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  1. I'm PRN and have been on call because of low census. I know we have COVID and r/o COVID patients; I'm actually "assigned" to the COVID floor, but because of my status + elective surgeries canceled + people avoiding the hospital, our census is low. I wonder what it will look like a week or 2 from now. In the Denver Metro area for reference!
  2. Susan E.

    12-Hour Shift | Life of a Nurse

    0445 Alarm goes off. Day 3 of my back-to-back 12-hour shifts. I hear regularly from friends (none of whom are nurses) “You’re so lucky, you only have to work 3 days for a full-time job”. Hmmm, wonder if any of them are getting up this early? 0615 Wait in bitter cold parking lot for shuttle bus to take me to hospital. 0630 Even though I am on the floor and starting to look up my patients so that I can be prepared for the day, I can’t clock in until 0650. I am in awe of the other nurses who just “slide in” right at 0700 safety huddle and start their day. 0700 Safety huddle with night shift and day shift. One of the RN’s called out today, each of us get an extra patient, bringing the total to 6 patients per RN. 0710 Bedside report, an opportunity to meet the patients and discuss with outgoing RN what is happening with each patient. One of our patients needs to use the restroom, patient requires both of us to get out of bed and put on his back brace. (In my mind I’m thinking, OMG I’m going to start my day behind because we still have 5 more patients to get report on, and I know I have 8 AM meds due). 0800 Time to actually start some nursing!! I usually do my assessment after I get my morning meds. As I wait in line with the other nurses to get to the pyxis we have an opportunity to quickly “catch up” with each other. “Julie, how are the little ones doing?” “Mary, how is your Dad, oh he’s in hospice, I’m so sorry”. Why come to work if you can’t have relationships with your co-workers? As nurses, we certainly don’t have time to discuss the day over a coffee break or at the water fountain but even in short spurts it makes such a difference knowing you’ve got others who are going through the same thing that you are. 0815 Call light going off on my Ascom, patient just received their breakfast and until I go get their blood sugar they are not supposed to eat. It has to wait, I’m next in line at the pyxis to pull my meds. Each of my 6 patients have approximately 6-10 different medications. Call light again, patient states their breakfast is cold now and will need to be re-heated when I come in for the blood sugar. 0830-1100 Grab my WOW (workstation on wheels) and start rounding on my patients. Let’s be honest, some patients, in fact, most patients are nice but some are not. The patient who didn’t get her blood sugar checked before eating her breakfast which is now cold was my “not nice” patient that day. Got her problem settled (cold meal) and explained I wanted to do a quick head to toe assessment and a fresh set of vitals. “Can’t you see I’m eating now?” Well, ok, at least let me take a quick listen with my stethoscope and get your pedal pulses…..AND I’m about to start, and the doctors and residents walk in! The team discusses the patient’s care among themselves and with the patient. One of doctors removes the dressing on a wound that the patient has on her lower leg, takes the dressing completely down and then leaves the room. Remember now, I’m still on my first patient, I need to run out to the supply room to get the items necessary to re-dress the wound. (Hmmm, the night nurse must have forgotten to share with me that this patient has a wound on her leg). 1130 I am finally getting to see my 6th patient. I walk into the room and my elderly male patient is crying to himself. “Mr. Jones, what is wrong? It looks like you’ve been crying” Mr. Jones learned earlier today that he will likely have to go to a SNF (skilled nursing facility) for further rehabilitation. “I just want to go home, my wife is in good health and she can take care of me, I don’t understand why everyone thinks I need to go to a nursing home to get better!” Even though my phone was going off continually with alerts, I sat down in the chair beside his bed and just listened to him cry while I held his hand. 1200-1500 I pull my WOW to a corner on the floor (maybe no one will see me and I can get some charting done) and start to chart my assessments. Call light, one of my patients needs to go down for an MRI and transport is here to get the patient. I and the care partner get my patient ready to go down for the procedure. Give a quick report to transport and then I can get back to my charting. Call light, one of my patients is ready for their pain medication. However, the patient is not due for the pain med until an hour from now. Go to the patient’s room and explain that they are not due for their pain med until 1300 (I have written the times on the patient’s whiteboard when I started the shift). “Well I am having breakthrough pain and I need the doctor to give me something.” I page the resident and explain the situation. Resident orders a one-time dose, go to pyxis to get it and it’s not available. Call the pharmacy to ask them to tube up the medication. Pharmacist states, “It’s going to be a while before we can get it up there”. Just as I head back to do some charting one of the other RN’s needs a witness to pull a narcotic, back to the med room. Oh, my goodness it’s 1400 and I know I have more meds due and have to hang an IV medication. My “not so nice” patient is due for the IV medication, however, when I arrive in her room she has pulled the IV out. I now need to start a new IV. My stress starts to rise since I am not very good at IV’s, but I at least have to try. Sticking this patient more than once is not going to go over well. “I don’t like being stuck and I want to talk to the doctor about why I even need this medication! Please page the doctor for me and get him in here.” I am able to get out the rest of my 1400 medications. 1500 Lunch break, finally! I will never understand the logic behind only getting 30 minutes for lunch in a 12-hour shift. I sit down in the break room to gobble down my lunch, we are supposed to have other RN’s carry our phones during lunch, but that doesn’t happen, no one has asked me to hold their phone for lunch, so I certainly don’t want to ask anyone either. It’s just an “unwritten” rule I guess among nurses. Just as I sit down, phone goes off again, “pharmacy has tubed up that medication for you Susan and the patient is waiting.” So much for 30-minute lunch, it was about 10 minutes at best. 1600 Patient’s family has arrived to pick up patient for discharge. My sweet elderly patient is being taken to the SNF by his daughter and his wife. I go into the room to review the discharge papers. My patient says to his family, “Susan has been the best the last few days, she seemed like the only person that really listened to me, everyone else just talks over me.” I am about to cry myself but I don’t. I take my patient in a wheelchair out to the entrance of the hospital after he gives me a big hug he gets in his car and leaves. It’s a gorgeous sunny day out, the fresh air feels wonderful! 1700 Susan, you’re up for first admission the patient should be arriving soon. That’s actually a good thing at 1700, I’ll get the new admission and I should have plenty of time to get them settled before the night shift arrives. Oh, my goodness, I forgot to call the SNF with report on my patient that was just discharged, they are on the phone now. I should be in the med room starting to pull my 1800 medications for my patients, but I’ve got to give report first. 1800 Starting to pass my 1800 medications, the nurse is on the phone with report for my admission. Patient arrives on the floor at 1830. It takes at least a half an hour to get a patient settled. 1900 Safety huddle for both day and night shift. 1920-2000 Bedside report for all 6 patients. I explain to the night nurse I will finish up the admission and get the meds out for that patient (they were left over from the nurse who didn’t have time to give them on the floor he was coming from). Hand my Ascom phone over to the night nurse. FINALLY! 2000-2100 Complete my charting. 2100 Wait on cold street corner to get shuttle bus back to my parking lot. 2130 Arrive home. Job Satisfaction I cannot think of any job that is more satisfying than being a nurse. Six people put their trust in me to care for them at a time when they’re not feeling their best; did I do it perfectly, no I did not. It’s a privilege to do what I do and I wouldn’t have it any other way!
