Rapid Changes of Nursing in US Hospitals

Hello Dormana.  Would like to say thank you so much for sharing to us some of the current trends in the deliverance of Health care in US of A.    This gives us a clear picture of how the US health care system differs so much  from that of OURS.  

Nurses in the pipeline awaiting for visas will definitely be eager to prepare themselves to face this kind of technological advancement moment uncle Sam opens his door for us. With the gifted flexibility/adjustability character that we possesses, and with the determined soul that we have, I believe it wouldn't be much of anything to get used with this systems in time.

I hope and pray, same like others does...that retrogression will finally be lifted.

God Bless us all... God Bless America...

There is one massive thing about Filipinos home and abroad : patriotism.  This culture led most of us to look after the other. My best friend, an Indian, had actually expressed appreciation and awe that we possess this attitude. Contrary to his countrymen behaving abroad. No harm meant.

 I am pretty sure that the adaptability of Filipino nurses will prove this a challenge dealt with accordingly. Right where my bum is stuck while writing this, I am pretty sure that to learn further aside and be open to updates in nursing  is some task willingly accepted by nurses overseas.  I am not worried at all. Filipino nurses who cast their dreams ashore will be too happy to prove their worth.

Kudos to the unselfish act of another hero, a Filipino nurse, who kindly kept us all abreast. Gratefulness abound..... 

:)

I am sharing these information because the learning curve is getting steeper and steeper.  

More than a few nurses are not passing the orientation period.

Nurses trained in US Hospitals have clear and distinct advantages--they are exposed early to the technology (they have at least 1 year exposure), and have more time to adapt.  

Foreign nurses upon seeing the system say "Hi Tech!" and have 6 weeks to qualify (some managers give you 12 weeks...and I know of 1 nurses who didn't make it after 6 months of orientation)--not an easy job, because the foreign nurse has to provide care to the patients, translate his/her nursing knowledge to the US setting, learn to use the technology, and learn what, when, and how to document nursing care.

I am just ringing the bell to rouse my kababayans from slumber.  I have met a couple of nurses who quit because they could not hack it. 

"Sabi nila madali lang trabaho dito."  

Don't believe this.

The work might get easier for you, but that's after you learn the ins and outs of the system--usually after at least 6 months to a year.

Until they introduce the next technological innovation.

So keep your chins up, make your hearts strong, and brace yourselves.

And ask for help.  

Sa aking karanasan, di ka tutulungan ng ibang lahi, at ng mga kababayang akala'y puti na ang balat nila...pero may mga Pilipino na handang tumulong, magtanong lamang kayo.

Keep praying and hoping that we'll get good news in 4 months.

thanks for that info dormana..I never thought thats how things are done in the US setting... Indeed thats totally different from what we have here in Phil..

Read up on PICC Lines.  These are the counterparts of our cutdowns.  There's a lot of them in US Hospitals.  Remember to always use 10 ml syringes when using PICC Lines.

The other thing we don't usually see in Philippine hospitals is the IV Pump.  There are at least 3 kinds...be familiar with them, even by just looking them up and reading about how to operate and backprime.  This is one thing that can trip up foreign nurses when they first work in US Hospitals.

Also PCA Pumps.  I don't know if we have these in Asian Hospital, St. Luke's, Cardinal, or Makati Med...try to know something about PCA Pumps, especially if you plan to go into Surgical Floor.

