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Chaya 7,764 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: 1,128 (19% Liked) Likes: 498

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  • 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! 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.

  • Dec 25 '16

    Well...that is a multifaceted question. First...there is a delay of I believe 90 seconds to try to stop rapid fire scamming (but they still get through...sigh).

    Second....ageism is alive and well in nursing. If you run through the forums you will see plenty of posts about older nurses. The truth of the matter is that hospitals try to get rid of older "seasoned" nurses. We are usually the highest paid with the most accrued time...that makes us expensive. We historically are very verbal and we don't put up with any crap which hospitals are spoon feeding the new to the profession. We are also older and use insurance more than our younger counterparts

    They get rid of us by attrition. They have recently resorted to mandating the RN go back to school for the BSN of lose our jobs. Many of us are at a time in our lives that incurring long term debt isn't fiscally prudent. Those of us who have been "downsized" have found it almost impossible to obtain another position. We hear things like..."you are over qualified". "We are pursuing another candidate that is a better fit". We run the "BSN" or "Masters" required even though we have been employed in that position for the last 30 years.

    It sucks.

    I don't think being male will make any real difference because it is all cash driven. Mnay of us thought we would be retired by now but lost our butts in 2008.

  • Dec 25 '16

    Quote from tjcnurse
    Take-downs? What's a take-down? Just like it sounds? Like MMA style? They teach that in school?
    They don't teach it in nursing school you learn it when you come to work in psych - Look up MAB Training also known as Management of Assaultive Behavior. I may be old but I can put most people on the ground when necessary. Just step away from the charge nurse and no one will get hurt. Seriously though it usually takes two to 4 people to get an average assaultive person under control without anyone including the patient getting hurt.


  • Dec 25 '16

    Quote from tjcnurse
    One trend is a lot of 20 something early 30 something nurses. Both male and female. Primarily female.
    All very professional and knowledgeable.

    What happens to the 40 to 70 year olds?

    Literally another case of NETO* or NECOB*


    *Nurses eating their old

    *Nurses eating crusty old bats

  • Dec 25 '16

    Quote from martymoose
    kind of a known thing in all job sectors- not just nursing/health care.

    The minute my father turned 65 ( had 40 yrs with employer,not healthcare, actually an engineer) they forced him to retire. He couldn't get anything else
    My uncle was in his 40's when he was let go from his professional job. He never worked another day in his life. We all think that being unemployed brought about his early demise.

  • Dec 25 '16

    Quote from tjcnurse
    why would they discriminate?
    kind of a known thing in all job sectors- not just nursing/health care.

    The minute my father turned 65 ( had 40 yrs with employer,not healthcare, actually an engineer) they forced him to retire. He couldn't get anything else

  • Dec 25 '16

    Christmas of 1981 -- it had been a horrible year. In May, I found my husband of three years, the church choir director, in bed with the soprano. In the wake of that disaster, we pulled up stakes and moved three thousand miles so that we could "work on our marriage" in the absence of what turned out to be Gerry's many mistresses. I was young and more or less fresh off the farm when we moved to the Big City. I didn't know anyone in the city except Gerry, and after I caught him cavorting with his boss's wife at the company barbeque and ejected him from our home, I didn't have him to talk to either.

    The patients and co-workers I was meeting in the Big City were SOOOOO different from the folks I'd grown up around on the farm, and even from the folks I met at the State College where I got my BSN. Nurses wore make-up to work and heels to go out for a drink on their weekends off. They called dinner (the noon meal) lunch and supper (the evening meal) dinner. They had more sophisticated tastes in music and books than I, had more sophisticated wardrobes and no one admitted to knowing how to milk a cow or fix a barbed wire fence. I had nothing in common with them except the 40 hours a week we spent together at the hospital.

    I was no stranger to working Christmas, but I'd never been alone on the holidays before. Since I had no seniority, I was working Christmas and since I had no money to fly home for a visit any time during the holiday season, I volunteered to work all of the holidays. It was the only place I've ever worked in a career that has spanned three decades so far where there was no holiday potluck planned for Christmas Day.

    Christmas morning dawned cold and clear and I had been up most of the night sitting alone in my living room, crying and feeling sorry for myself. I dragged myself into work and greeted my patients with a profound lack of enthusiasm. Late in the morning, a very well dressed middle aged woman appeared at the nurse's station where I was going over new orders asked me "where do you want me to set up the buffet?"

    "HUH?" I asked, articulately. "What buffet?"

    "Why the Christmas buffet, of course," she said. "Every Christmas I bring food for all the people visiting patients in the hospitals, and to the nurses, too. It's my way of saying thank you." She went on to tell me that "In the old building we used to set up in the waiting room between the ICU and the step-down unit, but this new hospital is laid out so differently I'm not sure where I can plug in my crock pot."

    No one had said anything to me about a potluck, but the nursing assistant working with me that day greeted the woman like an old friend. Together, they figured out where to set up the buffet, plug in the crockpot and seat the diners.

