Nursing ridiculousness

[narcusprince]

This one is so absurd I don't even know what to say. What next, labeling syringes as "10 cc syringe"? Idiotic.

Then again, they're trying to tell us to label LR bags with labels where they want you to write "lactated ringers" with the time and date. I generally don't waste my time doing stupid things though.

Wow. Labeling air as air. One pet peeve of mine is leaving drugs out in a room between cases. I guess I have a high level of mistrust but I never understand why its ok to leave a room with drugs out.

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[Twiggidy]

Wow. Labeling air as air. One pet peeve of mine is leaving drugs out in a room between cases. I guess I have a high level of mistrust but I never understand why its ok to leave a room with drugs out.

I definitely don't leave out narcs because I don't trust that the staff are not a bunch of junkies. I've heard first hand that a few nurses in my building have had "issues". Gotta love that strong nursing union.

 

[pgg]

Wow. Labeling air as air.

Well. You know. It might be xenon. Or phosgene. Did you ever think of that? Don't you care about patient safety? Huh?

 

[narcusprince]

Well. You know. It might be xenon. Or phosgene. Did you ever think of that? Don't you care about patient safety? Huh?

Lol!

 

[deleted50478]

Has anyone else heard the bs about the empty syringe for inflating the ett? If you have one out, it has to be labeled “air”

Do you just have to label it “air” when the plunger is withdrawn from the barrel or even if it’s fully inserted. I don’t think it would be right to label a completely empty syringe “air”. You might need to label it “empty”.

 

[Monty Python]

And yet ridiculous people require us to get a witness for narcotic wastage using a completely non-scientific method. Think about it ... I'm asking a PACU RN to log into the pyxis so he/she can witness me squirt into the sink a clear liquid of unknown (to them) molecular structure from a syringe bearing a blue label stating, "fentanyl." Unless their eyeballs are also mass spectrometers or NMRs, they have no way of knowing that it's actually fentanyl. Yet they blithely electronically witness that it was indeed fentanyl.

 

[nimbus]

And yet ridiculous people require us to get a witness for narcotic wastage using a completely non-scientific method. Think about it ... I'm asking a PACU RN to log into the pyxis so he/she can witness me squirt into the sink a clear liquid of unknown (to them) molecular structure from a syringe bearing a blue label stating, "fentanyl." Unless their eyeballs are also mass spectrometers or NMRs, they have no way of knowing that it's actually fentanyl. Yet they blithely electronically witness that it was indeed fentanyl.

Agree it’s a total waste of time and energy.

 

[Twiggidy]

And yet ridiculous people require us to get a witness for narcotic wastage using a completely non-scientific method. Think about it ... I'm asking a PACU RN to log into the pyxis so he/she can witness me squirt into the sink a clear liquid of unknown (to them) molecular structure from a syringe bearing a blue label stating, "fentanyl." Unless their eyeballs are also mass spectrometers or NMRs, they have no way of knowing that it's actually fentanyl. Yet they blithely electronically witness that it was indeed fentanyl.

It's no secret we could all "break bad"......it's just not worth it

 

[narcusprince]

Honestly the narcotic waste issue can be solved through pharmacy buy in. A practice I worked at had bins on every accudose where you placed your waste narcotics. And they were sent to pharmacy for random analysis. This system was great because you could dispose narcotics by yourself. Also all drugs were labled with patient specific and drug specific information.

 

[okayplayer]

Honestly the narcotic waste issue can be solved through pharmacy buy in. A practice I worked at had bins on every accudose where you placed your waste narcotics. And they were sent to pharmacy for random analysis. This system was great because you could dispose narcotics by yourself. Also all drugs were labled with patient specific and drug specific information.

That’s what we do and I agree it’s the best system. I also frankly would not care if we had random or triggered urine drug screens, because I have nothing to hide. Go ahead.

 

[MoMoGesiologist]

Wow. Labeling air as air. One pet peeve of mine is leaving drugs out in a room between cases. I guess I have a high level of mistrust but I never understand why its ok to leave a room with drugs out.

Why is this a pet peeve? I liked placing drugs for the next case in a clean towel on top of my cart so I could just unroll and be ready for the next case. I felt like it saved me some time and I don’t see what’s wrong with it.

