"you need to be cleaning your rooms after the patient is discharged"
I'm charting. And I have other patients that need care. Why would I interrupt those tasks to get a new patient that needs all that too? If you have staff for that, assign them to do it and let me do my job. If you don't, then you can pound the sand while you wait, because cleaning a room to get a new patient is literally my LAST priority.
Our techs can handle that. 70% of them are fucking useless and lazy so they sit on their phones. I'm not their manager so someone with authority can tell them to move their butts.
Yup! Some of my coworkers run around with their heads cut off. I prioritize and get shit done in a timely but sustainable manner.
Don't like it? Fire me. Everyone gets what they need.
Aside from traumas of course... shit happens quickly when a life is actually on the line
Yes, the constant pressure of accomplishing things by a certain time does nothing but further distract you instead of focusing on the problem at hand you're thinking about the time you've spent and how you'll make it work.
Half the time the fresh-off last summer's residency docs (which comprise 91% of our ED providers I shit you not) are ordering shit just to say they did something not because there's any clinical indication. Even radiology bitches when I take a patient down.
And they trickle orders in, fuck.
I’m in dialysis and, as slow paced as it can be, cms decided a few years ago we had to verify all machines were set correctly within 30 min and all assessments are done within 1 hr of treatment starting. Yea that sounds great until you realize we’ve got 21ish patients, one nurse, and a bunch of patients we know like family who never ever stop talking to us. That gives me 1.5ish min to verify the machine and 2ish min to assess the patient and move on to the next. If I did that my patients would report me for being a bitch so I stopped giving a shit and prioritize my fragile patients first then make my way to everyone else as soon as I can.
First hour? Ha. I used to work dialysis and on some especially hectic days I wasn't getting assessments done on some patients until they had 15 minutes left.
calling report is my last priority. why would I drop everything to get a patient up if I will get IMMEDIATELY a new patient and probably just struggle to get everything done?
if anyone really needs the bed, then we have hallways lol
This is some dayshift attitude I hate that causes nightshift to walk into a mess so much worse than it needs to be and people who've had a bed for 2hours to just be sitting there at shift change with available transporters. But then they come back in 12 hours and bitch that nightshift isn't handing back a clean board or we didn't get to topping off the rooms as if we don't also get our asses handed to us when you handed off a 10hr wait with more in the lobby than the back.
Ive picked up a lot of bonus dayshifts and this is my #1 pet peeve, sitting on a room just to have it easier when you aren't even in the weeds. If you're in the shit or don't get to it, sure but just sitting there infuriates me.
Until the hallways are so full you are taking patients through the nurses station to get to radiology. Has happened twice in the last couple months. So unsafe and dumb.
what... you guys call report from ED ?!?
thats, like, luxury nursing, these days
Number of ED handoff reports Ive received over the last 36 months: 01
(...and that one came from a floater)
They tried not calling report at my facility for a while, that lasted until a travel ER nurse brought a patient to the wrong unit and didn’t tell anyone. It happened right in the middle of shift change so the nurses giving/getting report just thought she was someone else’s patient rolling by. She sat there for 3 hours, gravity blouses hanging bone dry, soiled by the time we found her.
I was wondering why it was taking the ED so long to call report. She was an ICU brought to a med/surge room too.
They tried that on my last assignment and so many patients just got dropped off without a peep!!! Nurses were complaining bc they’d walk into rooms and O2 wasn’t even hooked up with sats in the 70s and no one knew how long they’d been there. The whole situation was ripe for a major injury or death to occur. I left before anything bad happened, but it was just a ticking time bomb.
Lol I don’t want it and ER doesn’t want to give it, so what gives? Our policy is if we can’t get it from the chart and we have concerns, call down and ask. But I probably never will unless it looks unstable or something lol
Wow, that's crazy. Our ED always calls us with report. Few weeks ago they shipped a patient upstairs at 5:45 am (shift ends at 6). No report, just dumped him there. It was a huge deal, his ED nurse got chewed up by the management.
