RNchat Transcript December 29 2009


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Transcript of RNchat for December 29, 2009. RNchat is a Twitter chat for registered nurses who discuss a wide range of topics related to the nursing profession and health care and technology.

Topics include:

T1 - Robo-nurses
T2 - Using software to deliver care using algorithms & decision-trees.
T3 - Malpractice Litigation

You can follow RNchat on Twitter:


Blog: http://Rnchat,org

Published in: Health & Medicine, Business
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RNchat Transcript December 29 2009

  1. 1. philbaumann: Our good friend @EllenRichter will moderate tonight's #RNchat - 9p EST. She'll show ya how to have fun with these chats. 12/29/2009 06:44 rnchat: Hello & welcome to the holiday edition of #RNchat, with me (@EllenRichter) barely filling the shoes of our star moderator @philbaumann :) 12/29/2009 20:59 rnchat: #RNchat is a way for nurses (& all others in health care!) to meet, tweet & share feelings, thoughts, ideas~ We welcome silent lurkers! 12/29/2009 21:01 rnchat: Lets begin the hour by seeing who is joining in. Introduce yourselves & tell us in 140 or less what brings you to #RNchat tonight! 12/29/2009 21:02 rnchat: Dont forget to include the #RNchat hashtag with your tweets! 12/29/2009 21:02 marcobucci: Hello everyone. Hope you all had a great holiday #rnchat 12/29/2009 21:03 ocdgirl2000: #rnchat how are all of you this evening? 12/29/2009 21:03 TeriRN: I'm Teri, a hospice travel nurse. I'm here to have fun talking w/fellow nurses & glean from their knowledge. =) #RNChat 12/29/2009 21:04 rnchat: Welcome all (and all lurkers) :) #RNchat 12/29/2009 21:05 tstitt: <--Tom Stitt, principal @aperial, open source web svcs for healthcare, sometimes moderator of #hcmktg, silent listener tonight #rnchat 12/29/2009 21:05 eggy1024: hello, hello from cold, snowy madison, wisconsin! hospice nurse now, ER nurse in past. looking forward to the chat. #RNchat 12/29/2009 21:05 rnchat: The topics will be labeled T1, T2, etc. Please remember to add topic label & hashtag #RNchat to ea tweet so we can track your responses! 12/29/2009 21:06 nursingpins: Hi all - good to see ya- critical care New Orleans #rnchat 12/29/2009 21:06 marcobucci: I'm recently new to the profession and am currently working in the ER #rnchat 12/29/2009 21:06 rnchat: Some new faces....welcome!! #RNchat 12/29/2009 21:06 TeriRN: @eggy1024 Wow what a change from ER to Hospice. #RNChat 12/29/2009 21:07 ocdgirl2000: #rnchat let me know when the topics change from T1 to T2, I tend to be ADHD or
  2. 2. ocd..LMAO!! 12/29/2009 21:07 lorryschoenly: #RNChat Hi, Ellen, mostly lurking fron my cell tonight 12/29/2009 21:08 ePatientDave: Department of Redundancy department: RT @MeredithGould: Silently lurking! #RNchat 12/29/2009 21:08 TeriRN: @ocdgirl2000 Don't worry you'll know when it changes. #RNChat 12/29/2009 21:08 rnchat: T1 Bedside nursing shortages have led to development of Robo-nurses. What types of nursing tasks can we SAFELY give up to a robot? #RNchat 12/29/2009 21:09 ocdgirl2000: @rnchat #rnchat or womanpower!! 