Content That Chaya Likes

Content That Chaya Likes

Chaya 6,893 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: 1,117 (19% Liked) Likes: 479

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  • Aug 23

    While I agree with you in theory (and, ironically, in a different thread came out strongly against working off the clock), I am almost always at least 15 minutes early. I use this time to look up orders, labs, meds, and to review the H&P. Meanwhile the night shift nurses hover, trying to get me to take report early so they can get out on time. It's my time to get myself organized and to get a clearer picture of what my day will be like. On days that I'm not able to look up my patients due to last minute assignment changes, etc, I find I have a much more stressful day and feel like I'm constantly playing catch up.

    If we did not have to hit the ground running to get everything done, I'd be happy to take a quick report and then have time to research my patients. Actually, I think there should be some time built into the start of our shift to do so, but it isn't.

  • Aug 11

    Well no duh!!! Of course if your patient looks horrid and the monitor doesn't reflect that you should most definitely perk up and do some investigating.

    Im regretting this post!

    Your assessment skills can fail you just as badly as a monitor can, we have to use ALL THE DATA at our disposal.

  • Aug 11

    "Look at the patient, not the monitor" doesn't work for me either. I've seen plenty of patients that look fine chatting away with a CI of 1.8 or an SBP around 200. So...as long as my equipment is calibrated correctly and not being assessed by someone who doesn't know how to properly use the devices, more often than not, I believe what my monitor tells me 100%.

    Your story is interesting and it sounds like it made for a terribly stressful day. Seems to me there may have been a failure in protocols. Did anyone check a pulse or responsiveness? Even if a monitor shows a shockable rhythm you still follow the BLS survey first. It also seems odd that the monitor in room A (which was presumably hooked directly up to the patient in room A) would show data from a different room. I'm no IT guy for sure, just seems very odd.

    I'd say my point of view only works if you know what you are doing. It doesn't work if you put the wrong size BP cuff on a patient, or if you have bubbles in your pressure lines, or if you don't check your patient's pulse and responsiveness when you have some strange artifact that often does look fib-ish.

    I just find this old expression to be only mildly useful. Of course you use your intuition and assessment skills, but the notion that you should treat based on what you see over data drawn from high-tech equipment seems a little over the top.

    I think treating the patient and the monitor should be on an equal plane....use all the data you can get.

  • Aug 11

    Quote from jk2185
    This is my least favorite "go-to" that I hear all to often. Why even have monitoring in the first place? I trust the monitors more than my own ability to intuitively know a patient's condition based on my limited assessment skills; and just to ward off evil comments spawning from this notion I want to remind everyone that we all have limited assessment skills, our senses can only do so much. And of course, if your monitor screams asystole or vfib and your patient is smiling at you politely asking for more apple juice, I do hope that we all know to check lead placement or something.

    We didn't have numbers 100 years ago and look what kind of healthcare we had...not the greatest.

    I just wish we could flush this saying out or maybe change it.
    Numbers have been around far longer than a century. Just saying.

    I'm sorry you dislike the expression. Does "look at the patient, not the monitor" appeal to you instead?

    Years ago -- decades ago, actually -- I worked in an old, decrepit hospital. A brand new hospital was built, and many new nurses were hired to staff the additional beds the new hospital afforded. Moving day came, and we moved into the MICU with it's bright, shiny new, state-of-the-art monitors. The first patient was moved in and hooked up to the monitor with a lot of fumbling because the monitors were new and unfamiliar. The second patient was moved in and also hooked up to the monitor . . . And so forth. Not long afterward, the nurses were gathered around the nurse's station when the monitor alarm went off. Patient 1 was in ventricular tachycardia. Everyone went rushing into his room with the code cart and code drugs, following accepted ACLS protocol. The rhythm deteriorated from ventricular tachycardia to ventricular fibrillation to asystole, despite the interventions. Then a wondrous thing happened . . . The patient began to strenuously object to defibrillation and chest compressions despite the asystole on the monitor.

    During the construction process, somehow the monitoring wires in the two adjoining rooms was crossed. Patient 1 wasn't in asystole; Patient 2 was. And because all those brand new nurses and former medical students (did I mention this was July?) were treating the monitor instead of the patient, a patient died. And the patient they were treating had some pretty bad burns and broken ribs.

