Latest Comments by macawake

macawake 52,881 Views

Joined Jan 1, '13. She has '10' year(s) of experience. Posts: 1,246 (97% Liked) Likes: 9,740

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  • 9
    Coffee Nurse, Irish_Mist, AJJKRN, and 6 others like this.

    Quote from Been there,done that
    It was unprofessional of your manager to mention it. You are all grown up, your black eye is your business.

    Honestly, I don't understand your comment. While victims of abuse aren't the only people who attempt to hide their bruises, it is common behavior in abuse victims and an indication that might be what's going on. If you do encounter this, I think reaching out to that person is the decent thing to do, whether you happen to be in a managerial position or not. It's just something I would do from one human being to another. Do you think the manager and other coworkers should just keep on ignoring it, even if their colleague keeps showing up with new bruises and perhaps worse injuries? Domestic violence is a killer. I think we owe it to each other to try to help a fellow human being who might be living under threat.

    From some of the sports I practice, my forearms and shins are often black and blue. While people at work can't see my legs, my arms are quite visible. When I was new at work, many of my coworkers would ask me why I was bruised. I appreciated their concern and by now they know it's from sports and I don't get much comments. The occasional patient does however ask me about it.

    OP, I don't know how you got your bruise but I will echo the advice offered by previous posters. If you are in a abusive relationship/unsafe situation, please do seek help.

  • 2
    WestCoastSunRN and BeckyESRN like this.

    Quote from missmollie
    When speaking to co-workers, try to use polite phrases such as "please" and "Thank you", and don't make demands.
    I get the feeling you'd hate working with me After many years of working in law enforcement where you often get to tell grown-ups how they can (or more often how they can't) behave and expect to be obeyed, my communication style is very direct and eerrr.. utilitarian. Most of the time it's not tempered/softened by polite niceties. In my defense, I don't bristle when someone asks me to do something in an equally direct manner. And I always say thank you after a person did what I asked them to do

    Since I started my nursing career I've been told by female coworkers on more than one occasion that I have a very "masculine" style of communication (whatever that means ), which is something I never heard in my previous career (well, at least not from coworkers ). Probably because we all communicated that way and no one thought it was odd.


    Quote from missmollie
    TLDR: Another nurse really made me fume when she stated I had to do something. I never have to do anything unless I make the decision to do it. That is the basis of nursing. We don't do something because the doctor said do it, we make educated decisions. Request, don't demand.
    I guess this really shows how we all interpret things differently. For me personally, if another nurse had called and said "You have to come down here and pick up this item", I wouldn't really view that as a demand, but rather a neutral statement that something needs to happen. I wouldn't feel like s/he was bossing me around and it wouldn't be important to me that they said please. Depending on my work situation at the time I'd either reply that I'd do it, or if I didn't have the time or disagreed with the request, I'd either explain that now doesn't work for me or why I think it's the wrong move and instead try to find an alternative solution to the problem that works for both of us.

    I guess my attitude is that I'm at work to get the job done (whatever it entails) and so are my coworkers. If someone asks me to do something that has to do with work I don't feel that I need a "please", because I don't view it as doing someone a favor. I'm just doing my job. The same goes if I'm asking someone to do something. It's not a personal favor to me, it's just something that needs to be done (ultimately for the benefit of a patient/patients). And as I said, if I have issues with the request itself, I will voice my objection, but I really couldn't care less if I'm asked in a "sweet" way or not.

  • 5
    poppycat, Orion81, Nurse Leigh, and 2 others like this.

    Quote from Truth_be-told
    No doubt the RNs who had the money from parents or wealthy spouses to afford to go through 2 years of school instead of 1 year are hostile to this idea and their egos will be assailed at the notion. Others will make up stories about how they donated blood to pay their way through RN school, or starved or lived off of cheese sandwiches for 2 years or ate lint off the carpet to get through RN school, but even when true, they are the exception, not the rule.
    Quote from Truth_be-told
    For that matter, I have a total of 10 years of college under my belt, my first Masters degree in secondary education didn't pan out, I got an associates degree in a different field that I found repetitive and boring, so by the time I waited to get into the LPN program, I was burned out with school, writing dazzling research papers, etc and had no desire as i grew older to work FT and go to school.



    Okay, I am dying to know... Did you have a wealthy wife who supported you while you got that Master's degree or were you doomed to an anemic existence, surviving on a diet consisting of cheese & lint sandwiches?

