Content That NRSKarenRN Likes

NRSKarenRN, BSN, RN Moderator 139,848 Views

Joined Oct 10, '00 - from 'RN Spirit from Philly Burb'. NRSKarenRN is a PI Compliance Specialist, prior Central Intake Mgr Home Care Agency. She has '35+' year(s) of experience and specializes in 'Home Care, VentsTelemetry, Home infusion'. Posts: 27,387 (22% Liked) Likes: 13,563

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  • Aug 19

    "I don't need it, Nurses are never or hardly ever sued". So, does the Nurse actually need Liability insurance? If so, why?

    A couple of questions that should be considered while making this decision would be: "Would my policy provide an attorney to defend me and reimburse me if I incurred costs ... and, "Would my policy include coverage for any disciplinary action taken by the Board of Nursing?"

    What do you think?

    Does the Nurse really need his or her personal liability insurance?

    Do you have one? And, if so, what was the main reason you obtained a policy?

    For more information on how to protect yourself visit our Nursing Liability Insurance page.

  • Aug 19

    CONGRATULATIONS, cardiacfreak!!!

  • Aug 19

    I was a new nurse during the height of the HIV/AIDS scare, new on nights and my first patient was a young man with AIDS. All I had to do was take vitals and call report to the floor. I went in to get his blood pressure without gloves on and he freaked out. I explained that it was safe, I was not drawing blood just taking blood pressure on an arm without any skin issues. He broke down in tears and told me that I was the first person that treated him like a human being. He got to where he would not come to the ER until night shift started and always asked for me. I was the last person that he recognized before he passed away. I guess he made the biggest impression on the way I treated all my patients.

  • Aug 19

    Mr. Clean - you chose one of my favorite things!

    Or - unfavorite, I suppose.

    To be honest, I am old enough (47 years of nursing practice!) to remember when body fluids were just an annoyance. I was a perinatal nurse for many years - and got everything on me - from amniotic fluid to saliva and everything in-between. We used gloves - sterile gloves - only for sterile procedures.

    Once gloves became the norm, I started wearing them - and was taught that gloves should be used to protect against others' body fluids. So - that's what I do now.

    I see healthcare providers (nurses, physicians, NP's, RT's, CNA's ..... the list goes on) wearing gloves every time they touch a patient for any reason. I mean ANY reason...... pushing a bed down the hallway, taking a blood pressure, listening to lung sounds....... any reason. Folks use them to touch a patient - and I don't understand that. (I'm sure that any situation can go from no fluid risk to high risk in a few seconds, but that isn't all the time - and if that were the main concern, then we should all wear complete protective gear every time a patient is touched.)

    Nursing is about touching people. I learned a lot about the 'healing touch' that nurses have.

    I had a patient with HIV - and I reached out to take his hand as he was going through an uncomfortable procedure -- and he said to me: 'You're the first nurse that has actually touched me in a long time.'

    I firmly believe in protecting myself and that others should do the same. I just can't see that protection applying to every time a patient is touched. For me, touching a patient to comfort, support, console and care for a patient is just part of my practice - as it is for other providers.

    There is not one of my own providers (NP's to MD's to PT's) who wear gloves to exam me - with the exception of pelvic and oral exams. None of them have caught anything yet!

  • Aug 19

    That pamphlet was very informative and easy to understand, Mr. Clean. In my experience there isn't a lot of confusion about when and where we gown, glove, etc.

    Sometimes people will decide to go beyond recommendations from designated authorities such as WHO. because they believe there will be a measurable advantage or lower percentage of cross- contamination.

    Many of us worked for decades without gloving up every time we were in the general vicinity of the patient.

    It was considered at the time that wearing gloves had a negative implication, just as adult briefs were considered an affront to patient dignity.

    Whether any of that is true could be up for discussion, but we're obliged to follow best practice guidelines regardless.

  • Aug 19
  • Aug 19

    CCU -- lots of teamwork and a great team. The patients were interesting -- we got EPS patients, and we were on the cutting edge of research on PTCAs and implantable defibrillators. The medical staff were great to work with, and my co-workers were universally interesting, nice people. So were the patients. Of course that was thirty years ago in a mostly rural setting, but I sure enjoyed it for the five years I was there!

