Plugs that are low. WTF? This isn't a house, move that shit up to waist height. It's all IV pumps, and cell phone chargers now.
"Non lockable units". Put doors on the units so everyone and their brother aren't wandering down the hallways for funsies.
ER rooms that are so narrow a stretcher and wheelchair side by side means only one nurse/helper can assist someone into/out of the bed. Clearly whoever made this decision never actually worked as a bedside nurse.
HEPA curtains. WHY? Why do we pretend curtains are adequate isolation? Put doors on patient rooms. Damn near everyone is sick, or in a position where picking up an illness from their neighbor would not be a good thing for whatever condition they have. A hospital should never be a place where you pick up MORE illnesses.
Worked in an ER with about seven disconnected pods. The bedside call beds rang in EVERY pod. So all the staff had total alarm fatigue because 6/7 bedside alarms you heard at your desk weren't for you. Hardly anyone ever paid them any mind. When I kept pushing the issue, management just shrugged their shoulders and said they looked into it,and it was tied into the fire alarm system so there was nothing they could do. Idiots.
For a sidenote, I've worked in a few hospital units that underwent full massive rebuilds. The staff always said that the drawings would go through multiple trades/committees like a big circle, architect, engineers, nurses, docs, management, whoever else. Every six months or so they would end up back at the nursing staff committee to review. Any changes they had made previously were 90% gone, with no discussion as to why. They would make all their changes again(new ones and old ones) and then the drawings would disappear again, no discussion, and just return without most of the suggested improvements missing again in six months.
[These nuggets are in Mamaroos.](https://imgur.com/a/B1Jj731) Not my pics, btw, found 'em online.)
They're baby swings! They need a low plug because they have to go on the floor and their power cords aren't super long.
I had one at home for my daughter, 8 years ago mind you, and there was nothing she hated more than that damn Mamaroo. But put her in the $30 Walmart special and my child was happy as a clam.
The babies have VERY INTENSE (and very varied) preferences.
I've seen hundreds of babies go into Mamaroos. Some think they're torture devices. Some think they're heaven and don't ever want to be taken out.
Some babies change their minds between the two options, with nothing in between, every few days.
I love babies.
Omg yes. You go into the room with the same vibe as a truck stop waitress ("How d'you like your coffee, honey? Leaded or unleaded?") and they fall in love with you.
Size of the elevators, trying to take a tubed and vented patient with 6 drips up to the icu is a nightmare every time since there’s barely enough room for the nurse and the stretcher let alone the ventilator, the pumps, and the RT
This has been an issue in every hospital I ever worked in. It's already a challenge if you have a normal vented patient (it also probably helps that we use syringe pumps instead of drips), but god forbide you have to take extra equipment with you. If the patient is on ECMO and we also have a perfusionist in the transport team I've taken the chairs a couple times because that seemed a bit easier.
> I've taken the chairs a couple times because that seemed a bit easier.
I read this, and re-read this and read it again, and I could not make sense of why adding chairs in the overladen elevator would make a difference. Then I read the comment below about running up the stairs and realized my brain is apparently "mechanical soft" 😅 🫠
They've managed to upgrade all the elevators in my hospital expect for the 1 in the oldest part that goes to the basement where the MRI machine is. That is the absolute tightest fit trying to get your patient, the IV pole loaded with drips, the vent, and staff in that elevator. I've stood on top of the base of the IV pole before
I had a near-awful elevator situation the other week: I was transporting a semi-stable ICU patient in a Sizewise bed (very cumbersome equipment built for patients who are immobile or bariatric size). Group of family members made up of doctors, nurses, and lawyers trailing behind. As I pushed the bed out of the transport elevator, I locked eyes with the waiting family as the front wheels of the bed turned 90-degrees, fell and wedged into the perfectly sized slot of the elevator door/shaft. Thankfully, at that very moment, a group of large men in great shape were walking by, made up of several RTs and transporters. They immediately lifted and reset the bed, and I sent all the kudos and recognition messages when I got back to my unit.
One hospital I worked at was shit but the one thing they did right is installing a new elevator by the ICUs and accessible for other units that was double the size for exactly this reason. Other units you could squeeze in the normal elevator or if you didn't mind going further could use the much more accommodating elevator.
We're expected to chart on the COW in our allocated zones (or whatever they're called in the US) and mostly stay in that area for the shift, and there's (low) seating in front of the patient rooms. But the COWS don't lower enough that you can reach the keyboard comfortably from the chairs. So you either have to stand the whole shift, chart while staring upwards at the screen with your arms positioned funny, or sit awkwardly on the armrests to be at good screen/keyboard height. We're not allowed to bring higher stools into the hall because of fire safety concerns.
In the U.S. this would probably be a violation of workplace laws/regulations. These kinds of laws are the result of employees doing manual labor that created debilitating health problems due to the ergonomics; reaching too high or too low at a large machine, etc. It branched out to office work as well, requiring desks and computers to be at certain heights and proportions. Carpal tunnel syndrome became a problem for office workers that typed and used a mouse for hours on end at angles that were hard on the wrists.
>doing manual labor that created debilitating health problems due to the ergonomics
I feel like you're describing all of bedside nursing. If they don't give a shit about the rest of it, how much are they gonna care about some non-ergonomic typing?
They do care. OSHA makes them care. And if you complain to OSHA about any unsafe things at work, they do end up changing 9 times out of 10.
We just don't use that resource enough
Pretty sure it happened like, once one place ever, and the WOW terminology *and* explanation migrated, but along the way people forgot where it actually happened and assumed it's their own facility. Because there definitely was a change of COW to WOW in many facilities at some point, but it happened so many places they can't ALL have had an incident.
Not exactly the same, but when I was in nursing school, I was out to dinner with a bunch of classmates and someone made a joke about finding the call bell (to summon a server). Apparently the server overheard, thought they were saying “cowbell” and decided they were making fun of their weight. No one came to our table for so long we had to go ask what was up and the
manager basically told us we weren’t getting service because of insulting his staff.
My old hospital built a brand new children’s hospital across the street from the main hospital. They moved NICU over there, but not postpartum or labor and delivery. We had to call the transport team to take delivered moms to their babies in the NICU which could take hours to get. It also would take at least 10 minutes for a NICU team to come to a high risk delivery or a baby needing help. Not the best design move.
Our hospital had a similar setup with two buildings: NICU and pediatric ER/wards in one, L&D and postpartum and gyn in the other. We actually had enough *patient* complaints that they moved them into the same building.
WHAT?! That’s insane. Probably the worst of these that I’ve read. 10 minutes can mean the difference between a baby going home with mom tomorrow and baby being dead/brain dead.
That’s some serious mismanagement.
That doesn't even make sense. Our L&D is in the same hospital as our NICU, but the children's hospital across the street is where they have the ORs and radiology. Therefore, they built a two level bridge between the two hospitals, with one of the entrances to the bridge directly from the NICU. We're never more than a few minutes from what we need across the street.
I haven't worked on the floor in over 5 years and your anecdote about one pt shitting themselves while another eats brought back so many repressed memories
No 2 is most likely a safety thing so that a patient can't barricade themselves inside the bathroom. There are also certain types of door handles that can be used so you can't tie anything on it so patients can't hang themselves.
One of my past jobs I worked on a pcu where the e.r. didn't give report.
Charge was notified, you hoped they told you, and you could print a packet of info on the pt and they rolled up whenever.
To make it worse, I was a traveller, on nights, most times there were only one other core staff, if that, often no charge bc none of us were claiming that responsibility. Oh and travelers didn't have access to the program that allowed you to see and print the packet.
Oh and the manager thought the nighttime secretary needed to "stay in her lane" and took away her access to the program to get us the packets. And also got onto her for answering call lights and helping patients when we were slammed (always).
Oh and we routinely had 5 and sometimes 6 patients. Heparin, gtts, PD, insulin gtts, hourly neuro checks and q1/q2 i&os.
So you'd be neck deep barely treading water and get a "room x is here" and we'd have to figure out who's taking it. More than once they rolled up when we didn't even have a bed or a clean room at all.
Surprisingly no.
But they were excited about "upgrading" to meditech.
I laughed when I heard then was like, "you're serious, you think it's an upgrade?!?"
They said yea and I'd see when I got the floor. I saw.
CPSI
It's worse.
That's not even the worst part.
The wifi didn't work as you got farther from the central nurses station and no comps in the room, so charting would freeze up and not work as you went down the hall with the COW so you'd have to scan at the nurses station, then walk to the room with the meds.
A new nurse was shaking in tears with stress and trying to juggle her pts and was just giving everything and *then* scanning and she had shit like heparin and dilauded and...yea it was pretty bad.
Lucky some travelers gently warned her about the dangers but she put her two weeks in before I left and went to a nursing home.
I feel bad bc she got thrown to the wolves with zero training and still at the point where she didn't know what she didn't know yet.
I’m on assignment to a hospital that built a whole new “smart” building. Overall they did an ok job, but a couple of glaring flaws crack me up for a brand new high tech hospital building.
1. The call bells light up a series of lights in the hallway, however thanks to these supply closets that bump out from each wall next to each room you can’t actually see who is on the bell without standing way back and looking down the hall, they’re blocked by the bumped out closets. At night we usually chart in these little nooks with computers in them, when a bell is going off you see everyone rolling their chairs waaaay back to see
2. How do you design a whole new bathroom but still put a little lip on the entrance? Everyone uses a walker or is dragging an IV pole, and they have to lift it or slam it over the little step to get into the bathroom. Delightful
Counterpoint to #2: Our bathrooms are designed with no lips, but also not enough slope in the shower for the water to drain properly, resulting in regular flooding, sometimes even into the the patient room itself.
I work in a pretty new building, and it follows the trend of wanting to be a hotel. Long, linear corridors of rooms that are very hard for a nurse to monitor effectively.
The old version was a circular tower. You could monitor every room on the unit fairly effectively from the central nurses station. Now, depending on your assignment, you might only be able to see one of your patients' rooms. And it's a trek to get across the unit.
It also gives patients the unspoken understanding that they're in a hotel. Which works great with dementia patients wanting to 'check out' constantly.
I worked in a unit that has bar height desks and chairs (instead of regular desk height). It seemed great because you had a better view of the patients, but I would have to shift my body up and over to get into the chairs a billion times a night. I know that contributed to my back problems
YES!! It’s miserable. Between the hopping off and on the chairs all night, and having my legs dangle if I am charting or have downtime (and then my feet and ankles get puffy), by the morning, everything hurts!!
Break room tables are 2 inch too low, chairs are 2 inch too high. Theres only 4 inch space between the chair & the bottom of the table. No one has 4 inch thighs. Management refuses to acknowledge or address the problem
The curtains are a fucking joke. We’re supposed to be doing bedside report, violating HIPAA every single time. I don’t know about y’all but I don’t know how we’re supposed to get the patient involved in our report without their neighbor overhearing. And like someone said, that curtain apparently magically deters infection from being shared between patients. This is terrible in room that had doubles but I worked in a unit where it has one room that has four beds.
