We had a patient recently who stated he wanted no provider of any kind who was not white or did not speak English. I was quite pleased when management told me to ask him what hospital he wanted to be transferred to. I have no tolerance for anyone who acts like this patient did and was glad the powers that be had our backs. Patient quickly back paddled.
To be frank, I deal with patient's only for a short amount of time (ER nurse). If someone is verbally abusive/screaming/yelling/acting inappropriate we will place them in a room, on the monitor, and shut the door partially. We deliver care and follow through on the MD orders, but if the patient refuses then we stop and again shut the door partially and continue to monitor the patient. If they are unable to control their actions due to medical diagnosis we will medicate them with haldol, geodon, ativan, or benadryl. We will place spit masks on the patient's that are biting/spitting, place pt's in restraints if they are physically aggressive. During all of this we do not engage/speak/attempt to placate the patient if it only furthers the behavior.
If the patient is alert and oriented, I will tell them to stop. I do not make demands, I will simply say: "That is unacceptable, you need to stop. There are children/other patient's nearby who are sick and this is not fair to them." I will then deliver the ordered care without verbally engaging with the patient. If the patient continues to be verbally inappropriate, I have had the MDs discharge them from the ER and have security escort them out. Legally we have an obligation to ensure they aren't dying/treat obvious life and limb situations but we do not have to put up with harassment.
If the patient is sick enough that they need to stay, I will continue to provide care but will not go to the bedside unless security is present/at least one other nurse is present to protect myself from being both physically assaulted and/or to prevent the patient from saying I did something inappropriate/did not medicate at ordered/etc.
Go to your local community college and speak with an academic advisor. The community college can test you, find your weaknesses, and advise which classes to take to be able to pass TEAS.
If you're seeing math on the TEAS that you haven't seen before, it may be that you simply haven't been taught the basics. The community college can bring you up to speed.
At the end of the day it's a social contract. We get vaccinated to protect the people who can't. Herd immunity requires 93-95% of the population to be immunized or it stops working. It's not for you, it's for your patients. And they are the whole reason we are nurses. Immunizations are at the bottom of the list of occupational hazards that surround us at work. We handle chemo, biohazard waist, body fluids, plastics and off-gassing furniture carpet and paint are everywhere, everything is coated in cleaning products that contain carcinogens, UV lights are being used more because they are bacteriocidal, hell even the air we breath isn't always safe. Who here actually thinks they have a perfect seal every time they wear an N95? No one knows what a lifetime of exposure to that environment does to US. At least we know what immunization side effects are.
Any through and sound research on any given topic requires evaluating *both* sides of the issue and every topic has two differing sides. The point is not to only research the findings of those who agree with you, but to honestly and objectively explore, examine, and educate oneself on both viewpoints, so that an unbiased and unprejudiced conclusion can be found.
Check out a podcast called Science VS by Gimlet Media. They basically do extensive literature reviews, speak to leading academics (on both sides), and lay out an objective dumbed down summary of their findings. Everything is fully fact checked and the resources are published on their website. They did a two part episode on vaccines and had very objective pros and cons backed up by peer reviewed research. They do a great job (in every episode) exploring every side of an issue, I've heard them conclude the oposite of "traditional" medical practice and theory, and I've even heard them say they don't know. Its also really entertaining. Their episode on immigration is great too.
because the huge majority of the medical community has a decidedly strong stance on the issue, most, if not the entirety of "peer reviews" come from individuals who share the same belief regarding the issue. So just because something isn't "peer reviewed" by the medical leading majority, doesn't mean it is invalid. D
You do realize "peer reviewed" does not mean a bunch of like minded individuals sitting in a room giving each other pats on the back for furthering their agenda, right? And you do know the driving force behind the entire medical field (nursing included!) is evidence based practice, right? And you do know EBP has its feet firmly planted in (guess what?!?!?) peer reviewed research!