Mga Kababayan kong nasa Pilipinas,

I know we're all under the Shadow of Retrogression.  It is a heavy load.
I feel, however, that you Dudes and Dudettes should know about the rapid changes of Nursing in US Hospitals.
Technology is being introduced at a fast rate, and even experienced US nurses are finding it difficult to cope.
I tell you this not to dishearten you, but to strike a fire in your belly to strive harder, to learn better.
I don't think we have the Omnicell nor the Pyxis in the Philippines.  US Hospitals have one or the other--for the Omnicell, you punch in your Username and Password to access it initially; subsequently you can use your fingerprint to enter the system.  For the Pyxis, you have to enter your Username and your fingerprint everytime.  After you gain access to the system, you select your patient name, then the medication.  After you press "OK," you open the drawer with the flashing light, then open the cubbyhole with the flashing light.  For narcotics, the Omnicell can drop a unit dose into a drawer; for both systems, you open a drawer and you have to count the medications, punch in the count, before you get one and close the drawer.  Needless to say, be careful with the medications--make sure you sign out before you leave the Omnicell or the Pyxis, because if you leave them without logging off, anybody can get all the narcotics they want...and you'll be liable for them.
Of course you'll have to document pain medication in the computer documentation--either Epic or Meditech.  They have their own styles of documentation--you'll learn them during your orientation.
Now there's another new thing in US Hospitals--eMAR.  Basically, the RN has to scan the patient's ID band, then the medications to be given, before giving the medications.  This can catch medication errors...but it's a dual-edged sword:  RNs are open to medication errors with this system.  US Hospitals use military time (so get used to that), and let's say a medication is scheduled at 2100, you have 30 minutes before and after to give that medication.  That's 2030 to 2130.  So if you scan the medication at 2131, that medication is automatically flagged as a medication error--remember "Right Time?"
Forewarned is forearmed.  I hope that my giving you Chongs and Changs a heads-up will help you adjust better and faster.
I hope the Retrogression lifts soon.  I look forward to working with you in the US.

-dormana

Dormana...wow what an organized and precise place to work with in a highly technological advanced healthcare like the U.S.The Omnicell and the Pyxis System is awesome.Love it!Must have been an accurate and well documented setting out there.I have my practice for quite sometime in the Mid East but the two sytems for Controlled and Narcotics were not in sight.Although most of the hospitals I worked  have been accredited with JCIA's, still the cupboards are yet manually accessed and with 2 RNs to double check everything, from inventories to replacement as well as administering such medications to the patients.Electronic documentation though are now also implemented in the Mid East.King Faisal Spec Hosp. and Research Centre had utilized Meditech during my pioneering days but have now improved their Health Information Sytem.Other hospital that I worked too whose partnered with Cleaveland Clinic Foundation have Phoenix as their Health Info Sytem and are now into paperless documentation from Nursing, Labs, Doctor's orders etc and eMAR are also practiced.Also documentation electronically in the Nurses notes are simplified the DAR(Data-Action-Response) only.And whatever updates or progress of patients conditions are re-evaluated.During surgeries...Doctors go onlive teleconferencing and videoconferencing live to their partnered hospitals.If an important patient requested that relatives can view him/her, surgical procedure can be viewed in a DOME surgical theatre and relatives can peer through on the glass covered dome theatre on aerial view.

There is one hospital too that I worked before and accessing to other units are done only through swiping of employees' badges and getting in and out to work can be recorded through a door scanner that records you time in and out for work..Nonetheless since it's a new thing theirs is still a sytem that is not perfect, sometimes it won't accept other employees' badges as system is not updated/badges not entered.But their call bell system is also advance like each nurses assigned to certain patients have a special ID tag that trackdown the whereabouts of Nurses.Thus if the patient calls  the specific name of Nurse assigned to such registers on the call bell screen and somehow the management knows if the nurse is attending to the needs of the patiently promptly or just languishing.The screen too is managed as a TOUCH SCREEN.Beds are mostly HILLROM types and with bedscales, TV and radio controls in it, with an automatic air mattress. Furthermore, PCA,IV Pumps and PCA Pumps are also used there now.Few brands I can recall are the Abbott, IMED, Fresenius and IVAC.They are strict too when it comes to documentations of patients administration of meds.Always 2 RNs to double check prior and after meds.And protocol to change IV lines, tubings and dressings, and IV bags.Military time is also utilized in the documentation of meds administered.But the timing they have is based on their start time protocols and unit dose are implemented to monitor medication supplies and errors too.RNs don't mix IV medication except ER meds.There is an IV pharmacist assigned to that and whatever IV medications needed in the unit are already premixed when you need, you just have to fax the orders of the doctors.PICC Lines, they have too their protocols in that when using it...and the SASH principle is adapted(Saline-Administer-Saline-Heplock)

Well it is always good to exchange infos and experiences...Learning a lot from you and this forum.

Thanks and hey have you heard yet of "MAGNA STATUS" there in the U.S.?Some hospitals in Mid East are now trying to acquire that status too.

Goodluck to you and to all out there!

Oppps...I mean "MAGNET STATUS".

Magnet Status...no, I'm not working in one.

wow what an organized and precise place to work with in a highly technological advanced healthcare like the U.S.

It is more organized than back in Pinas...but the checks and controls work much faster too.


