Graveyard shift at hospital sometimes just that

[Celebration]

http://www.suntimes.com/lifestyles/health/802670,CST-NWS-heart20.article

Hospitalized patients whose hearts stop at night or on weekends are more likely to die than those who suffer cardiac arrest on weekdays, according to a study in today's Journal of the American Medical Association.

Doctors say the results aren't surprising because fewer doctors and nurses are available to monitor patients at night and on weekends.


For every minute treatment is delayed, the odds of surviving cardiac arrest get worse.

"How sick patients were, whether they were on a monitor . . . and how long CPR was administered, none of these outweighed the impact of the time of day," said lead researcher Dr. Mary Ann Peberdy, of Virginia Commonwealth University.

"This should be seen as a wake-up call to hospitals and the people that run them," she said.

[HereSince1628]

1. De ja vu all over again

Another example of how the same things emerge decade after decade...and never really change.

[BrklynLiberal]

2. Heard this on the radio last night. They said that at least the ER had equal survival rates at all

times.
It would seem to be related to the quantity of medical personnel and perhaps, the seniority=experience of those on duty at the time.

[Warpy]

6. It is definitely related to reduced staffing and increased

patient acuity levels. In other words, fewer nurses are asked to care for more and sicker patients every year as hospitals try to cut costs on the backs of their staff, especially their nurses.

[Heddi]

8. An ICU nurse I work with the other day said

that the patients that are routinely admitted to the medical floor would have been telemetry patients 10 years ago, and the majority of telemetry patients would have been in ICU 10 years ago and the majority of our ICU patients would have been shipped to Seattle or died 10 years ago.

10 years ago, though, there was a hiring freeze at the hospital because there were TOO MANY nurses. Now we have the med/surg floor, with people fresh out of major surgeries, 40 bed units, with 3 nurses staffing at night and 1 nurse tech for 40 patients. And 2 of the 3 nurses have less than 6 months nursing experience, fresh out of school, and they're "Core" staff. The third staff member is floated from another floor.

Because my unit: Telemetry/ICU is so well staffed because of the event of codes, disasters, etc, we are generally the unit that gets to staff the other units who have such bad patient ratios that all of their nurses are leaving (generally coming to my unit because we have better ratios). So we get to staff the hospital, basically, and get to be under the high guidance of a new grad who has only been taking a patient load independently for 2 months. And they're so new, they don't know what they don't know, and don't know when their patient is going south. So not only do we staff the hospital, but we are the hospital "code" team (we really are). They send us to the medical floor because they know we at least KNOW when someone is circling the drain. Granted, we barely have time to wipe our own asses, much less the asses of 12 patients because of the high acuity and high census......but that has NOTHING to do with patient death or injury....no.....never....one nurse caring for 13 patients is NEVER unsafe :eyes:

[Warpy]

9. Tell me about it

Over the past 12 years my patient load doubled, hospital stays were halved, and acuities skyrocketed. Patients were getting fatter and assistive equipment was not purchased. Management just didn't understand why a 120 pound RN couldn't move a 300 pound patient by herself or why we weren't all eager to drop everything and work extra 12 hour shifts at their convenience.

50% of the licensed RNs in this country, myself included, have left the practice because of brutal working conditions. If this country ever nationalizes health insurance and the delivery of care rather than the paring of pennies in costs becomes the main focus, maybe that will change and staffing ratios will increase.

In the meantime, my back is fried, my eyes are bad, and I'm burned out. They'll just have to learn how to cope without me. I'll just have to hope I don't have to become a patient.

[Heddi]

10. Speaking of 400-pounders

today my husband, who is a nursing student about to graduate, is doing his senior practicum in the ICU where I work. The two patients he and his preceptor followed were both 350-400lb patients. I told him I thought it was poor planning on the coordinator's part to give one nurse TWO 400 lb'ers. Especially in ICU where they generally don't have NT's, or one NT between the 11 patients and 5 or so RN's.