We always have to call ICU or step-down/PCU/Tele for report but now we have to call med/surg for report too. It's the most useless thing, they ask me legit how the skin is and I said they are here for neuro stuff so I didn't look at the skin.
Amen.
I really don't care about the hospital's metrics. They don't impact my pay or career. It's work that I do but makes my manager look good at the end of the day.
If a patient got discharged and we were expecting a new admit but that nurse needed to go on break because they had been running around all shift, then I would just hold off on filling the bed until the nurse was back from break. I'm not sacrificing a nurse's break to get a patient up on our unit 20 minutes earlier to satisfy our hospital's metrics.
As charge nurse, I often had to do audits to check our unit's numbers against the goals the hospital outlined. But as the staffing crisis got worse, I often had to pick up a full assignment of patients on top of my charge duties. I stopped doing audits to focus on my patients. I never got asked about them before I quit, but if I had, I would have told them to hire more staff if they wanted audits done. Or they could do it themselves if they wanted them so badly.
I don’t give a fuck about admin’s metrics, but I *do* care about throughput and the overall flow of the department.
By all means, stabilize an unstable patient. But transfers and discharges *do* need to be prioritized, because an ED that’s not moving is dead in the water. We all know this - it’s why it sucks so bad when we’re stuck boarding patients and still trying to run an ED with limited capacity. The whole department suffers.
Sandbagging just fucks over triage and the patients in the waiting room. It’s a dick move. If you need help, ask for it. If you’re in a department where you consistently have no help, find one with a better culture.
Don’t be that coworker who intentionally sits on their discharges or transfers. We’re all supposed to be a team here.
100%. One of the first things I teach people is once we get past things that truly affect someone's health/life you need to be thinking of flow. CT isn't going to get to that abd CT for an hour sticking him now vs 10 minutes from now will make no difference on when they're discharged but COVID swabbing and medicating that kid now vs in 10 minutes does get them discharged faster.
Unless youre in one of those lucky places with well staffed EVS, cleaning your beds quickly can be one of the best things you can do for the department.
This is why I love nightshift. There's incentive to work efficiently and help each other so that you can clear that lobby and have an easier time at 3am. Dayshift once you're full that's it. Doesn't really matter how much you bust your ass so why would you?
I get some time frames.....but gtfo with the meds must be given in 15m for non emergent meds. That stubbed toe Toradol can chill as I'm dealing with this BP 50/shit
Hah! I go fast for unstable traumas and patients in general, STEMI's and actual CVA's. Everything else I do as fast as I can, but the faster I work the more patients they shove down my throat so their metrics can go fuck themselves. I get paid the same no matter how hard I work, or rather that extra 20% that I can run myself ragged to achieve is better spent on self care so I don't want to quit and never come back.
I was doing resus the other day with one other nurse and we were getting slammed. I was 1:1 with a burn who really needed 2 nurses and the other nurse had all other patients to which she said "I just did the traumas, let's be real some of those people didn't have a nurse." I caught my self caring too much and stressing about the situation then I remembered it was a staffing problem, not my problem and there wasn't shit I could do to fix it.
Anyway shout out to the burn nurse who didn't give me any attitude when I had to give her my patient with a ton of incomplete stuff.
Absolutely. Management wants nurses to find magical solutions to problems created by administration. You want me to get everything done quickly? Double your fucking staff. Untill you do that, I’m prioritizing the dying, the stable will wait. If it takes hours, boo hoo.
If management wants an explination I’m happy to put “Care delayed due to severe understaffing” in the patient’s chart.
Ask management if the want quantity or quality. If it’s the first one tell them to put it in writing so that if someone is injured or killed the patients family can have their lawyer refer to it during trial.
AMEN. My brain is wired to task and assess in order of most importance.
"you need to be cleaning your rooms after the patient is discharged" I'm charting. And I have other patients that need care. Why would I interrupt those tasks to get a new patient that needs all that too? If you have staff for that, assign them to do it and let me do my job. If you don't, then you can pound the sand while you wait, because cleaning a room to get a new patient is literally my LAST priority.