You get "educated" when you make a medication error, like administering a medication more than 30 minutes from the set time.  Or if you forget to date and time an order.

The Omnicell and the Pyxis System is awesome.Love it!

Me too.  I like the Omnicell better, especially if they set it for dropping the narcotics.

Otherwise you'll have to count the medications in the drawer each time.  

Must have been an accurate and well documented setting out there.

It's much easier to document.  I would advise our kababayans to learn how to type fast.  If you're still in the tuldok system, it'll take you a long time to finish charting.

I have my practice for quite sometime in the Mid East but the two sytems for Controlled and Narcotics were not in sight.Although most of the hospitals I worked  have been accredited with JCIA's, still the cupboards are yet manually accessed and with 2 RNs to double check everything, from inventories to replacement as well as administering such medications to the patients.

We used to have the locked cabinets (each nurse walk around with a narcotic key), but shifted over to Pyxis 2 years ago.


Yeah, I remember the narcotic counts--nobody can leave until the counts are correct.  If the count is really incorrect, everybody from the previous shift undergoes a urine tox screen.

Electronic documentation though are now also implemented in the Mid East.King Faisal Spec Hosp. and Research Centre had utilized Meditech during my pioneering days but have now improved their Health Information Sytem.Other hospital that I worked too whose partnered with Cleaveland Clinic Foundation have Phoenix as their Health Info Sytem and are now into paperless documentation from Nursing, Labs, Doctor's orders etc and eMAR are also practiced.

On the computerized workflow--I find that the Epic system is much better than Meditech.


It's amazing that you can see orders in the computer once the MD clicks on them.


The downside though is if you have MDs who input orders every now and then...argh!!!  You have to acknowledge each order, and before you can carry out the orders, you get new ones.  And that's only for one patient.

Also documentation electronically in the Nurses notes are simplified the DAR(Data-Action-Response) only.And whatever updates or progress of patients conditions are re-evaluated.During surgeries...Doctors go onlive teleconferencing and videoconferencing live to their partnered hospitals.If an important patient requested that relatives can view him/her, surgical procedure can be viewed in a DOME surgical theatre and relatives can peer through on the glass covered dome theatre on aerial view.

Our hospital is supposedly connected to a big teaching hospital, but I haven't seen teleconferencing here.


Patients transfer with DVDs though, and other data is easily transferred electronically.

There is one hospital too that I worked before and accessing to other units are done only through swiping of employees' badges and getting in and out to work can be recorded through a door scanner that records you time in and out for work..Nonetheless since it's a new thing theirs is still a sytem that is not perfect, sometimes it won't accept other employees' badges as system is not updated/badges not entered.

Some of our doors are opened by putting your badge near a scanner--it's a dark brown plastic plate with a red light, located beside the door.  We have them in our medication rooms too.

On timing in and out--some hospitals require badge swipes in a time clock...some requires you to call a central number, input your employee number and password, then press 1 to clock in or 2 to clock out.

But their call bell system is also advance like each nurses assigned to certain patients have a special ID tag that trackdown the whereabouts of Nurses.Thus if the patient calls  the specific name of Nurse assigned to such registers on the call bell screen and somehow the management knows if the nurse is attending to the needs of the patiently promptly or just languishing.The screen too is managed as a TOUCH SCREEN.

You mean the locator or tracker...it's part of the uniform, name badge and locator.  When you enter a patient room, the green light goes on above the door, so it's easy to see if a nurse is in a room.  The monitor also tracks each nurse, and if you press the touchscreen, the nearest intercom is activated.

Some areas are using the Vocera--it's like a walkie-talkie you wear around your neck.  It's cool as you can use it like a hands-free phone, but it's also not cool as you can always be called whenever you're in the hospital.  Even when you're on your break.

Beds are mostly HILLROM types and with bedscales, TV and radio controls in it, with an automatic air mattress.

 

I've seen Versacare and Stryker beds.  All controls are in the bed, plus the Bed Scale, so getting the weights is as easy as pushing a button.

Air mattress...some of the beds have powered air mattresses, and can provide massage, or pulmophysiotherapy.  

Furthermore, PCA,IV Pumps and PCA Pumps are also used there now.Few brands I can recall are the Abbott, IMED, Fresenius and IVAC.They are strict too when it comes to documentations of patients administration of meds.Always 2 RNs to double check prior and after meds.And protocol to change IV lines, tubings and dressings, and IV bags.

