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NRSKarenRN, BSN, RN Moderator 120,886 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: 27,341 (22% Liked) Likes: 13,441

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  • Feb 27

    Just a typical day for me. I hear this multiple times a day. It doesn't necessarily mean the family is in denial. It does mean they aren't ready for the discussion. Forcing the discussion only makes them stop listening. Meet them where they are. Listen. Be empathetic. Families will start asking questions when there is a change or when they are ready. As mentioned above, most folks think we are the Reaper. Palliative does not mean no Care nor Hospice. We also manage chronic illnesses such as MS, ALS, & Sickle Cell etc.

  • Feb 27

    Make sure the attending knows because they should be educating the family on a realistic prognosis.

  • Feb 27

    Saying that someone is in denial implies that they are being irrational on some level and might be dismissive of their perception of the situation. Is it denial or have they never seen someone die before? When we live in our day to day bubble of life and death, we really run the risk of projecting our knowledge on to other people and raise our expectations to unreasonable levels.

    Why not just say something like, "yes, she's having a better day today". Meet the family where they are with condition neutral statements. Be very open and frank with what her needs are and will be in the near future.

  • Feb 27

    Ask them what they see that looks better. You can gently say things like "Yes, it's encouraging that she is tolerating her tube feedings better today, but she's still not having much urine output, which means her kidneys aren't working well. Her blood pressure is at a good place right now, but we're using a lot of medications to keep it there, which means she's very critically ill. Can I answer any questions for you?"

  • Feb 25

    Quote from Cassiburtram
    I did my clinicals as a nursing student in many different facilities including acute care hospitals, psychiatric units, and long term care facilities. Yes, I was also on the ventilator off and on. I was fortunate enough to have my trach reversed my final semester of nursing school.
    I think you are being deliberately vague. The OP is going to require ventilation for 20 hours a day. And she's not asking about nursing school. To encourage her to even consider bedside nursing is doing her no favors especially since, by your own admission, you haven't actually done it. While I have the utmost respect for your overcoming your situation, I don't know if I would have the inner strength to do the same, we need to be realistic here. Yes, there are many things that a nurse with this disability could accomplish and some of them were listed in the inspiring post by Donna Maheady. I certainly hope the OP looks into some of those suggestions. However, the lack of acute care experience IS going to be limiting. A teaching or case management position requires that kind of experience. The OP's condition puts her at increased risk for infection and possibly will put her patients at increased risk as well. The liability of having her on the floor is astronomical and I just don't see administrators being willing to take on that risk. The logistics of dragging a ventilator around would make providing patient care very difficult and I'm not too sure having a nurse with this requirement would make the patients feel comfortable. Before you accuse me of being unkind I want you to know that I only have the best of wishes for the OP But at the same time don't want to set her up for disappointment. That would be the unkind thing to do. To the OP, I believe you would have a wonderful opportunity in the area of patient education and support. With your nursing background you would be able to answer the difficult medical questions at the same time being able to address the emotional and psych/social issues in a way patients would be able to very closely identify with. I'm sure you would have a significant and positive impact in this role both in person and perhaps as an author/editor. Congratulations on this enormous achievement while facing what to outsiders would seem to be insurmountable obstacles. You are an amazingly strong human being and I have no doubt will be just as amazingly successful in whatever you choose to do.

  • Feb 25

    Dear Nurse Beth,

    I recently found out that I would need a permanent tracheostomy. I have one more semester left of nursing school (rn) before I graduate, but I have taken a leave from school to work out all of this health stuff. I don't know when exactly I will get it, but I am trying to push it off as long as possible. I am still mobile and everything else is fine, but I would be hooked up to ventilation about 20 hrs of the day. My pulm said that I could actually be mobile with the vent.

    Can a person with a tracheostomy actually work in the hospital? The whole cross contamination seems like it could be a huge liability to the patients. Is there something I could go into right from graduation that I could work as an RN with the tracheostomy?


    Dear Needs a Trach,

    I'm sorry for your medical problems and applaud your spirit.

    The most important thing for you now is to take care of your health and adjust to your abilities and limitations. Give yourself time to stabilize.

    Nurses with medical histories and disabilities can make powerful connections with patients. I don't have an employment answer per se, and you are right, it may not be in acute care, but there are so many options in nursing.

    An at home setting would be ideal, such as working for an insurance company.

    I would find a community of nurses such as yourself for support and advice.

    I do have a great resource for you: Exceptional Nurse | Welcome
    This is a site run by Donna Maheady, an RN with expertise in nurses with disabilities. You will be inspired and amazed by her help and insight.

    Best wishes,

    Nurse Beth

  • Feb 25

    Dear needs a trach,

    I agree with Beth totally...first you need to take care of your health!

    I applaud your commitment and continued interest in working as a nurse.

    Just think of how many people you could have a positive impact on. What a role model!

    Honestly, I don't think acute care will be an option. But, I have a few alternative options for you to consider.

    You could:

    Facilitate an online support group for people with trachs.

    Develop educational materials for patients and families.

    Provide online training to families with technology dependent children.

    Work for a tracheostomy equipment vendor…. Make recommendations/answer patient questions regarding supplies and equipment.

    Work for an insurance company doing case management.

    Write a book about your experiences as a nurse and patient.

    Work for a non-profit such as the American Cancer Society or Lung Association.

    Write a blog for people with tracheostomies or health care professionals.

    Start a nonprofit to assist patients and families.

    Teach nursing online.

    Develop continuing education programs for nurses, respiratory therapists and first responders regarding tracheostomies, tracheostomy care and emergency interventions.

    Tutor nursing students online.

