Content That ixchel Likes

Content That ixchel Likes

ixchel, BSN, RN 39,443 Views

Joined Jun 3, '11. Posts: 5,062 (75% Liked) Likes: 19,399

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  • Jun 24

    OP, it sounds like everyone is having a good time except for you.

  • Jun 24

    No probs! I really like the WILTW threads btw

  • Jun 23

    Hi Ixchel, there's a few questions there, they might require quite a lengthy reply!

    In my experience, in the NHS (non-private) hospitals, patients don't often refuse to leave hospital but it can happen. It isn't that comfy in our hospitals, there are no fitted sheets or comfy blankets- everything is clean but minimal. There is often a lot of noise at night and during the day with new admissions or transfers taking place at any time in the med/surg equivalent. Patients are mostly in shared rooms, there can be 8, 10, 12, maybe more in a large area called a "bay". Bathrooms are often 1 per unit. TV is very expensive. Food is often not to people's tastes and there aren't always cold or hot drinks offered between meals, depending on staffing. Snacks are in theory always available 24/7 but not always offered. Water in jugs on bedside tables gets warmer throughout the day and isn't automatically topped up, again it is dependent on staffing and there often isn't ice. There are usually very strict visiting times. Our top priority as RNs is the patient's clinical/medical health and safety. There are rarely resources for more than this.

    However! Sometimes patients prefer hospital with regular meals and cheerful nurses for company to home. The nurses and Dr's explain to them that it is medically time for them to go. That they are better at home and there is a greater risk of infection in the hospital. They explain the bed is needed for another person who is unwell as they were. That they cannot justify the use of national resources when there is no medical indication. More and more senior staff are brought in to explain this and talk through the patient's worries until the patient agrees it is time to go. Security can be called if needed but senior staff have excellent communication skills rendering this unnecessary- I haven't seen this used.

    Sometimes "bed-blocking" occurs where it isn't possible to discharge someone as there is no appropriate place to discharge them. For example, a patient might require a nursing home after hospital and cannot safely return to their usual house. Relatives have been known to drag out the process of choosing a nursing home so the patient will stay in hospital for many months. Social workers are involved and many meetings are held to try to fix this situation.

    Sometimes people are discharged too early and return to hospital unwell. The incidence of this is monitored in an attempt to keep "unsafe discharges" to a minimum. If an RN feels the patients needs to stay for medical reasons but the MD says the patients needs to leave, the RN needs to produce valid concerns and a meeting can be held for a discussion. Ultimately, the Consultant decides and is responsible for an adverse incident that might occur after discharge if it could have been predicted to happen. The RN's role is to flag up any concerns and advocate for the patient. Physio's and OT's also play a very important role, they can assess and assist in planning as safe a discharge as possible.

    If your British friend were in the UK and had strong concerns about being discharged too early after surgery, they would be encouraged to voice their specific concerns. If for example the concern was pain management, their meds would be reviewed, they might be reviewed by the pain management team, expectations would be checked, the wound site would be inspected, an x-ray or scan might be called for if the pain was disproportionate to that expected, we'd work with the patient to see what helped or hindered etc. If something could and should be changed, it would be. If the pain was as normal for that stage of recovery, after advice was given we'd reassure the patient that was normal for many patients. That's just one concern, but it would work the same for anything.

    We don't discharge until the patient is clinically well enough (i.e. staying in hospital won't make them any better than being at home) and until they will in all likelihood be safe at home. If you considered a patient not ready for discharge in your opinion as an RN, we wouldn't either, for the same reasons as you.

    Edit: Just realised I had said nothing about medical bills. We do have some hospitals for privately insured patients in the UK and we have a very few patients in the NHS who pay privately- I don't know how payment works at all, I'm sorry. Who pays the bill for those in the NHS who stay over what is medically advised? The same people who pay for ALL the treatment and hospital stays; the tax payers.