  3. It seems talks about staffing ratios are taking the nation by storm. One group of nurses at Beaumont Hospital in Royal Oak, Michigan is taking matters into their own hands. BeaumontNurses.org is a 100 nurse-strong group which has launched a drive to unionize the hospital with the Michigan Nurses Association. The push to unionize is to achieve safer nurse-to-patient ratios, but the question remains if the group fully represents all nursing staff. The hospital employs about 3,000 nurses. This is the fourth union drive at the facility in the last 24 years. Susan Grant, RN, executive vice president, and CNO was interviewed in a recent article and reports that she doesn’t believe the group advocating for a union represents the majority of nurses at the facility. Grant cited a recent satisfaction survey in which 80 percent of the nursing staff reported feeling “engaged” with their work. However, the question at hand is this, “Can you feel engaged but also feel that having a union to represent the majority of the nurses across the hospital is a good thing?” Why They Want a Union Not only have these 100 nurses organized themselves, created a website, and publicly listed their names to express their support, but they are openly sharing their reasons for the desire to unionize. Here are a few: Philomena Kerobo, RN of 18.5 years in quoted stating, “Beaumont used to be a best place to work.” She went on to say that around 2007/2008 things changed at the hospital and today, she fears seeing her provider or having a procedure done because of the out of pocket expenses that she will have to pay for month or years to come. She wants the union so that she can have a “voice in what affects our patients and us (nurses).” Irina Schmidt, RN who has been a nurse in the Emergency Center at Beaumont for five years stated, “I want to form a union to advocate for safe staffing levels for nurses, transparency from our administration, and the pay and benefits necessary to recruit and retain quality RNs.” Christe Buck RN for 19 years at the facility reports that having a union will create a voice in decision making and allow for safer staffing. She ended her statement on the site with, “I’m proud to be Union Strong!” Where does the Michigan Nurses Association Stand? You might be wondering where the Michigan Nurses Association stands in all of this since the request to unionize was sent to the organization. The Michigan Nurses Association recently launched the Safe Patient Care Act in a 2019-2020 legislative session, in which they advocate for safe limits on patient assignments across the state. The act also calls for limitations on forced overtime for Michigan nursing staff and will require transparency of all facilities to report RN-to-patient ratios publicly. The MNA supports nurses efforts to obtain statewide legislation as well as facility-wide provisions that set staffing ratios, even if that means unionizing. Along with these goals, the legislation calls to create committees made up of 50 percent direct-care RNs to help monitor staffing levels and use to national evidence-based standards to set nurse-to-patient ratios. A few of the proposed ratios include: Emergency Room - 1:3 plus one ER nurse for triage Medical-Surgical - 1:4 Intensive Care, including ER, neonatal, and pediatric - 1:1 First stages of labor - 1:2 Hearing the Voice of Nurses Across the Nation It seems that the collective voice of nurses across the country is being listened to about staffing ratios. Whether it means that more facilities unionize or that states pass and enforce mandatory nurse staffing minimums is still to be seen. No matter what the answer is, we could be moving in a direction that’s much closer to patient safety, job satisfaction, and protection for nurses than we’ve ever been. You might even say that some of these nurses are working hard to put the “care” back into healthcare. What are your thoughts? Would you join a union if it meant having a seat at the table on critical issues like staffing? Do you agree with the provisions presented in the Safe Patient Care Act that Michigan lawmakers have been given? Let us know your thoughts.