Entire policies are based on peer reviewed research studies. Using alcohol based hand sanitizers? Peer reviewed research. No gel tips or chipped nail polish (especially in a NICU setting)? Peer reviewed research. The list goes on and on. Hospitals are not just making policies because they need something to do to keep things interesting, there are entire committees devoted to sitting around reading peer reviewed articles and comparing them to current hospital policy. It's how and why the standard of care continually improves.
I've seen some scars and had a look on my face like "what the hell is wrong with you?"
I blame parents. Parents are who kids, from the chute on up to 18, spend the most time with. No other adult. What time they spend in classroom is nowhere near as long as how they spend it with their personal families at home. Teachers won't provide you with breakfast and a warm meal at night and a bed. The parents do. That means that the amount of time they grow and learn how to behave is dependent on how the parent behaves and acts. If the parent likes to be informal and not resourceful, the kid will probably have an expectation that their parent will take care of them until they grow up and can feel good about leaving the house without a worry in the world about how they'll pay their rent. This is not always true. Eventually, the parent will grow tired of the kid thinking that the kid has no direction, but because the parent lacks resourceful information that provides useful for the kid, the parent struggles. Parents who are informal/formal and resourceful will raise kids probably the most effective way to live.
Umm, thanks?
My daughter was a cutter. Let me tell you something, it sucks to see your kid hurting so badly, that she feels cutting herself is her only option to feel better. "Obviously spoiled" is not a term that I would use to describe my child, or others that I have encountered who cut.
I am not a teen mother, had her when I was 28 years old in case you were wondering. She always had a warm meal and a bed at home. I am not going to bore you with my life and her life story, but suffice it to say, this type of behavior can happen to anyone, from any walk of life.
I find your response to this type of behavior from students under our care as school nurses very judgmental, and kind of confusing. I don't understand what you mean by a "resourceful" and "informal" parent.
Our job as school nurses is to meet the student where they are emotionally and physically, and be a calm, non-judgmental resource for these students. I don't assume anything about a student who comes to me with cutting behaviors. I physically assess the cuts and treat them, I assess suicidal ideation, and I refer to guidance. Often times guidance will bring these students to me for treatment.
I give ONE. I bought sugar free mint ones that the kids don't like as much and I figure, they're just nasty candy and when my supply is gone for the year...it's gone. I do point out to the non-coughers that they haven't coughed since entering my office. about 95 % of the time this will result in a fake, half-hearted attempt at a cough. This is purely for my own amusement as I'm going to hand over the cough drop anyway. Oh, and I never give one to the same kid two days in a row. I tell them they can bring their own and no one is frisking anyone in the halls for contraband cough drops.
I did have a kid today who came in for a cough drop, I gave it. He came back several hours later asking for another and I asked if it worked earlier. He said no, and I asked "why would I give you another when the first one didn't work?" He was stunned that I didn't just hand over the cough drop. But seriously, if something didn't work, do you try it again or move on to other intervention? Even a KN can figure that out.
So Hubby and I are [I]those parents [I] who worked with the school to keep his butt in his seat and cut down the social visits. :-D Meanies!!!
Mean love is good love! A new 5th grader at my school commented (after I called parent for pick up) that he was relieved bc the nurse at his last school was "mean" and I quickly defended her bc "sometimes we have to be mean to help you stay in class when you can" (and immediately wondered whether he will become a "frequent flyer"). You gotta guide them to love them and sometimes that requires some meanness!
BSNRNHS, I which I could email parents! Most of the time when I call I just end up leaving a voicemail which states only that the student saw me and to call back. I doubt most of the parents listen to the message. I have certainly learned that letting a parent know that their child has been in X number of times this week does help cut down on visits in most cases! Either with a visit to the doctor if legitimate complaints or a firm talk if invisible ones. At my school the other issue that makes this tricky is that most of our parents speak Spanish, which I speak as well but not natively. Most of the time I am glad just to communicate what happened. But it's a great point that we have to put the onus on the parents bc the teachers can't help sending if Johnny keeps complaining!
