3-One area of nursing that seems to be an ongoing problem is nurse to patient ratio. I feel like when this subject is brought up to those in charge of staffing, they want to roll their eyes at me or whoever is asking about it. I understand that nurses have been wanting less patients for as long as I can recall. The problem is more than just floor nurses complaining. With the advancements in technology and medicine, patients are able to have their cares at home or surgeries on an outpatient basis. Those “walkie talkie” patients are becoming fewer and fewer in the hospital. The patients that we take care of on a daily basis are sick. And I mean they are sick. These patients that may have been ICU patients in the past are now on acute care floors and are being cared for by a nurse that has four other very sick patients. If they had been admitted to the ICU, their nurse may have only one more patient. Floor nurses are being pulled very thin which also leads to nurses feeling burnt out and can have those nurses looking for a different job, which leads to the nursing shortage (Garretson, 2004). We have continued to have the same nurse to patient ratio for years now even though the patients being seen are getting sicker. If nurses had less patients to care for, closer attention can be given to their patients and the risk of mortality can be decreased (Shekelle, 2013)

Garretson, S. (2004). Nurse to patient ratios in American health care. Nursing Standard, 19(14), 33-37. Retrieved 8 29,

 2018, from 

      https://ncbi.nlm.nih.gov/pubmed/15633873

Shekelle, P. G. (2013). Nurse–Patient Ratios as a Patient Safety Strategy: A Systematic Review. Annals of Internal

5-I like your post. Of course Nurses play an important customer service role for hospitals, doctors offices and other medical facilities. Nurses are the ones with the most frequent, direct patient interaction. I just want to share  the best way to provide excellent customer services .

Be personable and connect with patients:

• Listen
• Use      touch when appropriate
• Make      eye contact
• Do      not rush interactions with patients
• Acknowledge      that you are understanding the patients desires and concerns by      summarizing and stating them back to the patient and verifying that you      both are on the same page.

Use appropriate language:

• Discuss      medical information in language that patients can understand

For example: If a patient has a fourth grade reading level do not use every big word and medical term possible when discussing medical information

Show that you care:

• Ask      patients if they have any questions or concerns
• Take      the time to listen to any questions or concerns that the patient may have
• Show      empathy and acknowledge their issues
• Address      their issues and keep them informed on actions being taken

Involve patients in their care:

• Give      patients choices whenever possible
• Take      their preferences into consideration and formulate a plan together
• Be      knowledgable and considerate of the cultural, social or economic factors      that influence their care, decision making, and interation with the      healthcare team

6-Medication errors are one of the most common causes of unintended harm to patients. Med errors can lead to patient disability or even death. The problem is many nurses are in a hurry or don’t even realize they have administered the wrong medication. This can not only lead to possible further harm but does nothing to correct the error as it goes unnoticed. A patient returns from surgery, anxious and in pain, with several I.V. lines and intracranial pressure (ICP), monitor in place. The I.V. tubing used in the operating room differs from the tubing used in the intensive care unit (ICU). In her haste, the ICU nurse prepares to inject morphine into the patient’s ICP drain, which she has mistaken for the central line. She stops just in time when she realizes she is about to make a severe mistake.  The nurse did not complete her five rights before administration leading to a med error. With the new mandated law of electronic charting, we are required to scan our meds which may cut back on the number of errors, but I do not believe it will eliminate them. Technology is growing in hospitals and helping nurses to go right path and prevent medication errors, but unfortunately, med error still exists. Nurses can help further eliminate medication errors by following five rights and completing the appropriate checks before administering any medications. A possible benefit to help reduce medication errors may be to extend new grads internships as well. Education is the key to prevent the medication error. Medication administration is a complicated multistep process that encompasses prescribing, transcribing, dispensing, and administering drugs and monitoring patient response. An error can happen at any step. Although many errors arise at the prescribing stage, some are intercepted by pharmacists, nurses, or other staff.

References

American Nurses today-ANA:https://www.americannursetoday.com/medication-errors-best-practices/

Nurse Perceptions of Medication Errors: What We Need to Know for Patient Safety: https://www.nursingcenter.com/journalarticle?Article_ID=514523

Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to thispatient?

These are some of the questions you might consider when selecting a treatment plan for a patient. As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives on a daily basis. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. In this paper, you explore ethical and legal implications of the following scenario and consider how to appropriately respond.

Scenario:

You see another nurse practitioner writing a prescription for her husband who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.

To prepare:

· Review  the following: 

·  

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

• Chapter 1, “Issues for the Practitioner in Drug      Therapy” (pp. 3–14)
       This chapter introduces issues relating to drug therapy such as adverse      drug events and medication adherence. It also explores drug safety, the      practitioner’s role and responsibilities in prescribing, and prescription      writing.
• Chapter 59, “The Economics of Pharmacotherapeutics”      (pp. 1009-1018)
       This chapter analyzes the costs of drug therapy to health care systems and      society and explores practice guideline compliance and current issues in      medical care.
• Chapter 60, “Integrative Approaches to      Pharmacotherapy—A Look at Complex Cases” (pp. 1021-1036)
       This chapter examines issues in individual patient cases. It explores      concepts relating to evaluation, drug selection, patient education, and      alternative treatment options.

As well as:

Drug Enforcement Administration. (n.d.). Code of federal regulations. Retrieved August 23, 2012, from http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

Anderson, P., & Townsend, T. (2010). Medication errors: Don’t let them happen to you. American Nurse Today, 5(3), 23–28. Retrieved from https://americannursetoday.com/medication-errors-dont-let-them-happen-to-you/

· Consider the ethical and legal implications of the scenario for all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family.

· Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario.

With these thoughts in mind:

Post an explanation of the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family. Describe two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario.