Latest Comments by JBMmom - page 3

JBMmom, MSN, RN 7,880 Views

Joined Jun 24, '09 - from 'CT'. JBMmom is a Nurse. She has '4' year(s) of experience and specializes in 'Long term care; med-surg'. Posts: 432 (41% Liked) Likes: 666

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  • 27
    JBudd, Coffee Nurse, not.done.yet, and 24 others like this.

    I'm aware that inside my head I can be pretty judgmental. Outside my head I don't generally share those opinions, I guess in a way that's being fake, but I truly wish I weren't as judgmental. I don't feel like I'm better than other people, so I'm not sure why sometimes I jump to judgment, but I figure at least not sharing out loud is half the battle.

    Anyway, a while back I got a call from the ED that my new admission was coming up. MVA due to alcohol intoxication. Immediately my thought is "well, I hope they didn't hurt anyone else" and since I'm not in the ICU I know they're not critically injured so maybe a little "you got what you deserve" crept in there, too. My patient rolled by on the stretcher while I was in another room, so as I wheeled my COW down the hall I had a minute to reflect that because of my own past experience with a DUI situation, I just didn't like this person already. But, I put on my faking it smile and walked in the room to introduce myself. What I expected to find was someone that had no regard for other people after making the decision to get in a car and drive after drinking. What I found when I walked in has truly started me on the path to less judgment.

    I saw a patient who was scared, embarrassed, in pain and really at a low point in life. We developed a pretty good relationship quickly and I even meant it when my patient asked if I was mad at them and I replied something like "I know you wouldn't have put yourself in any situation where you would have hurt people on purpose. You were drinking and were unable to make rational decisions at the time, otherwise you would have stopped yourself." My patient did not have their cell phone because it was still in the car, and they had no way to contact a single family member, or more importantly their AA sponsor. I had a stupid moment when I said "if you tell me their name I can look in the phone book", the response was, "well, it's anonymous so I don't know their name"- I felt a little dumb.

    Anyway, when my shift was over I was able to call a couple tow yards and locate the car and cell phone about 15-20 minutes away. I went and picked it up, and brought it back to my patient- their AA sponsor picked them up later that day at discharge. I think part of the reason I did that was to assuage my own guilt at my initial judgment of this person, but mostly it was because I knew what they needed most from me was not my medically focused assistance, but my support for them as a whole person.

    I just wanted to share this because I think it really was a first step in changing that part of me, and I hope to keep growing in a direction of non-judgment because that's not a constructive emotion in many situations. Maybe other people have had a similar moment that changed how they view things on a bigger scale.

  • 1
    Kitiger likes this.

    Quote from Rocknurse
    We used to give IV Tylenol and IV Toradol for post-op open-heart patients but they were both limited to three doses due to cost and toxicity. I didn't find them to be all that successful when you've had your chest cracked open and we usually ended up giving narcs anyway. All that happened is the patient was in pain for longer. I think it's ridiculous to withhold narcotics because of an opioid abuse situation that is happening in a different context. This is acute post surgical pain we're talking about. For cripe's sake just give them the meds! That's what they were intended for!
    I would never withhold pain meds from someone that needs them, I was just looking for information from those with expertise I do not have. (and I certainly did not direct this post towards post surgical patients) Thank you for sharing your experience.

  • 0

    double post

  • 2
    FranEMTnurse and ataymil8 like this.

    Thanks to all for the responses, I appreciate your time and feedback. I am well aware that I wouldn't single handedly end the opioid crisis by suggesting that my little old ladies not get dilaudid (wouldn't that be awesome), I was very interested to hear what my ER colleagues take on the pain control protocols are.

  • 1
    tining likes this.

    A local pizza place has taped spoons to all their pens so people stop signing their credit card slips and taking the pens. Maybe if you write on the box "THIS BELONGS TO THE NURSE" if someone's thinking about taking it, they'll think twice. Good luck!

  • 4

    I am on a med surg floor and recently I've had two occasions where patients were admitted to the floor and then asked for pain meds, both had been given dilaudid in the ED and that was the only prn pain med (other than tylenol for fever or pain). I always ask people whether the medicine they got in the ED was effective and did it make them nauseous, dizzy or sleepy. I ask if they've taken opioid pain medications in the past. These women both said they don't want opioid medications, one said she has a family history of alcoholism and wouldn't want opioids. They said no one in the ED told them what they were getting for pain.

    I'm no pain expert and I don't work in the ED, I'm just looking for information, not pointing fingers. I'm sure that many people need narcotics, but one of these women reported that the tylenol was effective for her pain (her pain was 3-4, same that she reported in the ED and she got 0.5 mg dilaudid), but tylenol wasn't given in the ED. When someone comes to the ED, why are they often given opioids without trying anything else? Is it the speed of onset? I never see IV acetaminophen or ibuprofen, but I know they exist, does anyone use them?

    With all the information about the current opioid crisis, I just wonder whether the medical system could be adding to some of this problem by so quickly administering opioids for any pain. I'd like to learn more about this if anyone has experience. Thank you.

  • 5

    You're setting a really high bar for yourself, give yourself credit for what you have done so early in your career. You sound like you're doing your best, and you're getting your feet under you. You've already been recognized for some of your caring ways, but working days on a busy floor is going to limit some of the time you have for "extras". I work nights and find that I have some time available to spend with patients that could use some extra support, because the pace of the floor is different at night. Don't be disheartened, you're going to find a way to do what's important to you, and until you can fit it in try not to beat yourself up. You can't be everything to every patient, but you're doing your best.

