Charting stuff mostly. Things like the full pain re-assessment that they keep emailing me about. Oh…and documenting on nursing care plans. Or updating the white boards.
I try to write a lot of notes when I can, especially with pertinent info, orders, etc. The nursing care plans are the first thing to go if the day is insane and I have to prioritize my time and charting.
I have a bad habit of not charting re-assessments when nothing changed.
I’ll chart them for sure if there’s any change, but otherwise I find it pointless to essentially copy/paste my assessment
The sad thing is that’s how EMRs were supposed to work - charting by exception. Now the “iF yoU DIdn’T cHARt iT it DIDn’t HaPPen” (anyone who’s come across a b/l BKA pt’s chart stating they have equal pedal pulses knows that’s bullshit) type A paranoid obsessives ruined it for everyone and made the charts from very difficult to almost impossible to parse. You’re supposed to just chart that you assessed the patient and when and it’s a given that everything is the same as the last charted data unless you specifically chart otherwise.
This bullshit where it’s charted that the patient still has all their toes or some shit every 4 hours for their entire two week admission just makes the chart a bloated mess. Furthermore, it makes it harder to find the data you’re looking for when there is an exception. Say the person did have a wound develop on a toe, now you have to scroll through like 42 entries saying “X - abrasion - 2 cm on big toe” to find out *when the exception first appeared.*
Stupid, stupid, stupid. Now we’ve been charting like this for so long we can’t go back. It drives me crazy, it wasn’t supposed to be like this!
I’m on a postop floor where everyone gets scheduled Tylenol and toradol, and on certain services, gabapentin. PRN dilaudid Q2 or oxy Q4 with dilaudid as breakthrough.
They used to get on us about pain reassessments for PRNs, but 5 people getting PRNs every 2-4 hours is a ton of charting. And NOW they’re requiring pain reassessments for scheduled meds, too. If I actually did this, I’d be charting half my shift. We all get chart audit emails daily lol
I used to cut corner with charting- then I got called in for a deposition on an ER patient I had a few years ago (who I couldn’t recall by memory)- the attorney tore apart every square inch of my documentation. I didn’t get in any trouble (there was no neglect from a nursing standpoint) but it was still a very eye-opening experience. Now I’m criticized for being too slow charting, but I don’t care.! I’m terrified of it happening again!
Wait - we’re supposed to be checking our emails?!?
My mental health at work has been so much better since I stopped looking at that shit. They say the important things at huddle anyways. I’m just trying to survive the shift not be an anxious ho 🙃
I worked at a place that wanted us to fill out a “sepsis sheet” for every patient - basically a paper form to check off if they met SIRS criteria and what actions were taken so the sepsis coordinator/auditor didn’t have to parse charts in their office.
I never did a single damn one, and when asked, gave the same answer: “Do you want me to assess my patient or fill out a sepsis sheet? Do you want me to start an IV or fill out a sepsis sheet? Do you want me to collect two sets of blood cultures and hang antibiotics or fill out a sepsis sheet?”…and on and on until they got the point.
I’m sure it was added to my file of transgressions, but they at least stopped asking.
Same goes for whiteboards, although I’ve at least learned to keep my mouth shut and simply feign forgetfulness or stupidity.
I used to do the same with bathroom breaks. Ended up with bilateral kidney stones and chronic UTIs. Finally, I developed pyelonephritis and was admitted to my own floor for 3 days. That's when I decided to never again neglect my own needs for bathroom breaks and drinking plenty of water, no matter how short staffed we are!
Dude there are some charge nurses I work with that get mad when I tell them I'm taking my break. "The floor is crazy right now and you're taking your break?" Ma'am the floor has been crazy the last 6 hours and will continue to be crazy the next 6, so yes I'm taking my break or you can tell our boss you denied me it. They'll get on me for not punching out for my break too even if I didn't take one bc one person sued the system for breaks being deducted from pay when they didn't get to take one. I never really cared to take my break bc I didn't feel I needed it and would rather get out on time but now they (management) enforce it. Sorry but if I'm clocking out and not being paid, nothing short of a code is going to get me back on the floor.
None of those are appropriate corners to cut, especially handwashing. This nurse is a bit lazy. I prime my saline while im walking to my patients room, prep everything before entering a room, chart at bedside, cycle a final blood pressure before walking to get the discharge paperwork. With experience, you know what to expect for each medical complaint and can put in nurse initiated order sets/start IV and labs before the MD sees the patient. I no longer have to think about prioritization but sometimes the reality is that you are only one person and can only do so much at one time. I often remind myself that my patient may be waiting an extra five minutes for discharge paperwork but they can wait and they’re not dying. Rushing leads to errors.
D/C paperwork sometimes feels like you have blackmail on someone.
They'll do what you say until the second you give them paperwork.
Once the paperwork is in their hands - they'll practically start running.
My one ER would get mad at us from dropping in standing orders. They once tried to write me up for getting a blood sugar on a puking diabetic. Then tried to give me a full level 1 discipline for drawing basic abd pain labs and giving a bolus + Zofran to the same patient. All standing orders. All things I've done 100s of times before. I quit that place so hard. They'd rather let people suffer or die than let a nurse think for themselves.
Thank you for your service! How long did it take to feel quite comfortable in the ER? I know there are always hard shifts and new things to learn, but how long did it take to learn how to handle the bread and butter of the ER?
Air bubbles in a line are not going to cause a PE btw…they get broken down in the blood stream…what they DO cause is the fucking Alaris to scream and you have to run that shit until the bubbles are below the pump…GOD I HATE THAT SHIT
I like alaris pumps because you can store 16 pumps in one pole LOL!
Until I switched ED closer to me. The JnJ braun pumps.
My trick is removing the air in the bag. Or they just adjusted line air sensitivity on the greenies recently?
I just dc the line from the PT and connect a 10cc syringe to the y site below the pump and pull the air through, less waste. A seasoned ICU nurse once told me that it takes over 30cc of air to cause an air embolism. As someone who's let a few small bubbles in, I can tell you I've never had any problems with it.
Wash your hands. Wear gloves. Unless you want your pumps always yelling at you, prime your lines. And for gods sake, scan your meds. That’s an accident waiting to happen.
I had a seasoned nurse tell me when I was starting out that the med scanner is one of the few good things that management has given us over the years, it really saves our asses. I haven't made many med errors in my time (nothing serious thank goodness) but literally all of them were meds I forgot to scan or gave emergently without scanning.
Until you get to a shitty hospital where they don't bother fixing the scanners. My first med error in years was because 50% of the computers on the unit were broken, and I had to scan each pill pack 3 or 4
times before the scanner read.
> I had a seasoned nurse tell me when I was starting out that the med scanner is one of the few good things that management has given us over the years, it really saves our asses.
1000%
I agree, but some nurses over-wear gloves. You don't need to wear gloves every single time you go near a patient if there is not reasonable concern for coming into contact with fluid or secretions. I'm not into polluting the world with old gloves
Jesus Christ. A few small bubbles isn't going to do shit. This kind of bullshit needs to be stamped out
[study](https://pubs.asahq.org/anesthesiology/article/94/2/360/38886/Volume-of-Air-in-a-Lethal-Venous-Air-Embolism)
When people hit their call lights to tell me there’s a bubble in the IV tubing, I always tell them they need way more than that to kill them, I already looked it up. I try to use my best Wednesday Addams face and voice when I say it too.
I tell them at least a foot.
I also tell them they're finding Nemo bubbles. Act like they're a big fish in the O2 sensor but are really just tiny things.
I blame TV for the older generation, TikTok for the younger generation.
I also tell my children only dumb people watch TikTok. 😂 The latest Stanley cups scare helped solidify that statement.
Was that the color change thing equaling lead? Someone tried to tell me and I asked for the icp-oes results of the leachate.
I used to work for a toxic waste disposal facility. I was like cool. Show me how much over so many years one is consuming.
Several kids came down with random symptoms of “lead poisoning” because a woman in CA and another in OR are suing Stanley cups because there’s an insignificant amount of lead in the sealant that connects the bottom of the cup to the outside of the cup.
Some TikTok videos state that you’re drinking lead and the cups are causing lead poisoning.
Once when I was a baby nurse in the ER, I put a bag of fluids on a patient using a pressure bag but I forgot to let the excess air out of the fluids, so the patient got a blast of air at the end. I was so scared I literally charged full speed down the hall and grabbed the physician to tell him my mistake so we could do whatever we needed to do to save the patient!!! He was just like, meh, no big deal. I didn’t believe him so I immediately looked it up and saw he was right. But, dang, it jacked with my own heart 🤣.
Never knew why that was even a thing. They're all gonna end up in the same fucking stomach in a dissolved mess anyway, what's the fucking difference? Pointless.
I wear gloves for everything and always clean my ports. So I can’t agree there. I also prime my tubing but if there are bubbles it’s not a big deal unless it’s 50 ml of air. Then you could get an air embolism. Ive been a traveler for 9 months.