  • Jun 23

    Quote from ixchel
    You know, I'm kind of into this idea.

    Here's the deal...

    About 3.5 months ago, I went on FMLA for a medical emergency. My PCP had mercy on me and wrote me out until surgery that was scheduled for mid-April. I scheduled that back in January, with full support of management.

    Unfortunately, the 5 weeks off PRIOR to surgery complicated things. First, for the emergency that created the need, second, for the almost lawyer-worthy issues that came of it, third, I needed every second of my 12 week FMLA for surgical recovery, but by mid April, I'd used up 5 weeks.

    After receiving verbal assurance that I'll be worked with at the end of FMLA, I went through surgery. Now, at ten weeks, I've been off for 3.5 months and my brain just can't be further removed from nursing most days. I have a giant pile of ideas for this thread when I make my weekly OPs while I'm working. While I'm not? It's a struggle!!! And I feel like keeping the thread fresh and relevant really does need a good OP.

    A lot of you have stepped up in a pinch, and I love you for it! If any of you has some ideas for a really dynamic, fun OP, get in touch! I also love it when students or nurses from specialties other than my own chime in because you're looking at nursing-relevant topics that I am not. It keeps things varied! Interesting! And most importantly - we all actually learn something. That's kind of the point, right? Part of it, anyway.

    So, yeah, if any of you wants in on OPs, I'm still out for at least 2-3 weeks, possibly a few more months if my recovery doesn't jumpstart soon. I do have thoughts for this week, but after that, who knows what I'll have!
    Hugs ixchel!

  • Jun 22

    Quote from NotAllWhoWandeRN
    And that poor ixchel could use a sign-up thread so she doesn't need to go hunting everyone down and messaging separately.
    Or maybe a rotation?

  • Jun 22

    And that poor ixchel could use a sign-up thread so she doesn't need to go hunting everyone down and messaging separately.

  • Jun 22

    I have also learned this week that when dealing with your own health concerns, being a nurse can get in the way of things. You know, we know too much.

  • Jun 22

    Quote from 2bNurseDR.T
    Maybe I exaggerated when I said the percentage of nurses whom are snobby and bitter...
    we're biter nurses, not bitter.

  • Jun 22

    Quote from mrsboots87
    I also give the most PRNs on my unit and I sometimes worry I will become the focus of a complaint. The good thing is we have cameras in the halls at my facility and I sign everything out as I should and give to the residents right away, so I know I would be fine. But people like this OP still make me worry a little.

    The he reason I give the most PRNs is because I believe people shouldn't have high anxiety or be in pain if they have PRN orders for relief. I have a guy who calls out all night and gets combative with cares if he doesn't get PRN Ativan at HS. I am the only person who just gives it too him at HS. The family doe not want it to be a scheduled med because they think we will just snow him. But he truly needs it. But every time I sign the narc book, there is maybe one or two other nurses who gave it to my 15 signatures.

    I also give PRN morphine more frequently than others in our hospice residents. I due watch for signs of pain, but I feel other nurses just don't think about it as much because the patients can't usually vocalize their pain while actively dying.

    Basicall, OP, don't assume. Unless you see her pocketing or swallowing pills direct from the NARC box, it is not your job to report it any higher than your manager. You could potentially ruin someone's career over a suspicion. Also keep in mind, I have plenty of alert and oriented people who sometimes think I didn't give them their pain meds when I know for a fact I did. Sometimes they just forget or have intermittent confusion. It happens. She may very well be diverting. She may not. But that's not for you to be judge and jury on.
    Me too. When I worked in ER many nurses thought people were drug seeking and I say, even if they are addicted, they still could feel pain, they are human. Many times I would get ignored for request to get the pain relief for patients, and the doctors refused to write orders until X-ray came back positive for fracture or other real things happening to poor patients. I could have been accused too but I was just doing the right thing for patient.

