Slackers: The Ethical Divide of Nursing

The ethical divide between professional nurses with morals and accountability, and the others, becomes clear just as soon as a newly qualified student nurse becomes a professional. As in many occupations, nursing has its share of sour apples. And, as in many professions, some employees work to find a way around the system. Some nurses commit timekeeping violations. Others goof off and text on the job. Some chat too much with other workers, ignoring monitoring and auditing tasks. Slackers send a message that nursing is not serious business.
Sooner or later many nurses developed a career path. Many nurses begin with small slips, like writing inaccurate representations of events to favor their colleagues. And some others gang up on certain patients, to teach them a lesson. it’s human nature in some people to become predators against others and take advantage, but better nurses withstand the temptation to abuse those vulnerable and in their care.
Many times advisors and instructors will stress the importance of contacts within the industry and joining new network of friends. But this can backfire. Nurses cherish the bonds of friendship between each other, and sometimes too much. Would a friend ask you to risk your license putting false paperwork into a patient’s chart? Would you report a friend who removed records from the chart and shredded them? Would you realize if a future supervisor didn’t hire you because they remembered the deeds of a nurse clique or “posse’ you used to be with in the past? Being able to choose the company you keep may be the last true luxury nurses have. You may pay a price in the future for fun times today.
Nurses starting their first job take their license as proof they have studied hard, mastered all materials, and learned the necessary techniques and skills to provide positive and meaningful care to benefit all patients. Yet after a while, newly licensed nurses will start to notice something. Not all nurses share their same commitment. Some are lazy, some never finish the job right, and some just find ways to do things that are sloppy and incomplete. Every nurse must find the way they choose to deal with this.
Some nurses view a nursing job as a part time paycheck an avenue to another career. They want to be an actor, or an artists, or even have another job. Maybe they found their way to nursing through family connections and it didn’t seem all that hard to do. But they really don’t like the work, and they don’t mind if it shows. These nurses use their phone a lot when they are supposed to be working, and spend a lot of work time goofing around, looking at take-out menus or chatting with vendors and providers who come by to visit. But the medical world does not smile on this kind of slacking.
This kind of nonchalance leads to many nursing errors, such as too much or missing medication, skipped insulin doses, erratic chart-keeping, and missed shifts due to inability to copy the schedule. These type of employees perhaps showed more promise once upon a time. And many facilities can‘t afford to let such nurses go because a shortage of qualified and experienced nurses keeps them reliant on current staff. They arrive at work and hang out, looking for ways to skip the work and get coffee, hide in closets and rooms to talk to others, and just hang around.
Usually for nurses like these, the big attraction to coming to work is to socialize with the people working there. This can be a problem, because the bonds between nursing co-workers should not be more important than the professional commitment as a provider. Often, many nurses can prey upon the weaknesses of others. They can use peer pressure to cause one nurse to treat a certain patient or even a co-worker nurse badly or with disrespect. This is slacker peer pressure.
Yet so many nurses convince themselves that coming to work late doesn’t matter, that calling in sick for entertainment and social reasons doesn’t help co-workers, and that unclocked breaks just don’t really count as infringements. These types of nurses can contribute to an entire downturn in morale, because nurses working hard observe their peers slipping by with doing much less. Why should work hard, a nurse might say to themselves, when if ‘so and so” was here, they would just watch the clock until the small hand clicked at the top?
Sadly, many types of people use nursing to abuse the system. The steal medications, overcharge insurance companies, send false bills, and sign invoices for amounts of supplies much larger than what was actually used. Nurses may not realize that when they are asked to sign a bunch of audits, or when other staff convince them to sign many orders the did not witness or to even file papers in the chart that are not legitimate, they are risking their license. And showing new nurses whom to trust on the job is not something you can teach in a textbook.
Insurance fraud usually starts in small to medium sized businesses where slacking off and discovery of errors puts some people at a disadvantage. A nurse who has noticed a serious error made by one of their co-workers can choose to report it, or instead leverage this information for better shifts, a raise, or even a promotion. Nurses should be vigilant to review their state nursing board website and keep updated on the regulations governing their license. Maybe some employees notice that an employee takes off work an hour early every day their manager is not in the office. A new nurse trainee observes that not every staff member has t clock in and out per timekeeping regulations. Maybe they notice that the physical therapy staff bill for more sessions with their patient clients that actually occurred. Any omission of reporting such things can build a situation where nobody has ethics and finally some incident brings the whole situation to light. And at that point, nobody is a winner.
Many slacker nurses or people who are just too burned out to care adopt a philosophy of “say nothing, do nothing” at work. They think this keeps them free from blame when situations arise on the job for nurses to commit dishonest acts or abuse patients. When the nursing employees have this many compromising issues on the job, the patient care comes second. Soon, going to work in really a tripwire into unethical behavior that could lose them their job, let alone their license. And many nurses later confess to horrible infringements of patient rights simply because they got strong-armed on the job from the director of nursing or the administrator.
It is so much easier, in nursing, just to keep a clean slate and make sure that the nurses you choose to associate with are the one most admired and emulated by all. The nurses with authority are the ones who should provide a leadership example for everyone. As a new nurse, any nurse who questions why a felow employee is performing a certain action or declaring certain statements or giving orders, should be vocal to their superiors about just what is going on. Just the knowledge that one person had noticed this might be enough to form a correction plan and sever “bad apples” from a healthy tree.

