Latest Comments by JKL33

JKL33 5,719 Views

Joined Oct 2, '08. Posts: 852 (81% Liked) Likes: 3,466

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  • 0

    Quote from JKL33
    Say she removes the jewelry and then tells everyone she swallowed it and that she is having sharp lower chest or epigastric pains. Doesn't matter if it's "likely" to cause any harm or not at that point - we're now off track and won't be able to get a psych bed for this patient anywhere that isn't med-psych - which in plenty of areas simply means you won't be getting a bed. These, and more, are the kind of things that happen. There are actually reasons for the SOP.
    Should say "or" that she is having pain (after having actually swallowed). The point is the freedom to manipulate OR to actually cause harm to self or others is not okay.

  • 0

    Quote from NurseCard
    And like canoehead said, once the dog is there, what can you do?
    IF there is no legitimate reason for the dog to be there, I guess I would call animal control. A hospital representative should handle this with him and let him know that is the plan going forward. I'm surprised they don't recognize that having a random dog in the ED is just a bit of a liability. Not to mention the nursing hours that are not being used for the care of emergency patients and are instead being used for dog-sitting.

  • 1
    Julius Seizure likes this.

    Quote from Anna Flaxis
    What harm have you seen swallowed nipple or navel rings cause? I'm trying to understand this, because it's not a button battery or a magnet. It's a small foreign body that will most likely pass with no adverse sequelae. Am I missing something? I'm really more curious than anything...
    I specifically didn't elaborate because I tend to agree with you and didn't want to make more of it than it is - - although digging, scratching, lacerations and other problems are certainly not impossible with body piercing jewelry. The issue isn't limited to what long-term "harm" it causes, though, but also what others can say about how well the patient's safety was being assured if they were able to do something like swallow a metal object. KWIM? What else might they have done ("since apparently no one was paying attention") - and yes, I have observed accusations like this. I won't even say it is likely to go anywhere legally. It is another layer of shenanigans that doesn't need to happen, and is not a therapeutic situation.

    Actually the more I think about it, the fact that any particular piercing may not cause much damage if swallowed may very well be purely secondary. The manipulations that tend to evolve from this general situation are a bigger deal, though. Say she removes the jewelry and then tells everyone she swallowed it and that she is having sharp lower chest or epigastric pains. Doesn't matter if it's "likely" to cause any harm or not at that point - we're now off track and won't be able to get a psych bed for this patient anywhere that isn't med-psych - which in plenty of areas simply means you won't be getting a bed. These, and more, are the kind of things that happen. There are actually reasons for the SOP.

    Would I allow someone to be assulted? No. Not if I could help it. Which is also what I already wrote. I've had my rounds with security and even the police going to bat about things like this. But earlier in my career I've also had situations where I didn't consider all the possible ways things could go wrong, so I'm pretty reluctant to just say sure no problem, we don't need to follow our procedures for you. Rather, my belief is that there are usually ways to follow procedure while educating and giving appropriate information and interacting respectfully.

  • 2
    Pixie.RN and Davey Do like this.

    Quote from KathyDay
    The smaller ER across town does not do any of that.
    That's really of no significance. It's just as likely they should.

    Quote from KathyDay
    This woman had piercings, nipple and belly button and she was told to remove them. I am not sure who made that demand, but when she refused, a security guard forcibly removed them lacerating both areas. Apparently a nurse was in the room. This exacerbated the woman's anxiety and she fought back...escalating the situation and she ended up netted and medicated.
    First, it is not usually a "demand," (which implies the requester is irrational) but rather SOP.

    We weren't there, but I personally would have tried to prevent security from becoming involved in this way. I prefer to try to talk with the patient and start to develop a rapport and basically explain our procedures and their rationales and an overview of the course of care.

    Quote from KathyDay
    As a retired RN who worked many years in an ER, I found this appalling. If a patient refused anything I would have brought that to the attending ER doc and gone from there. NEVER would I have allowed unprofessional, untrained, brutes to forcibly remove sensitive piercings like that.
    I tend to agree with you and would have consulted with peers, supervisor and security in deciding how to handle.

    Quote from KathyDay
    I was also told that patients in mental crisis are stripped and searched at that hospital where I use to work. Is that routine?
    That they will change into a gown and (usually) have their belongings removed from the area is routine wherever I have been. Nursing staff (RNs, techs, etc) perform this process. They are not "stripped" (again...wording), but asked to change into gown while privacy measures are taken.

    Quote from KathyDay
    What about calliing in professional mental health crisis workers?
    Mental health crisis workers will agree to make plans to come and evaluate the soon as the MSE (medical screening exam) is complete, which includes ruling out anything physical cause for the situation - the patient is "medically cleared." And usually not before.

    In fact, mental health agencies like to send people to the ED for the process of evaluating need for inpatient psychiatric hospitalization and/or assessing crises instead of taking care of it off-site as they used to. I don't necessarily fault them for that because there were very serious safety concerns about meeting patients-in-crisis in offices, especially after-hours.