12/29/2009 21:09 tstitt: T1-Example of nursing robot - like this? http://news.cnet.com/8301-17938_105-10320851- 1.html #rnchat 12/29/2009 21:11 TeriRN: T1 NONE! It bothers me 2C stats of bedside nurse shortage when I try 2get assignments in hospital & can't d/t out of hosp 4 6yrs #RNChat 12/29/2009 21:11 rnchat: Think we could have a robot do turns every 2 hours with a staff member in a hospital? #RNchat 12/29/2009 21:11 nursingpins: T1 Riobo-nurses would be another that we would be responsible for - will be another gen or 2 before they will be any help. #rnchat 12/29/2009 21:12 rnchat: @tstitt Exactly....like that! http://news.cnet.com/8301-17938_105-10320851-1.html #rnchat 12/29/2009 21:12 TeriRN: @marcobucci T1 but even then if the pt has A-fib the electronic BP can be inaccurate. #RNChat 12/29/2009 21:13 ocdgirl2000: #rnchat T1 um no..Robo nurses can't get in the face of an IV drug user & tell them they can't get dosed until they get in the bathroom & pee 12/29/2009 21:13 rnchat: What if the doctor ordered medication, pharmacy filled robot & robot scanned & dispensed to long-term pts? #RNchat 12/29/2009 21:14 ocdgirl2000: #rnchat T1 at least when it comes to dosing methadone..I don't think a robo nurse would be as effective 12/29/2009 21:14 eggy1024: T1 #RNchat BP checks would be great, but we still are responsible for checking to see if WNL, so wouldnt it just be easier to do ourselves? 12/29/2009 21:14
  3. 3. rnchat: Just thinking out of the box...we may not have the luxury of doing everything ourselves with shortages! #RNchat 12/29/2009 21:15 nursingpins: T1 -ANY help we got would be appreciated - even a Robo-nurse. - would be as good as some we have today - #rnchat 12/29/2009 21:16 TeriRN: @eggy1024 I agree. I've used electronic BP cuffs & manual on pts getting a wide diff. major when pt is on bp meds & adjusting d/t BP #RNChat 12/29/2009 21:17 eggy1024: #RNchat T1 what about things like emptying foley catheters, making beds, or stocking supplies? 12/29/2009 21:17 rnchat: I think we all know...its a given...that a robot could not replace a thinking human, but there are possibilities! #RNchat 12/29/2009 21:17 eggy1024: T1 I would LOVE a robo nurse to clean poop/puke up! #RNchat 12/29/2009 21:18 rnchat: @eggy1024 T1 good tasks to delegate to a robot #RNchat 12/29/2009 21:19 marcobucci: Ultimately, pt. care is neglected. We are stuck workingn in inadequate environments giving sub par care. #rnchat 12/29/2009 21:19 rnchat: @tstitt Thanks for that great link! Stroke/neuro robot-http://bit.ly/8QvZSr #RNchat 12/29/2009 21:21 rnchat: Almost time to move on to T2 #RNchat 12/29/2009 21:21 TeriRN: RT @eggy1024: T1 I would LOVE a robo nurse to clean poop/puke up!// that I'll let them do gladly. #RNChat 12/29/2009 21:21 ocdgirl2000: #rnchat T1 the stuff they like to nag us for attention! 12/29/2009 21:23 rnchat: OK, along the same lines of thinking...T2 addresses dealing with patient care despite man (and woman) power shortages #RNchat 12/29/2009 21:23 nursingpins: T1 -robo-nurses could never replace the human touch - one of the most important things in nursing #rnchat 12/29/2009 21:24 rnchat: T2 Should we rely on apps/programs to prompt health care personnel to deliver care using standardized algorithms & decision trees? #RNchat 12/29/2009 21:24 ocdgirl2000: #rnchat T2 that's a question for management!LOL! 12/29/2009 21:26
  4. 4. TeriRN: T2: I think nursing has been doing that for a while with clinical pathways. #RNChat 12/29/2009 21:26 rnchat: @ocdgirl2000 LOL T2 OK this is management asking!! ;) #RNchat 12/29/2009 21:28 ocdgirl2000: #rnchat T2 risk involved that more mistakes are made, who takes responsibilty? 12/29/2009 21:28 eggy1024: #RNchat T2 clinical pathways r everywhere, 4everything, but so often things arent 100% black and white; can b hard 2just go down an algrthm. 