There is a lot going on in a typical shift on your ward. As nurses we are taught to continuously assess and prioritise (then re-prioritise) our care. What is the most important thing I need to do next? But it is also uber important not to let the small stuff slip past. Often the small things are in actuality, big things, just a long way off. Sometimes this defective perspective hides a mass and velocity that are completely underestimated. Until impact. Our problem is that it is just so easy to pass over the small stuff in our battle with the clinical dragons that need slaying, and the mechanical beasts that demand feeding. The thing is this...because they are small they are usually sorted out quickly. And by fixing them now, you can save yourself and your patient a whole lot of grief later. Sweat the small stuff. I’m sure you have an idea of what I’m talking about here, check some examples of small stuff I noticed in a single shift just today. Cannula security. How often do you see a cannula that has been placed and hastily secured or ineffectually secured only to be pulled or fall out at some critical event where IV access is needed in a hurry. Call bell access. Patients who cannot easily make contact with a nurse will wait until the small stuff has become urgent before calling out. Think projectile vomit. Think wet bed. Think infarct. Think assault. Alarm parameters. Taking a few moments to adjust alarm parameters on monitoring equipment to reduce false alarms saves so much time, and improves the likelihood you will not experience the so called alarm fatigue …. oh, but how often do I find myself running around stabbing the alarm silence button only to have it sound again a couple of minutes later. And around I go again. Bad nurse. Curtain tracks. Let me explain ’cause this one really irritates me. In our own department the treatment areas are separated by curtains that must by changed each time they are soiled (don’t ask) or infected. We refer to this procedure rather euphemistically as a terminal clean. The cleaners are always in a hurry and throw the curtains up often missing links in the curtain rings or letting unused rings bunch up in a row. This small oversight means the curtains take an age to pull and coax around the railing each time a patient needs privacy, and even then there are gaps between curtains. And for the Doctors: “If it wasn’t written down it never happened” does not mean if you do write it down it WILL happen. Take a moment to find the right nurse to inform of your plans and orders. We do not always see your notes. There, that wasn’t too much trouble was it? I sometimes watch the small stuff slide past the corner of my eyes me as I run around with big things on my mind. I just know I should be paying more attention to them. Perhaps you might remember to try and notice what small things are whizzing past you tomorrow. Then notice how the best nurses make time to attend to the small stuff … and are rewarded with a little *more* space to deal with a little *less* of the big.
Posted on: Tue, 18 Jun 2013 07:18:04 +0000
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