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Answers to Your Nursing Career Questions

Accountability and role changes

March 19th, 2011 by – Sue Barton

  I was assigned to work as a nurse aid in a MICU. I am a RN and do not have
the training in MICU. The facility stated I would not be held accountable
as a RN. I do not agree. What do you say?

I say get some legal advice.  You are asking a legal question, and the facility may not have your best interests in mind.  You may be able to access legal advice from an attorney in the health professions field through your local or state nurses association.  Your state board of nursing should also be able to respond to this question.  It is an interesting one in that the facility is asking you to perform in a role that is under your skill level and licensure.  More often it seems nurses are in positions where they are called on to perform tasks that are outside of their scope of practice.  Clearly, in those cases,  nurses may be held liable for actions that are not within the scope of practice for their licensure level as defined by the state nursing practice act.

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Malpractice insurance for nurses

March 10th, 2011 by – Sue Barton

  I’m going to be finishing nursing school this spring and looking for my first RN job.  Will I need to get malpractice insurance?

Your employer will provide malpractice coverage.  You will find that some nurses also carry their own individual malpractice insurance.  As you look at nursing positions, ask about the type of malpractice insurance that is provided by the institution.  Here are some questions to ask:

Am I covered for off-duty situations?  If I am helping a neighbor or volunteering in an activity such as screening clinics, am I at risk?  Is the coverage portable?

What are the liability limits?  Are they comparable with other institutions?  Are the limits shared with other staff named in a lawsuit?  Will a defense attorney defend me or the institution?

Does the policy cover me for claims made about an incident at this institution if I have left employment by the time the suit is filed? (An occurrence policy will protect you at any time in the future as long as it was in place at the time of the alleged incident.)

Is there coverage for defense of my nursing license if needed?

The American Nurses Association recommends that nurses carry individual liability coverage and provides discounted coverage for members.

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Nurses and mental illness

March 7th, 2011 by – Marijke Durning

We can’t avoid it: news of Charlie Sheen’s behavior is all over  – and not just in entertainment news. But maybe instead of laughing at him, we should be concerned about him. Although he hasn’t been diagnosed, many who are familiar with bipolar disease and mental illness feel that this is exactly what is happening to him.

Maybe it’s not easy to identify with someone who has millions of dollars and lives life like Sheen does, but you don’t need to be famous or rich to suffer from mental illness.  One of the nurses you work with could be living with a mental illness. And when we laugh at public personalities who may be mentally ill, what does that say to the person next to you who may be fighting the same demons?

The most common types of mental illness are depression and anxiety. In fact, a study published in 2009 in the American Journal of Nursing, found that mild-to-moderate depression was common among nurses. According to the study:

“Somatic symptoms, stressful major life events, greater occupational stress, and lower income were correlated with the presence of depressive symptoms. Fatigue and low energy were bothersome to 43% of nurses; pain in extremities and joints, trouble sleeping, and back pain were also common. Having a mortgage or loan of more than $10,000 within the previous year was the most commonly reported (43%) stressful major life event. Others included changes in sleeping habits, vacation, and holidays. The most highly ranked occupational stressors were having insufficient time to provide emotional support to a patient and to complete nursing tasks, being required to complete many non-nursing tasks (such as paperwork), and inadequate staffing.”

What about other mental disorders?

According to the National Institutes of Health, one in four American adults have a mental disorder. There are so many mental disorders that it would be impossible to list them all, but some of the more common ones include:

- Bipolar disorder

- Eating disorders

- Obsessive-compulsive disorder

- Panic disorder

Mental illness is a hidden disease. It’s highly unlikely that a nurse with a mental disorder will share this with his or her coworkers because of the prejudice often seen towards people living with these illnesses. Perhaps we should all take a step back and look at  how we react to the different news stories that we see and hear about personalities and how they’re behaving. Our reactions to them may be very telling to those around us.

Posted in On-the-Job Fears

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3 reasons nurses make medication mistakes

February 28th, 2011 by – Marijke Durning

In nursing school, one of the most important things nursing students are taught is how to prevent medication mistakes. Whenever you give a medication, you must have the:

- Right patient

- Right medication

- Right dose

- Right time

- Right route

And yet, medication errors still happen. How is that?

