Nursing And Surgical Floor At Rady Children's Hospital

Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).

My clinical duties performed this shift involved practicing time management and reporting skills. That morning, I was responsible for getting a detailed hand off report of the three patients during our walking rounds. I then went on the computer charting system to acquaint myself with the three patients and get organized with my plan of care for the day. This also involved reviewing the laboratory results and active physician orders for all patients. For the active physician

During my first shift, the unit was busy and there was constant movement on the floor due to the high number of patients in the census. In addition, a rapid response was called on the unit, which contributed to the feeling that the floor was unusually active. At first I felt intimidated by the atmosphere that resembled chaos but I decided to jump in and do what I could to help. I figured, the more that was happening, the more opportunities there would be to learn; this was an accurate assumption.

Durning, (2010) tells how nurses are limited in giving quality care due to the number of patients they have on their shift. It also explains the huge difference in the task of caring for a post-partum mother and a patient recovering from a major trauma surgery. When nurses are too busy because they have too many patients to care for, they are more likely to overlook an important change in their patient. This will cause the patient to deteriorate unnecessarily and could potentially result in death (Durning 2010). “Nurses are the main surveillance system in hospitals” (Queensland Nurse, 2010, p.14). If they have too many patients to look after, something is more likely to be missed. There was a study done last year by Nursing Times, that showed the more nurses a hospital had per bed, resulted in fewer patient deaths, and actually lowered the patient’s length of stay (Queensland Nurse, 2010). The state of Victoria in Australia, like California actually has government mandated nurse-to-patient ratios. Since its implementation of the ratios 10 years ago, Victoria’s health system has been made considerably better. There is a safer environment for the patients, the workplace morale is better, and there are less complaints from the public about the quality of care they receive while hospitalized (Holmes, 2010).

Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked, overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.

I had my first two night shift this week on Sunday 9/13 and Wednesday 9/16. I am on 7 West at Sharp Memorial Hospital and the unit is PCU unit with tele monitoring. The unit had a high census this week, but proper staffing and no codes lead to the nights being relatively calm. I was working with Laura who is not my regular preceptor. She stepped in to work with me for this week while Elle, my regular preceptor, was on vacation. I had a wide variety of patients on my two shifts. The first shift I had a patient that was suffering from an exacerbation of COPD with a history of CHF and a patient that had polycystic kidney disease, which had progressed to end stage renal failure. The second shift I had four patients; one patient had been admitted to the hospital multiple times in the past month for GI bleeds, another patient with a history of diabetes and hypertension was admitted for fever and chills and was later diagnosed with sepsis, the next patient had a history of schizophrenia and was found on the ground in her home and was expected to have been there for over 24 hours resulting in deep tissue injury, and my final patient was suspected to have a history of alcoholism and presented to the hospital with shortness of breath and an oxygen saturation of 89%. The first clinical shift I was shadowing my nurse for a majority of the shift. I was being orientated to the unit and learning where to find supplies on the unit. The second shift I took a

Although it may seem that the United States’ Healthcare is more improved than that of third-world countries and other places around the globe, hospital errors are still the third leading cause of death in America as of the last couple years (Hospital, 2013). Whether it is due to a miscalculation of drug dosages, an avoidable infection, or even caused by an accidental mistake because the nurse was overwhelmed with numerous assigned patients, it is still occurring and there must be a change. On occasion nurses on a typical medical-surgical floor may be required to care for 4 or 5 patients a

In the result of this, a majority of her time was spent visiting doctors and taking medicine may be neglecting her daughter in the process. At the age of 10, Cynthia lost her mother due to the diagnosis of pancreatic cancer. The death of a parent is considered one of the most stressful life events that a young person can experience (Patterson & Rangganadan, 2010). Parental loss from cancer can impact upon many areas of a young person’s life, and may result in social impairment, threaten a young person’s emotional development and achievement of developmental tasks, and result in psychopathology, both during the immediate post-bereavement period and extending well into adulthood (Patterson & Rangganadan,

