The Mechanics of Nursing
One of the realities of every profession is that an occupationally trained worker must provide some part of their own tools of the trade. Perhaps they prefer a certain brand or model, and/or the facility hospital or nursing home does not provide up-to-date or working machines at all. Officially, a hospital or long term care facility will monitor the medical equipment, but this does not always happen. Nurses are often “stuck” using equipment that is borderline inoperable or unreliable. This is a very serious medical issue because the nurse must be able to trust the statistical metrics to assess and record the patient’s condition.
Due to low budgets and straining costs, many facilities may not have the money to replace aging or broken equipment. Thus the patients are relying on the nurses to be able to do a manual job of taking blood pressure stats every time. This can be time-consuming and a stressful part of the nurse’s day, when conflicting patient needs stress the limited time a nurse has to finish tasks. A professional nurse must be able to contend with broken or inoperable equipment and yet smoothly transcend this challenge for ongoing patient care.
One of the parts of nursing that always gets nurses technically caught out is the working and proper maintenance of the medical equipment. Many a testing and practicals skills environment training stresses the use of blood pressure tests using the old-fashioned lub-dub method. But many professional nurses grow to rely on the wrist machine, used to calculate digitally the readout of the patients blood pressure and oxidation. Investing in this mechanical device can save time and trouble taking vitals readings.
A nurse working at a hospital or long term care facility should catalog the errors they observe using a particular piece of equipment and report this in writing to the charge nurse or to the Director of Nurses. They should note for the record in the licensed nurse progress notes how many times the attempted the vitals test and what the time was from beginning to end. This can be verified using a video camera or the notes of the charge nurse.
It is important for any nurse to immediately report a malfunctioning piece of equipment to the working charge nurse per shift, additionally. Taking a digital picture with your cellphone may also show the strange result or wrong code on the LED that multiple attempts can give. This advise is not just boilerplate for an in-service or training video. A nurse should use their own judgment and be ready to submit this letter anonymously to whistleblower line or local ombudsman or patient safety suggestion box.
Documenting the issue with the nursing equipment that it is not operating correctly and the serial number or identification tag will also assist inventory staff using this complaint to take the unit in for repairs. This way the nurse has a concrete record of their own observations and the method they used to pass the information up the chain of command. Sometimes the persons in charge of purchasing and equipment maintenance don’t have any interaction concerning the operability of the equipment, when in fact a vitals cart or heart monitor may need replacing.
Other equipment related to patient safety is elevators, stairs, fire escapes, visitor chairs, bed rails, bathroom safety rails or bars, light fixtures, air conditioners or heaters, and more. Elevators should work without strange or unexpected delays, or stops on unselected floors. Lighting and access to floors using fire escape doors or flights of stairs should be reviewed for safety practices. Lack of integration of security responses for patient alarms and wheelchair alarms can make a nursing ward seem like a zoo of noise, buzzes, and call light alarms.
But specialized equipment is not the only device that a nurse should review for safety. A nurse should always give the equipment a “weather eye” and see if the cord goes in smoothly and does not pull away from the electrical socket, or that the wheels or runners turn and move smoothly. A tray table or table-based electrical equipment aid to nursing may need to be monitored for electrical discharge. A nurse should report when a patient organize belongings or possessions in a manner that conflicts with safety standards.
Even finger protectors made of plastic can prevent paper cuts. This is a serious problem for blood contamination of medical records and documents, as well as droplet contamination between nurse and patient. Given the amount of time that nurse spend handling the chart pages, even a small paper cut can become painful upon repetitive action.
As always, the most highly scrutinized equipment for nursing use is the needle. Privacy, calm and well-lit circumstances in administering patient care, and a good understanding of the patient is required. Advise the patient when you are going to stick them, how long it will be, how the site looks, and ask them again before you inject the needle if they are ready. This use of courtesy centerlines patient dignity even during a difficult procedure. Improving stick skills should be paramount. Causing bruises or painful injection sites repeatedly in a patient can result in being written up by a supervisor. Continuous disregard of patient dignity and skin fatigue or tearing, bruising or discoloration due to improper needle skills can be means for dismissal.
All in all, there are numerous challenges to safeguarding patient safety and mechanical device security in the occupational nursing workplace. But with attention to detail and a good attitude, the professional nurse can overcome obstacles while providing excellent patient care.