse is scary....I did report her....she has been reported several times, but the managment has no spine. She thows fits, and threatens racial motivation malarki!!

Any other suggestions? I am open to them all. I don't go to this facility any more...This same nurse became verbally abusive toward me a couple of weeks ago. I had a patient to be medflighted out the next day before 9am..He needed to have a hep loc inserted before departure...(he was being flown across country to another facility closer to his family). I asked this night shift supervisor to please insert the hep loc on the night shift...she became beligerent and refused. I called the doctor during the day because there was not even an order for the insertion of a hep loc, and got the order to insert it 1 day prior with flushes over night...Good thing too....because I could not get the hep loc in....he was very dehydrated, and we called the I.V. Nurse in. Well the night shift nurse was embarrassed because she realized that if I had waited till that morning, he would not have been ready for his $16,000 flight!! She tried to make it look like she was more than willing to put it in, and I didn't want her too yaddy yaddy ya....she screamed and yelled at me for about 20 minutes...I almost walked out, but I wanted to follow up on my pts. I finally told her to "shut up, and give me report, or I would leave" I also told her to take her concerns to the DON. She was so inappropriate...talking loudly to all the other staff on about me...I was appalled...I felt like I was in Junior High School!! I wrote up a report on this incident also.... The facilities reaction....They stated "we won't be using you agencies nurses, and don't count on us paying the bill!!" Can you believe that?

Sorry to ramble....this stuff is just so scary.....

Donna

Donna-thanks for the further info re possibly delayed onsets and peaks in the elderly/compromised patient. I didn't know that but it is valuable info.

As for that unsafe nurse-you did what you could, and have nothing to feel guilty about. I have seen several instances in my career where the hospitals cover for unsafe, dangerous practioners-docs and nurses. I don't understand it, but I continue to report incidents as they occur, even if I doubt anything will be done. If you keep documentaion, no one can accuse you of a cover-up after the fact when the dangerous nurse makes a mistake too serious to ignore!

Just as well to not be working there any longer. It is a shame that someone obviously unsafe is allowed to continue practicing, but you did all you can do.

Good job with the heplock incident. All too often, some nurses wait for the last minute or the next shift, often to the detriment of the patient. You sound like a truly caring nurse and patient advocate!