 

[jwk]

Why is this a pet peeve? I liked placing drugs for the next case in a clean towel on top of my cart so I could just unroll and be ready for the next case. I felt like it saved me some time and I don’t see what’s wrong with it.

It's not just a pet peeve - it's a big TJC red flag. We never leave drugs out on top of machine or cart unless we're in the room. When we leave the rooms, our carts are locked (also TJC requirement) and any controlled substances go with us. There's no reason you can't set up drugs for your next case, but leaving them unsecured just isn't that smart, and honestly, I'm surprised your facility allows that to happen. Sure, lots of the stuff we deal with is BS - this one is not IMHO.

There are some really stupid people working in ORs. Some of them see a syringe with a drug in it, any drug, and assume it will get them high. I am personally aware of a death of an OR employee who stole a syringe of sux off from one of our carts - he was found dead in a hospital restroom.

 

[Cryc_to_the_point]

Why not have a drawer, that has a tray in it, and you lay them out on that. Leave the room? put the tray in the drawer.

 

[WholeLottaGame7]

New study: infection risk caused by the entry of unnecessary clipboards and personnel into operating rooms. Their heads might explode.

 

[Psai]

It's not just a pet peeve - it's a big TJC red flag. We never leave drugs out on top of machine or cart unless we're in the room. When we leave the rooms, our carts are locked (also TJC requirement) and any controlled substances go with us. There's no reason you can't set up drugs for your next case, but leaving them unsecured just isn't that smart, and honestly, I'm surprised your facility allows that to happen. Sure, lots of the stuff we deal with is BS - this one is not IMHO.

There are some really stupid people working in ORs. Some of them see a syringe with a drug in it, any drug, and assume it will get them high. I am personally aware of a death of an OR employee who stole a syringe of sux off from one of our carts - he was found dead in a hospital restroom.

So it's our responsibility to keep other people from killing themselves because they're stupid?

 

[pgg]

And yet ridiculous people require us to get a witness for narcotic wastage using a completely non-scientific method. Think about it ... I'm asking a PACU RN to log into the pyxis so he/she can witness me squirt into the sink a clear liquid of unknown (to them) molecular structure from a syringe bearing a blue label stating, "fentanyl." Unless their eyeballs are also mass spectrometers or NMRs, they have no way of knowing that it's actually fentanyl. Yet they blithely electronically witness that it was indeed fentanyl.

It's security theater, a bunch of handwaving and noisy motion to reassure ignorant people with authority that they're doing the Right Thing.

A common thread to all diverters who are abusing controlled substances is the increasing volume of diversion. If pharmacies cared enough to look at individual use trends, they'd catch people pretty quickly. But they don't, and I don't know why. Once a month they could run the Pyxis or Omnicell numbers through a script to flag anyone whose use of a particular drug went up by 100% compared to the last month, and then have the department do a quick audit of some charts in that period.

I've posted this graph before - it's what a Pyxis audit showed for one of our staff. The trend was obvious 4-5 months before he was caught. But no one was looking. This guy was checking out and meticulously documenting 2-4 mg of hydromorphone for colonoscopies and CTRs. He was very high functioning, very smart, and his paper trail was perfect.

 

[Twiggidy]

He was very high functioning, very smart, and his paper trail was perfect.

I do believe studies have shown this is one of the big characteristics. It's rare that it's the person with sloppy paperwork, always late, etc.

 

[MoMoGesiologist]

It's not just a pet peeve - it's a big TJC red flag. We never leave drugs out on top of machine or cart unless we're in the room. When we leave the rooms, our carts are locked (also TJC requirement) and any controlled substances go with us. There's no reason you can't set up drugs for your next case, but leaving them unsecured just isn't that smart, and honestly, I'm surprised your facility allows that to happen. Sure, lots of the stuff we deal with is BS - this one is not IMHO.

There are some really stupid people working in ORs. Some of them see a syringe with a drug in it, any drug, and assume it will get them high. I am personally aware of a death of an OR employee who stole a syringe of sux off from one of our carts - he was found dead in a hospital restroom.

Ahh TJC red flag... why didn't you say so. It's not like this whole thread has been about how ridiculous TJC and the clipboard nurses are.

