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Chaya 8,143 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: 1,130 (19% Liked) Likes: 499

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  • 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.

  • Feb 19

    Ding Dong Ditch and Kindness

    Ding dong ditch. For many those three words bring on a negative connotation, a feeling of frustration, and the thought of annoying children. Don’t be so quick to judge. Since I was a small child, random acts of kindness have always warmed my heart. I played ding dong ditch with friends, but there was never a negative intent involved. Rather we made bouquets of flowers and left them on the door step, delivered handmade treats, and even a few times left hard earned money for a person we knew was going through a hard time. The mysterious ditching neighborhood children even received thank you notes from some of the recipients.

    National Random Acts of Kindness Day ~ February 17th

    February 17th is National Random Acts of Kindness Day. According to the Merriam-Webster dictionary (2017) random means “without definite aim, direction, rule, or method” while kindness is defined as a “kind deed”. In essence, performing kind deeds with no strings attached and no expectation of anything in return. This is the time to act!

    Favorite Random Winter Act

    As I’ve gotten older, I’ve continued this giving tradition in two intentional ways throughout the year. For years, I stuffed my work locker in the emergency department with brand new winter jackets to give to homeless or less fortunate individuals in need. I never shared this with my co-workers, but rather had this little ritual that filled my heart when no one was looking.

    Then one year I was asked to share a locker. Naturally it appeared I was completely hogging the locker space, so I shared with my locker mate, Jill, why the locker was so full. A week later I received an email from Jill telling me how during her rainy night shift, she had given the jacket away. She was hoping I wasn’t going to be mad. Jill giving the coat away was like a double gift, especially in reading her words and the joy she felt by participating in this act. We are no longer locker mates, but I hope Jill is continuing on with this tradition.

    Favorite Random Spring Act

    Every Spring I purchase volumes of daffodils and designate random days when I hand the flowers out. Anyone and everyone who looks like they need a pick me up gets a few flowers. Then I hand out extras to the fast food drive thru attendant, the grocery checker, post office clerk, garbage man, greeters in businesses…you name it! One of my favorites is randomly placing the flowers onto cars and secretly watching the person find them when they return. Something about giving warms my heart leaps and bounds. I can almost feel my heart dancing and smiling.

    Ideas for Random Acts of Kindness Day…or Any Day!

    Whatever random act speaks to your heart, go out and DO IT! This world needs a little more love and caring so here are 50 ideas to get you started.

    1) Reach out to someone going through a difficult time and offer to listen.
    2) Bring in a box of old clothes to a local emergency department, women escaping a violent environment, or to a foster parent in need (get permission first).
    3) Thank a security guard or officer for being present.
    4) Tell a teacher about the difference they have made in your life.
    5) Smile at everyone you come in contact with.
    6) Deliver a verbal compliment to strangers.
    7) Donate blood.
    8) Pay it forward. If someone pays your bill, grab the bill for the person behind you.
    9) Encourage kids to call their grandparents.
    10) Offer to brush snow of the neighbor’s car.

    11) Pick up trash on the side of the road.
    12) Sign up to volunteer at a local charity.
    13) Encourage a child to be the best they can be.
    14) Look someone directly in the eyes and tell them how much you appreciate them.
    15) Babysit for someone who needs a night off…for free.
    16) Bring magazines for the patients in hospital waiting rooms.
    17) Bring in flowers and have the nurses deliver them to patients with no visitors.
    18) Send an “I appreciate you” email to someone who never would expect it.
    19) Bring to work a poster board with sticky notes and write compliments to co-workers for everyone to see. Hopefully other co-workers will add to the board.
    20) Pay for the bridge toll of the person behind you.

    21) Offer to grab something at the store for a neighbor or friend.
    22) Deliver a meal to a pregnant mom, new mom, or a family in need.
    23) Deliver treats to your local public service agencies.
    24) Leave a good book on a bus stop or airport bench.
    25) Put a note in your child’s or spouse’s lunch.
    26) Leave a gift card in front of the corresponding store for a soon to be shopper to find.
    27) Put quarters in a parking meter that is expired.
    28) Buy the meal for public servants dining at a restaurant.
    29) Deliver balloons to someone…anyone…just for the fun of it!
    30) Write a note to someone you’ve never met and let them know they are important in this world.

    31) Spend extra time loving an animal.
    32) Sign up for Amazon Smile to donate to your favorite non-profit.
    33) Buy a pizza for another healthcare unit.
    34) Do nice things for others anonymously.
    35) Bring in coffee and bagels for your co-workers.
    36) Hand out crayons and coloring books to age appropriate children waiting in the hospital.
    37) Bring in a bag of apples or tangerines for staff. Something healthy and sweet.
    38) Deliver packs of “Lifesavers” to individuals who make a big difference in your life.
    39) Ride the elevator and hand out flowers to everyone who gets in.
    40) Sign up for a run for charity.

