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Kooky Korky 24,346 Views

Joined Feb 12, '10. Posts: 3,552 (53% Liked) Likes: 4,859

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  • Oct 15

    I've heard stories about there being orders for a glass of wine at bedtime (to help with sleep).

  • Oct 15

    Breast cancer - at least mine, anyway - is fairly straightforward. You either have it or you don't. The mass is malignant or benign. When you're diagnosed, things happen. You get a referral to a surgeon and a radiation oncologist and you're evaluated for treatment options. Things progress in a cookbook-like fashion - at least that's how it seemed to me. You do this, then you do that and then this and we'll re-evaluate then. People are empathetic, everyone tells you how brave you are. I never FELT brave - I was just putting one foot in front of another, doing what my doctors told me to do. And now, five years later, hopefully it's over.

    Domestic abuse is different. It's not all that straightforward. Everyone gets angry and yells, so when is it abuse? He has never HIT me, so how can it be abuse? Yes he calls me names sometimes, but is THAT abuse? If he's a little controlling, well that's marriage, isn't it? Of course no one WANTS to be in an abusive relationship, and sometimes there's a little denial built in. You think that your mother "fell down the stairs" often and wore long sleeves in summer and sunglasses at night. THAT's abuse. Your relationship is nothing like THAT. You don't want it to be abuse because then you have to do something about it . . . get him into a program or maybe even leave.

    When you're living with an abuser, no one calls you brave, few are empathetic. Either they don't know about your situation because you and he are so good at covering it up, or they do know (or suspect) and they don't understand why you don't just LEAVE. They say things like "If some man tried to do that to ME, I'd let him have it!" "I'd never put up with THAT." I said things like that when my colleague was brought to our ER covered in blood and bruises after her SO attacked her with an ax. She was late coming home from work because her patient coded at change of shift. I said things like that when another colleague was beaten to death by her husband on Christmas because she didn't have enough of his favorite beverage on hand. I didn't get it. Now I do.

    What I didn't get until recently was that even if he doesn't hit you, you might be living with an abuser.

    It starts gradually. He yells a lot, but he's under a lot of stress. He has a temper. He throws things sometimes. It isn't a big deal as long as he's not throwing things at ME, right? And then one day you realize that he's been yelling at you every day, sometimes three times a day. He blames you for things that aren't your fault or are actually HIS fault. He's NEVER at fault. You cannot bring up a grievance with him because he "goes ballistic" no matter how carefully you choose your time or your words. Nothing is a problem unless it's a problem for HIM. You don't bother him with things that might need fixing around the house because he'll tell you it's not a problem, or it's your fault, or he'll just have a tantrum about how useless you are and how he has to do EVERYTHING. He screams at you and calls you names, and you have no idea what set him off. You tried very hard to do everything the way he wants it done.

    And then the day comes when you dread hearing his car in the driveway, his key in the lock. Is the house clean enough? You don't dare let him catch you reading a book or listening to music - hurry quickly and find something to do so you look busy when he comes in the door. You've come from the hairdresser's and she's cut your hair too short and you start trying to explain how it's not your fault before he can explode. You're still thinking it might be your fault - maybe if you had told the hairdresser more specifically. Maybe if you kept the house cleaner, were a better cook, were thinner or more attractive he'd be happy with you and he wouldn't yell so much. There must be SOMETHING wrong with you to make him talk to you that way.

    One day he brags that you're so stupid he can get you to do whatever he wants just by having a tantrum. You realize that you're doing your hair the way HE likes it, not the way you like it. You're able to leave the house without a hassle if you're going somewhere HE approves of. You want to go to the bookstore (which he disapproves of) but you say you're going to the gym (because he approves of that.) You're getting ready to go to an important job interview and he starts screaming and smashing dishes . . . you cry all the way to the interview and you don't get the job. He doesn't want you to go to school or apply for a promotion or whatever because HIS needs come before yours. You realize that he's willing to drive you to your radiation therapy appointment (because he doesn't blame you for having cancer) but not to physical therapy after you get your knees replaced (because if you weren't too fat you wouldn't have needed a knee replacement.) You wonder what will happen when you're older and sick and need him . . . and you hope that whatever you get, it will be on the "approved" list.

