Cartoon and "cutesy" patterned scrubs. (Disclaimer: I do wear patterned scrubs.) Nurses and CNAs are the only healthcare workers I see who wear patterned scrubs. I have never seen a MD or PA wear patterned or cartoon scrubs. They will wear solid color scrubs. I think we look more professional when we wear solid scrubs or nice patterns versus mickey mouse. I think the "cutesey" scrubs should be reserved for pediatrics. I am in no way saying that nurses who wear such scrubs are less intelligent or less competent, but I think we look less professional when we dress this way.
Stop the Diploma vs. Associates vs. Bachelors infighting. There are great nurses with diplomas, Associate degrees, and Bachelor degrees. A degree does not equal competence. I'm not saying one is smarter than the other or less smart than the other. I do think, however, that we have to set a standard and in the eye of the public a Bachelor's degree means more than an Associate's degree or a Diploma. If we want to be respected as a profession, there have to be set standards, not three ways to become an RN. There aren't three different degree paths to become an MD. That being said...In my opinion, there should be a plan to phase in the Bachelor's degree as an entry level degree with current Diploma and Associate degree RNs being grandfathered in, and incentivized, but not forced to return to school. I don't think an Associate's degree RN who has worked for 30 years should be forced to spend hard earned retirement money get a Bachelor's degree. I do not think LPNs should be phased out. In fact I think they are underutilized. We could utilize a "med pass LPN" on the floors who can pass meds on a handful of patients who don't have IV push medications. They can share an assignment with an RN. I know this used to be done.
Speaking of infighting...The specialty wars that exist in some places is getting very tiring. Enough said.
Nursing schools must cut some of the fluff and focus more on the practical.
Titles/degrees. There has to be a standard that everyone follows for listing degrees and certifications. The standard is first name last name, highest degree, lowest degree (if highest degree is not a nursing degree), and then certifications. There should be standard for NP titles as well. Maybe just CRNP, followed by specialty or just plain CRNP.
The ratios. Nursing home ratios are insane. There are some med-surg units where the nurse patient ratio is 7-8 or more to one RN and there may or may not be a CNA. Patients are getting sicker and sicker. I don't know what we can do about this, but if we continue to put up with it and not speak up more it will continue. Part of the reason the ratios are being harder to deal with is because there is an increased focus on customer satisfaction.
The focus on customer satisfaction is killing nursing and killing patients too. I think it's only a matter of time before the data comes out that we are doing more harm than good. This is another thing that we should not have to put up with.
Speaking of data...nurse researchers should focus on publishing studies using randomized controlled trials with measurable data that offers practical conclusions. While there is a place for nursing theory, I feel there is too much emphasis on this in nursing education and research.
The documentation. Some places are better than others. I wish there was a standard way to document that could be used across the board which wouldn't be so time consuming.
Boards of nursing. I know that nursing is state regulated, but if you take the NCLEX, which is a national exam, your license should be valid in all states which means that all schools of nursing should be accredited by the two recognized national certifying agencies CCNE and ANCC. Nursing schools should be required to have accreditation. If there was a national board of nursing, the unaccredited schools would not get away with what they do.
Interactions with patients and colleagues. We should not have to put up with rude patients and family members yelling, hitting, throwing objects, stealing supplies/food, being disrespectful, spitting, cussing etc. Of course the exception is made if there is a clinical reason for their behavior. If this happened outside of the hospital would you put up with it? Or would you press charges potentially? The same can be said related to our colleagues, including physician colleagues. We should call people out on their inappropriate behavior and report it to management and then to HR if the behavior continues after intervention(s).
You are only encouraging drug seeking behaviors by pushing Dilaudid in 15 seconds. Dilute your Dilaudid in 10cc NSS and push over 2 minutes. FYI morphine should be pushed more slowly to avoid respiratory depression. At one place I worked, the doctors started ordering 1-2 mg Dilaudid diluted in 50 cc of NSS that ran over 1 hour. The ER I currently work in is "Dilaudid free." So changes are being made and there is increased awareness. Have you noticed this in your workplaces? Effective pain management means keeping up with pain not catching up with pain and utilizing your non-narcotic analgesics in conjunction with narcotics. Post op patients should have scheduled pain meds. Many times, providers give in to the requests of "frequent flyers" who request medications that are not indicated, such as Benadryl, Zofran, and Dilaudid cocktails. These patients often deny itching or nausea, but rate their pain upwards of 10/10. I feel that it is a violation of the five rights of medication administration to give a medication that is not indicated.
It's not my patient, it's OUR patient. If you get report from the day shift nurse and a dressing change wasn't done, labs weren't drawn, and/or the patient needs a new IV, don't make her stay to complete those tasks. Is this about YOU or the patient? Of course if there is a trend, laziness shouldn't be tolerated, but for your typical hard working RN, some days are just terrible, and the last thing you need is the next shift RN making you stay when all you want to do is go home. The better thing to say is "Hey Lisa, can we do that dressing change now together?" And I work both days and nights and nights are really busy too.
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Julius Seizure
1 Article; 2,282 Posts
Squirting the narcs down the sink and then pretending to give them (and documenting such) is not the appropriate way to handle this.
If you truly believe that it is unsafe to give the med, then you dont give it. Thats all.
If the family gets violent or disruptive, you call security. You can even call secruity in advance so that they will already be standing by when you tell the family that you will not give the med.
You call the physician and tell them your concerns over giving the med. Even if the doc wants it given anyway, you document, document, document to cover yourself. Then you can either tell the doc to come give it themselves or you can give it and document that you had spoken to the MD about your concerns. You keep narcan available. You let your charge nurse know whats going on.
You do not pretend to give the meds and not. Even when you are squirting them down the sink, this could be construed as diversion.