moia 1,331 Views
Joined: Feb 13, '04;
Posts: 137 (4% Liked)
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we bath on nights...most of the time it makes sense because its a surgical ICU and they need a post op bath..I do feel bad for our chronic patients though because no one on days ever thinks to give them a wet face cloth in the morning or let them brush their teeth. Most of our patients are too sick to care when they get their bath.
A doctor once explained to me that lido can cause problems on its on by increasing swelling at the site and obscuring the lac and causing worse scarring...for breast biopsy they don't use it because the lump will flatten out and disappear.
I know our docs weigh the pain versus the'look'..if it's a big lac with a ton of sutures we use lido because it becomes way too uncomfortable..for less than 5 the doc goes ahead but keeps asking the patient how they are doing and we will certainly stop and inject lido if the patient can't tolerate the suture placement.
we presedate the little ones and use lido because the pain is just too much......I have had docs interestingly enough inject lido when they were finished suturing as it relieves pain at the site and will last long enough for them to fill a prescription and get home. A lot of surgeons also do this at the incision site after surgery to stay ahead of post op pain.
When I worked er all our docs were very learner friendly and I got to suture more than my share of head lacs.....anything that wasn't on the face or hands and was pretty small we got to suture with guidance....we didn't get to inject the lido..that takes practice and a really good knowledge of nerves and blood supply.
wow that ain't pretty at all is it?
I can already hear you slamming in and out of a patients room loudly screeching you don't give a s**t while slamming their pills on the bedside table.
I will explain it once more...WE DON'T CARE WHAT YOU THINK YOUR VICIOUS SELF RIGHTEOUS ATTITUDE MEANS NOTHING...and won't you have a good laugh when it's you on unemployment begging for pain meds because your employer fired you because you couldn't recover quick enough from injury...and you are in the ER..and look who you meet...YOU! and you get to be called an unemployed junkie sucking on your childs college fund.......by the way..unemployment is a fund that workers support...meaning you can't get unemployment unless you actually work and pay into it...see it's unemployment INSURANCE...which means that drug addict? worked for a living before they ended up needing pain relief...they didn't think living on $150 dollars a week would be FUN.
You want to vent fine..but it's no longer venting when you label someone a drug addict on your say so...you are JUST a nurse..you don't have the training or knowledge to diagnosis anyone..leave it up to doctors to diagnosis and just do your job...I am a nurse and a good one but I have never diagnosed anyone...I am not an arrogant a**.
Thank God for the majority of you who realize we don't have a good grasp of pain and YES PAIN FREE IS A GOOD THING....when did it become an evil thing?
It some tests to detect heart defects we actually forcefully inject air bubbles into the patient to see if they cross the chambers...you would have to run the entire length of the IV tubing full of air into the patient before you saw any symptoms and even then it's pretty rare...funny the things they terrorize nursing students about...and they spend an hour on handwashing..the single biggest threat to the patient is unwashed hands.
I am a CVICU nurse and thank god I work nights because I remember when I had my orientation transferring patients to the floor. Every time I couldn't find a nurse, we had NO help getting the patient from our bed to the new bed...when the nurse finally showed up all I got was attitude . Nothing in the room was ready..no suction for chest tubes no IV pump...they got report but obviously made no effort to listen to it.
They were always deeply resentful on each new admission and it made me crazy.
The floor we use is a specialized stepdown used only for our unit...what did they expect when they took the job?
I worked trauma and ER made us crazy...I cannot tell you how many times a patient just showed up with no phone call at all.....this was the residents fault though not the nursing staff...the residents would freak out and say they could do more in the ICU and bam..there they were rolling in the door yelling for a central line and an art line...we scrambled...the Er nurses would never apologize though...I still think someone could have called that they were on the way...lack of communication is what makes me crazy.
Transferring a patient to an empty room with no nurse is just about the worse thing that can happen...it freaks the patient out...more than once I have had patients ask to go back to the ICU. It's also really disrespectful...I have another patient and a new OR on the way..I can't waste my time looking for a nurse and suction and a bed and a proper oxygen connecter and then repeating the report I just gave over the phone.
