However. I have one rule. The chicanery isn't necessary. I'll still take your damn report regardless of whether everything is done. I'll find out eventually what isn't after your ass is long out the door, but it will be more work for me to investigate the matter. Don't lie straight to my face and tell me stuff is done and then make up some bullshit story when I ask you about it. Just be a grown up, look at me in my face, and tell me that you consider yourself an excellent nurse despite the fact that you decided to leave me shit that was ordered as stat 8 hours prior to me getting here. Really. That's all I ask. I will pat you on the back and tell you to go home, have a glass of wine and a bubble bath and pat yourself on the back for being so awesome. Then I will silently file your name into the douchebag section of my mental rolodex.
Which brings me to the real point of this post-obviously lying and doing it poorly makes you a douchebag in my book, but at what point does unapologetically leaving a bunch of shit for someone else to do also put you in that category?" ER BFF and I were discussing this and had differing opinions, so I wanted to poll the internets and figure out- how old does an order have to be for you to feel like it should have been done already? I feel like three hours- an order written at 4PM in the 7P-7A world- should probably have been taken care of before I get there unless a really good explanation is offered. She felt that 2 hours- an order written at 5PM- should be plenty of time. But we both get stuff done pretty fast, so who knows, maybe we are princess bitches after all. So please give me your feedback, inter webs. I kind of want to use the power of math to average all the responses together so I can feel like I have a concrete number which I will, of course, use for academic research to quantitatively justify thinking someone is a douche.
1 hour for "stat" stuff, 4 for normal orders. (Because I get that sometimes you just can't stop answering callbells, trying to keep geriatrics from leaping out of bed, or leave the dude having a panic attack in the bathroom.)
ReplyDeleteThere are 2 DBs I have to follow at work. 1 persistently leaves me meds from 0900 (I come in at 1500), or tells me "oh, blood bank didn't have the units ready till now" when the order was written at 0700. We have a charge nurse who doesn't take an assignment, so for some of this stuff, there's no excuse- as her main reason for drawing a paycheck is to help sign off/enact/pitch in when an RN is in the weeds.
Blood bank stuff is tricky. If they find something weird it may take time to match. Stat is stat..end of story. 0900 meds at 1500 means time management counseling..jeez. Everybody gets behind so I would say it's the pattern of not getting sh*t done vs a time frame rule.
ReplyDeleteYou know, the running around like a chicken with it's head cut off syndrome. Those people drive me nuts!
I'd kind of say 3 or so depending on the situation and status. However if something isn't done, if I'm told it isn't done I'm not going to bitch and moan about having to do it. Like you said, nursing is a 24 hour job. It irritates me though when nothing is said and when you open the chart in the computer orders from the morning aren't noted so have likely not been "seen".
ReplyDeleteThree hours seems like it would be a good number in my field, but I consistently find orders hanging around from the night before..."oh,i didn't get to those therapy orders, my bad." I guess I shouldn't be too upset, at least they mention they didn't enter them!
ReplyDeleteI agree with a PP that for "stat" orders, they should be followed through WITHIN an hour - hence the use of that term - it's ASAP! Now I can understand if you have other crashing pt's that it's difficult to get these things done... but that's where delegating comes into play. If you're in the weeds, ask for assistance, so at least then the next nurse who takes over, doesn't have to initiate orders that should have been done much earlier. In regards to regular orders, 4 hours sounds reasonable, unless there is GOOD reason. Saying that bloodbank didn't have blood ready isn't good enough as that nurse could have escalated that to her resource nurse, manager or spoken to BB manager.
ReplyDeleteI know I CERTAINLY have been in the weeds, and left works for the next shift - but I have also stayed back to assist so that the nurse knew that I was at least TRYING to make her job easier and wasn't just sitting on my ass my whole shift.
I'd say 1.5 hours max, unless the nurses pt load was slammed. Like, multiple ICUs status. I agree, hospitals are 24 hour operations, but Not doing that shit slows the pts situation down for them, docs, and other pts in the waiting room who could use their spot if a decision were made about their dispo. It's sooo frustrating getting calls from docs saying "why is this not done, I ordered it hours ago!?" when all you can say is "uhh sorry dude, just got here".
ReplyDeleteOf course there's the fun scenario where doc writes order, doesn't flag it and leaves on desk or puts back in rack. Because we all have sixth sense about when an order is written.
ReplyDeleteIn my experience, these docs are usually the screamers of why wasn't this done.
