[twinmommy+2]

haha, yeah, we had that this weekend

All afternoon we were hearing from this pt literally right across from the nurses station moan as loud as he could. He was one that is homeless, comes in for a tx and leaves before being officially discharged according to other nurses. Needless to say his sats were fine and there were like four other people who were on deaths door and knocking to come in.

So I'm starting an iv as a favor for a woman who is knocking away like I said. I see her starting the bigenimy pvc's as her nurse is throwing an ekg on her. I get the IV in and no sooner she starts in vfib/vtach so we are hollering for a doctor to come in now.

Now let me tell you, this guy is right next to her and in a position to see the crash cart and streaming people going by his room and can hear all the commotion. As I finish her iv in a hurry I hear "I can't believe how long this is taking, I want to go home". Another nurse standing at the nurses station states "I am so sorry sir, I will get those papers for you right away, but when you come in pulseless I assure you we will be working on you just as fast as we are for her" got him out of there quick and in a hurry

love that nurse lol

[rph3664]

Originally Posted by AussieTina

The hospital I work at is mainly a rehab/waiting for nursing home placement hospital.

For any patients who try that type of thing, we just tell them seriously "well if you are starting to have problems doing things like that for yourself, maybe you should start to consider going into a nursing home, would you like me to arrange a meeting..."

It is amazing how fast they start to do stuff for themselves again, and how much better their walking ect gets

My grandmother, who died last year at age 91, had major surgery one time and refused to get out of bed. Someone (we never found out who) told her that if she didn't start walking, she would have to go to a nursing home upon her discharge.

At that point, she became more cooperative because she DID NOT want to go into one. She did spend her last 2 years in one because she could no longer live independently, but she hadn't reached that point when she had that operation.

[catshowlady]

[quote=chisgirl;2762122]
This is where nurses have lost it.... we used to CARE... I graduated with the knowledge of a professionaol RN.. but with the heart of someone who truly CARED..... we "pretended" that every patient might be someone we knew/cared about and we put ourselves in their position. We asked ourselves the question... "what would I want...". Medical staff, not just RN's don't ask that question anymore. They look for the most cost-effective/legal/time-saving route that will "take care" of the patient's request without costing them time/concern/anything....
quote]


I can't speak for everyone, but I know that everyone I have worked with still CARES about their patients, but, as a general rule, we are so overworked that we don't always have the time to do the things that show how much we care.

When you have to handle all the regular stuff (assessments, meds, charting, labs, new orders) that has a pretty high priority, plus the other less important but still mandatory stuff (care plans, dressing changes, tubing changes, trach care), and top that off with a code or a crashing patient, it can be too much for the nurse to meet all of his/her patients' needs. Unfortunately, emotional needs usually get put on the back burner, behind the ABC's, pain control, assessments, and meds. That doesn't mean that you can't or don't care, just that you're spread too thin. Every nurse I know cares deeply about what happens to his/her patients, and, yes, treats patients as s/he would want to be treated. Sadly, we don't always have the ability to follow through on that. Sometimes, the only thing I can do is get the doc to order a psych consult for the patient when I think s/he has emotional needs, even though it might be something I could otherwise help with (e.g. coping with loss).

It's a sad commentary on staffing levels, really.

[lamazeteacher]

Originally Posted by Natkat

See, here's the thing. We didn't know what was wrong with her. We just saw a patient lying on the floor unresponsive and eight other people stepping over her like she was a throw rug. She could have been in arrest. But no one even showed any concern or even bothered to say "hey someone passed out in the lobby." One of the staff happened to be walking past the door and saw her out there.

I actually like my job very much. I was merely adding to a discussion about self-centered behavior that we have witnessed. How you turned this into a discussion about mean old nurses who are taking the position of victim is beyond my comprehension.

My post was about the professional role nurses play dealing with medical emergencies; and that patients who are self centered due to their illness can't deal with others' troubles. Hopefully they didn't step on the patient who was down....... It's surprising that a regular dialysis patient who must have been known to have diabetes, may not have been recognized as being in hyperglycemia. I didn't mean to cast aspersion on the staff as "meanies", but I did want to call attention to the fact that patients' need for their own treatment is paramount, and the professionals needed to organize the care given to the emergency patient and the others, efficiently and appropriately.

