Outta Line........ - page 3

What a day!!! I get 9 patients and 3 different nurses. I'm an Extern, PCT or whatever you wanna call me. I had the middle hallway which included the nurses station so I was spread out. I started at... Read More

  1. by   GPatty
    Thank you for everything you do....believe me...all your work is appreciated!
  2. by   psalm
    ...Next time a patient refuses to have anything done, treatment, bed or gown change, meal, etc, always DOCUMENT it in the nursing notes. This is of course after you have encouraged the activity. But pts. have a right to refuse treatment, etc. Document, and quote the pt. if possible...pt refused to have bottom sheet changed, "I don't want to be bothered now with that, do it when I am in the bathroom". BTW, I think you are doing well, juggling all those pts!
  3. by   DADENTY
    Quote from hbncns35
    Thank you. I graduate BSN in May and this nurse on a different occasion told me to be more aggressive with a patient just out of surgery. She wanted him to take a shower. Well you know I just plain don't believe in being "aggressive" and overpowering my patients to bend to my will. I mean really.............This isn't Nazi death camp!!! I believe in the power of persuasion and being stern but not aggressive. I guess she was displaying "aggressive" behavior with me........Different styles I guess----
    Haven't seen her compassionate side yet! HB

    I am a new grad on a surgical/ paediatrics floor. I too felt that you shouldnt be agressive with post op patients. BIG mistake 13 yo appy, ended up with an ileus b/c he didnt get up and move around enough. Ended up in ICU for a week and needed 4 more surgeries before his insides got sorted out. My motto- Good morning here are your towels , I will change your bed while you shower, I will lock that iv for you for a few minutes. Some people will NEVER get up. They need the extra push to prevent complications.
  4. by   casper1
    At one time I agreed with you. I too felt it was cruel to get an elderly post-op patient out of bed shortly after surgury. In fact getting a patient out of bed and ambulating following surgury is one of my least favorite duties. I still feel I'm being mean. But I've come to realize it's in their best interest.

    I've also been on the recieving end of a doctor's tirade because I failed to get a post-op patient out of bed.

    Getting a patient out of bed and moving after surgury is very important to a quick recovery. It prevent blood clots, ateletisis, post operative infection.
    It important to start a patient moving and to institute post-op breathing exercises as quickly after surgury as possible. It may seem cruel ,but it will prevent complications down the road. I have had patients who refuse to get out of bed after surgury. Those are the patient who develop complications .
  5. by   dsomday
    Quote from hbncns35
    Just an update - Ms. Yell-o decided to be alot more civil to me today actually helping me change a patient and being more agreeable, guess she realized her mistake and made more of an effort..............Hb


    Why can't people just say "I'm sorry" instead of kissing *** when they KNOW they have done wrong? This drives me crazy.
  6. by   hbncns35
    For the last three posts:

    I like the documentation idea, and I will certainly pursue that in the future but I probably would have been yelled at anyway despite that.

    I understand how important it is to get someone up after surgery for all the complications stated but this particular patient was not post-op. It did take 3 of us to get him in the chair scale, we did have him sit there while we attended to his daily washing, then we put him back in bed and about 45min later had him up in a chair again for his family.(this was the next day after being chewed) In some cases PT arranges this if it is too difficult to move the patient. They usually have 2-3 people with them. Sometimes its hard to get 3 techs together at one time when there is just 3 techs for 26 pts. I think each situation is different and it is a good idea to work with the patient as much as possible unless their health indicates otherwise as to a more than stern move on the patients part.

    Why is sorry such a hard thing to say? Must be an ego problem..........
    HB
  7. by   chadash
    Quote from casper1
    At one time I agreed with you. I too felt it was cruel to get an elderly post-op patient out of bed shortly after surgury. In fact getting a patient out of bed and ambulating following surgury is one of my least favorite duties. I still feel I'm being mean. But I've come to realize it's in their best interest.

    I've also been on the recieving end of a doctor's tirade because I failed to get a post-op patient out of bed.