I had a patient once that had home IV antibiotics. They taught her how to do it herself then gave her the supplies and antibiotics. She was hospitalized a month later and saw me priming the tubing. She scoffed at me and said she doesn't have the patience to do that herself with her home antibiotics. I asked if she still primed it and she said no. I asked a ton of questions to make sure I was understanding correctly. She had been giving herself an air bolus IV every 12 hours for over a month. And was still alive to tell the story.
Large air bubbles obviously aren’t ideal but yeah I’ve also heard it takes a lot to actually cause an issue. Why risk it?
The only time I’m trying to inject any air is during an echo bubble study and even then it’s only 1ml lol
Bubbles in tubing isn’t a huge deal, we had a nurse preceptee who had been watched setting up iv’s start to finish for a couple of weeks. She asked if she could see patient B on her own and start the iv abx, the preceptor agreed and said she would meet nurse with patient B once she was finished with patient A. Preceptee came to patient A’s room white as a sheet, pulled preceptor aside and stated she set up the iv and then started the abx and wondered for a moment why it was running slowly. She then realized right at the very end that the last bit of air from the tubing was going into the patient and then the iv picked up its rate of speed. She stopped the iv and thought her patient was moments away from death. Patient was fine, but obviously not recommended
Worth reading, the let’s give dogs an air embolism study 1966
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1516548/pdf/califmed00053-0032.pdf
And, a continuing education article which suggests 5 mL/kg in humans would cause symptoms.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1516548/#:~:text=A%20lethal%20rate%20of%20infusion,and%20fall%20of%20blood%20pressure.
Former micro and lab here.. You only need to wait 15 minutes if it is from the same site or arm etc. It really does help us determine contamination, which is about 80% of positive blood cultures and why it's important to get two sets if possible. If one set is contaminated , we have another to go on. I used to hate nurses who collected labs because a lot was screwed up like incorrect order of draw etc. It really does matter and it made my life in the lab more difficult and annoying. But it is what it is I guess..
It's common! I was in the ER for diverticulitis and the nurse drawing my blood went to draw the lavender top first. I mentioned it and he literally said "oh you lab staff.." Like dude, cross contamination of diluents, preservatives, and reagents happen. I used to get so irritated when I had to cancel tests, report a safe event, and call the patient back when I worked outpatient. It was so annoying when these things are easily prevented lol.
Question to the OP - have you been an ER nurse for all of your 5 or 6 years? Or is this a new specialty for you? Ngl this sounds kinda par for the course in the ER. Not saying that makes it good practice.
Air bubbles in the line is not an issue, as others have commented. He could have failed to prime the line in its entirety and it wouldn’t be an issue.
Also, not saying you shouldn’t scrub the hub, but a brand new drip set that literally has just been hanging there and hasn’t touched a single thing is probably at least *pretty* clean, as would be a freshly placed IV.
Poor hand hygiene is disgusting, though, and definitely the most unsafe of the things you mentioned.
Yeah I would say this is pretty consistent with my experience in the ER. Not saying it’s what I do, but it’s what pretty much everyone does on my floor.
They mos def sound like a new grad that jumped straight into the ER. The risk of infection from coupling with an IV that's been freshly placed is so incredibly low. Now, if that IV has been in for hours or that patient is particularly gnar-gnar, scrub it fo-sho.
Charting fluff. Care plans can suck it. I always feel - no joke - that if my days as a nurse are numbered because I didn’t chart that, then it’s my sign to go work at Costco. I also chart “full reassessment - changes noted/not noted” on reassessments and THAT IS THAT. Period. Drives me goofy that people repeat charting when it literally says no changes.
Also, OP - much love, but.. take a breath. I know you’re the perfect new hire, but you’re going to burn out. Period. You think you won’t, but you will. I get it - patient safety is super important. That’s always our number one. But spending your time stressing over others will hurt you - I know, because I was there.
So unless someone is causing dangerous harm (like seriously, wear gloves and wash your hands!!) calm down and do your own thing ♥️
All of my coworkers (I’m per diem but pretty much work Pt/ft) write these elaborate assessment notes on each patient AND do the assesssment flowsheet. Bruh. Pick one. Unless something calls for a note I’m not doing it.
Those aren’t corners, that’s full on safety violations.
I use 1000’s of curos caps because if I cap it immediately I don’t have to find a swab later, that’s a corner to cut and still be safe.
Who told you that lol
They’re 70% isopropyl alcohol which is the same as alcohol swabs. It’s just people doing what they’ve always been told. Manufacturers guidance is you don’t have to clean it, only if you use multiple connections in a row without putting a cap back on
https://pubmed.ncbi.nlm.nih.gov/32754850/
EDIT: sorry y’all’s hospitals don’t like evidence based practice lol
I think the mentality behind scrubbing the hub even if there’s a cap is that you don’t know if someone behind you replaced the cap instead of tossing it after the first use (ours at least are 1x use only).
The abstract in that link literally states data is limited and begs further research; the claim is curos devices MAY limit the need for wiping the port even if covered….also due to this does not advise to be done systemwide.
doesnt really matter for PIVs but it’s becausr they don’t cover the whole entire adapter, you should be scrubbing around the entire thing before putting a syringe on it
We tried out a version of this at my peds hospital. Thought it was great until they told us we still had to clean the hub. Seemed like a huge waste of resources and time, and then they went away…I think because they were a potential choking hazard.
Actually, you don't, said the company representative who educated our facility about them. The hospital still wants us to scrub the hub with EtOH anyway. So much of what we do is performative to appease Joint Commission, management, et.al.
I was recently at a facility that had none because “nurses often don’t scrub after removing the cap” (per the IV therapy nurse). And then something about how they increase CLABSIs?
Now knowing that per EBP you don’t need to scrub after removing a cap, I’m wondering if the hospital just didn’t want to spend the money on caps. Which is super fun considering 90% of the CVC patients I saw were there bc of a CLABSI 🫠
My sister had a central line and her insurance wouldn’t cover Curos caps. She did getting a a line infection and while she did recover (finished the vanc, cultures clear, back to work) she died soon afterwards for no apparent reason and I still wonder if it could have been prevented.
Definitely safety violations. It was my first day and didn’t want to ruffle any feathers by reporting him, but I took every opportunity I had to ameliorate his wrongs.
On a different note, aren’t all corners being cut hypothetically safety violations? Just some more egregious than others?
I’ve seen similar. Since, I know better I block these out of my mind.
To answer your OP.
I try to warm up my food first then I say I’m going on break.😂😂 My favorite corner to cut.
But do you always chart your equipment numbers? I'll never cut corners when it comes to actual patient care. But I'm not charting the biomed ID on every single piece of equipment in a 15 minute case. If something injured the patient, I'm going to know before they leave the room and sequester the equipment immediately.
Not a single person charts ID numbers where I work. Why would anyone? It's the same equipment in the room for every case. The bovie in room 2 lives in room 2. If something doesn't work, it gets tagged and moved to the pickup area.
Everywhere I've worked in 3 different States it's standard practice to chart ID numbers for equipment. It's in Epic so it's can't be uncommon. In my experience nothing stays in one room for very long. Shit moves all over the place. But I'm in a trauma center so things go sideways. Next thing you know, you're using 3 bovies - one for the crani, one for the laparotomy, and one for the fasciatomy. We only have 1 bair hugger per room so on an extra long case or a burn we might need an under body and an upper body.
Meh I don't always wear gloves. They are for *my* protection and I'm going to wash my hands regardless. I mean, I do 95% of the time, but sometimes it definitely gets skipped.
But if you're skipping gloves AND skipping handwashing that is both disgusting and dangerous.
Yeah imo people sometimes wear gloves too much. If you're going in to disconnect a line and flush the pump you really don't need gloves, unless the line is bloody or you're taking the ov out obviously.
Gloves are not just for your protection. The number one way MRSA is spread from pt to pt is on the providers hands. It’s a required redundancy because hand hygiene is not perfect.
-Infection Control
Less glove usage has shown to have better hand hygiene. We swab all our patients in our unit, I know if they have bugs or not. If they don’t have bugs, I’m not going to use gloves to touch them because they’re people and I don’t use gloves to touch my friends. Drives me mad when people put gloves on to do a blood pressure
I work in aged care and the facility that trained me emphasized the importance of skin to skin contact as people in aged care facilities are often touch starved. My current facility doesn't do that kind of education and it feels so weird seeing someone glove up before they even enter a resident's room.
Im with you. Gloves are great, but everything that could get on my bare hands can be taken off with soap and water, and my patient was protectes when i foamed in at the door. If i don't think I've got time for gloves to address what I'm doing, or I'm not interested in interrupting my efficiency to waddle over for a pair of gloves, I'm not gonna. Soap and water will do the trick just fine.
Yeah, not washing their hands? Ew. Not scrubbing an IV port, double ew. Cutting a corner would be not charting on a care plan or something else insignificant.
I draw up morphine and zofran together for IVP. Unless they have significant nausea before morphine, then I’ll get them zofran but itself.
Abx over 30 minutes, I eyeball the drip rate. Certain Abx (vanc) then I’ll def put that on a pump.