I work nights now and the floor actively lies there a** off when I call to see how many beds they have for morning transfers...I have to call the supervisor to find out they have 10 open beds..then they start with the understaffing...well..they have new grads and agency....tons of nurses but they are too inexperienced to handle normal transfers...most of these people are self care patients for goodness sake...it's excuse after excuse...they never think that they are preventing someone from having open heart surgery...if there are no beds available surgeries get cancelled...and how do you tell a patient who has been waiting 2 months they have to go home because the floor nurses are feeling a little too inexperienced today to look after anyone?
We have addressed it with their manager and their educator and their 2 nurse practitioners...four extra nurses on shift everyday but still they can't take any transfers.
But ofcourse in the middle of the night when one of their patients needs a little extra care....like having to check their sugar every hour after someone gave way too much insulin..get them to the ICU!!!! and we have to scramble doubling and tripling patients and crossing our fingers no one crashes..and the fight to get this patient back to the floor? epic...
The floor is staffed for a patient ratio of 1:4, resource has no assignment..80% of the patients are self care ..they have 4 support RNs on dayswith no patient assignments for all chest tubes and resp issues and they have an assigned physiotherapist for only their floor every day...physio gets everyone up and walking.......
This is paradise when I see how illused and overworked the regular med floor is treated..the surgical floor is a little better but not much...they work like dogs...sometimes I wish I could haul our stepdown nurses into the unit for alittle tour of terror close up and then hand them off to the medsurg floor nurses for a little lesson on team building,organization and a sense of humour.
I have seen this attitude in two of the three of hospitals I have worked at...the third was great because they had to come to the unit for orientation for 3 weeks they worked beside us and knew why they had to hold up their end..we were all a giant team..alot like a little factory..and if the line stopped moving anywhere it was a disaster.
I have seen arrogance everywhere..I don't mind it at all...these people are really good at what they do..it's attitude I can't stand .
well if you can prove they lied start calling people...call her and let her know they lied and you will back her up...call the mangement and tell them you know it's lies and you are fighting for your friend...get loud and get ugly...but and it's a really big but...make absolutely sure you have all the facts.....don't climb onto your horse only to find out she did something that got her fired....
In the beginning I too wanted everyone to love me...I got over it....
I made a real choice to expend all my mental angst energies on the people who do already love me...patients and their families?....not a chance.
If I have a family member problem I ask them politely to accompany me to a quiet room and ask them politely why they are behaving like an idiot..if they don't have a good answer I give them the nurses bill of rights and underline the parts they have abused..I give them one warning and I tell them if the problem continues I will need to call the manager or house supervisor....I always give them the opportunity to explain their behaviour...if it is about taking to long to get a pillow or water I say to them directly...no one behaves that rudely over a pillow or water...what is the real issue here and how can WE solve it...always we...because they need to own their own mess.
I am more than sympathetic if they break down and howl over the injustice of their loved ones illness...it sucks and they need support but I am clear that I am ONLY AVAILABLE FOR SUPPORT...if they need to abuse someone they need to choose someone who has to put up with it... like a member of THEIR family.
ICU is a blessing..we can toss them out after a minute if they get obnoxious.
There is a ridiculous overemphasis on "cool skills" in student nursing...I know giving an efficient bath to 5 people in 40 minutes is boring,repetitive and well really boring but..guess what? that is what a nursing career is all about...I work CVICU...I still have to bath my patient and turn them and sit them up and dangle...every shift..for years and years and years.
Get really good at it and do it as the first thing you do..get them naked and move them around ...that"s the assessment...what do they look like and how hard is it for them to move?,,,what else will tell you all you really need to know?
You don't need a 35 page care plan to explain and treat my patient that has bruises everywhere and purple heels and can't turn because they get so short of breath they turn as blue as their heels. A good patho class EVERY term means students will know why this is happening....how about a 35 page paper on what happens to an elderly patient who doesn't get turned and mobilized while in hospital...forget the careplan..make them include pictures and diagrams....make things REAL.
take them to a long term care facility first term and have them pack the holes left behind from when people "forgot" to turn patients regularily.
No care plan and no in class ethics lesson will teach as much as the moment a new student sees a hole the size of their fist to the bone and they are responsible for packing and dressing it and making sure it never happens again.
Nursing students need to be challenged over and over again with real world tests..not in class tests.