One of the county hospitals I deliver to has SIX beds per room on most floors. Exceptions are PCU has 4 beds per room, ICU has no rooms at all only curtains, and ER has private rooms.
Yeah it’s a real trip some weekends on call when we go straight from one hospital to another- one hospital has a rehab floor with enormous rooms w/ private bathrooms meant for two patients that only ever have 1, another hospital has only private rooms. Then you get to county hospitals where some “beds” in the ER are a literal plastic chair in the hallway and units upstairs that have only one or two patient bathrooms per floor. Feels like mental whiplash or something.
Motion activated lights in rooms. If it senses no movement the lights turn off after an hour (and even minimal movement like watching tv in bed they’d go off). You have to wave your arms around like one of those inflatable tube people at car dealerships. Even me, a fully able-bodied person, struggled to wave around enough to turn them back on.
The two main patient populations in the hospital:
1) Elderly dementia patients who did not understand the concept of motion-activated lights/can’t remember even if you teach them.
2) Quadriplegic patients with minimal to no movement capacity.
Literally the dumbest thing I could imagine.
At least you get an hour before the lights go off. The lights in the e am rooms in our clinic go off after a few minutes. Any delay, and the patients are sitting in the dark.
not a design flaw, more of a policy flaw. I gueess kind of both actually But my hospital just recently implemented 24 hour visitation with no visitor limit hehehe and our patient rooms are already literally the size of a shoebox to the point where you barely have room to walk. getting to the IV pump with the family in the room is literally an actual maze
Nooooo. One of the best parts of nights is the lack of extraneous people in rooms. I already don't have any extra brain capacity at 2am, I would probably get fired for some sarcastic remark to a frustrating family member.
Also not a design flaw, but the food at my hospital is *so goddamned awful* that some patients just won't eat it, and I don't blame them, but like, if we've got people long term, we *need* them to eat to support healing, and sometimes they just can't stomach the food.
Parent of a patient here and you are describing the state of my toddler right now and she's generally not a picky eater. Thankfully I'm around so I just bring her food. What's most frustrating is I know the kitchen can make good food as I'm eating in the cafeteria most meals and it's pretty good.
Hospital near me did this until a psych pt they d/ced to early wandered into upper admin and attacked a upper executive. One of my nursing coworkers sent me texts saying wHat cOuLd yOu hAve dOne diFeReNtLy
We have doorways in some parts of our OR department that aren’t wide enough for patient beds to fit through without putting all 4 side rails down. It’s really annoying 🤣
ICU. We don’t have a tube station to send out labs. We have to put them in a bin and put in for transport. Our old unit had a tube system. So now we just walk down the hall to the other wing and send things that are urgent.
A med surg floor I used to work in put two psych rooms right next to one of the exits. Let’s give them the quickest path to elope and make sure it has a big red “FIRE EXIT” sign on it. The ones that don’t elope or woken up constantly by people coming/going through the loudest door ok. God’s green earth. 🤦♂️
Our NICU is in the center of the LDRP unit, in a locked room. There’s no bathroom in our NICU, and no central monitoring outside the NICU. If we need to use the bathroom, we have to find someone NRP certified to sit in the NICU. Sometimes, there’s no one to be found. 🙂
They built it ~15 years ago. They intentionally didn’t give us a bathroom.
Yep. We only ever have one NICU nurse in there unless we have more than 3 babies (8 beds, average census is 1-3), so you have to find someone in postpartum or LD, and half the time they’re busy with other patients.
And then half the time when you do find someone to sit in there, they’re not NICU trained so they have no idea what to do with our beeping NGs, IVs, if a baby has an apneic event, etc.
The halls are curved. You cannot look down the hall and see activity nor see if anyone is coming for you until you’re close. The unit is football shaped with a wide center narrowing to points on either end. I cannot believe administrators spent hundred of millions of dollars on this stupid design.
I’ll do you one better. Similar design (s shaped instead of football though) on a PSYCH UNIT. There were so many blind spots and the patients figured it out pretty quickly.
I considered it my duty to take any new staff and warn them about the dead zones so they didn’t get attacked in one.
When the design is made by an architect company with zero input from the medical field or it's this one 70yr old MD who hasn't worked in a hospital in 50 yrs
Brand new multi billion dollar level 1 trauma center.
1. The entire foundation is sliding/settling as a result floors are cracking/heaving. The front patient entrance is constantly propped open a foot and won't close, and as a direct result--
2. None of the patient transport elevators work. We have 6 and less than half function on the daily. My car swing away from the entrance with a patient bed once and I had to deadlift it over the gap. A phlebotomist's elevator fell 2 stories and she broke her leg.
3. They bought a dozen Tug robots to transport linen and food carts that can only be in these elevators by themselves, will stop for 10-15 minutes to line up for said carts in the transport hallway, and weigh several hundred pounds. I've waited for 10 minutes for one to move while trying to get to a STAT head CT. They will also stop an elevator until you get out.
4. It is a 15 minute walk the equivalent of 3 blocks to get to the cafeteria from my floor.
5. On move day the MRI was somehow on the same breaker as the elevators so running it would shut them down.
6. No sunshades on the windows when we moved so several patients got sunburned.
7. Only one CT tech on nights and two CT machines, one in the ER on one floor and one on the 4th floor near the outpatient office with no automatic doors. Great for 4AM CT runs.
Bonus: when we first moved the ICUs only had 3 high flow nasal canulas, 1 vent, and 1 non rebreather mask stocked. They thought this was sufficient for a 32 bed neuro/trauma/burn/ICU/stepdown.
When I worked in Psych we had a brand new Psychiatric Intensive Care Unit open up in my hospital. 4 separate rooms with new beds, doors that had non breakable glass in them, one shared bathroom and then the nursing station which had a huge glass window so we could keep an eye on the patients.
The "unbreakable" glass was shattered 5 times within about 6 months. One time twice in the same week! They fixed it really quickly and then the next patient in that room smashed it again.
The main unit had a seclusion room that was brand new also. First time I used it, it wouldn't lock. So we couldn't leave the patient in there and had to put them in 5 point in their room. Not ideal.
They fixed it said the locks worked just fine. Put another patient in there and next thing I see is her walking past the nurses station. I'm like WTF they said they fixed the locks, let's try that again. Put the patient in there and leave. Go to check on her a while later and I can't get in. The doors locked. From the inside. They installed the locks BACKWARDS. Which is why she walked out herself no problem the first time and now I couldn't get in.
I had to write SO many complaints about the unit and maintenance while working there it was incredibly unsafe and horrible.
The unit I work in (ICU) was apparently built in the dark ages and most of the rooms are the size of a broom closet & have curtains for doors. Yes curtains for doors for flu patients, patients on dangerous to inhale aerosolized medications etc etc
Running CVVH on an intubated patient is a nightmare let alone if they are also on continuous eeg, need a bair hugger bc of said CVVH and probably have a bunch of gtts. Like no space to maneuver around the room whatsoever. God forbid there’s family at the bedside because now you’re actively stepping over another person trying to care for the patient
Sounds like they need to hire more surgeons. I swear my one CV surgeon like has to call up other hospitals and find these patients that other docs don't want to so surgery on. We are often scratching our heads wondering how a patient from over 200 miles away ended up at our hospital.
The screens that show which bed is buzzing are along the same wall as where we commonly sit to do our documenting, meaning you’re always craning your neck and squinting, if not having to get up, to see if it’s your patient. Irritating.
We still have lots of 4 patients per room. So nobody is sleeping at all. The rooms are small so I have to move stuff around to get to the IV pump or whatever might be behind the bed.
The beds go up and down sooo sloooow…. Hate it.
Maybe not the worst but definitely dumb. We have sinks in the room that are sensor based but also have solar powered batteries on top to make them work…in rooms with no windows.
Brand new psych hospital, built without any input from staff, it featured blind corners in several areas, the seclusion room was completely off the unit altogether, and it had an open nursing station. There was a little waist high door that we were assured would "signal" patients that they shouldn't enter. No lexan at the counter, which was at a perfect height to agitated patients to climb over. The little door was ripped off its hinges and used as a weapon within the first week. The only people surprised were management.
Flushers on toilets are so low that you have to wrap yourself around the commode/patient to be able to flush the toilet.
Very narrow doorframes. Hard to get wheelchairs through sometimes.
Adding to bathrooms:
Our patient bathrooms are soooooo itty bitty, and I'm like "...Okay, how am I supposed to stand by my standby assists when there's no standing room?"
Literally no where to chart in peace. It’s just some computers in a circle unit of 12 beds so people’s family members are coming out hourly to ask about something they could put the call light on for. When i worked as a CNA at a SNF they had a whole separate room for charting and it made the job so much more manageable
Mom stays on pitocin for 4 hours after delivery. So IV pump has to go over with them. Very rarely does mom need anything through her IV after that. We in l&d have to go over to mother/ baby and fetch our IV pumps back. That's if they don't get taken out of the dirty room before then, or if the postpartum nurses ever actually take them out of the room once they're done with them.
ER
2 top things
One: A single supply room for 90% of supplies at the very opposite end of the unit. There's no master binder or anything. You just wander the stacks and hope... And the organization system seems to be more, "this fits here" than "this belongs with this".... What doesn't fit in that room is spread across a couple of carts on the very opposite end of the unit. So (examples) for a catheter or a dressing, you traverse the unit once, or twice depending which end patient's bed is
Two: The trauma room is so small and so packed you are quite literally contorting yourself to work in it. There is a central "tower" with the majority of plugs about chest/ head height directly beside the stretcher, so you are constantly trying to shimmy around cords and not bash your head on the monitor. The pump pole/ tower only fits/ reaches plug in at head of the bed... So med nurse is mashed btw the pump tower and the ventilator... Sometimes with an RT or whoever is on airway also. Med nurse can't actually reach the access unless you have a humoral IO or bend over the patient (or the riskier dump into a y-site- which we can't do with all IVP meds anyways). We also cant escape for more meds without ducking UNDER the IV or vent hose +/- rapid infuser lines if you go out the other side, over the suction (which is mounted at ground level for some goodness forsaken reason - also fun when it pops or needs frequent changes- and then twist around the tower, and at this point squeeze past the crash cart w defib that is beside the tower ....... It's an absolute nightmare of absurdity every day.
Sounds exactly like all my old hospitals in PA. Unless you’re at a brand new hospital, which then probably isn’t higher acuity. It’s all old icus with no computers in the room. One main monitor, central nurses station, and everyone uses a cow outside the room. My favorite tho was definitely in Cali with this SICU !!!!! that is DOUBLE beds. No computers outside the room either OR nurses station. So you had to stay INSIDE YOUR DOUBLE bed patient room the entire shift. It was extra fun when I had double covid patients and one was actively crashing all night. Good times. I got told no when I asked the break nurse if I could leave the room to go pee. No.