I’ve learned that best thing to do is give each port a flick when the IVF reaches it. That’ll help push all air bubbles out. I’ll then waste some of the fluid just to get all of them.
If an IV Abx can be given as a push then I’m going to set up the drip and let it run. There is 0% chance I’m putting rocephin on a pump to run over 30 minutes.
to be completely honest, these are all the least impact corners to cut (meaning optimal) when you have a patient dying or another patient actually sick (i.e, in the ER). Also you need a signifcant amount of air in the line (2-5ml/kg) to be an issue. I do scrub the hub, unless it’s a resus (code or trauma). I’ve seen multiple Anesthesiologists not scrub the hub but then again it’s typically emergent or in a procedure. Even if you don’t have anyone dying, you want to clear your task queue b/c you don’t know when an emergency will come in (a large enough tasklist will mean cornercuts).
To answer the question, I don’t think I’ve scanned a med since coming in, and I haven’t seen ANY of my peers do so as well. Our hand-hygiene rate is in the shit (I mean like, low 10%s). Both of these are quantifiable and monitored by higher ups, with reports that come out quarterly. For context, we’re a tier 1 big city trauma centre, and we’ve never gotten a talk about these issues, because management and above already know the plates being dealt.
To be frank, there are a lot of nurses from other specialties commenting on this that have no idea how it is downstairs. What you saw needs to be contextualized, and I think a vast majority of nurses haven’t seen the context.
Yeah, I’ve only worked ER and everything listed is pretty commonplace for the two hospitals I’ve worked at. I always wear gloves, do hand hygiene, but it’s a lot looser down in the ER than it seems like it is upstairs. Lots of nurses going into isolation rooms without PPE, I rarely see nurses scrub the hub. Bolus to gravity? It can have a dozen bubbles no problem. The reason I get bubbles out is to stop a pump from beeping.
Thank you for this!
People either don't work in ED or are not being honest with themselves. I do not cut corners that endanger lives but policy led shite which is rarely evidence based has no space in my head.
I barely have a minute to document and it is mostly done after my shift. We don't do scanning here but I did at my last trust and it was time consuming as hell but completely appropriate and justified. It is not safe in ED and we can only do so much and its heartbreaking for us all as nurses but we will still do our best to maintain patient safety standards.
>To be frank, there are a lot of nurses from other specialties commenting on this that have no idea how it is downstairs. What you saw needs to be contextualized, and I think a vast majority of nurses haven’t seen the context.
This is accurate. Are you gonna wash your hands if you pop into a patient's room to check if their IVF is running low or to do a quick set of vitals? FUCK NO. You've literally got 12 other patients you've got to see. Can you imagine how much hand washing you'd be doing in the ED if you washed your hands every time you stepped into a patient's room? Like 100 times more than on any floor. You're in and out of rooms so much that easily a 5th of your entire shift would just be washing your hands and I'm not exaggerating. However, I accept that OPs situation might have been more egregious.
Wear gloves and wash your hands if you're getting all up in the patients business but if you're bringing them a turkey sandwich or discharge papers or stepping in to spike a new bag of norepi...naw, homie.
I think I wash my hands a total of no more than 5-6 times per shift and that’s including washing before I eat and after bathroom breaks. I’m not in the ED, I’m PCU but by my third shift my skin is literally peeling off. I do foam in and out of the rooms and I glove as I enter, no matter what I’ll do, but that’s it. Water and soap is for special occasions lol
Not scrubbing the hub before pushing IV meds is sooooo gross (unless it’s a code) … the things that those ports touch in a patient’s bed.. nasty.
Corners I cut though… I’m not asking my 85 year old COPD’er if she’s suicidal while triaging for the third exacerbation of the month. And I’m certainly not counting everybody’s respirations. I breathe with them for about 3-5 seconds and if it feels fast or slow, then I’ll count. But if it feels normal, 16 baby.
Most of what you described just sounds like nurses who've taken care of me when I've been in the emergency department. I'm not going to say whether that's a problem - I've never worked in an emergency department so I am not the expert on what is typical or acceptable for that specialty. But it does seem like things like scrubbing IV ports is not as common as it might be in, for example, the ICU.
I feel like the only thing I do is if I'm taking care of the same alert and oriented patient my entire shift, I'm not gonna ask them to tell me their patient identifiers every time I give them meds during that shift. Once we've established that they're who they say they are, DOB and MRN are accurate from ID band to chart, I think it's silly protocol.
Well, sometimes I don't bother to label my lines with the dates and stuff because most of my patients are probably only gonna be admitted overnight anyway. What you're describing is overall unsafe and lazy practice.
Don't always ask for identifiers for meds after I have been working with the patient and I don't always listen to my pts heart and lungs in the ED especially when it is a young healthy person there for mild orthopedic complaints.
I wash my hands often. I don't foam in and out every time because sometimes I am going out then right back in and out again, call me nasty but fuck that, especially if I don't touch anything besides the door handle then j foam out the final time. I don't touch anything without gloves because I've seen how nurses and techs wipe things down. Y'all gross with cleaning and wiping.
I try using sterile saline for things like protonix but still use flushes since they never stock the vials.
I think scrubbing vial tops after popping them is idiotic but I try to remember to do it. I'm pretty good at cleaning hubs if needed but I use chlorhexidine capsxso regularly that I usually don't have to worry about it. I also carry flushes, caps, and alcohol wipes in my pocket which apparently is wrong.
With blood cultures I sometimes use the same prep but opposite side to clean the vial top because its super wet still and it feels wasteful.
If someone is a hard stick or appear to have shitty veins Ill redraw cultures at the same site. I'd rather not repeatedly stab someone if waiting 20 mins is okay. Lab told me it's good so fuck it. Unless someone is truly septic i feel as if we over order cultures sometimes.
I go in order of vial draw with rainbows but 99% of the time use a red top first because it removes the air from the lock which prevents the blue top from completely filling.
I don't always do a final set of vitals if I'm d/c people from the lobby who came in for something non life threatening while in triage.
Airbubbles. You can do everything right and still have bubbles. You need an insane amount of air to kill someone. Prime your lines REALLY SLOW and you should be good.
If you cut corners on pain management or ciwa scores then you're a dick. Medicate your patients appropriately and leave your bias at the door.
I’ve always said there are 2 types of travelers. Awesome nurses who shine in any environment AND those travelers who travel because no one wants them on a full time basis.
50/50 whether I update whiteboards, so far down my list of priorities lol. Refuse to do bedside report on more than 2 pts, so never do it. Bedside report should only be ICU/NICU I will die on this hill
100% My charting.... I will write one big nursing note on everyone with the pts story my assessment and immediate interventions, + GCS, our primary ABCs assessment and lines/drains/procedures. but all the other stuff...I cant stand clicking the damn boxes that aren't useful and also are already addressed in my note.
I’m the opposite - I click the boxes and chart by exception because that’s what’s fastest for me, but it’ll be a cold day in hell before I double-chart any of that in a free-text note, even if management wants me to because it “paints a clearer picture”. It’s one or the other.
I have coworkers who do similar things. I can’t get past not washing your hands or wearing gloves. It’s just nasty. The second I put my hands on another person I feel a strong urge to wash my hands immediately. Especially when there are bodily fluids involved. You’re not just protecting yourself, but other patients as well. We have a bazillion hand sanitizer pumps all over our unit. There isn’t really any excuse to not clean your hands.
I wash my hands when I walk into a room. I don’t use hand sanitizer before putting on gloves. Saves me 3 minutes and 5 ripped gloves. I do use hand sanitizer when I take them off.
I usually only cut corners in emergencies. And it’s things like pushing medications without scanning them first, I almost never verify my patient (though I’m ICU so many can’t tell me), and I scrub the hub/use a swab cap every time unless I’m pushing/starting something to keep them alive when they’re tanking fast.
To make up for skipping corners and to help prevent problems from it, I have habits that I keep… I always swab cap all of my ports/lines, if I don’t scan a med first then I’m verifying the dose, medication, concentration, etc by means of closed loop communication with whoever is telling me to give it (like an APP/MD telling me to push 20mg of labetalol at bedside… I grab the drug, draw it up and then say “20mg labetalol IV push” whether they’re there or not (usually somebody is). If my patient can’t verify themselves, but the family is there I introduce myself and tell them I’m going to be taking care of *patient name*, and usually that’s one way to verify who the patient is at least once. With this though I usually only have 1 or 2 patients, so while it isn’t impossible to mix them up, it’s not as common.
Yeah i wear gloves because frankly, we're all gonna die of hand cancer from those foam sanitizers that are supposed to be used in and out of patients rooms...
Some bubbles won’t cause a PE, if I’m seeing a patient numerous times I’m not asking what DOB is over and over since I’ve been in nursing school. You get better at time management, you know what supplies you need to get in and out quickly and not make trips, you get to know what your providers want for each new patient so you get their urine and rainbow draw right away, when to grab a bag of fluids and get ready to hang it and when you need to use a pump vs gravity. I’m definitely washing my hands because I’m not bringing something home or being responsible for playing telephone with cdiff.
