Sanity is madness put to good use. – George Santayana
Nurses at the Greatest Hospital in the World are encouraged to treat patients like hotel guests. This mandate from on high has now reached a fever pitch since JC is expected to walk through our doors as we speak. No, I’m not talking about Jesus Christ. I’m talking about JCAHO, an annoying organization that views itself as a deity, hence its new name. Our hotel nurse just left a chocolate on a patient’s pillow and the concierge is making sure that everyone has a filled water pitcher at their bedside. Like the original JC, the hospital staff must walk on water when JCAHO rolls into town.
Here on the psychiatric unit, our goal is to make sure that drug seeking patients don’t make us look bad when JCAHO comes onto the unit. Those bureaucratic pinheads always ask drug seekers if they are receiving enough pain medication to make them comfortable. Yeah, right. Drug seekers whine, moan, and roll around on the floor while accusing the hospital staff of not meeting their needs. Since we don’t want that to happen, our psychiatrist, who usually won’t order narcotics for anyone, is suddenly giving out oxycodone like it was candy. He’s also writing orders for liberal doses of Xanax, Ativan, and Valium. We keep drug seekers stoned and happy when JCAHO is in town.
I’ll hand out pills but I’m not fluffing pillows. I’m a nurse, I’m not a bellhop.
There has been a lot of chatter in the blogosphere about medical bloggers and HIPAA regulations so let me make this very clear: I write composite stories about many different people that I've cared for over the years.
Nursing Scrubs
tammy swofford
August 14th, 2008 at 9:09 am
In acute care, leave that chocolate on the pillow of the client in the midst of a 24 hour glucose tolerance test and see if JCAHO figures it out.
Yes…. I knew it was coming. Make legal stoneheads for the coneheads visit. Business will be brisk the next few days as word leaks out that the candy counter is open at your facility.
Regarding JCAHO, their job security depends on finding problems. I wish I had a dollar for every “problem” they have uncovered at our hospital. We no longer right “IVP” for I.V. push, because someone might think we wrote “IVP” to mean dye. We use “I.V.” as the designation and are careful to note things given “slow I.V.” if we are using Cardizem as an initial dose preceding a gtt or giving Digoxin, etc.
*Will JCAHO notice if all of your clients are sacked out on their beds in semi-comatose manner and missing group therapy??? smile *Pass me a donut with that second cup of coffee.
Tammy
katiebee
August 14th, 2008 at 9:49 am
Don’t forget to pick up the meal trays patients leave outside their door for you. Oh, and nursing call bells are also to ring the nurse to bring packs of mayonaise. Just so you know LOL
Kristi
August 14th, 2008 at 5:47 pm
Well shoot…….what with all those fresh JCAHO inspired paint and cleaning chemical fumes, it’s no wonder your patients need the extra meds! =)
Nathanael
August 14th, 2008 at 11:04 pm
I’ve only been reading your blog for a couple weeks but I absolutely love it. I’ve been considering becoming a RN, and possible even a psychiatric Nurse, for a few months now. Your blog encourages me to switch my major to nursing.
I was considering becoming a CNA and working in a hospice until I finish with my degree in a couple years. Would you suggest it?
Mother Jones, RN
August 14th, 2008 at 11:32 pm
Nathanael: Thank you for the compliment. I’m glad that you enjoy dropping by my blog. I suggest that you go here your heart leads you. Working in hospice will give you a big edge when you start your med/surg rotation when you are nursing school.
MJ
Jessica Bond
August 14th, 2008 at 11:36 pm
Amen! Even as a healthcare administrator, I’ve wondered why all our patient satisfaction scores ask the burning question…”how well did they control my pain…” This is a drug seekers heaven.
Jessica Bond
Laura in Alameda, CA
August 15th, 2008 at 12:52 am
Ahh, the treat them like guests thing. Well, I suppose. Unless they are flipping out and need to be restrained and stuff. Plus, when I worked in a hotel, I never started IVs on anyone..I dunno. Kind of a weird hotel, when folks are sad to come there and happy to leave.
NurseWilliam
August 15th, 2008 at 2:15 pm
Love the new digs!
Sorry for dropping off the planet for the last few months. I’ve been on a personal odyssey and have only recently returned. Leg one is posted at my hangout.
God bless, and please be safe. I would really hate for us to meet at MY place of business…
NW
Jean-Luc Picard
August 15th, 2008 at 3:25 pm
I’ve made it over to the new place! A very good location you have here!
somnambulant
August 15th, 2008 at 6:05 pm
I’m a brand-new student nurse and long-time lurker to your blog. I recently attended orientation where one of my professors informed us that part of our first day will include a test on our school rules/regulations as well as the 2009 JCAHO Patient Safety Goals. I’ve been working in clinics and reading nursing blogs long enough to shudder thoroughly.
tammy swofford
August 15th, 2008 at 9:31 pm
Ah yes, the new nursing curriculum to teach you to be a JCAHO parrot. Please…. do learn to titrate doses of medications and do kilogram to pound conversions, comprehend cardiac outputs, wedge pressures and lab values, acidosis v alkalosis.
Tammy
Healthcare Today
August 15th, 2008 at 9:32 pm
…
It’s JCACO season at the Greatest Hospital in the World, and it’s time to roll out the red carpet…and the narcotics. You know the drill: Keep the addicts smiling while JCAHO is in town….
Mike
August 16th, 2008 at 12:38 pm
With all the focus on healthcare facilities it seems very much like the expectation of hospitals is to be more “hotel” like. I suspect healthcare leaders will be implementing scripting for staff members at some point.
I wonder if we will be making little triangles with the toilet paper in the bathrooms soon? I know this is rather cynical but it seems to be the future of healthcare in some respects.
One more comment that I think all your readers should know. You mention in this post doctors orders with respect to what I assume are prn narcotics. Doctors orders and not orders they are requests. PRN doesn’t mean when ever necessary, it means Per the Reasoning of the Nurse.
AzRN
August 17th, 2008 at 8:38 am
actually PRN is latin for Pro Re Nata and means “for the thing born”; however, in healthcare we take it to mean “as needed”.
and, i would tactfully disagree with mike re: prn physician’s orders being requests. they are what they are…if they were requests, the nursing board wouldn’t mind me writing all the “requests” i felt my patients needed… in particular, the aerial misting of ativan throughout the facility (as needed, of course)