Content That Mermaidblues Likes

Content That Mermaidblues Likes

Mermaidblues 802 Views

Joined Jul 14, '12. Posts: 8 (25% Liked) Likes: 7

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  • Feb 5 '13

    Quote from BARNgirl
    Dear felow nurses:

    Please do not use your facility's position as a point of reference on how you should deal with abusive people in the workplace any more than you would care about whose side your boss would take if your partner physically abused you. It does not matter. Abuse is abuse, you will not be fired if you set your boundaries professionally and calmly. Let your documentation depict an objective description of the altercation, use quotes. It is the only ally you need. Supervisors and bosses are not there for you emotional support, let alone to be your friends: they represent the hospitals as a business, and "the client is always right".

    Signed,
    Been there, stopped that.
    :applause:

    Thank You!!

  • Feb 5 '13

    Dear felow nurses:

    Please do not use your facility's position as a point of reference on how you should deal with abusive people in the workplace any more than you would care about whose side your boss would take if your partner physically abused you. It does not matter. Abuse is abuse, you will not be fired if you set your boundaries professionally and calmly. Let your documentation depict an objective description of the altercation, use quotes. It is the only ally you need. Supervisors and bosses are not there for you emotional support, let alone to be your friends: they represent the hospitals as a business, and "the client is always right".

    Signed,
    Been there, stopped that.

  • Feb 5 '13

    We do meet people where we are and they are how we find them. However, that does not mean that you get "I Am A Doormat, Kick Me" printed on your forehead when you take a nursing position. It is very appropriate to use your therapeutic communication techniques you learned in school. Setting boundaries is perfectly acceptable.

    Patient/family: (Yelling) "You stupid (epithet), I came in here to get care and I get this ugly stupid (racial slur) ... don't you touch my mother...."

    You, cool as a cucumber, no flashing eyes, no raised voice: "Ms. Smith, I understand you're having a hard day and you're upset. We are trying to help you and I am the registered nurse assigned to this ward. Please do not use that kind of language to anyone on this staff. Now, what does your mother need for her....?"
    or
    "Mr. Smith, no one will be able to help you unless you can calm down. Would you like a minute to pull yourself together, and then we can discuss this more calmly?"
    or
    "Jerry, we are trying to help you. Settle down and watch your language."

    Any of these is perfectly OK. In my experience 8+/10 times it's enough to get people to hit the reset button. Sometimes they even apologize and say, "It's been a tough experience."

  • Feb 5 '13

    It all depends for me. I usually try to preempt things and come in working to charm people from square one and that can often ensure that people don't blow up when they otherwise might have.
    Sometimes it's important to consider why a person is rude or upset because it may have nothing to do with the complaint they are actively voicing. For example, I had a patient once who was just plain being a jerk and going off about every little thing, like the fact that the tech brought him water and dropped the straw but didn't bring him a new one as promised (she had to go deal with a poosplosion). Absolutely out of line for every minor inconvenience. What was actually going on was that the patient had been told by his MD that he had 2 shot valves and triple vessel disease, wasn't a surgical candidate and had 6 months or less to live. He really wasn't having issues with the minor service problems, he was having himself a freakout because he had just been told his days were numbered. Rather than defending myself to him I made myself available as a target for abuse, and a few hours later he got it out of his system and thanked me and apologized profusely.
    Sometimes people are jerks or have legit complaints, but sometimes our patients are in an emotional place where they have a real need to vent anger and frustration and it can be immensely therapeutic to do so.

  • Jan 9 '13

    I have not changed my habits at all. I was never germ-phobic. In Trauma, I see far more damage done to human bodies through poor choices than lack of sanitation.
    People tend to have more dread over things that seem out of their control(germs,planes, terrorists) while drinking too much, eating poorly, smoking and ignoring signs of bigger health problems.
    We are only human.

  • Jan 9 '13

    I'm doing my OB rotation right now, and I'm seeing a lot of "augmentations" of labor on my unit. The only true induction I've seen was for someone who was 39-5 and she was losing her health insurance in 48 hours, so they wanted to get the baby out before then so it was covered by insurance.

    Even spontaneous ROM seems to call for pitocin these days. Just boggles my mind... women have been birthing babies on their own for MILLENNIA -- why is it all of a sudden a 'medical procedure' that needs to be managed???