    And then one day someone on recommends a book about verbal abuse and you pick it up, just for a lark and you read it. And all of the things they describe in there - it looks just like YOUR relationship. YOU are in an abusive relationship. He's controlling, he's manipulative, he's nasty to you . . . but at least he doesn't hit you.

    At least he doesn't hit you, but he criticizes your body and refuses to have sex with you until you lose 50 pounds. At least he doesn't hit you, but he leers at other women in front of you, and tells you how hot they are and how not you are. You feel ugly and stupid and lazy and . . . all those other things he tells you you are.

    And then you look in the mirror one day and you realize that you no longer recognize yourself. This person isn't who you are. Your partner tore you down, damaged you emotionally, made you doubt and disrespect yourself.

    But at least he doesn't hit you. Until he does.

  • Oct 12

    Quote from jdub6
    I can maybe see a little where OP is coming from (giving benefit of doubt). In the ED at times it can be confusing at times as we resister people by their preferred name/gender and it can be difficult to know when we need an hcg or when to set up for a pelvic for that low abd pain.

    I wonder if there is a sensitive way to note biological status (whether a uterus is present, or testes, ovaries, etc). It's that much harder since people can have different degrees of surgical change. ultimately I guess we need to just ask the patient which parts are there-and there should be a way to alert staff in the medical record that the male patient meets hcg prior to radiology in the ED etc.
    The new law only applies to residents of a skilled nursing facility.
    I think the chart would use the patient/resident's legal name.
    Unless they are a celebrity or well known the legal name if used.

    We nurses and other staff call the persons how they wish to be addressed.

    I cared for a pleasant man in his ninties. He said, "Don't call me Mister *****. That is my father.
    We all fondly remember a patient who wanted to be called, "Big John."
    Often people like to be called, Buddy or Bud, Carrot Top, speedy, or Blondie.
    Then the common Pat, Patty, or Patsy for Patricia, Chuck, Chaz, or Charlie for Charles.

    I think that in general the admitting physician would document their patients conditions ans history.

    I have cared for intersex people whose chart didn't mention it. One example was a married grandmother whose clitoris looked like the penis of a two year old boy.
    It was noticed during her bath.
    When I asked her doctor about it he said. "It is normal for her and not unhealthy."
    I called her Mrs. *****.
    What is intersex? | Intersex Society of North America

  • Oct 12

    I thank you all for the reply. I'll hit on the most important first. Yes, I am a new poster. I am a 1 year licenced nurse and rarely post to social media. I felt this issue was part of a larger issue as I will explain next.

    I agree with what you are all saying, except about a man getting pregnant. That's silly and biologically impossible. For these reasons I ask:

    If this is such a easy to solve, not a big deal, just talk to your Pt. thing then why do we need to place laws demanding these requests be upheld? Why do we need to allow people the option to sue based on their preferences. I find it an unreasonable action for the state to strong arm this issue.

  • Oct 12

    Quote from nurseguy22
    Why is there such an enormous disconnect between real life nursing and nursing education??!?!?
    I do think there should be a heavier clinical focus, without necessarily removing some of the other stuff you're talking about - which I believe is actually important for those who wish to be treated like professionals regardless of role. One must be able to write coherent sentences without grammar and spelling errors, know how to source and evaluate information, and have some understanding of the disciplines that affect nursing and patient care. Social work? I think you should know about that - we're the original social workers, after all. We don't just see the patient when there's a consult, but instead are there all the time. But, since BSN is required for clinical practice, the course of study should significantly focus on and seek to grant experiences and didactic opportunities that lead to something much more than a "novice" understanding of bedside nursing practice. In other words, it should be of immediate benefit and applicability to the person who earns the degree, and ultimately benefit the patients for whom the nurse will be caring. In my ideal world, one would not graduate from nursing school knowing how to write a paper but not be able to proficiently do med math calculations, or be able to create a power point about handwashing but not be able to do an appropriate physical assessment guided by knowledge and insight. There would never be a school where you could obtain a nursing degree without having taken a decent pharmacology class for another example.

