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CoffeeRTC, BSN 18,312 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,691 (24% Liked) Likes: 1,775

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  • 12:43 pm

    for the love that is all that is holy...

    please mods lock this thread. I don't understand why it hasn't been before.

    This is an old thread OVER A YEAR AGO

  • Oct 13

    she knew, she wanted confirmation.

  • Oct 12

    Sounds to me as if you were just managing her symptoms to provide comfort. I've suctioned hospice patients and given oxygen.

  • Oct 12

    Quote from caliotter3
    I would rather do documentation while I am supposed to be on break, than to waste my personal time by staying after the end of the shift to get it done.
    I agree with you completely. I never could admit it on Allnurses.

    The whole "don't work on your break.....hospitals need to hire more nurses...you deserve your break, you are working for free ..etc."

    I hate to feel rushed, I hate staying overtime. I feel better, more in control, more relaxed, if I finish things up on my break, better than worry and hurry the whole shift thinking...."I can't leave work late today but I am getting behind on my charting."

  • Oct 12

    I don't know how old you are, but a job that offers state retirement benefits? That's almost unheard of.

  • Oct 10

    Quote from Davey Do
    A lot of Patients don't want to hear they've been prescribed an antipsychotic such as olanzapine: "I'm not psychotic!" they say, whether they are or aren't.

    So I say, "This med is prescribed for racing thoughts and to help with other mental processes". They're more accepting of that.
    Maybe it's just me and the fact that I work in LTC but I can't really think of any scenario where saying "anti-psychotic" would be helpful. Yes, we know that's what it is, but sometimes classifications like that are better left to be used among medical staff, etc.

    I feel like "This pill helps with your mood changes/sadness/anxiety" is perfectly fine.

    Do people really approach patients and discuss their "anti-psychotic" meds?

  • Oct 10

    Quote from ksusn
    Hello,

    I am a student nurse and I was pulled to work in the ED the other night to be a sitter for a psych pt. The pt has had a history of being very aggressive and claims to have seizures (which were determined to be fake by RN and MD). The pt was very agitated/anxious at the time with security on stand by. The nurse had drawn up olanzapine (antipsychotic) to give IM. The pt asked for anti-seizure med and insisted the RN tell him the name of the drug and the drug class in which he was about to receive. The RN told him the correct name of the drug, but told him it was an anti-seizure medication. I understand that if the pt had been violent, he may not have had a choice in whether he received the drug or not. However, I feel like it was wrong for the nurse to lie about the medication. Any thoughts on this or how the situation should have been handled? Thanks!
    The pt has had a history of being very aggressive

    The pt was very agitated/anxious

    I feel like it was wrong for the nurse to lie about the medication.

    The RN told him the correct name of the drug, but told him it was an anti-seizure medication.


    A- "This is Olanzapine, it is an anti-seizure medication."
    B- "This is Olanzapine, it will help stop your seizures."

    Which did the nurse say? Either one helps the patient get the medication he needs to keep him safe. B is also 100% accurate, and meets any definition of "ethical". But, in the heat of the moment, would you really draw an ethical line between these two statements? Is the nurse who was heads up enough to parse his/her words in a potentially dangerous situation really any more ethical than the nurse who is just trying to keep the patient safe?

    Lets look at option C:
    "This is Olanzapine. It is not an anti seizure medication, it is an antipsychotic. Oddly enough, it actually lowers seizure threshold. But, you my friend, are not having seizures. You are having a psychotic episode."

    This is the most truthful answer, and the most likely to cause harm to the patient. Would an ethical nurse choose this?

    • Beneficence - to do good.
    • Non-maleficence - to do no harm.
    • Respect for Autonomy.
    • Fairness.
    • Truthfulness.
    • Justice.


    Sometimes these principles can conflict with one another.
    Even if, in your situation, the nurse chose statement A above, he or she was still maintaining the first 2 principles, despite a sub-optimal choice of semantics.

    Also- remember that there are different theories of ethics. It looks like you are focused on Deontology. "This theory judges the morality of an action based on the action's adherence to rules."

    But, there are other ways to look at this.

    Ethical Relativism- "The theory states that before decisions are made, the context of the decision must be examined."


    Utilitarianism- " The value of the act is determined by its usefulness, with the main emphasis on the outcome or consequences. "

    Feminist Theory- "Feminist theory requires examination of context of the situation in order to come to a moral conclusion."

    Once, while working in the ICU at 0300, I got a call from a nurse on the floor, asking me to come upstairs and pretend to be a doctor. (I am a middle aged man) She said that she had a little old lady with dementia who really needed to take a medication. The nurse had told the patient "The doctor really thinks you should take this medication". The patient said she wanted to hear that straight from the doctor.

    I went up stairs, walked into the room, and said "Mrs Smith, you need to take this medication".

    Regardless of the fact that I did not lie, I deliberately mislead the patient. Did I do the wrong thing?

    I recently had a patient with pseudoseizures as a result of conversion disorder. The doctor was able to stop these seizures by pushing 3 ml of normal saline. This allowed us to accurately diagnose and treat the patient. On a moral scale of 1-10, where do we stand on this?

    Those are my thoughts on this. Now, I am going to ask you the question you asked:

    What do you think would have been the right thing to do with this agitated anxious patient with a history of aggression?