Dump the endless nursing philosophy...all those nuns and the like are great for Masters programs but for the rest of us? we don't need someone trying explain what nurses are or what nursing means or how nursing is a "real profession"..nurses know what they do and have no problem considering themselves professionals...all that nursing theory for me is a little like.... sorry to say it..academic masturbation....it's what people in academia like to sit and around and kvetch about... a little like college students playing with existentialism....useless in the real world but pleasant to fight about after a few drinks.
It can be mentioned in passing as a slightly amusing academic exercise for one hour of the program but don't waste real time for teaching. The questions have already been answered..we are a profession governed by law and policed by a supervisory board...we are a profession already, we have societies and lobbyists for goodness sake.
For those worried about skills...once you realize a catheter needs to go in a certain hole...well..the mystery is over...the only thing that changes is level of difficulty..bring a flashlight. Removing an IV...well it doesn't get anymore exciting than that first time...wash your hands..bring a piece of gauze and a bandaid..hold pressure till it stops bleeding..apply bandaid....
All the technical skills we do? Rarely change...all the rules remain the same..follow the rules.....now when you have a fantastically explosively incontinent patient?...well thats the time for your creativity to shine..and that one will never stop being really really surprising and different. thats why knowing how to give a complete bed bath in less than 15 minutes is a truly invaluable skill...because you really don't want to be in that room any longer than that or the smell will render you helpless.
Nursing school also needs a sense of humour and some foul language every once in awhile...lighten up occassionally...sometimes this stuff is really funny.
wow....I remember those first days and I still thank God I had a great boss who was more than happy to teach.
Nursing clinicals do very little to prepare a new nurse..they are too short , too controlled way too organized...too much time is spent in mini conferences with the instructor grilling and not enough time is spent actually providing nursing care.
I can remember the first term making beds and giving one bath..what a complete and utter waste of time...weeks spent worrying about a ridiculous hospital corner and the proper way to hold a washcloth...way too much emphasis placed on commen sense stuff and an insult to intelligent people..
No time spent on moving people ..in and out of bed..around the bed...how do you bathe properly, wash hair and change the sheets in 15 minutes or less..that would be something to practice over and over again since your whole career is going to revolve around bathing,moving,lifting.....making beds for weeks and then giving one bath...not gonna cut it.
Meds...meds and more meds training..don't wait for second term..start early and often...meds every clinical day..this is the biggest area of errors in the nursing profession...nursing school needs to indoctrinate safe meds....the only way to do it is to DO IT...not just one day or one week...every year every clinical...meds meds meds
Scrap some of the neverending ethics classes...teach ethics on the floor...real world ethical and moral debates when they occur...ethics in action with patients,nurses,doctors and families
How about teaching nurses the reality of working with doctors....prepare them for that moment when a doctor hangs up the phone or patronizes you in front of your peers or yells , throws things or calls you names.
How about teaching nurses about other nurses and that they won't be thrilled to see you because it means more work and they don't trust you...
Nursing school is a fairy land where all you have to do is make sure your clinical instructor likes you even if she is a psychpath and you have to tell her everyday she is God's gift to nursing to do it...and I had more than one of those. It was good practice for nurse managers...maybe you should also cover them too...they are not your friends...the union is your friend..your manager is the enemy, don't be shocked when they pretend to be your friend while cheerfully complaining about you to everyone they meet, they are masters of the passive aggressive.
If new nurses understood the realities they wouldn't get so upset...knowing your reality means you can prepare for it and get over it quickly and move on...it can be considered a nuisance instead of a devastation of ego.
Nursing students need real world experience...sitting in a class room practicing putting in a catheter is a complete waste of time.......noone looks like that plastic groin...instructors should be agressively proactive on the unit..every catheter should be a learning experience...be like docs...see one do one teach one..skip the neverending six week how to do a dressing...find a patient and show..teach on a real wound...show how to clean..tape...where to put your dressing tray when there is a lunch tray and nine paperbacks and three flower vases taking up all available room.
Real world teaching over and over and over so it becomes memory..all nervousness gone because you have done it a hundred times on a real person.
Stop wasting time on the "perfect" dressing change that must be graded and critiqued...concentrate on hand washing and how to use sterile gloves...this ridiculous concentration on sterile technique is just an intimidation tactic that freaks out students......try to remember the patient is NOT sterile...good handwashing technique is the answer to a multitude of sins....if you break sterility with filthy hands? bad news..but if your hands are clean or even better clean with sterile gloves on?..well everyone can relax.