Handling Patient Visitors

Until you see the light in a patient’s eye, when their relatives come, how their face lights up, you just haven’t lived. The sum total of life is right there. The programmatic dynamic of parents raising children is reversed. The residents (parents) now received the care from visitors (children). It is a singular statement in every individual patient’s case what kind of care they get from family members. Just as people look the other way in a community when children are abused, a low-level nursing home gathers the neglected ones together. It takes a compassionate care nurse approach to make sure patients don’t feel neglected or overwhelmed.

Nurses in any pay range should report any examples of abuse to their nursing manager or as an anonymous complaint to the regional ombudsman. The County Health Facilities Director may also take an anonymous complaint alleging abuse. Nurses in acute care and skilled nursing should counseled to look out for signs and symptoms of abuse and should make an assessment in the chart accordingly. If patients should complain of missed medications, pain, unusual symptoms or worries concerning their care, the charge nurse should be notified.

The sliding scale of who and what family members come to visit is one nurses will become familiar with. Some visitors only show up once a year, on birthdays or anniversaries. Some people bring the whole family, and it can be overwhelming for a recovering patient or fragile resident. Sometimes visitors bring children or babies to encourage the older resident or family member to enjoy the family life absent in a skilled nursing facility or acute care hospital.

Nurses should make sure visitors should wash their hands before skin or physical contact with the patient, administer or deliver no medications or narcotics, and otherwise observe infection control best practices at all times in and around the patient‘s room and bathroom. Visitors and family, friends and relatives may not realize that resident of a skilled nursing facility or patients in acute care are extra vulnerable to viruses, colds, and other communicable diseases. Diabetic patients should be discouraged from overdoing it indulging on special “treats’ that can harm their health and change their blood sugar and cause a crisis.

Others come every weekend, and bring things or even help with the physical care and chores of a nursing home patient. usually, among nurses, this will reflect the status of a patient’s relationship to the visitor. Nurses should be vigilant if a patient shows a marked dejection after certain visitors come, or a tendency to depression after no visitors come. Such patients should be redirected to group activities or have the activities director contact relatives and suggest a family visit.

While financially the nurses know and differentiate between cash-pay residents and Medicaid or Medicare recipients, technically there should be no cognizance of the patient’s status when treating them or attending their bedside needs. health care should be available to everyone regardless of the ability to pay. By seeing the way the patients are treated, some nurses also differentiate between patients who receive visits and those who do not. This can be an unfair but persistent bias.

There is one simple rule for this: the family members and visitors of a nursing home patient will track neglect or have conversations with the patients where criticisms or reports might reach the ears of others. It is essential in some cases to keep frequent visitors’ parents (patients) well cared for, as the family member will appear at any time all day, or stay during significant parts of the day during one single shifts. That one family member will not see the effort the nurses put forth for the rest of the shift for the rest of the floor, but they can make enough noise t bother the managers and owners of the facility for months.

It is hard to watch a CNA or LVN favor a patient or set of patients whose relatives frequently visit, while the ones who need contact and pepping up most fall to the end of the range. One can watch a single nurse neglect a patient’s bed, person, or dignity outright, and hustle to the next room to cascade attention and caregiving on the least in need patient in the place. But this is what happens when nurse managers do not periodically refresh the training and motivation of nursing staff.

Any nursing home patient that has a visit from a relative or friend, social worker or investigator from the county health department, must have them sign in to the visitor’s register. there is usually a physician’s room or private area where an investigator can conduct I interviews or research charts. Additionally, medical records staff will make themselves available t assure any visitor they receive the most assistance possible.

Patient Care and PTSD Cases

Nurses looking to get traction in the occupational workplace should be vigilant protecting the rights, privacy, and quality of care given when a PTSD situation arises. Patient care can include special cases, patients whose fears and experiences have traumatized them. These patients come from domestic situations, armed services experiences, violence and sexual assaults, where PTSD clouds the victim’s thoughts with shame, doubt, and a negative spiral of blame and inertia.

A professional nurse should tread carefully and follow the charted behavioral interventions and therapeutic approaches to the letter. Some patients who have genuine elements of PTSD in their makeup may have yet to be diagnosed. Post Traumatic Stress Disorder is a  condition whereby certain other conditions may be affected, such as ulcers, high blood pressure, depression, and more. Nursing practice for such (PTSD) patients includes maintaining a calm, relaxing environment where pain and anxiety are reduced in every way possible.

Disorders like PTSD come from traumatic incidents in the patient’s past, and may be unknowingly triggered without sincere and through querying of the patient’s social profile. A nurse can request a referral from the primary care physician for a psych referral. Any nurse should be careful not to disclose any specific medical information to observers or passersby. This is a HIPPA violation. Nurses should re-orient the PTSD patient (when acting out or presenting symptoms) back to their room and make the assessment in a private setting.

