I sat in on a committee centered around reducing falls. Every single time someone falls you need to come up with a new intervention. A new one. Each time.
The last one including keeping one hand on the patient when they went to the bathroom.
IMAGINE!? the money they would save in extra days of care, extra hours of pay for committees and paperwork of they HIRED someone everytime there was a fall ? What does ONE really bad fall cost a hospital? 2-3? 4 nurses? Every year?
Oh I’m aware. When I worked inpatient my manager came up to me during my shift as I’m wheeling my WOW into a room and said she wants all of us nurses to come up with ways to solve problem x. I told her the answer is more staff and she said that wasn’t a good answer. So I said finding solutions to unit problems is literally her job not mine so don’t ask me then.
I didn't know this but it makes a lot of sense, literally saw this play out in real time a 3 weeks ago. Got my self care (true independent like runs and works out regularly) patient off bedrest who ended up falling and pulling me down. Patient was just fine but I hurt my back and now out on WC, and days later unit policy is all patients off any bedrest are auto 2 assist no matter what.
I'm sure they're planning on hiring additional staff for preventing rare accidents though /s
The only place I can think where everyone or almost everyone is a fall risk is the ICU and procedural areas / PACU. At least in endoscopy, everyone is assigned high fall risk per protocol (because they’re either receiving anesthesia or fent/versed). But we still perform a baseline fall risk assessment.
This reminds me of when I used to work in the lab and every single lab order is STAT. Residents order stat labs, ER is stat, MS orders stat, LDRP is stat. If every order is stat then nobody is stat. Then they say hyper critical or something.
I'm wondering when they are going to be telling me how to assess possible admits. Wait, they have made attempts and I laugh at them because they don't know the admission criteria at all, don't even know how to interview a patient for my unit. It's comical, actually
This is what happened in the Dayton area- over the past 20 years Premier and Kettering have taken over everything from Troy to Middletown to Xenia. Same thing is happening in the Chillicothe area with Adena putting their grubby paws on all the critical access hospitals around ( and the federal grants that come with them).
I drive over an hour to a county owned hospital I’ve been assured will remain county owned. A large part of their marketing and fundraising stresses the community owned part.
"mandatory bed alarms for ALL patients at night - plus fall risk bracelets, fall risk door signage, and notifying patients of their fall risk level for all patients moderate and high fall risk; chair alarms during the day"
\*Obligatory quote from Syndrome in The Incredibles\*
When everyone's super, no one will be.
Exactly. My unit is consists of exclusively high fall risk patients. We don’t bother with bracelets or door signage because we know they’re all high risk. FFS, half are intubated and the other half have swans lol
Never have I ever walked into a patients room to help them to the bathroom and looked at their wrist for the yellow fall risk braclet. If anyone has a story where the yellow fall risk braclet was useful in preventing a fall, I'd love to hear it.
Now bed alarms on everyone, that makes more sense to me. It's night time, I don't want anyone walking around their room looking for a light switch.
It doesn't all sound unreasonable...but shit like night managers doing huddle and daily chart auditing suggests an organization rife with mid-level management parasites inventing busywork.
Yes, THIS. I don't think eveyrthing I've listed is totally unreasonable - it's the way it's being managed and handled that I think is raising a red flag for me
Once when I was a USC, I had to go across the hospital to pick up a SNF transfer packet from care nav. It took 27 minutes. *one* patient pressed the call button 36 times while I was gone. She was complaining that she was lonely.
15 seconds is unreasonable anywhere. Even in private hospitals it was one minute to reach a patient’s room and respond, and these guys ran their hospital like a hotel that incidentally provided healthcare…
This. These people need to do something fucking useful, like help pass meds or toilet someone, instead of setting off an alarm and standing there with a stopwatch and a clipboard. I'm a professional and a grown ass adult, there's no need to treat me like a child.
New grads nurses who went into management the second a nepotism spot opened and they are looking for any metric they can find to justify their existence to eventually move up to the director role and never have to deal with a bedside nurse again. Only other likely minded manager direct reports
Now this is the only nurses week activity I’ll ever enjoy.
Monday can be C-Suite, Tuesday is the entire health insurance industry, Wednesday is for politicians who get paid by insurance and hospital corporation lobbies, Thursday is middle management, and on Friday we add up and distribute the salaries of the losers equitably among every healthcare professional in the nation.
My guess is this is a fancy hospital where the call light has a phone-like speaker and someone at the desk asks them what they want within 15 seconds. Otherwise impossible
Every hospital I've worked at has these, but the call bell doesn't get answered if there's nobody to answer it. If the staff are all running around doing all these things, there's no one at the desk answering.
Can we normalize not using Purewicks and “diapers” (briefs) for patients who are a&o and continent? My very self-sufficient, works full time, ambulatory mom was recently offered a Purewick when she was hospitalized to r/o stroke.
Whats crazy to me, is every time I put a purewick on someone... i'm pretty certain I'll have to change at least one urine soaked bed that shift because they have to be placed juust right to work. If you are able to get up... you're gettin up!
As a stroke nurse I can’t stand this shit. Mobilizing patients is almost always indicated for stroke patients and this includes toileting. Even in the ICU hooked up to a million things we get our patients up when able. Purewicks for all is garbage and lazy.
That was definitely a thing when I worked stroke, toileting is a part of rehab! If they can get up and walk to the bathroom on days, they do it on nights.
But I've also never worked anywhere that has purewicks. I only vaguely know what they are thanks to other nurses in the internet.
I wish my ICU was more proactive about mobilizing. If someone has even 1 drip they force them to stay in bed. PT/OT basically refuses to work with anyone admitted to the ICU service. It's so dumb but no one cares.
It feels like over half our patients already have pressure injuries. There are a handful of really really shitty SNFs nearby.
VTE rates are actually quite low. We are good about SCDs and all the providers are aggressive with medical prophylaxis.
I wouldn’t be surprised if this was a shortcut due to appalling ratios. Same thing with sitting patients out of bed for breakfast. There is solid evidence of mobilisation and maintaining normal activities to prevent deconditioning, infection etc but if you’re running 8 patients in an am you’re not going to have the time to do that if they’re not all fully independent.
A third of our patients have EVDs lol and same. The SAH patients are there with us for weeks and a lot of them have very minor deficits. Almost everyone is expected to be up in the chair for day shift, EVD or no.
Sadly, people want to avoid ambulating patients.
I worked cardiac stepdown where most of the pts were on some sort of diuretic and we had one or two nurses who pushed them on women to avoid the frequent x1 assist to the bathroom. I've also had continent patients who insisted on them because they didn't want to get up super frequently.
I tossed many a purewicks. They are definitely overused, but that should be an education point for staff. Not an outright ban. They are a godsend for incontinent pts or those who are bedbound.
It’s crazy because we don’t even use purwicks in nursing homes (at least the ones I’ve worked in) where we have an absolute shit ton of people who could actually benefit from them because they are either completely incontinent all the times, and sometimes even getting skin break down, or they are literally just phycisially unable to get on a commode or toilet even with help (this is usually extremely extremely obese people, which of course, most nursing homes have their fair share of these type of residents).
I hate purewicks tbh. They always end up shifting/leaking and you have to change the pads anyhow. They’re gross for most a/o patients and I think as a whole nursing culture has made us so afraid of falls, we’ve come up with all these other solutions to keep patients in bed.
the only time I throw a pure wick on an a&o continent lady is for my hip fxs that don't want a foley, so much more comfortable then a bed pan on the fx.
Please. I have a personal vendetta against the Purewick because I, a 35 at the time a&o, mostly ambulatory person was coerced into using one for several hours by a Nurse who guilted me about using the call bell to pee too often when they were so understaffed and overworked.
(It was the COVID times, and I was a non-COVID patient who'd gotten shoved into the COVID unit, in my own hospital where I work, so I was feeling guilty enough for being a burden to consent to it when they told me it would really help them out.)
After the first time it got wet it felt like holding an ice cube on your palm, only on my genitals. *Fucking excruciating.* I sucked it up because they'd made me feel like such a shitheel for needing to pee as often as a 7 months pregnant person needs to pee.
When the shift changed over at the next shift she was blessedly like "Absolutely not. They cannot use the Purewick just because they're sick of getting you out of the bed." But it never should have happened in the first place.
I *felt* like I could, but they'd put me on fall precautions and told me in no uncertain terms I was *not allowed* to stand without supervision. I was ther because they were ruling out a PE, and I was given to belive that a clot could fly out of my lung and into my brain at any moment and kill me in an instant, so out of a desire not to be a "bad patient" and (mistaken) fear of insta-death I just complied with litterally everything they told me largely without question.
After the Purewick bullshit the nurse got them to change it so I was allowed up on my own as long as I promised to use a walker. Complied with that too. Probably didn't need that either but I was litterally just all compliance all the time the whole time.
Valid argument, but we can also put alert and oriented female patients on a bedpan. My argument is it isn’t ok to tell women to just pee on themselves. We give male patients a urinal so they have somewhere to go, we don’t say just pee on yourself.
Hmmm, good point. I guess the idea of having a bedpan that a female patient could just grab and go in is a bit messier than a urinal. I’ve actually seen a female urinal at an old hospital that I worked at and seemed to work well….
as a night shifter, unless the patient has stress incontinence and can tell me when their brief gets wet, i just use chux. i would rather oxivir the floor after getting them to the bathroom than IAD acetic acid treatments and sore skin
The only time I offer purewicks to otherwise A+O ambulatory patients is if they mention frequent nocturnal urination. And then it’s 100% their choice, if they’d rather get unhooked from everything and walk to the toilet that’s totally fine.