[Natkat]

Originally Posted by lamazeteacher

My post was about the professional role nurses play dealing with medical emergencies; and that patients who are self centered due to their illness can't deal with others' troubles. Hopefully they didn't step on the patient who was down....... It's surprising that a regular dialysis patient who must have been known to have diabetes, may not have been recognized as being in hyperglycemia. I didn't mean to cast aspersion on the staff as "meanies", but I did want to call attention to the fact that patients' need for their own treatment is paramount, and the professionals needed to organize the care given to the emergency patient and the others, efficiently and appropriately.

I repeat, WE DID NOT KNOW WHAT WAS WRONG WITH HER. She was unconscious. She could have coded. She could have choked and aspirated. She could have tripped and fallen and been knocked unconscious. She could have been shot. As you know, when a patient is down it's like trying to solve a puzzle figuring out what is wrong. It would have been nice if people would have stood back and let us work on figuring it out instead of standing around whining about how they should be put on first. They could have waited 10 or 15 minutes to be put on. Wheel of Fortune can wait.

The patients aren't self-centered due to their illness. They are self-centered because they choose to be.

But thanks for acknowledging that we're not meanies.

[squeakykitty]

Originally Posted by Natkat

I repeat, WE DID NOT KNOW WHAT WAS WRONG WITH HER. She was unconscious. She could have coded. She could have choked and aspirated. She could have tripped and fallen and been knocked unconscious. She could have been shot. As you know, when a patient is down it's like trying to solve a puzzle figuring out what is wrong. It would have been nice if people would have stood back and let us work on figuring it out instead of standing around whining about how they should be put on first. They could have waited 10 or 15 minutes to be put on. Wheel of Fortune can wait.

The patients aren't self-centered due to their illness. They are self-centered because they choose to be.

But thanks for acknowledging that we're not meanies.

I couldn't have said this better myself. Chances are, they were that way before they even had to have dialysis. I'll bet that not one of them even asked what was wrong with the pt. who was down.

[lamazeteacher]

Originally Posted by Natkat

I repeat, WE DID NOT KNOW WHAT WAS WRONG WITH HER. She was unconscious. She could have coded. She could have choked and aspirated. She could have tripped and fallen and been knocked unconscious. She could have been shot. As you know, when a patient is down it's like trying to solve a puzzle figuring out what is wrong. It would have been nice if people would have stood back and let us work on figuring it out instead of standing around whining about how they should be put on first. They could have waited 10 or 15 minutes to be put on. Wheel of Fortune can wait.

The patients aren't self-centered due to their illness. They are self-centered because they choose to be.

But thanks for acknowledging that we're not meanies.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - -
I haven't worked in a dialysis center, but I've heard that the nurse: patient ratio is low, so there should be enough staff for 1:3, to deal with the other patients, with 2 nurses assigned to the compromised patient.

We have to be meanies when clearing the area when the scenario you described happens. I've yelled "Clear the area" several times in public when someone is "down". With authority in my voice, crowds clear and I can assess the patient in 1 minute. Blood anywhere? Color? pale pink, not blue (not O2 deprived, so aspiration is out, as well as choking). Chest rising with breaths? Even better. A nurse calls 911 if O2 perfusion is in doubt, or O2 sat is under 92, according to your protocol; or if heart beat is absent or she's in VFib.

Pulse strong, weak, fast, slow? (No code there, unless you can't get a carotid pulse, hear the heart beating with your stethascope, without sounding like fibrillation.) Breath fruity? BG high? Aha! How many staff membersd do you need, to do that? One to assess, one delegated to get the crash cart, a Hoyer lift, wheelchair, and find the patient's kit for testing BG (if you don't have one in the unit). Take B.P. and watch face for drooping side, limbs for flacidity, etc. It could have been a CVA. All that shouldn't take 5 minutes! ? Incontinence - could have been a seizure.

Then the 2 nurses can get the patient in the wheelchair (using skilled body mechanics to avoid injuring themselves, and then one of you should draw up insulin for the patient and inject as ordered. (Diabetics must have orders and a supply of insulin in case of emergency.)

