Content That Anna Flaxis Likes

Content That Anna Flaxis Likes

Anna Flaxis, ASN 19,512 Views

Joined Oct 15, '10. Posts: 2,787 (67% Liked) Likes: 8,068

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  • May 3

    Quote from Altra
    I'm not the expert on all things compliance-related, but how do you make this work in terms of EMTALA?
    I think it comes down to stable vs. unstable. As I understand it, if your patient is stabilized, the EMTALA obligation is finished.

  • May 3

    Quote from TheCommuter
    Use 'I' statements...

    "I am feeling threatened whenever you resort to name-calling..."
    "I feel a hostile environment is promoted when you refer to nurses as monkeys..."
    "I feel you are behaving in an uncivil manner when you hurl insults. Please stop."

    "I feel like kicking you in the sack."

  • May 3

    Quote from Cola89
    Once in awhile this ER doc calls the nurses monkeys.

    How would you interact with someone who such an apparent disdain for nurses and other health care personnel?

    Always remember that when people say something like this it's all about them and their nasty mood/personality or their own insecurities, it's not about you. Don't take what they say to heart. They're really rather pathetic if they need to put others down in order to feel some sort of satisfaction.

    Thankfully almost all physicians I've worked with have expressed respect for the work we nurses do and those who haven't come right out and said that have at least been willing and capable of behaving like civilized adults and not been prone to childish name-calling.

    I only use "I feel" phrases when I'm trying to solve a conflict and when I don't want the other party to react in a defensive knee-jerk fashion. If the goal is to to negotiate a solution that is acceptable for both involved parties I will adopt a "soft" approach. I do it with patients and coworkers when necessary. If it's a type of situation where you want to have a constructive dialogue I think that this is the way to go.

    However, this is not the stance I would adopt if a physician or any other coworker called me a monkey or something similar. I don't wish to negotiate and reach an understanding that's appealing to both of us, I simply want the unwanted behavior to stop. In that scenario I would simply say that your behavior is unacceptable. It genuinely doesn't matter to me what you think of my intelligence. You are free to think whatever you like but in our future dealings you will keep your thoughts on the matter to yourself. Are we clear?
    I will look them straight in the eye while saying this. I won't smile and I won't try to add a joke/sense of humour into the mix to attempt to "soften" my message. There is in my opinion only one acceptable outcome and that is that we treat our coworkers with respect.

    In a situation where a person I work with is deliberately behaving in a condescending manner, every last ounce of diplomacy leaves me. I don't find it necessary to make an effort. They know that they are behaving in an unacceptable manner and are simply trying to figure out if I'm going to let them get away with it. If I grant them permission, it will almost certainly happen again. Seriously, any person over the age of five knows that it's not okay to call someone a monkey. It's a very deliberate insult when delivered by someone who has the intelligence required to make it through medical school.

  • May 3

    "Don't see any monkeys around here but I have spotted a horse's a&$."

  • May 1

    You are aware that you'll owe money if you break the contract, right? I don't have much experience with OR beyond what I did while deployed, so I am not sure what the normal progression is for newbie to circulator. If you do make the leap to the ICU, I hope the commute is at least shorter for you. Part of me thinks that you signed a contract and should honor it — they have made a significant investment in your training that $5000 doesn't cover.

    You say that you weren't aware of the lack of hands-on as an OR nurse, which leads me to believe that you didn't research the specialty at all. Have you researched ICU nursing? It would be terrible to break this contract, pay that money, take a new job, and not like that job either.

    Lots to consider. Good luck to you!!

  • Apr 30

    Quote from Anna Flaxis
    I am rarely caught by surprise when an otherwise sweet LOL suddenly turns into a raving lunatic. I actually kind of expect it.

    Some potential causes are UTI, constipation, hypoglycemia, sundowners syndrome, a pulmonary embolus, worsening illness, or even just being afraid and feeling helpless. A change in mental status should trigger inquiry into what could be causing it.

    UTI would be one of the more common causes, and constipation can be a contributing factor to UTI due to compression of the urethra by bowel contents, leading to incomplete bladder emptying and thus, urinary stasis. So maybe, your LOL's complaint about being constipated might not be too far off the mark. One of the more common symptoms of UTI in the elderly is altered mentation/delirium.

    Also consider the reason this person was admitted-for pneumonia. Her change in mentation could be related to a worsening of her condition.

