Fleatopia

a lifetime in a lifetime

I’m dissatisfied.  Let’s get that right out there in plain view.  I am dissatisfied with the direction that my place of employment is going.  I have been for a while now.  This has not changed.  What has changed is my level of frustration with this fact.

We’re moving to TX this coming summer so I have a survival mantra that is keeping me moderately sane:  It’s only ’til summer.  It’s only ’til summer.  It’s only ’til summer.

While this method works most of the time, this week has been absolute hell.

We’ve implemented hourly rounding on our unit.  The results of which, at this point, are we have to fill out yet more paperwork, a patient fall 15 minutes after I left his room, being yet more rushed, and I’ve become more dependent upon the reliability and trustworthiness of my Nurse Aide (henceforth referred to as CNAs).  NOTICE: These results do not include fewer call lights, patients saying that they feel more cared for, or increased patient safety.  All of which many high-minded and educated administrative types claim to be the benefits of hourly rounding.

Fact: On nights, most patients get really upset when you interrupt their sleep regularly.  It’s bad enough when you wake them up to strap their arm into a cuff and get a set of vitals, but some are really light sleepers.  And if they aren’t light sleepers at home, they are at the hospital because it’s an unfamiliar place with uncomfortable beds and you’re dependent upon the kindness of strangers.  Hospital doors are not quiet.  Hospital floors are not squeakless.  Our shoes are not spotless, sometimes sticky things cause your soles to make noises.

HCAHPs is this customer survey thing that our hospital uses to monitor our patients’ satisfaction with their care and stay.  The number one complaint on these things is that the hospital was too loud at night and the patient’s sleep was disturbed.

I do not see a world in which hourly rounds and high scores on this particular aspect of the survey can co-exist.

FACT: Our highest ratio on night shift is 8 patients to one nurse.  This ratio for CNAs is something like 21:1. This does not take into account patient acuity, confused patients, or the number of patients you have going for procedures in the morning.  If you come in at 2300, get report, then start your first round there is no way in hell you’re going to complete that first cycle in one hour.

Ideally, you have an awesome CNA (we have way more of these than crappy ones) and they’ll take that first round for you on the stupid paper you have to fill out.  So you take the 2400 ones.  Unless you have meds to give, then it’s all down the crapper.  So you fudge the 2400 column and move on to the 0100 one.  That one is mostly all right, except right after you left that one room, the confused patient within slid their legs right out the side of the bed and ended up on the floor.  He’s over six feet tall, not skinny, poo’d when he landed, and has a ileal conduit.  Yeah, the bed alarm went off, but how long does it take to slip out of a bed?  Not very fucking long, I’ll tell you.  So you and 2 CNAs glove and gown up cause, of course, the patient has C-diff, and wrestle the poor guy back into the bed.  The whole time he’s protesting that he did not try to get up. Call the Supervisor, call the house MD, get vitals, call the patient’s primary doctor, call the patient’s family, chart the fall, the results, and fill out the post-falls packet.  Guess what time it is?

2:20 fucking A.M. That’s what time it is.  Has anyone rounded on your other 7 patients?  No.  Everyone’s been in that room, wrestling and cleaning and checking over and generally TAKING CARE OF A PATIENT.

*deep sigh*

So you give up on your dream of getting ahead of things that night and just content yourself with surviving.

0300: Checking Med Sheets for the patients.  We do this every night.  The new sheets print out for the following day and we have to check them to make sure they’re accurate.  Some nights this is super easy because nothing has been changed since the current MARs.  However, on this night your unit was the recipient of a multitude of new ER and Surgery admissions (3 of your 8 are new) so everything’s handwritten and requires double-checking with the actual orders.

0400: Holy crap, you’re starving.  You don’t get lunch breaks on nights, so it isn’t unusual to just eat while you’re checking MARs.  Tonight that was impossible so you scarf down a few bites of whatever you brought or whatever you scrounged from the cantina since the cafeteria closed 10 hours ago before the bed alarm goes off somewhere else and you head that way.  What’s that beeping?  IV pump.  Get new fluids, grab the MAR to chart that and… Well shit.  Hourly rounds!  Thank God for your CNA.  She just saved your ass by doing the last two on her own hook.  That’s awesome.  Cause now? The phone is ringing and it’s an admission to your already maxed out unit.  They’re sending a nurse up with the patient though so that’s cool.  No wait, it’s a fresh gastric banding patient who’s got some inflammation and the only nurses allowed to take care of those patients are the ones on your unit.  ARgh!  Screw it.  She’s only going to have the patient for a couple hours and she’s been taking care of them in the ED so she’s going to keep that one.  Oh, while we’re at it, here’s another admission.  Just give them to the nurse we’re sending up.  Fine, fine.  Assign the beds, break the news to everyone else and give the CNAs their 13th patient each.  Lovely.  We were all bored anyway.

It’s almost 0500 and there are meds due.  Also, you haven’t charted your second assessment, much less DONE the things.

Craptastic!

Giving meds, trying to get assessments done, gotta stop and give pain meds a couple of times.  Oh yeah.  Do that PPD that was supposed to be done last night sometime.  Is that a bed alarm?  No.  IV pump.  Hey, is that the Supervisor I hear?  She just dropped off staffing for morning shift.  Shew.  Light at the end of the tunnel.  No wait.  Fiddesticks.  You’re in charge so you better get up there and make up the assignment.  Count keys?  No way.  Check the phones?  Are you freakin’ kidding me?  They’re lucky you have time and brainpower to do the simple math of assigning groups.

0600:  Tri-folds are picked up, I&Os are mostly added up.  The last hourly check is charted on the stupid papers. Everything just needs to be added to the charts.  Oh man.  That chick has a PCA… And you didn’t chart the stupid Q2 hour checks.  That throbbing behind your eyes is just a vein bursting as the stress has now reached nuclear levels.  The extra nurse comes to you and takes the papers physically out of your hands and does all the transcribing of numbers and putting of papers into charts for you.  You think it might be love that brings tears to your eyes.  Maybe it’s just that you need to pee so bad that your eyeballs are actually floating.  Doctors are on the floor, and more patients are being awoken by the increase in noise that is day shift.  People want stuff.  You run.

The next shift comes in at 0700 and you’d be willing to kiss someone full on the mouth if they were willing and able to clock in early and get you the hell out.

Eventually it ends.  Hourly rounding is a rousing success, yes?

NO.