    Quote from KathyDay
    This woman had not been declared incompetent, or a danger, so it seemed like they went way overboard.
    Well, the starting point isn't to assume that patients aren't a danger. Surely you know of plenty of stories (or experienced yourself) what happens when people make assumptions like that in the course of evaluating psychiatric concerns. Patients are there so that others can evaluate the patient's condition, including the potential safety concerns. That's part of the evaluation. It would be negligent to assume that there were no safety concerns when the formal evaluation hadn't even started yet.

    Being declared incompetent is a legal procedure that is often long-term with a guardian assigned.

    Piercings don't seem to pose too much of a threat to anyone, but people are creative and are already in the ED because things aren't going as well as usual. The typical thing with jewelery of this type is swallowing it, for instance.

    Based strictly on what you've reported, which is either second or third-hand, I would not agree with the actions of this security team. One of the most important goals for assessing psychiatric concerns is de-escalation and assurance of safety. As far as the immediate issue (the piercings) - - I don't know what to say. You have to remember that patient assurances about what will or won't happen when leeway is given are a dime a dozen and often don't end well. After things have gone wrong it's too late to have simply followed the procedure in the first place.

    They should reach out to patient relations or the patient liaison regarding this matter.

  • 3

    Quote from LibraSunCNM
    She said when she had discussed her questions about it with their pediatrician, she simply said, "Don't you wear your seatbelt??? It's the same thing."
    An excellent example of exactly what I'm talking about.

    It makes no sense to ever talk about vaccines in this pompous/sarcastic/demeaning tone. If people think you're simply taking them for idiots they aren't going to listen to a word you say, and rightfully so.

    Not to mention it doesn't appear to say very much for your scientific case if you can't even think of a logical response to what has to be a VERY common question.

  • 2
    Davey Do and OrganizedChaos like this.

    Quote from evastone
    Let this be a lesson to all. If your gut instinct tells you something is wrong, escalate. However busy you may be, errors in delivering proper care will only make your day busier. Also, make sure to confirm the dosage in mg or mcg rather than mL. I shudder to think of what would have happened if I had given the full mL of medication.
    And!!! If you are asked to double-check a medication, for the love of all that is holy STOP what you are doing and pay attention. If you're unable to do that you need to ask the person to find someone else to do the check!

  • 3

    I think good information is available to lay persons now, and I'm not sure it was always the case or that it was presented in a way that seemed as compelling as the information presented by the anti-vaccine side.

    Example: Parents often ask why the vaccines must be given on this particular schedule - and believed that this would overwhelm the baby's immune system. It was pretty common to hear a response like, "Your baby is exposed to multiple germs every day - hundreds or thousands! Even eating food introduces germs!"

    That's fine and good (and true), but it's not going to make sense to the parent because the parent isn't dealing with a feverish, fussy and/or "lethargic" baby every time the baby "eats food." It makes perfect sense to them that the immune system could be overwhelmed because clearly something is different; the child is acting a little different.

    [By the way, this same rhetoric is still available though reputable online sources; I know it's factual, but I call it rhetoric because it isn't answering the underlying unspoken question, which is, "why does my baby act so punky after getting immunizations, and is that okay?"]

    I was once told at my doctor's office that vaccines don't cause fever. I had inquired whether it would be okay to give a dose of acetaminophen prior to the visit - and was told it was unnecessary because if my baby had a fever after the previous set of vaccines, it must've been a coincidence.

    Misinformation and information delivered in a paternalistic manner breeds mistrust in people who simply feel very responsible for taking care of a tiny baby.

    I really wonder if more respectful, forthright discussions could have helped, especially before wide use of "Dr. Google." Back then, if you happened to come across Dr. Sears' book - you just might end up giving it all a lot of thought.

    No need to be a conspiracy theorist at all.

    BTW, everyone I am responsible for is FULLY vaccinated, on time.

  • 7

    Quote from Davey Do
    I sense you are a "nice" Person, who does her job and doesn't like to make waves.
    My first thought, too.

    "Nice" is different than "kind." People tend to call us "nice" when we don't upset their sense of comfort - when we don't contradict them, when we work to ease their situation, and when we generally defer to them. Walking on eggshells comes to mind.

    Here is an article that is really worth pondering! And a more recent version

    OP, another theme I notice in the examples you gave is that of worrying too much about what people might think of you, or what you think they might think of you. This leads to trying to defend oneself when really there is nothing to defend/nothing that "needs defending."

    I speak from experience when I say that all these things kind of go together and can be part of a larger problem of taking "responsibility" for others' feelings.

    In reality, others must take responsibility for their own feelings - well, even if they don't, that doesn't mean that someone else can or should.

    Start making a conscious effort to leave the responsibility for others' feelings with them. Start with the easy cases - - situations where you know without a doubt that they have nothing to do with you and the other person has ZERO reason to be upset with (or rude to) you. Then stay calm, minimize words, leave the area when you can, but DO NOT start falling over yourself with desperate attempts to put them at ease/stop the onslaught.

    I'll bet you're a kind person, as well as someone who gets called "nice." Start to think about those as two different things. Kindness means acts of sincerity. "Nice" is what people may call you when you defer to them and don't upset them.