    I asked my preceptor last week how often they see a fully unmedicated (anesthesia) birth on the unit. Her response was "rarely" -- it was kind of a big deal when they had the last one.

    Granted, some inductions are medically indicated, as are some c-sections. I myself was bound and determined to have a fully natural birth, but went to 41w and had decreased fetal movements and was induced. Later on when he had late decels and AROM produced meconium stain, I ended up with a c-section. However, it was medically necessary -- he was completely hog-tied in utero (which explained the lack of fetal movement) and never would have survived a vaginal delivery without brain damage.

    In instances like that, I'm glad we no longer live in the dark ages -- a hundred years ago, he would have been born mentally disabled or dead. Instead, while I didn't have the "perfect" birth experience I had hoped for, I left the hospital two days later with a healthy little boy who is now disgustingly happy, healthy, and smart.

  • Jan 9 '13

    Quote from LouisVRN
    I'm not an OB nurse, but as a mom who has had both an induction and a natural delivery (this past week) I did want to weight in on the subject. I had several other friends who were also pregnant and delivered within the last couple months. Out of the 5 of us 4 had c-sections. While I understand that there are many medical reasons that require c-section it seemed like an awfully high percentage that 80% required a c-section. As soon as I hit 38-39 weeks everyone began asking me when my "doctor" was going to induce me. Whether it was because my baby was measuring LGA or because I was nearing my due date I had to reassure my friends and family that this did not require an induction. My family was extremely concerned that I was going to have a midwife as my attending and that there was not going to be a doctor in the room. They also told me "take everything they will give you" in regards to medications after I had made the decision to try natural childbirth known.

    My induction was a horrible experience, especially as a first time mom. I was in "labor" for 48 hours, ended up with AROM and an epidural and as such pushed for another 4 hours. My induction was minutes from ending in a c-section. My son had to be in the NICU for 5 days (although as I was induced for medical reasons I can not say this was a direct result of the induction, although I do believe as he was having late decels he was 'stressed' by the prolonged labor). I ended up feeling completely not in control of my labor or of my first son. My natural childbirth on the other hand was entirely the opposite experience. I felt incredibly empowered and felt confident that this was what my body was meant to do and could do it without intervention.

    I feel that labor and delivery is probably the only time healthy people come to the hospital and they should be treated as such with as few interventions as neccessary to ensure a good outcome for mom and baby. As a friend I would encourage "Annabeth" to research all her options including the incidence of c-section with unnecessary induction of a first-time mom.
    could not have said this better myself. a million kudos.

  • Jan 9 '13

    Quote from losbozos
    So, what's the problem? Or the harm? Sometimes it seems a little strange but is more that we perceive it as confrontational & questioning our skills? If so, why? And if you think the patients can't see how you're feeling, think again. Birthing is an intensely personal experience that has become increasingly medicalized in the past 60 or so yrs. Welcome the birth plan; invite the parent(s) to detail it for you. Finding common ground is so important & will help the parent(s) have confidence in you. However, I do think it would be helpful for all if the providers could better inform the parents-to-be of the hospitals general routines. All of our babies go skin-2-skin & bf unless they need special attention.
    The only 'problem' I have is that patients read online all the things that they "should" want, and then they come into the hospital with unrealistic expectations because we have admission orders and policies we have to follow. Like someone wanting to waive erythro and vit K? Not gonna happen in my state. Someone wants intermittent monitoring but their attending's not around to write the order? Again, not at my institution. So I feel like it kind of sets up an "us vs. them" mentality, and that patients lose site of the fact that the nurses are on their sides (usually) but we are still bound by policies, laws, and our licenses (as well as the fear of litigation!) I don't mind the idea behind a birth plan, but most of them belong in a birthing center, not at my busy, high-risk facility.

    What I've started doing (I think as a result of advice from this board!) is just reviewing the birth plan with the patient at admission. I try to let her know that many of the things she wants, we want too (immediate skin-to-skin, infrequent SVE, her partner in the room the whole time, etc) but if there's something that's just not going to happen I let her know (Only your primary OB can change that order, so talk to him/her about that; I can only delay the eye drops an hour after birth). That seems to smooth things over and helps to manage expectations.