Why do I have to set up my machine and cart so that the lowest common denominator doesn't end up dying from something they shouldn't be doing? Because some idiot in your hospital gave himself sux, now every anesthesic across the whole country has to follow these arbitrary rules so it doesn't happen again? If someone wants to stick some sux in their vein, they will find a way.

After writing this post, I think the point of TJC and clipboard nurses is to make everything so protocolized that even the lowest common denominator can practice at the same level as doctors. Who needs doctors when the nurses can decide what to do, there's a rule for it!

 

[GandalfTheWhite]

Can you link the retraction? I can't find it for some reason.

I too would be interested. As chief of surgery I tried to fight the cap fight due to some of my surgeons asking me to and got stonewalled with aorn recommendations as the bible despite what ACS had to say about it.

A Statement from the Meeting of ACS, AORN, ASA, APIC, AST, and TJC Concerning Recommendations for Operating Room Attire

These clipboard administrators are absolutely ruining medicine. Wish some of the surgeons or anesthesiologists had the balls and backbone, but unfortunately, the generation now are a bunch of sissies.

 

[MoMoGesiologist]

Levels of evidence:
"Its policy!" (only if stated by a nurse) >
Nursing studies >
Meta-analyses >
RCTs > prospective studies > ...

Bonus strength of recommendation if the nurse has one hand on her hip and looks at you like you're an idiot

 

[narcusprince]

Working many locums gigs I did not trust anyone once I left the room. I have also worked in environments where drugs given did not have the desired effect. Burn me once shame on you burn me twice shame on me.

 

[jthedestroyr]

This one is so absurd I don't even know what to say. What next, labeling syringes as "10 cc syringe"? Idiotic.

Then again, they're trying to tell us to label LR bags with labels where they want you to write "lactated ringers" with the time and date. I generally don't waste my time doing stupid things though.

Fluid thing done at our children's, but not air syringe thing yet. I'm sure coming!

 

[Useruser]

Our nurses need signs to remind them how to be nice to other humans...

(User name created for anonymity.)

 

[Psai]

They make these ridiculous signs for everything

 

[nimbus]

I like the sign. I sent it to some of our nurses

 

[MirrorTodd]

A Statement from the Meeting of ACS, AORN, ASA, APIC, AST, and TJC Concerning Recommendations for Operating Room Attire

These clipboard administrators are absolutely ruining medicine. Wish some of the surgeons or anesthesiologists had the balls and backbone, but unfortunately, the generation now are a bunch of sissies.

Dude that ship sailed like 40 years ago and you're trying to blame the "now" generation? Nevermind the fact that medicine is entirely multi-generational.

 

[BreathDeep]

Once upon a time, an infection control nurse invaded my department. She headed into the break room, and after poking around she made her way to the microwave. It was dirty. It wasn't at bio-hazard quarantine level or anything, just some dried food/crumbs here and there and in need of a wipe down.

What we didn't know was that we had been "written up" for this 2 times prior. Apparently the microwave, which was located in the RT department, on a non-clinical floor, far far away from any patient care area, was a patient infection risk. As this was our third offence, our microwave was confiscated. Confiscated, you know, like high school.

So yeah, a nurse stole our ****ing microwave, from our private breakroom, in the name of "infection control". Nothing is sacred anymore.

 

[GandalfTheWhite]

Dude that ship sailed like 40 years ago and you're trying to blame the "now" generation? Nevermind the fact that medicine is entirely multi-generational.

So if someone ****s up something for you, should you not try to change it? Rather than saying that this was a lost cause because we were complacent in the past decades, should you not encourage the new/now generation to actually advocate for your rights?

 

[gasdoc77]

Once upon a time, an infection control nurse invaded my department. She headed into the break room, and after poking around she made her way to the microwave. It was dirty. It wasn't at bio-hazard quarantine level or anything, just some dried food/crumbs here and there and in need of a wipe down.

What we didn't know was that we had been "written up" for this 2 times prior. Apparently the microwave, which was located in the RT department, on a non-clinical floor, far far away from any patient care area, was a patient infection risk. As this was our third offence, our microwave was confiscated. Confiscated, you know, like high school.

