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Joined Feb 26, '10. Posts: 726 (60% Liked) Likes: 1,629

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  • Jun 22

    Quote from Chrishi
    The only complaint I know of was from a family member. I was in the middle of a long treatment on another patient. This lady wanted me to come listen to her husband's cough, despite the fact that I hadn't heard a cough for the first 7 hours of my shift. It took me probably 20 to 30 minutes to finish the treatment that I'd been doing, then I came to listen. No cough. I stood in his room for fifteen minutes (that I didn't have) just to hear his 'cough'. His lungs were clear on auscultation.

    The next day she complained to the administrator that she had to wait for 2 hours for the nurse to come listen to her husband and then the nurse 'didn't even do anything.'

    I think she wanted me to get an order for cough syrup or an antibiotic that he didn't need. Or maybe she just wanted me to act all excited. I don't know. Needless to say, I didn't get in trouble. But it's annoying when you're doing everything you can to help people & families have these unrealistic expectations of you.
    You're probably right about them wanting you to act excited. It makes families really angry sometimes when we don't respond in the way that they think we should. Like the pregnant patient that comes to L&D triage with no complaints of pain, leaking, or bleeding. Their only "complaint" is that they lost their mucus plug. I respond very calmly, and assure them that it's ok. Upon exam, I discover that her cervix is maybe 0.5 cm (if the examiner is generous), no contractions, and the baby looks beautiful on the monitor. Pt's mother has a come-apart. "But she lost her mucus plug!!!!" Omg, rawr, rawr, rawr, call the rapid response team! It didn't get any better when I calmly told her that I didn't have any to replace it with. Yeah, I should have held back, but come on! You can lose a mucus plug 2 weeks, 2 days, or 2 hours before labor starts, so big freaking deal. And NO! I do not want to see it (if I had a nickel for every time someone fished their mucus plug out of the toilet and brought it in a paper towel, ziplock bag, or baby food jar I wouldn't have to work. I'm happy to mitigate ignorance and educate, and I did attempt it in this situation, but the patient's mother wasn't accepting any knowledge. Her mucus plug came out, and therefore the nurse must....what? I never figured out what she wanted from me. I guess I was supposed to run around in circles in the room, throwing my hands in the air, screaming, "Lawd Jeebus, help us! She's done lost her mucus plug!" Maybe if I'd done that she would have taken it down a notch. The mother was very resistant to discharge, and I had to have the OB come in and speak to them. Said OB had been up for hours doing deliveries and had finally gotten a chance to lay down, so he was none too pleased and it showed. I'm sure she told everyone she came into contact with in the community that her daughter lost her mucus plug and we did nothing and didn't even care!

  • Feb 18

    What the young nurses should be worried about is the status of their personal malpractice insurance. You are much more likely to be sued for something that stems from a med error or understaffing than you are to have your license revoked. The BON doesn't worry me too much (not dealing or diverting! ) but trial attorneys worry me plenty. In our state the bar is set pretty high for even getting a med mal case into court, but who wants to deal with any part of a lawsuit, even if it's eventually dismissed?

  • Jan 3

    Quote from Jolie
    My experience with IV infusion of mag sulfate comes strictly from the OB setting (as a nurse and patient), so I can't offer any insight on office practices or standards of care.

    But I don't understand the use of IV mag sulfate for the treatment of a migraine in an ambulatory patient. The side effects of this drug (especially with rapid infusion) are horrific, and include intense dizziness, nausea, vomiting, weakness, flushing, tachypnea, tachycardia, etc., etc., etc. I can't imagine a migraine so bad that I would be willing to add these symptoms to the mix. Nor do I understand how you would then discharge this patient from the office without a lengthy recovery period, a ride home, and a caretaker.

    Aren't there plenty of other options for migraine treatment that are less invasive, and leave the patient in a more functional condition?

    I'll check back on this thread. This is very interesting to me

    Yes, for the "occasional" migraine patient, there are many other options. There is a subset of migraine patient, though, that require heavy duty, sometimes unusual meds. I'm one of those worst-of-the-worst chronic migraneurs. My background is L&D, so I was expecting bad side effects from mag, but honestly, compared to what I was going through with a days long migraine, the mag was NOTHING. I love mag. LOVE IT. I would have it on tap in my home if I could. It's a first line drug for my neurologist. It's cheap and it works when the triptans, NSAIDs, preventatives, and narcotics have failed. Why does it work for migraines? Probably some of the same reasons it prevents seizures in preeclampsia. It's also neuro-protective for fetuses.