  • 7
    elkpark, dishes, subee, and 4 others like this.

    Quote from lonewolfiern
    "Don't hang around any physician forums, but I have to wonder if they are in the habit of disparaging education the way I often see nurses doing.. ************************************************** *****************
    Quote from lonewolfiern
    MD's are the worse! What are you talking about! LOL!

    My hubs is a Simulation Manager. Every physician specialty has to come to the Simulation Center to perform their scenario to prove competency. The MD's hate it, as they already know how to do it!
    Well, hello there... You know, when you respond to someone and add a "lol" it might give the impression that you are mocking what the person you responded to said.. Frankly, it sounds a bit snooty & superior.

    Also, if you want to make sure that your reply actually makes sense, it's helpful if you include the entire paragraph you were responding to, instead of just half of it. LMAO!

    This is how it went...

    Oh, and remember... the title of this thread is "BSN is a joke"..

    OP wrote this...
    Quote from nurseguy22
    Yet here I am getting trained in areas I have no interest in, and will never ever use in my career. And for what? So I can say I have 3 letters behind my name and the school and hospital can make more money? Its a joke.

    My response to the above quote was...
    Quote from macawake
    I don't hang around any physician forums, but I have to wonder if they are in the habit of disparaging education the way I often see nurses doing.. While degrees aren't the be-all and end-all of our earthly existence, I guess I don't understand the negative attitude towards them.
    See, what I was commenting on doesn't have much, if anything, to do with what your "hubs" teaches. I was obviously talking about academic degrees. ROFL!


    Okay, I've had my fun The rest of the post is a serious response.


    These kind of BSN vs ASN threads pop up on a regular basis and I am always saddened by them. It's funny how I've never seen a thread started by someone with a BSN, MSN or DNP saying how bad diploma or ASN nurses are (simply because I don't think the vast majority of nurses with those degrees hold that view, I know that I don't), but I've seen many where BSN's are disparaged. I do think that it's counterproductive to voice contempt against professional degrees in your chosen profession. It's the exact opposite of promoting yourself and your profession. You are telling the world that the education you have or the education that your peers have is crap. How does that reflect on us all? Does anyone think that will strengthen the position and image of our own profession if we loudly and publicly badmouth the educational requirements?

    I stand by my original post. I've often heard nurses complain about stupid APA formatted papers and research, but I've never heard a physician whine that they had get a higher academic degree in order to practice as physicians. Have you ever heard a surgeon witch and moan that s/he had to do all this APA garbage, when all s/he is doing all day long, is cutting people up? I mean, that's one heck of a task-oriented job. Who cares if they know the difference between a high quality randomized trial, case-control design or a retrospective comparative study? Just give'em a scalpel...


    Quote from BostonFNP
    The more I read posts on this debate the more I think the crux of the issue really has nothing to do with degrees, coursework, application, or outcomes but rather with one group either feeling or being made to feel they are 1. left on the outside or 2. less of a nurse. It becomes so personal that way that implicit bias trumps any logical argument or data to the contrary.
    I think you hit the nail right on the head.

    These discussions almost always feel very emotionally charged, and not always rational/fact-based. Since I have never thought of any nurse as "less than" based purely on level of academic accomplishment, I am always a bit surprised when a poster feels the need to launch a seemingly unprovoked broad-brush attack on every single BSN-holder (or rather the quality/value of their education). I'm sure that some schools are academically more demanding and others are somewhat lower in quality, but that isn't in my opinion a good enough reason to designate a BSN degree, a "joke".

  • 2
    sevensonnets and brownbook like this.

    Quote from luckykitkat
    Hi, i work in a rehab facility wherein we get different patients everyday. Everytime you have a 2-day off, most patients are strangers to you. It's not a long term facility. So when we have no doctors around, and we get results from an ordered lab or diagnostics, we would call the on call doctors. Many would just want me to read what the results say and what meds theyre taking. But I have trouble with communicating to some doctors who want an in-depth information about the patient. It's so difficult to find the right answers.