12/29/2009 21:29 rnchat: T2 @ocdgirl2000 same responsibility as always, just following a standardized recipe #RNchat 12/29/2009 21:29 nursingpins: T2 algorithams & ACLS has been the biggest infl in saving lives I've seen in 35y of nursing - codes were a comp pandemonium pre #rnchat 12/29/2009 21:30 ocdgirl2000: #rnchat T2 unskilled personnel are now performing skilled tasks that they may not be qualified to perform adequately, 12/29/2009 21:30 marcobucci: Algorithms are an excellent tool to help point in the rght direction. But they can only be effective when used by the right person. #rnchat 12/29/2009 21:30 rnchat: T2 So if we are terribly short-staffed, can we give a less experienced RN an iPhone w/app for postop chole pt care? #RNchat 12/29/2009 21:30 rnchat: T1 & T2 So robots & algorithms are only as good as the people using them #RNchat 12/29/2009 21:33 ocdgirl2000: @rnchat #rnchat T2"less experienced" or "no experienced?" out of school vs someone who is agency..an unknown.. 12/29/2009 21:33 LoryRN: @RNchat so then what is nursing the person or the app-no thanks i want a person who can see outside the box #RNchat 12/29/2009 21:33 eggy1024: #RNchat T2 where do we draw the line? give a GN a fresh post-op CABG pt with an algorithm to follow? 12/29/2009 21:34 TeriRN: RT @rnchat: T1 & T2 So robots & algorithms are only as good as the people using them #RNChat 12/29/2009 21:34 marcobucci: Less xperienced RN should stay true to their knowledge base. Stepping beyond your scope only puts people at risk. App or not. #rnchat 12/29/2009 21:34 rnchat: T2 Great points. We still have much to do if we are going to combat the nursing
  5. 5. shortages soon! #RNchat 12/29/2009 21:36 eggy1024: RT @terirn: RT @rnchat: T1 & T2 So robots & algorithms are only as good as the people using them #RNChat 12/29/2009 21:36 rnchat: On to topic T3 folks :) And thanks for your patience with me! LOL~ #RNchat 12/29/2009 21:36 rnchat: T3 What are your fears as a health care professional regarding malpractice litigation? How do U protect yourself against a lawsuit? #RNchat 12/29/2009 21:37 eggy1024: @rnchat #RNchat where are the nsg shortages? nsg jobs are next to impossible to find around here and other parts of our state. 12/29/2009 21:37 TeriRN: T2 As a travel nurse, I think managers should look at years in nursing as well as experience. I would love 2 go 2 a med/surg floor. #RNChat 12/29/2009 21:38 rnchat: So true! RT @ocdgirl2000 #rnchat T2 there will be times when all you have on your staff will be new nurses and agency nurses! 12/29/2009 21:38 TeriRN: T2:managers won't look @ my profile d/t being in hospice for 6yrs. Still critical think & do all the RN task just in homes not hosp. #RNChat 12/29/2009 21:39 rnchat: @eggy1024 When the baby boomer RNs retire, there wont be many left at the bedside! #RNchat 12/29/2009 21:39 marcobucci: Nursing lawsuits are fairly uncommon in Canada. We do have union protection and lawyers regarding that. #rnchat 12/29/2009 21:40 rnchat: Do those of you who use computerized charting feel that it protects your documentation better from legal standpoint? #RNchat 12/29/2009 21:41 TeriRN: T3: I have my own coverage 4 malpractice I make sure I document everything I do Not documented not done my nsg instructor taught me #RNChat 12/29/2009 21:42 rnchat: T3 I find it amazing how health care lawsuits are not prevalent in other countries like in the USA #RNchat 12/29/2009 21:42 ShimCode: @tstitt User stories, checklists & algorithms – evolved by challenge, experience & anecdote! Meaningful Use...I say! Oh My! #rnchat 12/29/2009 21:42 TeriRN: T3:Computerized documentation helps in that there is no error in not being able to read the handwriting. #RNChat 12/29/2009 21:43