    Aim for "kind."

    Let other people take responsibility for their own feelings.

    Best wishes ~

  • 4

    Rules for this situation:

    1. Stay calm

    2. Stay calm

    3. Show no particular emotion.

    4. Rather than "deer in headlights," practice a "look of interest" +/- slowly nodding 'yes', as if to say, "Aha." or "Oh. I see."

    5. After the patient is gone, "explain" to coworker: "I am learning and I am trying. I appreciate the information you shared, but you need to do it respectfully. Please don't speak to me like that again."

    6-9. Stay calm.

    10. Learn what you should from the situation and let the rest go.

    Refuse to be emotionally troubled by individuals like this. It's one thing to be straight-forward. It's another thing to attempt to elevate oneself by humiliating someone else. This gal is in the latter category and her secret feelings of inadequacy are not your problem.

    Best wishes ~

  • 1
    Susie2310 likes this.

    Quote from JKL33
    Low-level ESIs already could be redirected to alternative services (urgent care/walk-in, primary care)...
    I should clarify the above statement. Patients who are determined by the triage nurse to have non-urgent/emergent concerns (primarily ESI 4 & 5) absolutely still require a medical screening exam, which is separate from triage and is performed by a medical provider.

    I can see from commentary elsewhere that the general public does not understand this issue (triage is NOT the MSE), so didn't want to add to the confusion.

  • 8
    Kitiger, Kkbrdr3, macawake, and 5 others like this.

    I'll just say what I think I would do: The Question is already in everyone's minds. Therefore, I think I would go back to my manager and say something like, "I wanted to come back and thank you for caring; for your inquiry about my black eye. When you asked about it, I had forgotten about it and was kind of caught off guard. [Blah, Blah]...I'm glad to know that if any of us here ever have a problem, help is available."

    Add brief deails of incident if appropriate to share and if the truth itself doesn't sound cliche (reasons of clumsiness, etc.) If it was something specific and innocent like my child carelessly swinging something that hit me in the face, for instance, I would just let her know.

    I looked up my state's reporter law. As is too often the case, there is some room for question. In some places it says "adult" and defines that as anyone over age 18, and in other places it specifies "vulnerable adult" and uses that phrase independently (i.e. as a substitution for "adult"). Suffice it to say your manager may feel obligated to report this, but nothing AT ALL is going to come of it if 1) you are not vulnerable 2) you don't need/want help.

    I would be remiss to not agree with/reiterate the other responders urging you to seek help if you are in a harmful situaton.

  • 3
    AJJKRN, elkpark, and chare like this.

    I'm not sure how her statements amount to an accurate portrayal of EMTALA. As it stands right now, patients must receive an MSE (medical screening exam) and emergency conditions must be treated/stabilized or transferred appropriately, active labor must be completed/delivered. Low-level ESIs already could be redirected to alternative services (urgent care/walk-in, primary care) but no one does it for various legit reasons.

  • 3

    Quote from meanmaryjean
    You signed. You pay. You're probably going to find a much worse job at which you will have to work many hours of OT in order to pay back the contract.
    Your high horse has no legs.

  • 8
    tara07733, Purple_roses, cyc0sys, and 5 others like this.

    Quote from not.done.yet
    You signed a contract. Your patient ratios were actually not that bad for a med-surg unit. It is a tough job with a steep learning curve. I am sorry you didn't stick it out. Your contract is likely binding. I would call them and see what you can do to work with them. If you left in good standing you may even be able to get your job back. It is not just "bad" employers doing these contracts. Nearly every hospital in my local area has them now due to providing new grad training only to have the new grads jump ship within a very short time period. It is very expensive to train a new graduate nurse. This helps them get at least a modest return on investment.

    I wish you the best of luck. If you can afford a lawyer you can afford to honor this commitment.
    I'm sorry but this is offensive.

    1. Based at least in part on a lie

    2. Irrelevant

    3. Only because their lies likely aren't in writing. Otherwise you very well know the spirit of this contract has already been broken. I suppose expecting and training (off the record, of course) employees to commit acts of fraud against the government is also in line with a legitimate binding contract that remains in full force?

    4. That was their choice and their business plan and they came up with it very deliberately.

    5. Their "return on their investment" is that, for the period of employment, they are able to continue to do business because they have nurses to take care of the patients whom they are billing for care. I don't care if it costs $10M to train a new grad, that is THEIR cost of doing business and a risk THEY chose to take - and they have their reasons for doing so. Which of your financial investments do you get to make risk-free? I didn't know life worked that way; I'll look for a broker who will sign a contract saying that s/he'll pay me the equivalent if I don't get the return I want! Please.

    6. Well there's an interesting can of worms. I wager that you don't actually believe the logical extensions of that statement.

  • 6

    Doesn't really matter how common this is as far as right vs. wrong is concerned. I think it's despicable; the bald-faced lying as an inducement to consider/sign the contract. Of course none of that is in writing.

    Unlikely the lawyer will have any good news, but might as well hear what s/he has to say.

    Steer clear of these pathetic loser places and their contracts. If the conditions were as good as they pretend, the contracts would be unnecessary.