    41) Leave a thank you note for your favorite barista at a local coffee or tea shop.
    42) Thank the fire department or ambulance crew if they visited your house this year.
    43) Leave a note or a treat for your mail person.
    44) Spend time with an elderly person who could use some company.
    45) Have your kids write cards to people who have made a difference in their lives.
    46) Thank the military via a letter or donation.
    47) Honor hospital ancillary staff via cards, food, or hugs.
    48) Deliver individual cupcakes to school teachers and administration.
    49) Make little bags filled with quarters and attach a note saying “Thanks for changing lives. Buy a treat on us”. Deliver anywhere!
    50) Give a coat or clean socks to a homeless person.

    Honor Each Other

    Honoring everyone you come in contact with, whether you do so with a warm smile, sincere hug, flowers, a thank you, or treats. Taking time to do simple things that make others feel important and special is invaluable. Research has actually shown these acts to be good for your moods and overall health.

    Together we can make the world a little brighter! What Random Acts of Kindness have you performed this year? Or what can you add to this list?

    References

    Merriam-Webster: Dictionary and Thesaurus (2017). Kindness. Retrieved February 13, 2017 from Dictionary and Thesaurus | Merriam-Webster

    Merriam-Webster: Dictionary and Thesaurus (2017). Random. Retrieved February 13, 2017 from Dictionary and Thesaurus | Merriam-Webster


  • Feb 10

    I always get the flu shot and so far have avoided ever getting the flu. As I age, the potential consequences of the disease become greater and greater and I have no desire to take that chance. I don't want to catch it from a coworker and I don't want to catch it from a patient. Nor do I want to be the vector for an outbreak.

    I am very much aware of the flu pandemic of 1918 which killed between 20 and 40 million worldwide; more than the body count of WWI. Like the black plague, an experience better read about than undergone.

    I have been immunized for many things in my life, going back to smallpox, polio, DPT, Hep B, and more recently shingles and pneumonia. If there's a way to avoid any of those diseases, I'll take it. I count my lucky stars that I have no drug allergies and have never reacted poorly to a vaccine. No doubt I'd feel very differently if I did.

    All of that being said, we have a special responsibility to our patients to protect them to the best of our ability. I would ask my fellow nurses to let that be their guide as to whether to protect themselves and others, particularly if the real issue for them is that they don't like being told what to do. Hey, get over it. We get told what to do all day long. We ought to be used to it by now.

  • Feb 10

    As a nurse, it is MY job to ensure my patient's safety to the best of my ability. That includes doing things like making sure I am completely vaccinated by getting the flu vaccine each year (even in years where it is a poor match). So I wholeheartedly stand behind the mandatory flu vax or mask if you are working in any setting where you can have patient contact. Hospitals, clinics, LTC, etc., but if you're working as a telephonic nurse and never visited patients then it's not as crucial (although if you've ever had the REAL flu you I can guess you would know enough to never want to get it again). If you're not willing to stay UTD on vaccines (those who don't believe vaccines work or are anti-vaxxers, not those with legit allergies) then maybe you should find another line of work, because medicine/nursing does not go hand in hand with pseudoscience.
    I would love also to see further studies done to determine what best use of mask would be as discussed in the article.

  • Feb 10

    Quote from RN/WI
    Although masking does help protect me from the patients that received the vaccines and are now in the hospital with sepsis and other viruses they are floating around!
    I'm sorry, but would you clarify this statement? It sounds like you are saying that you believe vaccines are making your patients sick and you're willing to protect yourself from sick patients but not protect patients from what you could possibly spread to them.

  • Feb 10

    I can't take the vaccine either. I will not mask , its discrimination. Although masking does help protect me from the patients that received the vaccines and are now in the hospital with sepsis and other viruses they are floating around!




    So you're willing to wear a mask to protect yourself from your patients, but you're not willing to wear a mask to protect your patients from you? Maybe I misinterpreted....

  • Jan 20

    bottom line, not enough hands to do the work at an acceptable level of care...

  • Jan 19

    One of my most memorable patients was Pete*. 85 year old Pete had come from a nursing home with significant abdominal pain and vomiting. After a quick trip through the ED, he got himself a CT of the belly, a NG tube, some IV fluids and some pain and nausea meds. Admitted to the 4th floor, he quickly started going downhill. The ICU nurses at the hospital where I worked served as resources for floor nurses if they thought a patient looked like they were declining…a measure put in place in hopes to avoid a code. His floor nurse had called ICU asking for help, so I headed on up to see Pete. Running into his surgeon in the hallway, we spoke briefly before going in to see Pete. It wasn’t good…at all.