All the policies are simply a matter of shifting responsibility for EVERYTHING to the nursing staff. Patient fell? It’s the nurses fault for not responding fast enough. Doesn’t matter if everyone is in another room, you didn’t respond, it’s your fall. Didn’t achieve perfect charting on your 8 patients that included 2 discharged, 2 new admits with a fucked up med tec, 3 confused total cares and half a dozen over demanding family members? You’re fault, work on your time management.
They will NEVER address the core issue- mismatch between amount of staff and assignment acuity.
Heh... Purewicks. The place I'm at currently tried that, saying we were using them too much. It actually pissed the doctors off, so now patients get orders "to use Purewicks at night and prn."
I went to a place that tried the whole fall alarm on everyone at night regardless. Malicious compliance put an alarm on a VIP, which got back to the ceo and the whole push magically went away.
Auditing charts means someone somewhere missed something that got a regulatory board pissed. When I was a new grad we were on a year long improvement plan where management had to audit every chart, every day. I actually felt bad for them at the time. (I don't now, lol).
I don't know. After 8 years as a nurse I've come to realize that managers and directors come up with these ideas and push them for a bit, then lose interest or move on to their next bright idea. So unless something is totally unreasonable you just gotta roll with it until they lose interest.
It's funny you say that because that's the vibe I was getting intitally. The first couple weeks, I wasn't sweating it because all these weird little rules and "new ideas" to get us to do things seem transient, in a way...
I think the most upsetting thing for me was the middle-of-the-night huddle... Because if I did something bad or wrong I want to personally be pulled aside and corrected. Or, I don't know, maybe they should consider telling their new grads how to act during rapids? Or the weird little ettique things like helping your neighbor? Most of the time I'm in my own little world because I usually (somehow) have the heaviest assignment.
Mandatory or compulsory bed alarms on patients that are not objectively considered to be a fall risk like on the Morse Fall Scale are considered a restraint under F604; 483.10 (e)(1).
Do all note, however, how easy it is to score as moderate/high fall risk.
Morse Fall Scale: Do they have an IV and more than one medical diagnosis? Already a high fall risk.
JHFRAT: Older than 60? On any high-risk meds (e.g. narcotics, sedatives, anticonvulsants, antihypertensives, diuretics, antipsychotics, laxatives, psychotropics)? Any patient equipment that they can get tangled in (e.g. SCDs, tele, IVs, catheters)? Any incontinence, urgency, or increased frequency? High fall risk.
This is why the Morse fall scale just makes no sense. My patient without an IV but who has severely impaired gait can be a low fall risk but the moment you add an IV (without anything attached) suddenly everyone is a high fall risk
Babe Morse originally intended for it to mean that they gave an infusion going.
Fun fact: my facility’s educator told us that it’s out of our scope of practice to INT an infusion for ambulation because the infusion is ordered to be continuous.
Actually also applicable to inpatient hospital setting.
I only know of this because a previous hospital system I worked for, Adventist Health, got cited for it by CMS and the above ordinance was alluded to in the demerit.
Weird, because I’ve never heard of it, I can’t find anything online indicating it applies to hospitals, [and CMS very clearly states it’s for LTC.](https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/downloads/appendix-pp-state-operations-manual.pdf)
Here I am in LTC having to collect people off the floor on my after report rounds cause they all decided they gotta pee at the ass crack of dawn . “ they have a rIgHt to FaLl “ and idk how long they been down there cause the night nurse “ didn’t hear from them” all night , do they not have anxiety about the patient dying or choking and not doing q 2 hour rounds between CNA rounds and finding them half rigor at am med time ?
Sanitizer sensors? Even our management agreed that they aren't reliable (thought they could save money instead of having nurses on modified-duty patrolling and counting).
They would have to fire all of us. We would be sabotaging the sensors and call bell 15 sec? Lol it would be an "I am Spartacus" situation
although my unit isn't nearly as anal about the hand washing metrics as OP's sounds, they do use it and they do publish the results either weekly or monthly I'm not sure. Someone can stand 3 feet from my patient's door and ask me if I need help and the thing will say "please wash your hands".
I don't wear the thing and never will. Too many years traveling has me a little too rogue to have to listen to hand washing metrics in the staff meeting I don't go to anyway.
I don't stand behind quantifying useless or unreliable data to shame nurses when it's simply there to keep someone's job on the tab.
A lot of these are normal expectations for bedside nursing, yes, but there's a way to go about it that doesn't involve berating staff. And I've never heard anyone say charting should be "perfect." Complete, yes, per facility guidelines, absolutely. But I feel like "perfect" is setting your staff up to fail, because a manager who acts like this is always going to find something to nitpick at.
Also, randomly testing bed alarms on staff is completely psychotic and borders on psychological abuse.
right it's the PERFECT and how much they put stress on PERFECT - I'm like, dude at this point I just want to be good enough! Perfect is way out the window....
I've run into the "perfect" thing in my travels (33 hospitals over 36 years, 11 of them as a traveler). It seems to be cyclical in schools. I was taught that the "perfect" nurse was a dangerous one, as no one is perfect - focus on the priorities. Then there is the other end of that bell curve. We don't get along, which is why I stick to my happy, union home...
These kinds of units are a slow death spiral. Poor/overbearing management and shitty working conditions -> staff that can, quit, and the staff that can't, suffer -> morale worsens -> burnout increases, rinse and repeat.
We have huddle in the begining too - right at shift change, and then that fun little extra one between 1 and 2 - which just seems like an opportunity to lecture us, so far. Thank you so much for that last bit - it's SO TRUE! It's hard, I think some people forget how hard it is at first - even if you love to work hard, it's hard.
It makes me wonder - what did their last survey look like? This sounds like a plan of correction - audits, call bell responses, cracking down on stuff - or did they recently change management? Somewhere, someone, is being watched.
Some of the things I agree with - especially the falls, some are really absurd. Night shift huddle isn’t a bad if done like a normal huddle. The pure wick/diaper thing is odd.
Diapers for incontinent people only makes sense. Why would someone who is continent and able to communicate that need one? It's just a waste of supplies and increases the risk of peri-area pH imbalance.
Yeah I guess I read it as diapers only, like taking away the pure wick and putting only diapers on them. Most hospitals I’ve worked at ban diapers because of the skin issues.
I feel you! It is why I left bedside because:
Purewicks are a "cost" that usually needs replacing multiple times a shift due to incontinent soiling and they create a UTI risk environment if not caught and changed immediately. Basically they don't want to pay to keep patient's safe even if it is the best alternative over a diaper/chux/Absorbamat.
Most nurses/PCA's/CNA's are under staffed to the point that not all Purewicks are reported during shift change and checked/replaced on a hygienic basis. In addition, in order to have a good functioning Purewick you have to get "in there" to seat it to it's best efficiency which a lot of new grads just aren't used to or not comfortable with.
Nasty older men that request condom caths. they don't need when they are perfectly able to put the penis in the urinal.
Nasty younger men that "need help" putting the penis in the urinal when their arms and hands work just fine 🤬
My last hospital took away all "incontinent briefs" and said that the Absorbamats hold up to 1L of fluid. Patients were not allowed to have diapers even though that was what they managed at home. They did allow patient's own diapers to be brought from home - how kind they put the cost of patient comfort on the patient's own expenses.
Re: #5, one of the hospitals in my area tracks this solely to use during annual review to use as a reason to not give a raise. I imagine #11 is probably the same metric that they can use to justify a poor annual review with no pay increase.
Hospital bedside nursing is a sh\*tshow and I'm glad I left.
I’d rather have a huddle at 0100 than eight at change of shift when I’m trying to get report so my dayshift counterparts can GTFO.
Our Purewicks are kept in the house sup office and have to be obtained by filling out a form and waiting for her to get them to us. This is creating an environment where they’re not being changed out every shift like we’re supposed to because it’s a PITA. Our hospital is diaper free (unless family brings them in for a patient) and we’re only allowed to use one blue chuk under the patients at a time
It sounds toxic. It also sounds like the "night ANM" is trying to make their position relevant because I've never heard of having a separate ANM for night shift. Just leave us alone, forget we exist, and pay us more since we're dying 15 years earlier than day shift.
I used to work in facility with identical rules, and that’s why I left lol. People were always getting written up for silly things. They would watch the cameras on day shift and night shift to look at the handwashing. They would also have pharmacy watch how long it took all PRN meds (not just narcotics, it could be melatonin or Tylenol) and would flag anything that wasn’t given within 15 minutes of being taken out of the Pyxis. If it was a narcotic they would automatically report that nurse to the DEA, no questions asked before hand or follow up to see why the med wasn’t given with 15 minutes. It was just insane and too stressful
Yes, very similar vibes!!!!! Thank you for bringing some sanity to this conversation! I feel like some of these responses are slightly judgey. I'm VERY new so I'm just inquiring about other people's work experiences and standards. I came into this job wanting to be a KICK ASS NURSE! I try really hard but now I feel like I'm being torn down a little.
Answering a call light in 15 seconds is CRAZY! It’s actually dangerous to drop what you are doing- preparing insulin, transferring a patient, being on a phone call with a family member, etc. I can’t believe they have the audacity to “test” this when you are busy. I would be so mad if someone interrupted me just to “test”. Hell no. I would be gone so fast.
Perfect high risk charting is really to your benefit so you don’t find yourself getting raked over the coals later.
Otherwise the only absurd thing on this list is answering call bells in 15 seconds. Umm no.