    Work for a camp for children with tracheostomies.

    Consult with school districts about services/inclusion of children with trachs in schools.

    Please get involved with other nurses with disabilities. They can offer you so much support!

    I wish you all the best and please feel free to contact me at any time.

    Donna Maheady

  • Feb 25

    Quote from Cola89
    Why are you following what I'm doing so closely? Are you a crappy nm too?
    Yep, you nailed it.

    I have an eidetic memory for things in writing. As a result, I remember usernames. And yours stuck out at me. I just don't get the value of constantly complaining about something, and not CHANGING it.

  • Feb 25

    Are they all in the same health system? Maybe it's just bad culture. I've worked in places (not in nursing) where all of the management were jerks. And then when I transitioned into a management position, I realized why.

  • Feb 25

    If you perceive one person as a jerk, that person probably is a jerk. If you perceive everyone (or in your case, all managers) as a jerk, you might want to indulge in some self-reflection. Nurses are human, so some are jerks.

  • Feb 25

    Is this the same manager you were complaining about last month? And the month before? I thought you were getting a new job?

    And yes, if every manager you have had is a jerk, and every charge nurse or long time nurse you've worked with is backbiting and a gossip, I would say that you are the common denominator.

  • Feb 23

    I am up front with addicts. Straight up tell them I am not there to judge them and I will give them what they are ordered when it is due unless they are snowed or vitals won't support giving it. I write down the times the different medications are due for my sift and follow through. In some cases I will tell them they can feel free to call the physician themselves. Many patient rooms have phones. If they can't talk the doctor into increasing their pain medications during rounds I am not going to get them to change them over the phone unless something changed. When nothing seems to be working I don't hesitate to advocate for IV Tylenol as a supplement. It seems to work in many abdominal surgery's and I have seen it work for other chronic pain patients post-op. Legalize marijuana especially for pill or liquid form. If they are using the call system excessively then I will place a mark on the communication board every time I go into the room to show the pt I am keeping track so that they can't say I have not tried to take good care of them. Most will agree 5 to 10 times an hour is excessive those that don't are one shift wonders. If there is a psych component you definitely need to factor it in... make sure Psych in on the case. They can help sift out if it is a pain issue or a psych issue. The may need ativan, haldol etc. as a bridge to get them back on track after surgery especially. We aren't going to cure addiction during hospitalizations so I advocate forgiving them what they are use to when they are at home. If they drink ask the doctor for some alcohol. All they can say is no and it is fun to see the shocked look for the doctors that say no. I had one very elderly lady that like her whiskey. Thank goodness that the doctor had the same philosophy. He ordered that she could bring her own in and ordered it PRN dosing. Worked like a charm. She was in her 80's and you can't argue with success. It kept her going for over 80 years! There was a time when I felt people should be responsible for their actions but I have learned people with pain or psych challenges usually have a valid reason for it and did not wake up one day saying I want pain or to have PTSD.

  • Feb 23

    Perhaps a good route to go would be to get a consult with a pain management team. My children's hospital has a team where that is what their focus is. Your patient can feel like their voice is heard from you, while someone who specializes in pain management can critically evaluate the patient's pain needs. Then you can at least rest easy to know that you are attempting to meet your patient's needs while also having more in depth orders regarding pain management. The reality is, this person likely does not have the coping mechanisms needed to go without pain meds, but a pain management team will be great at evaluating that.

  • Feb 23

    This is from the OldDude Institute for ADD/ADHD Studies:

    Predominant signs of ADD/ADHD

    Having something constantly in hands to manipulate.
    Grades are all over the map - 95, 92, 27, 31, many cases tests are not nearly completed.
    Homework or paperwork to go home is often found in a heap in the kid's desk or locker and they have no recollection of how it got there.
    Completing homework is an absolute nightmare for the parent.
    Replacing the word "Hyperactive" with the word "Impulsivity" will clarify the classroom behavior associated with ADHD.
    The child can stay interested and concentrate until the end of time on anything "they" are interested in. Today it usually is video games, TV, or reading about subjects of their interest.
    I've yet to run across an ADD/ADHD kid who isn't above average or gifted/talented...some have a genius IQ.
    This is the condensed version but it is the skeleton of signs.

    Diagnosis is simple and easy by way of teacher and parent questionnaires.
    Run from any pediatrician who wants a psychological referral to evaluate for ADD/ADHD.

    If a diagnosis of ADD or ADHD is made by the pediatrician the only long term successful treatment is the use of stimulants.
    Even though the initial medication dosage is at the lowest dose to start with the teacher will be able to see a positive effect on the 1st day it is taken.

    Reminder charts, seating arrangements, counseling, nutritional supplements, essential oils, probiotics, karate, or anything other than a stimulant drug doesn't work for an extended period of time.
    You can't reward these guys into compliance.
    You can't punish these guys into compliance.
    These kids are not intentional in their behavior, it's just how they are wired.
    Usually, at least one of the parents parent will relate to the above mentioned behaviors.

    I touch briefly on the consequences of untreated ADD/ADHD; risky behavior, drugs, alcohol, incarceration, increase in auto accidents.
    I share my observations of how much happier the kids are and how behavior issues disappear when kids are treated with stimulants.

    This is my spiel...I get reactions from horizon to horizon but I maintain these are observations I've made during my own transition from entering school nursing thinking ADD/ADHD was just an excuse for bad parenting and observation over the years of ADD/ADHD students and interventions; including my own child.

  • Feb 23

    Pretty much all of my life's lesson's be it in nursing, or outside in the world, have come through the school of hard knocks and mistakes. I'm a stronger and better person because of them.

    I am not my mistakes.