It's hell on your back because you have to turn these people q2 hours, do FULL baths once a shift (I think this is a bullshit rule--once a day is perfectly acceptable for all other patients... but what do I know...), move them for procedures, x-rays, intubation, bed pans, incontinence episodes, etc. Then just the regular moving them up in bed because they slipped down and are bunched up at the foot of the bed. IT's hell. I have had ONE 300 lb'er to take care of in a 12-hour shift and I got home feeling like I was beaten with a bat several times. It's hard enough having regular sized patients with the constant lifting, pulling, pushing, etc, that we do on a regular basis in our 12 hour shifts, much less TWO of them without any ancillary-staff to help you with that.

I am 32 and have already had surgery because of a herniated disk (long before I was an RN). Thank GOD My MD trusts me as a haggard nurse and not a drug seeker because she keeps me with a constant supply of Vicodin for work-related back and leg and neck and knee strain. Unfortunately I can't take it before or during work for obvious reasons, even though physiologically it doesn't have sedating effects or make me feel goofy. It actually makes me stay awake and thus, cannot take it before bed because I will not sleep at all. I have muscle relaxers I can take before bed or after work and I can sleep fine with those.

I fear that sadly we will both either become patients because of our work strain, or be one of those poor old hobbled people that we see and feel bad for and wonder how they ever got to a state of being so slumped over and wobbly.

THAT is how....

[chicagomd]

3. In the next 10 years

your physician will not be taking care of you in the hospital and there will be a clear division between out-patient and in-patient care providers. Hospitalists are becoming more and more popular for just this reason.

[Celebration]

4. and this means

it is every man/woman for himself/herself. Everyone arm yourself with information.

[chicagomd]

5. Actually,

what it means is that the people who take care of you in the hospital are going to be specialized in hospital care. This will actually mean a reduction in morbidity and mortality especially with respect to the OP.

On the other hand, chronic illness will remain in the hands of the community physician, so having a good understanding of your medical history and current medications will be key if you wind up in the hospital.

Hardly a every person for themselves situation, although in the future it would be a good idea to ask your doctor if they do any in-patient work. If they do not make sure they provide you with a list of current medications every time a change is made, or get one from your pharmacist. Also, ask if they have an electronic medical record system that is linked to your local hospital.

[Heddi]

7. Thankfully I work in Telemetry/ICU,

so all of our patients are on heart monitors so we can see when a heart rate starts to slow down, etc. In ICU the monitoring is even more complete, with blood pressures every 15 minutes, pulse oxemitry that is continuous, etc.

Telemetry has a pretty good nurse:patient ratio: 1:5. ICU is 1:1 or 1:2.

The medical floors, however, have much higher acuity: 1:10 or 1:13 if you have a nurse tech. If you have no tech, it's 1:8, and that's the nurse doing not only the nursy things like passing meds, charting, calling the MD, signing orders, checking orders, but the nurse tech things like toileting patients, monitoring I&O's, cleaning patients, turning patients, walking patients, etc.

Overnight (which I worked until recently), we had 4 nurses on Tele and 2 NT's between 11p-7a, so each tech had 10 patients, each nurse 5 patients (20 bed unit).

I swear that at night, if you're going to have a code, it's going to be at 8pm, 12am, 4am, or 6am because those are the only times the nurse goes into the patients rooms. THis isn't knocking the nurse at all---if you're the only person doing any care on 8 patients AS WELL as doing all the nursy stuff, you don't have TIME to go in their room more frequently than that. WE do our vital signs every 4 hours (8pm, 12am, 4am) and AM med pass usually starts around 5:30-6:30am. So that's when the codes and RRT's are called because thats' when the low or high blood pressures are found, or the unresponsive patients, or the people who have tumbled out of bed and are bleeding from their head, or are just found dead---they were alive at midnight, alive at 4am, but between 4am and 6am, who knows what happened...