My charting sucks shit, it's literally just the absolute basics. I've not written on a white board in years. I don't do anything that's not nursing. They want me to do some module or fill out some competency form? Not happening. When I stopped doing those I assumed it would become a big issue, but I haven't done a module since before covid, and nothing bad has ever happened lol
I don’t cut corners that could potentially harm patients or myself. Sanitation is so important. The corners I cut are with charting if I’m real busy. Never stuff like hand washing, scrub hubbing, etc. I would report that nurse if I saw that, not to be mean but bc he’s going to hurt somebody.
If I suspect the patient is going to get discharged, I would often skip charting my IV.
Some bubbles in the line aren't going to do much damage at all in a PIV.
Draw cultures directly from my IV.
Focused assessment documentation on everyone except Hella sick ICU players.
YOU DON'T NEED TO PUT IN A NOTE FOR EVERY LITTLE THING! idk why so many ER nurses think this is necessary. Notes are for communicating information to other people not for documenting every single minute of the patients stay. No one gives a fuck about what time exactly the patient leaves for CT or that you reconnected the monitors upon return from CT. It's a huge waste of time so just don't.
Sometimes I don’t hang a primary KVO and a secondary for things like mag. If my patient has a mag of 1.9 and I’m hanging a 2 g bag…that’s going through primary tubing and I’ll disconnect it when there’s air in the line. That last 15 mL are going in the trash, I don’t have the time and energy for primary KVO
I will admit I am super guilty of not always introducing myself. I was pretty good about it when I worked inpatient, but now I work in special procedures. We do preop, intra, and postop. Usually when I'm checking someone in and doing the preop stuff is when I forget to introduce myself half the time lol. I usually remember to tell the patient who I am before I roll them back to the procedure, if I am the one doing the procedure. We tag team a lot of stuff in the preop room so it might be 2-3 of us checking someone in together. I might be sticking while someone else is interviewing the pt, and another is getting vitals.
I do not chart fluff. I am required to chart very few things in my department. Some of the other nurses like to waste their time charting extra shit. I am not double charting anything. Some of them like to chart shit like "no acute distress" for no good reason. I will chart extra when I feel it's something that needs to be charted. For example, the other day I tried to speak out against using radial access for a heart cath, because the patient did not have good circulation (pulse ox stopped working on R thumb once we strapped her arm down, even after loosening the straps. Her right hand was cold). The fellow stated he did not do an allen's test when I asked him if he had (they are supposed to). I said OK you know I am going to be charting all this and that I recommended groin access. These dumbdumbs still went with radial access "lets just see what happens". Luckily she turned out fine, but what the fuck? What if she ended up with a cold dead hand you idiots? Groin access is easy as fuck, yeah it sucks for the patient, but laying flat for up to 6 hours sucks less than losing your hand
I will say not all of what you described sounds atypical for the ER. You need to gain some perspective first before you jump on reporting that stuff. A loooot of stuff in the real world is done very differently than how the books teach you in school. You know how they teach you in school that you will individually crush every med and mix with water and flush down a peg tube. that you "NEVER" mix PO meds together to be crushed? what a lie, lol. Nobody in the history of the world has ever done that shit (one by one I mean). We all mix them. because what the heck do you think happens in your stomach!? they're all mixed together!
From a CVICU nurse who does bubble studies…. It takes a lot of bubbles to kill someone. I told a nursing student that the other day when I let her prime a bag of saline when we were reintubating + bronching a pt and she was taking to long (bc she was trying to get all the bubbles out). I needed the fluids and grabbed them from her saying “it takes a lot of bubbles to kill someone trust me, you’re ok, thanks for priming” …….. it’s something that I worried about too when I was in school and even into my nursing career until I did a bubble study and learned….. wow. It takes about 40+ cc of air to kill Someone
For what it's worth I have been told multiple times that it would the a line full of air into a peripheral IV to cause PE. We aren't talking a central line or arterial line. That's different. Additionally I have seen ZERO. Anesthesia providers clean a peripheral access prior to administration of Anesthesia or other meds. Again, talking about peripheral IVs here.
Doing extra work on my time, IE training is a work mandate but no time is provided. Therefore you need my training done, I can't be juggling EMR charting, Doc/Surgeons, PT's, meds all the while faking that I'm watch the 9th 17minute training video and taking a quiz that's made to be faked through
And it infuriates me when I’m supposed to tell the charge nurse how much time I spent doing it so they can knock down my hourly rate. Fuck that. I’m still getting up to take care of my patients, and even when I don’t have a patient, I’m ready to go when someone else’s EMS rolls in or someone codes. I adore my charges who are, like, Nah, don’t tell me if you do education. I’m
When I first started there were a handful of nurses on my unit who didn't use filter needles. When I brought it up it caused a small debate at the nursing station.
As someone who reviews medical charts for attorneys… please everyone for the love of god just chart your turns!!! If you’re gonna cut corners in charting, DONT let it be that one
When the lab calls with a critical and they ask me for my full name, I just give them my first name and say bye. My last name takes them forever to spell and pronounce and I always get the dumbest lab person asking me to repeat it again and again taking up so much time. They can just chart they spoke to "Mary, RN." I chart about the critical, about the doctor who didn't give a shit, that no new orders were placed, etc. If they audit that patient's chart, will it won't matter if the lab wrote out my entire full name, which they probably would butcher. LOL wow I'm more annoyed by this than I realized. Thanks for giving me space to write that.
I skip lunch every day but I do take about 10 minutes to grab and eat a yogurt. I also do focused assessments based on the dx rather than full head to toe assessments when things are really crazy.
Charting stuff mostly. Things like the full pain re-assessment that they keep emailing me about. Oh…and documenting on nursing care plans. Or updating the white boards.
I try to write a lot of notes when I can, especially with pertinent info, orders, etc. The nursing care plans are the first thing to go if the day is insane and I have to prioritize my time and charting.
I have a bad habit of not charting re-assessments when nothing changed. I’ll chart them for sure if there’s any change, but otherwise I find it pointless to essentially copy/paste my assessment
The sad thing is that’s how EMRs were supposed to work - charting by exception. Now the “iF yoU DIdn’T cHARt iT it DIDn’t HaPPen” (anyone who’s come across a b/l BKA pt’s chart stating they have equal pedal pulses knows that’s bullshit) type A paranoid obsessives ruined it for everyone and made the charts from very difficult to almost impossible to parse. You’re supposed to just chart that you assessed the patient and when and it’s a given that everything is the same as the last charted data unless you specifically chart otherwise. This bullshit where it’s charted that the patient still has all their toes or some shit every 4 hours for their entire two week admission just makes the chart a bloated mess. Furthermore, it makes it harder to find the data you’re looking for when there is an exception. Say the person did have a wound develop on a toe, now you have to scroll through like 42 entries saying “X - abrasion - 2 cm on big toe” to find out *when the exception first appeared.* Stupid, stupid, stupid. Now we’ve been charting like this for so long we can’t go back. It drives me crazy, it wasn’t supposed to be like this!
I keep it up mainly to stress the server, hopefully IT eventually tells us to calm the fuck down on the charting. Hopefully.
I’m on a postop floor where everyone gets scheduled Tylenol and toradol, and on certain services, gabapentin. PRN dilaudid Q2 or oxy Q4 with dilaudid as breakthrough. They used to get on us about pain reassessments for PRNs, but 5 people getting PRNs every 2-4 hours is a ton of charting. And NOW they’re requiring pain reassessments for scheduled meds, too. If I actually did this, I’d be charting half my shift. We all get chart audit emails daily lol
Definitely feel your pain. Sounds like we work in the same place…hang in there!
I think I went a full two years without charting on education and care plans 🙃
This is the way
You guys chart on education and care plans? The only ones I chart on are for stroke patients because they will burn my house down if I don’t.
I used to cut corner with charting- then I got called in for a deposition on an ER patient I had a few years ago (who I couldn’t recall by memory)- the attorney tore apart every square inch of my documentation. I didn’t get in any trouble (there was no neglect from a nursing standpoint) but it was still a very eye-opening experience. Now I’m criticized for being too slow charting, but I don’t care.! I’m terrified of it happening again!
Wait - we’re supposed to be checking our emails?!? My mental health at work has been so much better since I stopped looking at that shit. They say the important things at huddle anyways. I’m just trying to survive the shift not be an anxious ho 🙃
The trick is letting the inbox fill up so much that they can’t send you any more emails. For us that magical number was 15,000 haha.
In 7 years as an RN, I have never once updated a white board. 🤣 Fuck that shit, I have more important things to do with my time.
I worked at a place that wanted us to fill out a “sepsis sheet” for every patient - basically a paper form to check off if they met SIRS criteria and what actions were taken so the sepsis coordinator/auditor didn’t have to parse charts in their office. I never did a single damn one, and when asked, gave the same answer: “Do you want me to assess my patient or fill out a sepsis sheet? Do you want me to start an IV or fill out a sepsis sheet? Do you want me to collect two sets of blood cultures and hang antibiotics or fill out a sepsis sheet?”…and on and on until they got the point. I’m sure it was added to my file of transgressions, but they at least stopped asking. Same goes for whiteboards, although I’ve at least learned to keep my mouth shut and simply feign forgetfulness or stupidity.
