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Chaya 9,170 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: 1,132 (20% Liked) Likes: 508

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  • Nov 5

    It sounds like this patient needed to have some limits set and enforced well before this happened. Patients who cannot behave appropriately and do not want to participate in their care can be discharged home.

    We do not allow smoking in the hospital or on property, and we do not allow patients to leave the unit to smoke. Patients who leave hospital grounds without an order (these are pretty much restricted to our oncology patients who are going to family events for a very short period of time) are considered to have eloped the facility. They are no longer patients and if they are a risk (including things like having an IV in place) we call PD for a check the welfare.

    If the patient hit your tech he or she needs to file a police report. That is never acceptable behavior, battery is not and never should be considered okay. I have sent patients to jail before for battery on a health care worker and would do so again. In my state it is a felony and I think it should be everywhere. Patients are in a position of trust with staff and if they abuse that position they need the same punishment that anyone else in a position of trust gets.

  • Nov 5

    Ringing the call bell 15 times in 10 minutes is not even normal drug-seeking (in the pejorative sense of the term). That level of short term memory loss is more consistent with dementia. Did anyone ask for a psych consult to help get a handle on mental health issues that might be affecting her behavior?

    Without having a fuller clinical picture, it's hard to be helpful other than to say that the first step would be setting firm limits that are consistently enforced by all staff. If admin isn't backing you up, that's pretty tricky.

  • Nov 5

    I'm surprised that such a demanding patient wasn't traded to different assignments for so long. If someone is known to be that draining, our charge nurses do their best to A)give the nurse the lightest possible assignment with the demanding patient and B) not assign the same nurse repeatedly- to avoid such a situation. As for their right, just no. I have told many patients things like- I am happy to provide the best care I can for you in the next eight hours, but I will not tolerate abusive language behavior towards myself or my staff. I will call security if it continues to be an issue. Most people calm down after that. Especially an alert and oriented person? Unacceptable. I also find it highly unusual that your patient can do out and smoke, I haven't seen that yet in my hospital. I would question why management did not get involved earlier with this patient's behavior. It was clearly disruptive to everyone and should have been addressed.

    Don't let this one experience drag you down too much. Focus on the positive experiences you've had, and will continue to have, after this miserable one. Good luck!

  • Nov 5

    At my former facility each patient was presented with a patient's bill of rights and responsibilities, which included that patients would be cooperative with care and follow facilities rules that included no weapons and no smoking. They were also informed that infractions may result in discharge. And they followed through with it.

    Use of any tobacco products, except for gum, patches or prescribed inhalers were not permitted on the grounds, for patients, visitors or staff.

  • Nov 5

    Patients have absolutely NO right to abuse us. Her behavior was so far from acceptable and should have been addressed as soon as it started. It is not ok to abuse the call bell or to scream and disrupt the entire unit.

    I can't believe the hospital allows patients to go outside and smoke. Both facilities I've worked at have been smoke free and the answer was always no to smoking- the patients were offered a nicotine patch. Staff also does not have time to babysit patients on smoke breaks- there are sick patients that take priority.

    The culture on my unit is to not put up with this. We call alert and oriented patients out on their behavior all the time. I've told a patient before I'm there to help, but I am NOT their servant and the way they are talking to me is not appropriate.

    I'm sorry you had to put up with this. Your charge nurses, manager, and supervisors should have had your back and should have addressed this disruptive behavior if the patient did not listen to you.

  • Nov 5

    Well Davey - sorry it didn't work out for you.

    Yes, I'm changing jobs and specialties and while I won't publicly reveal my age I've been a nurse 25 years and this is a second career.

    Go for it!

  • Oct 31

    Ah, the questions that our children ask: "Where did I come from?" "How does Santa Claus fly around the world in ONE NIGHT?" or... "Do you believe in ghosts, mommy?"

    Some questions are easier to answer than others.

    I have never seen a ghost--that ethereal mist that makes the hair on the back of your neck stand on end. The kind that makes the room suddenly turn bone-chilling cold. But that doesn't make me doubt their existence. As a nurse, I have seen their influence: the ghosts of the past--those shadowy glimpses of those who once lived, who never leave us. The ghosts of the present, who haunt us daily. Those of the future, who we would like to change, but wonder if we can.

    It was a beautiful summer day, when the sky was so blue that it seemed endless. This outside beauty seemed an unfair contrast to the dark, gloomy room, as I held the hand of my dying patient. "Martha, is that you?" he said as he looked at me. "No, I am not Martha, I am the nursing assistant," I replied. I knew that he had lost his wife a few years ago.

    "Martha, please stay, "he cried. "I am here," I said. "I am not leaving." He died peacefully, with his wife's name on his lips. On this day, I was the ghost.

    I had another patient, a new mother who seemed overly concerned about everything that her newborn was doing or not doing. "I think his lips are blue!" she would say. Or... "can you please check his temperature again? He seems too hot." Or... "he just isn't breathing right." It was kind of driving me crazy on a day that was already busy. Near the end of the shift, I finally had some time to go through the rest of her chart. And there it was: She had lost her first baby to SIDS, when he was only two months old. On this day, her first baby was the ghost.

    When I was a nursing student, I had to do my obligatory four-day rotation in mental health. I had mixed emotions about this. On one hand, I was thinking, this could be a nightmare, and on the other hand--it might just be interesting. It was actually a little of both. I was given a lot of autonomy at the facility, given that I was a nursing student. The nurse in charge basically said: here is a list of "safe" patients--you can give them their meds this morning. Um, OK. As I made my way around the unit, I wasn't sure what I expected, but I encountered patients who seemed very ordinary to me. Until I went into the fifth room. I heard voices from behind the closed door. I thought it was a private room. When I knocked and entered, there was a man sitting on his bed having a conversation. He questioned....and he answered. "Who are you talking to?" I asked. "The Prophet Elijah," he answered. What am I supposed to say now? I dove right in. "Can you tell me your name?" "God," he answered. Oh. I double checked his wristband, and gave him his meds, while he continued his conversation. On this day...the ghosts were within his mind.

    It was a cold, rainy day in December. I walked into my patient's room, not knowing what to expect. The report on paper didn't look so good. Teenage mother, history of depression, history of abuse. The scene was surprising. A lovely, young mother sat in her bed breastfeeding her baby. "Look, she has latched on this time without help!" she exclaimed with pride in her voice. "Good job!" I replied, sharing her enthusiasm. Then I noticed another woman in the corner of the room. She sat in the rocking chair with a sullen look on her face. She looked unkempt and smelled of cigarette smoke. Her hands were shaking. "I need to get some fresh air," she said and exited the room quickly. My patient looked embarrassed for her mother. The mother didn't return that day. We had an order not to let the stepfather into the unit due to his history of abusing our patient. I got to know my patient throughout the shift. She was tearful at times. "I am so scared that I will end up like her...she has made such bad decisions...bring that %^hole into our house." I realized that the ghost of her future self was haunting her. "You aren't your mother, and the decisions you make will be your own," I said.

    So many times in my nursing career, I have felt more of a counselor than a nurse. But I have come to realize that nursing is all of that--you can't separate taking care of the physical body from that of the mind and spirit.

    We have to take care of the patients and their ghosts--they are all around us.

  • Oct 15

    I bet you never do it again!

  • 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.