Latest Comments by KatieMI

KatieMI, MSN, RN 26,935 Views

Joined Jan 24, '10. Posts: 1,863 (75% Liked) Likes: 7,123

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  • 1
    brownbook likes this.

    There are no big veins around radial artery, and this is not groin or AC fossa where these two things run close together. In the wrist, if it is pulsating, it is in artery.

    ABGs in venous and arterial blood can "equalize" if patient is in severe distress, especially severe VQ mismatch. In this case, pulsation can be the only sing that the catheter is misplaced.

    Just my $0.02

  • 2
    TriciaJ and mrf0609 like this.

    Quote from mrf0609
    But I can be highly aggressive and have had a tendency to speak without thinking causing undo pain and bad feelings. Although I am aware of my communication style, I still believe I am a bully but am working on change. I am not empowered at all by my behavior but nevertheless belittling and demeaning a person is not nice and a behavior I am working on changing...I am finding it ebbs and flows, at times it is worse than others but it should never occur...thanks for your thoughts!
    The above proves that you are NOT a bully. You can trust me in that

  • 7
    awind, ~Shrek~, JustMe54, and 4 others like this.

    I do not feel that the described example was "bullying". It might be less than "polite", but it was not "bullying".

    "Bullying" would look somewhat akin to this:

    - you found that bag, then came to Katie and point your finger to her: Katie, you come here with me... NOW (in that super-polite, exagerratingly professional tone).
    - once in room, you give Katie a long, naughty lecture about her trying to kill the patient all night long.You name her "stupid" and "incompetent" in front of the patient (whom you, meanwhile, woke up) and made a scene looking like you personally saved the patient's life
    - you then proceed to more berating at the nursing station
    - then, while Katie was crying in the restroom, you spent 20 min on phone telling your manager how stupid Katie was, how her ponytail hairs were infection hazard and how you feel her giving everyone "attitude" every time you see her. You are now behind with your own assignments, but you don't care anymore.
    - then you fill incident report marking the event as "sentinel" (knowing all along that it was not)
    - then, you tell everybody who would listen how you just saved a life of a patient which was in grave danger from that one additional dose of antibiotic and how bad Katie was, both as a nurse and a person. You also invent a story of you catching Katie red-handed while digging into someone's lunchbox, and taking suspiciously long time in restroom right after you two pulled out a vial if Dilaudid 2 weeks ago. You make sure your manager and your pals all know about your "concerns".

    So no, you were not "bully". You were just irritated that Katie missed important part of info you gave her, and reacted, letting sometimes Impossibly high standards we apply to themselves as nurses, to go for a second. That was that. I hope Katie appreciated what you did as much as I do. I hope that, as we stop denying the reality of lateral violence in healthcare and start speaking about it, we will find way to eliminate this repulsive part of current "culture".

  • 11

    While I am a convinced supporter of the point of view about prevalence of bullying and lateral violence in modern American nursing being so high that it should be considered a cultural norm, I might side with previous posters this time. Nurses are supposed to wear so many hats and be responsible for so many functions nowadays that they, plain and simple, have no time to be super-polite with everyone and attend immediately to everything. Occupational therapy is hardly ever the highest priority in patient's care, and PT/OT people do not fill those Press-Ganey surveys. So, yeah, anything that PT/OT people think as being "very important" for what they are doing at that moment is likely to be at the lowest bottom of priority list for every nurse they address. Furthermore, your 5th request to unhook that lady's IV so that you can work with her automatically goes below that call light going off 4th time in 3 min (and every one of them being for downright silly reasons) because call light comes from "paying customer" who will fill that survey.

    Is it pleasant? Definitely, not. Is it bullying? Even I would say "no". Nurses are "justdojngtheirjobs", like you do. They just have WAY more things they are responsible for, and they are no more able to be in more than one place at once than you do. Please make an effort to understand this.

    And, BTW, while bullying is less common among peers in SOME Advanced Practice nursing specialties, it is a more than a well-known problem among CRNAs and CNMs.

  • 1
    xoemmylouox likes this.

    Quote from RNNPICU
    Many employers would not want to hire an NP prepared nurse to work an RN job.
    They also might not do so for legal reasons. An NP-prepared person who passed the Boards in many states is considered possessing knowledge and skills (and, therefore, liable for applying or misapplying them) even when functioning on RN level. In other words, if such an RN cares for a patient who has severe chest pain, tries to call provider to get orders for 12-leads and everything else and the patient dies in the process from AMI, that RN can be held liable as an NP because she, supposingly, had knowledge and skills to diagnose and treat ACS, even if she had no legal authority to do so and it was not within her scope of practice at that moment. I am in Michigan, and my class was expressively told to stop working bedside the day we know we passed Boards, for that very reason. This rule doesn't affect MSN/Ed, MSN/leadership, CNSs, and no one else but APRNs, at least in my state.