    The joke part is that advanced and expert-level knowledge isn't wanted at the bedside as far as I can see. At the same time that BSN entry level to practice is becoming more common, efforts are underway to, for example, decrease need and opportunity for critical thinking. Problems that we want to solve are not the problems that others come up with. There are many mixed messages and I won't pretend that that the disconnect you mention doesn't exist.

  • Oct 11

    Quote from morte
    the bible does not discuss abortion, never mind negatively. and it did exist in those times.
    The Bible does not discuss bombs made from fertilizer, the use of airplanes as weapons of mass destruction or gas chambers, either.

    We are taught "Thou shalt not kill..."

    I'll agree to disagree, but have no doubt that the aforementioned Commandment refers to the willful destruction of innocent life, regardless of the means.

  • Oct 11

    Holy cow! I wish my manager was like that. I never see her and I work day shift. She is always in meetings or off the floor. Never helps out, even when we are in a critical need.

  • Oct 11

    OP: The only thing I would add is if you are an Assistant Nurse Manager (entry level middle management) you may have to also be the charge nurse because you do not have one, so you are on the floor in-between meetings with operations working with patients, as Klone has pointed out (not so much the further you go up the food chain, however).

    Thus, you also must also:
    Deal with the complaints from your shift's dismay with his/her assignment
    Make the assignments for the oncoming shift
    Get yelled at by oncoming shift regarding his/her assignment
    Deal with staffing issues for your shift and the oncoming shift (to include sick or late staff and modified/injured employee issues)
    Reconcile staffing and productivity with whomever to make sure your current and the oncoming shift are not over or under budget based upon your staffing mix
    Huddle the oncoming and off going shift huddle unless your colleague wants to do so
    Perform audits in real-time to address documentation and concerns prior to regulatory fall outs
    Address regulatory fall-outs.
    Round on staff
    Round on patients
    Perform patient/visitor service recoveries
    Perform environmental rounds
    Talk to Engineering about some issue
    Talk to Housekeeping about some issues
    Talk to the ED Charge
    Coordinate admissions, transfers, and discharges multiple times with the House Supervisor
    Train your staff on some new process or some new equipment (you get minimal training but are suppose to be an expert in all things....)
    Count the Pyxis
    Attend trainings during, before, or after your shift
    Attend meetings during, before, or after your shift
    Be in multiple places at once and be all things to all people.....
    Don't forget to smile
    Don't forget to breathe

    There is more..... Klone and I are leaving things out because we are all things to all people so it is hard to recall it all....

    Good luck!

  • Oct 11

    Typical day:

    Sit in on report.
    Update the white board.
    Make a mental list of patients who will potentially be discharged.
    Glance at my emails from the past 12 hours to see if there's anything that I need to address now, or can it wait.
    Listen to my voicemails.
    Update the time cards to reflect any sick calls for the past day.
    Go to leadership safety huddle.
    Check in on staff to see how they're doing, do they need anything.
    Round on patients to make sure everything is okay, do they need anything.
    Update my spreadsheet for the past day's shifts to reflect patient census and staffing in order to get a daily PI tally.
    Address any incident reports that have been filed, do I need to address anything with a staff member? Do I need to involve executive leadership?
    A staff member has decided to accept a job in another state - need to submit a "request to post" her job. Log into the HR portal to see if there are any new applicants for the open positions we have.
    Someone from some company that offers a product specific to OB would like to send me samples - read about the product online, tell them sure, we'd love to see samples.
    Address the issue of why item XYZ is not getting restocked on the unit. Call central supply. Get it sorted out.
    Check in with the nurses and the unit secretary to find out if the patients we thought would get discharged actually have d/c orders. Find out the physician in question is not planning on rounding until lunch. Call provider, tell him he needs to round this AM because patient wants to leave and we need the bed.
    Check in with those nurses who do have discharge orders, find out where they are in the d/c process - do they need help with anything to get the patient out the door.
    Clinical manager meeting - discuss new initiatives and new processes that are going to be implemented.
    Look at our current census and staffing - suggest to charge nurse that she send a nurse home because we are now overstaffed for our census.
    Look into a 38-week induction of labor that's on the book for later in the week - read through patient chart to make sure she's medically qualified for an induction before 39 weeks (per our policy). Call the provider to get clarification on her medical diagnosis. Run it by the head of OB, decide it's not eligible. Call provider back and tell her that she needs to reschedule it until after the patient is 39 weeks. Listen to her rant and complain for 10 minutes.
    Look at staffing for next two shifts. Realize we're short a nurse for our current patient census. Send out a group text, asking if anyone is interested in picking up an extra shift.
    Charge nurse is getting slammed in triage, take one of her triage patients.
    A woman walks into the unit at 8 cm, screaming in pain. Help charge nurse get her into a labor room. Grab the IV start kit and throw in an IV, pull out emergency delivery meds from Pyxis and put them in the patient room. Ask the patient's nurse what else I can do to help her. Check over the infant warmer supplies to make sure everything is stocked and in working order. Ask the tech to set up a delivery table quickly and put it in the room.
    Break the unit secretary, who hasn't had lunch yet. Sit at the desk and answer phones/buzz people in. Hold a baby who's at the nurse's station crying and parents are outside smoking.
    Once everything settles down a bit, go back to my office and look over my emails. Email HR, asking where they're at with finding a traveler for us.
    Complete 2 annual performance evaluations.
    Have a closed door conversation with a nurse regarding a med error that took place, come up with a written plan together on how she is going to improve her practice, as this is her second error in just a few months.
    Sit in on afternoon shift report.
    Update the white board.
    Find out if any patients have a late discharge. Ask the nurse where she is in the process.
    Try to catch up on emails.
    Update time card edits.
    Check in with the evening charge nurse. Everything under control? Okay if I go home?
    Go home.
    Do it all again the next day, with individual variations.

  • Oct 10

    Quote from kbrn2002
    Be very careful with that. Making copies of an incident report and taking them off premises got a nurse I USED to work with fired. Not only was it against company policy but she was turned in for violation of HIPPA because copies of the report left the facility. I never did hear if she got in hot water with the BON for that, but she certainly could have.
    Who was it that turned her in?

    Her problem was that another person, other than herself, also knew about it.

  • Oct 10

    Quote from StaffNurseMcS
    Ive just been called a number of names and criticised for incident reporting that a colleague made a drug error despite it being clearly prescribed. This isn't her first error in fact its one of many but this one i felt needed to be reported so i submitted an incident report form to my manager. My colleagues now think I'm the devil and say i should of spoke to my manager first. Firstly my manager was on holiday at the time secondly i have voiced concerns previously with no action taken. I even triple checked with the doctor that it was indeed a medication error. Has anyone been in a similar position? Im leaving this job as a result of this many other things.
    May I recount a similar circumstance?

    I was an In-house agency nurse in a LARGE inner city facility . A nurse was sitting at the desk, scanning all of her meds from the desk .
    I reported it to the powers that be.. from there on in, I was afraid to walk to my car.

    Stay strong.. move on.

  • Oct 8

    Yeah....good idea. I should have told the first agency that since I hadn't heard back I had moved on.

  • Oct 8

    It sounds like you didn't do anything wrong, but my own suggestions are once one agency submitted you you should have told the other agency to forget it to prevent any double submissions or problems. There is conflicting information about double submissions. Some travelers say they have lost contracts over it, others have said it didn't effect anything and they got the contract. Personally, I wouldn't risk it.

    Secondly, the agency getting in a tizzy and demanding information...Well, I wouldn't have told them anything. It is of no benefit to you whatsoever and it's none of their business as far as I'm concerned.

  • Oct 8

    If it’s as bad as you say give your 2 weeks notice and go back to your old job.

  • Oct 7

    Quote from NICURN29
    Our hospital policy is that every med error must have an incident report completed. It is not a punitive process, but it is important that they be completed in order to improve our patient care processes.
    It's a punitive process, no matter what management says.