grrrrrrrrrr......... - page 5

:madface: :madface: My dad is in the hospital and is getting IV antibiotics...the cannula became dislodged, so he needed a new IV. This "nurse" (and I use that title loosely with this person) came... Read More

  1. by   momo'3
    Unfortunatley I have been in the hospital many times with family members since I became a nurse, one was after my Mother was diagnosed with terminal cancer after I had taken care of her for years because she had alzheimers and profuria cutanea tartar (I'm sure I spelled that incorrectly) Anyway, I only give you all this history to tell you I have alot of experience on both sides of the fence at the same time. I never tell staff I am medically experienced. In my experience, when you tell the nurses or doctors that you get one of two reactions, relief that they don't have to explain every little thing to you and/or oh no, she is waiting for me to do something wrong. I erred (sp?) on the side of listening to explanations I didn't need. When I NEEDED to speak up of course I did. I have also had pts. whose family are Dr., nurse, PT, EMT etc............. I try not to focus on them but it is hard when they start with "Im a.............." Just try to remember what everyone is there for and that the patients family sometimes needs alot of reassurance that we are all there to help the patient no matter who they are or what their education. Also try to remember that you are a nurse but this is your loved one, you may be a tad sensitive. If the patient is being cared for let the staff do it their way, your loved one needs your focus to be on them.
  2. by   Otessa
    "I guess I'm just going by things I was taught in school"

    I have learned over my 18 years in Healthcare as an RN that school & real world working as a Nurse are 2 VERY different worlds.......
  3. by   DemrixRN2000
    [quote=luvkitties]I guess I'm just going by things I was taught in school.

    As a nursing instructor myself, I make sure that my students know that there is a such thing as practical book knowledge and reality. There is absolutely no way that a nurse can perform in a timely efficent manner doing things by the books that we studied while in school. I am the person that others seek out to start IVs and I always gather my supplies, put the tourniquet on and then open the packages to prepare for the IV start. That's what has worked for me. Did I learn this in a book...no but experience has taught me that this is the best strategy for me. As a nurse you have to be able to critically think and know when something needs to be tweaked so that you get the desired outcomes.

    All experienced nurses do this.
    MA
  4. by   neneRN
    Other than the no glove thing, the nurse didn't do anything wrong. If you had muttered under your breath, "I'll do it"...the next thing out of my mouth would've been to ask you to step out of the room so I could concentrate on the pt and not on your snide comments. When the OP encounters a situation like this when she is the nurse, then she'll understand the point most of us are trying to make.
  5. by   caroladybelle
    Quote from luvkitties
    It doesn't matter as long as it's in not the same vein?!? Now why didn't my instructors tell me THAT?!? They pounded in our heads that you NEVER NEVER go distally--that once you've started a site, you keep moving towards the heart. I do trust what you're saying, but I'm just wondering why it seems that there's this broad continuum of ways to do things--why there is no consensus, so to speak.
    There are many things that your instructors tell you NEVER to do, that are in fact done, and many that EVIDENCE based practice has changed.

    That all typed blood products must always match. Some of the best facilities in this nation use typed platelets that do not "match". As long as it is limited amounts in a patient that is nonreactive, after proper blood bank checks are done, they are generally okay...but invariably freaks new onco nurses out. Not to mention the patient when you do the bedside check.

    That WBCs cannot be transfused. Well, they can but trust me, you REALLY don't want to have to do that to any patient.

    That you will not give morphine to someone with low BP. You will if they are dying and in pain.

    Think about it, how would it be completely possible to NEVER, NEVER go distally on repeated IV starts. Logically, you eventially will have to.

    Never doing BPs/venipuncture on the arm on the side of a mastectomy. This still is sometimes true, but in most cases, it is relatively harmless. However, since nurses are rarely apprised of exact types of mastectomies/lumpectomies and the patient often does not know whether lymph nodes are dissected or not, often a blanket prohibition is given. Modern breast cancer surgery is a far cry from the "old days" of radical masts that cut large amounts of chest tissue, blood vessels and lymph nodes. I have had a breast lump removed, without lymph dissection, and I will have some staff that make a big deal about marking that arm.

    NPO after midnight. There is generally no need to keep a pt completely NPO for 8-16 hours (depending on the surgeon) prior to standard surgery (barring obviously some colon procedures). In fact, it can pose an unnecessary metabolic stressor, and could be a problem for diabetics.

    Hold all insulin for patients that are NPO. No, no, no, no !!!!!!!! There is a proper calculation for managing NPO diabetic patients and insulin dosing, but it is complicated and many MDs are not motivated to use it.
    --------------------------------------------------------------------------
    Your instructors teach you optimal practices and those in line with the experiences you will deal with in school and your practice hospitals.

    You have graduated but it still takes an "internship" of 1-3 years to actually "become" a nurse.
    Last edit by caroladybelle on Sep 10, '06
  6. by   TazziRN
    Quote from caroladybelle
    You have graduated but it still takes an "internship" of 1-3 years to actually "become" a nurse.
    Oooo.....I like that comment, I'll have to remember that one.
  7. by   SmilingBluEyes
    Best wishes for improved health and healing for your Dad. It is never fun to have a loved one in the hospital and we all feel helpless and powerless at one time or another if we are hospitalized or have loved ones who are....so I understand your angst and anger somewhat.....also....

    wishing you the best in school....and beyond. But:

    Please take to heart the well-intended advice here, even that which may offend you. The words are BEYOND wise and will serve you well, if you listen and observe.
    Take care.
  8. by   ortess1971
    Quote from caroladybelle
    There are many things that your instructors tell you NEVER to do, that are in fact done, and many that EVIDENCE based practice has changed.