  • Sep 27

    Yup. I'm the fluid restriction educator, not the fluid restriction enforcer. if the patient is A&Ox4, aware of the restriction and the reason for it. Educate. Document. Move on.

    A power struggle with a patient is very unlikely to end well for you. Customer satisfaction, complaints, long, miserable shifts...I don't have the energy or the time. And I'm going to lose any way.

  • Sep 27

    Quote from Okami_CCRN
    To be honest, I would have just given him the cup of coffee when he asked for it, and educated him on his fluid restriction and why it is in place. If he wants to follow it great and if he doesn't you can inform the physician and document.

    I think that everyone saying let me ask your nurse/let me check your chart/let me talk to the doctor probably made him feel like people were avoiding him and his request.
    I agree. That type of patient is not worth aggravating myself over. I am a little irked with "Dr. Coffee", though ...I would have asked him to take pudding to room 206 and ice to room 300 since he was so eager to help out.
    I've had at least one VERY questionable discharge that haunts me to this day, so I understand how you're feeling about that. You've just got to live with it (and so do I).

  • Sep 20

    Yikes.

    I never withhold an inhaler even if the kids seems perfectly fine. That said, and it's easy to play Monday Morning Quarterback...the kid didn't have the proper paperwork filled out. And then it's somehow the nurses fault. The parent didn't do HER job. So, if it had been me and the child was seemingly fine, I'm talking VS, WOB, lung sounds, and if the kid had the original box with his name and directions, I probably would've given him a dose, regardless. If just a random inhaler I would've called mom and said "Johnny said he feels like he can't catch his breath, this is what I observed, if you feel like he needs his inhaler you will need to come and give him a dose or I can call EMS." Had he been struggling, I would've given him a dose. I'm not letting a kid struggle over paperwork.

    BUT, this is why it is so important to have your child's paper work completed. Don't put it on someone else, and then blame them for doing what they are legally supposed to do. What would this mom say if the inhaler hadn't been his, but Uncle Joe's and the nurse gave him a dose and he had some sort of reaction.

  • Sep 5

    Quote from purplegal
    You're right. I work sometimes 60-70 hours a week between my two jobs and still do not make as much as my classmates because one job pays $17/hr and one pays $26/hr. I keep the $17/hr job so I can get a nursing job with that employer, since they pay nurses $32/hr. .
    Wait, so you already work as a tech at the hospital where you hope to work and have applied 31 times for different RN positions?

    Time to face reality - they are not going to hire you. The hospital has decided that they do not want you working for them as an RN. Time to cut bait and apply to different hospitals. In the meantime, quit your $17/hour full time job and take a full time position at the SNF so you can get more NURSING experience and make more money, and NOT have to work 60 hours/week doing it.

  • Sep 5

    Quote from purplegal
    At $26.52/hr, the wage is not what you would expect a nurse with a BSN to be making, nor is this type of nursing really meant for nurses who have BSN degrees.
    Thought #1... what the what??? Did you just say that??

    Thought #2... uff da, yeah you really did. (Thought #2a) I typically don't say "uff da" unless I'm especially flabbergasted.)

    Thought #3...Actually, I had an amazing geriatric nursing class in my BSN program. Far and away, it was the class where I learned the most. Also, since geriatrics is a specialty practiced by GNPs, why the heck would geriatrics NOT be "meant for nurses with BSN degrees?" A BSN RN is hardly overqualified for geriatrics...... in fact one can be underqualified for it.

    Thought #4... This site has nearly a million members. I wonder if there are any nurse managers who find your resume awfully familiar?

  • Sep 5

    Quote from purplegal
    So, I am in the process of searching for a full time nursing position so I can leave my second job. So far, there are no offers except for numerous shifts at the nursing job I currently work part time at, a skilled nursing facility. At $26.52/hr, the wage is not what you would expect a nurse with a BSN to be making, nor is this type of nursing really meant for nurses who have BSN degrees. Because of this, I have been applying to the employer I have always dreamt of working as a nurse at, to positions that would pay at least $32/hr, which is more reasonable for a BSN nurse to be making. So far, all of decent paying positions have sent rejections. One possibility would be to apply to a skilled nursing facility associated with this employer so I could just have one job. However, the pay, at $23/hr, is unacceptable. I am looking to increase my pay, not decrease it. I do well in these types of nursing jobs, but as I mentioned, they do not meet my pay expectations. The jobs that meet or exceed my pay expectations do not appear to be interested or a good fit for me. Not sure what I should do. Should I possibly leave the nursing profession if I cannot find a good job with good pay?
    So the geriatric population isn't worthy of us almighty BSN educated RNs? *sarcasm*

  • Sep 5

    "nor is this type of nursing really meant for nurses who have BSN degrees"

    Okay, I'll go there.

    Did you really write this? I guess that means that (inferring from your writing) BSN nurses are more qualified, so patients in nursing homes are not worthy of highly qualified nurses...

  • Aug 24

    I work in SNF, and we look at these things on a case by case basis. We look at what they were taking in the hospital, and what they took before that at home. Some people have been taking narcs, sleepers, anxiolytics, and an anti-emetic all together in a handfull every night for years. It's no problem in those cases.
    But with new meds, it's a totally different story. Also different if the patient is palliative/hospice. There's no one answer for you.


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