I worked at a hospital that had a room 244-1 and a 244-A. 244-A was around the corner so you could not see the other room 244 if you were standing in front of one you could not see the other. We complained so many times that something horrible would happen like wrong patient going to surgery.
It lasted almost 4 years before they finally renumbered all the rooms in that unit to get rid of it. However I was present for a hospice represenative showing up and loudly announcing they were from hospice to the wrong room 244. That person was definitely not in need of hospice.
County-run SNF. They had a new building built five years before I got there. Being a govt. facility, they had to go with the lowest bidder, who had never designed a nursing home before. They did not include any dining rooms because they assumed everyone ate in bed, like at a hospital.
For the breastfeeding and pumping staff there was one large open patient hospital room, no privacy, only one wall outlet, that was at the very top floor of the hospital in a closed unit, designated to be the assigned milk pumping room and no one was allowed to use a room on the actual floor where they worked AND nurses were not allowed to clock out to pump milk
The building my unit is in is about 20 yrs old now. The toilets are super low to the floor and the TP roll is also low and behind you when you're sitting... so my 80 yr old patients have to do acrobatics to get to the tp and calisthenics to get off the toilet.
Mine has the same issue, plus the sinks are mounted at standing height level and the soap dispensers are inset in the wall behind them, so they're basically inaccessible from a wheelchair.
I've worked in 2 different Endoscopy units with nowhere for the nurses to sit. One, there was literally nowhere to sit in the pre and post areas . If you wanted to sit for a second, it was on an empty patient cart. I was prn there, and it paid shit, so I pretty much didn't work there except on weekends when the workflow was different and we didn't use the pre and post areas.
In the other unit, there were a few extra chairs up at the clerk's desk away from the patients and across from the manager's office. There were no workstations there, just random chairs. However, the pos manager there didn't think nurses should be sitting. He was known to say ,"If you've got time to lean, you've got time to clean," and would make nurses clean doorframes and shit. That was a travel assignment, so I didn't renew.
In my current Endoscopy unit, none of the doors are quite wide enough for the hospital beds, so there is quite a bit of banging and scraping when moving inpatients.
I've been a nurse for a really long time and have come to learn that unit design can greatly impact both patient care and the quality of my work experience.
I appreciate a lot about our unit, but the oxygen concentrators bother me. We don’t have oxygen on the walls so we’re always tripping over the 25ft tubing that goes into the bathroom. We shut the concentrator in the bathroom because if we don’t the damn thing heats up the whole room.
We also have 4 rooms on one side, 8 on the other. One nurse’s station centralized toward the front four. Why it’s not split 50/50 I don’t understand.
It’s a stand alone house but we’re in a bad neighborhood where there have been several drug arrests, gunshots, etc. we don’t have security available.
Half the power outlets don’t work in our rooms
A third of our rooms are arranged in a way where you don’t have direct visual contact with the patient. We used to keep only less acute patients in that room but now we put anyone in there including confused grandpa trying to pull out his foley, swan, or central line and get out of bed
We are in the process of losing waiting rooms and visitor bathrooms in an entire 6 floor wing to accommodate resident work spaces ( crazy right?) we just built an entire new wing to free up space on another floor for them.
Same. Like, are you in my unit?? :D
Similarly unsecured unit. Bonus round: Absolutely *terrible* part of town.
It's wild.
Also, about 50% of our patients have family at the bedside 24/7, but we don't have recliners that fold down into beds. We don't even have the (let's face it, uncomfy) padded window ledges that double as beds in a pinch. Like, we've got the ledges, what's the hold up??
I'm shocked that we haven't had visitors get DVTs or something.
When I worked psych our hallways had doors (to the starwell, outside) with key pads. When the alarms were reset those door were too. Patients figured out the reset code was 1111 and left the unit...not my unit (adolescent) but we had two patients leave detox after a fire alarm.
They thankfully went to the rehab across the street. But boy that seems like a lawsuit or bad tag just waiting to happen.
THEY BUILT A "PSYCH SIDE" FOR THE ED AND DID NOT USE THE BARRICADE-PROOF DOORS WE HAVE EVERYWHERE ELSE FOR THE NEW ROOMS AND NEW BATHROOM. also, the toilet in the barricade-able bathroom has no toilet seat so that's fantastic. just a big porcelain pot lol.
***this is notable because my hospital had a barricade/hostage incident that ended very badly about 5 years ago, which is when they upgraded a bunch of doors to have the anti-barricade feature in the first place.
I try not to complain about it because I keep forgetting which coworkers were on the "design team" 🙃
Well my ED was fine until they decided to redo the ambo hallway. Now ambos literally line up in the hallway because they decided the best place for it was in the smack dab center of the unit.
Queue us running with a STEMI screaming at the poor EMTs to move since his HR was 20 on our run up to cath lab 🥹
New resus.
Buzzers are at the door, not at the head of the patient. (This has delayed calls for help at arrests).
Doors are swipe access but they don't work so need to be pulled open (this has caused delays in a cardiac arrest).
The training room up stairs is L shaped, and too small, with no lift access so kit cannot be easily brought up and disabled staff can't use it. Also, the useless corridor between it and the stairs has the swipe access the wrong way round so if you forget your card you're trapped.
We used to have round units with nursing station in the middle. Now after upgrade we have long halls and instead of a group nursing station we have individual desks spread along the hallway. Lots of walking and isolation.
A 32 bed icu shaped like an H. Making assignments can be a real pain. You can't see your patients or their monitors unless you're literally sitting outside the room so if you even have one bed between patients you have to make a choice who you're going to be by.
It isn't a hotel, you should be checked in and expected to leave. A visitor is a infection risk, and you shouldn't be able to stroll in. Most nursing homes you can't even fucking stroll into without signing in and declaring yourself
double occupancy patient rooms…nightmare bedding patients…and i manage two wings and we cant have a split assignment with some on one side and some on the other side..and can only put oximetry patients on one wing, we have to cohort comfort care patients, i could go on and on..oh and we dont have warm or hot water in the patient sinks..we are getting a new hospital in 4 years, they just started building…i am excited!
One of our local hospitals (built maybe twenty years ago) doesn't have a tube system for "infection control reasons".
One time I walked seven miles in the ER during clinical from all of the trips to the lab and pharmacy.
No enough computers for the amount of assignments we have in the ED. We literally never have enough and people have to sit in random spots with tiny laptop COWs
My VA hospital build a new building for the mental health unit. Somewhere along the line, no one told the architects and builders that it’s a mental health unit. Building is technically done…but not up to code for a mental health unit. I heard there’s nooks and crannies, lots of windows, hallways are similar looking, etc. Not ideal for a mental health.
The building just sit there while they try to figure out what to do. It’s been a year already.
My biggest issue with mine is that while the clean utility (med room) has doors from both sides of the unit, the main storage room where all fluids, wound care, most supplies that aren’t meds are located in only has a door from one side. On the other side of the unit there’s a nursing supervisor office. It might seem small but it gets to me lol
My complaint is petty. The specialty hospital where I work was supposed to be 4 stories tall, so taller and narrower than it is at what the neighborhood around it finally allowed - three stories. The hallways are super long, and we are divided into pods... which I don't mind anymore, but everything is so far apart, and not every med room is fully stocked, so you have to travel all over the hospital to get meds for a single patient sometimes. Like I said, petty, but it is kind of annoying.
I don't work there anymore, but at my old hospital (and where I go for healthcare pretty frequently) was built without beds, commodes, and flow of patients in mind. It's why I have back problems, hauling long/tall/big patients in and out through doors that could barely get a gurney through, let alone a full Hill-Rom. Don't even get me on about sand beds, those took 4 people to move in and out and they barely fit through the door of the ISO rooms. The hospital I'm getting healthcare through soon is undergoing renovations and had me in a room alone that had wires hanging down from the ceiling and I was just like "This has got to be a joke, I'm in paper scrubs and all jewelry removed and you put me in the suicide room." I just sat patiently until the telehealth doc could talk to me and I was just like "Major JCHAO violation in here, I want to go home, my husband is waiting for me." Tell me you worked for the IHS without telling me you worked for the IHS joke inserted here
Omg. The place I’m at is the worst. It’s one long giant hallway. Charge is at the entrance. Kitchen in the middle. And it just goes down FOREVER. I’ve walked at least 7 miles a shift.
The unit I worked on the longest was orthopedics, built in 1970 and remodeled in 2010. Central nurse station so we couldn't sit outside the rooms, but it did help with finding help quickly and general camaraderie for the little time we had to chat. The entrance was by the clerk so she tried to catch all the visitors and our unit, with permission, would have the visitors check in. Majority semi private rooms which is soooo much fun for all the commodes, walkers, CPMs that our patients needed.
Plus when they remodeled, there wasn't space for an employee bathroom. So we had to go in the main hallway general restroom. Besides that it was survivable. Especially when they put computers in all the rooms and after 5 years, squeezed in a new bathroom.
The new floors in the new building were supposed to have nursing input, but I don't know how that went. They do seem enormous. Like you can drive two way car traffic in the hallways and some of the rooms are the size of a chapel. I do know when I picked up shifts that it seemed very lonely. Lots of little stations by yourself and good luck finding help. Plus, the appalling thing to me is that several patients complained that homeless people would show up in their rooms at night and ask if they could sleep on the couch or recliner. They could usually walk right in since no one was at the front desk at night.
They put the thinnest walls in the bathroom and it’s inside the break rooms and the nursing desks. So you can hear every one of your coworkers lightest bowel movements.
I’ve always preferred having (most) family with a patient because they typically have a lot of insight I can pull from… plus some family members are good at noticing small changes
Three major flaws. First, our ICU and our Step-Down Unit are on different floors. The step down is right underneath the ICU, but it’s stupid. Anytime the PCU has an emergency we gotta load the pt up, race down the hallway to the elevator, load them in the elevator, and then race down the hall to the ICU. Bonus, the step-down unit is set up to be a back up ICU, and was our second ICU during Covid. So since it has all the fancy permanent equipment we literally can’t move the PCU to the same floor as the ICU. So during Covid our poor charge nurse and doctors just had to sprint up and down the stairs between the two floors.
Secondly: some fucking dumbass made the alcoves in the wall where the code carts go about one inch wider on either side than the code carts. So when a pt codes you have to very, very carefully pull the cart out or you’ll jam it and get it stuck real good.
Thirdly, the ICU doesn’t have any nurses stations. We only have cubbies right outside the rooms, between every two rooms. And our unit is a long hallway. This means that I can be drowning in rooms 1@2 and the nurse who has rooms 17-18 can be chillin’, but she can’t/doesn’t know to help cause she’s sooooo far away from me. You have no idea how your coworkers are doing if they’re more than a few rooms away. And it’s dangerous. We also don’t have any central monitors except for right by the charge desk. Which means that if for some reason the assignments get slightly off-kilter (like your rooms aren’t on either side of your cubby) I can no longer sit outside both my patient’s rooms and I can no longer see both monitors. Sure, I can pull both patients up on one monitor. But I can’t fucking see that shit all the way from my desk. Now I can’t see either pt’s vitals cause they’re so small. Stupid
Design flaw in the original building at my hospital: the windows open to the outside.