    Now Pete was a tiny thing, probably 90 pounds soaking wet. It was obvious his appetite had waned significantly the last few months as he literally was skin and bones…except for the biggest brown eyes you could imagine. Eyes that mirrored his fatigue, anxiety and pain. So much was out of his control and he appeared a helpless victim in the war of disease. He was on a 100% nonrebreather mask when I first met him. His respirations were labored as he struggled to catch his breath. Yet, he clung to every word the surgeon told him…words such as small bowel obstruction, sepsis, cancer everywhere, poor surgical candidate, probably won’t make it off the table. Powerful words. His sister beside him openly wept while receiving the news. Afterwards, the surgeon headed out and told the patient and his sister to let me know what they decided, for they needed to decide soon before it was decided for Pete (via a code).

    I sat next to Pete and held his hand. I told him that I would support him in whatever he chose. If he wanted to fight, we would take him to surgery and afterwards to ICU if he made it. That we would do everything we could to save him and would try to minimize his distress. Yet, I made sure I explained to him and his sister what “do everything" entails. It’s not pretty…and it’s not easy. It’s certainly not like on TV! He needed to know that it would be an uphill battle, probably for weeks. I covered being on the vent and having multiple lines and tubes. He most likely would have to be restrained at times. The “do everything” was option #1. I also told him about option #2: comfort care.

    His doctor and I were recommending comfort care because we felt that Pete’s body was dying. With the poor odds of him surviving surgery and recovery, we felt like it was more humane to just make him comfortable. Yes, the doctor and I knew it would result in his death, but we also felt that aggressive measures would still result in his death, yet with the addition of much suffering. But, ultimately the choice was up to him and his sister. You see Pete had never married…nor his sister…they had been best friends their whole lives. Pete didn’t take long to decide…he revealed that he was so tired of hurting and struggling to live. He said, “I just don’t have any more fight in me. I know I’m dying. I’m fine with it. ” I updated the surgeon and called his hospitalist.

    A DNR (do not resuscitate) was signed and hospice consulted. A morphine drip was started with prn Ativan orders for any restlessness. The morphine did wonders. It truly is the drug of choice for air hunger. We were able to change his oxygen mask to nasal cannula for comfort. His respirations settled down, he was able to relax and go to sleep. As the evening passed, Pete’s coloring changed: his hands and feet became mottled, reflecting his lowered blood pressure as the sepsis progressed. He started having periods of apnea…5 seconds…then 10 second stretches…yet he slept peacefully on. His sister sat beside him, having said her goodbyes as the morphine was started. By midnight, Pete slipped away, peacefully and in the presence of the one who loved him the most: his sister.

    Many folks would ask, “How could you give up and do NOTHING?” Yet, there was much we did do: we gave a kind and gentle man rest, a peaceful passing in the presence of someone who loved him dearly. We gave his sister support during his transition and the chance for hospice to follow HER for 14 months after his death. Hospice is not only for the patient, but very importantly for the family, especially that first year after their death. Believe me, it IS something!


    *Name changed to protect patient

  • Jan 11

    I'm a brand new nurse still on orientation. I am learning a LOT during my first 90 days.

    I had the unfortunate opportunity of being rushed to the ED during my shift last week. And then I was admitted overnight in my own hospital! As awkward as it was knowing almost all involved in my care on a professional/personal level, I learned a lot. Things that I plan to improve on/things I learned:


    1) communicate frequently with patients about procedures, what you are doing while you are in the room, and their overall treatment plan. Not knowing this caused me great anxiety. I understand having 5 people work on me at the same time without much conversation is okay in the ED. It was truly an emergency. But once on the floor...talk! It's so easy to forget that just because you know their case inside out, that they don't know hardly anything. Put them at ease with some information.


    2) understand that the food really does suck, and that it's harder than it sounds to eat. I have true appreciation for my patients who won't eat because they can't stand the taste.


    3) GET MY PATIENTS OUT OF BED. Unless they have an activity restriction or have not yet been evaluated by PT, they need to be up, at least sitting on the edge of the bed or in the chair. It was unbelievable how weak my legs got after a day of bed rest. I'm a strong 26 year old. And I still felt weak after being in bed.


    4) Bedpans are a lot more difficult than they seem. I had to use one because I was unable to stand, and could barely even sit up. When your whole body is weak, lifting yourself up onto one is really rough. My nurse wanted to give me privacy and said that I could just get myself off of it and call her when I'm done (she was really trying to be nice). As a coworker, she wanted to reduce my embarrassment. But actually it was a lot more embarrassing when I tipped it and she had to clean me up. REALLY embarrassing. Please, stay with your patients while toileting! Modesty doesn't exist in the ED.



    I go back to work tomorrow, and I'm ready to be a better nurse

  • Dec 31 '16

    I'm not sure why you're thinking of quitting your job. Did you think that you would come into nursing automatically knowing everything you need to know to safely care for your patients? It takes experience to pull it all together, and that takes about two years. You will make mistakes, errors in judgement and outright "OOPs"s. Everyone does. "Being a nurse" doesn't mean you suddenly know it all.

