Dealing with confrontation:
Your significant other cannot get used to you working 12 hour shifts and hates that you come home exhausted. They think you don’t get to spend quality time together anymore.
Genuinely listen to their concerns and show compassion.Try to plan dates according to your schedules.
Support the team: Peer checking
You notice that the PCT is not cleaning the glucose meter in between patients when coming out of isolation/precaution rooms.
In this case because it is an infection control concern you must approach the PCT immediately and offer to clean off the machine for them. Later in the day you can remind them the importance of cleaning the machine in between patients and ensure that they know what products to clean with.
Validate and Verify: You receive an order to bladder scan your patient and obtain a result of over 700mls. What do you do next?
Validation is a quick, internal process. Ask yourself: Does this make sense to me? Is this what I expected? Is this right? When something fails the validation test, we need to verify. Validation demands a little more time and requires that we use a qualified, independent source to make sure the information is correct.
You decide to look up Piedmont's policy on bladder scanning.
Use the STAR acronym to ensure you get the best results when performing any task. STAR stands for: Stop, Think, Act, and Review. A pharmacist is filling a prescription and is beginning to assess the patient’s stated allergies when the phone rings. After finishing the phone call, she does not perform STAR, accidentally skips the ‘verification of allergies’ step and fills the prescription for the patient who has an allergy to the medication. What should she have done different?
She should of let the call go to voicemail to finish the task at hand or start the process over from the beginning.
When is hand off needed and what is an effective hand off?
It is required every time there is a transfer of responsibility and it is defined as: complete and accurate information provided in a timely manner.
Every time you enter your patient’s room, you spend at least 45 mins-1 hour and it’s putting you behind with your assignments for the day.
Try to bundle care and delegate duties at needed. Let the patient know that you will do all you can for them within this time frame or let them know what time you can come back and stick to that plan.
Support the team: Peer Coaching
You notice the case manager verified patient's name and date of birth and clarified if it was ok to talk in front of visitors before going over home medical equipment.
Thank the case manager for validating that they have the right patient and confirming they could speak freely in front of patient's visitors as this was respecting their privacy.
You are in PACU and your patient has a listed allergy of: Fentanyl but with no explanations of side effects or how severe. The patient has dementia and is very confused actively trying to climb out of bed because they are in pain. Upon reviewing the MAR the Anesthesiologists only placed an order for Fentanyl for pain control. What do you do?
Ensure that someone is at patient's bedside so they do not hurt themselves. Attempt to re-orient patient. Call the Anesthesiologists and confirm order for Fentanyl is correct and remind them of allergy.
You are about to administer blood to a patient and have a second nurse in the room ready to sign off but he is talking about his heavy patient load and how patient X in room #250 is constantly on the call light. What should you do?
Remind your co-worker that you are ready to here about their day AFTER the blood has been verified by the two of you for patient safety. You can say something like, "hold that thought for one minute. Let's sign off on this together real quick."
You start rounding on your patients as your shift starts and notice that there is a patient in your assigned block of rooms but no one has given you report. What should you do?
Ask the patient to verify their name and date of birth while comparing it to their arm band. Ask them what brought them into the hospital and how long they have been there. Ensure you leave the bed at lowest position and explain the call light use. Call your charge nurse to verify the patient is supposed to be here and if she can contact their previous nurse to call you with report.
You hate working with this person because they are lazy and are constantly asking you to help do even the smallest tasks. When you try to delegate or ask for help then they are no where to be found.
Speak openly and honestly with them on how teamwork is especially important to help the both of your days go smoothly. If there is no change, speak with your charge nurse/manager
Support the team: Peer Coaching
Doctor: “Nurse you did not enter that order correctly and since we have a private moment can I give you some feedback.”
Nurse: “I really appreciate you coaching to correct privately Doctor. That means a lot!”
During report you learn that your patient has an indwelling catheter that was placed by Urology. In your head to toe assessment you notice that the catheter does not have a yellow sticker. Your internal alarms are going off. What should you do next?
Verify that the foley catheter was actually placed by Urology, why, and how long it's supposed to stay. You can write the insertion date on a sticker and place it on the bag.
No distraction zones: situations or tasks that are safety critical when distraction of the individual should be avoided during this situation or while performing a particular task. This is both the responsibility of the individual performing the task, not allowing themselves to be distracted, as well as other team members, not interrupting individuals when they are performing these tasks. You are drawing up insulin and ask for a second nurse to verify and sign off with but she does not stay to see you draw up the medication but rather just signs off.