Yep.  We're shifting to vials now instead of the little bags.  Vials contain 30 mls each...it's a bummer when you get patients who are always pushing the PCA button, as you have to get the PCA key and the narcotic vial each time you change it...and document it too.

Military time is also utilized in the documentation of meds administered.But the timing they have is based on their start time protocols and unit dose are implemented to monitor medication supplies and errors too.

We have cycling guides--it's a chart on when to administer medications next.

RNs don't mix IV medication except ER meds.There is an IV pharmacist assigned to that and whatever IV medications needed in the unit are already premixed when you need, you just have to fax the orders of the doctors.

Same here.

PICC Lines, they have too their protocols in that when using it...and the SASH principle is adapted(Saline-Administer-Saline-Heplock)

This too.  We don't call it SASH, but that's how we do it.  Except with eMAR, we now have to scan even the saline flushes.

Well it is always good to exchange infos and experiences...Learning a lot from you and this forum.

This is the purpose of this forum, so we can learn from each other.

I decided to start this thread as some nurses are finding it hard to catch up with their work, especially with computerization of the MAR and soon Allergies and Blood Administration.

If nurses trained in the US are having difficulty, I think most of our nurses will also have difficulty adjusting.

I'm hoping this thread will prepare our nurses for when they get over to the US.

Read up on PICC Lines.  These are the counterparts of our cutdowns.  There's a lot of them in US Hospitals.  Remember to always use 10 ml syringes when using PICC Lines.
The other thing we don't usually see in Philippine hospitals is the IV Pump.  There are at least 3 kinds...be familiar with them, even by just looking them up and reading about how to operate and backprime.  This is one thing that can trip up foreign nurses when they first work in US Hospitals.
Also PCA Pumps.  I don't know if we have these in Asian Hospital, St. Luke's, Cardinal, or Makati Med...try to know something about PCA Pumps, especially if you plan to go into Surgical Floor.

-dormana

Never seen IV and PCA pumps in St. Lukes.I know because my I took care of my sister who's been ill and treated with CA there a year ago.Maybe in order there are pumps being used.They are still utilizing the count-drops system when patients are having IV lines.Including thermometer, still the mercurial type.Well, you're right dormana, getting used to backprime and setting up these pumps will take a while for a new user.And the machines are sensitive too with even a slight presence of air.Thus, it is definitely a must to be exposed with these machines.

Also, is the hospital you work used needleless kind of tubings...Specialized hospitals used it.KFSH used that for safety for their staff, like in ICU and OR settings.Oh...Stryker frame are also used there and hoist to transfer patients, bedridden ones from wheelchair and back to bed.

Furthermore, About Magnet Staus Hospital:

A Magnet Hospital for Nursing Excellence

Magnet hospital is one that has embarked on an extensive review and systematic evaluation of its nursing practice by the American Nurses Credentialing Center (ANCC). Magnet hospitals must meet stringent quantitative and qualitative standards that define the highest quality of nursing practice and patient care. Becoming a Magnet hospital means that the organization must meet over 65 standards developed by the ANCC. The standards must be demonstrated in a very extensive written document and validated and clarified by a site visit. There are only 67 Magnet hospitals in this country. The Miriam was the ninth to achieve this status and the first to achieve it in New England.

What Magnet status means to nurses and the hospital

The Magnet designation means that the hospital has created an environment that supports nursing practice and focuses on professional autonomy, decision making at the bedside, nursing involvement in determining the nursing work environment, professional education, career development and nursing leadership. This can only be accomplished with the support and participation of all the departments and employees in the hospital that place patient care first and foremost in the mission of their daily work. One hospital, "THE MIRIAM HOSPITAL" have created this environment with the patient in mind.

What Magnet status means for patients

Quantitative evidence indicates that hospitals that have achieved Magnet status have improved nurse to patient ratios and patient satisfaction is higher than in non-magnet hospitals. Health care consumers are becoming much more educated and discriminating and are seeking objective benchmarks that will aide them in choosing a health care provider.