  4. Have you ever considered that nursing excellence allows physicians to provide compassionate, patient-centered care? A recent study conducted by Press Ganey revealed that comprehensive nursing practice in high-performing hospitals creates high patient satisfaction rates for both nursing and physician delivered services. What is the professional practice environment really like? It's free of disrespectful, rude, and disruptive behaviors between staff. Professional relationships don't focus on power or the abuse of it. This allows the work being done to center around the patient, and not on how one group is defending itself against the other. A healthy workforce also consists of effective communication, collaboration, and mutual respect. Understanding the Nurse-Physician Connection Ask any nurse, and frankly, any physician and they are likely to tell you that the relationships between nurses and physicians matter. Knowledge of the professional practice environment is critical to not only to collaboration but also to nurses’ recruitment and retention rates. The professional practice environment is where medical and nursing care happens. Depending on how the nurses and doctors feel about the workplace and their collaborative roles with one another impacts quality. So is the professional practice environment really like? It’s free of disrespectful, rude, and disruptive behaviors between staff. There is no abuse of power or relationships between nurses and physicians and allows for work satisfaction for both professionals and quality patient care. It’s filled with communication, collaboration, and mutual respect. Nursing Excellence Initiatives The American Nurses Credentialing Center developed the Magnet Recognition Program for hospitals. It started in 1983 when they conducted a research study and identified 14 characteristics that made some organizations more able to recruit and retain nurses. Not only does the program require excellence, but it needs to be guided by a visionary nursing leader who supports, advocates, and practices nursing excellence. The 14 characteristics of nursing excellence, according to the American Nurse Credentialing Center include: Quality of Nursing Leadership Organizational Structure Management Style Personnel Policies and Programs Professional Models of Care Quality of Care Quality Improvement Consultation and Resources Autonomy Community and the Healthcare Organization Nurses as Teachers Image of Nursing Interdisciplinary Relationships Professional Development Nursing Excellence, Hospital Scores, and Physicians Press Ganey's study explored the relationship between Magnet status and National Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. This standardized publicly reported survey looks at the patient's perspective on hospital care, including the environment and how well physicians, and nurses communicated with them during their care experience. The Press Ganey survey found a connection between Magnet Status, which indicates nursing excellence, and higher patient ratings of their doctor’s skill, responsiveness, and bedside manner. While the difference appeared subtle in number, there was a meaningful difference in the patient’s perceptions. Out of 123 Press Ganey client hospitals, the survey found that 45 percent of those in the top quartile for engagement of physicians were also Magnet hospitals. Compare this to the 16 percent of bottom quartile facilities who also shared the Magnet designation, and you can see how nursing and physician care must be intertwined to deliver care that is perceived by the patient as having them in the center and being of the highest quality. Improving Nurse-Physician Relationships Considering that only about 8 percent of all hospital in the US achieve Magnet designation, we must find ways to enhance the nurse-physician relationship outside of this prestigious designation. Here are a few ways you can work on your relationship with the physicians in your facility to increase collaboration and positively impact patient outcomes. Practice as a Team While nurses spend far more time at the bedside than doctors, it’s critical that we remember that we each have a unique role in patient care. Share in the responsibility of patient outcomes with all staff members and work collaboratively. Uphold Professionalism When nurses uphold professionalism, the workplace runs smoothly. This includes simple things like getting to work on time, avoiding negativity, and working both autonomously and collaboratively. Develop a Strong Sense of Advocacy One of the pillars of nursing practice is to work as a patient advocate. You must learn to speak up for the patient and let the physician know your observations and thoughts about the patient’s condition. This can be difficult, depending on the type of relationship you have with the physician and other clinicians in the healthcare setting. Practice Effective Communication The ability to communicate with coworkers, including doctors, is critical to positive patient outcomes. You must learn to organize your thoughts before you pick up the phone. If you find yourself struggling to communicate concisely, check out a few different communication tools that can help you standardize your reports to the physicians and fellow nurses. Having a clear report can help the receiving clinician understand the patient’s needs better so that a comprehensive plan that addresses the most critical areas can be developed. How do you feel about your relationship with the physicians in your facility? Do you think that you have a good relationship, built on mutual respect? We would also love to hear from nurses who work in magnet hospitals to learn how you feel about your ability to support physicians and how the two groups work together. Let us know what you think by commenting below. Reference: How Great Nursing Improves Doctors' Performance
  5. Download allnurses Magazine Dear Dilemma, Congrats on your job offer! It’s natural to have concerns when changing jobs. Eight-hour shifts will fly by for you since you’re used to working 12’s. It will take a while to get used to working Monday through Friday, because you may feel you’ve lost some “me” time during the week. Instead of easily making your personal appointments on your days off, you’ll be fitting them in around your 8 hour days. Then again, this is what most working people do. You’ll be joining the majority of workers who are off on weekends and holidays. You may enjoy actually being in sync with the rest of the world. Working 12-hour shifts at the bedside has a relatively short life span and much as many of us love it, there’s a time to move on. You are wise to make this transition at the 20-year point, rather than waiting until the point of injury or illness. It takes time to adjust. Expect to go through a grieving process when you leave the inpatient setting. Depending on your new job, you may be giving up some patient contact, challenging practice situations, and skills. You can always change your mind, but give yourself several months, at least, as you will feel differently as time goes on. Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!