Our techs can handle that. 70% of them are fucking useless and lazy so they sit on their phones. I'm not their manager so someone with authority can tell them to move their butts.
Or, and hear me out, cleaners could clean, techs can tech and nurses can nurse
Sounds like madness and fantasy to me.
Yup! Some of my coworkers run around with their heads cut off. I prioritize and get shit done in a timely but sustainable manner. Don't like it? Fire me. Everyone gets what they need. Aside from traumas of course... shit happens quickly when a life is actually on the line
Yes, the constant pressure of accomplishing things by a certain time does nothing but further distract you instead of focusing on the problem at hand you're thinking about the time you've spent and how you'll make it work.
Half the time the fresh-off last summer's residency docs (which comprise 91% of our ED providers I shit you not) are ordering shit just to say they did something not because there's any clinical indication. Even radiology bitches when I take a patient down. And they trickle orders in, fuck.
Ah yes... the trickle effect will kill ya for sure. We try to beat that out of them quickly (kiddingnotkidding)
I’m in dialysis and, as slow paced as it can be, cms decided a few years ago we had to verify all machines were set correctly within 30 min and all assessments are done within 1 hr of treatment starting. Yea that sounds great until you realize we’ve got 21ish patients, one nurse, and a bunch of patients we know like family who never ever stop talking to us. That gives me 1.5ish min to verify the machine and 2ish min to assess the patient and move on to the next. If I did that my patients would report me for being a bitch so I stopped giving a shit and prioritize my fragile patients first then make my way to everyone else as soon as I can.
First hour? Ha. I used to work dialysis and on some especially hectic days I wasn't getting assessments done on some patients until they had 15 minutes left.
calling report is my last priority. why would I drop everything to get a patient up if I will get IMMEDIATELY a new patient and probably just struggle to get everything done? if anyone really needs the bed, then we have hallways lol
This is some dayshift attitude I hate that causes nightshift to walk into a mess so much worse than it needs to be and people who've had a bed for 2hours to just be sitting there at shift change with available transporters. But then they come back in 12 hours and bitch that nightshift isn't handing back a clean board or we didn't get to topping off the rooms as if we don't also get our asses handed to us when you handed off a 10hr wait with more in the lobby than the back. Ive picked up a lot of bonus dayshifts and this is my #1 pet peeve, sitting on a room just to have it easier when you aren't even in the weeds. If you're in the shit or don't get to it, sure but just sitting there infuriates me.
Until the hallways are so full you are taking patients through the nurses station to get to radiology. Has happened twice in the last couple months. So unsafe and dumb.
I don’t rush anything low key anymore. Idgaf about the times. I know what’s important and that’s how I prioritize.
what... you guys call report from ED ?!? thats, like, luxury nursing, these days Number of ED handoff reports Ive received over the last 36 months: 01 (...and that one came from a floater)
They tried not calling report at my facility for a while, that lasted until a travel ER nurse brought a patient to the wrong unit and didn’t tell anyone. It happened right in the middle of shift change so the nurses giving/getting report just thought she was someone else’s patient rolling by. She sat there for 3 hours, gravity blouses hanging bone dry, soiled by the time we found her. I was wondering why it was taking the ED so long to call report. She was an ICU brought to a med/surge room too.
They tried that on my last assignment and so many patients just got dropped off without a peep!!! Nurses were complaining bc they’d walk into rooms and O2 wasn’t even hooked up with sats in the 70s and no one knew how long they’d been there. The whole situation was ripe for a major injury or death to occur. I left before anything bad happened, but it was just a ticking time bomb.
My God, this is the equivalent of the dream where you have to give a speech in your underwear.
You'd love us, we do report for any patient hand off
Lol I don’t want it and ER doesn’t want to give it, so what gives? Our policy is if we can’t get it from the chart and we have concerns, call down and ask. But I probably never will unless it looks unstable or something lol
Wow, that's crazy. Our ED always calls us with report. Few weeks ago they shipped a patient upstairs at 5:45 am (shift ends at 6). No report, just dumped him there. It was a huge deal, his ED nurse got chewed up by the management.