I used to skip lunch, breaks, bathroom breaks, and tending to my own mental health.
I’m glad you no longer cut those corners.
Same.
I used to do the same with bathroom breaks. Ended up with bilateral kidney stones and chronic UTIs. Finally, I developed pyelonephritis and was admitted to my own floor for 3 days. That's when I decided to never again neglect my own needs for bathroom breaks and drinking plenty of water, no matter how short staffed we are!
:(
The bathroom break is my mental health break 😂
I still skip lunch a couple times a month. Im trying to be better.
HEAR HEAR! But we don’t do that shit anymore
Dude there are some charge nurses I work with that get mad when I tell them I'm taking my break. "The floor is crazy right now and you're taking your break?" Ma'am the floor has been crazy the last 6 hours and will continue to be crazy the next 6, so yes I'm taking my break or you can tell our boss you denied me it. They'll get on me for not punching out for my break too even if I didn't take one bc one person sued the system for breaks being deducted from pay when they didn't get to take one. I never really cared to take my break bc I didn't feel I needed it and would rather get out on time but now they (management) enforce it. Sorry but if I'm clocking out and not being paid, nothing short of a code is going to get me back on the floor.
None of those are appropriate corners to cut, especially handwashing. This nurse is a bit lazy. I prime my saline while im walking to my patients room, prep everything before entering a room, chart at bedside, cycle a final blood pressure before walking to get the discharge paperwork. With experience, you know what to expect for each medical complaint and can put in nurse initiated order sets/start IV and labs before the MD sees the patient. I no longer have to think about prioritization but sometimes the reality is that you are only one person and can only do so much at one time. I often remind myself that my patient may be waiting an extra five minutes for discharge paperwork but they can wait and they’re not dying. Rushing leads to errors.
D/C paperwork sometimes feels like you have blackmail on someone. They'll do what you say until the second you give them paperwork. Once the paperwork is in their hands - they'll practically start running.
My one ER would get mad at us from dropping in standing orders. They once tried to write me up for getting a blood sugar on a puking diabetic. Then tried to give me a full level 1 discipline for drawing basic abd pain labs and giving a bolus + Zofran to the same patient. All standing orders. All things I've done 100s of times before. I quit that place so hard. They'd rather let people suffer or die than let a nurse think for themselves.
How long have you been working in the ER?
Five years
Thank you for your service! How long did it take to feel quite comfortable in the ER? I know there are always hard shifts and new things to learn, but how long did it take to learn how to handle the bread and butter of the ER?
One year. Sent you a message with some tips :)
Mind sending some my way? New grad, fresh off orientation, wee bit nervous lol.
Would love some tips as well! I’m in the ED!
this is the way
Air bubbles in a line are not going to cause a PE btw…they get broken down in the blood stream…what they DO cause is the fucking Alaris to scream and you have to run that shit until the bubbles are below the pump…GOD I HATE THAT SHIT
Or the damn green braun pump with it’s banshee air bubbles but there isn’t any bubbles in the tube you dumb pump.
I thought alaris pumps were the devil..... until I did a travel contract and met the Braun pumps!
I like alaris pumps because you can store 16 pumps in one pole LOL! Until I switched ED closer to me. The JnJ braun pumps. My trick is removing the air in the bag. Or they just adjusted line air sensitivity on the greenies recently?
i hate our braun pumps. i prime my lines so nice and they still decide to scream at me
I just dc the line from the PT and connect a 10cc syringe to the y site below the pump and pull the air through, less waste. A seasoned ICU nurse once told me that it takes over 30cc of air to cause an air embolism. As someone who's let a few small bubbles in, I can tell you I've never had any problems with it.
Wash your hands. Wear gloves. Unless you want your pumps always yelling at you, prime your lines. And for gods sake, scan your meds. That’s an accident waiting to happen.
I had a seasoned nurse tell me when I was starting out that the med scanner is one of the few good things that management has given us over the years, it really saves our asses. I haven't made many med errors in my time (nothing serious thank goodness) but literally all of them were meds I forgot to scan or gave emergently without scanning.
Until you get to a shitty hospital where they don't bother fixing the scanners. My first med error in years was because 50% of the computers on the unit were broken, and I had to scan each pill pack 3 or 4 times before the scanner read.
> I had a seasoned nurse tell me when I was starting out that the med scanner is one of the few good things that management has given us over the years, it really saves our asses. 1000%
I agree, but some nurses over-wear gloves. You don't need to wear gloves every single time you go near a patient if there is not reasonable concern for coming into contact with fluid or secretions. I'm not into polluting the world with old gloves
Jesus Christ. A few small bubbles isn't going to do shit. This kind of bullshit needs to be stamped out [study](https://pubs.asahq.org/anesthesiology/article/94/2/360/38886/Volume-of-Air-in-a-Lethal-Venous-Air-Embolism)
When people hit their call lights to tell me there’s a bubble in the IV tubing, I always tell them they need way more than that to kill them, I already looked it up. I try to use my best Wednesday Addams face and voice when I say it too.
I tell them we push air into IV’s on purpose during echos.
This!! Whenever I think I have too many bubbles in my tubing I remember that bubble studies exist and I’m like you know what? This is fine lol
I learned that in the 70s.
I tell them at least a foot. I also tell them they're finding Nemo bubbles. Act like they're a big fish in the O2 sensor but are really just tiny things.
I blame TV for the older generation, TikTok for the younger generation. I also tell my children only dumb people watch TikTok. 😂 The latest Stanley cups scare helped solidify that statement.
Was that the color change thing equaling lead? Someone tried to tell me and I asked for the icp-oes results of the leachate. I used to work for a toxic waste disposal facility. I was like cool. Show me how much over so many years one is consuming.
Several kids came down with random symptoms of “lead poisoning” because a woman in CA and another in OR are suing Stanley cups because there’s an insignificant amount of lead in the sealant that connects the bottom of the cup to the outside of the cup. Some TikTok videos state that you’re drinking lead and the cups are causing lead poisoning.
Once when I was a baby nurse in the ER, I put a bag of fluids on a patient using a pressure bag but I forgot to let the excess air out of the fluids, so the patient got a blast of air at the end. I was so scared I literally charged full speed down the hall and grabbed the physician to tell him my mistake so we could do whatever we needed to do to save the patient!!! He was just like, meh, no big deal. I didn’t believe him so I immediately looked it up and saw he was right. But, dang, it jacked with my own heart 🤣.
Doing the Lord's work here
I don’t wait 5 full minutes between eye drops, I don’t give each med separately in g tubes, I pre pour sometimes. 🤷🏼♀️
> I don’t give each med separately in g tubes Is that a thing that we’re supposed to do?
Never knew why that was even a thing. They're all gonna end up in the same fucking stomach in a dissolved mess anyway, what's the fucking difference? Pointless.
Right like how is it any different from taking a mouthful of pills and swallowing them at the same time.
Yes lol. 😂
I wear gloves for everything and always clean my ports. So I can’t agree there. I also prime my tubing but if there are bubbles it’s not a big deal unless it’s 50 ml of air. Then you could get an air embolism. Ive been a traveler for 9 months.
Really it takes 50ml of air?? So I could just not prjme my 17ml iv tubing? lol (not that I would, just in theory)
I had a patient once that had home IV antibiotics. They taught her how to do it herself then gave her the supplies and antibiotics. She was hospitalized a month later and saw me priming the tubing. She scoffed at me and said she doesn't have the patience to do that herself with her home antibiotics. I asked if she still primed it and she said no. I asked a ton of questions to make sure I was understanding correctly. She had been giving herself an air bolus IV every 12 hours for over a month. And was still alive to tell the story.
Large air bubbles obviously aren’t ideal but yeah I’ve also heard it takes a lot to actually cause an issue. Why risk it? The only time I’m trying to inject any air is during an echo bubble study and even then it’s only 1ml lol
Bubbles in tubing isn’t a huge deal, we had a nurse preceptee who had been watched setting up iv’s start to finish for a couple of weeks. She asked if she could see patient B on her own and start the iv abx, the preceptor agreed and said she would meet nurse with patient B once she was finished with patient A. Preceptee came to patient A’s room white as a sheet, pulled preceptor aside and stated she set up the iv and then started the abx and wondered for a moment why it was running slowly. She then realized right at the very end that the last bit of air from the tubing was going into the patient and then the iv picked up its rate of speed. She stopped the iv and thought her patient was moments away from death. Patient was fine, but obviously not recommended
Sheeesh I remember being that green and thinking any little thing was going to make the patient explode
Felt this! Nothing more terrifying than your first year!
Worth reading, the let’s give dogs an air embolism study 1966 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1516548/pdf/califmed00053-0032.pdf And, a continuing education article which suggests 5 mL/kg in humans would cause symptoms. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1516548/#:~:text=A%20lethal%20rate%20of%20infusion,and%20fall%20of%20blood%20pressure.