    Use your judgement. Sometimes, the monitor can alert you to the beginnings of badness before anything else will alert you. Other times, the monitor's malfunction will send you careening down the wrong path. According to Samuel Shem in "House of God," the first pulse to check in a code is your own. Maybe you like that expression better.

  • Aug 4

    Not allowed to ask employer if you were terminated; they get around that by asking"would you rehire this person" That answer kind of tells the story

  • Aug 4

    I worked for a major insurance company, and was terminated "for cause", from a telephonic position, for going over and above for a patient. It was a witch hunt. For months prior to termination, I was given accolades, awards, handwritten letters of commendation for my "service". When I asked how to go through the steps to possible promotion, 4 days later, I was recommended for termination. Yes, I know for certain that if you have a boss that just doesn't like you, you can and will be fired. It has kept me out of work for months. A termination that I can honestly say that I really have no clue what I did "wrong", other than try to help, which is why we are all nurses in the first place.
    I feel for you. Stay positive (as I am trying), and the right opportunity will come your way.

  • Aug 4

    I see a lot of people saying this wouldn't happen at a Magnet hospital, and that's just not true. Magnet means nothing. My FT job is magnet and I have seen a ton of unfair firings, and more subtle examples of making the workplace so intolerable that people leave on their own. I have seen a unit leader go up to staff and tell them not to help a certain person because the unit leader doesn't like her and the unit leader wants her to drown. I have seen people with better experience and abilities passed over for open opportunities because management likes a certain new nurse better who actually doesn't even meet the minimum qualifications for the position. Magnet status isn't worth the paper it's printed on, and definitely has nothing to do with fairness or unfairness.

  • Aug 4

    Quote from dishes
    Do you have copies of your performance appraisal and letter of termination? Human resources usually keeps copies of both on your employment file. If you have copies, can you show them to an experienced nurse you trust? See if they can give you tips on how you can recognize weaknesses and take steps to improve. When you're knocked down, the way to get back up, is to accept responsibility for what you can change about the situation.
    The thing is, none of these letters will ever word something in particular. They know better that every their word or sentence can be used as a base for a lawsuit. Not that it happens often, but it does and nobody wants to get involved in that mess - therefore, the letter will be super-politically correct, with no single suspicious comma.

    In fact, HRs typically are not allowed to give out any information except "employed from date x to date z" and "eligible (or not) for rehire" unless there is a Court order (which they disregard more ofthen than not unless agency like EEOC becomes involved).

    Also, it is not a big secret that employees who left on their own will can be made "ineligible for rehire" for this mortal sin alone, for they inconvenienced management by submitting their final notes. All these situations were discussed on this forum, more than once.

    Besides, sometimes there is just nothing to improve. Everything that the new nurse did wrong was breathing 0.456 times/min more than we always do here. She did not like the same candy as her preceptor. She once sided herself from the old-timer who reeked with tobacco smoke. She was too smart/too quiet/too shy/too bubbly/fill the blank here. In plain English, she did not fit, and that was her one and only mistake.

    The universal answer on the question "why did you leave?" is "there was not a good fit" or "the specialty was not a good choice". As WAY too many nurses found themselves in the same situation, it is not usually pursued any further, AFAIK. There are multiple agencies offering, for $$$, to find out what exactly previous employer/reference will say. Mostly, it is not worth the money due to the HR limitations stated above, but if one job hunts within the same system, using these services might make sense.

    One way to avoid the problem is to find the PRN job through agency, as they usually do not conduct any interviews at all. As long as a nurse can fill a shift and drug-free, she is ok to go. After half a year or so of doing a few shifts a month in different places one can form enough new contacts and connections to get a pad for a new start. Agency jobs have a whole lot of their own quirks and pitfalls, but if the problem is how to avoid being "investigated" like 3 y/o caught near a cookie jar, it is a solution.

    I do not tell that it should not be "homework", reflection, acceptance of mistakes and such. But the existing system is so cruel toward newly hired nurses that I do not see a crime in someone's attempt to escape it.