  • Jun 22

    Quote from floridaRN38
    If the pts are complaining they did not receive there pain medication u did right by reporting it.
    Also if pts are asking and not receiving from this nurse and the pt is telling u this. U can have the pt talk to supervisor that it is happening. Have the pt report it. I remember when my dad was in a rehab for a hip fx even though he was 90 years old he also was SHARP. AAO*4. He was in pain. He also was the type to not take pain meds unless he really was In terrible pain Tough guy. BUT in this rehab when I went to visit him he said he was in so much pain while sitting up in a w/c. Also he was very diaphoretic. He said he hurt so much. I asked him if he received his Percocet 5 mg he said no. So I went to the nurse and asked about it. She said he took it an hour ago. I think she was full of it. It is scary what we see as a nurse when on the other side. [emoji17]
    What's a "pt"? What's a "u"?

    Seriously, you can type out "supervisor" but not "you"? What's "AAO"? Text speak is against the terms of service, and besides that it's just rude and unprofessional.

    And disrespecting a fellow nurse without knowing a thing about the situation other than what your 90 year old father told you? One Percocet may not have been enough for his pain, perhaps he needed two. Maybe he needed Dilaudid. Maybe he got it and forgot it. You weren't there and you don't know.

    I've been a patient or the family member of a patient all too often in the past ten years. Maybe I'm just lucky, but I've only encountered one nurse that scared me. She was on orientation and her preceptor promptly set her straight.

  • Jun 22

    I give a lot of pain medication, too. Sometimes I'm the only one who gives it to a particular patient (non-verbal, PEG tube, grimacing, huge wounds, for example). And I will frequently give it a little early if the next dose is due right after change of shift (as a courtesy to the oncoming nurse).
    I also have patients claim they "didn't get" their pain medication, on occasion. Sometimes they're attempting to manipulate and get an extra dose, other times they're just really drugged up and actually can't remember.
    Something may be going on with your co-worker, but it may not be. Hopefully not!!

  • Jun 22

    If you're going to potentially damage someone's career and jeopardize their livelihood by reporting them for narcotic diversion, you should be willing to stand up and do it without being anonymous. If you say you KNOW this person is using drugs, then stand up.

    On the other hand, if you think the person may be using drugs but aren't 100% sure, then you have no business reporting that they are. Report what you SEE, not what you THINK.

    If a medication is due every eight hours prn, then 15 minutes on either side of it is not a big deal. An every two hour prn med would be different. If the patient has been waiting for everyone to get out of report so she could have her pain meds and is in significant pain, it seems kinder to go ahead and medicate her before going into report so that the next nurse doesn't have a patient in uncontrolled pain to deal with.

    You already talked to your manager; you've done your due diligence. It is now up to your manager to follow through. It is also not your manager's duty to report to you how the situation is resolved. If there is disciplinary action, you don't get to know about it. It's confidential.

    I don't see any facts in the original post -- except the 7:15 and 2:45 times which seem pretty sensible to me. Are you sure your concern is narcotic diversion or potential narcotic use rather than getting someone into trouble?

  • Jun 22

    Quote from AJJKRN
    Just think if all of the "non-emergent" cases were to stop, staffing would decrease, people could and probably would be laid off or just lose their job all together...hmmm...job stability would be one good reason for me to take a Pt with a headache and smile about it
    Yeah, no. It is actually lose-lose.

    I didn't become a nurse - especially an ED nurse - for "job stability." In as much as I didn't become a nurse to treat "customers" instead of "patients."

    This is exactly the kind of hokum peddled by un-supportive management to ensure a continuation of ED abuse and over-crowding. A few years ago at my old ED job, management tried to convince ED nursing staff that an establishment of an "Observation Unit" (monitoring admitted, stable Observation patients - usually for chest pain/ r/o ACS) was in our best interests. More "hours posted" for nurses/techs to pick up, hence bigger paycheck etc.
    NONE of the nurses/techs 'assigned' the Obs Unit liked working it - for obvious reasons (not all that different from taking care of holds/boarders!)