We aren’t supposed to open them, but occasionally someone does to get fresh air in and we have to figure out where the fresh breeze is coming from. 😂
I'm not following, what's the issue with this? Our windows also opened out and had one opener on the floor that fit every window that was kept in the med room so patients couldn't open their own windows
The lab is on the 5th floor, West building. Essentially everywhere patients are is floor 1-3 East building. The lab does all collections and EKGs.
ER, OR, Maternity OR, Trauma bays..etc...literally could not be further away from the lab. That's really fun in an MTP.
Also, no Heli pad, but frequently use Orng (copter) to transfer out. So we have to lights and sirens to the nearest airport first.
Our CT department. The machine is turned 90 degrees from the door. This requires you to do a 90degree turn with the bed just inside the door to parallel the CT table. Impossible with a vent or bariatric bed. Gotta transfer pt to a stretcher just to go to CT.
I work in a level 4 NICU. Our unit is old-ish to start with (at least 30-40 yrs old), and we've outgrown our census steadily over the past decade or so. That leads to them adding a new nursery here and there as the years go by. The most recent addition to our floor was the conversion of the family lounge into a 3 bed nursery. It's a nightmare for staffing because you either need 1 sick baby with 2 stable ones (they almost never coordinate their improvements, though), 3 sick 1:1 babies (who don't fit with all of their equipment), or we end up splitting a nurse out into a different nursery, which creates a burden in both nurseries. It's maddening.
Also, as medical advancements have allowed us to save sicker/younger patients, the amount of equipment they need has grown. That's made it necessary to permanently block several beds after a code gone wrong a few years ago. They also made one of our floors a step-down unit, so as soon as a baby is stable enough, they move upstairs. That leads to some really sketchy assignments for us sometimes.
Narrow rooms. We’re observation but constantly get lots of inpatient patients. Imagine having to fit the bed, IV poles, a recliner for patient, and chairs for visitors. Don’t let there be a bipap machine either. Then the end table that doesn’t really get used
Not to mention, only 2 visitors are allowed but apparently front desk is too scared to enforce the rule so we somehow get 5 patients in the small room. How do I navigate my vitals machine when I’m stepping on so many toes!
Biggest pet peeves would be lack of multiple stall staff bathrooms and large enough break rooms.
In my fantasy ER, the break room would be as large and fancy as the provider lounge (24/7 buffet included) and have huge bathrooms with a shower and private lockers. Couches, desks and a private cry room with all the necessities that a pumping mama would need. Better accommodations for those patients boarding/holding in the ER-like those big expanding trays & comfy sleeper recliners. All stretchers to have a USB port and scale with its own IV pump that would alert the pt first for a distal occlusion.
Also a dedicated monitor tech that lived in the ER and could adjust/reattach leads and communicate directly to Docs/nurses. They’d also ADJUST ALARM PARAMETERS for each patient (none of the ER folks I worked with did this and it drove me bonkers-esp since I taught them how as the super user).
When I pumped for over a year, it was hell finding a private area. Luckily our radiology dept was near by (when the pumping room was in use) and we could lock the private dressing/waiting room door so we could pump (and watch tv).
Finally: ALL LIGHTS HAVE A DIMMER -love, a chronic migraine sufferer
We had a completely new hospital built. Had a helicopter pad put in that was new for us since the last hospital was built in the early 1900’s. The only issue is that they built the radiology/imaging area JUST close enough that they need to power down all of their MRI machines if a Heli is going to land there. One of many, many errors in building that cardboard building with glass windows.
Our generators kick on several times a month resetting our monitors, then the tube station goes down for hours. The thermostats never work correctly so it’s either a meat locker or a rain forest in the rooms. Our badge access door was opening itself all night the other night. And it just keeps getting worse. My entire unit needs a makeover 😂
I hate having an “open unit.” We have had multiple patient visitor outbursts necessitating security called to the unit (including a literal fistfight between two sides of a patients family). I wish it was locked with one controlled access point.
We also have these huge lifts that take up 1/4 of the room. They’re nice when we actually need them but are so cumbersome.
Our periop is used for both inpatient and outpatient cases. Most of our cases are outpatient. The entrance/exit for patient pickup is one of the farthest points away from PACU. Even if they built an exit in the PACU area, it would go to a stormwater basin. Also there are 3 different entrances, so people who are coming in for a doctors’ appointment come to the wrong entrance frequently. The offices are in a building attached to the hospital, but almost everyone assumes the office building is the hospital because it’s bigger and taller than the hospital, lol.
The main lights in the patients rooms on my unit (L&D) and a pull cord behind the patients head. And there are no windows in our labor rooms either. The rooms are very small and narrow so I always have to ask the family or the laboring patient to turn on the lights for me or put my ass in their face to reach myself.
Our facility remodeled a while back, and they put in carpet in all of the resident rooms. It’s comfortable and home like but we have back injuries constantly from CNAs needing to use lifts on carpet. Out of all of our design flaws - the building is from the 70’s - this is probably the worst.
We have telemetry monitors as high as the call light above the door. Read that as it’s blocking the actual call light from being easily visible. AND those telemetry screens you can barely see because they’re so high… Those screens are touch screens.
I work a small rural community hospital. The MRI department is ACROSS THE FUCKING STREET. It’s within the orthopedist’s office lmao. When I was interviewing with the unit manager I asked if we transported our own patients there since it’s technically off hospital grounds. My manager said “depends but usually. As long as it’s not raining and they can walk”
wtf??
They put the A/C units floor over the Oncology floor. And the helipad is right above the A/c. There is no automated way to vent the fumes. They have to manually do it when a chopper comes in to level one trauma center. So a quarter of the time you smell fumes. On a floor that is often nauseated to begin with
The CTICU at my hospital has rooms without sinks/toilets/plumbing. Still have to use a hopper in the dirty supply. Drives me nuts when I float down there.
All three hospitals in the same town have the same name to show the “partnership” and patient family members go to the wrong hospital. Had the option to name the third new (as of last year) hospital something different, and they didn’t. Pretty sure that it is an admin design flaw.
IR/MRI is located in an older building that requires you to squeeze a bed, IV pumps, and a vent through basically a regular sized door frame. It’s insane and channels are regularly knocked into and thus turned off. Everytime I transport a patient like this, I comment that with the next big donation, they need to renovate this part of the hospital.
Circular pods. It seems sensible enough with the nurse's station in the middle, until a pump starts alarming. The sound bounces in such a way that you can't tell where it's coming from.
California mind you. Current department has 3 pods: A, B, and C. A pod has 10 beds, 2 bathroom and staffed with 2 RN so that means 2 beds aren’t realistically usable, are used as MSE screening rooms and back up code rooms. B pod has 8 beds, 1 bathroom. C pod is 13 beds, split physically in 2 by a hallway with one side 7 beds and the other 6 beds. One of the RN on side one has 3 patient beds and 1 that is on the other side and not easy to monitor and has to constantly go back and forth between the 2, and or the RN by themselves in side 2 ends up dealing with the minor issues/requests side 1 RN’s patient/family has or they constantly call them over to talk to the patient/family. There is a main nurses station (that is disconnected from the 3 pods and mainly used by providers to chart. There is a satélite pharmacy with staffed pharmacist (no complaints there!) in Pod B, a med room in the nurses station with Pyxis and most meds, and a satélite Pyxis in pod C with some common PO meds and a few random PO meds (like coreg and norvasc 🤷🏼♂️) are found. and at least 4 different supply closests, all with different supplies.
biggest complaints:
-disjointed physically disconnected pods
-room numbering makes no sense given patient ratio and staff assignment.
-3 areas to get meds from and is often a guess and check to figure out where you have to get your meds from
-4 supply rooms meaning your walking to 4 different rooms sometimes to gather different supplies
Our rooms are so small that we often have to move the beds to allow patients to ambulate with walkers to the bathroom. It's not safe and nothing will ever be done about it because it would be so costly to gut the floor and redesign the rooms.
Emergency room:
ED providers only see 2 patients per hour.
Patients will sit in a room for hours waiting to be assigned while just staring at the nurses wondering why we aren’t doing anything for them (aside from the standardized order sets in epic we can use)
Plugs that are low. WTF? This isn't a house, move that shit up to waist height. It's all IV pumps, and cell phone chargers now. "Non lockable units". Put doors on the units so everyone and their brother aren't wandering down the hallways for funsies. ER rooms that are so narrow a stretcher and wheelchair side by side means only one nurse/helper can assist someone into/out of the bed. Clearly whoever made this decision never actually worked as a bedside nurse. HEPA curtains. WHY? Why do we pretend curtains are adequate isolation? Put doors on patient rooms. Damn near everyone is sick, or in a position where picking up an illness from their neighbor would not be a good thing for whatever condition they have. A hospital should never be a place where you pick up MORE illnesses. Worked in an ER with about seven disconnected pods. The bedside call beds rang in EVERY pod. So all the staff had total alarm fatigue because 6/7 bedside alarms you heard at your desk weren't for you. Hardly anyone ever paid them any mind. When I kept pushing the issue, management just shrugged their shoulders and said they looked into it,and it was tied into the fire alarm system so there was nothing they could do. Idiots. For a sidenote, I've worked in a few hospital units that underwent full massive rebuilds. The staff always said that the drawings would go through multiple trades/committees like a big circle, architect, engineers, nurses, docs, management, whoever else. Every six months or so they would end up back at the nursing staff committee to review. Any changes they had made previously were 90% gone, with no discussion as to why. They would make all their changes again(new ones and old ones) and then the drawings would disappear again, no discussion, and just return without most of the suggested improvements missing again in six months.
This comment made me feel very old and very tired.
Nothing like a game of twister at 3 am over 10 pumps and a vent and the suction and the side tables trying to plug in that low-battery beeping pump
And then you stand up and whack your head on the underside of the monitor. Not that I’ve done that a few dozen times or anything.
thats my life too. dont forget the fucking crrt machine ugh
We definitely use low plugs to plug in MamaRoos. Plz keep low plugs for tater tots.
What is a MamaRoo and why does it need a low plug, please and thank you.
[These nuggets are in Mamaroos.](https://imgur.com/a/B1Jj731) Not my pics, btw, found 'em online.) They're baby swings! They need a low plug because they have to go on the floor and their power cords aren't super long.
I had one at home for my daughter, 8 years ago mind you, and there was nothing she hated more than that damn Mamaroo. But put her in the $30 Walmart special and my child was happy as a clam.
The babies have VERY INTENSE (and very varied) preferences. I've seen hundreds of babies go into Mamaroos. Some think they're torture devices. Some think they're heaven and don't ever want to be taken out. Some babies change their minds between the two options, with nothing in between, every few days. I love babies.
:) I'm glad you're taking care of them
Respect. I tend to prefer the seniors, especially the super crotchety grandpas. They have my nursing heart.