    Another consideration is that often, elderly folks with milder forms of dementia compensate well at home in their normal, predictable environment, but once they are in an unfamiliar environment with different routines, the altered mentation is more noticeable. Family members may tell you that "Grandma has all her marbles" or is "as sharp as a tack", but that's in the home environment where she is able to compensate. The hospital environment interferes with this ability to compensate, and so you will see behavioral changes that would go otherwise unnoticed.

    So, to answer your question, how I handle this type of situation is first, I do what I need to do in order to keep the patient safe. Make sure the room is free of clutter, the patient is wearing nonskid slippers, and offer to toilet her. I will offer warm blankets, another pillow, PO fluids or a snack. I will offer a distraction, such as TV, or ask her about her life- her children, pets, where she grew up, etc etc. Once the patient is calmed down and safe, I will take a complete set of vitals, including a temperature; if diabetic, check a CBG; and I will then notify the physician of this change in condition. The physician may want to order a UA, or a repeat chest xray, as her change in mentation may be related to worsening pneumonia.

    I would then document the patient's behavior, the actions I took to ensure her safety, my assessment data, that I notified the physician, and whether any new orders were received.
    This is an excellent post and exactly what I was thinking as well. I personally would check a blood glucose whether they were diabetic or not, simply because I have had more than one elderly patient become hypoglycemic suddenly with no history of such issues.

    But my first bet would be on sundowning, UTI or worsening pneumonia. Honestly it doesn't matter that she was oriented at the beginning of the shift. That was HOURS ago. That assessment is completely invalid by 6 AM. Obviously.

    And no, I would not tell them to "cut the crap and stop being nasty", primarily because my mind would be on what is bringing about this change in mentation and secondarily because it would be morally wrong and unjust. If I took a patient's attitude to heart every time they take an ugly turn I would go home crying every night. I'm not her friend, I am her nurse. She is counting on me to watch her with objectivity, intelligence and sharp critical thinking skills. Retaliating against her behavior by being nasty back doesn't honor any of those traits.

  • Apr 28

    Quote from NurseRatchedTheBest
    can someone explain to me how this post is not a hipaa violation????
    Was enough information provided to identify the patient? There are no names, dates, locations provided. This scenario can play out in every single hospital across the country and perhaps even the world.

    Do you believe you have proof to state that the post is a HIPAA violation? If so, please explain. If you're going to start such a discussion, it is upon you to explain why it is.

  • Apr 28

    Quote from maryel
    rude much?
    If you find that the tone that a poster uses rude, then what is your own post supposed to demonstrate? Is this an attempt on your part to encourage a more civilized or cordial discourse?

    OMG! Where in this post did the OP ask what her diagnoses might be? The question was essentially how do you handle a difficult patient.
    Reading is fundamental, friends. Understand the question first before offering irritating answers.
    @ Jaykalkyn, BSN, RN Was the OP really asking how we handle difficult patients? As I understand it OP felt like telling her patient to cut the crap and stop being nasty and wondered if anyone here had ever done that. Beyond that, I didn't really see OP asking for advice on successful ways of dealing with difficult patients. Did you read something different?

    OP described her patient as a very pleasant and sweet older female who was hospitalized for an infection (pneumonia). When a patient like her suddenly changes her mood to agitated and rude, a nurse should start thinking about if the cause for this altered behavior can be due to disease (-process) or the effect of meds. Given this patient's age and reason for hospitalization, she is not the right patient to be told "to cut the crap".

    There are as discussed in this thread many possible medical reasons for the patient's change in behavior. OP doesn't seem to have taken these into account and is perhaps not even aware of them. That would be bad, as they are things that a nurse is expected to know.

  • Apr 27

    Quote from XNavyCorpsman
    This may sound a little harsh, but you are NOT nursing material. You took a controlled substance without a prescription. And to top this off, your mother gave it to you.
    More than "a little." The OP made a mistake; let's not get carried away. Families share medication all the time, and most people don't realize that taking a controlled med prescribed for another family member, and shared voluntarily by that family member, is illegal. The OP's mom was trying to be helpful. I haven't heard anything yet that suggests to me that the OP is "NOT nursing material."

  • Apr 26

    I had this really difficult resident at an adult foster home I worked for. She had MS, terrible bed sores, cath, needed daily digital manipulation for bowel movemts, etc... She was just bad off.