Emphasize errors will be made but if your hands are clean the end of the world can be averted.
Use common sense. avoid scare tactics...explain why things are important without invoking terror tactics...teach ORGANIZATION...how to plan your day..how to de stress and how to let the unimportant things go for another day
Good handwashing..being organized , excellent med skills and being good and fast at giving a bedbath will make a new grads life a lot easier.
Once many many moons ago..I had a nitro gtt...my patients BP was way too high so i set the pump to bolus for a set amount of time...or so I thought......instead I had reset the main pump and the timer backwards......big bolus over very short time...I couldn't figure out why my patients BP was barely there until the pump alarmed time up.....thank goodness they bounced right back but for that 1 minute I was holding my breath.
Find the book that has all staff home phone numbers in it and right beside your name write DO NOT CALL for extra shifts.
I know exactly what you mean. I had a recent back surgery, not elective but I felt the same way.
I felt like as a nurse I didn't get the same attention from the other nurses that a civilian would get...I was so concerned about being a really good patient and not upsetting anyone.....I was prescribed tylenol3 after surgery and I had to tell them I just can't tolerate them because of the caffeine.......I don't mind plain codeine it's just that the caffeine in two tylenol 3's makes me feel crazy and itchy....they then offered percocet which is an awful drug...I don't know what is in it but it makes me crazier than all the caffeine....it just makes me feel desperate and anxious and nauseated........they had to send down the resident and finally I just went with the t3's and had to get my husband to pull over on the way home so I could be sick.
I think nurses looking after nurses just assume you know stuff and are really quickly frustrated ....like we should know better..so you don't get the kind of post op teaching that would give you some idea of how bad the next week of recovery is going to be......it's always a surprise...I was so sick and I was way too embarrassed to ask if this was normal....
I didn't get any post op instructions except not to have a bath for 2 weeks...
I wish nurses would just treat me like everybody else and assume I haven't got a clue about looking after myself...that way I would get a good education about what to expect....I imagine if a nurse had told you that you were going to be really really sore for a good two weeks and badly bruised but that in a month you should see a huge difference you could have a better less traumatic first week...it's all about knowing what to expect and what "normal" looks like and that you WILL begin to recover......
even nurses need to be reassurred that everything is going to be alright and that our decisions are good ones...
I want to thank those that offered concern and I want to say I am not calling people names or asking them to defend themselves because a patient drove them crazy for 12 hours.
I believe as a nurse it can make a nurse crazy when our patients complain of unelenting pain despite the pain meds we give...it makes us anxious and upset because for alot of us we are thinking the worst...some horrible complication that we are missing and will kill our patient...I know I have felt more and more frantic as a shift went on when I have had a patient that appears to never be out of pain despite the gallons of morphine I am pumping in....
I will try to offer some more perspective...when I first began this journey the doc started me on celebrex...it made me sick...and did nothing for the pain..so..vioxx...which was worse...so tylenol 3 which I ate like M&M's...then percocet...which made me sick and horribly anxious and out of control...so back to tylenol 3...added amitryptilline...stopped being able to pee...at all....clonazepam...so sedated I drooled..literally all the time...so then oxycontin...with neurontin....sedated...couldn't speak without a terrible stutter..anxious and comatose..drooling and crazy..unable to pee or move my bowels....on to morphine..off clonazepam......on to muscle relaxants and ativan......back to codeine...off all sedation...codeine and neurontin...finally...surgery ....at present...off all meds except occassional tylenol......take St Johns wort for generalized anxiety from withdrawal of neurontin..hopefully will be able to be drug free very soon.
So...I am not a strange case....the majority of patients are going to need experimentation in meds to find something that gives some relief without destroying the person.....the doc and the nurse and the patient should be working together...if you are spending a 12 hour shift with a patient who gets no relief alarm bells should be ringing...the immediate "junkie" response should NOT be what you reach for...what you should be saying is wow ...this med doesn't work for this patient at all...
I think it's time to stop pushing this drug and try something else because this is not working...
Instead ...we get venting posts that scream my patient is a lying junkie that is manipulating everyone.....why? Why get into such a competitive attitude with a patient? You are demanding that the patient prove their pain to you...how? what do you want the patient to do? They cry and complain and beg and whine and curse you out for relief...what else can they do?