  • Jan 9 '13

    plus, i always say in my childbirth classes that birth plans are like Christmas wish lists--you may or may not get everything you want on the list. that seems to lace the idea with some reality! ok, back to bed--

  • Jan 9 '13

    pt requesting "clitoral stimulation" from nurse during induction on birth plan=not gonna happen

    that said, most birth plans i am coming across lately have been okay--usually printed off the internet --and i wonder if pts even have any idea of what they are requesting! i just think pts are not educated enough coming into the process and have no idea what they are talking about in 75% of the cases. i'm a childbirth educator, BTW--so biased, here.

    excuse the lack of caps and punctuation--recovering from 3-in-a-row

  • Jan 9 '13

    So, what's the problem? Or the harm? Sometimes it seems a little strange but is more that we perceive it as confrontational & questioning our skills? If so, why? And if you think the patients can't see how you're feeling, think again. Birthing is an intensely personal experience that has become increasingly medicalized in the past 60 or so yrs. Welcome the birth plan; invite the parent(s) to detail it for you. Finding common ground is so important & will help the parent(s) have confidence in you. However, I do think it would be helpful for all if the providers could better inform the parents-to-be of the hospitals general routines. All of our babies go skin-2-skin & bf unless they need special attention.

  • Jan 9 '13

    Unfortunately, my hospital is not very conducive to natural laboring. Upon admission, orders go in for everyone to be clear liquids, continuous EFM and toco, and LR running at 125 ml/hr. For any woman to come in with a birth plan is a little bit humorous because if you don't want an epidural, then why did you want to get admitted? That's truly the mentality---don't come in unless you want an epidural or are fully.

    Still, we had one birth plan state "in the event of an emergency C-section, I would like my husband and doula to be in the room, the drape lowered so I can see the baby, be able to breast feed immediately and be sewn up with steri strips, not staples." Some people want to sign a waiver for the erythro and vit K, but its against New York State law. One woman decided she wanted an epidural but not an IV, but per anesthesia pts must be bolused with a liter of fluid before they'll place an epidural. So then she capitulated but wanted an 'IV nurse' to start it. Well, the IV team doesn't start until 8am and this was the middle of the night.....

    What I don't understand is, if these women do enough research to learn what steri strips and saline locks are, then how come they don't research the hospital's policies to know if that's a place they'd like to give birth?

  • Jan 9 '13

    Like previous posters, I welcome a birth plan as a means of opening a dialog with a couple I've just met and understanding their preferences and desires. All good.

    But I draw the line when those plans involve "demands" that would prevent me from delivering quality nursing care, and I explain this to the couple. For example, "I do not wish to have IV pain medication (OK so far), and no one is to offer it to me at any time or under any circumstances (no longer OK). I understand and admire a couple's desire to avoid IV pain medication and will go to the ends of the earth to provide other comfort measures. But we all know that there are times when other measures don't work, the patient is bordering of loss of all control due to pain, and would benefit from pharmacological measures to help her remain composed and able to focus on laboring and/or pushing effectively. I have had patients at that point give their consent for a trial of IV pain meds, only to have a partner step in and try to prevent me from administering it.

    To avoid a possible scene at this point, I let the couple know at the beginning that I will honor their wishes and not offer pain meds frivolously, but if I believe that there is a dire need, I will discuss the option with the patient. If she consents, I will not be deterred by the partner, who (with all due respect) is not my patient, and will not be allowed to interfere with the necessary and appropriate care of my patient.

    Unfortunately, I have had more than one experience with overbearing men demanding that their partners not receive pain medication despite the woman's request. They have gotten a social services referral toot sweet.

  • Jan 9 '13

    Haha laminated? Rotfl!


    When people ask me "how long" I now say "ask your baby"--I get 10-20 seconds of completely vacant and then they usually start to laugh like I've made a joke

  • Jan 9 '13

    Quote from itsnowornever
    Why couldn't ONE person give me this definition?????? Thank you!!!!!
    I would hope that you would have gotten that training from your facility before being turned loose to figure it out on your own!! If they haven't put you through a basic FHR monitoring course you'd best find one and take it. Working without knowing standard definitions is dangerous both for your patients and for your license.


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