    If the idea of mag amazes you, then the list of things I've tried over the years would probably leave you speechless. There is only 1 medications FDA approved for migraine prevention, Topomax. But the list of things that migraine specialists will try stretches past 200. I've tried Risperdal, Seroquel, Lamictal, DHE, methergine (yeah, methergine), and Botox just to name a few. And I don't have any mental health dx, so the Risperdal and Seroquel were solely for migraine prophylaxis. I've been given lidocaine, magnesium, steroids, ketamine, benadryl, and toradol in different IV sessions in attempts to break long cycles of migraines. If I walked into my neuro's office for my next visit and he told me that there was a new treatment from Asia involving IV water buffalo urine, I'd probably consent to it because I'm that desperate for relief.

    So, in summary, if the migraine patient can usually take something PO or just go to bed, and that's all it takes to get rid of their 3-times-a-year migraine, then mag may be a bit of overkill. But for the patients who are chronic and difficult to treat, mag is a very useful, basic step in treatment.

  • Oct 21 '16

    I think you handled it well, but that doesn't mean she got the answer she wanted, and it could affect your job prospects. Illegal or not (and it most definitely was), if you don't get the job, how in the world could you prove it was due to religion? She can always say she didn't think you'd be a good fit, someone else was more qualified, etc. In some areas of the country, and in some facilities, your religion can definitely give you a huge leg up. If it's an LDS (or Seventh Day Adventist, or Catholic or whatever) facility, some nurse managers are honestly going to prefer the idea of a nice Mormon (or SDA or Catholic or whatever) over an equally qualified Wiccan or whatever. And in this job market they can be choosy.

  • Sep 27 '16

    Quote from VICEDRN
    We have in fact been reading the same thread. My point is that today the pharmacist is giving injections, tomorrow they will be doing your job at the hospital for you just like they do at my facility.

    There are nurses I work with in the level I trauma I work at who have NEVER pushed code meds and have NO IDEA how to start a drip because the pharmacist always does it. The next step will be to prevent nurses from ever starting drips because pharmacy can do that now and oh! we will be increasing your patient load since you don't have to worry about the drips.
    I have noticed some changes over the years. When I started, we did not have a 24 hour pharmacy in our hospital, and so the nurses prepared many IV piggybacks. I mixed many bags of magnesium sulfate, pitocin, and antiobiotics beyone measure. Now, you'd think we were asking to waltz into the OR and do a bit of neurosurgery if we suggest mixing our own IV bags. I can calculate dosages, and I know sterile technique, so why is it ok for a pharmacy tech to do it, but it's not okay for me, a licensed, college educated professional to do it? It causes delay in treatment a lot of the time, but we are told we must wait for pharmacy to do it.

  • Sep 18 '16

    Quote from GrnTea
    I had a colleague in the 70s who had had many lost pregnancies, and the only tocolytic they had was IV alcohol. So they put her to bed at about 5 1/2 months on a drip, and she brought it to near-term and had her baby, finally.... but as it grew up it had what we later learned to call fetal alcohol syndrome. Not fun at all.
    That is horrible.

  • Sep 18 '16

    Quote from tnbutterfly
    Speaking of the harrowing 2-day ordeal of State Boards...... One of my classmates was so worked up about taking the boards that she fainted and missed part of the first day's testing. In fact, I don't know what became of her....whether or not she was even allowed in the testing room at all. I try to block out all memories of those 2 days.......except for the miraculous fact that I passed!!!!
    I went into a 3 year fugue state and went to law school (okay, not a fugue, just bad judgment). The Bar exam is still a 2.5 days of torture, with all the law students in one large room in the state capitol. At one point during the day, I got up to get a drink of water and just rest for a second, and I noticed that one of my classmates who had been sitting 5 feet from was missing. Turns out that he had passed out and an ambulance had come and carried him out on a stretcher. Five feet from me. And I didn't notice because I was so focused on the exam. Oh well, passed it, didn't get a job, and went back to the hospital, but it does give me some interesting stories.

  • Sep 16 '16

    In nursing school, we were lucky enough to have our own home health patients, we would go out in pairs to see them. One of our patients was a retired nurse in her 80s, and this was in the mid 1990s. We would always spend a long time with her, just talking. She had great stories! Like how they would prepare baby formula, setting milk aside and letting the cream rise to the top. She got in trouble with her DON because she purchased 3 new uniforms when she was hired. Her supervisor came to her and told her they were too short, so she let the hems out. They then told her that it wasn't enough, that she should put false hems on them. Everyone was very scandalized that her ankles were showing!


    It really amuses me, because we had a bit of an upheaval in our unit because some of the younger girls were coming to work wearing skin-tight babydoll T shirts instead of scrub tops, and several of them also usually had a thong visible above their scrub pants. They were counseled over these issues, and none of us got to wear t shirts ever again (we had cute unit t shirts, most of us wore them loosely fitting). Wow, how things have changed.

