Things not to do as a nurse, part LVIII

Here's another installment of the popular section on what not to do as a nurse. Listen up, new grads. This is NOT the way to get your 15 minutes of fame.

If you think it is, just remember, NCLEX is getting harder. Here in RehabLand, the pass rate went down, but luckily, the licensing folks are thrilled we are still above the national average pass rate.

Here are a few things that got nurses in RehabLand in trouble lately. Just remember, don't try these at home (or work, either) if you plan on keeping that bright, shiny license.

1. If you're supposed to monitor someone in the ICU, monitor them.

Don't paint your nails, don't go on Facebook, don't blow off the newer nurse you're working with who points out the fact that your patient now has a heart rate of 160 and maybe you should call the doc for orders. Also, when said heart rate goes to 200, don't tell everyone that "I had no idea."

Doesn't work. End of story.

2. If you plead guilty to felony theft, you may lose your license.

Another pretty simple example.

3. Falling in love with a felon could get you in trouble.

No, it's not related to #2, but it could be. Jailhouse Nurse falls for an inmate she's caring for. She goes out and gets him a handcuff key and a gun.  To add to the fun, she smokes some marijuana (a friend brought it in from a legal state) and gets caught doing that while with said inmate/felon. Boundary violations are not a good thing.

4. Oxygen saturation is important for everything.

Remember your ABCs: Airway Breathing Circulation. Yes, those are important. Failing to notice low oxygen sats and to do something about it, can get you into licensure trouble.

5. When you are a private duty nurse, you have to be there (both physically and mentally).

Two examples: one nurse decided to run "personal errands" for almost two hours while caring for her private duty patient, who had hourly vital signs. She also "forgot" to chart that "errand."

Another private duty nurse decided to huff some Dust-Off while her patient's mother fell asleep. The mom found the nurse passed out in the living room on the couch, and when aroused he/she was in no state to work.

6. Why you don't want to become Walgreens/CVS/insert favorite drug store here.

This was pretty interesting. Two nurses were  cited related to "collecting medications to give to poor/uninsured patients" Surprisingly, my license does not say MD or registered pharmacist, either.
Some medications just should not be shared (one RN took unused vials to reuse).

7. Don't bring medical records home.

Ever. No matter how behind you are at work. Can you say HIPAA? This RN took home records that affected a patient's care. Very ugly.

And finally...

8. Don't spank your patients.

Even if they are kids who wriggle around and smack you on the nose while doing their dressing.

That is all. Stay tuned for more in our next installment.

The gift horse (aka "I ain't got time...}

Heard at the Hotel (or relayed by stunned observers).

1. When our nurse manager (who now does quality review) asked one nurse about his/her documentation and lack of a shift assessment, the answer was "I don't have time for that".

Really? So what is it we hire an RN for...assessment skills? Maybe you need to take one of our open CNA positions.

2. One nurse got a chance (was selected) by the Hotel to go all-expenses paid to a national conference because he/she has gone for years on his/her own dime. The catch: since we have a new chief nurse at our location, she told him/her that he/she would have to do a presentation to the unit staff when he/she returns.

After lots of paperwork, discussion, permission from umpteen people (because  you can't just GO to a conference anymore at the Hotel....) he/she comes to my office and says, "Oh, I'm going to call and let them know that I'm going to go on my own. I don't have time to do a presentation."

3.  One (actually several) of our professional staff notes that patients request information, etc., via  e-mail or text message. This is even in their notes.

Will he/she/they even contemplate using the Hotel's patient portal, with secure e-mail included (it even writes your notes for you)?

Nope. It requires one training class (about 30 minutes) and you have to teach your patients (most of whom already use the portal) to contact you that way.

I just wonder what everyone is doing with all that extra time...

How to perturb patients

These are just a few things I've picked up here in the SU.

1. Leave them in the waiting area forever. Yes, yo-yo unit secretary, once they're checked in,  you do need to call me or get me so I get them moving. I do have a lot more to do than read my e-mails and paint my nails (caught said secretary at that the other day).

2. Don't give them xx med. Oh, I told Dr. P. we need a sign outside that says, "If you want any of these, go away." and list Vicodin, Oxycontin, and every other short-acting opioid, and abusable drug on that list.

My favorite patient today had a pain level of 10/10, told me he really needed morphine and only morphine, since methadone, "just dehydrated me." then danced down the hall once his session was over at the chiropractor next door. Hmm....

3. I don't do this one, but Dr. P. gets the pleasure of sending out the "since you skipped your scheduled appointment, you violated your opioid agreement, so we're cutting you off." This usually means I get to schedule them for an "appointment" (with the good ol' urine drug screen) and they get a follow-up. Some people think the agreement isn't enforceable. Think again, kiddies.

4. Our secretary contributes to this one yet again...improper scheduling or omissions, or my personal favorite, requesting a time on one day, then scheduling patients on another day. On top of it, she can be rude. One of these days, I'll straighten it all out.


So glad this week is over! Enjoy your weekend, wherever you are.