So yeah, a nurse stole our ****ing microwave, from our private breakroom, in the name of "infection control". Nothing is sacred anymore.

Dude! You were on double secret probation

 

[Dejavu]

Once upon a time, an infection control nurse invaded my department. She headed into the break room, and after poking around she made her way to the microwave. It was dirty. It wasn't at bio-hazard quarantine level or anything, just some dried food/crumbs here and there and in need of a wipe down.

What we didn't know was that we had been "written up" for this 2 times prior. Apparently the microwave, which was located in the RT department, on a non-clinical floor, far far away from any patient care area, was a patient infection risk. As this was our third offence, our microwave was confiscated. Confiscated, you know, like high school.

So yeah, a nurse stole our ****ing microwave, from our private breakroom, in the name of "infection control". Nothing is sacred anymore.

This will go on your “permanent record”, young man.

 

[MirrorTodd]

So if someone ****s up something for you, should you not try to change it? Rather than saying that this was a lost cause because we were complacent in the past decades, should you not encourage the new/now generation to actually advocate for your rights?

And calling the current generation a bunch of sissies on an internet message board is helping how?

 

[GandalfTheWhite]

And calling the current generation a bunch of sissies on an internet message board is helping how?

Its not meant to help. Its meant to convey my opinion. Its an internet message board after all. What is said here wont directly 'help' address the issue, but it is to make one aware that the situation we are in is in large part due to the pushover personality that led to the erosion of our profession.

 

[jthedestroyr]

A Statement from the Meeting of ACS, AORN, ASA, APIC, AST, and TJC Concerning Recommendations for Operating Room Attire

These clipboard administrators are absolutely ruining medicine. Wish some of the surgeons or anesthesiologists had the balls and backbone, but unfortunately, the generation now are a bunch of sissies.

Good luck defending yourself as an anesthesia resident. I can count on one hand staff I know that would back us at our place.

 

[jwk]

So it's our responsibility to keep other people from killing themselves because they're stupid?

apparently.

 

[vector2]

Other day had a POD1 ruptured AAA s/p EVAR and decompressive lap who's now crumping and coming back to hybrid for dead bowel vs endoleak. Just finished putting in cordis and am now checking blood with CRNA. Clipboard nurse (JCAHO prep for real visit) decides that now is a good time to stroll in and tell me that my tshirt under scrubs isn't allowed and I need to button the last two buttons of my OR jacket.

I swear, these people are literally dumber than a box of fcking hammers.

 

[nimbus]

Other day had a POD1 ruptured AAA s/p EVAR and decompressive lap who's now crumping and coming back to hybrid for dead bowel vs endoleak. Just finished putting in cordis and am now checking blood with CRNA. Clipboard nurse (JCAHO prep for real visit) decides that now is a good time to stroll in and tell me that my tshirt under scrubs isn't allowed and I need to button the last two buttons of my OR jacket.

I swear, these people are literally dumber than a box of fcking hammers.

That’s when you tell them it is not a good time, that they are compromising patient safety, and ask them to leave. There must be a JCAHO rule against distracting you while you are checking blood.

 

[jwk]

Other day had a POD1 ruptured AAA s/p EVAR and decompressive lap who's now crumping and coming back to hybrid for dead bowel vs endoleak. Just finished putting in cordis and am now checking blood with CRNA. Clipboard nurse (JCAHO prep for real visit) decides that now is a good time to stroll in and tell me that my tshirt under scrubs isn't allowed and I need to button the last two buttons of my OR jacket.

I swear, these people are literally dumber than a box of fcking hammers.

Tell them you'll be reporting them for a HIPAA violation for being in the OR when they're not involved with patient care of that particular patient.

 

[pgg]

Tell them you'll be reporting them for a HIPAA violation for being in the OR when they're not involved with patient care of that particular patient.

Heh, that has a certain turnabout style to it, but it won't hold up.

Just say you're busy with an emergency, they are distracting you from your care of the patient, that you'll speak with them later, and please step out of the OR. They will. If they don't, call security to remove them.

 

[FlowRate]

Back to the topic at hand, of course ethanol based hand sanitizers are flammable.

So here's a 5 year old lighting it on fire and then picking it up (without getting injured.)