  6. 6. rnchat: @TeriRN T3 your instructor was correct...not documented = not done #RNchat 12/29/2009 21:44 MeredithGould: RT @LoryRN: @RNchat T3 Chart everything, get families permission in writing when needed, and pray a lot #RNchat 12/29/2009 21:44 TeriRN: T3:If nurse is lousy documentor by hand they tend to be lousy documentors on comp. Although comp helps with some assessment docum. #RNChat 12/29/2009 21:45 lrm4z: #RNchat Logan here sorry a bit late. T3 first few months on my own I was constantly concerned that something i did would get me sued... 12/29/2009 21:45 rnchat: T3 Many EMR programs prompt you to document things you would normally never hand- write ritually #RNchat 12/29/2009 21:46 ocdgirl2000: #rnchat I stay late, work off the clock, do documentation for others as well..which I should NOT do.. 12/29/2009 21:46 rnchat: Welcome @Irm4z T3 Yes, most of us fear getting sued all the time! Even when we do things correctly~ #RNchat 12/29/2009 21:47 rnchat: @ocdgirl2000 T3 pssst....never document for others! :( #RNchat 12/29/2009 21:47 TeriRN: "cont. to rest quietly" one of my pet peeves. too ambiguous & can be interpreted in any way by a lawyer. #RNChat 12/29/2009 21:47 lrm4z: #RNchat T3 only thing I've learned to do is be as diligent as poss and keep a positive attitude, as well as work off the clock :( 12/29/2009 21:48 ocdgirl2000: #rnchat T3 we have # of clients assigned, each- it's only a few hrs to do it, for heavens sakes! once a month you update their notes, and + 12/29/2009 21:48 TeriRN: RT @rnchat: @ocdgirl2000 T3 pssst....never document for others! :( // definitely a no no protect your license. U worked 2 hard 4 it #RNChat 12/29/2009 21:49 lrm4z: #rnchat RE: documentation, no I don't feel protected, it's so easy to point and click and not "really document" 12/29/2009 21:49 rnchat: T3 Litigation is real & can be frightening for a health care worker. We must always be diligent when charting to cover ourselves #RNchat 12/29/2009 21:49 eggy1024: @TeriRN #RNchat i hate "will continue to monitor" and then never see charting reflecting f/u. 12/29/2009 21:49
  7. 7. nursingpins: T3 the lit is full of evid. that many lawsuits could be avoided by est. relationships and honesty etc before an event - have seen it #rnchat 12/29/2009 21:50 TeriRN: @eggy1024 I agree. monitor what? esp as final not of shift. You left so who monitored. another pet peeve too. #RNChat 12/29/2009 21:51 rnchat: @TeriRN T3 Yes, I really hate redundant, empty charting statements like the one u mentioned #RNchat 12/29/2009 21:51 rnchat: @nursingpins T3 Yes, big move toward openness & honesty with the pt from the get-go can reduce frequency of litigation episodes #RNchat 12/29/2009 21:52 ocdgirl2000: @RNchat #rnchat T3 not FOR her, just do her patient's notes when she's not up to date for the month! it has to get done! or, dr needs it 12/29/2009 21:52 lrm4z: T3 #RNchat someone explain the repercussions of documenting for others pls... I do it too, and have even been asked to do so by others 12/29/2009 21:53 eggy1024: @ocdgirl2000 #RNchat r u documenting stuff you saw/did? how do you know what to chart/can you trust the other nurse actually did it? risky! 