Document carefully any interactions with the patient that cause you concern. Make sure that you follow the best nursing practices when a PTSD incident occurs. When dealing with a patient who is confused, lost, or suddenly bewildered by where they are, or if they forget what they are doing, be prepared. If the PTSD patient shows exaggerated reaction to noise, other patient’s conversation, amplified reaction to nearby distractions, and has poor tolerance to exterior sounds, check with the charge nurse for further instructions. .

The physician’s instructions for treatment should include necessary approaches for environmental comfort. Refer to the patient’s medical chart and care plan for instructions and advice. Patients’ response to their intake survey should indicate what likes and dislikes they will respond to and against. PTSD patients must avoid trigger incidents or scenarios to avoid recurring attacks of anxiety and panic attack crisis.

These behavioral afflictions are defensive disorders the human psyche concocts to shield a person from environmental/mental pain or abuse. This patient will be wary, vigilant, and acutely (and sometimes aggressively) combative against unknown situations. Often sufferers of PTSD are extremely vocal. Nurses can utilize this feature of the patient profile to engage them out of a negative spiral. Redirect the mental focus of the PTSD patient onto a pleasant matter or other topic, such as movies or books, poetry or sports. Avoid discussions of politics or crime.

PTSD is a misunderstood disease which many old-school nurses may scoff at or otherwise fail to evaluate a patient for. Nurses should tread carefully with diagnosed PTSD sufferers and use exceptional patient courtesies to make sure such patients feel insulated from their triggering episodes. PTSD should never be made to feel threatened or stressed. This constitutes patient abuse. Nursing or facility staff who persist in creating tense or uncomfortable incidents, or provoke the patient should be reported both directly to management and reported anonymously to the State Nursing Board or the LVN/Psychiatric Nursing Association.

Incidents which recur in the PTSD patient’s life are the situations with sounds, odors, or persons who spark the Post Traumatic Stress Disorder are responsible for triggering painful situations and outsize scenes within the patient’s room, ward, or floor. Nurses and nursing aides of such patients should make sure all patient needs are addressed during each shift. Lab technicians or phlebotomists new to the patient should be escorted by familiar staff. In this way, proper nursing patient care makes certain that the accidental triggers of a particular trauma do not become re-created and take the patient by surprise.

   PTSD patients rely on skilled nursing staff for optimum recovery outcomes. And more educated consumers will know the difference between incompetent nurses and those who just choose to disregard noted interventions.

Nursing for Sports Medicine

Nursing for sports medicine is a big movement in local and general practice health. The popularity of gyms, sports, and teenage and high school league sports, as well as childhood league sports can crowd a waiting room with single patient injuries or an entire team of them. The demands of the nursing challenge for these situations test nurses on their diagnostic skills, patient communication skills, and observational aptitude for patients who may not want their physical conditions commented upon or checked out.

The high school and college professional team sports system is rife with excesses that endanger student health. Education system nurses should brush up on sports medicine for concussions, artificial performance enhancements in teenager and young adults, and other wellness related issues for young athletes and sports participants of any age. Anorexia, alcohol abuse, drug abuse, and illegal substances may cloud behavior and vital signs.  Nurses should learn to read patients of all ages that might conceal or confuse physicians who may not factor in other elements in the patient diagnosis due to a lack of information.

Occupational sports medicine can have a broad range of employment opportunities. A television show where the contestants lose weight should have a physical wellness consultant to examine patients during extreme events and competitions. A recreational cruise should have a competent nurse to review case of passengers who have disabilities or health issue before they come on board.

Nurses should know about the ramification of high school sports and college sports, and recreational sports play and how much delivers patents in pain to the hospital on a regular basis. Sadly, people have a mind to ignore hat their doctor tells them and play anyway. Nurse should be rote in the conditions of sports related concussions, trauma, bruising, bone breaks and sprains, muscle tears and the incidence and symptoms for a diagnosis of concussion.

Nurses for sports medicine might branch off after years of general health practitioner employment or LVN work in the treatment of sports-related concussions and other sports injuries. In children and teenage athletes, there is the potential for serious long-term outcomes, such as brain damage, dementia and other risks such as substance abuse after the injury or trauma. Weekend athletes are prone to even more injury because they are likely out of condition or aging, not warmed up or not wearing suitable support equipment.

Emergency rooms can be filled with skateboard kids, bikers, roller skaters and surfers who refuse to wear proper headgear, pads, knee guards, etc. Participating in sports activities in the wrong time and place can also result in physicial injury. Sports concussions have a window of serious concern following immediate hospitalization where the patient must be scrutinized for brain damage, motor neuron fluctuations, synapse irregularity, or other disorders of the brain.

The competent sports medicine nurse will be able to diagnose and define sports-related concussions and the seriousness of the and the sports in which they are most often found. Family friends, and the patient (and coach) will want to know the immediate and long-term symptoms of bone breaks, fractures, and sports-related concussions. Nurses can take the opportunity in seminars and clinicals to discuss expert recommendations for preventing and managing sports-related concussions, to pass onto students and patients.

The Mechanics of Nursing

nursing equipment

vital statistics 

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.

 

 

 

1 2