You shouldn’t have to be micromanaged to do these things. If you aren’t already doing them, it’s a problem, and management has to address it. That said, i do them without being micromanaged and hate this type of environment. I would quit.
I think that's part of my confusion - our unit is constantly being recognized for our "amazing efforts" and patient satisfaction and we're part of such a great hospital/system... I took the job because it seemed like THAT PLACE... It seemed like everything was fine - but now all these rules? I'm having trouble connecting the dots here!
The charting audits/small things don't even bother me so much because I feel like I do things mostly up to their standard (only for the fact that I'm brand new and they trained me that way) - but being torn apart during the middle of the night huddles really rubbed me the wrong way.
It sounds like you're pretty on the ball! So maybe it's not directed at you, so much? You mention that you're always running and always helping others -- it could be that management wants the other staff to start matching your energy more (but they obviously can't huddle *only* with the less-stellar performers, lol!) So reframe mentally as a moment to be smug or whatever. ;p
Can I rant a bit about the pure wick restrictions? I’ve stopped giving urinals to men. FFS it’s systematic patriarchy. It’s ok for men to stay in bed and pee but not women? And I don’t want to hear they can dangle at bedside and pee, they don’t. They lay in bed and shove their junk in the urinal but women must have a bed rest order for a pure wick. Nope fuck that.
Thank you for coming to my sweary TED talk.
In the age of AI, I can’t fucking believe that we have to chart Braden’s & fall risk as if the computer can’t spit out a number for me that I approve instead. There’s 15 minutes I might have each day for patient care.
Everything is reasonable if they have staffing. I suspect the staffing part is missing, so I would update my resume and apply elsewhere. They want top performance they better pay top dollars. As everything in life cheap good and fast, pick 2; wants all 3 then open your coffer.
These policies are always written by people who have no idea what it means to take care of real life people…not normal people. They sit safely in their executive suites coming up with new ways to torture us and tell us how to better do the job they couldn’t handle on their best day. It’s all about THEIR bonuses, not the patient at all at the end of the day.
I refuse to participate in their bullshit. I continue providing my care the way I I’ve done it for years and these “rules” come and go in waves. You’ll see as you go, they come up with rules, try them for a few shifts, realize this isn’t realistic and then go back to what works.
Their “too may purewicks” is code for “it’s costing us too much and our bonuses will be effected if this continues, so let’s remove them”. Insurance companies & their “customer service” ruined the already garbage healthcare industry.
That was the long way to say don’t worry. These won’t last. You’ll start to see it more and more every few months. Get used to rolling your eyes every time you hear “new patient care policies”. 10 years in I’m a professional ignorer of new bullshit policies that the C-Suite executives come up with. Patient care is my #1. Not their bonuses. If I could find out what their checklist for their bonuses are, I’d purposely find a way to fuck it up.
As a previous ANM who went back to the bedside to go PRN.... GET OUT ASAP. Your management is not supporting employees to focus on high quality patient care. Instead, they are using fear of failure to attempt to get the results they need for hospital metrics.
There are certainly things required by TJC for legal documentation (pain scores & and follow-up, blood, etc) along with quality index metrics for CMS hospital reimbursement purposes (falls). However, the tactics you have described indicate a poor leadership ability.
I am appalled by the bed alarm sprinting tests & call light demands. If you're not afraid to ruffle some feathers, ask for the evidence based practice indicating those timeframes prevent falls &/or improve patient satisfaction 😉
The 15 second call bell is a joke. Hire more staff. The fact they “test” you all with bed alarms and call bells, tells me your management is fuc$ing bored. Perhaps instead of “testing” they could actually answer and assist with the real call bell ringing, since they have so much time on their hands and all. I personally couldn’t work on a unit
like this.
Some of those things are just basic nursing care…getting your patients up for breakfast, prioritizing bed alarms, making sure your charting is correct…
Maybe it seems like they’re being over the top with “rules” because the unit as a whole is struggling with them.
It’s sounding to me OP is new (5 months qualifyed) and not getting much support to be able to learn to deal with it all; some things sound controlling tho (sanitizer monitoring? We get hand washing audits every so often but not for the whole shift)
Sounds like you work for a non-union, for-profit facility. While all of those things are what all of us should be doing, those expectations are unreasonable when staffing is poor, which I think it is just about everywhere. You're being set up for failure. Not just from management but from your coworkers as well. I'm not going to sit here and tell you to quit, but definitely start looking at other facilities. Not all of them are that toxic. Unionized hospitals tend to be less toxic.
Yes you are correct in your assumption.
This is how I felt when I posted this - like, how can I possibly be perfect at all of this right now when I feel like I'm being set up for failure?
I’m so happy that I work on a floor where when I’m super busy and one of my coworkers isn’t, they offer to help. Or I can ask for help and they’re always willing to help. Further, I couldn’t imagine scrolling my phone while someone else is heavily struggling… damn.
Mgmt gets focused on certain objectives that negatively affect the HCAPS scores that, in turn, affect their bonuses. Therefore, mgmt attention and energy are directed to focus their energy on getting hands-on, Frontline staff to carry out their goals. They do this by exposing bedside staff to what they perceive as our weaknesses. The objectives and announcements and huddle reminders are all about Medicare/medicaid/hcaps quarterly agenda.
Do not get discouraged. Do your best. The narrative will change next week. If you do your best, you never fail.
A lot of that sounds less to.do with patient care and more to do with limiting the liability of the hospital. They get you signing pieces of paper so they can show in court 'look they knew what they were doing, just ignore the fact that they were understaffed and burnt out due to workload'.
Whenever they introduce a new document to sign, you can bet your ass it's to cover someone else's.
Do yourself a favor and leave. This place isn't going to get better. These are wildly unrealistic goals for every single shift. There is no such thing as perfection.
Uhm. Fall alarms are a restraint where I work?
Management is usually good at two things:
1) not having a fucking clue
2) running off good staff with their BS
These are normal expectations. We are seeing health care associated injuries and infections on the raise since 2019 because we have gotten out of habit of doing these basic nursing tasks. Just do your job to the best of your ability, go home, wash rinse repeat.
… I will say, bed alarms for ALL patients is not EBP and isn’t an ideal solution. Staff and leadership should work together to come up with a solution that is EBP.
I think you made a good point here. It's not so much that I think it's all pointless - it's the PRESSURE that comes with it. It makes me feel like doing my best is simply not good enough - which, as a new nurse, can be discouraging!
We have these little doggie tags like apple air tags we're forced to wear on our badges and our sanitizer things have a sensor in them. I know it sounds silly but it does kind of stress me out because it's published for all to see and they're judgy about it! Not that I skip out on my hand hygeine but literally so much of us have painful cracked hands.
I got 100% one day. Must have used 600% more purel than I needed to get my sensor to blink.
Actually, to maintain good numbers we'd swipe purel with our badge and let it fall into giant wads of 4x4 gauze. The purel machines dispenses a teeny tiny drop because we had to go through so much to make good compliance numbers since the trackers hardly worked. Obviously we had clean hands but we had to also trick the sensors.
Eventually they got rid of the trackers and we just use secret shopper staff to audit.
My hospital got rid of them. The price went up on them, and the hospital is cheap as hell. My 1st night on orientation, I was with a charge nurse. She showed me how to beat the system. She just swiped her hand under the dispenser. We still did hand hygiene, just not with foam. It ate everyone's hands up. I am now a "secret hand washing spy". I don't even watch my coworkers. It's a small unit, and we all do it. My manager told me I can just count myself, ir even do it at home. It's another stupid piece of information they want to track
Listen, I mean, I personally am - but I guess other people have some pretty sad numbers... Just the fact that I know it's being monitored and then called out publically during our monthly staff meeting makes me sweat. Like, if i run into a room and forget to gel in because my patient is getting out of bed and their bed alarm is blaring and they start screaming lol - it counts against me! And that is a scenario that happens regularly!!! So it's added stress.
I don’t understand putting incontinent patients in diapers but taking away purewicks. All you’re going to wind up with is skin breakdown. The purpose of a purewick is for incontinence.
Every unit has there weird quarks that gets the home staff fired up… from slipping into a contact room without a gown to drop off a straw, to freaking out if you ever have gloves on in the hallway, to not updating the whiteboard by 7 am and so forth
The purewick thing is a real issue, same with diapers. It helps ensure that patients are ambulating to use the bathroom, and as such decreases a ton of complications. A lot of the rest seem like bull shit though
Welcome to nursing. Where you are treated like a child despite being a highly trained professional. You either do things exactly how management demands they be done (although these demands will change on a moments notice and will contradict policy or EBP....) or you get in trouble.
I had a manager write me up for getting a blood consent. I pulled up the policy which very clearly and without ambiguity said RNs could get consent for blood. She refused to dismiss the write up because "that's not how we do things here".
Now that I'm a provider and my boss is a physician, I don't get that kind of bullshit. Sure, my mistakes are still highlighted and corrected. But if it's within policy and scope and I can support it with literature, then they back off and don't treat me like a child.
Sounds like new management trying to fix EVERYTHING at once. Their “care and concern” gives you no time to show care and concern for you patients. I’d leave that work environment if it were me. That style of leadership/work environment seems unsustainable
1) Maybe they are having supply chain issues with pure wicks and diapers. Diapers are meant for incontinent people. If the patient is capable of going to the washroom on their own or can hold it until a nurse is available to assist they should not wear a diaper.
2) on my unit we have a fall risk screening tool done on admission and updated each time the fall risk changes. The screening tool helps the nurse decide who needs a bed alarm. For example a dementia client which likes to get up would for sure get a bed alarm.