If i could somehow understand what nurses are looking for I would have done my best to give them that...I would have cried and begged and kissed your feet if the nurse would have held my hand and told me it was going to be okay and she was going to get me some help....
This subject is horribly distressing to me because I know that nurses were thinking this about me...I know they were thinking it can't be that bad...she doesn't need those drugs...only cancer patients should be getting morphine...
The thing is this... venting here within our communtity is one thing...but too many nurses actually believe that they are only venting here....
I said before and I say again...you aren't fooling anyone......that patient who asked for more meds? they KNOW you think they are a liar and a junkie....you made them feel powerless...and ofcourse the more waves of disapproval you drown them in the more they act out and got angrier and more disgusted with you......
It seems to me that nurses disapprove of pain medication...why? why do you care?
Why such crazy disgust over drug use? Why so much disgust over someone asking for drugs? Is this person taking something from you?
Why can't you just give them what is ordered without saying in your head...wow what a junkie...they cannot possibly need all those drugs and I would know this because I am a nurse and I am an expert in rating other peoples pain...I just loved that "Iam a good judge of pain."..oh yes you are.....aren't you..judge..jury...you will be the one to decide if the patient needs pain relief right...because it's YOUR judgement that matters.......still you don't get it....nurses are NOT judges of pain...it's not your job to judge if the patient is having pain and how much ...your job is to RESPOND to the patients needs....without judgement....you don't like it I get that...some patients can make you feel like you are not doing your best...pain makes everyone involved anxious and defensive but there are ways to address that.....
What if you had told that patient I am really sorry for this situation, I feel awful about it, I have tried every way I know to help...is there anything else we can try? hot shower...cold,walking ,sitting in a chair.....the patient would have felt that they had a friend and the desperation and fear would have lessened...and to some extent the pain...the biggest fear I had was someone was going to stop my meds...I lived in terror at the thought...what would happen to me if this pain got out of control...would I have to kill myself?
FEAR is what is motivating a lot of pain patients...the thought that someone somewhere will decide that they can't have any relief and they will somehow have to try to survive the pain...knowing full well they won't be able to.
All I am asking is that before you decide that the patient is a manipulative lying junkie you try some compassion...treat their feelings despite your own...reassure them that you are there and that they will have access to relief...tell them that you won't let their pain get out of control...you may be happily surprised.
My apologies to those that got their feelings hurt..I do understand the frustration of feeling like you spent a lot of time with a patient and never could meet their needs...I just really feel that pain should never be an issue of such condemnation and judgement.
well...I am a nurse and I am going to try to help you understand.
I hurt my back...and yes I felt every wince from everyone...oh yeh...back pain...righhht...
so I went to work because that is the response I got....do some exercise...take a tylenol.....I tried rest...I tried cold..heat..physio......I had progressive acute sciatica but you see I was embarrassed......I kept going to work...because all the nurses loved to belittle pain and make fun of back injuries....
so I tried to get off the couch on a day off...I screamed until I vomitted.....MRI...2 herniated discs....I took pain medication and lots of it and I lay on the couch hoping that the pain would kill me or end...
I had surgery 7 weeks ago after suffering for a year because you see no one believes in back pain or back injury anymore......even with a MRI....they say take vioxx or percocet or oxycontin..neurontin.. ...it will get better on it's own...some days I cried all day...sure I was being driven insane by nerve pain that never stopped...some days I got up had a shower and went shopping determined not to say a word because of the LOOK everyone gives you...ohhh back pain ...rigghhht
so some days I am sure you would look at me and think..well it can't be that bad...she is clean and coherent and walking...and having a smoke...so I am a liar in your eyes...
after surgery I have slowly and carefully regained some part of my life again... I had to stop my meds...I didn't believe I needed them anymore...I had horrible side effects from stopping antiseizure medications which are truly the only treatment available for neuropathic pain...I am a nervous wreck because my brain has been stripped of all the neurochemicals that protect it.....
