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mercurysmom, RN 6,536 Views

Joined Jul 25, '11 - from 'New England'. mercurysmom is a Disabilities Advocate; Consultant. She has '27' year(s) of experience and specializes in 'Early Intervention, Nsg. Education'. Posts: 165 (72% Liked) Likes: 548

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  • 3:13 am

    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.

  • 2:59 am

    Well we generally don't know going in who those people are who will do well. Should we give up on them? One of my more recent codes was for a mom in her 30s, hours after delivering a premature baby. Her children still have a mother. A man in his 40s was coded a LONG time -- over an hour on the LUCAS device!! Not only did he survive, but he returned to his high-pressure, high-thinking job.

    Now we do definitely code people who should (in my opinion) be DNR/DNI. If someone has already sustained a brain stem stroke or anoxic brain injury, or other conditions with poor prognosis, elderly etc, we do know their outcome will almost certainly be poor. That really should be considered.

    Why it's not...it's a complicated issue. Sometimes providers' communication is lacking. I remember being in a care conference for a woman who had a pontine stroke. When discussing options, the neurologist said "she would need 24 hr care, and she would always need someone to feed her." I cut in and said "just to clarify, by 'feed' you mean 'administer tube feeds,' correct?" I knew the answer -- that woman was never going to take anything PO! But I thought as a layperson, "feeding" her would mean spoon feeding.

    Families made up of laypeople typically haven't seen a code, or poor outcomes following ROSC. They have seen on medical dramas though, where codes last 60 seconds and end well. Others have the misguided belief that agreeing to DNR is the same as murder.

    When discussing with family, it's a fine line between being real, and being biased against coding.

  • 2:40 am

    Do you know how to fill the oxygen tank? I had a patient once who's concentrator had an attachment to fill her O2 tank. While the patient was in bed at night with the concentrator running it was simultaneously refilling the tank. Therefore in that case it would be very important that night shift make sure the tank was connected to the concentrator- as that was the time the refill would be happening.

  • Sep 7

    I know a few kid who are or have done early college. The challenge with all of these children is that they were/are still children despite going to college at a young age. A younger college student is NOT like and adult college student. Children and adolescents have different developmental needs than adults. This doesn't mean a kid shouldn't lunge ahead academically if they are ready, but if I were you, OP mama, I would try to shift my perspective (and help shift my daughter's) into seeing the constraints on becoming a nurse a blessing instead of a curse (or something to try to get around).
    To keep her challenged, motivated and moving in an absolutely positive direction, I suggest (as others have) that you encourage her to focus on math and science -- without negating writing/communication. If her interest is in healthcare, I might go forward as you would in a pre-med degree -- which the options for that are vast. Look into requirements for PA schools and make sure she's getting those in her undergrad. Get her in a CNA class as soon as possible and volunteering at the hospital. Give her a chance to really explore what working in healthcare looks like. If she finishes her non-nursing undergrad early -- think about a gap year doing mission work. There is SO much she can be doing and learning while still achieving great things and not rushing others.

  • Sep 7
  • Sep 7

    Quote from chris5720
    JKL33, I completely understand your premise. I definitely agree that more employees on a shift would solve a lot of the issues we and many others face in the industry. However, from a business and management perspective, that is not a feasible solution for our current time and environment.
    I will need more time to think about the remainder of your post.

    In the meantime, please think about this. You have told me that my solution is not feasible from a business and management perspective. I must ask if you understand that there are now entire departments of "fake problem solvers" and entire industries that have cropped up to solve the fake problems. So I will take it that you don't mean that my solutions are not feasible from a financial stand-point, but rather simply from a "preferred theory" standpoint.

  • Sep 7

    I have never once been confused about which precautions I needed to take based on patients' known diagnoses. I also don't get confused about which room I'm in, or which patient I'm presently working with.

    Therefore, and yes, I'm making an assumption - - I assume that someone has decided something like "we have to come up with a better way for RNs to 'remember' infection control measures specific to each patient" - - as if the majority of the problem is that we have "forgotten" where we are or what we're doing.

    No. The problem is that there is not enough time in the shift to care for each patient the way s/he deserves to be cared for based on staffing levels in many, many places.

    The problem is that nonsense has taken over, and we spend too much of the time we DO have, doing non-sensical "tasks" to meet non-sensical objectives instead of providing excellent hands-on care.

  • Sep 7

    Quote from chris5720
    JKL33, thank you for your honest feedback.

    To elaborate on the project/problem I'm working on, I'm trying to lower the stress of our staff through easing their mind with visual cues and reminders. My goal is to implement new technology that makes it easier on staff to remember patient details. Thus, limiting the stress of memory on an individual.

    Where do you believe I'm missing the premise? What would you define as the problem that should be the main focus?

    Also, I'm not planning on spending my life solving this issue. I'm just reaching out to as many individuals with experience that I can, to help optimize the workflow at my employing institution.
    Chris, I appreciate your honesty very much. That said, can you see how the problem you are tasked with solving is probably not really the issue?

    The premise that administrators are always missing is that more time with each patient would solve (or improve) absolutely innumerable patient care issues. And yet it never fails that they would rather come up with 100 non-issue "problems" and provide 100 ridiculous (and sometimes even more burdensome "solutions") than to do something like, say, simply put another RN on the shift.

  • Aug 30

    I'm more concerned about the lack of soap than med cart. Did they open before they were done building?

  • Aug 30

    This place has red flags all over it. I'd be looking for a new job. No sanitizer or soap? Meds in baggies and boxes? Infection control and safety risks.

  • Aug 30

    Quote from twinsmom788
    What is REALLY sad is that the patient DIED. "Drama Much"...yes it is...to his family and friends. Actually, "Biter" has 2 ts. Bitter.
    This is a long-standing joke on this forum. Ruby is completely aware of how to spell the word "bitter".

  • Aug 30

    Quote from That Guy
    this approach always bothered me. Once everything cools down I think it does need to be discussed. So often things happen and get brushed under the rug, but if we talk about the issues, we are less likely to make the same errors as others have. Why should we always hide the bad things that happen? They can be used as great learning tools. I know that after my medication error, I made sure to talk about it with other staff to see where I went wrong and I learned a great deal from it.
    Physicians have morbidity and mortality forums. Certainly agree nurses should have the same.

  • Aug 30

    Please try to avoid phrases such as "My co-worker killed someone." That makes it sound like he did it on purpose and only inflames an already tragic situation.

    To answer your basic question: When serious safety events happen, they are investigated -- and the actions that are taken depend on the results of that investigation. If it was a truly inadvertent mistake, the nurse might not be punished at all. If the incident was the result of purposeful negligence, criminal charges can be filed. And every possibility in between is a possibility depending upon the exact situation. There is no "one size fits all" outcome or action plan.

    Hopefully, everyone involved will learn from this tragedy to prevent similar events in the future.

  • Aug 28

    I am so disgusted that the whole made a med error, scared I'll lose my job or license mentality still exists.

    Over 20 years ago leaders in the medical field proposed that medical errors be handled the same way the NTSB and airlines handle crashes. No one person is blamed, no ones job is threatened. What went wrong is investigated and whatever helps prevent it happening again is instituted.

    You all may be to young to remember but airplane crashes used to be more frequent.

    The nursing culture instills such blame and shame nurses are afraid to admit they made an error.

  • Aug 28

    Not sure. I quit my job today and actually have peace and two interviews lined up. The good Lord will lead me to where He wants me to go.


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