  • Aug 19

    OP stated that s/he thought the Dr would be found guilty of criminal battery.

    It wouldn't be criminal battery. It would be medical battery.

    Criminal battery would be prosecuted by the district attorney. The penalty would be a fine paid to the state and/or jail time.

    Medical battery is a civil violation. It occurs when a medical professional touches or performs a medical procedure without consent. The patient or family would have to file a lawsuit. The penalty would be financial and paid to the patient or next-of-kin.

  • Aug 19

    Quote from milly
    The problem comes when it is mixed up with palliative care. Thing being is the vast majority of people who end up with them for that purpose dies.
    Perhaps that is because those on palliative care are on it because they are nearing death due to a disease process or old age?
    I know there is a school of thought that stat doses and syringe drivers are so very close to euthanasia. That is something that totally adds up when I think about it logically.
    Euthanasia is the giving of medications with the intent to cease life. Palliative care manages the symptoms of a disease process that is nearly at the end of a patient's life. The patient will die regardless; the compassionate, professional way to treat that patient is to relieve the pain, air hunger, and other unpleasant aspects of death.

    It's not about ego. Or a lack of empathy. I want to be able to sleep at night knowing if do e the best for my patient's i can. And for the record I strongly believe that these patients are the people who we need to advocate for more so than any other. But I also want to be safe and protect both them and my own registration.
    Doing the best for your patients who have reached the point of palliative care is managing the symptoms. As long as you act within your scope of practice and don't willfully give a dose of medication with the intent to end a life, your license should be fine.

    I don't understand how the rules change so much. For instance morphine in a surgical scenario, if respiration rate is below 12 it is contraindicated as it suppresses the breathing further and that is dangerous.. Yet in a palliative scenario it doesnt seem to matter because they are dying any way...
    It has to do with the purpose of the medication and planned path for the patient. In a surgical scenario, the plan is for the patient to return to a better level of health. In palliative care, the goal is to provide a death that is not torturous.

    How do I know that these medications which are very potent and quite a cocktail doesn't play a part in the poor souls demise... I don't know how to wrestle with my conscience on this point. I do indeed plague myself torturing myself wondering if my so called caring act isn't some how killing someone under another guise. And that terrifies me ..I just want to have peace with it. There are hundreds who are incredibly blasea I want to be like that too..
    These patients are most likely going to die, and soon, regardless. It is the goal of therapy that matters- to provide a death where symptoms are managed and the patient is kept as comfortable as possible. If this is something you cannot handle, then you would be best served by finding another nursing speciality where you will not work with patients in palliative care.

  • Aug 19

    Quote from milly
    Hello

    I know that there will be allot of people disagree with me here
    This is a really odd way to start a post. What are we expected to disagree with? You sound as if you realize that your opinion about something is quite controversial and perhaps inflammatory, and that it's probably one that many people will be opposed to. But you aren't being very clear. I suspect your fears have nothing at all to do with the syringe driver itself. Are you suggesting that we shouldn't treat a dying patient's pain? I hope that isn't what you're saying.

    Quote from milly
    Am I only nurse that is quite simply terrified of syringe drivers?
    I definitely am not terrified of them, I think they are a great. I use them every day in the OR and they are a valuable tool that helps me provide safe anesthesia.

    What is it about syringe drivers that terrifies you (terrify is a very strong word)? You need to spell it out. Are you not properly trained in managing them and worry about not programming the infusion rate/dose correctly? Do you view them as some scary technical monster that can blow a fuse and run amok, suddenly delivering 50 ml in 0.1 seconds? (not that that could happen) What's so terrifying in your view? What are you so afraid of?


    Quote from milly
    Are they really agents of death?
    No, they are not.


    Quote from milly
    How can you make peace with it all ?
    I'm not sure what there is to make peace with, but I can guess.