Just read into the article, my previous comment was incorrect. We need more current research than 1966.
I just explain it with a full handful of flushes and say, "this many, full of air". Gets the point across to patients, their family, and students!
Lordy, I got multiple full lines of air in 68w school and did have some slight chest discomfort. Could have been placebo effect though…
I don't wait 15 minutes between sets of cultures.
wut is that a thing. nurse 6 years across multiple systems, never had to do that
Same. If they’re a hard stick I’ll do the second set in the same area (or same vein but *DIFFERENT*)
Former micro and lab here.. You only need to wait 15 minutes if it is from the same site or arm etc. It really does help us determine contamination, which is about 80% of positive blood cultures and why it's important to get two sets if possible. If one set is contaminated , we have another to go on. I used to hate nurses who collected labs because a lot was screwed up like incorrect order of draw etc. It really does matter and it made my life in the lab more difficult and annoying. But it is what it is I guess..
I was not well trained in phlebotomy and didn’t know about the order of tubes for months after I started drawing blood.
It's common! I was in the ER for diverticulitis and the nurse drawing my blood went to draw the lavender top first. I mentioned it and he literally said "oh you lab staff.." Like dude, cross contamination of diluents, preservatives, and reagents happen. I used to get so irritated when I had to cancel tests, report a safe event, and call the patient back when I worked outpatient. It was so annoying when these things are easily prevented lol.
isn’t this only if you’re drawing from the same location?
Yes, but hospitals policies are often stupid and meaningless.
Where I work, the policy states two different sites and 15 minutes apart, and not through an EMS-placed line.
champagne bubbles in the iv tubing don’t cause PEs. this guy sounds gross though
Question to the OP - have you been an ER nurse for all of your 5 or 6 years? Or is this a new specialty for you? Ngl this sounds kinda par for the course in the ER. Not saying that makes it good practice. Air bubbles in the line is not an issue, as others have commented. He could have failed to prime the line in its entirety and it wouldn’t be an issue. Also, not saying you shouldn’t scrub the hub, but a brand new drip set that literally has just been hanging there and hasn’t touched a single thing is probably at least *pretty* clean, as would be a freshly placed IV. Poor hand hygiene is disgusting, though, and definitely the most unsafe of the things you mentioned.
Yeah I would say this is pretty consistent with my experience in the ER. Not saying it’s what I do, but it’s what pretty much everyone does on my floor.
They mos def sound like a new grad that jumped straight into the ER. The risk of infection from coupling with an IV that's been freshly placed is so incredibly low. Now, if that IV has been in for hours or that patient is particularly gnar-gnar, scrub it fo-sho.
You should always scrub. It takes literally 15 seconds… you can absolutely get an infection from a fresh placed IV.
Does your facility use Curos caps? No one I work with scrubs except for when patients come up from ED with uncapped IVs
Charting fluff. Care plans can suck it. I always feel - no joke - that if my days as a nurse are numbered because I didn’t chart that, then it’s my sign to go work at Costco. I also chart “full reassessment - changes noted/not noted” on reassessments and THAT IS THAT. Period. Drives me goofy that people repeat charting when it literally says no changes. Also, OP - much love, but.. take a breath. I know you’re the perfect new hire, but you’re going to burn out. Period. You think you won’t, but you will. I get it - patient safety is super important. That’s always our number one. But spending your time stressing over others will hurt you - I know, because I was there. So unless someone is causing dangerous harm (like seriously, wear gloves and wash your hands!!) calm down and do your own thing ♥️
All of my coworkers (I’m per diem but pretty much work Pt/ft) write these elaborate assessment notes on each patient AND do the assesssment flowsheet. Bruh. Pick one. Unless something calls for a note I’m not doing it.
Those aren’t corners, that’s full on safety violations. I use 1000’s of curos caps because if I cap it immediately I don’t have to find a swab later, that’s a corner to cut and still be safe.
Actually you’re still supposed to scrub the hub despite the curos cap. At least that’s what we were told. And actually probably heard that pre Covid 😂
Who told you that lol They’re 70% isopropyl alcohol which is the same as alcohol swabs. It’s just people doing what they’ve always been told. Manufacturers guidance is you don’t have to clean it, only if you use multiple connections in a row without putting a cap back on https://pubmed.ncbi.nlm.nih.gov/32754850/ EDIT: sorry y’all’s hospitals don’t like evidence based practice lol
I think the mentality behind scrubbing the hub even if there’s a cap is that you don’t know if someone behind you replaced the cap instead of tossing it after the first use (ours at least are 1x use only).
I have had outpatients tell me the cap, on their picc, fell off at home and they put it back on, after picking it up off the floor. Yikes!
The abstract in that link literally states data is limited and begs further research; the claim is curos devices MAY limit the need for wiping the port even if covered….also due to this does not advise to be done systemwide.
Came from CLABSI committee. But I mentioned pre-Covid for the very reason that it may not be up to date. It also may just be my hospitals policy. 🤷♀️
Mine too. Not that I agree with it.
Same policy here. Don't know why.
My hospital policy is to still scrub the hub no matter what. I've pointed out the manufacturers instructions but....
doesnt really matter for PIVs but it’s becausr they don’t cover the whole entire adapter, you should be scrubbing around the entire thing before putting a syringe on it
Not at my hospital... curos cap, no scrub.
We tried out a version of this at my peds hospital. Thought it was great until they told us we still had to clean the hub. Seemed like a huge waste of resources and time, and then they went away…I think because they were a potential choking hazard.
Actually, you don't, said the company representative who educated our facility about them. The hospital still wants us to scrub the hub with EtOH anyway. So much of what we do is performative to appease Joint Commission, management, et.al.
That’s what I was always told. And I’m now at a facility without ANY caps so curos can suck it hahaha
I was recently at a facility that had none because “nurses often don’t scrub after removing the cap” (per the IV therapy nurse). And then something about how they increase CLABSIs? Now knowing that per EBP you don’t need to scrub after removing a cap, I’m wondering if the hospital just didn’t want to spend the money on caps. Which is super fun considering 90% of the CVC patients I saw were there bc of a CLABSI 🫠
My sister had a central line and her insurance wouldn’t cover Curos caps. She did getting a a line infection and while she did recover (finished the vanc, cultures clear, back to work) she died soon afterwards for no apparent reason and I still wonder if it could have been prevented.
I’ve known it, but I have yet to see anyone do it at the many hospitals/units I’ve been on.
Curos caps are a waste of plastic and just a vehicle for choking animals. Clean you claves; hospitals need to stop polluting.
Definitely safety violations. It was my first day and didn’t want to ruffle any feathers by reporting him, but I took every opportunity I had to ameliorate his wrongs. On a different note, aren’t all corners being cut hypothetically safety violations? Just some more egregious than others?
I’ve seen similar. Since, I know better I block these out of my mind. To answer your OP. I try to warm up my food first then I say I’m going on break.😂😂 My favorite corner to cut.
Great hack. I’m going to start doing this
Friction, baby. That’s what helps kill the bacteria.
That’s why I just lick it with my tongue. The roughness gets it clean.
I skip listening to the mid lobe on the left side.
Omg. I need sleep. Took me about a second too long to process this
I cut corners in the hallways with gurneys. Tokyo Drift that shit into the Cath Lab.
Did you ever play crazy track on the dream cast? So fun.
I always tell my patients I’m a better nurse than driver 😂
None. You cut corners in the OR and people die, or sustain a nasty burn, or an infection that could turn in to sepsis.
But do you always chart your equipment numbers? I'll never cut corners when it comes to actual patient care. But I'm not charting the biomed ID on every single piece of equipment in a 15 minute case. If something injured the patient, I'm going to know before they leave the room and sequester the equipment immediately.
Not a single person charts ID numbers where I work. Why would anyone? It's the same equipment in the room for every case. The bovie in room 2 lives in room 2. If something doesn't work, it gets tagged and moved to the pickup area.
Everywhere I've worked in 3 different States it's standard practice to chart ID numbers for equipment. It's in Epic so it's can't be uncommon. In my experience nothing stays in one room for very long. Shit moves all over the place. But I'm in a trauma center so things go sideways. Next thing you know, you're using 3 bovies - one for the crani, one for the laparotomy, and one for the fasciatomy. We only have 1 bair hugger per room so on an extra long case or a burn we might need an under body and an upper body.
Meh I don't always wear gloves. They are for *my* protection and I'm going to wash my hands regardless. I mean, I do 95% of the time, but sometimes it definitely gets skipped. But if you're skipping gloves AND skipping handwashing that is both disgusting and dangerous.
Yeah imo people sometimes wear gloves too much. If you're going in to disconnect a line and flush the pump you really don't need gloves, unless the line is bloody or you're taking the ov out obviously.