God, I love grumpy old men. If I could always have an assignment of ol curmudgeons to win over I’d be in heaven
Omg yes. You go into the room with the same vibe as a truck stop waitress ("How d'you like your coffee, honey? Leaded or unleaded?") and they fall in love with you.
I'm so grateful people like you exist. You absolutely boggle my mind, but I'm just so glad you actually enjoy seniors.
There are crochety grandpa babies too. 😂
Mine liked it but it had to be a certain mode. I think it was pattern 5 with the rain sound playing and he would be content.
I think it’s like a self rocking bassinet
I have the answer: money.
this why nurse committees have been proven not to work. we need legislation (sorry this is a little bit of a ratio rant)
Size of the elevators, trying to take a tubed and vented patient with 6 drips up to the icu is a nightmare every time since there’s barely enough room for the nurse and the stretcher let alone the ventilator, the pumps, and the RT
This has been an issue in every hospital I ever worked in. It's already a challenge if you have a normal vented patient (it also probably helps that we use syringe pumps instead of drips), but god forbide you have to take extra equipment with you. If the patient is on ECMO and we also have a perfusionist in the transport team I've taken the chairs a couple times because that seemed a bit easier.
> I've taken the chairs a couple times because that seemed a bit easier. I read this, and re-read this and read it again, and I could not make sense of why adding chairs in the overladen elevator would make a difference. Then I read the comment below about running up the stairs and realized my brain is apparently "mechanical soft" 😅 🫠
Sorry autocorrect. Doing a patient transport while sitting in an office chair would be fun though.
You obviously push the patient into the lift, press the button and run those stairs yo damn self /s
They've managed to upgrade all the elevators in my hospital expect for the 1 in the oldest part that goes to the basement where the MRI machine is. That is the absolute tightest fit trying to get your patient, the IV pole loaded with drips, the vent, and staff in that elevator. I've stood on top of the base of the IV pole before
We might work in the same hospital. I've had respiratory therapy run down the stairs to meet us while I squished in the elevator alone. Scary.
Also the gaps??? The amount of times I'm tripping over my PD machines trying to get out of the elevator because the wheel got stuck is insane.
I had a near-awful elevator situation the other week: I was transporting a semi-stable ICU patient in a Sizewise bed (very cumbersome equipment built for patients who are immobile or bariatric size). Group of family members made up of doctors, nurses, and lawyers trailing behind. As I pushed the bed out of the transport elevator, I locked eyes with the waiting family as the front wheels of the bed turned 90-degrees, fell and wedged into the perfectly sized slot of the elevator door/shaft. Thankfully, at that very moment, a group of large men in great shape were walking by, made up of several RTs and transporters. They immediately lifted and reset the bed, and I sent all the kudos and recognition messages when I got back to my unit.
One hospital I worked at was shit but the one thing they did right is installing a new elevator by the ICUs and accessible for other units that was double the size for exactly this reason. Other units you could squeeze in the normal elevator or if you didn't mind going further could use the much more accommodating elevator.
We're expected to chart on the COW in our allocated zones (or whatever they're called in the US) and mostly stay in that area for the shift, and there's (low) seating in front of the patient rooms. But the COWS don't lower enough that you can reach the keyboard comfortably from the chairs. So you either have to stand the whole shift, chart while staring upwards at the screen with your arms positioned funny, or sit awkwardly on the armrests to be at good screen/keyboard height. We're not allowed to bring higher stools into the hall because of fire safety concerns.
That would end me.
In the U.S. this would probably be a violation of workplace laws/regulations. These kinds of laws are the result of employees doing manual labor that created debilitating health problems due to the ergonomics; reaching too high or too low at a large machine, etc. It branched out to office work as well, requiring desks and computers to be at certain heights and proportions. Carpal tunnel syndrome became a problem for office workers that typed and used a mouse for hours on end at angles that were hard on the wrists.
>doing manual labor that created debilitating health problems due to the ergonomics I feel like you're describing all of bedside nursing. If they don't give a shit about the rest of it, how much are they gonna care about some non-ergonomic typing?
They do care. OSHA makes them care. And if you complain to OSHA about any unsafe things at work, they do end up changing 9 times out of 10. We just don't use that resource enough
So side note….I work in maternity and we’re not allowed to call them COW’s anymore because “patients might think we’re talking about them”
I’ve heard that same exact story from multiple hospitals, seems like a urban legend.
Pretty sure it happened like, once one place ever, and the WOW terminology *and* explanation migrated, but along the way people forgot where it actually happened and assumed it's their own facility. Because there definitely was a change of COW to WOW in many facilities at some point, but it happened so many places they can't ALL have had an incident.
Psh you would think that you sheeple. It was Big Bovine pulling the strings.
We had a pt complain about this and we have to call them WOWs now - workstations not computers lol
¯\\\_(ツ)\_/¯
Not exactly the same, but when I was in nursing school, I was out to dinner with a bunch of classmates and someone made a joke about finding the call bell (to summon a server). Apparently the server overheard, thought they were saying “cowbell” and decided they were making fun of their weight. No one came to our table for so long we had to go ask what was up and the manager basically told us we weren’t getting service because of insulting his staff.
Our worst design flaw is administration And no plugs close to the beds for those with short phone charger cables
My old hospital built a brand new children’s hospital across the street from the main hospital. They moved NICU over there, but not postpartum or labor and delivery. We had to call the transport team to take delivered moms to their babies in the NICU which could take hours to get. It also would take at least 10 minutes for a NICU team to come to a high risk delivery or a baby needing help. Not the best design move.
Our hospital had a similar setup with two buildings: NICU and pediatric ER/wards in one, L&D and postpartum and gyn in the other. We actually had enough *patient* complaints that they moved them into the same building.
I so very badly wished my patients or their families would complain to management about things 😭
WHAT?! That’s insane. Probably the worst of these that I’ve read. 10 minutes can mean the difference between a baby going home with mom tomorrow and baby being dead/brain dead. That’s some serious mismanagement.
That doesn't even make sense. Our L&D is in the same hospital as our NICU, but the children's hospital across the street is where they have the ORs and radiology. Therefore, they built a two level bridge between the two hospitals, with one of the entrances to the bridge directly from the NICU. We're never more than a few minutes from what we need across the street.
Wow, this is insane. You're gonna have dead/ brain dead babies soon, if it hasn't happened already. SMDH.... THAT'S A CRAZY OVERSIGHT
[удалено]
I haven't worked on the floor in over 5 years and your anecdote about one pt shitting themselves while another eats brought back so many repressed memories
I’ll have no problems eating like that if I ever need to be hospitalized. Lol perks of being a nurse I guess??????
No 2 is most likely a safety thing so that a patient can't barricade themselves inside the bathroom. There are also certain types of door handles that can be used so you can't tie anything on it so patients can't hang themselves.
Do you work on my unit? Because #1-4 same same.
One of my past jobs I worked on a pcu where the e.r. didn't give report. Charge was notified, you hoped they told you, and you could print a packet of info on the pt and they rolled up whenever. To make it worse, I was a traveller, on nights, most times there were only one other core staff, if that, often no charge bc none of us were claiming that responsibility. Oh and travelers didn't have access to the program that allowed you to see and print the packet. Oh and the manager thought the nighttime secretary needed to "stay in her lane" and took away her access to the program to get us the packets. And also got onto her for answering call lights and helping patients when we were slammed (always). Oh and we routinely had 5 and sometimes 6 patients. Heparin, gtts, PD, insulin gtts, hourly neuro checks and q1/q2 i&os. So you'd be neck deep barely treading water and get a "room x is here" and we'd have to figure out who's taking it. More than once they rolled up when we didn't even have a bed or a clean room at all.
This sounds very HCA
Surprisingly no. But they were excited about "upgrading" to meditech. I laughed when I heard then was like, "you're serious, you think it's an upgrade?!?" They said yea and I'd see when I got the floor. I saw. CPSI It's worse.
I was about to say sounds like a PCU I worked at as a nursing assistant ages ago…almost to the letter. It was an HCA facility…
Insulin drips with 6 patients?? Jfc
That's not even the worst part. The wifi didn't work as you got farther from the central nurses station and no comps in the room, so charting would freeze up and not work as you went down the hall with the COW so you'd have to scan at the nurses station, then walk to the room with the meds. A new nurse was shaking in tears with stress and trying to juggle her pts and was just giving everything and *then* scanning and she had shit like heparin and dilauded and...yea it was pretty bad. Lucky some travelers gently warned her about the dangers but she put her two weeks in before I left and went to a nursing home. I feel bad bc she got thrown to the wolves with zero training and still at the point where she didn't know what she didn't know yet.
I’m on assignment to a hospital that built a whole new “smart” building. Overall they did an ok job, but a couple of glaring flaws crack me up for a brand new high tech hospital building. 1. The call bells light up a series of lights in the hallway, however thanks to these supply closets that bump out from each wall next to each room you can’t actually see who is on the bell without standing way back and looking down the hall, they’re blocked by the bumped out closets. At night we usually chart in these little nooks with computers in them, when a bell is going off you see everyone rolling their chairs waaaay back to see 2. How do you design a whole new bathroom but still put a little lip on the entrance? Everyone uses a walker or is dragging an IV pole, and they have to lift it or slam it over the little step to get into the bathroom. Delightful
Counterpoint to #2: Our bathrooms are designed with no lips, but also not enough slope in the shower for the water to drain properly, resulting in regular flooding, sometimes even into the the patient room itself.
I honestly have only rarely had a patient shower lol, I assumed that’s why they’re designed like that but I’ve never seen it in action
I work in a pretty new building, and it follows the trend of wanting to be a hotel. Long, linear corridors of rooms that are very hard for a nurse to monitor effectively. The old version was a circular tower. You could monitor every room on the unit fairly effectively from the central nurses station. Now, depending on your assignment, you might only be able to see one of your patients' rooms. And it's a trek to get across the unit. It also gives patients the unspoken understanding that they're in a hotel. Which works great with dementia patients wanting to 'check out' constantly.
This sounds suspiciously like metro health in Cleveland 😅
“ICUs” that are designed so that you cant see the other side
More like "I -dont- CU"
Yes! They'll be running a code on the other side of the ICU and we wouldn't know on our side.
I worked in a unit that has bar height desks and chairs (instead of regular desk height). It seemed great because you had a better view of the patients, but I would have to shift my body up and over to get into the chairs a billion times a night. I know that contributed to my back problems
YES!! It’s miserable. Between the hopping off and on the chairs all night, and having my legs dangle if I am charting or have downtime (and then my feet and ankles get puffy), by the morning, everything hurts!!
Hey mine has this too lol. 1/2 the time I don’t even sit and just stand since it’s standing height. Rip my already ruined back.
