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NRSKarenRN, BSN, RN Moderator 143,857 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: 27,388 (22% Liked) Likes: 13,565

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  • Dec 10

    I turf these sorts of things ASAP (ask others to get involved, such as requesting a care conference and letting management know that q2hr phone updates is not a viable plan that I will be able to accommodate). In direct dealings with family members I would entertain this phone call one time, and "cheerfully" try to establish as good a "phone rapport" as possible, then toward the end of the conversation make a different plan for the rest of the day ("May I call you between 6:30 and 7pm to let you know how the day has gone? Unfortunately because I'll be busy actively working with patients, I won't be able to give full updates every two hours, but I will contact you if there are changes during the day...other than that, let's plan to talk again this evening..."). If I received a call two hours later despite having made a reasonable plan, I would kindly state, "I'm sorry, I'm with a patient and can't talk right now, but I plan to call _____ near the end of my shift to give an update."

    This phrasing is a little more focused on positive terms about what I'm going to do rather than making a request about what I don't want them to do. It's too bad it's so tricky talking to people such that a word or two (or a change of phrase like I'm suggesting) makes the difference between people being irate vs. reasonable, but that's the way it is.

    None of us can fault you since you were mindful to be polite and professional. We are often encouraged to make reasonable plans like what I'm suggesting, but then when people get angry anyway we may be undermined - avoiding the opportunity for others to undermine us is accomplished by getting them involved early on as I suggested above.

  • Dec 7

    Quote from Emergent
    Just because you are a man doesn't give your essay more veracity. If I am a Jew and say the Holocaust never occurred, that does no make it true. Your gender is irrelevant.

    I argue that, perhaps my response may very well have a ring of truth. Society, in the last 50 years, has become emasculated. Strong male role models are increasingly rare, with the breakdown of families, feminization of the educational system, lack of discipline of our youth, loss of religious values and delineated moral codes.

    And what is the result? What I observe is rampant drug abuse, mental illness and violence. I see a decrease in civility. There are regular mass shootings of innocent people. The societal decay is self-evident.
    I didn't claim it gave more validity. I was simply stating this fact, because people seemed to assume a female must've written this.

    Drug abuse has been rampant and in no way is correlated with the vague claim that male role models are less "strong" or that education has been "feminized" (something I'd like you expand on). Trying to find causation in the opioid epidemic isn't going to be traced to something like you're claiming nor would it be possible even if it were true.

    I wasn't commenting on causality. I was simply saying that the paternalistic, masculine view of Society and the healthcare system likely contributes to resistance. Like I've stressed, it's not a claim that employs blame toward me. It's a social lens to examine the dynamics in a patient-provider relationship and the way it may shape treatment.

    It seems my error, which I'd correct if I could, was to use the words "masculine/feminine" rather than "maternal/paternal." I thought I elaborated in that, but I can see and admit I didn't in an adequate way.

    Another way to put it, is to compare the nursing model and the medical model. The medical model is frequently regarded as paternal, while the nursing model is seen as maternal. The results? Nursing is the most trusted profession, nurse practitioners see higher satisfaction rates and their patients often modify maladaptive lifestyle choices.

  • Dec 7

    There's well documented sexism in the history of medicine. Anytime women had an issue, it was dismissed as "hysteria". I mean, there are terms out there like "bikini medicine". Women have history been under-treated and dismissed. I don't see how anyone could argue that it's important for a female patient to be seen as an equal when being treated for a medical condition. I've been dismissed due to my gender plenty of times. I've been spoken to like "well I've found with women they tend to" in a derogatory way. We aren't included in medical studies at the rate men are, either - which impacts evidence based practice.

    While I'm not sure that it has anything to do with the opioid crisis, or fixing it, dismissing the problem would be a big mistake. IMO, of course.

  • Dec 5

    Quote from Marisette
    I hope for this too, but my gut tells me this is not likely to happen. The old days when a nurse walked into the human resources departments and they rolled out the red carpet and asked you where you wanted to work and offered nurses a sign on bonus are gone, and not likely to return. Patients were admitted a day prior to surgeries for testing. If a patient was ill, off to the hospital he would go where the testing and nursing care would begin and the mystery illness diagnosed and treated. This would require admission for several days.