    What did you learn from this?

    If the family sees a change in the resident, investigate. You did that one right, even getting someone else to look things over and give you advice and a second opinion.

    You learned that if the chest X-ray shows something abnormal, changed or unexpected you need to communicate with the physician. If, after half an hour or four hours (my background is ICU so your timeframe may be somewhat different -- go by the timeframe appropriate to your setting) you haven't heard from the physician, call them back. "Radiology says Mrs. Pulm's X-ray looks like pneumonia -- have you had a chance to look at it?" Physicians get busy and forget to check back. As your patient's advocate, you can't let them forget your patient.

    If there's a change in your patient or some reason to think there may be a change (that X-ray? the family's observations?) take vital signs more frequently. It is better to catch that blood pressure on the way down or that heart rate on the way up than it is to catch it four hours later when suddenly everything catches up with the patient and she can no longer compensate. It's entirely possible that you DID take the vital signs more frequently and you just happened to get her last "fine" set of signs and the other nurse just happened to walk in when she had decompensated. It happens. It happens to even fine, experienced nurses. It can certainly happen to a new grad who hasn't yet learned to pull it all together. The doctor may have been kicking herself for not paying more attention and lashed out at the nursing staff, too. That happens. It's not desirable, but it's not the end of the world, either.

    No one walks into nursing completely competent. Competent nurses still miss things. So do competent physicians. I once had a patient complaining vaguely of "chest feels funny", nausea and fatigue. Some little voice told me to do a 12 lead ECG, which I did. It showed minor S-T changes, barely making the criteria for change. Some nagging little voice told me to show it to the cardiologist, so I found him where he was making rounds in the MICU and showed it to him. He dismissed it as "no big deal." But that little voice kept nagging at me, and persisted in asking him "so these small changes here and here aren't a big deal, even given the symptoms he's describing?" Something in my voice or my delivery must have gotten the cardiologist's little voice going, because he walked over to the CCU with me. We did another ECG, and this one was quite clearly abnormal. We got him to the cath lab for an intervention just in time. If I hadn't been persistent, we would have missed the ECG changes until that patient was in real trouble.

    It's very easy for the CNAs to sit at the nurse's station, and with their 20/20 hindsight conclude that "the nurse should have known." Nursing is a team effort. If they had concerns, it was their obligation to voice them at the time, not engage in Monday morning quarterbacking.

    You had a patient develop pneumonia and decompensate on you. Hopefully, you went home and read up about pneumonia and how it presents in the elderly, what to watch out for and what should be done. And you learned, didn't you? Next time, you'll have a better idea of how to deal. That's what being a good nurse is all about. Learning from mistakes, from near misses, from what could have happened. You never quit learning.

  • Dec 26 '16

    Quote from CaffeinePOQ4HPRN
    When your ex or their mistress/lover is the patient? Have any of you Nurses had this happen to you?
    No, I haven't. If an ex-partner or his new partner was assigned to me I'd approach my manager and ask her/him to assign the patient to someone else. Unless I was the only available nurse within a hundred square miles, I'd expect my manager to honor my request. If I for some unfathomable reason didn't request a change of assignment, I would expect the manager to switch the assignments around if/as soon as it came to her/his attention that the patient and I shared some kind of personal history.

    Imagine the relationship ended very badly (ex. your ex cheated/was a narcissist/abusive) and then he/she (or their mistress/ lover) is admitted to your unit and assigned to you...
    I don't think that there necessarily has to be some sort of negative personal history between a nurse and her/his patient, for it to be a constellation that's best avoided. I wouldn't want to have my neighbor, my dentist or my kid's teacher as a patient either. To me it just has the potential to make leaving work at work more difficult. I like to have separation between my professional and private lives. (Now I realize that this might be more difficult if you live in a small town, but I don't).

    Now, if some the shared history is bad, I think that makes it doubly inappropriate. I've never been in an abusive relationship but I see so many risks if that particular dynamic exists between a nurse and her/his patient. Depending on the individuals involved and exactly what has happened between the two of them in the past, the possibility exists that the patient doesn't get the appropriate care. It is also possible that the abuser continues the emotional/psychological abuse causing the nurse psychological harm, even from the hospital bed. If the nurse makes a mistake (for example a med error), there will be the added suspicion that it might have been intentional because of their shared history, even if it was an honest mistake. Being your abuser's nurse is just a terrible idea and should be avoided if at all possible.

    If I remember correctly I have on three occasions asked to have my assignments switched when I realized that I know the patients in my private life. Two other instances involve situations where the patients were individuals whom I had previously placed under arrest, testified against and who were subsequently convicted based on my testimony. On neither of these five occasions, did my charge nurse or manager object. They thought it was the right thing to do.


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