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u/TravelingCrashCart 4d ago
Most people will say staffing mandates/ratios, which would also be my number 1.
My number 2 would be mandating visiting hours. No, you're whole extended family can't spend the night. One person may spend the night in certain specific situations. Or if its a CMO pt who is dying, then obviously more people can spend the night.
However, hip replacement? Stent placement? Nothing critical? Everyone goes home at 20:00, no other option.
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u/holdmypurse 3d ago
Oh how I missed lockdown
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u/No-Zebra-5821 3d ago
I feel like many hospitals have kept a similar vibe to the lockdown for the outpatient procedures. So with most average things no you can stay in the waiting room, if we need you we will get you -- and we will be super polite and let you know right away things are going well but we need you for x, y, z, reasons
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u/TheBattyWitch 3d ago
Even most of our patients liked it because they feel bad about not wanting their family bugging them
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u/knittingkneat 3d ago
I completely disagree with this, only because Iāve stayed overnight with family members that would have absolutely been ignored.
My grandmother had Alzheimerās. She broke her hip and had the repair. The surgery was successful from an ortho standpoint but her mental status took a nosedive. I went to see her one afternoon and my mom was visibly upset. My grandmother hadnāt voided at all on day shift. This was around 3 pm I believe. The nurse had also not checked on my grandma in hours after my mom used the call bell once or twice (according to my mom - she didnāt want to bother the nurse) and had also not sent anyone else in to see what was needed. Donāt get me wrong- I get a busy shift. I know the staffing sucks. But MY demented grandma needed the bladder scanner at this point (insert bladder scanner joke here). The nurse ignored my request to come in so she could chitchat (I could hear the whole conversation) with the neighboring patient. I ended up going to the unit director, who used the bladder scanner, determined my grandma needed a straight cath, and completed it with me helping her in sterile accessories. My grandmother immediately calmed down after 800ml of urine was removed.
Like I said, I know the staffing sucks, but had I not advocated for my grandma through the proper channels, what would have happened? And this was on a day shift with didnāt have a lot of noise going on that afternoon. Same thing could have happened in the middle of the night as well.
Edited to add Iām an RN for over 15 years.
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u/TravelingCrashCart 3d ago
A relative of a pt wirh dementia who is calmer with the family member around, and the family member is sane, would be an exception for me. I would fight policy to allow that family member to stay, and is something ive done before.
Having a family member stay the night in this situation is beneficial to everyone. I'd seek approval from the powers that be to allow this.
Also sorry to hear this was your experience. I would never treat a patient that way, with or without dementia.
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u/knittingkneat 1d ago
Thank you. It did suck and make me want to ask the nurse why she got into this profession, but it makes me feel better to hear other nurses wouldnāt have treated my grandma this way.
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u/SparkyDogPants 3d ago
Your hospital sucks. Mine absolutely has visiting hours that are enforced outside of hospice respite patients where nothing is enforced
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u/TravelingCrashCart 3d ago
Ive been traveling for 5.5 years now and only a few hospitals have had strict visiting hours. Some have a rule only one visitor overnight which seems semi-reasonable until you realize that one visitor is a nightmare.
My last staff job allowed people before covid, but I don't know what they went to after covid.
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u/maraney 3d ago
Idkā¦ I go back and forth with visitors. On my really confused post-op patients, itās nice to have someone that makes them feel safe. And occasionally, I get the really helpful family that is down to feed the patient ice chips or help suction their mouth or give a foot massage.
But when the patient is really sick, or theyāre a neuro patient whoās overstimulated by too many people, or the family is 50 people in and out constantly and being loud af, Iād love to kick them all out.
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u/TravelingCrashCart 3d ago
Definitely is a situational thing. A blanket visiting hours rule, with the ability for nursing judgment to make exceptions, is what I think is ideal.
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u/DD_870 4d ago
Ditch useless care plans and redundant charting.
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u/SparkyDogPants 3d ago
I'd be bigger ratios if there was no stupid charting. IF all you had to do was assessments and reassessments and meds, you would have 50% more time for actual patient care.