12/29/2009 21:54 TeriRN: If U didn't do the assessment of the pt & document the assessment based on what UR told UR name is on bottom line. #RNChat 12/29/2009 21:54 rnchat: T3 @Irm4z If you document for others, are you stating THEIR findings? If so, THEY should be charting them, not you #RNchat 12/29/2009 21:55 TeriRN: If something goes wrong U R the one called in to court not the nurse who actually did assessment. #RNChat 12/29/2009 21:55 ocdgirl2000: #rnchat T3 things have 2 get done, I do them.notes charting,pt's stating things,urinalysis results,breathalizer results,Takehome schedules 12/29/2009 21:55 lrm4z: @rnchat no no, do the assessment myself, and chart for them, even if they did an assessment too. #rnchat 12/29/2009 21:56 rnchat: T3 When reading medical records, its assumed that the writer is writing about THEIR findings #RNchat 12/29/2009 21:56 rnchat: Well, sitting in the moderator seat, this hour flew like it was 15 minutes!! I enjoyed being on the other end of the questions! :) #RNchat 12/29/2009 21:57 TeriRN: @ocdgirl2000 If U heard the pt say it saw the lab & test results then U can doc that but if
  8. 8. nurse told U it's UR word against theirs #RNChat 12/29/2009 21:58 nursingpins: T3 charting should be eth objective or subjective and listed as so - too many opinions get charted as fact #rnchat 12/29/2009 21:58 marcobucci: U could be documenting things that were never done & be held liable for them. also breaches privacy of pt. If you're not primary RN. #rnchat 12/29/2009 21:58 lrm4z: @rnchat Thanks sorry I was late :) I'll be more on time next time, scouts honor! #rnchat 12/29/2009 21:58 ocdgirl2000: @lrm4z #rnchat T3 they probably didn't even do that...LOL! I do what probably never got done..if you know what I mean.. 12/29/2009 21:58 eggy1024: @rnchat yes, what a great time! this was my first #RNchat. quite enjoyable. thanks to you and others who were here too! 12/29/2009 21:58 rnchat: Thanks to everyone for participating so actively tonight! It was fun! Great responses to all the topics! THANKS! :) #RNchat 12/29/2009 21:59 TeriRN: @rnchat I think U did great Ellen. Missed Phil but glad U could step in and help. Thanks. Glad I was finally able to join in again. #RNChat 12/29/2009 21:59 TeriRN: @lrm4z Glad you were able to join in when you could. #RNChat 12/29/2009 21:59 rnchat: @philbaumann will decide the next chat so be on the lookout for further tweets! :) #RNchat 12/29/2009 22:00 ocdgirl2000: #rnchat T3 we have computerized notes, schedules and dosing. 3/4 or more of the notes are written by me. That's a fact. I only work 20 hrs. 12/29/2009 22:00 nursingpins: Thanks Ellen for taking over tonight - great job #rnchat 12/29/2009 22:00 rnchat: Transcripts of the chat will be provided by @philbaumann later on or tomorrow...hes great about that! :) #RNchat 12/29/2009 22:01 lrm4z: @TeriRN thanks for the warm welcome! #rnchat 12/29/2009 22:01 rnchat: LOL guys....thanks for the cheers!! @tstitt @nursingpins @TeriRN @ocdgirl2000 #RNchat 12/29/2009 22:02 TeriRN: @JimRN You missed a great chat. =( Look for the transcript. We missed you. #RNChat 12/29/2009 22:02
  9. 9. marcobucci: Good stuff tonight. Take care all! #rnchat 12/29/2009 22:02 ocdgirl2000: #rnchat Thank you Ellen! it was fun and great to be back at Nurse chat! stim as usual! clap clap clap!! 12/29/2009 22:02 eggy1024: @RNchat how often do you guys get together for this? #RNchat 12/29/2009 22:02 rnchat: You all are welcome to continue. I'm slipping back into my own Twitter account now! Enjoy your nite & Happy New Year!! #RNchat 12/29/2009 22:03 rnchat: @Eggy1024 we do it weekly, trying to alternate hours & days Glad you came! :) #RNchat 12/29/2009 22:04 ocdgirl2000: @eggy1024 #rnchat whenever I get enough reminders!LOL! also I have to not be working depends on hours