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ixchel, BSN, RN 46,997 Views

Joined Jun 3, '11. Posts: 5,158 (75% Liked) Likes: 19,768

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  • Feb 15

    Jan, your post was beautiful and thorough, and I very much appreciate it! Sloughing of bowel was actually one thing that happened with my now deceased loved one. It was hard to understand just how much she had deteriorated in only a few days. I was thankful the nurse was candid with me, though. Any site I have read so far with the position that Jahi is not dead has cherry picked comments left and right. You can tell because the people who are crying out for prayers and miracles are slinging profanity at comments that no longer exist. I'm blown away that in one sentence they ask for and offer unconditional support, but they immediately follow it up with a bunch of eff yous and insults.

  • Feb 15

    So, physiologically..... What is going on inside her right now? She's had no nutrition, and meds are keeping her going, right? But what's happening in her body? A dear family member passed on in November after a pulmonary embolism in a pulmonary vein, which stopped her heart and she never did wake up. She was sedated (only because she'd seize when they tried waking her up), had vasopressors, and was on a vent. Now, she was facing cardiac death, not brain, but ultimately, her organs started failing. Her kidneys stopped, her intestines stopped, they stopped feedings because her residuals indicated nothing was moving beyond her stomach. She was mush, pretty much. Jahi has extremely different circumstances, of course, but 3 weeks with nothing going in but meds, and no basic brain function .... Wouldn't she essentially be mush as well?

  • Feb 9

    Quote from BrandonLPN
    But, in this specific scenario, it really wasn't feasible to obtain an order for PICC draws right at that moment, in time for that blood draw that needed to be drawn at that time.

    I think adressing it in the morning, to be taken care of that day, is fine and being an advocate and a prudent nurse and all that.

    If this had been passed on from shift to shift with no one owning it, and the patient getting poked over and over, that'd be another story.
    Thank you, Brandon. And yes, that's what I'm saying. This patient facility hops and has a ton going on with her. The PICC was placed a hospital 30 miles south of where I work before she was discharged to a short term place. When she was admitted to my hospital, my understanding is the admitting hospitalist received from the MD who placed and is managing the PICC that we are allowed to run meds through it ONLY. I don't know why, nor was I given the opportunity to ask. Based on the way that shift went, the thought didn't even cross my mind until lab was there, telling me I needed to draw the labs. The order and note specifically said the PICC was for meds only. At 4:30 in the morning, no, I was not going to contact the hospital's ONE night time hospitalist (who specifically is only there for symptom management, not plan of care issues, unless the patient is unstable or newly admitted - neither applied to her) to tell him he needed to call a doctor who consults for a neighboring hospital to change the order.

    Yes, I understand advocating for patients. A million and one percent, I understand advocating for patients. I also have a realistic understanding of what is possible. We are not a large hospital with residents in abundance. I work for a small rural community hospital without access to everything we might want right then and there. It's a skeleton crew on night shift. Unfortunately it does mean that there will be times when we have to give things to day shift. I didn't get her back, so I don't know if the order changed. Genuinely, I do hope it did.

  • Feb 9

    Quote from Been there,done that
    "Not sure why" doesn't cut it. Your patient is lying helpless in an ICU bed, repeatedly being stuck with needles. You need to speak with the doc (that does not give a rat's pattooty that their patient is receiving multiple invasive and painful procedures) and get their rationale as to how this benefits the patient. Unless the PICC is used for TPN, there is NO reason it cannot be used for blood draws.
    PLEASE advocate for your patient.
    Because the doctor said so.... is never a reason to carry out any order.
    It was 4:30 in the morning, we were short staffed (5:1 on a stepdown unit) so I didn't look at her labs ahead of time, and the MD who placed the PICC is an outpatient doc without hospital privileges. I included the issue in report that morning. I don't just blindly follow orders or like excessive, unnecessary sticks. It was not something I could change for the purposes of that lab draw.

  • Feb 9

    Does this happen at your hospital?

    Recent examples:

    #1:
    Radiology tech: "this patient has q0600 portable chest X-rays part of his old ICU order set. They normally DC these but they didn't DC his. Do I really need to do this?"

    #2:
    Me, to a different radiology tech: "we just discovered he might have foot fractures and I'm putting in orders right this exact second. Do you mind grabbing images of his feet while you're here?"
    Rad tech: "the order wasn't already in so your, have to get that later."
    Me: "the order is in right now."
    Rad tech: "no."
    Two seconds later, does the images anyway, because she realized it meant she'd have to come all the way upstairs again.

    #3:
    Respiratory: "Earlier MD asked for a different patient to have ABGs done at 0800" (after RT's shift would be over) "so we can just do this patient's in a few hours, too, right?"

    #4:
    Lab, after walking the whole unit to find me: "that patient has a PICC, why can't you draw her?"
    Me: "I don't have orders saying I can."
    Lab: "I saw her get drawn off that line last week, you need to draw her."
    Me: "her line isn't being used for labs. I don't have an order saying it can be. I CAN'T use it. You need to draw her."

    If it weren't the same people trying to get out of their orders every time, I'd figure they were just confirming things, but I am absolutely convinced they're trying to get out of doing their job, and they're trying to get the RN's "okay" so they can pass the buck to us, I am so done with this! If they want to questions orders, they should call the people writing them. :\

  • Feb 9

    Anecdote.....