  • Sep 16 '16

    Quote from amoLucia
    Just thought of the old metal plate addressographs that we used to stamp chart records, charge slips etc. I remember once being so annoyed that I was having to stamp a new, late-admission chart. I was just slamming that thing absent-mindedly when I slammed my thumb under the top press. Boy, did I see stars --- no fractures but I did break the skin. Got my first tetanus shot that shift.
    I remember that thing! You could really vent some frustration with it. Ka WHAM! Ka WHAM!

  • Sep 16 '16

    Quote from GrnTea
    I had a colleague in the 70s who had had many lost pregnancies, and the only tocolytic they had was IV alcohol. So they put her to bed at about 5 1/2 months on a drip, and she brought it to near-term and had her baby, finally.... but as it grew up it had what we later learned to call fetal alcohol syndrome. Not fun at all.
    That is horrible.

  • Sep 16 '16

    In nursing school we had to wear white uniforms, and because the dresses were much cheaper than the pants and tunic option, I got to wear dresses. Knee length, and straight, they were totally impractical. It was almost impossible to get things off the floor without appearing lewd. It did look rather professional, though, I have to admit, with the white hose and proper white shoes. One memorable day, an elderly "gentleman" exposed himself to me and then cackled about it. I was rather flustered and upset. An hour or so later, I bent over to pick up his CPM for his knee replacement. The bell of my stethoscope caught the hem of my dress and WHOOPS! I bared everything from the waist down. He got a nice view of proper nude colored panties encased in white hose. My instructor just looked at me and said, "Guess you got him back for exposing himself."

    I have worn dresses at other times in my career. I had a cute A-line jumper that came to mid shin. Very comfortable, and very modest. It was long enough and full enough that I could do anything I needed to do without baring anything. I hated it when it finally was too worn to wear, and I've never been able to find another one. I have seen a nice maxi scrub skirt in the Uniform Advantage catalog that I'm seriously considering. Now that I'm doing public health, I don't have to worry about crawling under beds to retrieve Foley bags and climbing up on top of beds to move patients.

  • Sep 16 '16

    Quote from tnbutterfly
    Speaking of the harrowing 2-day ordeal of State Boards...... One of my classmates was so worked up about taking the boards that she fainted and missed part of the first day's testing. In fact, I don't know what became of her....whether or not she was even allowed in the testing room at all. I try to block out all memories of those 2 days.......except for the miraculous fact that I passed!!!!
    I went into a 3 year fugue state and went to law school (okay, not a fugue, just bad judgment). The Bar exam is still a 2.5 days of torture, with all the law students in one large room in the state capitol. At one point during the day, I got up to get a drink of water and just rest for a second, and I noticed that one of my classmates who had been sitting 5 feet from was missing. Turns out that he had passed out and an ambulance had come and carried him out on a stretcher. Five feet from me. And I didn't notice because I was so focused on the exam. Oh well, passed it, didn't get a job, and went back to the hospital, but it does give me some interesting stories.

  • Sep 16 '16

    Quote from Pepper The Cat
    It certainly is! I had someone come to me and say that she was getting a low pulse reading and she tried 3 machines and each one gave her a different reading with a range from 30 - 60 BPM.
    So I asked her what is was manually. she looked at me like I had 3 heads and said "Oh, I didn't think to do it that way". I checked, and the pt had a very irregular heart rate which probably caused the problems.
    We had a patient hemorrhaging after a cesarean, and we couldn't get a BP on her! The equipment in our recovery room would not register one, and no manual cuffs were to be found. It was very frustrating for us, and we finally borrowed one from a med surg unit. By that time, her BP was down in the scary area of just being palpable, and only one number. I think every unit should have a manual cuff for these occasions. Now I carry one in my new job, and that's the only kind I use.

  • Aug 24 '16

    I've had it since I graduated. Why? Because I knew that when the proverbial crap hit the fan that my employer would be looking out for their interests, not mine. I'm the only one who really cares, at the end of the day, about me. It's a very little bit to pay for a whole lot of peace of mind. I've never needed it (thank you, Lord) and hope I never do, but it sure is nice to know it's there.

  • Aug 19 '16

    I got very frustrated with nursing and went to law school. I did pass the Bar (first try, go me), but I couldn't find a job. The job market for new lawyers is even worse than the market for nurses. I could have opened my own office, but I watched classmates do that and realized that it wasn't for me. I was making more as a nurse than my classmates that went into their own practices. I'm so far out of law school now that I doubt I could ever get a job as a lawyer. I have a job in public health, though, so I'm extremely happy where I'm at in nursing, now, and have no desire to be anywhere else.



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