    Getting a patient out of bed and moving after surgury is very important to a quick recovery. It prevent blood clots, ateletisis, post operative infection.
    It important to start a patient moving and to institute post-op breathing exercises as quickly after surgury as possible. It may seem cruel ,but it will prevent complications down the road. I have had patients who refuse to get out of bed after surgury. Those are the patient who develop complications .
    True, but of course check orders before moving a pt in anyway. Ambulate as ordered, not based on your experience as a CNA. Aren't there exceptions? and Turning and repositioning the pt has to be done by some means to prevent pressure sores. (check to see if there are any special criteria on how) Sheet change is a good opportunity for repositioning. I know I don't like to be moved after surgery, but communicate to the pt the rationale, and they are more likely to cooperate. "Mr. so and so, I am going to roll you to change your sheet and take the pressure of this area. Support your abdomen with this pillow. now I am going to lower the bed.....etc. {if he is resistant then say } how about if I will get the nurse to help roll you, to make this more comfortable..."The nurse will just love that! :wink2:
    Possibly it was time for pain meds, and he would have been more willing after his pill. It has got to be done if it is soiled, so sometimes giving a limitted option, like, would you rather I wait for you meds to take effect more? Sometimes, if you approach things casually as if it is assumed this is going to happen, and just do it as empathetically as possible, it just happens. Of course, if someone really refuses, well report and record.

    from a NA
  8. by   chadash
    oops,,,guess this was arm fistulas? There again, another worker to support his arms while you turn him or what ever will make the process more comfortable. Always get all the help you need to assure the pt is dealt with in the most comfortable and compassionate way.
    but unless indicated for some strange reason, they gotta be repositioned at least every two hours anyhow!
    Of course, this is coming from some one who cant even get a job in the hospital!
  9. by   purplemania
    As a nurse I feel the techs/aides are there to help me, not do it for me. So I try to work together to get the work done faster. It also helps the patient to see the nurse involved and I get to examine skin, etc. Hope you have a better day next time.
  10. by   kadokin
    Quote from chadash
    True, but of course check orders before moving a pt in anyway. Ambulate as ordered, not based on your experience as a CNA. Aren't there exceptions? and Turning and repositioning the pt has to be done by some means to prevent pressure sores. (check to see if there are any special criteria on how) Sheet change is a good opportunity for repositioning. I know I don't like to be moved after surgery, but communicate to the pt the rationale, and they are more likely to cooperate. "Mr. so and so, I am going to roll you to change your sheet and take the pressure of this area. Support your abdomen with this pillow. now I am going to lower the bed.....etc. {if he is resistant then say } how about if I will get the nurse to help roll you, to make this more comfortable..."The nurse will just love that! :wink2:
    Possibly it was time for pain meds, and he would have been more willing after his pill. It has got to be done if it is soiled, so sometimes giving a limitted option, like, would you rather I wait for you meds to take effect more? Sometimes, if you approach things casually as if it is assumed this is going to happen, and just do it as empathetically as possible, it just happens. Of course, if someone really refuses, well report and record.

    from a NA
    Good advice. I agree.:wink2:
  11. by   javanurse2000
    Quote from jackie53
    ...Next time a patient refuses to have anything done, treatment, bed or gown change, meal, etc, always DOCUMENT it in the nursing notes. This is of course after you have encouraged the activity. But pts. have a right to refuse treatment, etc. Document, and quote the pt. if possible...pt refused to have bottom sheet changed, "I don't want to be bothered now with that, do it when I am in the bathroom". BTW, I think you are doing well, juggling all those pts!
    I agree! Also would like to add that with any nurse (but especially with nurse B) let them know when any patient refuses care as soon as possible. At my facility, if a patient refuses a care then the nurse has to also make an attempt at giving whatever that particular care is. As far as nurse B's behavior...definately, out of line
  12. by   chadash
    Quote from nursewendy2000
    I agree! Also would like to add that with any nurse (but especially with nurse B) let them know when any patient refuses care as soon as possible. At my facility, if a patient refuses a care then the nurse has to also make an attempt at giving whatever that particular care is. As far as nurse B's behavior...definately, out of line
    Yep, sounds like the nurse had an attitude from the getgo...
  13. by   FroggysMom
    How awful for you and how awful for nurses in general. We (as nurses) like to talk the talk --- "work together", "respect us and each other", "everyone on the patient care team is valuable" --- but do we walk the walk? Unfortunately, not always. It may have been a 'bad day' for this nurse, but I am less tolerant that I should be in this regard. Harsh words sometimes have unexpected consequences. Harsh words can change peoples feelings, their self-respect, and in some cases entire lives. I'd venture a guess we have had harsh words hurled at all of us at one time or another and they hurt worst when they are undeserved.

    In words spoken at another time, but still meaningful, "Can't we all just get along?"

    I hope you let this one slip off of you, and continue to do the good work that you do.

    As for me, I will take from this post a warning to myself, that bad days do not excuse rude or unfeeling behavior.

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