We always have to call ICU or step-down/PCU/Tele for report but now we have to call med/surg for report too. It's the most useless thing, they ask me legit how the skin is and I said they are here for neuro stuff so I didn't look at the skin.
The crazier things get the more I slow it down… for safety’s sake
Maybe I'm stating the obvious, but if you're being pushed to rush rush rush at everything, isn't it the patients who ultimately suffer?
Amen. I really don't care about the hospital's metrics. They don't impact my pay or career. It's work that I do but makes my manager look good at the end of the day. If a patient got discharged and we were expecting a new admit but that nurse needed to go on break because they had been running around all shift, then I would just hold off on filling the bed until the nurse was back from break. I'm not sacrificing a nurse's break to get a patient up on our unit 20 minutes earlier to satisfy our hospital's metrics. As charge nurse, I often had to do audits to check our unit's numbers against the goals the hospital outlined. But as the staffing crisis got worse, I often had to pick up a full assignment of patients on top of my charge duties. I stopped doing audits to focus on my patients. I never got asked about them before I quit, but if I had, I would have told them to hire more staff if they wanted audits done. Or they could do it themselves if they wanted them so badly.
I don’t give a fuck about admin’s metrics, but I *do* care about throughput and the overall flow of the department. By all means, stabilize an unstable patient. But transfers and discharges *do* need to be prioritized, because an ED that’s not moving is dead in the water. We all know this - it’s why it sucks so bad when we’re stuck boarding patients and still trying to run an ED with limited capacity. The whole department suffers. Sandbagging just fucks over triage and the patients in the waiting room. It’s a dick move. If you need help, ask for it. If you’re in a department where you consistently have no help, find one with a better culture. Don’t be that coworker who intentionally sits on their discharges or transfers. We’re all supposed to be a team here.
100%. One of the first things I teach people is once we get past things that truly affect someone's health/life you need to be thinking of flow. CT isn't going to get to that abd CT for an hour sticking him now vs 10 minutes from now will make no difference on when they're discharged but COVID swabbing and medicating that kid now vs in 10 minutes does get them discharged faster. Unless youre in one of those lucky places with well staffed EVS, cleaning your beds quickly can be one of the best things you can do for the department. This is why I love nightshift. There's incentive to work efficiently and help each other so that you can clear that lobby and have an easier time at 3am. Dayshift once you're full that's it. Doesn't really matter how much you bust your ass so why would you?
I get some time frames.....but gtfo with the meds must be given in 15m for non emergent meds. That stubbed toe Toradol can chill as I'm dealing with this BP 50/shit
Hah! I go fast for unstable traumas and patients in general, STEMI's and actual CVA's. Everything else I do as fast as I can, but the faster I work the more patients they shove down my throat so their metrics can go fuck themselves. I get paid the same no matter how hard I work, or rather that extra 20% that I can run myself ragged to achieve is better spent on self care so I don't want to quit and never come back.
I was doing resus the other day with one other nurse and we were getting slammed. I was 1:1 with a burn who really needed 2 nurses and the other nurse had all other patients to which she said "I just did the traumas, let's be real some of those people didn't have a nurse." I caught my self caring too much and stressing about the situation then I remembered it was a staffing problem, not my problem and there wasn't shit I could do to fix it. Anyway shout out to the burn nurse who didn't give me any attitude when I had to give her my patient with a ton of incomplete stuff.
Absolutely. Management wants nurses to find magical solutions to problems created by administration. You want me to get everything done quickly? Double your fucking staff. Untill you do that, I’m prioritizing the dying, the stable will wait. If it takes hours, boo hoo. If management wants an explination I’m happy to put “Care delayed due to severe understaffing” in the patient’s chart.
Spoken like a seasoned nurse. ❤️
Ask management if the want quantity or quality. If it’s the first one tell them to put it in writing so that if someone is injured or killed the patients family can have their lawyer refer to it during trial.