    That all typed blood products must always match. Some of the best facilities in this nation use typed platelets that do not "match". As long as it is limited amounts in a patient that is nonreactive, after proper blood bank checks are done, they are generally okay...but invariably freaks new onco nurses out. Not to mention the patient when you do the bedside check.

    That WBCs cannot be transfused. Well, they can but trust me, you REALLY don't want to have to do that to any patient.

    That you will not give morphine to someone with low BP. You will if they are dying and in pain.

    Think about it, how would it be completely possible to NEVER, NEVER go distally on repeated IV starts. Logically, you eventially will have to.

    Never doing BPs/venipuncture on the arm on the side of a mastectomy. This still is sometimes true, but in most cases, it is relatively harmless. However, since nurses are rarely apprised of exact types of mastectomies/lumpectomies and the patient often does not know whether lymph nodes are dissected or not, often a blanket prohibition is given. Modern breast cancer surgery is a far cry from the "old days" of radical masts that cut large amounts of chest tissue, blood vessels and lymph nodes. I have had a breast lump removed, without lymph dissection, and I will have some staff that make a big deal about marking that arm.

    NPO after midnight. There is generally no need to keep a pt completely NPO for 8-16 hours (depending on the surgeon) prior to standard surgery (barring obviously some colon procedures). In fact, it can pose an unnecessary metabolic stressor, and could be a problem for diabetics.

    Hold all insulin for patients that are NPO. No, no, no, no !!!!!!!! There is a proper calculation for managing NPO diabetic patients and insulin dosing, but it is complicated and many MDs are not motivated to use it.
    --------------------------------------------------------------------------
    Your instructors teach you optimal practices and those in line with the experiences you will deal with in school and your practice hospitals.

    You have graduated but it still takes an "internship" of 1-3 years to actually "become" a nurse.
    Good post but I'm going to disagree with the NPO statement. Anesthesia will still cancel your surgery if you have had food or water past midnight because of the risk of aspiration pneumonia. We have had to cancel a hip surgery on the weekend because the patient had orange juice that morning. Bad for the patient and it was a financial waste as well, due to supplies that couldn't be reused(sterile field technically shouldn't stand idle for more than an hour) and the call people they had to pay for nothing(if you get called in and sent home, they still have to pay you for 3 hours).
  9. by   catlady
    Quote from ortess1971
    Good post but I'm going to disagree with the NPO statement. Anesthesia will still cancel your surgery if you have had food or water past midnight because of the risk of aspiration pneumonia. We have had to cancel a hip surgery on the weekend because the patient had orange juice that morning. Bad for the patient and it was a financial waste as well, due to supplies that couldn't be reused(sterile field technically shouldn't stand idle for more than an hour) and the call people they had to pay for nothing(if you get called in and sent home, they still have to pay you for 3 hours).
    I think caroladybelle was saying that, despite the anesthesia rule (and they all seem to still do it), there's no clinical rationale for keeping people NPO after midnight. IOW, it's just an archaic rule that they should re-evaluate. Not that they've bothered. It might be a good QA project for someone. What do you suppose the risk of that hip patient aspirating his orange juice really was?
  10. by   TazziRN
    Quote from catlady
    What do you suppose the risk of that hip patient aspirating his orange juice really was?
    I used to think the same way, until a few years ago. One of our FP docs came into the ER and mumbled to me, "I don't feel good." Several tests and CT scan later he was shoved into surgery with a ruptured diverticulum. He was so sick that he went straight to surgery in spite of having tried to drink fluids that day. He came through the surgery fine but vomited and aspirated after extubation. He ended up being flown out and spent nearly two months in a tertiary ICU and then stepdown unit because of setbacks.

    I will never again think that anesthesia is being anal about a pt's NPO status.
  11. by   caroladybelle
    Evidence based research has identified a only short period of true NPO before most surgeries is adequate for prevention of aspiration in most cases. Depending on the researcher and study, most patients may safely have clear fluids until about 3-6 hours before surgery. Solid food is withheld from 6-8 hours. For children/babies the time periods of NPO may be lower.

    Again, as in the prior post, some bowel procedures and some patients may require more time, due to other medical issues. And people can aspirate on fluids produced in the gastric track, even if they have been NPO.

    This post was not to say to completely disregard orders for NPO, but that they are not necessarily as strict as previously believed. Often MDs will permit a "light breakfast" and nurses will make the patient NPO, because of a previous practice that has been proven to be incorrect.

    Now many surgeons like to play the fitin game, of let's make the patient NPO every morning for several in row, "just in case" they can get a procedure in early. That is not always in the best interest of the patient's overall health.
    Last edit by caroladybelle on Sep 10, '06
  12. by   catlady
    Quote from TazziRN
    I used to think the same way, until a few years ago. One of our FP docs came into the ER and mumbled to me, "I don't feel good." Several tests and CT scan later he was shoved into surgery with a ruptured diverticulum. He was so sick that he went straight to surgery in spite of having tried to drink fluids that day. He came through the surgery fine but vomited and aspirated after extubation. He ended up being flown out and spent nearly two months in a tertiary ICU and then stepdown unit because of setbacks.

    I will never again think that anesthesia is being anal about a pt's NPO status.
    If they knew that the patient had taken fluids, why didn't they drop an NG tube and aspirate the gastric contents?
  13. by   TazziRN
    Don't know. All I'm getting at is that it can happen. I've sent many a pt to the OR for emergency surgery and I've never heard of any of them being drained.

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