I had a horrible injury with agonizing pain...it lasted over a year......I wanted desperately to go to the er...I went once...the nurses all gave me the look...back pain...rigghtt...I never went back
I suffered because of nursing judgement and crappy attitudes...
why nurses think they have any right to judge another human beings pain is beyond me...I think it is disgusting........just a nice moral superiority moment...well....it can happen to you just like it happened to me...turned that patient just a little wrong... and you will get to be at the other end of the look at the junkie speech
what is interesting...I never had a doctor hand down that morally superior judgement.....just nurses.
If you have a problem with pain management and you think your patient is a liar and the treating physician is a fool maybe you need to stop and have a look at yourself....I know people want to vent...but nursing and pain control has been a never ending nasty problem and I think nurses need to cut it out....give the patient the medication ordered...if they continue to complain call the doctor and address it...save your look at the dumb junkie moral superiority ...it's hard enough to endure pain but to have to endure some snotty nurse calling you a liar is just too much.
I refuse to give nurses the right to judge pain and I thank GOD every day I didn't have to rely on a nurse for access to pain control... despite continuous education this attitude prevails...that is why doctors prescribe...if we left it to nurses everyone would get a tylenol and gravol only if they vomit with three witnesses.
before this happened I was a big pain control advocate...all my patients got pain services if the standings failed...I worked with nurses who gave NOTHING in 12 hours to open heart patients and whined that they wouldn't cough and their sats were terrible....it never occurred to them the patient was in agony...they were too scared to ask for relief because they were told by the doctor the nurse will give you pain relief....they didn't want to challenge the nurse...what a terrible thing that in 2004 nurses still behave this way.
I don't care if you think 125mg of demerol is way too much......it's not your business...your business is to assess and evaluate and watch for side effects and address those...
Pain control is not a power issue...nurses act like it is...pain control is a compassion issue and it's time to start thinking what if it was ME in this bed? What if I had abdominal pain and nausea that came and went with a terrifying force and NOONE could figure out why?
I had an emergency appy after a 6 months of that....the appy was a disgusting dessicated pus filled mess.....i was told i had stress and perimenopause...see I didn't have a temp or much of a white count...it was only until an er doc thought things were just a little too weird that he called in a surgeon and he opened me up to look around and was shocked at the mess...I had ultrasounds and a ct that showed nothing...
so some poor schmuck is lying in a hospital bed because they FEEL sick...please don't tell me someone spent 8 hours waiting to be seen in an er on a whim...you can get drugs a lot easier than that...treat them with some dignity...it could be you.
Stop using pain and pain medication to feel superior...yes you are really lucky...you don't have pain...feel grateful..... but when you begin to think that your patient is a liar and a junkie..stop and remind yourself...that could be me..or my child or my loved one...
Cynicism is incompatible with compassionate nursing....believing your patient is a liar and a con artist means you are NOT giving good care...you may think just because I do everything ordered I am doing my job...the patient knows you think they are a liar...you are not hiding your disgust..it's coming off you like cheap perfume and as a patient I have had more than enough.
I understand nurses want to vent but for me this is not a venting issue...it is a power and superiority issue...it is belittling and degrading.
I had a funny one...I ws new to CV and it was the done thing to get ALL patients up in a chair by 6am...so I did all the prep work...a couple of test dangles and then the big move....all lines remain in when we walk them to the chair...so he is a pretty young guy and has no problems at all ...I get him settled...feet up tray to the side television on remote in hand and I look up and ask him if he needs anything else....he starts growling at me...like a very angry dog...with foam...a lot of foam and growling......he is foaming at the mouth and I begin to freak out....all I can think is holy cr** this guy has rabies...I move away slowly and check the monitor....sinus, BP...way too high...I step into the hall and yell for help...a crowd comes flying into the room....and they all stop and start backing up....he is really really really growling now and the foam has become cartoonish...it is everywhere
It was surreal...then the monitor alarmed asystole...I was never so relieved to see asystole in my life.......so as a group we all grap a limb and lift him towards the bed...except the bed is too high...so we count one two three...on three we were supposed to lift him up high enough to get him into the bed....we missed and he clanged into the side railing...........silence
then a small voice..".I'm okay."...it was the mad growler...fine once again
Doctors..neuro..CT...nothing......mother comes in and she reveals the big secret...he had seizures as a kid...deep growly ones.....hadn't had one in 15 years....nobody thought to mention it....we still don't understand what set him off but he had two more and ended up with a pacemaker/defib just in case.
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