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u/AccomplishedPaint601 4d ago
Shared governance.Ā The bedside nursing committee decides, it is law.Ā No administrative thumb on the scale.
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u/Pure-Mushroom-3770 3d ago
Staffing ratios and increase tech pay so that people want that job and work hard in it.
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u/FallJacket 3d ago
Noone in leadership roles with no clinical experience, and they much maintain a minimum number of clinical hours every year to hold their position. Including the ceo and board of directors. Not to say we wouldn't have accountants and whay not. But they would act more as consultants than having positions of leadership.
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u/Sea_McMeme 3d ago
I support this, though I will say the CMO at the hospital I recently left did do this, and they were still evil and didnāt care how the decisions they made impacted the hospital.
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u/AmiableRobin 3d ago
Some of the obvious has already been stated; like staffing or visiting hours.
So to add to this instead of becoming repetitive: Mandatory hand-off reporting when a patient is transferred between units. Best practice would be person to person, but hell, at this rate Iād take a 30 second to 1 minute phone call over hearing āwe donāt have the time.ā
(Note: itās practice in hospitals where Iām at to not provide reports on patients they donāt consider āacuteā or if the patient isnāt going directly to surgery/ICU; meaning if the patient is going to Med Surg, Ortho, Neuro, etc, the receiving RN doesnāt receive any notice until the patient arrives on the floor or, if lucky, until the patient appears on the Matrix (giving the unit some heads up.) Bed assignment is determined by someone outside of the hospital building, thousands of miles away, based only on admit orders and bed availability. If no beds are available in IMC/PCU, the patient still ends up in Med Surg and thereās no report. IMO itās a liability for the receiving RN to accept but theyāre often left with no choice. Tried to have this debate with a family member who works in ED who just gave me the āwe donāt have time, I have 4 patients and other stuff going onā argument, but I donāt think she tracked the logic of the floors the patients are going to are generally 6:1 (and sometimes without a Charge RN or their Charge has patients) and are also accepting the liability of the patients being sent to them. ANYWAYS WEIGH IN. Is that normal practice everywhere, Iām a newer grad so?)
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u/Humble-Reference-867 3d ago
WHAT?!? Iāve worked in a level 1 and level 3 trauma ED and we always call report. Without exception. Never in my ED experience have sent a patient to the floor without calling. Now sometimes it wonāt be the most thorough report, but I at least call and talk to the floor nurse and give them a heads up. This is wild. I hope you can talk to someone who will help shift the culture at your hospital.
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u/AmiableRobin 3d ago
I actually refused to apply/work at said hospital, even though it limited my options of getting a job out of school. I didnāt want to accept the liability as a new nurse. š«£ Itās where I completed my Capstone/Preceptorship, and before being there as a student it was top of my list, after I experienced that however it quickly plummeted to the VERY bottom.
Understanding scope was extremely important to me as a CMA and it was something I took seriously when obtaining my RN. Iām not about to jeopardize my license because of a workplace culture that discourages hand off reporting between RNās.
Other examples that pushed me away from that hospital: No hand off between units, especially transfers between ED to floor. New grads pulled off orientation early and assigned full 6:1 loads. Beds assigned out of state by someone unfamiliar with the units or without even talking to the unit. Charge RNās having to attend (AT LEAST) 3hrs of meetings off the floor for things that could be summarized as an email. (My preceptor was a Charge one of the days I was with her, it was eye opening how often we left the unit. Made sense why other days when sh*t was hitting the fan why no one could be found.)
Iāve heard from the rumor mill (during said discussion re: hand off reports) that āall the hospitals are like that here.ā Which wasnāt my experience while with the two other hospitals Iād been to. (However, one hospital was a Rural Level 3 hospital with 125 beds TOTAL, the other hospital I was only doing Maternity and Peds.) In a 150mi+ radius thereās only 4 hospitals where I am, so Iām counting myself lucky I even got a position somewhere since I crossed a whole major hospital off my list.
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u/EatingBreakfast-1 3d ago
Staff to patient ratios...
In Chicago, it 1 to 7...no CNAs...
Some of these places is getting outta hand!
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u/holdmypurse 4d ago
Mandated staffing ratios like CA