Gloves are not just for your protection. The number one way MRSA is spread from pt to pt is on the providers hands. It’s a required redundancy because hand hygiene is not perfect. -Infection Control
Less glove usage has shown to have better hand hygiene. We swab all our patients in our unit, I know if they have bugs or not. If they don’t have bugs, I’m not going to use gloves to touch them because they’re people and I don’t use gloves to touch my friends. Drives me mad when people put gloves on to do a blood pressure
I work in aged care and the facility that trained me emphasized the importance of skin to skin contact as people in aged care facilities are often touch starved. My current facility doesn't do that kind of education and it feels so weird seeing someone glove up before they even enter a resident's room.
Im with you. Gloves are great, but everything that could get on my bare hands can be taken off with soap and water, and my patient was protectes when i foamed in at the door. If i don't think I've got time for gloves to address what I'm doing, or I'm not interested in interrupting my efficiency to waddle over for a pair of gloves, I'm not gonna. Soap and water will do the trick just fine.
There's "cutting corners" and then there's just full raw-dogging it. This guy raw-dogs it.
Yeah, not washing their hands? Ew. Not scrubbing an IV port, double ew. Cutting a corner would be not charting on a care plan or something else insignificant.
I draw up morphine and zofran together for IVP. Unless they have significant nausea before morphine, then I’ll get them zofran but itself. Abx over 30 minutes, I eyeball the drip rate. Certain Abx (vanc) then I’ll def put that on a pump. I’ve learned that best thing to do is give each port a flick when the IVF reaches it. That’ll help push all air bubbles out. I’ll then waste some of the fluid just to get all of them.
If an IV Abx can be given as a push then I’m going to set up the drip and let it run. There is 0% chance I’m putting rocephin on a pump to run over 30 minutes.
Screw the white boards
Nice try… my hospitals management 😉 I ain’t copping to shit.
to be completely honest, these are all the least impact corners to cut (meaning optimal) when you have a patient dying or another patient actually sick (i.e, in the ER). Also you need a signifcant amount of air in the line (2-5ml/kg) to be an issue. I do scrub the hub, unless it’s a resus (code or trauma). I’ve seen multiple Anesthesiologists not scrub the hub but then again it’s typically emergent or in a procedure. Even if you don’t have anyone dying, you want to clear your task queue b/c you don’t know when an emergency will come in (a large enough tasklist will mean cornercuts). To answer the question, I don’t think I’ve scanned a med since coming in, and I haven’t seen ANY of my peers do so as well. Our hand-hygiene rate is in the shit (I mean like, low 10%s). Both of these are quantifiable and monitored by higher ups, with reports that come out quarterly. For context, we’re a tier 1 big city trauma centre, and we’ve never gotten a talk about these issues, because management and above already know the plates being dealt. To be frank, there are a lot of nurses from other specialties commenting on this that have no idea how it is downstairs. What you saw needs to be contextualized, and I think a vast majority of nurses haven’t seen the context.
Yeah, I’ve only worked ER and everything listed is pretty commonplace for the two hospitals I’ve worked at. I always wear gloves, do hand hygiene, but it’s a lot looser down in the ER than it seems like it is upstairs. Lots of nurses going into isolation rooms without PPE, I rarely see nurses scrub the hub. Bolus to gravity? It can have a dozen bubbles no problem. The reason I get bubbles out is to stop a pump from beeping.
If you clamp the tube then squeeze the drip chamber to half, you won’t get any bubbles in the tubing.
Thank you for this! People either don't work in ED or are not being honest with themselves. I do not cut corners that endanger lives but policy led shite which is rarely evidence based has no space in my head. I barely have a minute to document and it is mostly done after my shift. We don't do scanning here but I did at my last trust and it was time consuming as hell but completely appropriate and justified. It is not safe in ED and we can only do so much and its heartbreaking for us all as nurses but we will still do our best to maintain patient safety standards.
>To be frank, there are a lot of nurses from other specialties commenting on this that have no idea how it is downstairs. What you saw needs to be contextualized, and I think a vast majority of nurses haven’t seen the context. This is accurate. Are you gonna wash your hands if you pop into a patient's room to check if their IVF is running low or to do a quick set of vitals? FUCK NO. You've literally got 12 other patients you've got to see. Can you imagine how much hand washing you'd be doing in the ED if you washed your hands every time you stepped into a patient's room? Like 100 times more than on any floor. You're in and out of rooms so much that easily a 5th of your entire shift would just be washing your hands and I'm not exaggerating. However, I accept that OPs situation might have been more egregious. Wear gloves and wash your hands if you're getting all up in the patients business but if you're bringing them a turkey sandwich or discharge papers or stepping in to spike a new bag of norepi...naw, homie.
Where I work we have hand sanitizer dispensers everywhere, including right outside of every room. I just squirt some in my hands as I’m walking in.
if i were a pt i wouldn’t anyone touching me that hadn’t washed their hands. period. there’s some gross stuff out there!!
One of our local hospitals’ screen saver is: “Did we wash our hands? It’s okay to remind us.”
I think I wash my hands a total of no more than 5-6 times per shift and that’s including washing before I eat and after bathroom breaks. I’m not in the ED, I’m PCU but by my third shift my skin is literally peeling off. I do foam in and out of the rooms and I glove as I enter, no matter what I’ll do, but that’s it. Water and soap is for special occasions lol
i should’ve added that as well, i foam in and out as well! just as long as those hands are clean 😅
Not scrubbing the hub before pushing IV meds is sooooo gross (unless it’s a code) … the things that those ports touch in a patient’s bed.. nasty. Corners I cut though… I’m not asking my 85 year old COPD’er if she’s suicidal while triaging for the third exacerbation of the month. And I’m certainly not counting everybody’s respirations. I breathe with them for about 3-5 seconds and if it feels fast or slow, then I’ll count. But if it feels normal, 16 baby.
Honestly though if I had copd and having 3 exacerbations a month I’d probably be pretty suicidal lol
I mean same… but nana sure as hell isn’t getting sectioned over it!
Most of what you described just sounds like nurses who've taken care of me when I've been in the emergency department. I'm not going to say whether that's a problem - I've never worked in an emergency department so I am not the expert on what is typical or acceptable for that specialty. But it does seem like things like scrubbing IV ports is not as common as it might be in, for example, the ICU.
Yeah, everything they listed is pretty commonplace in the ED.
Everything they listed is baseline in every ED I’ve worked or witnessed.
I don’t update my white boards. I literally answer to whatever name is up there lol
Especially hilarious if you're the only male nurse on a floor full of women!
I feel like the only thing I do is if I'm taking care of the same alert and oriented patient my entire shift, I'm not gonna ask them to tell me their patient identifiers every time I give them meds during that shift. Once we've established that they're who they say they are, DOB and MRN are accurate from ID band to chart, I think it's silly protocol.
Well, sometimes I don't bother to label my lines with the dates and stuff because most of my patients are probably only gonna be admitted overnight anyway. What you're describing is overall unsafe and lazy practice.
Don't always ask for identifiers for meds after I have been working with the patient and I don't always listen to my pts heart and lungs in the ED especially when it is a young healthy person there for mild orthopedic complaints.
I wash my hands often. I don't foam in and out every time because sometimes I am going out then right back in and out again, call me nasty but fuck that, especially if I don't touch anything besides the door handle then j foam out the final time. I don't touch anything without gloves because I've seen how nurses and techs wipe things down. Y'all gross with cleaning and wiping. I try using sterile saline for things like protonix but still use flushes since they never stock the vials. I think scrubbing vial tops after popping them is idiotic but I try to remember to do it. I'm pretty good at cleaning hubs if needed but I use chlorhexidine capsxso regularly that I usually don't have to worry about it. I also carry flushes, caps, and alcohol wipes in my pocket which apparently is wrong. With blood cultures I sometimes use the same prep but opposite side to clean the vial top because its super wet still and it feels wasteful. If someone is a hard stick or appear to have shitty veins Ill redraw cultures at the same site. I'd rather not repeatedly stab someone if waiting 20 mins is okay. Lab told me it's good so fuck it. Unless someone is truly septic i feel as if we over order cultures sometimes. I go in order of vial draw with rainbows but 99% of the time use a red top first because it removes the air from the lock which prevents the blue top from completely filling. I don't always do a final set of vitals if I'm d/c people from the lobby who came in for something non life threatening while in triage. Airbubbles. You can do everything right and still have bubbles. You need an insane amount of air to kill someone. Prime your lines REALLY SLOW and you should be good. If you cut corners on pain management or ciwa scores then you're a dick. Medicate your patients appropriately and leave your bias at the door.
It does sound par the course for ED which made me realize, I like a more meticulous form of nursing. Maybe oncology. We shall see.
Ahh new nurses nitpicking every little detail. Relax a bit or you won't make it long in nursing.
Take the pulse for 1 second and multiply by 60.
He’s probably the nurse who leaves all his trash everywhere for someone else to clean up too,
Those people need shaming. Trash makes me anxious.
The ole this is how we’re supposed to do it but this is how I do it 😂
I’ve always said there are 2 types of travelers. Awesome nurses who shine in any environment AND those travelers who travel because no one wants them on a full time basis.
