Reflection-healthcare quality and safety

The following reflection will describe my understanding of the current status of health care quality and safety and my ideas for the best way to improve patient safety. I am just finishing my third semester of the Masters of Science in Nursing program. Since I am at the halfway mark, I should be feeling like I know something more than when I came into this program. I have taken Nursing Theory (again), Nursing research (again, twice) and Decision Making. This semester I took Nursing Economics, and this course, Nursing Quality and Safety. Although this is supposed to be a reflection of the concepts learned in this course, every concept builds upon the next, just like my career experiences over the years. Instead of feeling like I know more, I feel like I know less, especially when it comes to the best way to improve patient safety. Read More

Our unit needs your good vibes...

We've lost 2 precious angels recently, including one that I was attached too pretty strongly...and we have a gaggle remaining that are circling the drain. It's been a rough 4-5 days around my unit.

As always, the post-mortem care/bath reminded me of the special nature of what we do. Not just anyone can bathe that precious dead baby. Or unhook that ET Tube and turn off that ventilator. It's an honor to be allowed to do it...to pay that last little bit of respect for that sweet angel. Read More

What do you think of 12 hour shifts?

12-hour shifts have been gaining in popularity among nurses and hospitals ... Do you think this is a good idea? Do you find it more dangerous to work a 12-hour shift vs a 10-hour shift? Would you prefer sticking to the standard 8-hour shifts? Read More

RN or NP: which role was more stressful?

For those who practiced bedside as RNs (especially for a few years or more) and then became NPs: which role did, or do, you find more stressful? And why? (asking as one who's very burned out at bedside and hoping the change will do me good). Read More

DO NOT pass on the poop

Hi gang! I've been an RN for almost 3 years now. My first two years was spent in a medical clinic and now a brand new ER nurse. My training has been going well and I've been confident with my progress in the ER until I made the huge mistake of leaving poop cleaning for the next nurse on shift. Call me an idiot but I had no idea that doing so was a NO, NO! I'm certain that it was the headline of the day. In the clinic, I was often delegated to deal with enemas and manual disimpactions so it didn't seem like a big deal to me to inform the next nurse 5 minutes before my shift was over that changing was needed. Following that incident, I was told that passing on the poop is not proper nursing etiquette. Call it a case of common sense not so common. I'm thoroughly embarrassed and now that I think about it, I can understand that it was not cool for me to do that. I did speak with that nurse and apologized and cleared the air. But still...if I was delegated that task by a nurse whose 12 hour shift was just about over, I would gladly do so with no complaint. I would appreciate any thoughts anyone might have about this and any other common nursing etiquette no-no's that would help me survive my new position in the ER. Read More

Staffing and patient abandonment

Here's the situation: Oncoming shift nurse is no call, no show. No one can come in to pick up the shift. Oncoming shift is already overloaded and refuses to take an extra 3 pts each (don't blame them, they already have 7 each, grid states 5, busy med-surg floor). House supervisor says, "stay put." I have to be back at 7 am. Our NPA states that failure to stay beyond scheduled shift is NOT abandonment; it's a staffing issue for which the facility is responsible. What would be he correct thing to do if staffing is their problem but no one will take report? Read More

Shockingly Humbled

Oftentimes, we find ourselves in extreme circumstances. As nurse leaders, we feel confident in taking charge of emergent situations. When we feel strongly about patient care, we can be quite assertive. Sometimes, we are humbled by the outcome.

“She’s crashing!” yells the second year anesthesiology resident.

His high pitched voice slices through the alarms that pierce the green tiled operating room. His forehead creases, and his eyes are wild as he rapidly glances from his patient to the monitor. His meaty hands awkwardly search for the phone. Fumbling, he can’t dial the numbers in his haste. He throws it down to the floor, yelling expletives and breaking the cheap plastic into pieces. The monitor continues to alarm, and everyone hears the rapid staccato beeping of the heart monitor... Read More

Psychiatric nurse practitioner certification vs CNS certification?

I have worked in the same medical center for all 27 years of my career. I had worked as a CNS for 3 years then as an NP for 7. The output. clinic were I last worked closed & the medical center had no compatible position so I took a staff nurse night position. That was 12 years ago. I recently applied for a per diem NP position in the medical center & I was denied credentialing by the medical board because my ANCC certification is as a CNS. I was under the assumption I would be grandfathered into the system because when I obtained my Master's 21 years ago, there wasn't any NP ANCC exam. I have tried to explain this to administration but I was told maybe I could work somewhere else! Of note, there are NP's with the same certification I have currently working in the medical center. Any suggestions would be greatly appreciated. As per ANCC, I am not eligible to sit for the exam as I didn't graduate from an NP program. The university I graduated won't write me a letter for ANCC exam as they currently don't have an advanced practice psych program. Read More

Failure to maintain sats on ventilator

Has anyone ever had or heard of a patient who was unable to be properly oxygenated/ventilated on a ventilator? I recently had a patient who could not maintain oxygen saturations above 80-85 on a ventilator-- with the RT trying every possible setting and combo. Pt had to be emergently intubated post thoracotomy and BPs were in 70s before pressors and ended up on an extreme amount to keep pressures up.

I just wondered if anybody could share some light on this and what might have made the patient so hard to oxygenate/ventilate. Im guessing it was a result of true cardiogenic shock but I'm not sure. Read More!

Organizational Barriers to Professional Development for Nurses

Existing research supports the notion that nurses poses an ongoing drive to acquire knowledge placing value on their own professional development and that healthcare organization play a role in hindering achieving professional development goals. This qualitative survey research study explores the perception of nurse regarding organizational barriers, correlating the findings with demographic statistics and professional goals. The cross-sectional survey was delivered via the AllNurses.com platform, resulting in a participant selection process that produced a varied, nationally representative sample population of registered nurse. Read More

New Grad, where to start career?

Recently offered a new grad academies on Psych & ICU. Interested in different perspectives on both. I wouldn't mind working on either and salary is not a issue. One is literally right down the street the other 30 to 45 minutes. One has great benefits the other not so much. They both are at great facilities. The major difference is one no weekends the other I would have start my orientation on the weekend, which not be an issue except the orientation is rather lengthy (5 months) I have a family 4 kids and I think it would be hard for them. Anyhow this has turned into a rant, all comments and/or advice is welcome. Read More

Best way to administer low volume IV meds to micro preemies

Out unit is trying to find the safest and easiest way to give IV meds to micro-preemies. We want the baby to get the IV medication in the prescribed time but have a few constraints. We leave all our medication tubings attached to our main IV lines. We just keep giving meds on the line and flush after each. Twice a week all of our lines get changed completely (CABSI stuff). We are not allowed to add any extra volume to our prepared meds. Pharmacy has to do it under a hood (infection concerns). We have to use our syringe pump libraries to give IV meds and cannot bypass it to give volume over time or push in IV meds. Right now, our nurses have been doing their own thing and we would like a consistent way to give IV meds, especially those with low volume. We want to ensure that the med gets to the baby in those 15 or 20 minutes and hasn't been left way up in the IV line or flushed in in 2 minutes instead of the 20 minutes. Thoughts? Read More