    She gave people a horrible time because she was living a horrible existence.

    That's not to say I never struggled. Sometimes she would get really abusive, I would excuse myself, step away and regain composure, then come back. Sometimes when she would get really bad I would remind her that I was a person too, that would help for a while.

    She was really hard... But she showed me a depth of patience that I didn't know I had.

    That patient is why I will be a nurse.

    Point being: find a silver lining of optimism to get you through. Then, come emotionally unload here, we all know those feelings well!

  • Apr 25

    I'm also thinking delirium or some form of dementia. And none of us were there so we have no idea. But I honestly could tell you crazy stories of what differing meds can do to patients. I won't simply because of hipaa and I would never want anyone from work recognize me. But know that we see patients at their absolute worst, most vulnerable. Does that give them the right to abuse you? No. But keep in mind mental status patients especially in the elderly indicate something else is going on.

    Investigate all other causes first. Then just deal as pleasantly as possible with the patient, but firmly. Always try to put yourself in their shoes. Constipation can be extremely uncomfortable. And there could be another cause for it as well.

  • Apr 24

    Overheard a conversation the other day between a pt's family member and a doctor. I was sitting at the nurse's station and he was sitting beside me. Family member walked up to him and began yelling that her loved one is not getting the proper nursing care and demanded to know why the pt was not any closer to discharge status. Dr says pt had been educated on post-op plans and had been refusing to take initiative to begin the recovery process (i.e. getting up, ambulating, incentive spirometer, etc.). Per documentation, RNs have been charting (in detail) that pt has been refusing.

    Family member screams, "It's THEIR job to help him heal!" Dr responds, "If he doesn't want to help himself, they can't help him. They provide excellent nursing care and it's evident where the problem lies."

    Family member continues to yell/scream (literally screaming) about an NA who "got urine all over him while helping him use urinal in bed." Dr says, "I don't understand, why can't he use the urinal without assistance?" She says (through gritted teeth), "if my son, who is sick and in pain and unable to sit up or get out of bed, needs to pee, you better be darn sure someone here is gonna hold his penis in a bottle for him...and NOT spill his **** all over him!!" Dr replied, "well ma'am, then I suggest you re-familiarize yourself with your son's anatomy and provide that care yourself."

    At this point, I'm picking my jaw up off the floor. On behalf of all RNs and NAs, I wanted to give him a big, fat wet one!!

    FYI, pt is twenty-something 3 days s/p lap sleeve gastrectomy.

  • Apr 24

    Quote from RNperdiem
    I also wonder if she has some home meds that were abruptly discontinued. Over the years, I have discovered that many elderly ladies take meds "for their nerves". If they get admitted to hospital and these meds are suddenly stopped, they can go into withdrawl.
    Conversly, meds can trigger behaviors, too. Benzos are notorious for being disinhibiting. Paradoxical reactions are more common than we think - I'm always verrrry ginger about giving them, especially if it's a new order and especially to elders. They're also a total no-no if you suspect delirium.

  • Apr 24

    I also wonder if she has some home meds that were abruptly discontinued. Over the years, I have discovered that many elderly ladies take meds "for their nerves". If they get admitted to hospital and these meds are suddenly stopped, they can go into withdrawl.

  • Apr 20

    Quote from Stella_Blue
    My manager was really nice about it really. She just basically told me what was said, not sure how she got hearsay of it, whether it be a satisfaction survey or directly from family member. She just basically told me that she had to verbally tell me and document that she did so. It wasn't even a right up. I definitely see where I could have done things different in the situation. I am just the type of person that if I get in trouble or I feel that someone is upset with me it eats me up. I've already wondered if my manager isn't a huge fan of me, and this definitely won't help. Luckily I know my coworkers have been saying good things about me.
    I'll definitely take this into account with the rest of my career and hopefully grow and learn from it.
    Don't let this eat you up. (I know that is a lot easier said than done.)

    I don't know anyone who likes hearing that someone wasn't satisfied with their performance.

    Your manager would be doing you a disservice if she didn't inform you of the complaint. If you do not know about a complaint, it denies you the opportunity to reflect on and improve your performance. It sounds like your boss did not want the discussion to be punitive. She was giving you feedback to enable you to improve. That is a positive thing.

    If it helps - it was probably an uncomfortable conversation for your boss too.