    Treating pain, nausea and anxiety when I have the means available to do that is the humane, professional and loving/caring thing to do. I know that it is the right thing to do, so I personally don't have to make peace with it. Not treating it is cruel. Knowing that I could ease a patient's suffering but choosing not to do so for egotistical reasons is simply not an option in my opinion.

    Syringe drivers are great in that they permit good symptom control through steady levels of plasma drug concentrations. (You might still have to give a bolus or change the delivery rate as changes happens in the patient, but it's a good way to provide symptom control). Any type of infusion pump has this advantage as you avoid having to give multiple, repeated injections. It benefits your patient.

    Quote from milly
    Please help me.. If got to get involved with it all tomorrow and I can't sleep..and I'm on the verge of a panic attack already..
    What do you mean, get involved with? Are you starting a new job as a nurse? If you are, you do what you always do. Administer medications as they are prescribed by the patient's provider (as long as the prescription is correct and safe to give) and ALWAYS advocate for your patient. Make sure that your patient's symptoms are adequately treated. Your personal beliefs aren't the focus here, your patients' needs are.

    You are not killing your patients when you provide good symptom control. Disease processes/ injury/old age is what's killing you patient. You have the power, and in my opinion the ethical obligation, to make the process less torturous.

    Quote from milly
    I had hoped for some encouragement..

    Iv hardly slept. Can hardly breathe and I just want to cry.. Hoping beyond all hope that I manage to survive today without a panic attack.
    I'm not sure what we could say to encourage you. You seem to have a very strong reaction to this.

    The only advice that I can offer is, treat your patients with nursing professionalism and kindness. Alleviate their pain and suffering using all the means at your disposal. Administer the medications that help them and offer a listening ear and a hand to hold.

  • Aug 19

    The ones I use usually contain Ativan (to keep them asleep and unaware while medically paralyzed) or Flolan (to help them oxygenate).

    Anyone on end-of-life meds, I think not of the meds hastening death -- the meds make **the death that is already underway** more comfortable.

  • Aug 19

    Quote from Pepper The Cat
    I am so tired this type of posts.
    I am a rehab nurse. Yes, you nurses who work in ER and ICU may save the persons live, but you know what what? I am the person that gives them their life back.
    We rehab nurses are the ones the get the pts bladder and bowel control back. We take the person who was a hoywr lift to person who can get up with minimal assist.
    We get the pts from being totally dependent on help to being independent.
    My job is not glamourous. It's not excitingly.
    But I am very proud of what me and my colleagues do.
    I worjed acute care all of my career. I always hated having patients stuck on my floor that just needed rehab. I felt like it was helpless and they just withered until they died.

    Then my sister became an OT. She did a rotation at a hospital that just did rehab. I got to visit her there and meet a few of the patients in passing and several of the staff. The one patient I spoke with was ecstatic about how much he had recovered and talked about moving from a wheelchair to a walker to just his cane after his stroke. He was so thankful.

    The nurses were so passionate about what they did, I with many being specialty certified in rehab.

    They had so much specialized equipment I have never seen before.

    It really opened my eyes to a new appreciation of rehab and showed me how wrong my conceptions were.

  • Aug 19

    I never felt more glamorous than when I was wearing Nomex and jump boots in 90+ degree heat cleaning up puke in a aircraft that only had AC when at cruising altitude but otherwise sat on a hot pad that acted as a de-facto reflector oven. Woooo baby. That was some fine living!

  • Aug 19

    I am so tired this type of posts.
    I am a rehab nurse. Yes, you nurses who work in ER and ICU may save the persons live, but you know what what? I am the person that gives them their life back.
    We rehab nurses are the ones the get the pts bladder and bowel control back. We take the person who was a hoywr lift to person who can get up with minimal assist.
    We get the pts from being totally dependent on help to being independent.
    My job is not glamourous. It's not excitingly.
    But I am very proud of what me and my colleagues do.

  • Aug 19

    Glamorous...hmm...the Real Nursewives of Telemetry, brought to you by LOTS of hairspray, full-on makeup and lashes at 7:00 AM.


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