    Id say "Doctor, this pt has this diagnosis, age this, takes these medications, she was ordered these because she had symptoms of this"
    then the doctor would be like "be more elaborative with your information. You know her more than me."
    Quote from luckykitkat
    Im the desk nurse and the med nurses are the ones who really spend time with bedside care. Paperworks are my responsibility. So there were times when i would excuse myself and run to the med nurse and have them talk to the doctor, and if they dont know either they would just say "i dont know her doctor, she just came in a couple of hours ago so i dont know how she was in the past." Then the doctors would just kinda sound as if they give up. Any tips on how i can be a better informant to on call doctors?
    If I understand you correctly you work in a rehab facility and most patients don't even stay two days in your facility? Those are very short stays. I don't really understand which role the stay at your facility fills in the patient's "care path"? When do patients come to you and what criteria have to be met before they are discharged? What kind of decisions does the on-call physician have to make over the phone? I assume the patient is seen by a physician/provider in person before they are discharged? Also, your job from what I understand is purely administrative and the so called med nurses are the ones who meet, assess and chart on the patients? I assume though that you have access to all of the patient's charts? That would mean that you have two possible ways/sources to find out more about the patients, the med nurse (who can of course ask the patient pertinent questions) and patient charts.

    If many or most on-call physicians are happy with the the report you give them (the lab results etc), I suggest that you ask the physicians who want more in-depth information specifically what it is they want to know/what kind of information they want included in the report. Perhaps if they ask specific questions instead of just a general/vague request for more "in-depth" information, you might actually already know the answer. Otherwise you'll have to get back to them after finding out (if possible). This way you'll learn what type of information is valuable to them and the next time you'll know to try to find that information before making the call.

    Doctors are individuals with individual quirks just like the rest of us and I don't think that those who want more specifics necessarily want the exact same information. In my opinion it's better to ask them directly rather than asking us. If you find out what their expectations are, that will likely reduce friction/improve communication and patient safety going forward. Ideally for safety reasons, I think that the same healthcare professional who actually has eyes on the patient (the med nurse in your situation), should be the one making the report to the physician but if this is how your workplace has organized things, I guess you can only try to make the best of what you have to work with. The fact that your role is something of a "middleman", might contribute to some of the frustration that you and/or the physician might be experiencing when giving/receiving report.

    Also, I personally think it's helpful to organize the information I want to convey in a standardized format. SBAR (Situation-Background-Assessment-Recommendation) is great, if you're not familar with it there's information on the internet. I think it's a good way to communicate clearly and minimize the risk that important information is overlooked.


    Good luck!

  • 11
    vintagemother, poppycat, CCRN89, and 8 others like this.

    Quote from jay_prn
    I went into my studies not sure what type of nursing I wanted to do. I never thought I'd enjoy my OB rotation but it ended being my favorite rotation. I loved it. My current clinical instructor for advanced med/surg is an OB nurse, and she arranged for me to shadow on the L&D unit and help out at a pregnancy fair. The nurse manager on the unit took notice of my work and asked me to apply for the nurse residency program once I graduate. "I want to hire you," she said.
    Quote from jay_prn
    I love the work of OB and the feedback I've received from clinical instructors and other nurses is that I would shine in this field. But bearing in mind the fundamental principle of healthcare/nursing praxis, "do no harm," I am concerned that a man in OB might be too controversial and divisive.
    You've found a specialty that you find interesting, seem enthusiastic about and you have received positive feedback regarding your performance. I say; follow your heart. I'm sure a few folks might think you've chosen an odd specialty, but I personally wouldn't let that bother me.

    Quote from jay_prn
    I didn't have any reservations about it until I posted an article about men in OB nursing on Facebook. While the overwhelming majority of responses were positive, there were those who professed a strong and passionate objection to men in the OB field. That childbirth is a uniquely female experience, and men can never relate to their patient as closely as a woman nurse can, was one reason given.
    I've heard some women express that opinion, but I don't personally understand it. It's the same as saying that you can't be a good oncology nurse or oncologist unless you've had cancer, and I don't believe that to be accurate either. I'm convinced that both men and women who can't have or choose not to have children can still be excellent OB nurses.

    Quote from jay_prn
    The concern for women with a history of sexual abuse and trauma and how a male nurse could reintroduce feelings of trauma or open up emotional wounds was another.
    I had the same gynecologist for fifteen years. An excellent physician, he was someone whose professional skills I trusted and whom I felt comfortable with. When he retired I had to go searching for a new doc. I had one annual checkup with this new physician, a female. She was awful. I told her before I left that it was a good thing that I don't have any traumatic sexual experiences, because if I had, her cold (arctic) demeanor and malfunctioning motor skills (seriously rough examination) would certainly have triggered flashbacks. I found another physician who also happens to be female and I've stayed with her since. She's exactly what I want from a doctor, 100 % professional with a caring attitude. My point is; it's the level of professionalism and personality that makes me trust a healthcare professional. Their sex isn't important. I suspect many, perhaps even most, people feel that way.