they decide to have it~~ 12/29/2009 22:04 TeriRN: @eggy1024 Usually once a week around this time and this day. @philbaumann post time and day. Pls come back and join in #RNChat 12/29/2009 22:04 EllenRichter: THANKS for your help everyone!! I know I messed up a lot...forgot to type T2, T1, LOL~~ #RNchat 12/29/2009 22:06 TeriRN: @EllenRichter I think you did great. Hard to remember all of that. #RNChat 12/29/2009 22:06 EllenRichter: Boy, you guys that chart for others...thats wavy seas!! I wouldnt suggest doing that very much! Even if its to save time! #RNchat 12/29/2009 22:07 MeredithGould: @EllenRichter No mess ups apparent! Totally great job. #RNchat 12/29/2009 22:07 EllenRichter: @TeriRN thanks :) Glad u made it home early! #RNchat 12/29/2009 22:08 eggy1024: no, it was fun! you did great. thanks! @EllenRichter #RNchat 12/29/2009 22:08 EllenRichter: @MeredithGould Yes...I got your DM but was afraid to respond on my account while signed into @RNchat LOL ~TY though!! #RNchat 12/29/2009 22:09 TeriRN: @EllenRichter Me too. Left home of 2yrold actively dying. Needed this 2nite. Thanks #RNChat 12/29/2009 22:09 EllenRichter: @eggy1024 I missed your intro...what type of nurse? #RNchat 12/29/2009 22:09 EllenRichter: @TeriRN I just love hospice nursing more each year. If I didnt love critical care, hospice
  10. 10. would be my next choice #RNchat 12/29/2009 22:10 eggy1024: @EllenRichter now hospice, have done mostly ER tho...still kind of miss it! #RNchat 12/29/2009 22:11 eggy1024: @EllenRichter @TeriRN i find there's more charting in hospice nsg than ER nsg. #RNchat 12/29/2009 22:12 EllenRichter: I work in geriatric critical care which means more than half of my pts end up hospice if they make it...it really helps families #RNchat 12/29/2009 22:12 ocdgirl2000: @eggy1024 #rnchat charting is more for medicare reimbursement? 12/29/2009 22:14 EllenRichter: Well, in 2015, we will be directing our robo-nurses to follow algorithms that we will electronically chart about from home #RNchat 12/29/2009 22:15 TeriRN: @EllenRichter That's a scary thought. I don't ever want to give up my face to face with pts. #RNChat 12/29/2009 22:16 EllenRichter: Should be interesting to see how nursing care twists & turns with health care reform cost cuts #RNchat 12/29/2009 22:16 ocdgirl2000: @EllenRichter #rnchat in 2015 I'm going to be retired!! that's the YEAR! then I can work agency and get free bennies where I am now! 12/29/2009 22:17 DONNAinOHIO: RT @EllenRichter: Should be interesting to see how nursing care twists & turns with health care reform cost cuts #RNchat 12/29/2009 22:17 EllenRichter: No, @TeriRN neither do I want to give up face-to-face patient contact! I love being a bedside hospital nurse #RNchat 12/29/2009 22:19 EllenRichter: LOL @ocdgirl2000 I wish I could retire in 2015! Geez thats right around the corner! Lucky YOU! #RNchat 12/29/2009 22:20 EllenRichter: Thanks for the RT @DONNAinOHIO :) #RNchat 12/29/2009 22:20 EllenRichter: OK people...my 2 dogs' eyes are yellow from holding it in!! I need to take them out! Have a great nite~ :) #RNchat 12/29/2009 22:22 ocdgirl2000: #rnchat I like the idea of being "available" 2 some select places that I become "familiar" with,comfortable with..just 2 help with patients 12/29/2009 22:22 ocdgirl2000: #rnchat I don't want to be a slave to a bullying boss and a scheduled lifetime of people telling me what I can and cannot do..tired of it.. 12/29/2009 22:23
  11. 11. JimRN: Don't hospice & critical care have opposite goals? #justaskin #rnchat 12/29/2009 22:33