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.




3 Toxic Patient Scenarios-Study Tips

Three Examples of a Toxic Patient- Nursing Study Study Guide
[Use this section as a discussion guide. Consider and argue how it would be best from a nursing point of view to handle the following cases. Support your case with guidelines, advice from nursing hotlines, or hospital or facility policy manuals. ] Real examples of a “toxic patient’ follow.
(a)In a major metropolitan county hospital, one ward included a patient who yelled in the early morning hours about his transportation. Although it was only 2 or 3 a.m. in the morning, the patient got into his wheelchair and sat in the doorway of his room, bellowing about how the nurses needed to call the doctor’s office for the car to come and get him. His howling distracted nurses and completely disturbed any peace of mind for any resident for 500 yards in any direction.
In all of these circumstances, consistent reporting to the physician, explicitly detailed note taking habits, and attentive observation could have prevented anxiety and stress to all parties concerned. But some shift nurses didn’t bother to take the time to document correctly the times and frequency of the incidents. Many other patients complained but were discouraged by nurses uninterested in documenting problems with their part of the hospital. Escalating the matter to senior administrators might have cut down on the amount of total time this patient caused stress and anxiety to staff and patients around him.
Study Questions for Toxic patient Example A: Nursing Study
(1) Should the Director of Nursing have forwarded this case to the resident psychiatrist?
(2) Should one of the nurses have called the whistleblower hotline for the Ombudsman?
(3) Why wasn‘t the patient shifted to the floor of the hospital specifically for Psychiatric patients?

(b) In another scenario, a male patient over eighty years of age was admitted to the nursing home by his family members after a brief hospitalization. He was documented as having entered the rooms of other female patients in the nursing home and acting in a socially unacceptable way. Despite his frequent habit of wandering all around for years, the staff of the facility grew used to him being up dressed and out of his room, unsupervised, at all hours. They simply grew too used to his walking back and forth and stopped keeping track of him.
One day the patient simply wandered out the front door to the street, and down the sidewalk. By the time a nurse noticed he was missing, the four nurses he had walked by couldn’t even remember what he had been wearing to describe to police. The security guard set by the door had been fired to cut costs. The housekeeping staffer they had appointed for that position had been called away to clean a shower upstairs. The long term care facility (nursing home) was on the hook for the incident. The nurse who was scheduled to be supervisor on duty was made redundant (fired), for cause.
Even though the nurse was busy doing ten other things at the time, and the situation was completely normal, institutional responsibility was suffering. Technically the nurse was at fault for failing to direct other staff to prevent this calamity. The nurse should have told others under her supervision to watch the person, follow him, or secure the door. Even though the facility had allowed the situation to deteriorate to a point where the nurses were no longer vigilant, the nurse on duty that day was termed responsible.
If the nurses previous to this incident had completed their shift with documented letters to their supervisors, or copied the Director of Nurses on their notes reporting such incidents, the ongoing risk would have been noted and set into the patient resident care plan. Except that high turnover allowed even veteran nurses to forget the poignancy of such a risk and go about their other business as if it were no longer their problem to watch this man and where he went. The Certified Nursing Assistants blamed the nurses for not reminding them. The nurses were blamed for not reviewing (and updating) the situation in the licensed nurse progress notes.
Study Questions for Toxic Patient Example B:
(1) was the nurse to blame or the nursing supervisor for the shift?
(2) Should the nurse (or the housekeeping employee turned security watcher) have been fired instead?
(3) Does the nurse who was fired have a case with the State Nursing Board to have the case reviewed for Unfair/Illegal Termination Without Cause?
Toxic Patient Scenario C – Nursing Study
At a nursing home several nurses have been alternately assigned to “Jane Marx”, a patient who has a lot of complaints and irritations. “Jane Marx’ has gotten a bad rap from the newer nurses, while the nurses who have been employed a longer period of time have a much better grasp of the patient’s individual maladies. The older nurses know, for example, that the patient’s health had changed and that the patient had gone through a lot of painful operations and suffered through many unforeseen difficulties.
But ‘Jane Marx’ has a habit of putting complaints in writing to the facility administrator about problems that crop up. One of the problems she talks about is that one of the nurse consistency sleeps on the job, and watches TV and surfs the Internet watching Youtube. This nurse is older, and should know better. Other nurses have been fired for using their cellphones and none of the female nurses ever sit on the desk watching TV. ‘Jane Marx” was the patient who reported them. The current Director of Nurses has never lectured the sleeping nurse or cut his hours.
Recent staff shortages make the nurses recall other employees who quit recently. The staff discuss a very good nurse who left the facility months earlier, who got lectured by the Director of Nurses for being constantly late. Yet this male nurse gets to arrive late and wind the clock down doing nothing to ‘make up his time.” “Jane Marx “ has observed the elder male nurse staying late at night, while working nurses were busy, ‘to make up his time on the clock”. No other employee simply gets to arrive late, ‘Jane Marx” maintains, and stay after, doing nothing past their scheduled time in lieu of real work during their earlier scheduled time.
The nurses learn that ‘Jane Marx” has been raising the topic of the sleeping nurse in her care plan meetings. She has been consistently catching this nurse napping at night at the desk. No other employees of the facility ever sleep on the job. “Jane Marx” has been told that some of her treatment options are too time-consuming to pursue. Every night that “Jane Marx” comes out and find a nurse asleep, or twiddling his thumbs to “make up his time”, she argues there is time for her treatments and that the facility is not organizing its staff resources properly.
But “Jane Marx” argues that as long as nurses can “hang around watching TV” there should be enough staff to get the extra stuff done. The nurse in question often drifts around nibbling snacks and reading, waiting for the clock to wind down. Many employees dismiss the complaints of “Jane Marx’ on this topic due to her other many complaints. The day the Department of Health came around, asking questions, many nurses were startled. The agency was taking note of all this patient’s reported sightings of the sleeping nurse. The nursing home was cited and fined.
Study Questions for Example C, Toxic patients, Nursing Study
1. Why Couldn’t Peer Pressure have kept the nurse from sleeping on the job?
2. What steps should the Director of Nursing have taken to prevent this situation from happening?