    I have spondylolisthesis, which was discovered in 2012 after a fall. I fought muscle spasms for nearly a year before turning to acupuncture. I believe that should be long enough to discount placebo effect. I had noticeable improvement after my first treatment, incredible improvement in quality of life after the second, and have had my pain under control 90% of the time since my third or fourth.

    I initially turned to acupuncture, though, after trying IVF and having an unsuccessful embryo transfer. The second transfer, I started acupuncture at the same time as starting meds. On the exact same medication protocol, and changing absolutely nothing else in my life, I had a 25% thicker endometrial lining than at the first transfer. Perhaps it was a coincidence, but I only tried it at the suggestion of my midwife, who handed me a newspaper clipping saying that studies were showing acupuncture to be effective at boosting IVF success rates. My first treatment ever, I was laying on the table thinking, "okay, really.....? There is no way this actually does something...." It did, though. (As evidenced by two little monkeys )

  • Feb 8

    Had a young guy ambulate to the hallway to let us know he needed help ambulating to his bathroom (which was closer to his bed than the hallway).

  • Feb 4
  • Jan 31

    Quote from Been there,done that
    Sunshine,. lollipops and rainbow aside.

    How can anyone with a disability, perform nursing care for the disabled?
    I have a broken, anteriorly displaced spine and epilepsy. I care for them quite well, actually.

    At work, I chose to disclose one and keep the other to myself. At school, I found out about both (spine first semester in the program, epilepsy the third) and without knowing at that time how impaired these diagnoses made me, I disclosed both.

    Admittedly, I'm only impaired to the extent that I just need to be mindful and self-aware at all times. I keep up on exercises and meds, I keep with good body mechanics, I avoid seizure triggers.

    The word "disability" includes a massive spectrum of impairment. At this time, I'm a very fortunate girl. But, I do have disabilities. I choose to remain functional on bad days, knowing the good ones still balance them out.

    I agree, though, that realistic understanding and expectations are required. If my seizures become uncontrolled or my spine hinders my ability to remain physically active, I'll have some very tough decisions to make. I do worry that those who jump into nursing with higher levels of impairment may be setting themselves up for disappointment and struggle after graduation.

    Yet another reason why nursing school really should teaching real world nursing. I get that there is a massive variety of opportunity out there, but so, so many jobs expect that coveted year of med/surg before they'll look at your resume.

    When I learned about my spine, I had a clinical instructor try to talk me out of staying in the program. I hated her for it. Thinking back on it, her delivery could have been better, but there was an element of truth to it, and she was the only person who dared to share it. She was overall a jerk. If it had been anyone but her, I might have been convinced to not do nursing. Glad it was her, though. It's been worth it for me so far.

  • Jan 29

    Quote from NOADLS
    1) Diaper (not sugarcoating the product being used is in fact a diaper)
    2) Bodybag (shroud)
    3) Paperwork (Candycrush)
    4) Paperwork (extended break)
    5) On the phone with the hospital (extended break)
    NOADLS. Why you no post for so long? We love you long time. Don't hide.

  • Jan 29

    Quote from target98765
    I have been a nurse over 20 years. My mother did the same thing to me. Don't do it, nursing will crush your soul. I am pretty much dead inside, have tons of health problems and hate my life.
    I think we found a new motto for AN's desktop banner.

    All joking aside, I wish I could hug you. I do hope you find small ways to remember joy from time to time.

  • Jan 28

    Quote from hollyspiller0253
    I am a full time nurse 3p-11p. Our 11-7 nurse is out on DBL. The charge nurse told me she will file Abandonment charges against my license If I don't pick up some of those extra shifts.

    Here is the thing...it isn't Abandonment because they knew of those absences in a reasonable time frame to find appropriate coverage. We even have contract nurses available.

    What can I do about all of this?

    And she didn't even ask me to pick up the shift. She threatened me with mandation, and when I informed her she could not legally mandate me she immediately told me she would file abandonment charges against my licence.

    I'm in NY.

    HELP
    Ask her what kind of charges she'll try for if you put in your two weeks' notice.

    Your charge nurse deserves some well-chosen cuss words describing her intelligence. You are not required to do overtime. I imagine federal labor laws trump your BON, not that they would even begin to view this as abandonment.

  • Jan 24

    My views of male nurses consist of the top side, the bottom side, the left side, the right side, the front side, the back side, and the outside. I've never seen the inside of a male nurse.

  • Jan 22

    Quote from AcuteHD
    Had a lady call me asking if we do fresenius dialysis, when I told her we are not afiliated with fresenius she asked, "well, what kind of dialysis do you do there?" I guess I could've explained that fresenius is a company and the different modalities of dialysis, but I didn't...I refered her to an outpatient clinic (not fresenius either). I guess I'm bad.
    Forgive me for picking this bone, but I'm bummed that you didn't take the time to at least go into the basics. This wasn't a strange call at all. Many people that are newer to dialysis don't realize they have choices in companies and types of dialysis. I've had patients devastated by the news they had to get dialysis because they've mistakenly assumed they'd have to give their lives up because of the 3x weekly 4 hour commitment they now would need to make.

    I'm not saying this to call you out or be cross. I'm saying it more so that the next time you get a confused individual, you might take the opportunity to guide them just a little, even if to say, that is a company, not a type, and by the way, outpatient dialysis offers a couple of choices/types. No sense in going into way too much detail since you're inpatient (I'm guessing by your SN), but at least help her get her head on straight so she wouldn't be so confused when she calls the next place.

  • Jan 13

    Had a young guy ambulate to the hallway to let us know he needed help ambulating to his bathroom (which was closer to his bed than the hallway).


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