    I'm sure that there are some victims of sexual abuse who wouldn't be comfortable with a male nurse or physician regardless of their level of professionalism, but that doesn't worry me since you seem to be sensitive to the needs of your future patients. With your insights I'm sure that you'll have no problems understanding and respecting if a patient expresses that they prefer a female nurse. There are many reasons a patient might prefer a same-sex nurse or physician. In my opinion it's important to respect a patient's wishes/autonomy regardless of what specialty we work in.

    Quote from jay_prn
    Finally, many women expressed that, in the current cultural/political landscape, women need more safe spaces where men are not present.
    Don't let the fact that you have a commander-in-chief who brags about his *****-grabbing skills keep you from choosing a career which seems to be one that you will enjoy and be good at.

    Sorry... completely off-topic, but couldn't help myself there...



    Best wishes!

  • 57
    deannejo, Cococure, ilovemypup, and 54 others like this.

    Welcome to AllNurses.

    Quote from nurseguy22
    Yet here I am getting trained in areas I have no interest in, and will never ever use in my career. And for what? So I can say I have 3 letters behind my name and the school and hospital can make more money? Its a joke.
    I don't hang around any physician forums, but I have to wonder if they are in the habit of disparaging education the way I often see nurses doing.. While degrees aren't the be-all and end-all of our earthly existence, I guess I don't understand the negative attitude towards them.

    I live and work in a country where nursing has been BSN-entry level since the 90's. If you want to work as an ICU nurse, OR nurse, anesthesia, ambulance (pre-hospital medicine) or as a midwife an MSN is required. You can also get an MSN in surgical care, medical care, psychiatric care, pediatrics, geriatrics, oncology, district nursing and probably a few more that I'm forgetting. The latter ones aren't required, but they are encouraged. They all involve APA format papers/research.

    University studies are free for the student (funded through taxes) so education is basically just a cost for society. Yet someone still figured that education has value and that it was worth the cost....

    Quote from nurseguy22
    Its a joke. I'm learning nothing of value.
    You're the only one who can change that. Your education will be what you make of it.

    Quote from nurseguy22
    My patients don't care if I can wrote a wonderful APA formatted paper. They just don't.
    While it's true that your patients probably don't care even a little bit about your APA formatted papers, they surely benefit from having a research-literate nurse caring for them. Both the medical field and the nursing field is evidence-based. I suggest you spend this time to gain more knowledge regarding how to critically read research. That way you might even feel like you've gained or improved a useful skill. (I wrote gain or improve because for all I know, you already possess the fundamentals or more, but there's in my opinion always something new we can learn that will deepen our understanding of a given subject matter).

    If you've decided to get this degree, why not make the best of it and try to enjoy what you can?

    Good luck!

  • 7

    Quote from jeastridge
    In its place came the pain scale that we use today and the altogether new approach, "A patient's pain is what they say it is." Unspoken was the undercurrent that pain is the enemy to be removed completely whenever possible.
    Well, I think that most people agree that pain negatively effects quality of life and as nurses we know that it has many physiologically detrimental effects on the human body. So yes, I agree with thinking of pain as an enemy. It's only really useful in the ultra-short term when it signals to us that we should pull away from/stop doing whatever's causing the pain in order to protect us from sustaining further injury. Beyond that, it's just one huge stressor on the body.

    Quote from jeastridge
    Studies show that initial dependency often happens after surgery for orthopedic problems, wisdom teeth or other "routine" procedures.
    Could you provide links to those studies?

    Quote from jeastridge
    I tried to point out in my article that chronic pain is a separate category and that there are no easy fixes--no one size fits all--when it comes to pain management. I hope that I was clear in pointing out that one of our primary concerns as nurses is for us to begin to shift our teaching--especially with acute pain--so that narcotics become second line drugs instead the go-to answer for short term pain management.
    Quote from jeastridge
    Teach better.