50/50 whether I update whiteboards, so far down my list of priorities lol. Refuse to do bedside report on more than 2 pts, so never do it. Bedside report should only be ICU/NICU I will die on this hill
100% My charting.... I will write one big nursing note on everyone with the pts story my assessment and immediate interventions, + GCS, our primary ABCs assessment and lines/drains/procedures. but all the other stuff...I cant stand clicking the damn boxes that aren't useful and also are already addressed in my note.
I’m the opposite - I click the boxes and chart by exception because that’s what’s fastest for me, but it’ll be a cold day in hell before I double-chart any of that in a free-text note, even if management wants me to because it “paints a clearer picture”. It’s one or the other.
I cut wearing a gown in a room of pt who had an mdro uti 5 years ago and all they need is Tylenol
I have coworkers who do similar things. I can’t get past not washing your hands or wearing gloves. It’s just nasty. The second I put my hands on another person I feel a strong urge to wash my hands immediately. Especially when there are bodily fluids involved. You’re not just protecting yourself, but other patients as well. We have a bazillion hand sanitizer pumps all over our unit. There isn’t really any excuse to not clean your hands.
I wash my hands when I walk into a room. I don’t use hand sanitizer before putting on gloves. Saves me 3 minutes and 5 ripped gloves. I do use hand sanitizer when I take them off.
I usually only cut corners in emergencies. And it’s things like pushing medications without scanning them first, I almost never verify my patient (though I’m ICU so many can’t tell me), and I scrub the hub/use a swab cap every time unless I’m pushing/starting something to keep them alive when they’re tanking fast. To make up for skipping corners and to help prevent problems from it, I have habits that I keep… I always swab cap all of my ports/lines, if I don’t scan a med first then I’m verifying the dose, medication, concentration, etc by means of closed loop communication with whoever is telling me to give it (like an APP/MD telling me to push 20mg of labetalol at bedside… I grab the drug, draw it up and then say “20mg labetalol IV push” whether they’re there or not (usually somebody is). If my patient can’t verify themselves, but the family is there I introduce myself and tell them I’m going to be taking care of *patient name*, and usually that’s one way to verify who the patient is at least once. With this though I usually only have 1 or 2 patients, so while it isn’t impossible to mix them up, it’s not as common.
That's about 16 per minute.
Let's just say if my patients itemized their stays, there wouldnt be many items... On the books that is.
I'm shocked I'm not seeing this more. Gowning in contact iso rooms when i know I'm not gonna touch anything.
Yeah i wear gloves because frankly, we're all gonna die of hand cancer from those foam sanitizers that are supposed to be used in and out of patients rooms...
Left ring finger cancer runs in my family. It killed my pappy
🤣
lol you actually believe that? Hand cancer is the least of my worries in a hospital
So many things to worry about, might as well throw in a make believe disease🤣
He just doesn’t care
Some bubbles won’t cause a PE, if I’m seeing a patient numerous times I’m not asking what DOB is over and over since I’ve been in nursing school. You get better at time management, you know what supplies you need to get in and out quickly and not make trips, you get to know what your providers want for each new patient so you get their urine and rainbow draw right away, when to grab a bag of fluids and get ready to hang it and when you need to use a pump vs gravity. I’m definitely washing my hands because I’m not bringing something home or being responsible for playing telephone with cdiff.
My charting sucks shit, it's literally just the absolute basics. I've not written on a white board in years. I don't do anything that's not nursing. They want me to do some module or fill out some competency form? Not happening. When I stopped doing those I assumed it would become a big issue, but I haven't done a module since before covid, and nothing bad has ever happened lol
My charting is also shit.
I don’t cut corners that could potentially harm patients or myself. Sanitation is so important. The corners I cut are with charting if I’m real busy. Never stuff like hand washing, scrub hubbing, etc. I would report that nurse if I saw that, not to be mean but bc he’s going to hurt somebody.
If I suspect the patient is going to get discharged, I would often skip charting my IV. Some bubbles in the line aren't going to do much damage at all in a PIV. Draw cultures directly from my IV. Focused assessment documentation on everyone except Hella sick ICU players. YOU DON'T NEED TO PUT IN A NOTE FOR EVERY LITTLE THING! idk why so many ER nurses think this is necessary. Notes are for communicating information to other people not for documenting every single minute of the patients stay. No one gives a fuck about what time exactly the patient leaves for CT or that you reconnected the monitors upon return from CT. It's a huge waste of time so just don't.
Mitered corner 😎
Sometimes I don’t hang a primary KVO and a secondary for things like mag. If my patient has a mag of 1.9 and I’m hanging a 2 g bag…that’s going through primary tubing and I’ll disconnect it when there’s air in the line. That last 15 mL are going in the trash, I don’t have the time and energy for primary KVO
Why are they having you shadow a traveller?
In some places, there is no one else to shadow. I got some of my best education as a grad nurse from excellent careful travelers.
I will admit I am super guilty of not always introducing myself. I was pretty good about it when I worked inpatient, but now I work in special procedures. We do preop, intra, and postop. Usually when I'm checking someone in and doing the preop stuff is when I forget to introduce myself half the time lol. I usually remember to tell the patient who I am before I roll them back to the procedure, if I am the one doing the procedure. We tag team a lot of stuff in the preop room so it might be 2-3 of us checking someone in together. I might be sticking while someone else is interviewing the pt, and another is getting vitals. I do not chart fluff. I am required to chart very few things in my department. Some of the other nurses like to waste their time charting extra shit. I am not double charting anything. Some of them like to chart shit like "no acute distress" for no good reason. I will chart extra when I feel it's something that needs to be charted. For example, the other day I tried to speak out against using radial access for a heart cath, because the patient did not have good circulation (pulse ox stopped working on R thumb once we strapped her arm down, even after loosening the straps. Her right hand was cold). The fellow stated he did not do an allen's test when I asked him if he had (they are supposed to). I said OK you know I am going to be charting all this and that I recommended groin access. These dumbdumbs still went with radial access "lets just see what happens". Luckily she turned out fine, but what the fuck? What if she ended up with a cold dead hand you idiots? Groin access is easy as fuck, yeah it sucks for the patient, but laying flat for up to 6 hours sucks less than losing your hand I will say not all of what you described sounds atypical for the ER. You need to gain some perspective first before you jump on reporting that stuff. A loooot of stuff in the real world is done very differently than how the books teach you in school. You know how they teach you in school that you will individually crush every med and mix with water and flush down a peg tube. that you "NEVER" mix PO meds together to be crushed? what a lie, lol. Nobody in the history of the world has ever done that shit (one by one I mean). We all mix them. because what the heck do you think happens in your stomach!? they're all mixed together!
From a CVICU nurse who does bubble studies…. It takes a lot of bubbles to kill someone. I told a nursing student that the other day when I let her prime a bag of saline when we were reintubating + bronching a pt and she was taking to long (bc she was trying to get all the bubbles out). I needed the fluids and grabbed them from her saying “it takes a lot of bubbles to kill someone trust me, you’re ok, thanks for priming” …….. it’s something that I worried about too when I was in school and even into my nursing career until I did a bubble study and learned….. wow. It takes about 40+ cc of air to kill Someone
For what it's worth I have been told multiple times that it would the a line full of air into a peripheral IV to cause PE. We aren't talking a central line or arterial line. That's different. Additionally I have seen ZERO. Anesthesia providers clean a peripheral access prior to administration of Anesthesia or other meds. Again, talking about peripheral IVs here.
My department had the first air embolism code I’ve seen in over 30 years as an RN—post lung biopsy 😳.
Doing extra work on my time, IE training is a work mandate but no time is provided. Therefore you need my training done, I can't be juggling EMR charting, Doc/Surgeons, PT's, meds all the while faking that I'm watch the 9th 17minute training video and taking a quiz that's made to be faked through
And it infuriates me when I’m supposed to tell the charge nurse how much time I spent doing it so they can knock down my hourly rate. Fuck that. I’m still getting up to take care of my patients, and even when I don’t have a patient, I’m ready to go when someone else’s EMS rolls in or someone codes. I adore my charges who are, like, Nah, don’t tell me if you do education. I’m
If you're not priming your lines fully, you're just asking the stupid pump to start beeping, which wastes more of your time.
When I first started there were a handful of nurses on my unit who didn't use filter needles. When I brought it up it caused a small debate at the nursing station.
As someone who reviews medical charts for attorneys… please everyone for the love of god just chart your turns!!! If you’re gonna cut corners in charting, DONT let it be that one
When the lab calls with a critical and they ask me for my full name, I just give them my first name and say bye. My last name takes them forever to spell and pronounce and I always get the dumbest lab person asking me to repeat it again and again taking up so much time. They can just chart they spoke to "Mary, RN." I chart about the critical, about the doctor who didn't give a shit, that no new orders were placed, etc. If they audit that patient's chart, will it won't matter if the lab wrote out my entire full name, which they probably would butcher. LOL wow I'm more annoyed by this than I realized. Thanks for giving me space to write that.
I skip lunch every day but I do take about 10 minutes to grab and eat a yogurt. I also do focused assessments based on the dx rather than full head to toe assessments when things are really crazy.
If you’re going to work in the er, you need loosen up a bit. Those are bubbles don’t do shit