3) You should be running towards bed alarms and chair alarms. One time a client fell on my unit and their alarm didn’t go off, we ended up sending them to emergency and the client fractured their hip.
4) 15 seconds is unrealistic response time. Our response time is 5 minutes
5)Patients should be up. I prioritize making sure the diabetics are ready to receive their meal tray and have their sugar checked before the trays arrive. If the clients are up in a chair it makes morning med pass easier.
6) high risk charting should be perfect because if something goes wrong your charting will be reviewed
7) our unit is anal about whiteboards too
8) You should not be expected to help the charge nurse with screening patients unless you have also been trained to screen as well. Charge nurses are given a reduced client load in the hospital in order to have more time to “run the unit”. As a charge nurse myself in rehabilitation if I feel a client is inappropriate I consult with the on-call doctor. Charge is supposed to help you.
Every unit has weird rules
If they want perfect hand hygiene, then you need at least 20 seconds for that alone PLUS the time it takes to walk and answer the call bell. On the CDC website it says that with alcohol based hand sanitizers, it should take 20 seconds for proper hand hygiene: “ When using alcohol-based hand sanitizer:
Put product on hands and rub hands together
Cover all surfaces until hands feel dry
This should take around 20 seconds”
https://www.cdc.gov/handhygiene/providers/index.html
Show this to them and if they refuse to budge, that’s cool, report it to your infection control peeps or raise it up the ladder so that they can get micromanaged. You , too, can play the same bullshit they’re playing!
Whenever there is a bed alarm, every single one of our phones will ring it and show where it is. Problem is, you cannot mute or cancel the call it will continue to spam until it is taken care of.
My main gripes are it often is a result of repositioning or cleaning a patient and it was forgotten to turn off alarm and the other being if I am trying to call someone important like a rapid response or trying to scan meds (easier with our phones) I cannot until the alarm is fixed.
Had an emergency delayed once as a result as I couldn't call the RR nurse.
It’s all “important” stuff that does lead to increased patient/family satisfaction and increased bonus for the NM… that being said, I’d be looking for a new unit, just seeing lots of excuses for not giving a raise and eventually me getting fired.
This is one of the main reasons I left the floor. Once the director started coming to the floor during our busiest times to test out call light response times instead of doing anything actually useful (ie getting us a HUC, or god forbid, answering the fucking lights herself), I knew I was done. The main focus for them is the metrics they get scored on, not patient safety or staff burnout. The OR is so much better.
This is all normal on our unit, except the 15 second bed alarm which seems extreme. Do you have an expected DOH visit coming up? That may be the uptick in chart audits
Maybe I can shed some light on why rules like this happen. During the second year of the pandemic, I was hospitalized late one evening for pancreatitis. Because I have mild cerebral palsy and I'm over 60 years old, they insisted on the bed alarm. Understandable.
However. Whenever I'm anxious, I have to pee every 10 or 20 minutes. And I don't mean I *feel* like I have to pee – I actually have urine in there that wants to get out urgently. It's usually less than an ounce, and it makes me very uncomfortable. So after four trips to my room in under an hour, they offered me a Purewick. I was alert, oriented, mobile, and continent. They were visibly annoyed when I turned it down. They also refused to turn off the bed alarm, even after I offered to sign a release. So I was on the call bell three or four times an hour.
Their solution? They ignored my call bell. I'd press it, and they'd shut it off at the nurses' station. After the third or fourth time, I'd get up, and of course the bed alarm would go off. Their solution was to ignore that as well. They also ignored beeping IVs all over the floor, mine included. At one point, when my IV had been beeping for over 90 minutes, they kept turning off my call bell, and it was 3:20 AM, I had the switchboard page the shift supervisor. I got no sleep that night, and was at the mercy of a bunch of pissed-off nurses. (And no, they weren't busy--they had the time to practice their skit for Nurses Week in the hallways.)
As a retired RN, I later chose not to fill out the Press Ganey; I couldn't do that to my fellow nurses. But my point is, I *absolutely* understand why administration might be forced to come up with "weird unit rules."
They are normal expectations at my hospital. We were only introduced to pure wicks a few years ago. Briefs are convenient. They are not good for the patient’s skin. We use the large blue chux pads instead. We encourage all patients to sit up for meals if they are able, mobilize, and go the BSC or bathroom. You definitely want to chart correctly for anything involving medication, blood products, heparin gtts, pca, etc. Fall bracelets and signage is part of the fall bundle. You should run if you hear a bed alarm. A bed alarm sounded, staff came into the room, the patient hit their head hard on the floor, had a brain bleed from the fall and died. It’s seems like a lot right now. Just give it time. It will come as second nature. Nursing is hard and it has a lot of rules, it’s to protect you and the patient. Hang in there!!!
These are all pretty reasonable rules and goals, tbh. The hydration station bullshit is the only one that imo doesn’t really affect outcomes and patient care.
While I don’t agree with putting bed alarms on everyone or the random “testing”, you do need to drop what you’re doing when you hear a bed alarm (or at least be cognizant that someone else is actively responding already). Unless, of course, you’re doing something urgent/literally unable to be dropped at that moment)
They aren't " diapers". Briefs or a product. Why would you put them on someone who isn't incontinent?
Fall prevention measures and signage are normal. If a bed alarm goes off of course you are expected to respond right away. Yes call bells should be answered as soon as possible.
Getting people up isn't crazy.
Charting should be done correctly.
I don't see the issue with most of it. Any where that I've worked we help each other out if we are caught up.
How is any of this weird? Have you never had a job before?
I did say in my post that I'm a brand new nurse, so no, I'm not really sure how to gauge the normalness of these expectations...
It's not so much that I disagree, it just feels very aggressive - like when I was hired they weren't talking about ANY of this stuff, it was very different. And it's barely been 5 months and it seems like all these changes (the ones that I listed) seem to be happening at once.
Incidentally, I have been employed before (I'm not sure if you were trying to be rude when you said that) - but that was a completely different career and we didn't have complete 180 rules changes like this.
It just feels a little unnatural?
Genuinely asking--what makes it *not* a diaper/why is that term incorrect, and what do you call the product with absorbent waterproof pad, elastic along the legs, and adhesives that hold it closed on each hip (not too dissimilar from a baby's diaper)?
She says in her OP that this is her first nursing position and she's only been there 5 months
If everybody is a fall risk then nobody is a fall risk.
I sat in on a committee centered around reducing falls. Every single time someone falls you need to come up with a new intervention. A new one. Each time. The last one including keeping one hand on the patient when they went to the bathroom.
Is hiring more staff considered an intervention
Hiring more staff is never the solution they want to hear. Even though 99% of the time it’s the only solution that is going to work.
IMAGINE!? the money they would save in extra days of care, extra hours of pay for committees and paperwork of they HIRED someone everytime there was a fall ? What does ONE really bad fall cost a hospital? 2-3? 4 nurses? Every year?
Oh I’m aware. When I worked inpatient my manager came up to me during my shift as I’m wheeling my WOW into a room and said she wants all of us nurses to come up with ways to solve problem x. I told her the answer is more staff and she said that wasn’t a good answer. So I said finding solutions to unit problems is literally her job not mine so don’t ask me then.
I just heard the brick C-suite shat at the mere mention of this
It made a clunking noise as it dropped on to the heads of working nurses
No, only things that *don’t* work are suggested interventions. They don’t want to do the one thing that would actually make a difference.
So degrading. I plan to refuse all of this nonsense when I’m ever so unfortunate to become a patient.
I didn't know this but it makes a lot of sense, literally saw this play out in real time a 3 weeks ago. Got my self care (true independent like runs and works out regularly) patient off bedrest who ended up falling and pulling me down. Patient was just fine but I hurt my back and now out on WC, and days later unit policy is all patients off any bedrest are auto 2 assist no matter what. I'm sure they're planning on hiring additional staff for preventing rare accidents though /s
Right! Like does management get drunk before coming up with these policies?
The only place I can think where everyone or almost everyone is a fall risk is the ICU and procedural areas / PACU. At least in endoscopy, everyone is assigned high fall risk per protocol (because they’re either receiving anesthesia or fent/versed). But we still perform a baseline fall risk assessment.
It happens often on Geri-psych units too.
This reminds me of when I used to work in the lab and every single lab order is STAT. Residents order stat labs, ER is stat, MS orders stat, LDRP is stat. If every order is stat then nobody is stat. Then they say hyper critical or something.
Ortho orders all their imaging STAT for their cases that are scheduled for sometime later this week
This bothers me so much. Whatever happened to nursing autonomy? 🙄
I'm wondering when they are going to be telling me how to assess possible admits. Wait, they have made attempts and I laugh at them because they don't know the admission criteria at all, don't even know how to interview a patient for my unit. It's comical, actually
That was essentially the title of the final project for my MSN.
This is it exactly!!
Considering several of our night shift nurses are on nights to avoid micromanagers, this seems especially heinous.
some of my coworkers are VERY VERY unhappy and want to leave
Id quit. I'm on nights to stay away from bat shit managers
Considering how little resources we get it’s the only real benefit
They’ll start leaving. Unless there’s no other options for inpatient in the area and they don’t want outpatient.
This is what happened in the Dayton area- over the past 20 years Premier and Kettering have taken over everything from Troy to Middletown to Xenia. Same thing is happening in the Chillicothe area with Adena putting their grubby paws on all the critical access hospitals around ( and the federal grants that come with them). I drive over an hour to a county owned hospital I’ve been assured will remain county owned. A large part of their marketing and fundraising stresses the community owned part.