Here's my update: I did ask the health director for help and she said she would talk to Becky. Here's what we have: My health office will now be getting siderails for all of our beds in the health office! Really. The director insisted that there's nothing we can do, and we must accommodate her or she could "sue us."
When Becky feels like she's going to have a seizure I ask her to sit on the floor and I put pillows on the floor next to her so if she falls over, her head is protected. This has kept her safe during the seizures she's had in my office. Apparently she doesn't like that and took advantage of the talk time with the director to complain. I'm at a loss for words.
She could never sue you guys, She has admitted to being noncompliant with her treatment which is what is causing these issues. Your cots (and all of the supplies in your office) are for STUDENTS, NOT for staff.
Document EVERYTHING she says and does. I would tell your health director that you are uncomfortable being put into a position where you are constantly being taken away from students to help a staff member who isn't following her doctor's treatment plan.
I'd say it's time to get the administration involved. It's becoming an issue in the classroom, safety wise and probably performance wise. That's above your pay grade.
I think it stems from this totally false idea we hold culturally, that if you do everything right as a parent, your kid will be perfect, or at least very well behaved. This causes parents to look for excuses instead of solutions.
Those of us that have more than 1 or 2 kids know that some kids are naturally obedient and some kids are born to be wild. What we need to look at, is our response to that. What response works in helping a child grow? The answer is not always clear. And what works for one kid won't necessarily work for another. Sometimes parents are mismatched in temperament or personality to their children, and those relationships will be strained.
It really does take a village. We need to let other people correct our children and hold them accountable. We need to trust each other on a basic level in order to do that. We need to not bash each other when things go wrong. It happens both ways. A kid acts up in school; the parents bash the faculty and the faculty bashes the parents. In any way we can, we need to aim for a spirit of working together for the child's well being.
And let's not be so quick to pathologise children's behavior. When I was a kid we sang this terrible version of "Deck the halls". It was rude and obnoxious and it went like this "Deck the halls with gasoline, falala-la-la, la-la, la-la. Light a match and don't be seen, falala, la-la, la-la, la-la. Watch the school burn into ashes, Falala, falala, lalala. Aren't you glad you play with matches..." People would roll their eyes or say "Stop that song." Now a kid would be sent to crisis for a psych eval and maybe charged with terroristic threats for this kind of thing. I work in child psych and I have seen this. When I was a kid, I remember making a hate list of people I wished were dead. These were kids who were mean to me and once in a while my sister or my mom would make the list for something that made me mad. No one ever saw it because I enjoyed privacy, but if they did, they would have just blown it off. I have had kids admitted to my unit for this very thing. Some of the frequent flyers are absolutely convinced that they are just messed up individuals because of this kind of overreaction. And it can be a kind of self fulfilling prophecy.
You are in the Transition Zone, (i.e. where a layperson becomes educated as a healthcare person). The entertainment industry has a huge love affair with high tech medical miracles. They make it seem like it happens everyday and pretty much to be expected that we can bring everybody back from the jaws of death to wake up and resume their previous life. Maybe even with improved function or superpowers.
Actually, we do CPR on dead people.
The reality we (ex) ICU nurses see is the futile efforts practiced on persons actively trying to die. I have seen codes used strictly as learning experiences for Residents to try intubating, central line insertion, chest compressions etc. Crackling ribs and frothy respirations do not make a pleasant soundtrack for TV medical dramas, so that part of a code is conveniently left out. The fantasy version of bringing the dead back to life is what everybody wants. The serious conversation about what really happens in and after a code is what nobody wants.
What's their NCLEX pass rate?
We had a patient recently who stated he wanted no provider of any kind who was not white or did not speak English. I was quite pleased when management told me to ask him what hospital he wanted to be transferred to. I have no tolerance for anyone who acts like this patient did and was glad the powers that be had our backs. Patient quickly back paddled.