1- Misinterpretation of the doctor’s order or an incorrect order

Doctors’ orders can be difficult to understand. Part of a nurse’s role when transcribing orders is to ensure the orders are correct. If she has any concerns or questions about an order, it is vital that she question the order rather than assuming or guessing.  However, mistakes aren’t always done because an order is misunderstood – sometimes the doctor makes a mistake. This is why the nurse, again, must be very prudent. By knowing the different types of medications she has to give and looking up those she doesn’t know, errors should become apparent.

2- Incorrect transcription of medication order

While transcribing orders, the nurse shouldn’t be uninterrupted, leaving him or her to concentrate on the task at hand. Unfortunately, this doesn’t always happen and the nurse can become distracted and make an error in the transcription. Even when double checking, the nurse may not notice the mistake.

3- Break in the 5 Rights

Many nurses know that feeling – that feeling that hits as soon as they realize they’ve given the wrong medication to the wrong patient. The same happens when the nurse has picked up the wrong medication to give to the patient. Many errors happen when there’s a break in the 5 Rights, often due to inattention or distraction from other people while giving out medications.

These three reasons are preventable. We just have to remember to use the utmost attention when giving medications.

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Correcting an error in a patient’s chart

February 25th, 2011 by – Derek Brocklehurst

If you make a mistake on charting what’s the proper way to correct it?

Charting, or documenting your nursing notes in a patient’s chart, is an important aspect to nursing care. Charting properly can prevent ethical, legal, and safety issues from arising. When learning how to chart, pay particular attention to the timing of procedures. You want to make sure the exact times are recorded for assessments, evaluations, blood draws and medication administrations. At any time, JCAHO, or the Joint Commission on Accreditation of Healthcare Organizations, can show up at your health care institution and scrutinize your work. Be prepared by organizing a clean and easy-to-follow chart!

If you make an error or mistake in a patient’s chart, do not use white-out or make multiple cross-outs to the error. The best way to correct an error is to make a single black line through the error, date and initial next to the line, and write in the correct information above or next to the line. Never throw out the piece of paper and start all over as that would indicate you were trying to hide something.

Make sure you check out Medi-Smart’s Do’s and Dont’s of Nursing Documentation directory for more information.

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Nursing self-assessments: part of growing as a nurse

February 18th, 2011 by – Marijke Durning

Do you have to do self-assessments at work? Often as part of nursing evaluations, nurses are asked to do their own assessments: how do they feel they are doing at work and what do they feel they should improve on.

While it seems that this could be a good tool, many people who find themselves in the situation don’t always agree. It’s not always easy to take a look at how you’re doing in your job, being as objective as possible. Some nurses are much harder on themselves than they should be, while others seem blinded to any faults they may have. The only way for a self-assessment to be effective is to do it fairly and honestly – after all, they are put in place to help you be a better nurse.

The issues in assessing ourselves are many, whether you’re a nurse, an engineer, or a salesperson. Some skills and tasks are easy to assess, while others are much more “surreal,” so to speak.

For example, nurses start intravenouses (IVs), insert catheters, give medications, chart observations, and so on. Either you are starting your IVs properly and successfully or you’re not. You’re either inserting catheters properly and successfully or you’re not. Medications are given at the right time to the right patients in the right form or they’re not. But, is your charting good? Is your communication effective? Are you a good team player? Are you a good leader? How do we assess these?

If you know your self-assessment is coming, it may help to sit back and take stock of how you’ve been working the past while. Here are some questions you may want to ask yourself:

- Do I come to work on time? Am I prepared to work when I get there?

- Am I working effectively, in an organized manner?

- Am I having trouble getting all my work done by the end of my day?

- How do I react if someone criticizes me or complains about something I have done or not done?

- Am I a good teacher when I have to explain things to patients, family, and/or colleagues?

- Do I ask when I need help? Do I offer help if I see someone else needs it?

- What would I like to do better? Where would I like to improve or what new skills would I like to learn?

These are all questions that can help you look a bit more objectively at how you are doing your job. We all like to think we’re good nurses and many of us are. But we need to look at ourselves honestly to see where we can improve to be sure that we are good at what we do.

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What is a clinical documentation specialist?

February 12th, 2011 by – Sue Barton

  I just started working as a clinical documentation specialist.  It’s an interesting and challenging job; but sometimes people don’t see this work as really being a nurse.  I was doing bedside care for years, so to me it’s a logical career move now.