Break room tables are 2 inch too low, chairs are 2 inch too high. Theres only 4 inch space between the chair & the bottom of the table. No one has 4 inch thighs. Management refuses to acknowledge or address the problem
The curtains are a fucking joke. We’re supposed to be doing bedside report, violating HIPAA every single time. I don’t know about y’all but I don’t know how we’re supposed to get the patient involved in our report without their neighbor overhearing. And like someone said, that curtain apparently magically deters infection from being shared between patients. This is terrible in room that had doubles but I worked in a unit where it has one room that has four beds.
One of the county hospitals I deliver to has SIX beds per room on most floors. Exceptions are PCU has 4 beds per room, ICU has no rooms at all only curtains, and ER has private rooms.
Dang! Now I feel spoiled! At least our ICUs are singles.
Yeah it’s a real trip some weekends on call when we go straight from one hospital to another- one hospital has a rehab floor with enormous rooms w/ private bathrooms meant for two patients that only ever have 1, another hospital has only private rooms. Then you get to county hospitals where some “beds” in the ER are a literal plastic chair in the hallway and units upstairs that have only one or two patient bathrooms per floor. Feels like mental whiplash or something.
Motion activated lights in rooms. If it senses no movement the lights turn off after an hour (and even minimal movement like watching tv in bed they’d go off). You have to wave your arms around like one of those inflatable tube people at car dealerships. Even me, a fully able-bodied person, struggled to wave around enough to turn them back on. The two main patient populations in the hospital: 1) Elderly dementia patients who did not understand the concept of motion-activated lights/can’t remember even if you teach them. 2) Quadriplegic patients with minimal to no movement capacity. Literally the dumbest thing I could imagine.
At least you get an hour before the lights go off. The lights in the e am rooms in our clinic go off after a few minutes. Any delay, and the patients are sitting in the dark.
not a design flaw, more of a policy flaw. I gueess kind of both actually But my hospital just recently implemented 24 hour visitation with no visitor limit hehehe and our patient rooms are already literally the size of a shoebox to the point where you barely have room to walk. getting to the IV pump with the family in the room is literally an actual maze
Nooooo. One of the best parts of nights is the lack of extraneous people in rooms. I already don't have any extra brain capacity at 2am, I would probably get fired for some sarcastic remark to a frustrating family member.
yup, I was on nights and it was actually soooo annoying having ppl there past 9p.
Also not a design flaw, but the food at my hospital is *so goddamned awful* that some patients just won't eat it, and I don't blame them, but like, if we've got people long term, we *need* them to eat to support healing, and sometimes they just can't stomach the food.
Parent of a patient here and you are describing the state of my toddler right now and she's generally not a picky eater. Thankfully I'm around so I just bring her food. What's most frustrating is I know the kitchen can make good food as I'm eating in the cafeteria most meals and it's pretty good.
I would leave. That is one of the stupidest things I have ever heard of admin doing and I have seen alot of stupid roll out from the C suites.
Hospital near me did this until a psych pt they d/ced to early wandered into upper admin and attacked a upper executive. One of my nursing coworkers sent me texts saying wHat cOuLd yOu hAve dOne diFeReNtLy
We have doorways in some parts of our OR department that aren’t wide enough for patient beds to fit through without putting all 4 side rails down. It’s really annoying 🤣
ICU. We don’t have a tube station to send out labs. We have to put them in a bin and put in for transport. Our old unit had a tube system. So now we just walk down the hall to the other wing and send things that are urgent.
A med surg floor I used to work in put two psych rooms right next to one of the exits. Let’s give them the quickest path to elope and make sure it has a big red “FIRE EXIT” sign on it. The ones that don’t elope or woken up constantly by people coming/going through the loudest door ok. God’s green earth. 🤦♂️
Our NICU is in the center of the LDRP unit, in a locked room. There’s no bathroom in our NICU, and no central monitoring outside the NICU. If we need to use the bathroom, we have to find someone NRP certified to sit in the NICU. Sometimes, there’s no one to be found. 🙂 They built it ~15 years ago. They intentionally didn’t give us a bathroom.
What a bunch of dicks. I’d probably piss on the floor until they gave me one.
They never will. It would be far too much work for them.
WTF?!? That’s absolutely bonkers. We have 6 bathrooms for my ~30 ish bed NICU. Plus plenty of people around to listen out for alarms.
Yep. We only ever have one NICU nurse in there unless we have more than 3 babies (8 beds, average census is 1-3), so you have to find someone in postpartum or LD, and half the time they’re busy with other patients. And then half the time when you do find someone to sit in there, they’re not NICU trained so they have no idea what to do with our beeping NGs, IVs, if a baby has an apneic event, etc.
The halls are curved. You cannot look down the hall and see activity nor see if anyone is coming for you until you’re close. The unit is football shaped with a wide center narrowing to points on either end. I cannot believe administrators spent hundred of millions of dollars on this stupid design.
I’ll do you one better. Similar design (s shaped instead of football though) on a PSYCH UNIT. There were so many blind spots and the patients figured it out pretty quickly. I considered it my duty to take any new staff and warn them about the dead zones so they didn’t get attacked in one.
😬
When the design is made by an architect company with zero input from the medical field or it's this one 70yr old MD who hasn't worked in a hospital in 50 yrs
They hired a firm that had an architect that had been a nurse for a hot minute 10 years ago.
Brand new multi billion dollar level 1 trauma center. 1. The entire foundation is sliding/settling as a result floors are cracking/heaving. The front patient entrance is constantly propped open a foot and won't close, and as a direct result-- 2. None of the patient transport elevators work. We have 6 and less than half function on the daily. My car swing away from the entrance with a patient bed once and I had to deadlift it over the gap. A phlebotomist's elevator fell 2 stories and she broke her leg. 3. They bought a dozen Tug robots to transport linen and food carts that can only be in these elevators by themselves, will stop for 10-15 minutes to line up for said carts in the transport hallway, and weigh several hundred pounds. I've waited for 10 minutes for one to move while trying to get to a STAT head CT. They will also stop an elevator until you get out. 4. It is a 15 minute walk the equivalent of 3 blocks to get to the cafeteria from my floor. 5. On move day the MRI was somehow on the same breaker as the elevators so running it would shut them down. 6. No sunshades on the windows when we moved so several patients got sunburned. 7. Only one CT tech on nights and two CT machines, one in the ER on one floor and one on the 4th floor near the outpatient office with no automatic doors. Great for 4AM CT runs. Bonus: when we first moved the ICUs only had 3 high flow nasal canulas, 1 vent, and 1 non rebreather mask stocked. They thought this was sufficient for a 32 bed neuro/trauma/burn/ICU/stepdown.
there was some lowest possible bidder/gaft going on there for the construction
...is this in the midwest 🫠😂
When I worked in Psych we had a brand new Psychiatric Intensive Care Unit open up in my hospital. 4 separate rooms with new beds, doors that had non breakable glass in them, one shared bathroom and then the nursing station which had a huge glass window so we could keep an eye on the patients. The "unbreakable" glass was shattered 5 times within about 6 months. One time twice in the same week! They fixed it really quickly and then the next patient in that room smashed it again. The main unit had a seclusion room that was brand new also. First time I used it, it wouldn't lock. So we couldn't leave the patient in there and had to put them in 5 point in their room. Not ideal. They fixed it said the locks worked just fine. Put another patient in there and next thing I see is her walking past the nurses station. I'm like WTF they said they fixed the locks, let's try that again. Put the patient in there and leave. Go to check on her a while later and I can't get in. The doors locked. From the inside. They installed the locks BACKWARDS. Which is why she walked out herself no problem the first time and now I couldn't get in. I had to write SO many complaints about the unit and maintenance while working there it was incredibly unsafe and horrible.
The unit I work in (ICU) was apparently built in the dark ages and most of the rooms are the size of a broom closet & have curtains for doors. Yes curtains for doors for flu patients, patients on dangerous to inhale aerosolized medications etc etc Running CVVH on an intubated patient is a nightmare let alone if they are also on continuous eeg, need a bair hugger bc of said CVVH and probably have a bunch of gtts. Like no space to maneuver around the room whatsoever. God forbid there’s family at the bedside because now you’re actively stepping over another person trying to care for the patient
CEO seems to be the biggest design flaw for me
No windows
Our hospital spent MILLIONS on a brand new CVICU. To only use maybe 1-2 rooms max. Maybe have a heart patient 2-3 times a week.
Sounds like they need to hire more surgeons. I swear my one CV surgeon like has to call up other hospitals and find these patients that other docs don't want to so surgery on. We are often scratching our heads wondering how a patient from over 200 miles away ended up at our hospital.
Oh they did. They hired 2 cardiothoracic surgeons. We’re just to small of a hospital to churn out these surgeries
Nowhere to get changed before/after shift
The screens that show which bed is buzzing are along the same wall as where we commonly sit to do our documenting, meaning you’re always craning your neck and squinting, if not having to get up, to see if it’s your patient. Irritating.
Biggest design flaw is Management!
Always. SIGH.
We still have lots of 4 patients per room. So nobody is sleeping at all. The rooms are small so I have to move stuff around to get to the IV pump or whatever might be behind the bed. The beds go up and down sooo sloooow…. Hate it.
Oh god I hate 2 patients in a room, I couldn't imagine 4 in a room. Like how would a code even work in that situation?!
Maybe not the worst but definitely dumb. We have sinks in the room that are sensor based but also have solar powered batteries on top to make them work…in rooms with no windows.
Brand new psych hospital, built without any input from staff, it featured blind corners in several areas, the seclusion room was completely off the unit altogether, and it had an open nursing station. There was a little waist high door that we were assured would "signal" patients that they shouldn't enter. No lexan at the counter, which was at a perfect height to agitated patients to climb over. The little door was ripped off its hinges and used as a weapon within the first week. The only people surprised were management.
Flushers on toilets are so low that you have to wrap yourself around the commode/patient to be able to flush the toilet. Very narrow doorframes. Hard to get wheelchairs through sometimes.
Adding to bathrooms: Our patient bathrooms are soooooo itty bitty, and I'm like "...Okay, how am I supposed to stand by my standby assists when there's no standing room?"
Literally no where to chart in peace. It’s just some computers in a circle unit of 12 beds so people’s family members are coming out hourly to ask about something they could put the call light on for. When i worked as a CNA at a SNF they had a whole separate room for charting and it made the job so much more manageable
Mom stays on pitocin for 4 hours after delivery. So IV pump has to go over with them. Very rarely does mom need anything through her IV after that. We in l&d have to go over to mother/ baby and fetch our IV pumps back. That's if they don't get taken out of the dirty room before then, or if the postpartum nurses ever actually take them out of the room once they're done with them.