  6. Shortly after 4pm on Monday, May 6th, nurses, physical therapists, and paramedics at Mercy Health St. Vincent Medical Center in Toledo, Ohio went on strike. The group of workers, represented by the United Auto Workers Union was unable to reach an agreement with hospital management concerning health care costs, on-call regulations, and overtime policies. WCPO in Cincinnati reported that president of the health center, Jeff Dempsey, declined to discuss the plan to replace those on strike. He did, however, report that the facility was prepared to handle the walkout. The hospital said last week that they felt the contract they presented to the workers was generous and included increases to staff’s wages. A Family-Member's Perspective Have you ever wondered what happens to patient care during a strike? Shirley Parrott- Copus, a family member of a Mercy Health St. Vincent Medical Center patient, was interviewed by 13abc about the changes in the care she observed. Shirley said that services had dropped since the strike began. She went on to describe the nurses before the strike as “wonderful.” She stated that the morning after the strike started, she was woken by a nurse who asked her where her dad was because she didn’t know. Shirley was alarmed by this event and worried that they had lost her father. Of course, there are many different reasons for the possible missing patient, but to a family member, a statement like that can impact their ability to trust employees. Parrott-Copus is a nurse herself and stated, Who Cares for the Patients? When facility administrators can see a strike on the horizon, they prepare by calling in non-union travel and agency nurses to fill in for staff. The nurses who step up to work don’t have any connection to the hospital, but probably understand the issues at hand. They usually won’t cross the picket line and try to keep a low profile on the job. Travel agencies warn their nurses that tempers can flare at any time during a strike. They advise staff to travel in pairs, remove their name badge and scrubs in public, and to avoid engaging in conversations about the strike with patients, family members, or hospital staff. During a strike, the work is hard and the hours are long. Many nurses work up to six 12-hour shifts each week. Many agencies require staff to sign a contract agreeing to work up to 72 hours a week if needed. Because the hospital is desperate, they need all hands on deck, but what do these long hours do to patient care? The Impact to Quality Care One study conducted in the state of New York found that patient care suffers during nursing strikes. The effects of strikes between 1984 and 2004 revealed that in-hospital mortality increased nearly twenty percent and readmissions went up by 6.5 percent for those patients who came to the hospital during the strike. The study also estimated that 138 more people died because of the strikes. While patient care continues and nurses from agencies fill in, it’s just not the same as having nurses who are comfortable with the inner workings of the hospital, unit, and even politics of the facility. Other issues such as a sense of ownership might be at play for those who are just there to “fill in” until an agreement is made. What’s the Answer? You might be wondering if there is a better solution. Is it better for nurses to continue working in unsafe and conditions, so that patient care remains at a higher level or should they strike and potentially place their patients at an increased risk for adverse outcomes? We’re not sure if there is a right or wrong answer in this situation. What do you think?
  7. Some of our patients might think that hospital accommodations are equal to a luxurious Bed and Breakfast or a 4-star-get-away-package-deal vacation. NOT! LOL! But, have you ever been sick or injured and forced into a vacation? Many Nurses never get real down time or planned vacations where we come back well rested and rejuvenated. How about you ... have you considered a little R&R at your hospital just to get a vacation?
  8. As nurses, we are on a constant go. We usually like it a little cool where we work. But what about the patients? There they are with flimsy hospital gowns and a sheet....maybe even a thin blanket if they are lucky. What do you do to help take the chill off for your patients?

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