Nurses today wear so many hats that it is long past time for all of us to support those nurses in nontraditional roles.  There is a tendency to be a bit snide about the “white coat and clipboard” nurse who is working with policies and papers rather than at the the bedside.  The reality is that in these diverse roles, nurses are using their experience and education to contribute to better patient outcomes.

According to Paul Weygandt writing in this article called “The Clinical Documentation Specialist: A Key Member of Quality and Patient Safety Teams,” which was published on the Patient Safety and Quality Healthcare website,  a Clinical Documentation Specialist, or CDS, is an experienced RN “with additional training in documentation rules and regulations, definitional nuances, and opportunities for improving documentation.” By reviewing medical records and identifying risk factors, the CDS is in a position to make important contributions to both safety and quality of patient care.

You can learn more about this role, including certification and networking opportunities from the Association for Clinical Documentation Improvement Specialists website.

Posted in General, On-the-Job Fears

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Nursing care plans 101

January 28th, 2011 by – Derek Brocklehurst

How many days does a care plan need to be completed upon admission of a patient? How many days does it take for it to be evaluated?

Nursing care plans are an integral part to a patient’s long term care and well being. As nurses are pushed to work longer shifts and see more patients, it becomes even more vital to complete a comprehensive nursing care plan for new admissions at the end of every shift. When a new nurse comes on to shift and takes over for your patients, your nursing care plan should already be completed and easily understood. All newly admitted patients should be comprehensively assessed in order to formulate an adequate and proactive care plan.

Nursing care plans can be evaluated by the primary care providers, other RNs, charge nurses or nurse supervisors. This might happen over the duration of the patient’s stay in the hospital. The Joint Commission on Accreditation of Healthcare Organizations, or JCAHO, may perform an audit of your hospital, thereby scrutinizing your charts, care plans and work. It’s important to always keep care plans up to date, refreshing lab data and altering nursing diagnoses as the patient’s health deems so.

Check out Medi-smart’s Nursing Care Plan Resources directory for more information!

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Posted in Common Nursing Procedures, On-the-Job Fears

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Accusations and allegations against a fellow nurse

January 24th, 2011 by – Derek Brocklehurst

I suspect that one of my coworkers indirectly robbed me of $6,200. Is this considered unprofessional conduct on her part? Can I report her to State board if she fails to return my $6,200?

Before you begin to notify your supervisors of a potential accusation or allegation, you want to make sure you have not misplaced funds, miscalculated amounts or otherwise made an error on your part. Accusing someone, whether they end up proven innocent or guilty, will cause a barrage of investigations and questions from authorities.  A nurse found guilty of stealing will potentially lose his or her license, causing huge lifetime changes. Make sure you are fairly certain of your allegation before accusing a fellow nurse of wrongdoing.

Accusations and allegations are taken very seriously by your employer as well as the State Board of Nursing. If you are suspicious of a co-worker’s activities, notify your charge nurse or nurse supervisor immediately. You do not want to do any personal investigating as that may only confound evidence for the case. Notifying your supervisor will allow for the proper investigation to proceed with minimal confusion. When you notify your supervisor, they should notify the prospective authorities, be it your State Board of Nursing or local police enforcement agency. Be sure to keep any documents, receipts or documentation you believe is evidence for the case at hand.

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Nursing Student Documenting

January 10th, 2011 by – Derek Brocklehurst

Can vocational nursing students document in a patient’s chart? What are the legalities?

Great question. All nursing students should be under the direct supervision of a registered nurse who is employed at the health care institution. It is important to remember that the #1 priority for a nurse is to cause no harm to the patient as well as to ensure patient safety. Therefore, the nursing student is responsible for speaking up during procedures that he or she does not understand.

If you have questions about how to perform an assessment, administer a medication, or help reposition a patient, ask your nurse supervisor or another nurse in the vicinity. It is important to document everything you do to a patient, as well as the time it was performed. In order to avoid legal liabilities, you must make sure your registered nursing supervisor dates and initials at the bottom of the chart, so as to demonstrate it was looked over and approved by a licensed health care professional.

Make sure you check out the Medi-smart Do’s and Don’ts of Nursing Documentation directory for more information on how to properly document in a patient’s chart.

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The material on this site is for informational purposes only, and is intended as a supplement, not as a substitute for medical advice, diagnosis, or treatment provided by a qualified health care provider.