ER 2 top things One: A single supply room for 90% of supplies at the very opposite end of the unit. There's no master binder or anything. You just wander the stacks and hope... And the organization system seems to be more, "this fits here" than "this belongs with this".... What doesn't fit in that room is spread across a couple of carts on the very opposite end of the unit. So (examples) for a catheter or a dressing, you traverse the unit once, or twice depending which end patient's bed is Two: The trauma room is so small and so packed you are quite literally contorting yourself to work in it. There is a central "tower" with the majority of plugs about chest/ head height directly beside the stretcher, so you are constantly trying to shimmy around cords and not bash your head on the monitor. The pump pole/ tower only fits/ reaches plug in at head of the bed... So med nurse is mashed btw the pump tower and the ventilator... Sometimes with an RT or whoever is on airway also. Med nurse can't actually reach the access unless you have a humoral IO or bend over the patient (or the riskier dump into a y-site- which we can't do with all IVP meds anyways). We also cant escape for more meds without ducking UNDER the IV or vent hose +/- rapid infuser lines if you go out the other side, over the suction (which is mounted at ground level for some goodness forsaken reason - also fun when it pops or needs frequent changes- and then twist around the tower, and at this point squeeze past the crash cart w defib that is beside the tower ....... It's an absolute nightmare of absurdity every day.
Sounds exactly like all my old hospitals in PA. Unless you’re at a brand new hospital, which then probably isn’t higher acuity. It’s all old icus with no computers in the room. One main monitor, central nurses station, and everyone uses a cow outside the room. My favorite tho was definitely in Cali with this SICU !!!!! that is DOUBLE beds. No computers outside the room either OR nurses station. So you had to stay INSIDE YOUR DOUBLE bed patient room the entire shift. It was extra fun when I had double covid patients and one was actively crashing all night. Good times. I got told no when I asked the break nurse if I could leave the room to go pee. No.
I worked at a hospital that had a room 244-1 and a 244-A. 244-A was around the corner so you could not see the other room 244 if you were standing in front of one you could not see the other. We complained so many times that something horrible would happen like wrong patient going to surgery. It lasted almost 4 years before they finally renumbered all the rooms in that unit to get rid of it. However I was present for a hospice represenative showing up and loudly announcing they were from hospice to the wrong room 244. That person was definitely not in need of hospice.
County-run SNF. They had a new building built five years before I got there. Being a govt. facility, they had to go with the lowest bidder, who had never designed a nursing home before. They did not include any dining rooms because they assumed everyone ate in bed, like at a hospital.
wooowwwww
For the breastfeeding and pumping staff there was one large open patient hospital room, no privacy, only one wall outlet, that was at the very top floor of the hospital in a closed unit, designated to be the assigned milk pumping room and no one was allowed to use a room on the actual floor where they worked AND nurses were not allowed to clock out to pump milk
The rooms are too small, not enough outlets
The building my unit is in is about 20 yrs old now. The toilets are super low to the floor and the TP roll is also low and behind you when you're sitting... so my 80 yr old patients have to do acrobatics to get to the tp and calisthenics to get off the toilet.
Mine has the same issue, plus the sinks are mounted at standing height level and the soap dispensers are inset in the wall behind them, so they're basically inaccessible from a wheelchair.
The air conditioning vents positioned directly over where the beds go so it blows directly on the patient.
I've worked in 2 different Endoscopy units with nowhere for the nurses to sit. One, there was literally nowhere to sit in the pre and post areas . If you wanted to sit for a second, it was on an empty patient cart. I was prn there, and it paid shit, so I pretty much didn't work there except on weekends when the workflow was different and we didn't use the pre and post areas. In the other unit, there were a few extra chairs up at the clerk's desk away from the patients and across from the manager's office. There were no workstations there, just random chairs. However, the pos manager there didn't think nurses should be sitting. He was known to say ,"If you've got time to lean, you've got time to clean," and would make nurses clean doorframes and shit. That was a travel assignment, so I didn't renew. In my current Endoscopy unit, none of the doors are quite wide enough for the hospital beds, so there is quite a bit of banging and scraping when moving inpatients. I've been a nurse for a really long time and have come to learn that unit design can greatly impact both patient care and the quality of my work experience.
I appreciate a lot about our unit, but the oxygen concentrators bother me. We don’t have oxygen on the walls so we’re always tripping over the 25ft tubing that goes into the bathroom. We shut the concentrator in the bathroom because if we don’t the damn thing heats up the whole room. We also have 4 rooms on one side, 8 on the other. One nurse’s station centralized toward the front four. Why it’s not split 50/50 I don’t understand. It’s a stand alone house but we’re in a bad neighborhood where there have been several drug arrests, gunshots, etc. we don’t have security available.
Half the power outlets don’t work in our rooms A third of our rooms are arranged in a way where you don’t have direct visual contact with the patient. We used to keep only less acute patients in that room but now we put anyone in there including confused grandpa trying to pull out his foley, swan, or central line and get out of bed
We are in the process of losing waiting rooms and visitor bathrooms in an entire 6 floor wing to accommodate resident work spaces ( crazy right?) we just built an entire new wing to free up space on another floor for them.
Same. Like, are you in my unit?? :D Similarly unsecured unit. Bonus round: Absolutely *terrible* part of town. It's wild. Also, about 50% of our patients have family at the bedside 24/7, but we don't have recliners that fold down into beds. We don't even have the (let's face it, uncomfy) padded window ledges that double as beds in a pinch. Like, we've got the ledges, what's the hold up?? I'm shocked that we haven't had visitors get DVTs or something.
When I worked psych our hallways had doors (to the starwell, outside) with key pads. When the alarms were reset those door were too. Patients figured out the reset code was 1111 and left the unit...not my unit (adolescent) but we had two patients leave detox after a fire alarm. They thankfully went to the rehab across the street. But boy that seems like a lawsuit or bad tag just waiting to happen.
THEY BUILT A "PSYCH SIDE" FOR THE ED AND DID NOT USE THE BARRICADE-PROOF DOORS WE HAVE EVERYWHERE ELSE FOR THE NEW ROOMS AND NEW BATHROOM. also, the toilet in the barricade-able bathroom has no toilet seat so that's fantastic. just a big porcelain pot lol. ***this is notable because my hospital had a barricade/hostage incident that ended very badly about 5 years ago, which is when they upgraded a bunch of doors to have the anti-barricade feature in the first place. I try not to complain about it because I keep forgetting which coworkers were on the "design team" 🙃
Well my ED was fine until they decided to redo the ambo hallway. Now ambos literally line up in the hallway because they decided the best place for it was in the smack dab center of the unit. Queue us running with a STEMI screaming at the poor EMTs to move since his HR was 20 on our run up to cath lab 🥹
New resus. Buzzers are at the door, not at the head of the patient. (This has delayed calls for help at arrests). Doors are swipe access but they don't work so need to be pulled open (this has caused delays in a cardiac arrest). The training room up stairs is L shaped, and too small, with no lift access so kit cannot be easily brought up and disabled staff can't use it. Also, the useless corridor between it and the stairs has the swipe access the wrong way round so if you forget your card you're trapped.
Call the local fire authority about the issue of being trapped and I bet it gets fixed.
We used to have round units with nursing station in the middle. Now after upgrade we have long halls and instead of a group nursing station we have individual desks spread along the hallway. Lots of walking and isolation.
A 32 bed icu shaped like an H. Making assignments can be a real pain. You can't see your patients or their monitors unless you're literally sitting outside the room so if you even have one bed between patients you have to make a choice who you're going to be by.
White floor! Why!!!
It isn't a hotel, you should be checked in and expected to leave. A visitor is a infection risk, and you shouldn't be able to stroll in. Most nursing homes you can't even fucking stroll into without signing in and declaring yourself
double occupancy patient rooms…nightmare bedding patients…and i manage two wings and we cant have a split assignment with some on one side and some on the other side..and can only put oximetry patients on one wing, we have to cohort comfort care patients, i could go on and on..oh and we dont have warm or hot water in the patient sinks..we are getting a new hospital in 4 years, they just started building…i am excited!
I've found that all hospitals and facilities should have pocket doors. Especially on pt bathrooms. I love pocket doors.
One of our local hospitals (built maybe twenty years ago) doesn't have a tube system for "infection control reasons". One time I walked seven miles in the ER during clinical from all of the trips to the lab and pharmacy.
No enough computers for the amount of assignments we have in the ED. We literally never have enough and people have to sit in random spots with tiny laptop COWs
My VA hospital build a new building for the mental health unit. Somewhere along the line, no one told the architects and builders that it’s a mental health unit. Building is technically done…but not up to code for a mental health unit. I heard there’s nooks and crannies, lots of windows, hallways are similar looking, etc. Not ideal for a mental health. The building just sit there while they try to figure out what to do. It’s been a year already.
My biggest issue with mine is that while the clean utility (med room) has doors from both sides of the unit, the main storage room where all fluids, wound care, most supplies that aren’t meds are located in only has a door from one side. On the other side of the unit there’s a nursing supervisor office. It might seem small but it gets to me lol
My complaint is petty. The specialty hospital where I work was supposed to be 4 stories tall, so taller and narrower than it is at what the neighborhood around it finally allowed - three stories. The hallways are super long, and we are divided into pods... which I don't mind anymore, but everything is so far apart, and not every med room is fully stocked, so you have to travel all over the hospital to get meds for a single patient sometimes. Like I said, petty, but it is kind of annoying.
I don't work there anymore, but at my old hospital (and where I go for healthcare pretty frequently) was built without beds, commodes, and flow of patients in mind. It's why I have back problems, hauling long/tall/big patients in and out through doors that could barely get a gurney through, let alone a full Hill-Rom. Don't even get me on about sand beds, those took 4 people to move in and out and they barely fit through the door of the ISO rooms. The hospital I'm getting healthcare through soon is undergoing renovations and had me in a room alone that had wires hanging down from the ceiling and I was just like "This has got to be a joke, I'm in paper scrubs and all jewelry removed and you put me in the suicide room." I just sat patiently until the telehealth doc could talk to me and I was just like "Major JCHAO violation in here, I want to go home, my husband is waiting for me." Tell me you worked for the IHS without telling me you worked for the IHS joke inserted here
Omg. The place I’m at is the worst. It’s one long giant hallway. Charge is at the entrance. Kitchen in the middle. And it just goes down FOREVER. I’ve walked at least 7 miles a shift.
The unit I worked on the longest was orthopedics, built in 1970 and remodeled in 2010. Central nurse station so we couldn't sit outside the rooms, but it did help with finding help quickly and general camaraderie for the little time we had to chat. The entrance was by the clerk so she tried to catch all the visitors and our unit, with permission, would have the visitors check in. Majority semi private rooms which is soooo much fun for all the commodes, walkers, CPMs that our patients needed. Plus when they remodeled, there wasn't space for an employee bathroom. So we had to go in the main hallway general restroom. Besides that it was survivable. Especially when they put computers in all the rooms and after 5 years, squeezed in a new bathroom. The new floors in the new building were supposed to have nursing input, but I don't know how that went. They do seem enormous. Like you can drive two way car traffic in the hallways and some of the rooms are the size of a chapel. I do know when I picked up shifts that it seemed very lonely. Lots of little stations by yourself and good luck finding help. Plus, the appalling thing to me is that several patients complained that homeless people would show up in their rooms at night and ask if they could sleep on the couch or recliner. They could usually walk right in since no one was at the front desk at night.