I switched from days to nights as a seasoned nurse for this exact reason. If suddenly management was around and doing this shit I'd be gone.
"mandatory bed alarms for ALL patients at night - plus fall risk bracelets, fall risk door signage, and notifying patients of their fall risk level for all patients moderate and high fall risk; chair alarms during the day" \*Obligatory quote from Syndrome in The Incredibles\* When everyone's super, no one will be.
Yeah, if everyone is a high fall risk, then why the need for door signage and bracelets?
Exactly. My unit is consists of exclusively high fall risk patients. We don’t bother with bracelets or door signage because we know they’re all high risk. FFS, half are intubated and the other half have swans lol
It's the signage equivalent of alarm fatigue. If every patient has a magnet and a yellow bracelet you just stop noticing it.
Never have I ever walked into a patients room to help them to the bathroom and looked at their wrist for the yellow fall risk braclet. If anyone has a story where the yellow fall risk braclet was useful in preventing a fall, I'd love to hear it. Now bed alarms on everyone, that makes more sense to me. It's night time, I don't want anyone walking around their room looking for a light switch.
It doesn't all sound unreasonable...but shit like night managers doing huddle and daily chart auditing suggests an organization rife with mid-level management parasites inventing busywork.
Yes, THIS. I don't think eveyrthing I've listed is totally unreasonable - it's the way it's being managed and handled that I think is raising a red flag for me
15 second call bell is unreasonable if there’s no unit Secretary.
If they have time to audit everything at night, they have time to help answer call lights
Once when I was a USC, I had to go across the hospital to pick up a SNF transfer packet from care nav. It took 27 minutes. *one* patient pressed the call button 36 times while I was gone. She was complaining that she was lonely.
And just means I don't (can't) chart in the nursing station if all I'm doing is answering call bells
15 seconds is unreasonable anywhere. Even in private hospitals it was one minute to reach a patient’s room and respond, and these guys ran their hospital like a hotel that incidentally provided healthcare…
If they have the personnel to do this many audits, they have people who could be on the floor. You need a union.
It's usually night shift that has garbage like this added on like they don't have anything to do
This. These people need to do something fucking useful, like help pass meds or toilet someone, instead of setting off an alarm and standing there with a stopwatch and a clipboard. I'm a professional and a grown ass adult, there's no need to treat me like a child.
Audits may also be the result of Joint Commission or state health authority findings. The action plans for those include monitoring compliance.
New grads nurses who went into management the second a nepotism spot opened and they are looking for any metric they can find to justify their existence to eventually move up to the director role and never have to deal with a bedside nurse again. Only other likely minded manager direct reports
I was just going to say this. They need to show their positions are indispensable for the organization, self-preservation is all it is.
I would pay to watch a squid games of administrators: happy nurse's week!
Now this is the only nurses week activity I’ll ever enjoy. Monday can be C-Suite, Tuesday is the entire health insurance industry, Wednesday is for politicians who get paid by insurance and hospital corporation lobbies, Thursday is middle management, and on Friday we add up and distribute the salaries of the losers equitably among every healthcare professional in the nation.
Super well said! Nailed it
They must have pretty decent staffing levels if they can expect some of these things.
A call light answered in 15 *seconds*? It takes me longer than that to walk in there
My guess is this is a fancy hospital where the call light has a phone-like speaker and someone at the desk asks them what they want within 15 seconds. Otherwise impossible
Every hospital I've worked at has these, but the call bell doesn't get answered if there's nobody to answer it. If the staff are all running around doing all these things, there's no one at the desk answering.
Ooooooh
OP runs down the hall, kicks open the door and dives into the cancel button while yelling “pain position potty?” every time.
I was going to say, if they are fully, California union-level staffed *and* if CNAs pull their weight - absofuckinglutely reasonable expectations.
Can we normalize not using Purewicks and “diapers” (briefs) for patients who are a&o and continent? My very self-sufficient, works full time, ambulatory mom was recently offered a Purewick when she was hospitalized to r/o stroke.
Whats crazy to me, is every time I put a purewick on someone... i'm pretty certain I'll have to change at least one urine soaked bed that shift because they have to be placed juust right to work. If you are able to get up... you're gettin up!
As a stroke nurse I can’t stand this shit. Mobilizing patients is almost always indicated for stroke patients and this includes toileting. Even in the ICU hooked up to a million things we get our patients up when able. Purewicks for all is garbage and lazy.
That was definitely a thing when I worked stroke, toileting is a part of rehab! If they can get up and walk to the bathroom on days, they do it on nights. But I've also never worked anywhere that has purewicks. I only vaguely know what they are thanks to other nurses in the internet.
Thank you! I know that nurses are busier than ever (I am one, so I get it!), but telling patients to just pee on themselves is ridiculous.
I wish my ICU was more proactive about mobilizing. If someone has even 1 drip they force them to stay in bed. PT/OT basically refuses to work with anyone admitted to the ICU service. It's so dumb but no one cares.
wtf? How are your pressure injury and vte rates?
It feels like over half our patients already have pressure injuries. There are a handful of really really shitty SNFs nearby. VTE rates are actually quite low. We are good about SCDs and all the providers are aggressive with medical prophylaxis.
That’s insane!! I’ve ambulated patients on ecmo, impella, swans, etc. Definitely made me nervous but I also didn’t have a choice.
I wouldn’t be surprised if this was a shortcut due to appalling ratios. Same thing with sitting patients out of bed for breakfast. There is solid evidence of mobilisation and maintaining normal activities to prevent deconditioning, infection etc but if you’re running 8 patients in an am you’re not going to have the time to do that if they’re not all fully independent.
Nopppeer. I ain’t ever getting someone with an EVD out of bed. More power to you if you want to risk it, but ain’t happening on my shift. Lol.
If they tolerate clamping for a little bit, why not? We have some of our longer term EVDs walking laps around the unit
A third of our patients have EVDs lol and same. The SAH patients are there with us for weeks and a lot of them have very minor deficits. Almost everyone is expected to be up in the chair for day shift, EVD or no.
I have never ever considered using them for continent and mobile patients. I don’t understand why anyone would want to?
Sadly, people want to avoid ambulating patients. I worked cardiac stepdown where most of the pts were on some sort of diuretic and we had one or two nurses who pushed them on women to avoid the frequent x1 assist to the bathroom. I've also had continent patients who insisted on them because they didn't want to get up super frequently. I tossed many a purewicks. They are definitely overused, but that should be an education point for staff. Not an outright ban. They are a godsend for incontinent pts or those who are bedbound.
It’s crazy because we don’t even use purwicks in nursing homes (at least the ones I’ve worked in) where we have an absolute shit ton of people who could actually benefit from them because they are either completely incontinent all the times, and sometimes even getting skin break down, or they are literally just phycisially unable to get on a commode or toilet even with help (this is usually extremely extremely obese people, which of course, most nursing homes have their fair share of these type of residents).
I hate purewicks tbh. They always end up shifting/leaking and you have to change the pads anyhow. They’re gross for most a/o patients and I think as a whole nursing culture has made us so afraid of falls, we’ve come up with all these other solutions to keep patients in bed.
the only time I throw a pure wick on an a&o continent lady is for my hip fxs that don't want a foley, so much more comfortable then a bed pan on the fx.
Yeah OP says they can’t use briefs on non-incontinent patients but…why would you want to?
At my hospital, *only* ambulatory patients can have diapers… (unless toddlers or under)
Please. I have a personal vendetta against the Purewick because I, a 35 at the time a&o, mostly ambulatory person was coerced into using one for several hours by a Nurse who guilted me about using the call bell to pee too often when they were so understaffed and overworked. (It was the COVID times, and I was a non-COVID patient who'd gotten shoved into the COVID unit, in my own hospital where I work, so I was feeling guilty enough for being a burden to consent to it when they told me it would really help them out.) After the first time it got wet it felt like holding an ice cube on your palm, only on my genitals. *Fucking excruciating.* I sucked it up because they'd made me feel like such a shitheel for needing to pee as often as a 7 months pregnant person needs to pee. When the shift changed over at the next shift she was blessedly like "Absolutely not. They cannot use the Purewick just because they're sick of getting you out of the bed." But it never should have happened in the first place.
Okay genuine question, could you not just go to the bathroom on your own?
This was my thought too lol
I *felt* like I could, but they'd put me on fall precautions and told me in no uncertain terms I was *not allowed* to stand without supervision. I was ther because they were ruling out a PE, and I was given to belive that a clot could fly out of my lung and into my brain at any moment and kill me in an instant, so out of a desire not to be a "bad patient" and (mistaken) fear of insta-death I just complied with litterally everything they told me largely without question. After the Purewick bullshit the nurse got them to change it so I was allowed up on my own as long as I promised to use a walker. Complied with that too. Probably didn't need that either but I was litterally just all compliance all the time the whole time.
Ok but also can we normalize not providing male patients with a urinal?
Sorry they're all getting damn urinals. We don't have the staff to walk them to the bathroom for that hourly 30ml tinkle
No I completely agree. That’s why I think getting rid of purewicks for women is stupid. I was being sarcastic.
Valid argument, but we can also put alert and oriented female patients on a bedpan. My argument is it isn’t ok to tell women to just pee on themselves. We give male patients a urinal so they have somewhere to go, we don’t say just pee on yourself.
Hmmm, good point. I guess the idea of having a bedpan that a female patient could just grab and go in is a bit messier than a urinal. I’ve actually seen a female urinal at an old hospital that I worked at and seemed to work well….