    I know one guy who held and uses his RRT, RN and NP licenses (and so works as either) within the same facility, but he is there longer than I am alive, and he is clearly an exclusion frtom the rule.

  • 1
    Emergent likes this.

    There are multiple patients who demand home care just in order to be wiped and cleaned every day because that's what "they always do for me while I am in hospital". As well as multiple people in the nearest Walmart who walk around looking (and smelling) like if they didn't wash themselves and change their clothes for weeks.

    Truly, for some of them even the simplest life tasks are big hurdles. They cannot afford $10 for clothes in Goodwill, leaving alone gas for car to get there, if they have a car. They exist in drug-induced stupor most of the day, and when they accidentally float out of there, they just cannot muster enough energy anymore. They cannot drag laundry baskets down to basement and out of there. They are morbidly obese, so they just do not have hands long enough to reach and wipe themselves. And, I would say, in poorer area there are plenty of such folks. But the rest... I am lost at why they would do that.

  • 3
    Mavrick, caliotter3, and Kitiger like this.

    Quote from klone
    Most RN-MSN programs that I'm familiar with cover everything that is in a BSN program (statistics, community health, etc).
    But that doesn't matter if the program doesn't formally grants BSN. No the letters after last name - no degree - no job which mandates BSN.

    I am pretty much sure, though, that the problem only affects mostly those who want nursing jobs which require BSN while having MSN in specialties other than Advanced Care, like education, leadership and such. These specialties carry higher risk of not finding job after graduation than APRNs and new grads might want to return to bedside. If they live in an area with facilities requiring BSN for entry level positions, they can end up as not eligible for employment.

  • 57
    mushyrn, nrsang97, rn1965, and 54 others like this.

    Speaking short, what you want comes as close to "impossible" as it gets. If caring for female patients crosses your religious views, you might want to find another occupation.

  • 6
    BedsideNurse, jrbl77, Creamsoda, and 3 others like this.

    Quote from TriciaJ
    The rest of us need to eat our veggies, wear our seatbelts and pray we never get hospitalized.
    Amen, sister/brother of mine!

  • 4
    SummitRN, Creamsoda, TriciaJ, and 1 other like this.

    Yup, that's how things are now... almost everywhere.

    During my time in LTACH, at least half of our clientelle got there directly because those poor souls were cared for by nurses (and doctors, too) who did things by the books, to the last dot, and provided "amazing customer service" instead of medical treatment.They followed every policy and every "gold standard" without ever turning their brains on, and got all "recognition awards" for doing so. Worse still, they convinced families that their loved ones received the best care possible, and only some ominous touch of destiny sent them to chronic life support with GCS below 7.

    Even worse were those people from "quality control" who, supposedly, had BSN degrees but seemed to forget the basics of the basics after years of hunting down every one little thing they were made responsible to. My worst nightmare were about them descending in full rage and fury when a patient with cardiac history happened to be not put on two blood thinners, b-blocker and ACE/ARB "as per corporate policy". Meanwhile, I was trying to keep this poor soul from being transferred to ECU ("ethernal care unit") and praying about his b-blocker serum conc dropping below t1/2 so that I could get him off escalating doses of Levophed and fluids with his kidneys and liver failing already. And that was after I spent 3 or 4 hours hunting down every doc who ordered all that meds "according to gold standards" and explaining them why those standards were probably not applicable anymore.

  • 5
    jeastridge, jasia52, gardenia1, and 2 others like this.

    Yep, subway to Grayfriars, then 10 min walk. Or right across Victoria bridge.

    The museum is truly amazing. So, a couple more facts about Ms. Nightingale:

    - she actually did very little of bedside care. Her famous "rounds with the lamp", if any of them actually took place, were about getting things into order.
    - she was a born manager. Sharp, creative, resourceful, not always pleasant to deal with, but able to make people to get things done.
    - to accompish the above, she liked to drive others crazy with her multiple maladies, most of which were classified as "hysteria" even at her lifetime. Her letters describing them are on exhibition and everyone can read them if able to drag through ol' good Victorian handwriting. I did, and the content truly reminded me some of my office patients who live under modus operandi of "I ALWAYS get what I want, when I want, and exactly the way I want it".
    - she was, at her time, probably the best European applied statistics specialist. The Lords of Admiralty knew all along that 30% of soldiers died from diarrhea, malaria and such shortly after they arrived in Scutari, and another half of survivors didn't make it through wounds which otherwise would be classified as deep cuts and scratches due to sepsis and malnutrition. Flo put all that in stat tables, and the numbers cried out louder than any human could
    - she invented heavy, difficult to manage uniforms of her first nursing squad in Scutari with one very clear purpose in mind: the nurses, mostly of gentry origin, would have to be around young men who didn't see a woman for months, and heavy and difficult to remove (and, accidentally, also difficult to put on and keep clean, on which many nurses complained) dresses, aprons and ribbons were to serve as a sort of protection. Flo'd never get married, but she was very far from being naive!
    - she had a very sharp mind where it came to critical review of current research. For one example, she embraced "bacterial theory", which at that time was highly controversial. People still believed in "miasms" and "bad air".
    - accordingly, she despised "uneducated" women who followed the armies since times immemorial and sold soldiers necessary things such as alcohol, which Flo totally abhorred. Even when those women had a lot of practical knowledge in caring for wounded, Flo was very much against their presence and participation
    - Russian troops during Crimean War also had first nursing corps formed by a famous surgeon N. Pirogov. The main difference between Russian nurses and Flo's ones was that in Russia around that time women, especially of noble origin (which were the majority among nurses on both sides) were de facto not allowed any education except in languages, handiwork, fine arts and religion. Therefore, everything they actually could do while dealing with mass war caualties was holding hands, praying aloud, making supplies and keeping things as clean and neat as possible. The concept still prevailing in Russia of "nurse as a doctor's helper", not a partner, stems directly from there. In Europe, on the other hand, ladies could receive education in science even if strictly within their own homes, and there were many hospitals traditionally led by nuns, who were quite abreast with modern medical views and theories while remaining "traditional" in every other way. The "beguinage" nuns who fully ran hospital in Brudges (modern Belgium) were in fact closer in modern Advanced Practice Nurses in their functions than to "traditional" nursing or anything else. Flo spent quite some time in that place. (of note, the hospital was functional from XII century to 1990th, and a small part of it is still partially open as a modern mental health care asylim).

    I really would like to know if there is a way to post pics I did in these museums, for the benefits of those who won't get a chance to visit it any time soon. If anyone from the Forum admins would please let me know how to do it, that would be appreciated.

  • 2
    Orca and not.done.yet like this.

    A DNR (and any other similar document) won't be seen as legally bonding unless it contain some defining words. One of mandatory phrases is: "I, such-and-such, being over X (state dependent) years old and in my right and clear mind...

    This is also the reason why advanced directives must be notarized to become active. Forms can be downloaded for free all right, but notarization/witnessing still must happen.

    I'd seen people bringing crumbled pieces of paper torn from school notebooks on which their parents supposedly wrote that they would wish to be allowed to die or kept alive indefinitely. It just didn't work like that.

  • 5

    Pregnancy is a naturally T-deficient condition, so in theory the probability of PPD false negative result might be increased, especially at late term. Ask for Quantiferon, and relax.

    I actually wonder why in the country which is supposed to be a beacon of progress in medical science and where so many people are chronically immunosupressed (every patient who takes an equivalent of 15 mg of prednisone orally/24h for more than 1 month, everybody with bone marrow suppression caused by any cause including chronic diseases such as CKD IV - V, everybody taking bone marrow supressors like methotrexate, everybody taking certain biologicals for IBD, psoriasis, lupus, etc, etc.) a test which is so unreliable as PPD is still practiced at all. It is cheap, it brings up $$$ because of two visits needed and it is "tried and true" (while not implying reliability and high quality), but I just cannot see why it should be still on board when we have Quantiferon. Quanti depends on peripheral B-cells function, which is notoriously difficult to supress.

  • 2

    Quote from 3ringnursing
    I just went to the ER last Friday for a cat bite - I am blonde, blue eyed, and so pale skinned I burst into flame in the sun: I was asked this question, not once but several times.

    I guess I could be a citizen of another country, but now that you mention it, I did think it was a bit odd (then again I will do ANYTHING to avoid the ER, so I'm not up on their current practices).

    Another thing to consider is an ER cannot turn away anyone based on inability to pay. Maybe they want to know up front if they will be writing this one off the books?

    I may have taken offense though if I had that gorgeous dark skin, hair and eyes comb I've wished for and admired my whole life. I can't say I wouldn't have.
    You should take offence and refuse to answer this question, like any other that has nothing to do with your medical condition. Likewise, we all should get less prone to giving out our financial, personal and family private info.

    Every time you spell your email or phone and zip code to that cute shop assistant who is "justdoingherjob" and hand her your credit card, you provide enough info to get your bank account hacked. Nowadays, it is just a fact of life.

  • 3
    Here.I.Stand, morte, and KelRN215 like this.

    If a Briton gets into US hospital, the national insuranse system of the GB won't pick up the tab. He would have to get special travel insurance before the trip - or pay out of pocket. Or just leave the country in time and let us pick up the slack. Same will happen with all other national insurances.

    I am coming closer and closer to conclusion that they do it just because they can and because people sheepishly follow every stupid "requirement" they are asked for. When a beauty salon "requires" every client to provide a whole bunch of private info including email, two alternate phones and "emergency contact" and an application for hospital privileges for an NP requests name, SSN and contact info of the spouse of the applicant, I just do not buy any further explanations. That just makes no sense. Characteristically, I refused both and was told that it was ok, "we just want to know more about you". Huh?