To be frank, I deal with patient's only for a short amount of time (ER nurse). If someone is verbally abusive/screaming/yelling/acting inappropriate we will place them in a room, on the monitor, and shut the door partially. We deliver care and follow through on the MD orders, but if the patient refuses then we stop and again shut the door partially and continue to monitor the patient. If they are unable to control their actions due to medical diagnosis we will medicate them with haldol, geodon, ativan, or benadryl. We will place spit masks on the patient's that are biting/spitting, place pt's in restraints if they are physically aggressive. During all of this we do not engage/speak/attempt to placate the patient if it only furthers the behavior.
If the patient is alert and oriented, I will tell them to stop. I do not make demands, I will simply say: "That is unacceptable, you need to stop. There are children/other patient's nearby who are sick and this is not fair to them." I will then deliver the ordered care without verbally engaging with the patient. If the patient continues to be verbally inappropriate, I have had the MDs discharge them from the ER and have security escort them out. Legally we have an obligation to ensure they aren't dying/treat obvious life and limb situations but we do not have to put up with harassment.
If the patient is sick enough that they need to stay, I will continue to provide care but will not go to the bedside unless security is present/at least one other nurse is present to protect myself from being both physically assaulted and/or to prevent the patient from saying I did something inappropriate/did not medicate at ordered/etc.
You should have never discussed your personal religious beliefs with a patient ...especially a crazy one. Now he knows exactly which buttons to push.
Go to your local community college and speak with an academic advisor. The community college can test you, find your weaknesses, and advise which classes to take to be able to pass TEAS.
If you're seeing math on the TEAS that you haven't seen before, it may be that you simply haven't been taught the basics. The community college can bring you up to speed.
Go for your dream!
At the end of the day it's a social contract. We get vaccinated to protect the people who can't. Herd immunity requires 93-95% of the population to be immunized or it stops working. It's not for you, it's for your patients. And they are the whole reason we are nurses. Immunizations are at the bottom of the list of occupational hazards that surround us at work. We handle chemo, biohazard waist, body fluids, plastics and off-gassing furniture carpet and paint are everywhere, everything is coated in cleaning products that contain carcinogens, UV lights are being used more because they are bacteriocidal, hell even the air we breath isn't always safe. Who here actually thinks they have a perfect seal every time they wear an N95? No one knows what a lifetime of exposure to that environment does to US. At least we know what immunization side effects are.
Entire policies are based on peer reviewed research studies. Using alcohol based hand sanitizers? Peer reviewed research. No gel tips or chipped nail polish (especially in a NICU setting)? Peer reviewed research. The list goes on and on. Hospitals are not just making policies because they need something to do to keep things interesting, there are entire committees devoted to sitting around reading peer reviewed articles and comparing them to current hospital policy. It's how and why the standard of care continually improves.
My daughter was a cutter. Let me tell you something, it sucks to see your kid hurting so badly, that she feels cutting herself is her only option to feel better. "Obviously spoiled" is not a term that I would use to describe my child, or others that I have encountered who cut.
I am not a teen mother, had her when I was 28 years old in case you were wondering. She always had a warm meal and a bed at home. I am not going to bore you with my life and her life story, but suffice it to say, this type of behavior can happen to anyone, from any walk of life.
I find your response to this type of behavior from students under our care as school nurses very judgmental, and kind of confusing. I don't understand what you mean by a "resourceful" and "informal" parent.
Our job as school nurses is to meet the student where they are emotionally and physically, and be a calm, non-judgmental resource for these students. I don't assume anything about a student who comes to me with cutting behaviors. I physically assess the cuts and treat them, I assess suicidal ideation, and I refer to guidance. Often times guidance will bring these students to me for treatment.
I give ONE. I bought sugar free mint ones that the kids don't like as much and I figure, they're just nasty candy and when my supply is gone for the year...it's gone. I do point out to the non-coughers that they haven't coughed since entering my office. about 95 % of the time this will result in a fake, half-hearted attempt at a cough. This is purely for my own amusement as I'm going to hand over the cough drop anyway. Oh, and I never give one to the same kid two days in a row. I tell them they can bring their own and no one is frisking anyone in the halls for contraband cough drops.