Our union is trying to get my hospital to get mandatory staffing ratio's on the medical floors and the hospital is really bucking. THey say that we already have too few nurses as it is and that increasing the number of nurses needed would be impossible. Union members counter that nurses are LEAVING the hospital precisely because we DON'T have good ratios. They want to decrease the tele ratio to 1:4 and hire an extra RN and an extra NT on nights. They want the med/surg ratio to be no more than 1:7 even with a tech.

It will never happen without legislation on the state level. Nurses at our hospital, fresh out of school, start out at $24 an hour plus weekend and shift differentials. The pay increases with years working as a nurse and go up to $45 I believe for 20+ years experience. The hospital, which is a non-profit community hospital, fears the cost increase that is associated with hiring an estimated 100+ new nurses. The RN's, however, look at the costs beyond staffing---the costs of extra hospital stays for patients, the costs of lives affected, the costs of nursing burnout. I can attest that you can only take care of 8 total-care patients for so many nights in a row, or 13 non-total care patients for so long before you just. stop. caring.

It's exhausting work. I dread having to float to the medical floor because I, as a nurse, do not feel safe in those settings. I feel like in a 12 hour shift I barely have enough time to do a cursory physical exam (lungs, heart, pulses), throw some meds down their throat and hope they're okay before I get around to seeing them again in 8 or 10 hours from now.

In telemetry/ICU, you are constantly monitoring your patients. Even during the middle of the night, you're in teh room, checking them out, listening to lungs and monitoring heart. You have time to look through the chart and get a full picture of your patient's condition and treatment. You have time to see what Rx's they're on and whether they should be on them to begin with. You have time to THINK about your job.

On the medical floor you don't have that time. As a nurse, you are FAR too busy doing the repetitive paperwork (chart on the doorside chart, chart in teh computer, chart in the chart, chart on the kardex. Note blood sugars on the doorside chart. Note in the computer. Note in the chart. Chart progress notes at least once a shift with updates as necessary. 24 hour check on all previous MD orders written. Making sure all labs ordered were done and that critical results were notified to the doctor. Making sure there is no change in condition that would warrant further tests. Verifying medication and labs ordered by the doctors. Making sure the pharmacy entered the right medications. Making sure there are no duplicate medication orders. Making sure all AM meds are in the patients' rooms. Preparing the patients for AM procedures. Putting in the computer orders for tomorrow's labs. Noting these labs and tests on the kardex. Passing on report to the next nurse. Keeping the NT updated on all changes in your patient. Having your NT give you changes on all patients). Yo

IT's dangerous and I feel we need not just state-level, but NATIONAL staffing levels for hospitals. We have far too many patients for far too few nurses and nurse techs.

This report is no surprise to me.

[grasswire]

11. are there no ward clerks/unit clerks anymore?

For transcribing orders to the cardex, etc.? Geez.

[eilen]

12. They don't staff clerks from 7p to 7:30a

I quit my hospital job last summer. S0 Burnt out. I realized I was not being therapeutic to anyone and not a help to my patients. They turned a specialized floor-- oncology/hematology to a med-surg floor with a specialty of hem/onc. Which meant if we had any empty beds we would get filled up with whatever the ER served up and our scheduled chemo patients would be out of luck the next day because the hospital leadership found documentation that transferring patients within the hospital increased stays.

I'm with you on the half-tonners, big lazy half tonners that don't want to lift their own arm. They even sent us ortho surgery patients, insane. Yet still, on our annual reviews were supposed to have progress or acheive ONS certification -- I would go weeks without a hem/onc patient. We often would get social admits and placements as well.

I am about ready now to go back to work (part time) but I am concerned about where to go. I plan to use a temp agency and just do a few days a week. If it is still too toxic, I'll get a retail job.

I used to work nights, then went to days. The best thing about nights is not as much people to run a frigging obstacle course around in the hallways. The worst, not getting sleep. Days were a managerial nightmare and the pace is unsustainable. So many chiefs, not enough indian and every week more paperwork or changes to this or that. If you want to heal from an illness, do not go to a hospital, the stressed out energy is not good. And don't forget the crazy people who ring their bell every ten minutes for you to fetch juice, etc.