You receive a verbal order for insulin sliding scale but the physician is speaking very softly and the nurse's station is very loud. How can you use alpha- numeric clarifiers to ensure your order is correct?
Just to clarify the order Dr. XYZ you said sliding scale to start at a blood sugar of one five zero? or one one five?
One of the patient's on your team is a patient of Dr. XYZ. Dr. XYZ has falsely accused you of performing a task that they did not order and is making a scene at the nurse's station. How do you handle this situation?
Remain calm, get your charge nurse involved to help de-escalate the situation and clarify what task they think you did without an order. Because you handled the situation calmly and professionally, the physician apologized once she realized you were carrying out the surgeon's orders.
Peer checking: Your favorite nurse co-worker asks you to review their discharge instructions to see if it makes sense. Unfortunately they have missed a lot of key components like: dressing instructions and physician follow up appointments. You know they are swamped and have had multiple incidents today.
You can type the missing components and point them out to your co-worker while thanking them for the opportunity to check their work for patient safety. You can also offer to share your "cheat sheet" for what to type in discharge instructions.
When speaking up for safety you can use the ARCC method as an escalation process. ARCC stands for Asking a question, Request a change, report a Concern, and if there is no resolution go up the Chain of Command. In this scenario you see the your PCT consistently fails to empty the foley catheter bags when they are half full. How do you address this scenario with ARCC?
You can gently remind the PCT that our CAUTI policy includes that the foley catheter bags should be emptied when half full and see if they need help emptying them. (Request the change.) You can voice your concern that patient's are more likely to develop a UTI if urine is not emptied on a consistent basis. If the PCT does not change their actions that you can escalate to your charge nurse/manager.
Your nurse co-worker asks you to come sign off on their heparin rate adjustment but do not have the heparin adjustment table specific to this patient pulled up, instead just show you a printed version of how to adjust. What do you do?
Ask the nurse to pull up the correct table according to the patient's order. If they do not know how to do that, show them.
Read back and verify also helps with effective communication: how can you use this tool when receiving multiple orders from a physician?
To ensure my orders are correct I would like to repeat back what was ordered.
1 liter of normal saline stat, EKG stat, CBC and CMP Q 4 hours and albuterol atrovent breathing treatment now for one dose. Is that correct?
Your manager is doing your evaluation based off feedback from your Bi-weekly report submitted by your Preceptor. However, some of the information is conflicting to how you actually feel like you are progressing with your skill set. How do you approach the situation?
Debriefing: convert your situations into learning opportunities. You just finished a code and are happy because the patient survived but noticed that your preceptee was not really participating during the event.
Take the time to privately encourage your preceptee for being present during the code and asked how they felt? Is there anything they could have done different? Is there anything they would like to volunteer for in the next code? Remind them of the principal roles during a code and stress the importance of team working in a timely manner.
An assertive statement uses structured communication when to increase effectiveness. Use the person's name, voice the concern, and provide a solution. How do you handle the following scenario: you see the PCT consistently fails to empty the foley catheter bags when they are half full.
Jane, I am concerned that the catheters are not being emptied when half full. Can we look at it together?
Jane, I am uncomfortable that Patient X in room 250 is walking to the bathroom by themselves because their gait is very unstable. Can you please assist them and place a fall precautions sign on the door?
This is a safety issue. We need to have the hoyer loft readily available to safely turn patient X in room 250 every 2 hours.
You are performing your fist Neuro check on an ICU patient admitted for hemorrhagic stroke but the PCT is waiting for you to finish your assessment so she can start on the bed bath. She keeps interrupting the assessment by distracting the patient by coming in and out of the room with supplies. What should you do?
Remind the PCT that this a critical assessment and this time should be considered a "no distraction zone" for you and the patient. She can come back in 15 minutes when you have left the room and the assessment is complete.
S=Situation (a concise statement of the problem)
B=Background (pertinent and brief information related to the situation)
A=Assessment (analysis and considerations of options — what you found/think)
R=Recommendation (action requested/recommended — what you want)
Your patient does not have effective pain control from the ordered medication of: Tylenol #3 1 tab PO Q 8 hours. How will you use SBAR to call the provider?
Good evening Dr. XYZ, I am Claudia, RN working on 3 South with your patient Patient X in room #250. They had a total left knee done today and the only medication ordered for pain was Tylenol #3 1 tab PO Q8 hours but they report pain is still a 10/10, throbbing in left knee two hours after Tylenol was administered that is unrelieved with rest or ice and worsens with movement. Would you like to order something else for pain control?