LadysSolo 6,984 Views
Joined Dec 17, '06.
Posts: 335 (70% Liked)
I worked oncology, and after several rounds of chemotherapy, if the patient refused a port, often the largest gauge you could get in them was a 24. Blood infused fine, and sometimes we were pushing the limit on how long blood could hang, but it worked. I worked as a vet tech one summer, and dogs and cats have HUGE (for their body size) veins in their front legs! I was stunned how big they are.
Many of my patients I see in home (in fact all of them, actually) have told me not to knock (I do the first time) and just to come in. They know when (approximately) to expect me. If I would go in and find one of them down I would follow CPR protocol (establish pulselessness/breathlessness and call 911, etc. if appropriate.) I of course know their CPR status. If they are a DNR/CCA and have arrested, I would follow their wishes.
I think Assisted living and home health aides should be covered by Medicare - cheaper than SNF, and many people don't need SNF but can't afford self-pay for AL or home health aides daily. I also agree with universal health care at a basic level for all (preventive care in particular - "we won't pay for PT but you can have all the drugs you want,") and if you want to pay for additional you can, and I agree no "satisfaction surveys" for reimbursement (I couldn't have morphine for my hangnail, so you get poor survey results.") And outcomes to base reimbursement on - PLEASE! GET REAL! Until a way can be found to allow me to force my patients to do what I recommend, despite educating until I am blue in the face, PEOPLE DO NOT LISTEN UNLESS THEY WANT TO!!! I have entirely too many "fix me in spite of myself" patients.
They are trying to accomplish the nurses being sure what meds the resident is refusing, which I get. But they are going to accomplish the residents refusing all the meds, or if they take their meds, refusing their meals (which are more nutritious) because they are full of applesauce or pudding. Then you will have a weight loss, which will require more supplements, which will further reduce the amount of meals taken, etc, etc. I think any regulations should come from someone who has actually had to work in LTC.
Sorry, I LOVE Flaming hot Cheetos, but I can eat Habanero peppers and only think they are warm. I love hot food, but just wait till one of your students puts contact lenses in after handling these peppers (and I speak from personal experience - forgot I had handled them, as I had washed my hands - the oil is persistent!) The pain is excruciating, but it DOES go away after much eye watering!
I have had to explain to PCPs in the past that a LTC facility is the resident's home, and just like a home in the community, if the resident wants ice cream, pancakes with maple syrup, whatever, they can have it and we have no right to stop them (unlike the hospital where if it is not ordered they cannot have it.)
I have chronic pain, and I use chiropractic once a month, ibuprofen and acetaminophen if I need it in between, and am very active. I believe, however, that most people would react very negatively if providers suggest alternatives to opioids.
The "shadowing nurses" idea was done at one hospital where I worked. The hospital board wanted to cut staff, and we asked if one of the board members would follow one of us for a day before they made the decision. The board member made it for 4 hours, and said "there will be no cuts - I don't see how you do it with the staff you have!" A success in my opinion!
OHRN2011, there is light out the other side. I too am in Ohio, and I have worked with two nurses who have completed the program. Both were still under restriction, but able to work. One was able to work in a NH but not pass any controlled meds while under restriction, the other worked as an STNA in a facility while under restriction, so at least both were able to work. You did it, so you will have to "do your time," so to speak, but you can do this!
You have to be VERY careful in how you do this. For example, I had a patient one time who had surgery, and it was done rather poorly, and the post-op care was very poor. I suggested to the patient that perhaps her PCP should be aware of the surgery, and perhaps she should make an appointment. The PCP had a fit about how the wound was looking, and fixed the problem, without me making comments about the surgeon. Issue handled diplomatically!
BTW, I do understand chronic pain. I have a back injury, and for the last 27 years I have lived in chronic pain (5 to 6 on the pain scale) every day of my life. I have accepted that this is my normal, and continue to work every day. On days when it gets to 7 or 8, I take two Ibuprofen and two acetaminophen 500mg, and it brings it back to a 5 or 6. I am lucky that I have found something that works, but to say that opioids are required for chronic pain is not true.
In the clinic I used to work in I had a 16-year-old come in because he had been to the ER a couple of days before and gotten Percocet for his sore throat, and wanted more. Physical exam negative, sent him home to do warm salt water gargles and use throat lozenges. THIS is how addiction/abuse starts!
Sounds like you are being treated like an agency nurse. Quitting by phone or e-mail is very bad form, and the LTC market (at least in my area) is small enough that everyone knows everyone, so it can make it hard to get another job if you quit that way. I get what you are saying, I did some agency nursing in my past, and it can be like you said, but it CAN get better as you get more sure of yourself. I can only recommend getting in early enough that you can get the med cart organized, and in relatively short time you will have seen all the areas of the facility and will feel you can handle anything! Good luck to you! It DOES get better!
In my experience (32 years) I have found physical therapists to be bigger "bullies" than nurses, although passive-aggressive. In one facility they were the only ones permitted to cut tubigrips for the patient, they refused to do it. I had a patient who needed diabetic shoes, and they refused to order them because the patient would not do what they wanted in therapy. I have had physical therapists tell me what MY job is (sorry, I know what my job is, do yours,) and be so snotty to me I nearly punched one of them. In most places I work, the therapists think they are "God," their therapy time takes precedence over anything else the patient needs ("I have two more minutes of therapy I have to do!") Really? The patient needs to go to dialysis. Or needs an x-ray. Or needs to go to the bathroom. Or whatever.
I became an NP partially because in my 40s (after 23 years at the bedside) I decided I physically could not lift and turn people for 20 more years. There was never enough staff to get help with moving larger people. I now plan to return to the bedside in another few years, I have discovered a proliferation of better Hoyer lifts, sit-to-stands, etc. and I believe it is possible again.
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