  • 1
    pebblebeach likes this.

    I'm glad you found success in your program and much of your material seems valuable to others. I would caution you, however, throughout your career to avoid the sweeping generalizations such as the one made in your pet peeves section. While you may have been annoyed with the students that were CNAs before nursing school, your pet peeve is more of a highlight of an attitude that may get you into trouble in the future. There are certain things you just need to let go. If someone needs to feel a little more confident by sharing that they have past experience, how does that really affect you? I found during nursing school that I wished I had CNA experience because in many cases they were just more comfortable in the patients' personal space. They are often more efficient at some aspects of care, and those are valuable skills even at bedside nursing level. Try to find the learning experiences you can from everyone around you, even if it's learning what you don't want to do.

  • 2
    Sour Lemon and brownbook like this.

    Good luck in the supervisor role, you're obviously motivated to do a good job and that will take you far. I've been told that my coworkers like it when I'm supervising, so here are a few tips from me. Be fair and firm, as long as you don't play favorites and you show that you're doing what's best for your employees and residents, little bumps along the way will work out. NEVER get sucked into the gossip game, even if you have a relationship where you become closer with some coworkers than others, you need to stay out of that stuff entirely. And always be willing to help. Every employee in the building knows that I will never ask them to do something I'm not willing to do myself. Enjoy your new position, there might be some challenges, but it will be worth it!

  • 0

    That's what I thought at first, but we were specifically told that organizational sheets should no longer be used. All of handoff report should be in front of the computer, completely uniform among staff. I think they're making too big a deal about that point, it doesn't sound so far like anyone else works without a single piece of paper.

  • 2

    An unbiased opinion based on the tone of your post is that you should not pursue something you dislike before you've even really started. But as Sour Lemon pointed out, talking with people that know you better will probably be helpful, and support from family and friends is important when evaluating life decisions.

  • 0

    I was just wondering about how others have transitioned to not using paper, if anyone has. I'm not concerned about the cost of two sheets of paper, nor do I really think I will be fired for using them. Thanks for any tips.

  • 0

    Our facility recent changed EHRs, and we're being told that soon we will not be allowed to have any papers for our patients. The previous system provided multiple sheets per patient with the orders printed out, and I found it very cumbersome to navigate. I have my own sheet and I can cover my 7-8 patients on 2 pieces of paper. The EHR has a report page that we are told we will reference during bedside report, but to me that is very difficult to synthesize into an informative report. And I use my paper as a checklist throughout the shift, to remind myself when I've checked patient #1's IV flushed, and cleared the pump volume for patient #4, done my education and care plan on everyone, etc. Are there other med-surg nurses out there that have gone totally paperless? Any tips on how to do it? I really think that some of us are just list/checkbox people and to demand that we not use them, just to save 2 pieces of paper, seems like focusing on the wrong aspects of our job. Ensuring that I'm able to do my job thoroughly and safely, even if I need some paper, doesn't seem that awful to me. I'm not resistant to change for the sake of being resistant, and I'm definitely willing to give it a shot, I could just use to tips. (Or others with experience that it did or didn't work out). Thanks!

  • 3

    I agree that getting the most useful information at report and prioritizing based on that will be key. I come in for third shift, so it's slightly different because some of my patients are (theoretically) sleeping. If you have a complete handoff report, you shouldn't need to do much research, if any, before seeing your patients. I am personally not as concerned with what a note/lab/computer charting says, as I am with putting my eyes, ears and stethoscope on the patient. I would estimate that report is usually done between 11:30 and 11:40pm. By 12:30am, I've usually seen everyone, in order of most critical to least, and I've done my safety check- name and date of birth compared with bracelet, checked what's hooked up to the patient- IV, O2, Foley, etc., and asked if they are having any pain. It doesn't always work out that way because if patient's number 2, 3 and 4 all need pain meds, now we're past 1am before I've seen the others.

    Use your available resources. If you're lucky enough to take report on all your patients from one nurse, ask them- based on this assignment, how would your prioritize my next steps? Everyone was a student at one point, and everyone was a new nurse. There's no problem with asking a question to help you learn the best approach and any nurse should be willing to spend a minute to go over the assignment quickly for prioritizing. After you've seen everyone, then you read the notes, labs, etc. If you see a sodium level of 126, you might be very concerned, but if you've been in and spoken with your patient and there no complaints of weakness, fatigue, headache, muscle cramps, etc- that's might not be out of the person's baseline. Also, many people will share with you important information like "my sodium always runs low because I drink a lot of water", during an initial conversation.

    It will all come with time, don't worry too much, you sound like you're very much on the right track. And meds will come with time, you'll start seeing some of them over and over and will not need as much work there. Good luck!

  • 2
    Here.I.Stand and Everline like this.

    I always tell my kids that boredom is a reflection of the person, not the situation. You can find something to keep you challenged in just about any setting. (except maybe, as my kids have pointed out, working in a factory putting the toothpaste cap on tubes- but even then, someone has to do it). I think you need to find the area of specialty that you would enjoy and you'll automatically find a way to grow and learn in it. You've had some really smart people answer you here and look where they are- ICU, midwife, floor nurses, etc. There's no smart nurse specialty. Smart people are everywhere, and they're smart in part because they've learned what will make them happy and play to their strengths. The great thing about nursing is those opportunities are out there- hope you find yours.