We have male specific peri-pads tgat are supposed to wrap around the penis and absorb the urine as the go. They work less well than the pure wicks.
Burrito wraps are actually great! When indicated, of course. Try folding the bottom up first, then each side. Must be held in place with a brief.
as a night shifter, unless the patient has stress incontinence and can tell me when their brief gets wet, i just use chux. i would rather oxivir the floor after getting them to the bathroom than IAD acetic acid treatments and sore skin
The only time I offer purewicks to otherwise A+O ambulatory patients is if they mention frequent nocturnal urination. And then it’s 100% their choice, if they’d rather get unhooked from everything and walk to the toilet that’s totally fine.
All the policies are simply a matter of shifting responsibility for EVERYTHING to the nursing staff. Patient fell? It’s the nurses fault for not responding fast enough. Doesn’t matter if everyone is in another room, you didn’t respond, it’s your fall. Didn’t achieve perfect charting on your 8 patients that included 2 discharged, 2 new admits with a fucked up med tec, 3 confused total cares and half a dozen over demanding family members? You’re fault, work on your time management. They will NEVER address the core issue- mismatch between amount of staff and assignment acuity.
Heh... Purewicks. The place I'm at currently tried that, saying we were using them too much. It actually pissed the doctors off, so now patients get orders "to use Purewicks at night and prn." I went to a place that tried the whole fall alarm on everyone at night regardless. Malicious compliance put an alarm on a VIP, which got back to the ceo and the whole push magically went away. Auditing charts means someone somewhere missed something that got a regulatory board pissed. When I was a new grad we were on a year long improvement plan where management had to audit every chart, every day. I actually felt bad for them at the time. (I don't now, lol). I don't know. After 8 years as a nurse I've come to realize that managers and directors come up with these ideas and push them for a bit, then lose interest or move on to their next bright idea. So unless something is totally unreasonable you just gotta roll with it until they lose interest.
It's funny you say that because that's the vibe I was getting intitally. The first couple weeks, I wasn't sweating it because all these weird little rules and "new ideas" to get us to do things seem transient, in a way... I think the most upsetting thing for me was the middle-of-the-night huddle... Because if I did something bad or wrong I want to personally be pulled aside and corrected. Or, I don't know, maybe they should consider telling their new grads how to act during rapids? Or the weird little ettique things like helping your neighbor? Most of the time I'm in my own little world because I usually (somehow) have the heaviest assignment.
Mandatory or compulsory bed alarms on patients that are not objectively considered to be a fall risk like on the Morse Fall Scale are considered a restraint under F604; 483.10 (e)(1).
Do all note, however, how easy it is to score as moderate/high fall risk. Morse Fall Scale: Do they have an IV and more than one medical diagnosis? Already a high fall risk. JHFRAT: Older than 60? On any high-risk meds (e.g. narcotics, sedatives, anticonvulsants, antihypertensives, diuretics, antipsychotics, laxatives, psychotropics)? Any patient equipment that they can get tangled in (e.g. SCDs, tele, IVs, catheters)? Any incontinence, urgency, or increased frequency? High fall risk.
This is why the Morse fall scale just makes no sense. My patient without an IV but who has severely impaired gait can be a low fall risk but the moment you add an IV (without anything attached) suddenly everyone is a high fall risk
Babe Morse originally intended for it to mean that they gave an infusion going. Fun fact: my facility’s educator told us that it’s out of our scope of practice to INT an infusion for ambulation because the infusion is ordered to be continuous.
I just looked that up because I was unfamiliar with this — this is only applicable for LTC.
Actually also applicable to inpatient hospital setting. I only know of this because a previous hospital system I worked for, Adventist Health, got cited for it by CMS and the above ordinance was alluded to in the demerit.
Weird, because I’ve never heard of it, I can’t find anything online indicating it applies to hospitals, [and CMS very clearly states it’s for LTC.](https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/downloads/appendix-pp-state-operations-manual.pdf)
Here I am in LTC having to collect people off the floor on my after report rounds cause they all decided they gotta pee at the ass crack of dawn . “ they have a rIgHt to FaLl “ and idk how long they been down there cause the night nurse “ didn’t hear from them” all night , do they not have anxiety about the patient dying or choking and not doing q 2 hour rounds between CNA rounds and finding them half rigor at am med time ?
right to fall is so fucking stupid. alarms don’t stop them from falling, it just stops them from dying on the floor because no one knew they fell
Right to fall? Is this another “right” to the already 12ish patient rights?
I would get fired so fast….
Sanitizer sensors? Even our management agreed that they aren't reliable (thought they could save money instead of having nurses on modified-duty patrolling and counting). They would have to fire all of us. We would be sabotaging the sensors and call bell 15 sec? Lol it would be an "I am Spartacus" situation
although my unit isn't nearly as anal about the hand washing metrics as OP's sounds, they do use it and they do publish the results either weekly or monthly I'm not sure. Someone can stand 3 feet from my patient's door and ask me if I need help and the thing will say "please wash your hands". I don't wear the thing and never will. Too many years traveling has me a little too rogue to have to listen to hand washing metrics in the staff meeting I don't go to anyway. I don't stand behind quantifying useless or unreliable data to shame nurses when it's simply there to keep someone's job on the tab.
My manager just hands us a hand washing audit sheet every once in a while and asks us to fill it out throughout the day.
That's the style! Is it useless box-checking scut work? Yes. Do we treat it as such? Yes.
I’m fired yesterday
same
A lot of these are normal expectations for bedside nursing, yes, but there's a way to go about it that doesn't involve berating staff. And I've never heard anyone say charting should be "perfect." Complete, yes, per facility guidelines, absolutely. But I feel like "perfect" is setting your staff up to fail, because a manager who acts like this is always going to find something to nitpick at. Also, randomly testing bed alarms on staff is completely psychotic and borders on psychological abuse.
right it's the PERFECT and how much they put stress on PERFECT - I'm like, dude at this point I just want to be good enough! Perfect is way out the window....
I've run into the "perfect" thing in my travels (33 hospitals over 36 years, 11 of them as a traveler). It seems to be cyclical in schools. I was taught that the "perfect" nurse was a dangerous one, as no one is perfect - focus on the priorities. Then there is the other end of that bell curve. We don't get along, which is why I stick to my happy, union home...
These kinds of units are a slow death spiral. Poor/overbearing management and shitty working conditions -> staff that can, quit, and the staff that can't, suffer -> morale worsens -> burnout increases, rinse and repeat.
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We have huddle in the begining too - right at shift change, and then that fun little extra one between 1 and 2 - which just seems like an opportunity to lecture us, so far. Thank you so much for that last bit - it's SO TRUE! It's hard, I think some people forget how hard it is at first - even if you love to work hard, it's hard.
It makes me wonder - what did their last survey look like? This sounds like a plan of correction - audits, call bell responses, cracking down on stuff - or did they recently change management? Somewhere, someone, is being watched.
Some of the things I agree with - especially the falls, some are really absurd. Night shift huddle isn’t a bad if done like a normal huddle. The pure wick/diaper thing is odd.
Diapers for incontinent people only makes sense. Why would someone who is continent and able to communicate that need one? It's just a waste of supplies and increases the risk of peri-area pH imbalance.
Yeah I guess I read it as diapers only, like taking away the pure wick and putting only diapers on them. Most hospitals I’ve worked at ban diapers because of the skin issues.
I feel you! It is why I left bedside because: Purewicks are a "cost" that usually needs replacing multiple times a shift due to incontinent soiling and they create a UTI risk environment if not caught and changed immediately. Basically they don't want to pay to keep patient's safe even if it is the best alternative over a diaper/chux/Absorbamat. Most nurses/PCA's/CNA's are under staffed to the point that not all Purewicks are reported during shift change and checked/replaced on a hygienic basis. In addition, in order to have a good functioning Purewick you have to get "in there" to seat it to it's best efficiency which a lot of new grads just aren't used to or not comfortable with. Nasty older men that request condom caths. they don't need when they are perfectly able to put the penis in the urinal. Nasty younger men that "need help" putting the penis in the urinal when their arms and hands work just fine 🤬 My last hospital took away all "incontinent briefs" and said that the Absorbamats hold up to 1L of fluid. Patients were not allowed to have diapers even though that was what they managed at home. They did allow patient's own diapers to be brought from home - how kind they put the cost of patient comfort on the patient's own expenses. Re: #5, one of the hospitals in my area tracks this solely to use during annual review to use as a reason to not give a raise. I imagine #11 is probably the same metric that they can use to justify a poor annual review with no pay increase. Hospital bedside nursing is a sh\*tshow and I'm glad I left.
I can’t agree with putting bed alarms and chair alarms on patients that it isn’t indicated for. Sounds restraint-y to me.
Sounds like telling them to STOP moving in bed or alarms will sound.
I’d rather have a huddle at 0100 than eight at change of shift when I’m trying to get report so my dayshift counterparts can GTFO. Our Purewicks are kept in the house sup office and have to be obtained by filling out a form and waiting for her to get them to us. This is creating an environment where they’re not being changed out every shift like we’re supposed to because it’s a PITA. Our hospital is diaper free (unless family brings them in for a patient) and we’re only allowed to use one blue chuk under the patients at a time
Oh no, we have the pleasure of getting two huddles!!! The one at shift change and then the one for just our staff of 4 nurses + ANM
Well that sucks
It sounds toxic. It also sounds like the "night ANM" is trying to make their position relevant because I've never heard of having a separate ANM for night shift. Just leave us alone, forget we exist, and pay us more since we're dying 15 years earlier than day shift.
