What I Would Love To Send to My Hospital's Inpatient DON
Nursing is a very physically and emotionally demanding profession. Here are some ideas I would love to send to my DON that would make my job a little easier.
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.
Less emphasis on Press Gainey scores and magnet status. Focus on measurable outcomes. Incidence of falls, CLABSIs, CAUTIs, SSIs , readmission rates, VAPS.
A singular focus on customer satisfaction is unethical. What is best for the patient is not always what they want.
Giving the Diabetic keto acidosis patient unlimited meals and hydromorpho en is bad practice. But they are satisfied (so was Michael Jackson)
One more thing. People may visit at the nurses discretion. Disruptive visitors and those who pose a threat to the patient's health and well being will be escorted out by security Immediately. No more Jahi McManns.
Specializes in Alzheimer's, Geriatrics, Chem. Dep..
These are awesome suggestions, and I love the comments!
How many times did I write these lists, and just throw them away since I knew that changes would not be made. But there were a few DON's who did listen. They ROCK (hint hint, DON's, lol)
Specializes in Parkinson's, stroke. elderly care rehab.
Perhaps it's different on this side of the Atlantic, but British nurses have long fought against being made administrators of care, rather than deliverers. If you're a charge nurse, you've got there (I hope) by demonstrating high-level nursing skills. Why give them up?
I'd say to them to get off their REAR END and come check out how it is now instead of what it was when they where a bedside nurse. On the aspect of charting, I'd like to have the ability to speak into the record (like Dragon speak app). I could get more done and I can chart as I go. Just give me a headphone/mike setup and leave me alone. A transcriptionist could also end up typing my charting, similar to what the doctors do. This would create some jobs in the long run...
As for the British nurses....Brian, brother, I've heard the horrific/stupid/DA things you guys endure with your counterpart MDs. I would not put up with that. I would for sure not last in nursing. It is time for your nursing body to stand up and get things right. Fight for your right!
I do not mind going to the ___________________(fill in the blank) place in this planet or galaxy, but being deployed to AFG under nursing British rules while supporting a contingency really is the last straw for many of us getting deployed to places like Bastion.
I would like to send the same letter, with a couple of additons.
1. How can you base a portion of MY review on pt communication with doctors? I work nights, I barely have the opportunity to communicate with the docs myself, much less facilitate.
Also
2. How can you base a portion of MY review on how well housekeeping does there job? If I call for cleaning assistance, I MIGHT get someone to come to my unit, but it usually takes at least three phone calls.
3. In this era of tigher budgets, how is it fiscally responsible to have 2 hour staff meetings every month when little or no new information is provided at the meetings and staff is not allowed to voice questions or concerns? (Seriously, this has to be on the order of several thousand dollars a month spent on time sitting.)
In a hosp I worked at years ago, on a med surg floor (I was a CNA, for 'technically' one part of the patients, but I hated the fact of just hanging around if those people were taken care of.. I'd do stuff on the whole floor). But the nurse:patient ratio was abt 1(LPN): 6. Then the RN was in charge of them, and also the other pts on that side, and any others up to 8 (if there was full capacity). When my partner was in ICU in the past, there was 1:2. This last time, when she passed away, it was 1:1, mainly b/c she was so bad and was hooked up to everything you could think of....IV's, dialysis, cooling/heating machine, blood. I know if she was still here, she'd definitely agree that they took very good care of her.
Specializes in CVICU, CCU, PCU, Neuro, Cath Lab, EP lab, TEE.
I feels that what happens is these nurses who move in to management positions forget what it was like to be a nurse. I think that for you to be able to call yourself a Registered Nurse you should have to perform clinical duties. It saddens me that these so called nurses get bonuses and kick backs by making their fellow nurses suffer. They forgot what it was like to care for very sick patients. It also saddens me that only California has a state law for pt/nurse ratios. We are one of largest work forces out there and getting larger everyday, but we have yet to get a national law on the books to protect us. It is sickening.
My facility uses Cerner, and recently the physicians have come on board and now they are responsible for putting in their own orders. It's not going so well :-( Mainly a lot of them are grumbling that they should not have to do it. One even went so far and said "What are the secretaries for?" Sigh.
We have Soarian, and it was like this in the beginning too. It got better though, several years in...
The attendings are still resistant and will write written orders they are apt to be missed but residents, interns are on board.
love this , I so sharing this with others, I work on a subacute floor and I had to take patients on long term care and supervise last week, I was so tense ,ended the shift with an intense headache and to realize a nurse had canceled herself for the morning shift:arghh:
your docs will get used to Cerner. we have been "live" for 5 years and had some growing pains initially. If the physicians will use the powerplans it makes ordering much easier too. Hang in there!
ProgressiveActivist, BSN, RN
670 Posts
I would like to add
Less emphasis on Press Gainey scores and magnet status. Focus on measurable outcomes. Incidence of falls, CLABSIs, CAUTIs, SSIs , readmission rates, VAPS.
A singular focus on customer satisfaction is unethical. What is best for the patient is not always what they want.
Giving the Diabetic keto acidosis patient unlimited meals and hydromorpho en is bad practice. But they are satisfied (so was Michael Jackson)
and keep coming back.