KatieMI, MSN, RN 34,370 Views
Joined: Jan 24, '10;
Posts: 2,124 (77% Liked)
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You also might want to know how it comes to be that generic eszopiclone costs $370 for month low dose supply in US Walmart but only $10 from online Walmart pharmacy in Canada.
It all sounds great. Yet...
The Powers that are can do what they are doing partially because they feel almost invincible. Workplace violence, unless it is about "protected categories" and expressed as such, is not punishable even in civil court. And "not getting bridges burned" tactic helps a lot with it. It is nice and easy to railroad someone if you know that this person will keep silent doesn't matter what.
I didn't do that. I burned bridges with my first nursing job, where I was treated like gestapo prisoner, a bit later but the fire was burning long, bright and high. It did not affect anything but my not-to-hire status in that place, which was there anyway. Even more, I was courted by facilities which competed for highly qualified staff in the area with a view that I wouldn't have too many options to run away to if hired. Three years later, I have privileges in this very hospital as a provider and when the people from nursing administration accidentally bump on me, they clearly wish to just dissolve into thin air. They know that I did not shut up and that I won't keep silent if I see another nurse crying in the corner. And they better remember it for a good time.
Verbal: (you ask patient how he is doing and if he needs something; your name is not Minnie):
5: hi, how'ya doin'? I'm fine, just my head hurts like h*** and I want turkey sandvich and some coffee and lots of sugar in it... LOTS. Where's my phone? What pill it is? Thank you, you're sweetheart!
4: (after being nudged a bit, speaks slowly): hi... my head hurts... my head... dun'know, my head hurts, give me some water, I want to drink... thanks...
3: head... water... Minnie, help me!... head...(cannot say who Minnie is)
2: moans and groans, tries to speak but can't
In any case, it is not that important if patient knows the year, month and who's the President. What is important is symptom (i.e. speech) remaining the same or worsening during the time as you care for the patient. And you need to differentiate between changes caused by disease and effects of drugs you administer.
You were in situations more than once, where you walked in to find a parent watching terror videos, encouraging violence in front of a minor child? So you didn't feel safe, but were not concerned about the safety of the patient? I'm not sure if you read my actual post.
Agree with Davey, but I was in just such situations more than once and, except the time when I was very new and in very abusive environment, asked to remove me from care of this patient immediately because I did not feel safe and comfortable to provide care for him/her.
Private care agency in rich area (you don't have to live there)
Find a high demand skill, master it and market it around.
I personally know one LPN who just has a magic touch with gery/psych patients. We live in relatively high income area where some families can afford private care for their "problematic" loved ones (read: patient is so aggressive and unpredictable that he was refused admissions in ER without psychiatrist on call, leaving alone almost every facility 100 miles around). This LPN takes private duty calls till med regiment is settled, charges $65/hour and has waiting list. And she is trusted more than many M.D. psychiatrists.
When one is in ICU and has two patients, that's ok. If one is floating in medsurg and has assignment of seven, that'll be another story.
Personally, I never understand that. Unless one uses strict 1:1 care with full isolation like for Ebola, transmission is inevitable. The very same patient with that MDR Proteus in urine and MRSA in nose will go home tomorrow, sitting near you in a bus, going to the same Walmart, picking the same gas dispenser with unwashed hands and peeing in the same public restroom. He will lift and kiss his 1- month old grandchild, then sleep in the same bed with his wife who is ESRD, HD, DM II and recent chemo for ovarian cancer and it is not 100% given that he would at least wash his hands before touching either of them. And I do not even mention that he is right now walking down the corridor with 5 of his family members, wearing the same gown, sneezing around and snatching a box of Kleenex from station. We think nothing of all that, although he must spread infection like fire in dry forest - why, then, spend the time on compulsively wiping everything which only can potentially touch the guy?
And, BTW, there is no evidence about anything except good 'ol handwashing and selected types of PPE and disposables (while being used consistently in enforced and supported environment, which has nothing to do with a real medsurg floor) being effective for "protection against transmission of MDR pathogens". At least 75% of that hulabaloo comes from the same source as policies which require putting every blister from each Coumadin pill in separate biohazard bag lest "something might happen", or prohibit any action whatsoever on extremity of the side of simple mastectomy done 25 years ago. In other words, from so-called "administration" which has to prove that they worth their salaries, benefits and fat bonuses without ever doing anything even remotely useful or constructive.