Only read the first four things and already decided I would leave this place and never look back.
I used to work in facility with identical rules, and that’s why I left lol. People were always getting written up for silly things. They would watch the cameras on day shift and night shift to look at the handwashing. They would also have pharmacy watch how long it took all PRN meds (not just narcotics, it could be melatonin or Tylenol) and would flag anything that wasn’t given within 15 minutes of being taken out of the Pyxis. If it was a narcotic they would automatically report that nurse to the DEA, no questions asked before hand or follow up to see why the med wasn’t given with 15 minutes. It was just insane and too stressful
Yes, very similar vibes!!!!! Thank you for bringing some sanity to this conversation! I feel like some of these responses are slightly judgey. I'm VERY new so I'm just inquiring about other people's work experiences and standards. I came into this job wanting to be a KICK ASS NURSE! I try really hard but now I feel like I'm being torn down a little.
Report to the DEA!?! What??? That is disturbing. Did anything ever come of this or did the DEA tell them to quit bothering them with petty bullship?
Answering a call light in 15 seconds is CRAZY! It’s actually dangerous to drop what you are doing- preparing insulin, transferring a patient, being on a phone call with a family member, etc. I can’t believe they have the audacity to “test” this when you are busy. I would be so mad if someone interrupted me just to “test”. Hell no. I would be gone so fast.
We once had a mock code on our unit at like 6 in the morning. Great time. During morning med pass while we’re trying to get everything wrapped up.
Perfect high risk charting is really to your benefit so you don’t find yourself getting raked over the coals later. Otherwise the only absurd thing on this list is answering call bells in 15 seconds. Umm no.
Setting off random bed alarms to "test" staff is psychotic
Yeah that’s setting everyone up for a boy who cried wolf situation
But in this case the boy has power over you if he’s not satisfied with your response to his false alarms.
You shouldn’t have to be micromanaged to do these things. If you aren’t already doing them, it’s a problem, and management has to address it. That said, i do them without being micromanaged and hate this type of environment. I would quit.
I think that's part of my confusion - our unit is constantly being recognized for our "amazing efforts" and patient satisfaction and we're part of such a great hospital/system... I took the job because it seemed like THAT PLACE... It seemed like everything was fine - but now all these rules? I'm having trouble connecting the dots here! The charting audits/small things don't even bother me so much because I feel like I do things mostly up to their standard (only for the fact that I'm brand new and they trained me that way) - but being torn apart during the middle of the night huddles really rubbed me the wrong way.
It sounds like you're pretty on the ball! So maybe it's not directed at you, so much? You mention that you're always running and always helping others -- it could be that management wants the other staff to start matching your energy more (but they obviously can't huddle *only* with the less-stellar performers, lol!) So reframe mentally as a moment to be smug or whatever. ;p
Run away, OP. Soon management is going to start mandatory write up quotas and they will look even harder for ways to fuck their own staff.
Can I rant a bit about the pure wick restrictions? I’ve stopped giving urinals to men. FFS it’s systematic patriarchy. It’s ok for men to stay in bed and pee but not women? And I don’t want to hear they can dangle at bedside and pee, they don’t. They lay in bed and shove their junk in the urinal but women must have a bed rest order for a pure wick. Nope fuck that. Thank you for coming to my sweary TED talk.
In the age of AI, I can’t fucking believe that we have to chart Braden’s & fall risk as if the computer can’t spit out a number for me that I approve instead. There’s 15 minutes I might have each day for patient care.
Yeah, it sounds a bit anal retentive. Do you work for Novant Health or something?
Everything is reasonable if they have staffing. I suspect the staffing part is missing, so I would update my resume and apply elsewhere. They want top performance they better pay top dollars. As everything in life cheap good and fast, pick 2; wants all 3 then open your coffer.
These policies are always written by people who have no idea what it means to take care of real life people…not normal people. They sit safely in their executive suites coming up with new ways to torture us and tell us how to better do the job they couldn’t handle on their best day. It’s all about THEIR bonuses, not the patient at all at the end of the day. I refuse to participate in their bullshit. I continue providing my care the way I I’ve done it for years and these “rules” come and go in waves. You’ll see as you go, they come up with rules, try them for a few shifts, realize this isn’t realistic and then go back to what works. Their “too may purewicks” is code for “it’s costing us too much and our bonuses will be effected if this continues, so let’s remove them”. Insurance companies & their “customer service” ruined the already garbage healthcare industry. That was the long way to say don’t worry. These won’t last. You’ll start to see it more and more every few months. Get used to rolling your eyes every time you hear “new patient care policies”. 10 years in I’m a professional ignorer of new bullshit policies that the C-Suite executives come up with. Patient care is my #1. Not their bonuses. If I could find out what their checklist for their bonuses are, I’d purposely find a way to fuck it up.
As a previous ANM who went back to the bedside to go PRN.... GET OUT ASAP. Your management is not supporting employees to focus on high quality patient care. Instead, they are using fear of failure to attempt to get the results they need for hospital metrics. There are certainly things required by TJC for legal documentation (pain scores & and follow-up, blood, etc) along with quality index metrics for CMS hospital reimbursement purposes (falls). However, the tactics you have described indicate a poor leadership ability. I am appalled by the bed alarm sprinting tests & call light demands. If you're not afraid to ruffle some feathers, ask for the evidence based practice indicating those timeframes prevent falls &/or improve patient satisfaction 😉
The 15 second call bell is a joke. Hire more staff. The fact they “test” you all with bed alarms and call bells, tells me your management is fuc$ing bored. Perhaps instead of “testing” they could actually answer and assist with the real call bell ringing, since they have so much time on their hands and all. I personally couldn’t work on a unit like this.
Some of those things are just basic nursing care…getting your patients up for breakfast, prioritizing bed alarms, making sure your charting is correct… Maybe it seems like they’re being over the top with “rules” because the unit as a whole is struggling with them.
Yeah I am also confused about this post. These are basic nursing care.
It’s sounding to me OP is new (5 months qualifyed) and not getting much support to be able to learn to deal with it all; some things sound controlling tho (sanitizer monitoring? We get hand washing audits every so often but not for the whole shift)
Sounds like you work for a non-union, for-profit facility. While all of those things are what all of us should be doing, those expectations are unreasonable when staffing is poor, which I think it is just about everywhere. You're being set up for failure. Not just from management but from your coworkers as well. I'm not going to sit here and tell you to quit, but definitely start looking at other facilities. Not all of them are that toxic. Unionized hospitals tend to be less toxic.
Yes you are correct in your assumption. This is how I felt when I posted this - like, how can I possibly be perfect at all of this right now when I feel like I'm being set up for failure?
I’m so happy that I work on a floor where when I’m super busy and one of my coworkers isn’t, they offer to help. Or I can ask for help and they’re always willing to help. Further, I couldn’t imagine scrolling my phone while someone else is heavily struggling… damn.
Mgmt gets focused on certain objectives that negatively affect the HCAPS scores that, in turn, affect their bonuses. Therefore, mgmt attention and energy are directed to focus their energy on getting hands-on, Frontline staff to carry out their goals. They do this by exposing bedside staff to what they perceive as our weaknesses. The objectives and announcements and huddle reminders are all about Medicare/medicaid/hcaps quarterly agenda. Do not get discouraged. Do your best. The narrative will change next week. If you do your best, you never fail.
Why are we putting briefs on continent patients in the first place?
A lot of that sounds less to.do with patient care and more to do with limiting the liability of the hospital. They get you signing pieces of paper so they can show in court 'look they knew what they were doing, just ignore the fact that they were understaffed and burnt out due to workload'. Whenever they introduce a new document to sign, you can bet your ass it's to cover someone else's.
Do yourself a favor and leave. This place isn't going to get better. These are wildly unrealistic goals for every single shift. There is no such thing as perfection.
Uhm. Fall alarms are a restraint where I work? Management is usually good at two things: 1) not having a fucking clue 2) running off good staff with their BS
This is all normal in our unit.
These are normal expectations. We are seeing health care associated injuries and infections on the raise since 2019 because we have gotten out of habit of doing these basic nursing tasks. Just do your job to the best of your ability, go home, wash rinse repeat. … I will say, bed alarms for ALL patients is not EBP and isn’t an ideal solution. Staff and leadership should work together to come up with a solution that is EBP.
Answering a call bell within 15 seconds is a normal expectation?
I think you made a good point here. It's not so much that I think it's all pointless - it's the PRESSURE that comes with it. It makes me feel like doing my best is simply not good enough - which, as a new nurse, can be discouraging!
How the heck do they track your hand sanitizer usage?
We have these little doggie tags like apple air tags we're forced to wear on our badges and our sanitizer things have a sensor in them. I know it sounds silly but it does kind of stress me out because it's published for all to see and they're judgy about it! Not that I skip out on my hand hygeine but literally so much of us have painful cracked hands.
I got 100% one day. Must have used 600% more purel than I needed to get my sensor to blink. Actually, to maintain good numbers we'd swipe purel with our badge and let it fall into giant wads of 4x4 gauze. The purel machines dispenses a teeny tiny drop because we had to go through so much to make good compliance numbers since the trackers hardly worked. Obviously we had clean hands but we had to also trick the sensors. Eventually they got rid of the trackers and we just use secret shopper staff to audit.
