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Chaya 8,604 Views

Joined Mar 5, '03 - from 'Bosstown metro area'. He has '15' year(s) of experience and specializes in 'Rehab, Med Surg, Home Care'. Posts: 1,134 (20% Liked) Likes: 506

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  • Jul 19

    I am shaking, peds codes/death's and that she had been in the ER less than 24 hours earlier, I can't imagine a worse case. Thank you for sharing, I hope sharing the story also helps you deal with it.

    Your Medical Director is an idiot. I did the same thing, except (thankfully) with an elderly man who came in via ambulance, ACLS in progress. The code was called soon after arrival. Several family were there, they saw his body and left, I took him to our morgue. About two hours later an adult granddaughter came in and wanted to see him.

    Luckily I was the House Administrative Nurse, on the the 11 - 7 shift, so I had no one to answer to. I explained to the granddaughter that the morgue was old, not very pleasant, he would be on a metal slab. She still wanted to see him. I went ahead, made him a presentable, and brought her back. She was fine.

    I wonder if I broke some policy? I would have done it irregardless. That is the good part about working nights. No administrators around to mess things up!

  • Jul 16

    Quote from Orion81
    Lol, you asked for it....
    f you remove fibroids, will it create scar tissue that can prevent implantation? And if you have a somewhat small tumor, can it grow bigger over time?
    Ahhhhhhhhhhh, crap. IDK about preventing implantation (I would think not, but fertility is not my niche, I work with the end result of fertility treatments), and yes it can definitely grow bigger over time. Dang it, asking me hard questions. Haha.

    P.s. can the OP please update with what the final diagnosis ended up being? Inquiring minds want to know.

  • Jul 16

    What you're describing is angioedema with a threatened airway (inability to talk suggests swelling in the larynx) which is an automatic ED trip by medics in the event he requires intubation prior to ED arrival. I'm guessing (hoping) the MD had some reason to know there was no risk of the patient losing their airway.

  • Jul 16

    Quote from coffeemamaRN
    Just curious to know what other nurses think. To me it sounds obvious, but maybe I'm missing something...

    Let's say you have a patient in an outpatient clinic with the following symptoms: he cannot swallow, cannot talk, and is drooling because he cannot swallow properly. He never had problems with swallowing or talking before this.
    Personally, first off I'd like to rule out epiglottitis. (It could be caused by infection or injury to the throat).

  • May 28

    It's "wildly inappropriate" to ask a coworker how many patients they have? That's news to me!

  • May 23

    Thanks for a very sobering post. The fallout from being reported to the BON and/or terminated has huge repercussions. For me, as it seems for you, the emotional toll it takes on a practitioner is unbelievable. Providers who make mistakes are often the second victim. And for those of you who still sit on your high horse (as I once did), it CAN HAPPEN TO YOU! No one is bulletproof.

    I've been sued and a claim was paid out on my behalf because of an error I made.

    I wish the students and new APNs could understand that though we are paid well, have great benefits and respect, that when push comes to shove, you WILL stand alone.

  • May 13

    I'm with you ... hate buzz words and scripted phrases. Just talk to me like a normal person.

  • May 7

    You knew I was late at bringing you the ice water you had asked for. I know you knew this because the nurse who relieved me that day told me about how you complained for quite some time about it. How you couldn’t believe I couldn’t keep up with the two patients I had in the CDU. You knew you didn't want to be in the hospital on Christmas Eve. You knew you had more important things to be doing. You knew you had family waiting for you to get home. But here are a few things you didn't know.

    You didn't know that my other patient, just across the hall from you, a 23 year old daughter of a loving family, mother of a 3 year old boy, had just gone from bad to very much worse. You didn't know how I kept my voice calm in the room as I told my aide to call for the doctor even though my internal voice was screeching. You didn’t know how many times I kept telling myself this wasn’t happening. I had taken a job away from my usual ICU so this wouldn’t happen. You didn't know, as I did, that her heart was going to fail her three seconds before she did. You didn't know the fear in her mother's eyes as I caught her gaze as I was compressing her daughter's chest. You didn't know about the controlled chaos that the code team always brings with it, the intubation, the bagging, the endless rounds of code drugs. You didn't know the word I uttered when the doctor finally gave up, nor the hatred with which it was uttered.

    You didn’t know how I begged him for one more minute even though I knew it would make no difference. You didn't know I was left alone in the room to clean up the aftermath, to make a very unnatural scene look somewhat natural for the family when they came back in. You didn't know that while I was getting that ice water that you received late I was thinking about what I could have possibly missed that would have made a difference. You didn't know that by the time I gave you that ice water I was blaming myself. You didn't know that after the family left I sat by her and told her how sorry I was that I failed. You didn’t know how incredibly heavy her body was as I assisted the funeral home worker transfer it from my bed to his stretcher.

    You didn't know that on that Christmas morning I wouldn't be thinking of my son and his third Christmas, but of another 3 year old boy instead, a boy who would forever remember Christmas not as a time of joy, but instead as the day he lost his mother. You didn't know that a part of me will always remember it that way as well.

    You didn't know any of these things because I didn't let you see them as I gave you that ice water, late as it was. I simply apologized and asked if there was anything else I could do for you. The fact that you didn't know any of those things is a source of pride to me. It proves that I can go about my duties with a calm demeanor, regardless of what calamity may have happened. That fact says something about me, but as I get older I'm not sure it says anything positive. In fact, it seems to point to something very tiring indeed.