  • Aug 4

    Quote from dishes
    Showing children by example, that education can take a person out of a life of poverty, can be a lesson that they can internalize and carry forward into their own lives.
    There are tons of studies supporting this. Childred of educated parents tend to educate themselves.

  • Aug 4

    Showing children by example, that education can take a person out of a life of poverty, can be a lesson that they can internalize and carry forward into their own lives.

  • Aug 4

    Thanks RNKPCE. You absolutely right and yes we both will miss each other. That is what hurts me the most. I do want to secure his future but I don't want to sacrifice precious time with him.

    True, not all responses are going to be positive but they should be constructive. People should be mindful of the words they choose to type but hey people will be people regardless. Thanks again for your insight.

  • Jul 30

    And since this is a political thread... I doubt Donald Trump of today who is a sexist bigot born with a silver spoon in his mouth, has any respect for nurses. Especially since many of us are female, work for a living, people of color, and/or were not born to the upper echelons of this society.

  • Jul 23

    I don't agree. Soon patient's family members see you fill a new one and they filling used ones.

  • Jul 23

    A Day in the Life of a Hospice Nurse

    I slung my computer bag over my shoulder and pondered the question one of my nurse colleagues who worked at the hospital asked me. She wondered what my typical day was like. I wanted to laugh because “typical day” and “nursing” probably don’t fit in the same sentence. As I headed around to the back door of Mrs. J’s house, the familiar gravel path crunched under my shoes. I knocked on the screen door and heard Mrs. J’s daughter calling me to come on in. Mrs. J was in the den in the hospital bed, a real change from my previous visits when she had been able to get to the kitchen table and sip on her coffee while we talked.

    “How was the yard sale?” I smiled at her as I took her hand in mine, feeling for her pulse. She had planned for weeks to have a big sale “so my kids won’t have to do it.” She smiled weakly at me, and said, “It went good. Got rid of a bunch of junk. I feel better about that.” Then her expression changed to one of determination as she said, “I’m all set to go now.”

    I had been visiting Mrs. J for several months as she experienced a slow decline from her metastatic breast cancer. With her pain well managed, she had been able to continue to do many things she wanted to do: attend a family reunion, take her granddaughter back to school shopping, and watch her youngest daughter’s pregnancy blossom. Her weakness, fatigue and shortness of breath had gradually become worse and now it was apparent that the final days were near. I tended to her needs, talked at length with her daughter and made sure everyone’s questions were addressed.

    When I got back to my car and finished up charting my visit, I looked ahead at the rest of the day—I had four more patients to see to try to wrap things up by my 4:30. I made some mental calculations about distance and priorities—always seeing the most needy first and those in institutions later in the day. I thought some more about my friend’s question. How could I tell her what a hospice nurse really does? Some of it might really surprise her!

    Hospice nurses don’t generally go from one actively dying patient to another.


    Often, a hospice nurse, (also known as a Hospice Case Manager) spends her day seeing a series of patients that she knows, some of them for several months and in different stages of their disease. When a decline is gradual, patients meet the criteria of having a six month life expectancy but some of them live a little longer than that and some much less. Many hospice patients stay in the home setting the entire time they are in hospice. If there are symptom management issues they may have to go to a facility, such as a hospice house or a nursing home for a short period of time, always with the goal of going back to the home setting.

    Hospice nurses focuses heavily and teaching and providing emotional and spiritual support.

    While there can be many technical interventions in the home: pain pumps, pleur-x catheters, dressing changes, wound management—these are not the focus of care but instead are tools to help promote comfort while dying. More interventional monitoring such as blood work, X-rays, scans, IVs and even pulse oximetry loose the center stage presence they occupy during the treatment phase of the disease process.

    In the home, families and patients are a lot more in control
    .

    As hospice nurses we learn that we are there to provide the tools and the education but we do not force our way on the patient. From the very beginning, even during the admission visit, we tell patients that we are there to serve them; we want to help them have what they need in the home; we want them to know how they can call us and that we will come; but we spend much time teaching them how to respond to a variety of problems that might potentially come up. Being in our patient’s home also puts a responsibility on them and the family in terms of agreeing to use their medications as prescribed. In these days of prescription medication abuse, we lay out clearly how the medications are to be given and then we explain that we will count meds at each visit to ensure they have an adequate supply.