    And let me remind everyone - ED overcrowding is as serious as a heart attack, and can be just as deadly! How many of you would like to bring your Father or Grandmother to the ED with complaint of chest pain and be told to wait in the waiting room? Or let us assume the initial EKG shows an acute MI but the ED is so full (with emergent and 'non-emergent' complaints), the staff has to "create a bed" to accommodate an obvious emergency - would you like the nurse taking care of your Father or Grandmother, to also be responsible for 5 other patients? Or would you prefer that the nurse be able to hand off her patient load momentarily so that s/he can pay undivided attention to your loved one in their hour of crisis?

    Or let us even assume that the initial EKG at triage was normal or borderline - how many of you would want the triage nurse to send you back to the waiting room instead of a monitored bed? Be truthful!

    Quote from klone
    I saw a woman who had called the ambulance and went to the ED for "vaginal itching/yeast infection".
    I had one a few months ago.
    Very young, adult female. Came in by EMS. I triaged her out to the waiting room because I had no open beds. At 0830 in the am. She huffed and certainly appeared offended that she was going to the 'waiting room' even though "I came by ambulance."
    As the EMTs were wiping down their stretcher and getting ready to head out, I noticed that their radios were going off constantly. The EMTs looked upset. I leaned over and asked "Y'all ok?"
    "No. Not ok. That's the third call out requesting an ambulance to transport a critical patient but nobody in the township or county can respond because we're tied up with BS calls!"

    The very young, adult female that came by EMS? Her chief complaint?
    'Vaginal discharge'...
    Nope, not kidding.

    Quote from AJJKRN
    Just think if all of the "non-emergent" cases were to stop, staffing would decrease, people could and probably would be laid off or just lose their job all together...hmmm...job stability would be one good reason for me to take a Pt with a headache and smile about it
    * Have you EVER had to take a "chronic headache patient" and smile about it, when it is the patient's 240th visit in the ED in 2016? For the same "chief complaint"?
    The ones who are allergic to everything except Dilaudid and Benadryl/Phenergan? None of which are drugs recommended to treat chronic migraines or headaches?
    * The ones who refuse Imitrex (for example) because "it doesn't work. That drug what starts with the D... Dilauntin.... usually helps."
    * The ones who occupy a stretcher in the ED with their chronic, non-emergent complaint - while 80 year old gramma lies in withering pain in the waiting room!

    Not burned out - but I am certainly very frustrated!

    cheers,

  • Jun 21

    Quote from aeris99
    All it would have taken was 5 minutes for someone to listen to his lungs, eyeball him and tell me he was ok.
    It's frustrating when your waiting room is packed with people who just need five minutes. That's what so many patients say — I just need this one thing, can't I just get it and go? Which translates to can't I just jump ahead of everyone else who just needs five minutes? It's frustrating for patients, and frustrating for staff.

    Quote from aeris99
    Instead we waited for 4.5 hours and no one even assessed him.
    By the time he was finally looked at (and I really DO mean looked at. That's all that happened.) his skin color and temp had returned to normal.
    Was he not seen by an RN in triage? Vitals stable?

    So glad he's okay, I am sure that was scary for you. Unfortunately that happens all too often — kids looks great by the time physicians see them! Good for the kids, but the parents then think we think they're crazy! But we believe you, parents.

  • Jun 21

    Quote from aeris99
    PCP's sending patients to the ER because it's too close to closing time to see anyone
    I work in primary care (adults only) and often I am the only provider in the clinic. I often have to make the decision when patients call with chest pain, shortness of breath, stroke symptoms, system allergic rxns, etc of having them come into the clinic or go right to the ED. It's not easy and I don't turn people away because it is closing time but I do if I think that it is dangerous for them to be in the car or in my office. Often times people aren't happy that I tell them to go to the ED and I worry they feel like I am blowing them off but the truth is I do it for their safety.


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