    We can start now with modifying how we teach our patients about narcotic use for post operative pain and chronic pain. Simply taking time to discuss non-narcotic pain relief legitimatizes it and helps it be the first line of defense when pain begins. NSAIDs, Tylenol, ice, heat, distraction, music, topical analgesics are all part of our arsenal of tools for addressing pain. The simple expectation that narcotics are a second choice can open doors for patients who are looking to manage their pain in ways that don't promote dependency.
    (my bold)

    While I have no doubt that you are well-intentioned I always worry when I read posts like yours, describing the problematic "opioid epidemic" and suggesting that the solution to it can be found in the acute care setting, and in how we manage postsurgical pain. I think that this fear (sometimes bordering on hysteria/moral panic in my opinion) of causing addiction negatively affects many patients, both individuals who suffer from chronic pain and patients who have recently had surgery.

    There's nothing wrong with a multimodal approach to pain treatment for postsurgical patients (the same goes for chronic pain) and I'm not saying that many of your suggestions don't have merit. They do. But opioids often (almost always, unless the surgery is very minor) have to be the first choice in the immediate period following surgery. You will not cure the opioid epidemic in the acute care setting. It's not the time nor the place.

    Pain isn't "innocent", it isn't a mere nuisance that we can stoically suffer through without any ill effects.

    Undertreated postsurgical pain results in needless suffering for the patient. The sustained stress response that is the result of undertreated pain causes elevated catecholamines, cortisol and increased catabolism. That is not beneficial. It increases anxiety, leads to poor sleep, limits mobility, increases risk of thrombosis, pulmonary morbidity (both pneumonia and embolus), suppresses the immune system, delays wound healing and increases the risk of infection and also increases the risk of the pain becoming chronic (persistent postsurgical pain).

    Please don't let your fear of opioids make you undertreat your patient's pain. It will hurt them.

    Before I became a nurse I've had half a dozen surgeries, several of them traumas. Fortunately I had nurses and physicians who weren't in the least bit scared of opioids and they treated my postsurgical pain to as close to zero as they could come. That allowed me to heal and do my physiotherapy and recover fully with no sequelae. I never needed opioids for much more than a week after any surgery and sometimes just days, but they would have treated me for as long as it was necessary. I'm glad I had knowledgeable healthcare professionals.

    These days, I make sure that my patients are as pain-free as I can make them.




    "Old-ish" but still relevant:

    Improving the Quality of Care Through Pain Assessment and Management - Patient Safety and Quality - NCBI Bookshelf

    Understanding the physiological effects of unrelieved pain | Practice | Nursing Times

  • 5

    Quote from applewhitern
    It isn't that unusual. I have worked in a large hospital that did not allow the nursing assistants to take care of the opposite sex. The female nursing assistants took care of the females, and the males took care of the males. Never seemed to be a problem.
    Does that mean that the hospital also didn't allow opposite-sex OB/Gyn's and urologists or were nether-region physicians of the opposite sex deemed acceptable? I suspect I know the answer to that but I'm asking because I'm genuinely curious to find out if different rules apply to different professions, despite the body parts being the same.


    Quote from applewhitern
    I can't believe you guys find that odd. Many females prefer a female assistant, especially when placing a urinary cath or something. No reason to not accommodate them.
    I agree there's no reason not to accomodate patients.

    Personally, I find it odd for two reasons. First, it's something that doesn't exist in my country. While patients are always free to choose their caregiver, all employees are hired to be able to take care of all patients. Second, it must put a massive strain on whoever does the scheduling. If all staff can only care for ~50% of the patient population, you always have to make sure that staff gender mix is roughly equal to patient gender mix, on any given shift. Seeing as how the gender mix might change from day to day and it might not be possible to reschedule staff according to gender on short notice, I guess that on some days female patients get good care, and on others it's the men's turn. CNA Bob calls in sick and CNA Sue is available to cover that shift... Nope, doesn't work. Need a male replacement (assuming there's no male nurse on duty either), or the male patients will have to spend the whole shift in soiled briefs...

  • 6

    Quote from elkpark
    While I agree that being willing to only provide care for one gender is going to be problematic in most healthcare settings and may, in the end, be simply unworkable, I don't see any reason to be dismissive of anyone's religious beliefs. That's not a road I want to start down.
    I'm not sure if you're suggesting that someone has been dismissive of someone's religious beliefs in this thread?