  • Apr 30

    I have been following this and am so glad for the update, what a terrible ordeal. Hoping the writer continues to get better, and knows a good attorney because if that was me I'd sue the socks off them-and I am not the kind to say that normally.

  • Apr 30

    Some people give shots like they have to push the needle in to the point it shows through the other side of the arm. I worked as a flu shot nurse and have given thousands of flu shots over the years. In one day I gave over 300 shots and never game close to hitting the bone on any patients because it is all about technique. Feel where you are going to stick first and make sure it is the proper place etc. You can't give the shot in the same exact place as you did one person. Everyone's bone and muscle is placed slightly different (some muscle is atrophied). You also have to pay attention to the size of the person (thin vs a heavier person). It is thanks to the flu-shot job that I developed an ability to give pain free shots as a whole. Many patients would say thanks for me not hurting them because it usually hurts. I do think of the patient and also try to be careful knowing that there is a chance harm can be had my the patient if I am not careful (plus I can get sued).

  • Mar 12

    I think I might have said something like, "We're doing an awful lot of tests on her to find out what's going on, shouldn't we maybe give her some pain meds just in case there really is something? She seems like she's in a lot of distress." There are ways to get what you want without being overly confrontational. Of course sometimes it depends on the doctor!

  • Mar 12

    You are right; nurses need to advocate for their patients with doctors and clarify/challenge orders that are/appear to be wrong or not in the patient's best interests. As nurses we are the last defense before an order reaches the patient. I think your topic is a very important one and I thought your examples were decent, except for the first one, and that is the one I am going to comment on:

    This was a fictitious illustration but you told the doctor that his patient (who I assumed was also your patient) is asking for pain medicine; he said there's nothing wrong with her etc., and you retorted that if there's nothing wrong with her why are we doing $8000 worth of tests and maybe we should give her some pain medicine just in case. To me that seems unnecessarily confrontational; especially as you didn't state that you told the doctor what your assessment of the patient's pain was. It sounds as though you either hadn't assessed the patient when they asked for pain medication or you had done this but hadn't communicated this to the doctor, and that both you and the doctor needed to determine/discuss the patient's current pain assessment to understand why the patient wants pain medication.

    We need to clarify and challenge orders when necessary, but we need to be aware of being unnecessarily confrontational, and we need to be able to provide sufficient assessment information to back up our requests of the doctor to act in regard to the patient (you were asking the doctor to act when you told him/her that his/her patient is asking for pain medication, weren't you?).

  • Mar 9

    I've worked an 11a-11:30p ER shift, the heavy traffic hours, and alternated 4-shift and 3-shift weeks for nearly 24 years. We get one 30-minute lunch break in the middle. I workout at a gym for 30 minutes before going in on work days and do an hour of dance fitness on days off. A healthy lifestyle goes way beyond having our work hours bunched together. Some may prefer or need shorter shifts for family reasons. A choice would be good, but I like having whole days off. You are right that we need to advocate for ourselves, but I believe there are far greater challenges to our health and our profession than 12-hour shifts.

  • Mar 2

    Quote from calivianya
    Recently, we had a new admit who ended up buying himself a ventilator really quickly because he was not breathing well at all. All during the intubation, and while the physician was dropping a central line, everyone was commenting on how huge and weirdly shaped the patient's nose was. After everyone else left the room, I decided to investigate further and squeezed it. What I found was never-ending whiteheads that smelled like rotting fecal matter, so I deduced pretty quickly that the size of the nose was probably due to a cyst or something right under the surface. No matter how much I squeezed, more pus-like material came out. By the end of the shift, I'd had at least five coworkers in the room squeezing on the patient's nose, because we are all freaks like that on my unit.
    "Each was squirming slightly, and had a number of large, shiny swellings upon it, which appeared to be full of liquid.
    'Bubotubers,' Professor Sprout told them briskly. 'They need squeezing. You will collect the pus... ...Wear your dragon-hide gloves..."
    [...]
    "Squeezing the Bubotubers was disgusting, but oddly satisfying. As each swelling popped, a large amount of thick yellowish green liquid burst forth, which smelled strongly of petrol. They caught it in the bottles as Professor Sprout had indicated, and by the end of the lesson collected several pints..."

    Harry Potter and the Goblet of Fire

  • Feb 19

    But boomers demand much more than that, and this is the problem. They want to live the way they were in their thirties - while applying as little efforts as physically possible
    Stereotype much?? Boomer here. That isn't even vaguely close to describing me or anyone I know. I wonder if it's a regional thing? One thing for sure, we want to be active participants in our care. We aren't afraid to insist on explanations & tend to get very grumpy with condescending attitudes about "old people", whether it's from our auto mechanic or health care provider.

    Health care in the US is evolving rapidly - mostly driven by ACA-mandated changes. Who knows what's going to happen now that the focus is on eliminating/reversing all of the last major legislation. At any rate, the main determinant of staffing in any setting will continue to be DEMAND, not supply.... The number of nurses caring for patients will be decided by how many nursing jobs are available. Shrinking labor budgets are triggering a return to "team nursing" and increased use of UAPs. That's the reality.


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