    When my turn to eat came, I was astounded to see the well-dressed woman with her husband and a grown daughter serving Christmas dinner next to a very shabbily dressed older woman and her family. I found myself sitting all alone to eat my Christmas dinner with all the trimmings, and obviously taking pity on me, the well dressed woman sat down to chat with me while I ate. After a bit, the shabbier older woman came to sit with me as well, and then her younger daughter-in-law. Bit by bit, the story emerged.

    The week before Christmas some years ago, the 18 year old son of the well-dressed woman had shot himself in the head while they were vacationing on the seashore. He was airlifted to our ICU, but it turned out that he was brain dead. In the same ICU was the other woman's 30 year old son in end stage congestive heart failure with no hope for survival other than a transplant. I'm sure you know where I'm going with this. Although we try to keep donors and recipients out of the same ICU, it didn't happen that way. The well dressed woman sat next to the family of the other patient in the waiting room and they began to talk to one another. As families sometimes do, they bonded. As they eagerly awaited news of their individual sons, they rejoiced at each tidbit of good news together and mourned together when the decision was made to let the 18 year old go.

    "I wanted to donate his organs," the boy's mother said. "I wanted something good to come out of this horrible situation." It turned out that the other woman's son was a match. If this were fiction, I'd have the teenager's heart transplanted into the young father of three and have him do well and live happily ever after with his wife and children. But this isn't fiction and it didn't turn out that way.

    After making the wrenching decision to say goodbye to her son and give his organs away, the well dressed woman found out that his heart was going to the son of the woman she'd been waiting with hour after hour, day after day. So after saying goodbye to her son, she sat with the other man's mother and his wife, waiting helplessly while the surgical team worked on the young father. It was her son's heart after all. She wanted to hear it beating in the other man.

    Things didn't go well in the OR that night -- and as Christmas Eve turned into Christmas morning, the young father of three bled out on the operating room table. All through that night, the three women sat together holding hands and praying together, and when the surgeons came out with the horrible news, they cried together.

    The following Christmas, the three woman found themselves in touch once again, grieving over the loss of the 18 year old with so much promise and the young father who would never see his children grow into adults. They claim not to remember whose idea it was, but the idea was born to serve Christmas dinner to other families stuck waiting for news on Christmas day, and to the hospital staff who tried so hard to save both men. "We can't do much," they said, "but we can make someone's Christmas a little less bleak."

    And so it was that every year the three women and their families put together a Christmas dinner with all the trimmings and served it to the staff and visitors in the waiting room of the hospital where they'd lost so much. It turned out to be the last year for the elderly woman.

    How could I continue to feel sorry for myself after hearing a story like that? As I swallowed my turkey past the big lump in my throat, I felt my spirits lifting. It proved to be, it seems, that the big city women weren't all that different from the women in the small farming community where I grew up. They love their families, they pray with strangers and they give back whenever they can. That was the turning point for me -- I resolved to stop feeling sorry for myself, stop looking backward and to move ahead with as much grace and dignity as I could muster. As long as I live, though, I'll never match the grace and dignity of the three women I met that Christmas Day.

  • Dec 24 '16

    Firstly, I want to clarify something. As a CNA, I actually am state licensed. I was certified when I finished my CNA classes, but had to pass the state practical & written exam to receive my license.

    Secondly, I am not a nurse & do not refer to myself as one. I call myself a "nurse aide" to residents and their families.

    I have a bachelor's in psychology & am applying to several accelerated BSN programs, and I can't wait to use the title "nurse" once I have earned it!

  • Dec 24 '16

    Quote from LovingLife123
    It's not necessarily about being uneducated, it's not something that was ever taught. I know at least my school never taught it, and I'm sure that it was not taught generations before me.

    I can remember though me and my friends talking about it in junior high and trying to figure out just how many holes a woman had. Some thought three, some thought just one. And just think, men have one. They ejaculate and pee all the same hole. So why would women not think it was the same?

    It's not amazing at all to me that most women don't understand.
    I don't think it is amazing either. And I grew up in the era where women sat around in circles with mirrors and looked at their genitals.

    Personally, until I became a nurse and had to start my first foley, I didn't know exactly where the urine came out. I knew we had a "pee hole and a baby hole" though!

    I was also surprised at how low into the vagina that opening was in some older women.

    A Lady's Guide To Getting To Know Your Genitals [NSFW] | Lifehacker Australia

  • Dec 24 '16

    Quote from klone
    Yes, it's pretty sad. Also, vulvas are mythical/mystical/magical in a somewhat evil kind of way, I've learned. Even many people in healthcare don't want to know anything about them.

    I did my MSN capstone QI project on trying to decrease contaminated urine samples in an outpatient OB/Gyn clinic. As part of my project, I made a graphic representation (color drawing) of a vulva with labia separated, to visually show the two holes and where they're located, how to clean the area before peeing, etc. I posted the drawings in the patient restrooms. OMG, the complains I received! From other staff! One particularly vocal complainer was a pediatrician whose practice was with adolescents! The pictures regularly disappeared off the bathroom walls.

    Six months later, I was invited to do a poster presentation at the local EBP symposium, and when I submitted the .PDF of the poster (which had a the graphic on it) I was asked by the symposium coordinators (who were healthcare people) to please remove the vulva from my poster.
    Demonizing educational materials is how we wind up with these ignorant people in the first place. Maybe the people running these seminars would prefer to discuss HooHoos and Coochies instead????