There is one wonderful phrase in nursing I learned long ago on this forum:
- I am so sorry but THEY do not let me/allow me to do (whatever it is)
In 99 cases out of 100 there comes no question of who these mysterious "they" might be and the subject gets dropped. In that one remaining case, the answer is "my administration". The following quest about looking for and meeting "them" usually dissolves the rest of the issue.
Thank you, guys (blushing smiley)
The fact is: there must not be such thing as "hypotension protocol". At all. Whatsoever. Under no circumstances.
"Hypotension" is too relative thing and it has too many possible causes to be managed under premise "one size fits most". My own normal working BP is 90/50, maybe less, with HR usually low 100th. I lost count of how many times I had to literally run AMA for my life because someone with accidental RN or MD after last name decided that these numbers alone justify every test, task and thing known to humankind to be done because "they satisfy criteria". I am also sick and tired of treating patients with known systolic CHF, ESRD, on 5+ hypotensives, etc. after they were given a liter or two bolus for "dehydration" and then tankload of Lasix for "elevated BNP".
Levophed is not "better" and not "worse" than dopamine, or vasopressine, or dobutamine, or any other pressor. They all work differently and therefore each of them has separate indications, contraindications, precautions and side effects. Study your pharm, pathophysiology and, first and foremost, know and access your patient. Then you will know what is the best choice in every clinical situation. Treat patient, not numbers, charts or monitor screen. Become a clinical expert and advocate for your patients if you see someone holding onto numbers for dear life instead of treating them. And, above it all, be a CLINICIAN, not a "task-oriented" protocol follower.
Sorry for not giving you what you want to hear. But it is for every single one of us, every single mouth, set of eyes and pair of hands to prevent substitution of various protocols for critical thinking. I am not against all protocol and guideline but hanging Levophed or dopamine on everybody whose BP is 90/50 or below doesn't matter why and what is just as "intelligent" and safe as bloodletting everyone first thing, like it was done 500 years ago.
Your comments are thought-provoking. I remember the first time I learned, "What?! you can turn away a cancer patient? Did you see Patch Adams? I admire his healthcare model.
My husband and I visited with folks from England and Canada who have socialized medicine. They empathize with our mess. I've read about England adopting a nationalized health service after WWII to care for veterans. I dream of a nationalized system for us..
Medical tourism for cancer treatment is flourishing in the USA and well within means for upper middle class' finances. Also, smart people shop for meds all over the world and save big $$$$ this way. Just letting you know. And do not let me start about naturopats of all kinds available immediately right here.
But the main point is that drugs for cancer are not Epipens. They, especially the newest ones, are ridiculously expensive to develop, make and introduce, and everything about them (delivery systems, monitoring, $$$ to pay that RN who pushes them 36 hours/week, etc) is not coming free from Heaven either. The massive research system, which makes all the above possible, costs even more. And, last but not least, support and treatment of "comorbidities" is possibly the biggest elephant in the room. Obesity alone adds over 20% (that's one fifth part) to the US health care spending.
Life in Golden Billion has its own negatives. Please consider saving those $2.50 per bag of chips, $6.16 per pack of cigarettes and $5 for empty calories overladen Starbucks drink today, and you might have less problems later.
If lack of darkness is your problem, here is one solution for you:
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At least it is cheaper than a twin mattress, even a used one.
Unfortunately, I think we assume because we're nurses, we will be properly educated on this topic. The actuality is we're not. And we behave mostly like the rest of the population when it comes to vaccination.
Vaccines are complicated. Talking about risks and benefits is also a complicated discussion. In general, I believe the benefits outweigh the risks but I think healthcare workers should be able to objectively answer concerns in a knowledgeable manner. Our education does not prepare us to do that, honestly.
The potential for side effects is microscopic compared to the benefits for the world's entire population of children. It's another order of magnitude altogether. Joy
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