    Home hospice nurses visit patients at home wherever home might be

    That can include nursing homes, assisted living facilities, group homes, retirement centers, apartments and regular homes that run the gambit from very modest to thoroughly grand.

    A regular skilled nursing visit can take less than an hour
    ....

    Or continue for several hours, depending on patient need. If there are serious symptom management issues then the nurse will often stay to make sure the patient is more comfortable and that proper interventions are put in place.

    All the “other stuff” takes up lots of time
    .

    As in other nursing work, hospice nursing is heavily dependent on careful documentation, communication and one other factor—travel. In these days of bluetooth hands free cell phones, some of the talking to doctor’s offices and home base can get done in the car, but making sure everyone is on the same page can take up a good part of each day.Knowing who to call and when to call are integral parts of becoming an expert in the field. In addition to daily communication, each week hospice nurses participate in Interdisciplinary Team meetings (IDT), a time when social workers, chaplains, administration, doctors and even families share information and work together to coordinate care. And of course, there is on call time. Most full time hospice nurses take some call, often scheduled once a week, an addition to a full schedule that can sometimes be difficult to cope with.

    As I backed down Mrs. J’s driveway, I carried some sadness with me. But I also felt a sense of accomplishment and peace because I knew that our team had done what we could to help Mrs. J and her family cope with and be prepared for this time of transition.

  • Jul 20

    ***Some things are specific to the speciality but I want a general nurse reply as it can happened anywhere! Thanks.***

    Please tell me I'm not the crazy one!

    I work have worked in the NICU for about 3 years. Over the years, I have noticed some nurses on the opposing shift are a bit feisty but I have gotten over it for the most part. BUT, this small stupid thing has put me in a tizzy (sp?), and I more so need to vent than anything, but all are welcome to input your little "over-the-edge" incidences and what you do in response/to get over it.

    So to the point. I was having a really fantastic day; all my babies were cooperative, all quietly snuggled back in, parents all had a good (as good as it can get) day. It was not crazy admit day or let's make a bunch of changes day - IT WAS A GOOD DAY! It was nearing the end of my shift and as I almost always do unless we are slammed, I made the haul to restock all of my patients' supplies, any and everything they would need for the next 2 shifts.

    Shift change happens and I give report on my first two babies and I come to my third who is a different nurse taking them. I start my report as always, name, parents, etc. After the whole introduction, I casually skipped to the respiratory support. In the middle of saying, "I have only titrated my Os between 24% an--" the nurse butts in, holds up her hand and says, "Please,... (*hand to a fist now*) what's the patient's history?" Me: Uhhhh, PTL.

    THAT WAS IT... PTL. You know, I thought about it, and yea, maybe I should have said PTL before jumping right into the whole gaggle. Maybe I should have also added the 3 weeks old apgar scores and the whole resuscitation efforts. Maybe I should have gone through the whole pregnancy timeline.

    I know, I'm going too far but it kinda irked me. Yes, if there is a significant amount of history, I will start with that. But seeing as it was such a short and kinda insignificant history, it slipped my mind this time. (Serious on the apgar scores, I'm not telling you 3 week old apgar scores unless it's like 0,0,2,4,5,7)

    And to be honest, I would not even mind to have stopped right there to say the history had it not been asked of me in a completely ******* rude way and tone. Honestly, I would have even given an, "Opps, sorry."

    I just don't get it. What makes people behave like this after not even being somewhere for 5 minutes. I get you have a life, but don't treat people like scum of the earth just because your mind cannot get over having respiratory before history. Like, MY GOD, sorry I ruined your day...



    Sorry, I know I took a mole hill and turned it into a mountain. I get that. What I don't get is how people lack a decent sense of manners.

    Thanks for reading. But please do leave your experiences NICU and non-NICU. These situations happen everywhere, so even if you have them, say your non-nursing related stories too. I like to read on your guys experiences which far outweigh mine!


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