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Kooky Korky 16,351 Views

Joined Feb 12, '10. Posts: 2,759 (51% Liked) Likes: 3,574

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  • Dec 3

    When she says you lack confidence she needs to give specific details. I had a manger like her, she would say that i have complaints against me, when I asked her to provide details of the complaints she couldn't. I worked there as a cna and left when I passed my boards. I can not personally work for managers who behave likes that. Shows poor manager and leadership skills. Your manager feedback is not an example of constructive criticism.

  • Dec 3

    This would have been a good question for your clinical instructor or your classroom instructor. Also, if you did a care plan on this patient, that would be one aspect to research too.

  • Dec 3

    Sorry! Wasn't sure what you guys did and didn't need to know to help me understand what I was seeing!

  • Dec 3

    IME when MDs can't figure something out, they often go to a psych origin. Truth is, many physicians refuse to admit sometimes they just don't know.

  • Dec 3

    How did the pt respond?? You wrote so much but wrote nothing about how the pt responded.
    Not saying this lady was not experiencing a true issue, but I've seen some crazy things people do to get attention, drugs or admitted to the ICU.
    I have also given pts Ativan for resp issues, it does calm them down enough to help ease their breathing efforts. I have also given morphine for the same reason. Sometimes it works, sometimes it doesn't. If she needed to be intubated, she was in the right place.
    Was the doc right, I have no clue, was he an ass, maybe. The ICU is a tough place to be and you will see lots of suffering if you stay.

  • Dec 3

    Quote from KatieMI
    As a chronic patient myself and future provider, I have to tell something.

    The current epidemics of all-the-drugs-ever-known-to-humankind-resistant bugs is caused directly by this very phrase: "it works for me". This phrase was said by BOTH patients and providers, innumerable number of times, and interpreted accordingly. First it was Bactrim that "works for all this-and-that". Then it were cephalosporins. Then it was vancomycin. And now we have some guys for whom nothing works. These people not always shut into high-isolation rooms. 2.5% people off streets and 5% direct-care health workers are infected with MRSA, often with the most amazing resistancy profiles. Luckily for everyone, due to bacteria's genome limitations, the carrier state for MRSA is usually as short as a few weeks but it might be quite enough to meet the wrong person at the wrong time.

    Therefore, County Public Health services and microbiology departments in hospitals do their jobs to the point. Every month or so, all health care providers in every county receive some long email or letter with "preferred" (read: ordered to be that way) antibiotics for different pathogens spread in particular communities, plus they regularly go through John Hopkins guideline or similar source. Most of them will not cross these guidelines because they do not want to get a teen with a big angry pimple (caused by Community Acquired-MRSA) to breed a resistant bug to be spread all over the high school swimming and wrestling teams just because the teen's mom insisted on Cipro because "it worked for him", and then bring this bug into her own nose in an ICU where she is working a sa nurse, as well as to the teen's BFF who is just getting off mononucleosis. Meanwhile, the teen got his Achilles ruptured and now has to go for surgery - again, because his mom was insisting on Cipro. Things like that happen surprisingly often, and sometimes carry on a whole chain of "unfortunate events" ending up in big ugly lawsuits - big enough so all medical community gets to know about them, and takes the message VERY close to their hearts - or, rather, to their licenses.

    If Bactrim is not listed as "indicated" for URI, there's usually a good evidence-based cause for it. You are welcome and free to try to find someone who will risk his or her license if caught into a chain of events like I described above. Better chances to do so with PAs, because they are always, unlike NPs in many cases, 100% dependent on MDs, therefore they are used to "satisfy that customer" and then promptly thrown under the bus if something happens.

    BTW, Kenalog helps a lot for the inflammation, but it also can make the whole ordeal a bit longer due to immunosupression. Just letting you know.

    The whole article remains me about my current daily battle with patients who came from "so kind and understanding" doctor from the former next door practice who "always listened" and "always was sooooo supportive". That doctor will walk out free somewhere close to my retirement time due to prescribing of "good stuff" by tankloads, which scripts directly led to several of his patients being found dead. Those who are still alive and transferred into other practices just cannot get why their sweet pain-and-nerve pills party is now over and why "everybody" is so "mean", "never listening" and "not understanding" toward them.
    I do understand the importance of antibiotic stewardship. The guidelines call for Amoxicillin for acute sinusitis. What antibiotic do you then recommend for Amoxicillin- resistant acute sinusitis with a duration of 3 weeks?

  • Dec 3

    Love your comment: "The best doctors (like my usual doctor) partner with their patients and agree on treatment. There is evidence-based practice, and there is practice-based evidence. Both are important."

    Couldn't have said it better & so true. Also, yes...See's candy will change your life. It's the best gift to give and get!

  • Dec 3

    Paying for Medicare! Yes. My mom has Tricare, and is still required to carry Medicare B, which I pay for to the tune of over 400 for three months. I also struggle with the Dr/patient relationships for her appointments.

    If we see her regular NP, it is not a problem: we communicate great. IF she sees one of the multiple "specialists" that she needs to be referred to, the ball is in the air. The last appointment was due to concerns regarding her oxygen, memory loss at altitude due to lack of oxygen, and so on. We were told (because she is on Lasix) that her breathing issues were due to CHF, and I need to cut back on salt while cooking, she needs to cut back on her pain medication, and she needs to exercise more (can only walk short, and I mean short! distances without becoming dyspneic).

    If I tell them I am a LPN and retired Paramedic, I get dismissed. If I don't say anything, I get treated like I'm stupid. What's a caregiver to do? Except become more assertive, and develop their own plan of care with the blessing of the NP who is able to think outside of the box.

  • Dec 1

    Quote from ixchel
    While this sucks big time, short staffing tends to pull the team together to close the gaps and get the job done. Perhaps the other two shifts could split the short shift, work 12s, and rotate which person draws the short straw for that. 12s are at least bearable, and it would be a more fair way to get it done.
    It only pulls the team together for a short duration of time; some team members aren't on board and won't help, the others simply get burnt out. Mandation as a means to fill shifts is a recipe for disaster and losing more employees!

  • Dec 1

    Kindly print your charge nurse a copy of the labor laws for your state that prohibit mandatory overtime, and use your chain of command all the way up the ladder to administration if you have to. That should work, but if it doesn't get a lawyer and file a harassment complaint for hostile work environment. While you are at it go ahead and file a complaint with the Department of Labor and your State Board of Nursing. They will only bully you if you allow it to happen.

  • Dec 1

    Quote from RIRed
    Your charge is a deceitful, heinous bully who should be reported to her higher-ups. Please stand up for yourself and for the other nurses she is abusing-- I doubt you're the only one! If you abandon your patients, then yes she can file charges against her. But she's still an a$$4013.
    The higher ups no doubt know all about the charge's attempts to get those shifts covered without hiring. But go ahead -- report her. I hope you have enough money saved up to go without a job for awhile.

  • Dec 1

    Your charge is FOS. I like the idea of printing the state law and leaving copies in several places. I would also record her telling you that she is going to report you for abandonment. .. because it is not abandonment. Then take that to HR and let them know you are filing harassment charges for her threatening you.

  • Nov 29

    OP, when I use my phone at work, it's because I'm looking up a medication. Don't assume.

  • Nov 29

    People gift things that THEY would like. We had a family once bring us the most horrible, grease-soaked 'hamburgers shaped like hot dogs' once. They were AWFUL- but this family was so pleased to share it with us. It was apparently a great delicacy to them.

    Never look a gift horse in the mouth. They're doing the best they know how.

  • Nov 29

    I know. I'm saying it's hard to turn them down when their right there in front of you if your trying to eat healthier


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