About the ANCC

The American Nurses Credentialing Center (ANCC) was established in 1991 as a separately incorporated entity of the American Nurses Association. The ANCC has provided certification opportunities in more than 30 specialties and advanced practice areas of nursing. It is the only national system for accreditation and approval of continuing education in nursing.
The Magnet Recognition Program for Excellence in Nursing is based and administered by the ANCC. The program was based on research completed by nurse researchers in the early 1980s who identified the attributes of organizations that were able to recruit and retain professional nurses.
The Magnet program identifies excellence in the provision of nursing services, an environment that fosters and rewards quality nursing, recognizes the management philosophy and practice of nursing services and the adherence to standards for improving the quality of patient care.

One hospital in Middle East have been working on this"Magnet Status", but for sure it will take a while to get its accreditation to the credentialing body like how the process is with JCIA.

For more info on Magnet hospital, visit this link:
http://www.lifespan.org/tmh/services/nursing/magnet.htm

You get "educated" when you make a medication error, like administering a medication more than 30 minutes from the set time.  Or if you forget to date and time an order.
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That's right...same practice in Mid East.It must be given 30 minutes before or after the actual time.Also 2 nurses get to double check the ordered meds before administration.Primary Nursing care is implemented in taking Care of patients.

It's much easier to document.  I would advise our kababayans to learn how to type fast.  If you're still in the tuldok system, it'll take you a long time to finish charting.
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That's true.Somehow, the hospital in Mid East too created for a better flow accessing computers for documentation, they put one laptop each with a stand outside each room of a patient so that during doctors rounds and other members of the health team, everybody can have access and no hindrance to access the system to check records and progress of patients.We also have a monthly training before set up by the IT department teaching the staff basic use of programs in the system.Even the hospital's access to intranet like use of outlook.

We used to have the locked cabinets (each nurse walk around with a narcotic key), but shifted over to Pyxis 2 years ago.

Yeah, I remember the narcotic counts--nobody can leave until the counts are correct.  If the count is really incorrect, everybody from the previous shift undergoes a urine tox screen.
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Ha!ha!ha! Seriously, they do that to staff? Never came that far in the Mid East setting.

On the computerized workflow--I find that the Epic system is much better than Meditech.
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Yap meditech has its flaw, once the sytem is down..it really shuts down.KFSH thus changed theirs since 2004 into a new system which it's at the tip of my tounge but can't recall, it starts with "M".

It's amazing that you can see orders in the computer once the MD clicks on them.
The downside though is if you have MDs who input orders every now and then...argh!!!  You have to acknowledge each order, and before you can carry out the orders, you get new ones.
 And that's only for one patient.
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The nurse have to get it going carrying out orders promptly so that flow of documentation will not make you "toxic".

Our hospital is supposedly connected to a big teaching hospital, but I haven't seen teleconferencing here.
Patients transfer with DVDs though, and other data is easily transferred electronically.
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KFSH parterns with John Hopkins Univ. Hosp. and Mayo Clinic, thus the teleconferencing is often utilized to exchange infos for a better case studies of clients cases and as such if patients needs advanced treatment that the facility is not yet equipped, they flew patients to the U.S. via MEDEVAC for referral and further treatment
Yes, copies of the patients data is also available upon patient's request, copied too in CD's.

Some of our doors are opened by putting your badge near a scanner--it's a dark brown plastic plate with a red light, located beside the door.  We have them in our medication rooms too.

On timing in and out--some hospitals require badge swipes in a time clock...some requires you to call a central number, input your employee number and password, then press 1 to clock in or 2 to clock out.
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More with features than the one I am used.But quite same idea.

You mean the locator or tracker...it's part of the uniform, name badge and locator.  When you enter a patient room, the green light goes on above the door, so it's easy to see if a nurse is in a room.  The monitor also tracks each nurse, and if you press the touchscreen, the nearest intercom is activated.

Some areas are using the Vocera--it's like a walkie-talkie you wear around your neck.  It's cool as you can use it like a hands-free phone, but it's also not cool as you can always be called whenever you're in the hospital.  Even when you're on your break.
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Yap, that's the one.Even during emergency you can ask help from colleagues right away by pushing a button intended for ER purposes only.

I've seen Versacare and Stryker beds.  All controls are in the bed, plus the Bed Scale, so getting the weights is as easy as pushing a button.

Air mattress...some of the beds have powered air mattresses, and can provide massage, or pulmophysiotherapy.  
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That way, weights of patients are monitored well even bedriddens and having mobility problems.
Definitely airmatresses are good to prevent skin breakdown and decubiti.

Nice sharing dormana.Till next post.Thanks.