  • Dec 24 '16

    "Picking" is not always in relation to hospice patients. I work on a Neuro Critical Care unit and many patients (who fully recover), exhibit the picking behaviors. Usually it's a hyper focus on one item, such as a SAT PROBE, straightening the bed linens, or pulling at the nape of their gown. It's related most often to frontal stroke injury, and is common within the first week or so after a stroke or re-bleed.

  • Dec 13 '16

    OK - Full disclosure.. I am definitely a COB (crusty old bat). We're in this pickle because we have allowed the tail to wag the dog.

    I am not computer phobic.... heck, I taught myself to program back when personal pcs were just a pipedream. I love all things tech - especially all those lovely "machines that go bing" (tribute to Monty Python's The Meaning of Life).... but somewhere along the way, clinical folks lost influence & clinical systems have been designed by people without any insight as to how patient care actually takes place. We now are expected to modify our patient care work to meet the needs of the documentation system. This is nuts.

    If the system was designed more logically, nurses wouldn't be doing manual documentation at all - we'd have mechanisms in place to accurately capture patient interactions, nurses could simply dictate as they performed the work, carefully placed cameras would help capture assessment findings, interventions and such.

    Hey, a COB can dream, right? It could happen.... after all, in 1976, no one even dreamed that we'd all be carrying powerful computers capable of wireless communication around in our pockets.

  • Dec 13 '16

    Quote from coolnurseclubRN
    I have been a med surg nurse for 20 plus years. I worked at the same hospital for 20 of those. I was terminated because I simply cannot keep up any longer. I have accepted and learned CPOE. med scanning,computerized charting, etc. BUT...I cannot go completely "paperless" and always chart in "real time" . ( just to mention two out of many gripes). The last year of my employment at this facility that I loved and grew up with, changed administration when 2 new hospitals opened in the area. During that time most of us "older" nurses (highest paid) either mysteriously left or retired early after years of employment, all being replaced by new grads. No offense to new grads, you are very much needed and have been trained in the new ways. I feel like an old dog being kicked to the curb. I am a good, caring nurse. Spent "too much time with my patients". Forgot twice to document if smoking cessation education was given and no flu and pneumonia vaccine status documented. That won't happen again! So what if I was trying to keep my patient from coding trying to get a transfer to ICU all by myself while all the docs and charge nurses and supervisors were at their morning meetings and not responding to pages "in a timely manner" sooooo... I didn't chart or give all my meds in that "timely manner" many times and have been doing the same since I was a new nurse. That is fact and I'm sure many of you will agree you've had to do the same. I guess I just don't know how to be a nurse any longer. Can anyone relate to this? I don't know what to do. I can't retire (lost most of it in the '90's) and had to live off the rest when I lost my job. Its a dog-eat-dog world out there and new nurses are in demand. I am 53 years old and never thought the career of my dreams would end up this way. I do start a new job in a LTC facility next week. Maybe this will work out. I'm too old and poor to go back to school now. My greatest advice to all you new nurses is, hang in there and take good care of me when I need you, and start putting in a lot for your retirement right from the start. I truly have been traumatized to the point I feel incompetent and I know that is not the case.(PTSD) Please help me guys! I need feedback!
    When I got my first job as an RNLP, I was 22, fresh out of college, with a shiny new BSN. I passed Boards, earned the right to drop the LP, and started on my 36 year (and counting) journey. That was in 1979.

    I was a bedside Nurse for 26 years, first in Peds, then MedSurg. I had no desire to go into management-mainly because I didn't like any of the people who were lol. I also had no desire to play the hospital politics game.

    I realize most newly minted nurses now would probably consider me a failure, since I "only" wanted to do direct patient care, and they are trying to figure out how to get away from actually touching sick people as quickly as possible.

    I know that I would not be able to keep up now, not after being away for 10 years. I wouldn't even want to try. The technology doesn't faze me, I love it. But I'm a dinosaur. That doesn't bother me, because over the last 10 years, I found my niche.

    I did Home Care for awhile, but the driving and the feeling of wasting my time with noncompliant patients showed me that it wasn't what I was looking for.

    And then I found Hospice. True, many agencies are on computer for charting, but the pace is less frenetic, there really aren't any emergencies in Hospice, it's fairly low tech (we have the occasional Pleurex drain for malignant pleural effusion, but that's about it).

    It's a true team effort, you aren't expected to do ALL the things (yes, you manage the care, but you have people watching your back).

    You might want to check out some agencies in your area. Most now have dedicated after hours and weekend staff, so on-call isn't the soul sucker it used to be. You may have a fair amount of driving, but some companies also maintain inpatient Hospice units.

    Your MedSurg background would be a plus, and you would learn Hospice specific information during your orientation.

    I work full time, M-F, and have almost no stress. This is what I plan on doing until I retire. You may have been kicked to the curb in favor of young blood who has known the technology practically since birth, but you do not have to stay there.

    Taking care of yourself is your first and most important responsibility. Counseling may help you gain your confidence back, and teach you some effective coping skills.