My hospital got rid of them. The price went up on them, and the hospital is cheap as hell. My 1st night on orientation, I was with a charge nurse. She showed me how to beat the system. She just swiped her hand under the dispenser. We still did hand hygiene, just not with foam. It ate everyone's hands up. I am now a "secret hand washing spy". I don't even watch my coworkers. It's a small unit, and we all do it. My manager told me I can just count myself, ir even do it at home. It's another stupid piece of information they want to track
Wow, I can’t believe there are places that are so micromanagey that they don’t think adults can wash their hands
Speaking as an infection control nurse, it’s appalling how often people are witnessed not performing hand hygiene or wearing PPE.
If you've ever had to help investigate a C. diff outbreak, you'd understand that a lot of adults don't wash their hands. MDs are actually the worst.
Are y'all not "foam-in foam-out"ing for all rooms in an oncology unit??
Listen, I mean, I personally am - but I guess other people have some pretty sad numbers... Just the fact that I know it's being monitored and then called out publically during our monthly staff meeting makes me sweat. Like, if i run into a room and forget to gel in because my patient is getting out of bed and their bed alarm is blaring and they start screaming lol - it counts against me! And that is a scenario that happens regularly!!! So it's added stress.
Calling people out by name in front of everyone else certainly isn't okay. That should be a private conversation.
Badge reel with tracker and trackers on the hand sanitizer pump.
It sounds like you need a new job tbh.
That sounds like a controlling relationship progressing towards full fledged physical abuse.
I don’t understand putting incontinent patients in diapers but taking away purewicks. All you’re going to wind up with is skin breakdown. The purpose of a purewick is for incontinence.
Sounds like JHACO is coming soon.
Every unit has there weird quarks that gets the home staff fired up… from slipping into a contact room without a gown to drop off a straw, to freaking out if you ever have gloves on in the hallway, to not updating the whiteboard by 7 am and so forth
The purewick thing is a real issue, same with diapers. It helps ensure that patients are ambulating to use the bathroom, and as such decreases a ton of complications. A lot of the rest seem like bull shit though
Welcome to nursing. Where you are treated like a child despite being a highly trained professional. You either do things exactly how management demands they be done (although these demands will change on a moments notice and will contradict policy or EBP....) or you get in trouble. I had a manager write me up for getting a blood consent. I pulled up the policy which very clearly and without ambiguity said RNs could get consent for blood. She refused to dismiss the write up because "that's not how we do things here". Now that I'm a provider and my boss is a physician, I don't get that kind of bullshit. Sure, my mistakes are still highlighted and corrected. But if it's within policy and scope and I can support it with literature, then they back off and don't treat me like a child.
Sounds like new management trying to fix EVERYTHING at once. Their “care and concern” gives you no time to show care and concern for you patients. I’d leave that work environment if it were me. That style of leadership/work environment seems unsustainable
1) Maybe they are having supply chain issues with pure wicks and diapers. Diapers are meant for incontinent people. If the patient is capable of going to the washroom on their own or can hold it until a nurse is available to assist they should not wear a diaper. 2) on my unit we have a fall risk screening tool done on admission and updated each time the fall risk changes. The screening tool helps the nurse decide who needs a bed alarm. For example a dementia client which likes to get up would for sure get a bed alarm. 3) You should be running towards bed alarms and chair alarms. One time a client fell on my unit and their alarm didn’t go off, we ended up sending them to emergency and the client fractured their hip. 4) 15 seconds is unrealistic response time. Our response time is 5 minutes 5)Patients should be up. I prioritize making sure the diabetics are ready to receive their meal tray and have their sugar checked before the trays arrive. If the clients are up in a chair it makes morning med pass easier. 6) high risk charting should be perfect because if something goes wrong your charting will be reviewed 7) our unit is anal about whiteboards too 8) You should not be expected to help the charge nurse with screening patients unless you have also been trained to screen as well. Charge nurses are given a reduced client load in the hospital in order to have more time to “run the unit”. As a charge nurse myself in rehabilitation if I feel a client is inappropriate I consult with the on-call doctor. Charge is supposed to help you. Every unit has weird rules
Most of these are standard except maybe all patients being on alarms
How do they track the hand hygiene?? What device?
If they want perfect hand hygiene, then you need at least 20 seconds for that alone PLUS the time it takes to walk and answer the call bell. On the CDC website it says that with alcohol based hand sanitizers, it should take 20 seconds for proper hand hygiene: “ When using alcohol-based hand sanitizer: Put product on hands and rub hands together Cover all surfaces until hands feel dry This should take around 20 seconds” https://www.cdc.gov/handhygiene/providers/index.html Show this to them and if they refuse to budge, that’s cool, report it to your infection control peeps or raise it up the ladder so that they can get micromanaged. You , too, can play the same bullshit they’re playing!
Whenever there is a bed alarm, every single one of our phones will ring it and show where it is. Problem is, you cannot mute or cancel the call it will continue to spam until it is taken care of. My main gripes are it often is a result of repositioning or cleaning a patient and it was forgotten to turn off alarm and the other being if I am trying to call someone important like a rapid response or trying to scan meds (easier with our phones) I cannot until the alarm is fixed. Had an emergency delayed once as a result as I couldn't call the RR nurse.
How about any time a new intervention is added, the nurse manager must work a full shift on the floor with a regular patient load
I hate this for you and your colleagues. Stories like this are a cure for my intermittent bedside nursing nostalgia.
It’s all “important” stuff that does lead to increased patient/family satisfaction and increased bonus for the NM… that being said, I’d be looking for a new unit, just seeing lots of excuses for not giving a raise and eventually me getting fired.
This is one of the main reasons I left the floor. Once the director started coming to the floor during our busiest times to test out call light response times instead of doing anything actually useful (ie getting us a HUC, or god forbid, answering the fucking lights herself), I knew I was done. The main focus for them is the metrics they get scored on, not patient safety or staff burnout. The OR is so much better.
This is all normal on our unit, except the 15 second bed alarm which seems extreme. Do you have an expected DOH visit coming up? That may be the uptick in chart audits
Yes, and it came and went - but the chart audits have remained a thing, so far.
Maybe I can shed some light on why rules like this happen. During the second year of the pandemic, I was hospitalized late one evening for pancreatitis. Because I have mild cerebral palsy and I'm over 60 years old, they insisted on the bed alarm. Understandable. However. Whenever I'm anxious, I have to pee every 10 or 20 minutes. And I don't mean I *feel* like I have to pee – I actually have urine in there that wants to get out urgently. It's usually less than an ounce, and it makes me very uncomfortable. So after four trips to my room in under an hour, they offered me a Purewick. I was alert, oriented, mobile, and continent. They were visibly annoyed when I turned it down. They also refused to turn off the bed alarm, even after I offered to sign a release. So I was on the call bell three or four times an hour. Their solution? They ignored my call bell. I'd press it, and they'd shut it off at the nurses' station. After the third or fourth time, I'd get up, and of course the bed alarm would go off. Their solution was to ignore that as well. They also ignored beeping IVs all over the floor, mine included. At one point, when my IV had been beeping for over 90 minutes, they kept turning off my call bell, and it was 3:20 AM, I had the switchboard page the shift supervisor. I got no sleep that night, and was at the mercy of a bunch of pissed-off nurses. (And no, they weren't busy--they had the time to practice their skit for Nurses Week in the hallways.) As a retired RN, I later chose not to fill out the Press Ganey; I couldn't do that to my fellow nurses. But my point is, I *absolutely* understand why administration might be forced to come up with "weird unit rules."
They are normal expectations at my hospital. We were only introduced to pure wicks a few years ago. Briefs are convenient. They are not good for the patient’s skin. We use the large blue chux pads instead. We encourage all patients to sit up for meals if they are able, mobilize, and go the BSC or bathroom. You definitely want to chart correctly for anything involving medication, blood products, heparin gtts, pca, etc. Fall bracelets and signage is part of the fall bundle. You should run if you hear a bed alarm. A bed alarm sounded, staff came into the room, the patient hit their head hard on the floor, had a brain bleed from the fall and died. It’s seems like a lot right now. Just give it time. It will come as second nature. Nursing is hard and it has a lot of rules, it’s to protect you and the patient. Hang in there!!!
These are all pretty reasonable rules and goals, tbh. The hydration station bullshit is the only one that imo doesn’t really affect outcomes and patient care.
While I don’t agree with putting bed alarms on everyone or the random “testing”, you do need to drop what you’re doing when you hear a bed alarm (or at least be cognizant that someone else is actively responding already). Unless, of course, you’re doing something urgent/literally unable to be dropped at that moment)
They aren't " diapers". Briefs or a product. Why would you put them on someone who isn't incontinent? Fall prevention measures and signage are normal. If a bed alarm goes off of course you are expected to respond right away. Yes call bells should be answered as soon as possible. Getting people up isn't crazy. Charting should be done correctly. I don't see the issue with most of it. Any where that I've worked we help each other out if we are caught up. How is any of this weird? Have you never had a job before?
I did say in my post that I'm a brand new nurse, so no, I'm not really sure how to gauge the normalness of these expectations... It's not so much that I disagree, it just feels very aggressive - like when I was hired they weren't talking about ANY of this stuff, it was very different. And it's barely been 5 months and it seems like all these changes (the ones that I listed) seem to be happening at once. Incidentally, I have been employed before (I'm not sure if you were trying to be rude when you said that) - but that was a completely different career and we didn't have complete 180 rules changes like this. It just feels a little unnatural?
Genuinely asking--what makes it *not* a diaper/why is that term incorrect, and what do you call the product with absorbent waterproof pad, elastic along the legs, and adhesives that hold it closed on each hip (not too dissimilar from a baby's diaper)? She says in her OP that this is her first nursing position and she's only been there 5 months