I think it depends on the order and the nurse as well. I totally agree that STAT orders should be done within the hour. I'm not sure about other hospitals, but we can see when blood is ready, so there's no excuse not to give it. Although doctors do forget to flag orders, I think some if it is also nursing judgement. Ie-if your patient has a hgb of 78, they will most likely be getting blood, so maybe look for the order? I think 3 hours is good, 2 on our ward might be pushing it a bit, as dinner comes at around 5pm, we've got 1700 med rounds, pts start sundowning, etc. That being said, if you know there is something that you didn't do on your shift and it needs following up on, put on your big girl panties and talk to the next shift. Nobody likes getting a nasty surprise mid shift.
ReplyDeleteI am a charge nurse on a busy geri-med floor and I will happily give meds, insert IV's, insert NG's, foley's, take vitals, check blood etc to help my nurses. That's my job, to make sure they can do their jobs.
In summary, I think 3hours is plenty of time to at least be aware of the orders. Sometimes other things hold them up (like lack of techs, pharmacy, etc)
In my med-surg unit, I would say an order received by atleast 5 should be done, if it is really simple, maybe 6. I know when I am getting ready to leave I will do anything that pops up before 645 or so, cause it's clearly still when I am getting paid to do my job!
ReplyDeleteWhat the Hell, are you talking about ER stuff?
ReplyDeleteI get line, labs, urine, and related done in about 10-45 minutes total, depending on if the patient is a hard stick or not. Most of the time, that type of stuff is done before the orders even, so my times might be in the negatives.
I'm a big proponent of Avoidance Of The Lingering UA. Hate it when people have UAs on the board for like 2-3 hours because the patient can't pee. Okay, well, looks like you should have gotten the straight cath done 1.75 hours ago. Pretty much every old lady with any kind of fever/weakness/urine anything gets an immediate straight cath unless they're totally A&O and mobile.
1.5 hours MAX. We all know what it's like in the ER and how it can get sometimes but the busier it gets, the faster that nurse needs to be moving her ass to get shit done. Use delegation skills to delegate tasks to techs to get smaller stuff out of the way and use your time to get those nursing tasks checked off.
ReplyDeleteI'm thinking one hr or less. In our dept, we jump in and help each other--it's just good karma. Being nice eventually comes back to you just like being a dick does. We have a big white board where orders are written and ANYONE can chip away at the list. We don't play "it's not my patient". Seriously, it's extremely rare that everyone is balls to the walls at the same time.
ReplyDeleteWe've had a lot of holds down here (like, 48 hours and stuff), so you can pretty much forget about that shit getting done in any kind of timely fashion but yeah. I ended up with one that was seriously ordered now at 1130 AM the other day. I realize my expectations for ER orders are probably way too generous, but I grade on a curve when it comes to our day shift. I mean, really. None of those bitches help each other. Usually I'm just not in the mood to fight with anyone about it.
ReplyDeleteWTF, for ER orders put in by the docs via electronic order entry, that shiz should be done in an hour or less. 2 hours if you're being nice. It's different if you're on the floor, or if your hospital does written orders that have to be flagged, then entered, then acted on...but in the ED with electronic orders? 2 hours, tops! (And I'll still probably secretly think you're a lazy douche unless you're taking care of a ton of patients and crying during report.)
ReplyDeleteI work as a floor nurse, we still have paper orders- then either the nurse or secretary puts them into the computer so they can be acted out- if its something like a sample that needs to be collected- that should be done first thing you get the order, especially when the nurse tells me "He's been peeing all day...but I forgot to get the sample." If its stat labs, that should be under an hour. if its a new med- the order has to be scanned to pharmacy and they have to profile it for us and may have to bring it to floor if it is an uncommon medication. So for meds- anything before 5pm should be given already.
ReplyDeleteSorry for jumping in late.
ReplyDeleteI'm a baby nurse in the ER, and unless the admitting MD dumps 20 admit orders on me at 6 pm (that we aren't even supposed to do but try telling them that), I won't leave anything for the new nurse. If the admit MD decides to be a douche, I'll make sure to do the more annoying/time sensitive orders at a minimum. I'm far more likely to have leftover charting to finish than meds to give or IVs to start.
The only thing I'll leave is urine, because we get that from pretty much everyone and unless we're thinking UTI, we just hang a bolus and wait. That's pretty standard in our ER though.
I know that I get a little pissy if I take report from someone and I see an order that was put in place 2 hours before and has not been done. I will even ask that it be done at that time unless something really bad has been going on.
ReplyDeleteI'm a floor nurse. STAT C-diff samples are the bane of my existence...if the patient DOESN'T have C-diff. And proceeds to NOT defecate for an entire shift. Lately I've been after the docs to write a NOTE in the order that says "if patient does not defecate in 12 hours, cancel test"
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