    Healthcare has changed. Much of the testing and diagnosing is done outside the hospitals. Only the acutely ill are hospitalized and often discharged quickly. Jobs for technical assistants to work with nurses in cardiac cath. and endoscopy are more common with the nurses being in charge of several assistants and coordinating care. I don't see a return to more nursing hands on care which is what it would take for the nursing demand to increase. I yearn for the good old days, but I don't see them returning.
    Please let it be noted that all of this occurred prior to the ACA.

  • Dec 4

    Read the medication insert that comes with Lovenox - that explains the presence of the bubble.

  • Dec 4

    Quote from TriciaJ
    I think a combination of catastrophic care plus health savings account would be the way to go. A catastrophic policy is usually pretty inexpensive but takes away the financial worry if something major happens. A health savings account would pay for the routine stuff and you would be using the money you otherwise would for high premiums.

    I have noticed that people absolutely hate the idea of using their own money for health care. I don't know why that is. We use our own money for everything else.
    Try paying for certain chemo out of pocket. I'm on a PARP-inhibitor that costs thousands of dollars a month. That's just for one med. If you can't work, how are you supposed to set money aside for health care, let alone pay for the health care you need?

  • Nov 29

    I think that you might be right about linking the style of teaching with the fact that most of your instructors are Nurse Practitioners. For some people, "nurse" has become almost synonymous with "nurse practitioner." I think that you are making a valid point that should be taken seriously.

    The fact that you have done a few caths, started an IV, etc. is good. Nursing technical skills are important, too, and too many programs have failed to teach them well enough. However, there is no need to do 100 of them -- a few should be sufficient to introduce you to the skills and your employer should be able to give you additional practice with them after teaching you their particular protocols and procedure statndards. But you should be getting class material on the science behind these skills so that you understand the skills.

    So ... I think you raise a legitimate concern. In many schools, the pendulum has swung to far in the NP direction. Entry level programs should not be teaching from an NP perspective and/or teaching the NP role (unless they are entry-level NP programs). They should be teaching staff nurses skills from a staff nurse role perspective.

  • Nov 29

    Klone hit the nail on the head. You will not, and should not be blindly following orders because the physicians are the ones who put in orders.

    Understanding pathophysiology and being able to figure out what's happening with your patient allows them to be treated quicker and more efficiently. It allows you to better care for them as well.

    Every single day on my unit, I round with physicians and it's never just them assessing the patient and just giving me orders. We discuss the patient's case *together* and come up with a plan *together*.

    Example: I had a patient a few days ago who has no history of kidney disease, yet he hasn't urinated a lot duringy shift. I knew this because I had been *assessing* him all day. I understand the *pathophysiology* so I was able to take action. I went and grabbed the ladder scanner to see if he was retaining or if he just plain wasn't drinking enough.

    Turns out he had retained a bunch of urine in his bladder. I then straight cath'd him (we have policies in place that allows this) Why? Because I knew that not only would this cause him discomfort, but that it would damage the bladder had it continued. Off the top of my head, I could think of about 5 different things that could be going on with my patient that would cause this. I assessed him further, called the attending, and we came up with a game plan.

    That is the role of the nurse. It happens everyday, everywhere.

    You need to understand and get sharp at assessments. Small changes can indicate large issues that you'll miss if you're not assessing properly.

    You need to understand how to read diagnostics and lab results. You'll be the one following up on the care (patient has a potassium of 2.5 - you need to know what to do) Patient has a diagnostic come back showing a small bowel obstruction - you'll know that you're going to need to place them NPO and prepare for surgery.

    There is so much more to nursing than random tasks throughout the day. The job, when done correctly, is much more mental than physical.

    My advice: stop bemoaning the thought of advanced education and focus on your current level and what they're teaching you. If you don't, you can be placing your patients at unnecessary risk because you thought you knew a nurses job better than those who were trying to teach you.

  • 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!