I did have a kid today who came in for a cough drop, I gave it. He came back several hours later asking for another and I asked if it worked earlier. He said no, and I asked "why would I give you another when the first one didn't work?" He was stunned that I didn't just hand over the cough drop. But seriously, if something didn't work, do you try it again or move on to other intervention? Even a KN can figure that out.
BSNRNHS, I which I could email parents! Most of the time when I call I just end up leaving a voicemail which states only that the student saw me and to call back. I doubt most of the parents listen to the message. I have certainly learned that letting a parent know that their child has been in X number of times this week does help cut down on visits in most cases! Either with a visit to the doctor if legitimate complaints or a firm talk if invisible ones. At my school the other issue that makes this tricky is that most of our parents speak Spanish, which I speak as well but not natively. Most of the time I am glad just to communicate what happened. But it's a great point that we have to put the onus on the parents bc the teachers can't help sending if Johnny keeps complaining!
Document EVERYTHING she says and does. I would tell your health director that you are uncomfortable being put into a position where you are constantly being taken away from students to help a staff member who isn't following her doctor's treatment plan.
I'd say it's time to get the administration involved. It's becoming an issue in the classroom, safety wise and probably performance wise. That's above your pay grade.
I think it stems from this totally false idea we hold culturally, that if you do everything right as a parent, your kid will be perfect, or at least very well behaved. This causes parents to look for excuses instead of solutions.
Those of us that have more than 1 or 2 kids know that some kids are naturally obedient and some kids are born to be wild. What we need to look at, is our response to that. What response works in helping a child grow? The answer is not always clear. And what works for one kid won't necessarily work for another. Sometimes parents are mismatched in temperament or personality to their children, and those relationships will be strained.
It really does take a village. We need to let other people correct our children and hold them accountable. We need to trust each other on a basic level in order to do that. We need to not bash each other when things go wrong. It happens both ways. A kid acts up in school; the parents bash the faculty and the faculty bashes the parents. In any way we can, we need to aim for a spirit of working together for the child's well being.
And let's not be so quick to pathologise children's behavior. When I was a kid we sang this terrible version of "Deck the halls". It was rude and obnoxious and it went like this "Deck the halls with gasoline, falala-la-la, la-la, la-la. Light a match and don't be seen, falala, la-la, la-la, la-la. Watch the school burn into ashes, Falala, falala, lalala. Aren't you glad you play with matches..." People would roll their eyes or say "Stop that song." Now a kid would be sent to crisis for a psych eval and maybe charged with terroristic threats for this kind of thing. I work in child psych and I have seen this. When I was a kid, I remember making a hate list of people I wished were dead. These were kids who were mean to me and once in a while my sister or my mom would make the list for something that made me mad. No one ever saw it because I enjoyed privacy, but if they did, they would have just blown it off. I have had kids admitted to my unit for this very thing. Some of the frequent flyers are absolutely convinced that they are just messed up individuals because of this kind of overreaction. And it can be a kind of self fulfilling prophecy.
Dear OP,
You are in the Transition Zone, (i.e. where a layperson becomes educated as a healthcare person). The entertainment industry has a huge love affair with high tech medical miracles. They make it seem like it happens everyday and pretty much to be expected that we can bring everybody back from the jaws of death to wake up and resume their previous life. Maybe even with improved function or superpowers.
Actually, we do CPR on dead people.
The reality we (ex) ICU nurses see is the futile efforts practiced on persons actively trying to die. I have seen codes used strictly as learning experiences for Residents to try intubating, central line insertion, chest compressions etc. Crackling ribs and frothy respirations do not make a pleasant soundtrack for TV medical dramas, so that part of a code is conveniently left out. The fantasy version of bringing the dead back to life is what everybody wants. The serious conversation about what really happens in and after a code is what nobody wants.