What I Would Love To Send to My Hospital's Inpatient DON

Lev, MSN, RN, NP

This is what needs to be instituted to keep your nurses and patients happy:

Mandated nurse to patient ratios

The suggested ratios are: 1:5 Acute care, 1:4-5 Observation 1:4-5 Surgical acute, 1:4 Heart Care Unit, 1:3 Intermediate Care, 1:6 SubAcute, 1:2 ICU, 1:4 ED. These ratios should not be breached!

Secretaries on the floor to handle non-nursing tasks

They can fill out medical release forms, make copies of advanced directives, stock forms on unit, and pick up old charts and bring them to desk for filing.

Instituting visiting hours and limits to how many visitors at a time

Family members must get special permission to stay the whole day/night. Family members can be great, but they can be detrimental to patients and staff. Some patients want and/or need their rest. Sometimes they don't want visitors. Sometimes family members want to be served by staff. They want drinks and snacks. The hospital has a cafeteria. They can also order guest trays for only $8 a tray. Sometimes family members are so demanding that their family member who is the patient is embarrassed at how they are acting. Staff is very busy. They are not always available to answer questions. There are things that must be done that have time constraints, such as medication administration, documentation of assessments, and hourly rounding documentation. If there were posted visiting hours such as from 1:30-4pm, nurses could be prepared and anticipate family members coming in at that time with questions. Family members expect visiting hours. They ask us what the visiting hours are very frequently.

IV team available to assist the nurses with lab draws/new IV starts

This would be a huge help.

Charge nurses should not have to take patients unless there is a true emergency

Charge nurses are needed to control patient flow, triage admissions and assign them to rooms, handle patient/family concerns, help with lab draws/IV starts, help with admissions, and educate staff. When the charge nurses have patients, they suffer, the staff suffers, and their patients suffer.

No more double documentation!

Aspiration documentation can be done in the daily adult assessment form, and an area for bronchial hygiene can be added in the adult respiratory section. Documentation takes away enough time from our patients and double documentation is a waste of time.

PROVIDERS/Pharmacy in the ED responsible for medication histories

Nurses do not prescribe medications. They are not familiar with all medications and dosing, especially if they are a new graduate nurse. If a patient has an unfamiliar medication and gives the dose incorrectly, it may be a dose that is way off the norm, but a nurse may not recognize the dose as off. Patients come to the unit with incorrect medication histories, and medications are ordered based on this. Wrong times, wrong dosages, or wrong medication! The patient gets annoyed that a PM medication is scheduled for the AM. Then the nurse has to call pharmacy to get it straightened out.

Nurses should not be held responsible for asking providers to order things patients need such as VTE prophylaxis

This is a provider responsibility! Instead of disciplining nurses, providers should be contacted directly. Or there should be a protocol in place that allows nurses to order Teds, SCDs and/or foot pumps given patients do not have vascular compromise in the legs or wounds on the legs.

Anything to add?