Can You Take a 3rd Patient?

I work in an ICU and for the most part we are understaffed.  There have been several times when the staff is asked to take a 3rd patient.  The problem is when taking that 3rd patient makes your patient load unsafe to all of your patients.  Published studies show that appropriate staff helps to decrease medical and medication errors, patient mortality, hospital readmissions, and length of stay. The number of preventable events such as patient falls, pressure ulcers,central line infections, healthcare-associated infections (HAIs), and other complications related to hospitalizations are also reduced. It decreases nurse fatigue, thus promoting nursing safety, nurse retention, and job satisfaction, which all contribute to safer patient care. 

Most ICU's have a 1:1 or 1:2 Nurse/Patient Ratio depending on the acuity level of the patient.  However, most states don't have any laws in place to make this mandatory.  CA is the only state that stipulates in law and regulations a required minimum nurse to patient ratios to be maintained at all times by unit. MA passed a law specific to ICU requiring a 1:1 or 1:2 nurse to patient ratio depending on stability of the patient. Federal guidelines require hospitals who participate in Medicare to have adequate licensed  registered nurses to all patients as needed.  What does this mean for the Professional nurse if you are understaffed?  A higher workload?  Remember you do have the right to refuse any unsafe assignment.  However, isn't it so much easier to have a law in place so you don't even have to refuse?

Some states are taking action to ensure the nurse staffing is appropriate to take care of the patient needs.  Visit The Registered Nurse Staffing Act and write your Congressman today!

All comments are appreciated!

Code Status

Have you made your wishes clear regarding what you would want if you were close to death?  If not it would be wise to do so.  It would take a burden off your family to make the decision for you.  There are different types of code statuses.  Let me explain them to you.

1.  Full Code means you want everything done to save your life.  This includes intubation (placing a breathing tube in your mouth and into your trachea to provide an airway so you can breathe). Oxygen is then provided using a ventilator (breathing machine).  Chest compressions are performed if your heart stops and medications are given to help get it back started.  Defibrillation (shock) to your heart if it goes into a rhythm where the heart is fibrillating (quivering).

2. Do Not Resuscitate (DNR) means if your  heart stops or you stop breathing we let you  go in peace.

3.  Do Not Intubate which means  chest compressions can be done and medications can be given  but you do not desire a tube placed in your mouth and throat to help you breathe.  This option in my opinion is useless.  It doesn't matter if your heart is beating if you can't breathe!

4.  Medications Only which means we can give medications if you stop breathing or your heart stops but you don't want chest compressions or a tube to help you breathe.  This option also is useless in my opinion because if the medication can't circulate through your body (by the bloodstream) it can't do any good.


Also talk to your family and let them know you have put your wishes in writing and ask them to respect them.  Most times families bypass the wishes of their loved one and do just the opposite of what they wanted.  Don't be afraid to discuss it!  Get the facts about code statuses and make your wishes known!

Why I Love My Job

Everyone can always tell you the negative aspects of their employer.  No matter how much money you make, you have something negative to say about your job.  Well today I am here to say something positive about mine and why I love what I do.  I work as a Registered Nurse  in the Medical Intensive Care Unit of a teaching hospital.  Most of our nurses take pride in their job.  One of the best qualities I find in  our physicians and nurse is we go above and beyond the call of duty for our patients.  A person could have no chance at all for survival and we will do everything under the sun to try and keep them alive if it is the wishes of the family.  When there is no hope, we provide a glimmer with our duty to save lives.  We get cursed out, scrutinized and sometimes even threatened in our line of duty.  We high five each other when our teamwork pays off and we enable someone to go home to their loved ones.  We also cry and empathize with those losses we have to share with families when no matter what we tried, it seemed to fail.

When all is said and done, I am a proud member of this team and I take my hat off to every doctor and nurse who helps to provide the quality of care we give.  

Have a job you are proud of?  I would love to hear your comments.

A parent's nightmare

One of the worst feelings a parent can ever have is not being able to make their child feel better.  This time of the year is the worst time for respiratory infections in most people but especially babies.

Respiratory syncytial virus (RSV) is a very common virus that leads to mild, cold-like symptoms in adults and older healthy children. It can be more serious in young babies, especially to those in certain high-risk groups.RSV is the most common germ that causes lung and airway infections in infants and young children.. The virus spreads through tiny droplets that go into the air when a sick person blows their nose, coughs, or sneezes. Children in daycare environments will generally spread the virus to other babies around them. Mainly because you can catch RSV if a person with RSV sneezes, coughs, or blows their nose near you. You touch, kiss, or shake hands with someone who is infected by the virus. You touch your nose, eyes, or mouth after you have touched something contamined by the virus, such as a toy or doorknob.  This is also why hand washing is so important.  It one of the best protective barriers you have for infections.