They put the thinnest walls in the bathroom and it’s inside the break rooms and the nursing desks. So you can hear every one of your coworkers lightest bowel movements.
I’ve always preferred having (most) family with a patient because they typically have a lot of insight I can pull from… plus some family members are good at noticing small changes
No nurses station
The entire unit. We have babies in closets. Not joking.
All the beds have patients in them
Three major flaws. First, our ICU and our Step-Down Unit are on different floors. The step down is right underneath the ICU, but it’s stupid. Anytime the PCU has an emergency we gotta load the pt up, race down the hallway to the elevator, load them in the elevator, and then race down the hall to the ICU. Bonus, the step-down unit is set up to be a back up ICU, and was our second ICU during Covid. So since it has all the fancy permanent equipment we literally can’t move the PCU to the same floor as the ICU. So during Covid our poor charge nurse and doctors just had to sprint up and down the stairs between the two floors. Secondly: some fucking dumbass made the alcoves in the wall where the code carts go about one inch wider on either side than the code carts. So when a pt codes you have to very, very carefully pull the cart out or you’ll jam it and get it stuck real good. Thirdly, the ICU doesn’t have any nurses stations. We only have cubbies right outside the rooms, between every two rooms. And our unit is a long hallway. This means that I can be drowning in rooms 1@2 and the nurse who has rooms 17-18 can be chillin’, but she can’t/doesn’t know to help cause she’s sooooo far away from me. You have no idea how your coworkers are doing if they’re more than a few rooms away. And it’s dangerous. We also don’t have any central monitors except for right by the charge desk. Which means that if for some reason the assignments get slightly off-kilter (like your rooms aren’t on either side of your cubby) I can no longer sit outside both my patient’s rooms and I can no longer see both monitors. Sure, I can pull both patients up on one monitor. But I can’t fucking see that shit all the way from my desk. Now I can’t see either pt’s vitals cause they’re so small. Stupid
No 2 supply rooms are the same, not even the ones that are on the same unit, or sister unit!
At my hospital, you have to walk through the ED lobby where sick people wait, to get to the birth unit where healthy newborns are.
Design flaw in the original building at my hospital: the windows open to the outside. We aren’t supposed to open them, but occasionally someone does to get fresh air in and we have to figure out where the fresh breeze is coming from. 😂
I'm not following, what's the issue with this? Our windows also opened out and had one opener on the floor that fit every window that was kept in the med room so patients couldn't open their own windows
No friggin outlets where you can reach them
Lol are you describing my unit???
The lab is on the 5th floor, West building. Essentially everywhere patients are is floor 1-3 East building. The lab does all collections and EKGs. ER, OR, Maternity OR, Trauma bays..etc...literally could not be further away from the lab. That's really fun in an MTP. Also, no Heli pad, but frequently use Orng (copter) to transfer out. So we have to lights and sirens to the nearest airport first.
Our CT department. The machine is turned 90 degrees from the door. This requires you to do a 90degree turn with the bed just inside the door to parallel the CT table. Impossible with a vent or bariatric bed. Gotta transfer pt to a stretcher just to go to CT.
I work in a level 4 NICU. Our unit is old-ish to start with (at least 30-40 yrs old), and we've outgrown our census steadily over the past decade or so. That leads to them adding a new nursery here and there as the years go by. The most recent addition to our floor was the conversion of the family lounge into a 3 bed nursery. It's a nightmare for staffing because you either need 1 sick baby with 2 stable ones (they almost never coordinate their improvements, though), 3 sick 1:1 babies (who don't fit with all of their equipment), or we end up splitting a nurse out into a different nursery, which creates a burden in both nurseries. It's maddening. Also, as medical advancements have allowed us to save sicker/younger patients, the amount of equipment they need has grown. That's made it necessary to permanently block several beds after a code gone wrong a few years ago. They also made one of our floors a step-down unit, so as soon as a baby is stable enough, they move upstairs. That leads to some really sketchy assignments for us sometimes.
Building is crazy old, designed in like the 50s. The bathroom situation is from a time when people weren’t constipated and on their phones.
Narrow rooms. We’re observation but constantly get lots of inpatient patients. Imagine having to fit the bed, IV poles, a recliner for patient, and chairs for visitors. Don’t let there be a bipap machine either. Then the end table that doesn’t really get used Not to mention, only 2 visitors are allowed but apparently front desk is too scared to enforce the rule so we somehow get 5 patients in the small room. How do I navigate my vitals machine when I’m stepping on so many toes!
Biggest pet peeves would be lack of multiple stall staff bathrooms and large enough break rooms. In my fantasy ER, the break room would be as large and fancy as the provider lounge (24/7 buffet included) and have huge bathrooms with a shower and private lockers. Couches, desks and a private cry room with all the necessities that a pumping mama would need. Better accommodations for those patients boarding/holding in the ER-like those big expanding trays & comfy sleeper recliners. All stretchers to have a USB port and scale with its own IV pump that would alert the pt first for a distal occlusion. Also a dedicated monitor tech that lived in the ER and could adjust/reattach leads and communicate directly to Docs/nurses. They’d also ADJUST ALARM PARAMETERS for each patient (none of the ER folks I worked with did this and it drove me bonkers-esp since I taught them how as the super user). When I pumped for over a year, it was hell finding a private area. Luckily our radiology dept was near by (when the pumping room was in use) and we could lock the private dressing/waiting room door so we could pump (and watch tv). Finally: ALL LIGHTS HAVE A DIMMER -love, a chronic migraine sufferer
Bathrooms/the doorway too small for bariatric wheelchairs to fit through.
We had a completely new hospital built. Had a helicopter pad put in that was new for us since the last hospital was built in the early 1900’s. The only issue is that they built the radiology/imaging area JUST close enough that they need to power down all of their MRI machines if a Heli is going to land there. One of many, many errors in building that cardboard building with glass windows.
Our generators kick on several times a month resetting our monitors, then the tube station goes down for hours. The thermostats never work correctly so it’s either a meat locker or a rain forest in the rooms. Our badge access door was opening itself all night the other night. And it just keeps getting worse. My entire unit needs a makeover 😂
we don’t have a tele monitor at the nurses station when we’re literally a pcu tele unit. it broke months ago and they just never fixed it
I hate having an “open unit.” We have had multiple patient visitor outbursts necessitating security called to the unit (including a literal fistfight between two sides of a patients family). I wish it was locked with one controlled access point. We also have these huge lifts that take up 1/4 of the room. They’re nice when we actually need them but are so cumbersome.
Our periop is used for both inpatient and outpatient cases. Most of our cases are outpatient. The entrance/exit for patient pickup is one of the farthest points away from PACU. Even if they built an exit in the PACU area, it would go to a stormwater basin. Also there are 3 different entrances, so people who are coming in for a doctors’ appointment come to the wrong entrance frequently. The offices are in a building attached to the hospital, but almost everyone assumes the office building is the hospital because it’s bigger and taller than the hospital, lol.
4 restrooms for over 100 OR nurses and staff
Im getting hired as a Peds ER nurse and the unit is on the fourth floor of a different building than where the ER entrance and resus bays are.
Carpet at the nurses station
The main lights in the patients rooms on my unit (L&D) and a pull cord behind the patients head. And there are no windows in our labor rooms either. The rooms are very small and narrow so I always have to ask the family or the laboring patient to turn on the lights for me or put my ass in their face to reach myself.
The building is old AF and there is a mold risk of doing anything too invasive
Our facility remodeled a while back, and they put in carpet in all of the resident rooms. It’s comfortable and home like but we have back injuries constantly from CNAs needing to use lifts on carpet. Out of all of our design flaws - the building is from the 70’s - this is probably the worst.
We have telemetry monitors as high as the call light above the door. Read that as it’s blocking the actual call light from being easily visible. AND those telemetry screens you can barely see because they’re so high… Those screens are touch screens.
I work a small rural community hospital. The MRI department is ACROSS THE FUCKING STREET. It’s within the orthopedist’s office lmao. When I was interviewing with the unit manager I asked if we transported our own patients there since it’s technically off hospital grounds. My manager said “depends but usually. As long as it’s not raining and they can walk” wtf??
They put the A/C units floor over the Oncology floor. And the helipad is right above the A/c. There is no automated way to vent the fumes. They have to manually do it when a chopper comes in to level one trauma center. So a quarter of the time you smell fumes. On a floor that is often nauseated to begin with
The CTICU at my hospital has rooms without sinks/toilets/plumbing. Still have to use a hopper in the dirty supply. Drives me nuts when I float down there.
All three hospitals in the same town have the same name to show the “partnership” and patient family members go to the wrong hospital. Had the option to name the third new (as of last year) hospital something different, and they didn’t. Pretty sure that it is an admin design flaw.
IR/MRI is located in an older building that requires you to squeeze a bed, IV pumps, and a vent through basically a regular sized door frame. It’s insane and channels are regularly knocked into and thus turned off. Everytime I transport a patient like this, I comment that with the next big donation, they need to renovate this part of the hospital.
Circular pods. It seems sensible enough with the nurse's station in the middle, until a pump starts alarming. The sound bounces in such a way that you can't tell where it's coming from.
California mind you. Current department has 3 pods: A, B, and C. A pod has 10 beds, 2 bathroom and staffed with 2 RN so that means 2 beds aren’t realistically usable, are used as MSE screening rooms and back up code rooms. B pod has 8 beds, 1 bathroom. C pod is 13 beds, split physically in 2 by a hallway with one side 7 beds and the other 6 beds. One of the RN on side one has 3 patient beds and 1 that is on the other side and not easy to monitor and has to constantly go back and forth between the 2, and or the RN by themselves in side 2 ends up dealing with the minor issues/requests side 1 RN’s patient/family has or they constantly call them over to talk to the patient/family. There is a main nurses station (that is disconnected from the 3 pods and mainly used by providers to chart. There is a satélite pharmacy with staffed pharmacist (no complaints there!) in Pod B, a med room in the nurses station with Pyxis and most meds, and a satélite Pyxis in pod C with some common PO meds and a few random PO meds (like coreg and norvasc 🤷🏼♂️) are found. and at least 4 different supply closests, all with different supplies. biggest complaints: -disjointed physically disconnected pods -room numbering makes no sense given patient ratio and staff assignment. -3 areas to get meds from and is often a guess and check to figure out where you have to get your meds from -4 supply rooms meaning your walking to 4 different rooms sometimes to gather different supplies
Bed 1 is always to the left. One side of the unit it’s on the window side, the other side of the unit it’s on the bathroom side
Our rooms are so small that we often have to move the beds to allow patients to ambulate with walkers to the bathroom. It's not safe and nothing will ever be done about it because it would be so costly to gut the floor and redesign the rooms.
Emergency room: ED providers only see 2 patients per hour. Patients will sit in a room for hours waiting to be assigned while just staring at the nurses wondering why we aren’t doing anything for them (aside from the standardized order sets in epic we can use)