In the facility where Shirley was located, the facility had failed to meet its own staffing standards for 51 of 59 days, a staffing supervisor stated that administration had warned against the cost of augmenting the number of nurses scheduled, in addition, a staff nurse produced documents providing evidence that employees had shared their concerns that short staffing was having a deleterious effect on patient safety (Curtain, 2011). Given the preceding information, it is clear the hospital was not listening to the distress regarding staffing. There is substantial data illustrating that staffing has a direct impact on patient morbidity and mortality (Aiken, Clarke, Sloan, Sochalski, &

I agree!! Somehow the priorities, patients and nurses being most important, have changed. Today, it is more about how fast can we get the patients to the admission bed, instead of what we can do to support their medial and physical condition that presented. A very sad, but true situation. While I understand that payment is an important part of the health care process, I become frustrated quickly about why I should be concerned with admission times, when nothing is being done about inappropriate staffing ratios. One would think that someone would see the issues that are created by low staffing, and do something to amend the situation. I have worked night shift my entire career, and never understood why night

At my last placement, a maternity ward, I had four patients including their newborns. My preceptor congratulated me on having this number of patients but stated that all patients were stable, with three discharges that day, so there was no test to see how I would do under different circumstances. She informed me that I need to keep working on my prioritizing and time management skills, as each day will be different and it is important to have a set of skills that can help me prepare for the these changes. Another example was when I was doing general assessments on my patient when I had a morning caesarian section coming over to the unit. Instead of prepping the room for our new mom, I continued to care for our other patients. When she came, I had not prepared the room but luckily my preceptor did earlier. This situation showed me the importance of managing my time and prioritizing tasks. These scenarios demonstrated to me that as a student nurse we have just as responsibility as a RN but this responsibility only increases as the number of patients we have

A nurse’s typical day isn’t without stress; it is usually a lot of complex planning, critical thinking, time management, an abundance of communications with all departments of the hospital, and documenting events that have happened throughout the day on their entire patient assignment. “Nurses who are mandated following the completion of their regular shift are often ill-equipped to continue working. They have not planned for that situation with: proper advanced rest, arrangements for

These were my eighth (10/31) and ninth (11/06) night shifts following Meagan on the medical/surgical floor at Rady Children’s Hospital. On the first Friday, the floor started out with 29 patients, 14 nurses, and no health unit coordinator (H.U.C.) or patient care assistant (P.C.A.) to run the front desk. Since there was no one in charge of the front desk, the charge nurse, Meagan, and I worked together to answer all of the phone calls and meet all of the patients’ requests while simultaneously taking care of all their other responsibilities to their assigned patients. The atmosphere of the floor felt hectic everywhere, but since everyone was working together so well, all calls were answered and patients requests met safely and in a timely manner. On my second Friday shift, Meagan was the charge nurse. This was my second time following her while she was in charge. There were 30 patients and 11 nurses on the floor. The floor had to float 5 nurses to other units and something was different about their pay for the night which created quite a bit of drama and was a very “hot topic” throughout the night. Several of the nurses spent the majority of the night complaining about and debating the situation. In this journal, I will discuss the topic of humility.

Being a pediatric operating room nurse, I frequently encounter children who have Cystic Fibrosis (CF) when they come to the hospital for surgery. These patients will inevitably have multiple surgeries in their lifetime due to the course of their disease. CF surgical candidates range from the “well” ones, who are seeking maintenance care (e.g. nasal polypectomy), to the sickest ones, who are seeking a diagnosis as to why they are not responding to IV antibiotics (e.g. sinus surgeries to obtain cultures). I have developed a special interest in this topic because I have formed a bond with multiple CF patients. Vaughn was able to demonstrate the significance of her phenomenon of interest on improving respiratory outcomes of pediatrics with CF by

Friday and a full house with 14 patients’ already and this was before the weekend. Friday night and the