It could be that the patient didn't take the time to eat dinner, and ate candy on the way to dialysis. When you get a chance, while checking her BG a half hour after the insulin was given (in case it dropped drastically), ask what she's eaten that day, nonjudgmentally. Call the doctor.

The other staff can get other patients started on dialysis, with those who need to go to work, first (although if "Wheel of Fortune" is on, it must have been evening). Ask a patient to turn the TV on. Tell the others with authority in your voice, that emergencies come first there (gently).

If they see that their staff operates like a well informed, practised professional team, they'll respect you more and whine less if you're dealing well with someone who is in worse shape. They'll be reassured knowing that you have excellent coping skills, and if they were in that situation, they can trust your abilities to do what's necessary.

Also, some staff member must have worked with the needy patient before, recalling that she is diabetic...............

I hope that helps some, and that derision of patients' behavior has stopped. I appreciated my nurse's understanding when, while having a transfusion during a severe gastric bleed (after taking prescribed Ibuprophen EC), I cried outside into my cell phone, to a friend who is a physician and lives 500 miles away, that I couldn't stand the stress of worrying about AIDs, HepC, etc. if I had more than 1 unit. I'd regressed, and I was self centered.......

[AngelfireRN]

I HAVE worked in a dialysis center, and it is much like the floor, such as staffing goes, at least in my area. There is the "expected" or so-called "usual" staffing, then there's reality.

I am still mystified as to how you consider yourself to be "helping". I don't think any of us on this thread NEED help. I think that venting here is pretty healthy ( years of psych experience speaking). We are not hurting anyone. I'm also not sure when it became necessary to "stop the derision of patient behavior". That will continue till the end of time, and it will continue because no matter how much "authority in your voice" you have or "coping skill" you employ, some dinklepuss is always going to complain.

What you described as the "proper" way of handling the scenario at that dialysis clinic proves that you are missing the entire point of this thread, which is about patients that are too lazy to do for themselves, that are selfish beyond belief, that have a sense of entitlement beyond the pale.

We come here to talk about these things in a safe, understanding, nonjudgemental environment, not to have someone tell us that we need an attitude adjustment. I realize that you have had issues in your life that may have colored your view of this, and I am sorry that that was the case. But, I do not think it entitles you to come on here and bash us for letting off steam, in the guise of Mary Sunshine with the "Your attitude about them must be coming through. Their electrolytes must be out of whack.", and various and sundry other excuses for these nonsensical and obnoxious behaviors. Then you have the gall to tell some of us that we are not suited to the profession, in your opinion.

Who are you to judge? As I have said before, you do not know me, so I could care less about your opinion of me. But what does steam my clams is the fact that you continue to come on this thread and tell us what we should do, make excuses for why a patient acts like a B-on-wheels, and tell us that if we can not handle it, it's our fault, and we're bad nurses. You sound like one of 2 things to me: 1)an administrator who has been to the Disney meetings or something along the lines who has all the grand and wonderful ideas of how things SHOULD work, with NO understanding of how they DO work, and no empathy towards those of us stuck in the trenches trying to implement these grand ideas, or 2) a disgruntled family member and former patient who has had some knocks and is giving advice based on the way you percieve things should have been done, with no real understanding of the magnitude of what those things require.

So, since you see fit to give advice to the rest of us, here is a bit for you.....go work the floor for 6 months, just 6 months. Put up with what we're talking about. Deal with it day in and day out. Roll in it. Then, if you can come back and say all your tips and techniques worked, I'll apologize. I'm banking on the fact that they won't.

Or, if you can not do that, stay where you are, write in your journal, read your "Dance of Anger", and leave the rest of us who DO deal with this in peace. This thread may just be part of what's keeping someone else from having to pry our hands from around a snotty patient's throat. Also, putting cutesy emoticons on a snotty post does not make it come across any better.

Thank you, I will turn over the soapbox now.

[canoehead]

DUDE!

Rock on.

[jlsRN]

Lamaze Teacher, your profile doesn't say much about you and your area of nursing practise. Do you work at the bedside? Frankly, you sound like someone steeped in theory and textbook nursing, either a nursing instructor, policy maker for JCHAO, or a recent grad without direct care experience.