WHY??

Nurses General Nursing

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Hi everyone! My unit was just told that starting next week our pt assignmt will not be posted until 5 min until shift starts...there are some nurses including myself that arrive to work early..on our time(not clocking in early) to look at our kardexs and prepare our brian sheets...we are not doing anything except looking at kardexs in the report room, it helps us all feel alittle more prepared for our day and more prepared to take report..according to our supervisor, she said that our legal departmt is sayin its a "legal issue" and they will no longer allow staff to come in early as we have done for yrs. I dont understand why this is a legal issue? We are no doing any pt care..doing nothing but looking at the kardexs...and we are not asking to be paid...does anyone know why this would be a legal issue? I really need the extra time to feel prepared..it has been my routine since i started 2 yrs ago i am very upset about this and just do not understand why it would all of a sudden be an issue?? I could understand if we were asking to be paid for the time or jumping in and doing pt care..we dont even anwser the phones??! Does anyone understand this? Ive talked with my supervisor and explained to her that I really need that time..she says its not her, its our legal departmt. If anyone has any suggestions as to how I can keep my routine I would greatly apprecated!!!:idea: I do it for myself and Im not and would never expect to be paid for this time. :confused:

Taped report is an absolute waste of time on both ends, never mind it is in direct conflict with jcaho published hand-off procedure guidlines.

A nurse needs no time to prepare. (That's school nonsense) A nurse needs ABC's, and prioritization skills.

A victim who collapses before you comes with no kardex, no history, and no care plan.

"Safe Nursing Practice" does not come with planning, it comes with prioritization.

it makes the day go alittle easier to have the info I need with me, instead of running back to the chart and cking! I'm not saying I need to prepare for a code situation..I am preparing for my day..saving precious time. I do and have to prioritize...but likeo I said it saves time to have the needed info on my brain sheet rather than having to keep cking the chart..which is hard to get my hands on half the time anyway! With 6-7 pts there is way to much going on not to have a working brain sheet to refer to. It looks like you're wking in the ICU's so Im sure you have alot fewer pts than I..which makes it alittle easier to keep your pts info straight.

Okay wait a minute here Flying ICU RN. You state the safe nursing does not come with planning but comes with prioritazation. How do you prioritize without a plan?

Someone collapsing in front of you without a kardex is not the same as planning to prioritize your pt care.

Thank goodness my hospital has never said we cannot come early. All of night shift on my floor comes in 1/2hr early to review MD notes, nursing notes, H&P, etc. I would be VERY upset if they said we could not do this anymore.

I feel nurses get the shaft too often. And then they expect us to provide flawless pt care. When we are actually not really given the room in which to do this, yet it is still expected, end of story.

Okay wait a minute here Flying ICU RN. You state the safe nursing does not come with planning but comes with prioritazation. How do you prioritize without a plan?

This is entirely dependent on how the individual nurse defines (sees) their job/function, and how he/she goes about performing that function. My personal nursing mantra has always been "timeliness of appropriate interventions." To do this effectively, I eliminate whatever I determine to be (in my opinion) unnecessary work or distraction to stay ahead of the game, or in aviation parlance, to "fly the damn plane," Situational awareness, as opposed to just going for a ride. Too many nurses (in my opinion) overload themselves unnecessarily.

The nursing antihesis of the above being the all too familiar, "chicken with the head cut off" syndrome.

Specializes in acute care med/surg, LTC, orthopedics.

If your employer doesn't allow you to come in early to get organized, then simply take the time needed at the other end of the spectrum - after your shift starts.

I don't know how many times the ward clerk will interrupt me while I'm getting my assignment/report to tell me a patient is ringing for me. My reply? I will start rounds as soon as I'm done getting report. If this means the patient waits for 20 mins, so be it. I refuse to buy into the habit of being interrupted before I've had the opportunity to mentally plan by workload and prioritize my time. I see too many nurses "hit the ground running" then complain about being disorganized/overwhelmed the rest of the shift. If your employer doesn't support safe/efficient practice, then enforce it yourself.

You may not be doing hands-on patient care, but planning and preparing is considered work and legally you must be paid for that work. You as an individual may say, "but I won't make you pay me for this," but that means nothing. The law says you cannot work off the clock, even if you want to. (And WHY would you want to?) If this practice has been going on for years, as you say, then your facility legal department must be praying that they're not going to get hit with a lawsuit for unpaid wages--all of you would certainly have a case. Just ask WalMart.

Now don't flame me--I mean well--but I wonder if you really can't give safe, efficient care without an elaborate planning sheet or if you're just used to having everything written down. Maybe you'll find you can do just fine with a streamlined approach.

Plus, every time you copy something that is originally recorded elsewhere, you run the risk of a transcription error. If you can't get your hands on the chart itself, at least the kardex is a reviewed resource. And your kardexes should be easily accessible.

As an aside, I notice that a lot of newer nurses have been taught to have elaborate planning sheets. I don't have a problem if it works for you, but my experience over the years is that patients and/or physicians can blow a well-planned day to smithereens! Because of that I write reminders to check certain things and note times for meds in the margins, leaving the whole thing pretty loose so that I can adjust to changing conditions.

I would think you could come in, get assignment and hear report, go briefly check on your patients, fix anything that can or must be quickly attended to, and tell them you'll be back to discuss plans for day after you review their chart. Then you can hopefully have 15 to 20 minutes to add anything you need to to your report sheet.

Sounds good...however..if it was only that easy! When we hit the floor there is no time to review charts and add to our sheets..and Im not kidding. We start right away with pulling all labs, tele strips, calling docs with critical lab values, ck on all pts and then try our hardest to get in an assessmt or 2 before the big med pass begins and pts leaving the floor for procedures with the charts. Im just saying the things I have on my sheet to prepare me for my day works best for me and does save me alot of time. There are so many other issues this hospital could and should be more focused on.

Specializes in acute care med/surg, LTC, orthopedics.
I would think you could come in, get assignment and hear report, go briefly check on your patients, fix anything that can or must be quickly attended to, and tell them you'll be back to discuss plans for day after you review their chart. Then you can hopefully have 15 to 20 minutes to add anything you need to to your report sheet.

This statement isn't taking into consideration a very prominent occurrence that happens on busy units... interruptions. And lots of 'em. So 45 minutes has gone by and you STILL haven't properly reviewed the care plans, etc. If you inadvertently missed something important, who's gonna be blamed? You are.

I'll probably get a lot of flak for this, but I find a part of this thread humorous. On this site we constantly hear about hostile work environments, unfair labor practices, etc as laid out in federal labor law. However, when the employer wants you to follow labor law that is asking too much? If you think it is a bad law, then fight to have it fixed. Of course without it you'll have people being taken advantage of by their employers. You gotta take the good with the bad. And, if you want to get there whenever and be cool to work however you want, get a salaried position. Having been both an exempt and non-exempt employee, they both have their plusses and minuses, but to freak out because an employer is insisting that both you and the hospital follow the law is a bit short-sighted.

I agree with one2gofst. The labor laws should be followed. However, nursing as it exists in many places is not given the opportunity to prep for a shift. From the moment of the beginning of shift it is expected that we will gather our pt histories, pt medications due, review labs, the md's clinical notes for the day, etc, etc. Then go provide pt care using the necessary info we've just gathered. Yeah, sure, in a perfect world. However, that is not the reality because the work load we are given is too demanding and does not permit the 10 to 20 minutes needed to plan for pt care. Management knows this but does not care. It often is not about pt care but how much work can we get out of these nurses with the least impact to the bottom line.

What we need to do is be active in discussions, negotiations, legislation so that we can create a reasonable work environment.

I'll probably get a lot of flak for this, .

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Expect the worst and you'll never be disapointed, LMAO :devil:

As an aside, I really love pictures like that. my grandfather, whom I never got to meet, was a radio operator on a B-17 Flying Fortress in WWII and even received the Distinguished Flying Cross. I am fascinated by B-17s and aircraft in general. Maybe that is why I want to become a flight nurse. Thanks for the photo ;)

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