In general, RSV symptoms include: 

Bluish skin color due to a lack of oxygen (cyanosis)

Breathing difficulty or labored breathing

Cough

Croupy cough (often described as a "seal bark" cough)

Fever

Nasal flaring

Rapid breathing (tachypnea)

Shortness of breath

Stuffy nose

Wheezing

Many hospitals and clinics can rapidly test for RSV using a sample of fluid taken from the nose with a cotton swab.  Antibiotics do not treat RSV. Mild infections go away without treatment. Infants and children with a severe RSV infection may be admitted to the hospital . Treatment will include Oxygen, Moist (humidified) air, Fluids through a vein (by IV).

A breathing machine (ventilator) may be needed. 

A simple way to help prevent RSV infection is to wash your hands often, especially before touching your baby. It is important to make certain that other people, especially caregivers, take steps to avoid giving RSV to your baby.

The following simple steps can help protect your baby from getting sick:

Insist that others wash their hands with warm water and soap before touching your baby.

Have others avoid contact with the baby if they have a cold or fever. If necessary, have them wear a mask.

Be aware that kissing the baby can spread RSV infection.

Try to keep young children away from your baby. RSV is very common among young children and easily spreads from child to child.

Do not smoke inside your house, car, or anywhere near your baby. Exposure to tobacco smoke increases the risk of RSV illness. 

The drug Synagis (palivizumab) is approved for the prevention of RSV disease in children younger than 24 months who are at high risk for serious RSV disease. Ask your doctor if your child should receive this medicine.

Lets keep our babies happy and healthy.  

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Demanding Patients and Families

Sometimes patients and their families make you want to pull your hair out!  It really bothers me when you are doing everything you can for a patient and it never seems to be enough.  Mostly it is the family whom you can't seem to please.  Can you move mother's head? Can you fluff her pillow?  Father needs to be moved again. I think dad is in pain.  Can you get some ice water?  All of these questions come after you have just left the room is what makes it even worse.

 I could see if your family member wasn't being cared for but when the nurse is going over and beyond to make them comfortable you should back off a bit.  The continuous nagging and nit picking can seriously reduce the going over and beyond because apparently no matter how well you care for the patient it won't be enough. 

Then you have the patients who forget how to do anything for themselves when they come to the hospital.  If your legs and arms still work you can wipe your own butt!  The hospital isn't a place for you to be waited on, it is a place for you to get better and go home.

I'm sure you have a story to tell so let us hear it.  Maybe you were a demanding patient, if so tell us why.  Feel free to post your comments.

Home Remedies

Growing up I remember my parents and grandparents had remedies for everything.  My mother always made tea out of orange peels for us to drink when we had a cold.  Grandmother made her own cough syrup which consisted of honey, lemon and peppermint.  I think the adults added whiskey to theirs.  My uncle always coated his chest with Vick's vapor rub, turned on the heat and got under a blanket to sweat it out.  Tried that once and thought I would die.  My latest discovery was a hot toddy and I believed it worked.  My kids grandmother said she would rub garlic under the bottom of their feet to keep them from getting sick.  She said it worked. There are also lots of herbal remedies out that also work.  Some people believe they have to have prescribed medications like antibiotics and prescription cough syrup to get better. 

Experts tell us colds take time.  Antibiotics are not necessary unless there is an infection.  The steam from your hot drinks will help open your nasal passages.  This includes hot milk despite the old wives tell of it increasing mucus formation.  Also be sure to include those essential vitamins like Vitamin C and Zinc to boost your immune system. Dressing properly will help too.

Have any home remedies or tips you would like to share?  Drop a line or two and share.

Doctor-Nurse Relationship

The relationship between the doctor and nurse can have a difference in the care of  a patient.  Nurses are generally the ones who see what is going on with a patient. They are at the bedside giving the care, noticing changes and communicating these findings to the doctor.  Hopefully the doctor utilizes the expertise of the nurse to treat their patients.  However, in my many years of nursing I have found some doctors really don't respect nurses at all which puts a strain on the respect a nurse has for the doctor and jeopardizes the care a patient gets.  Nurses are advocates for their patients and when they feel a plan of treatment is not right for the patient, doctors should at least listen to why they feel this way.  Doctors and nurses will not always agree but we must show enough respect to each other and discuss it professionally for the best outcome for the patient.

I work in a teaching hospital and one of the best advice an attending can give a medical student is to listen to and befriend the nurses.  We love doctors who will at least listen whether they agree with us or not.  Then you have the doctors who know it all and think nurses only do anything they can to get out of working.  These are the doctors who will jeopardize patient care because the nurse can't assist someone who knows it all already. 

It is important to note that the doctor-nurse relationship is sacrosanct and building a professional relationship is essential. Patient care should not be a tug-of-war between nurses and doctors, but instead it should be about professionals working together for the good of the patients. The medical team of doctors, nurses and other medical professionals that engage and respect each other will create a positive working environment and perform at an elevated level which can produce quality patient care with exceptional patient outcomes. This is the ultimate goal. 

What do you think? Share your thoughts and concerns.