    I was simply wondering if there actually is a religion that forbids men to care for women and women to care for men. It struck me as odd. I don't know of any, but that doesn't mean they don't exist. Hence the request for a clarification.

    OP only mentionened non-life/death situations, which I took to mean (perhaps mistakenly) that it would be okay for a "opposite-sex" healthcare professional to help out in life or death situations, but not otherwise.

    The problem I see is that there are many situations/conditions that a patient can experience, that while not immediately life-threatening, are still extremely uncomfortable, undignified and even painful. I'm trying to understand/find out if there is a religion that specifically dictates that a human being has to have this experience/suffering prolonged even when there is a medical professional present who is qualified to relieve the suffering, but due to their biological sex is forced to simply let the uncomfortable/undignified/painful situation continue until someone of the same sex as the patient, shows up/has time. I'm hoping that isn't the case but as I said, I don't know.

    Quote from Shananigan
    OP, consider private duty options. If it's private duty through an agency, you might be able to request only male patients.
    That sounds like a good idea to me. I don't know if CNA's do home care in the U.S.? If they do and the agency/employer finds the idea of male-only clients acceptable, it's a good way to ensure that no patient suffers because a member of staff is unable to care for them.

  • 27
    nrsang97, h00tyh00t, Horseshoe, and 24 others like this.

    Quote from Firas5
    For religious reasons I cannot do females.
    ?



    Quote from Firas5
    I cannot understand how, in a non life/death situation, where a male and female CNA is available, a male CNA is changing/toileting, cleaning and dressing a woman, while on the other side of the curtain, a woman is doing the same for a man. Thats crazy and there's no explanation for this.
    I might seem crazy to you, it doesn't to me. To me, we're first and foremost human beings. We have much more in common than differences. We laugh, we cry, we love, we hate, we hurt, we bleed. And sometimes we need help because we're injured or sick and can't care for ourselves.

    When I studied anatomy and physiology, there wasn't a man book and a woman book. Of course there was a chapter or two to cover the differences, but that's it. The essence/core that makes us human isn't really the physical body, but rather the thoughts, feelings, our actions and the hopes and fears that we all have. My advice is to help the human being in need, instead of fixating on the few body parts that are different. You think it's crazy that a man cares for a woman and vice versa. Personally, I think it's crazy to allow body parts define who you can and can't care for.

    Imagine the impact on healthcare if all staff (CNAs, nurses, physicians etc.) refused to care for human beings of the opposite biological sex...

    Forgive my ignorance, but do religions that forbid people to help a human being in need actually exist? Is there really scripture text to that effect or is it someone's interpretation? It's just seems wrong to me. Helping someone should be something we could all agree on is a "good deed".

    Quote from Firas5
    Does anyone know any facilities in NYC or queens where they don't give male CNA's females?
    As I'm not in New York or even in the U.S., I don't. The only places I can think of are all-male prisons or similar.

  • 20

    Quote from joeygiglio
    Can I be discriminated against for political beliefs?
    Quote from joeygiglio
    With colleges and i'm assuming places of work being very liberal is there any way I could not be able to become a nurse because of me using my first amendment rights and expressing my beliefs?
    I'm not sure what you're asking exactly. Though I'm not an American I'm still reasonably sure that there aren't any questions on the NCLEX regarding your donkey/elephant status. You should be able to become a nurse if you pass all the required exams and background checks etc. I'm sure you already knew that so I guess what you're really asking is whether your (over)sharing regarding your political beliefs on social media, might negatively affect your employability and career advancement opportunities?

    You know what, I once had a boss who'd always chew with his mouth open when we had lunch. Gross habit. I was completely within my legal rights to share my opinion of his manners with him. However, just because you can do something, doesn't mean you should

    The First Amendment doesn't have much to do with this. It doesn't protect you against what people (such as your managers) will think of you, and like it or not what people in power think of you does affect their willingness to hire you and to promote you.

    So if your future managers and coworkers thinks that Trump walks on water, you're in luck. (Assuming those are the views you express on Facebook). If they don't, perhaps it's wiser to not share your admiration for him on social media. That's simply being career smart and doesn't have anything to do with free speech. Those of us who live in democratic societies enjoy free speech and don't have to worry that our government will jail us if we criticize it, but our family, friends, neighbors and employers are still free to think that we're idiots for what we say.

    It's really your choice. While you have a legal right to debate politics on Facebook as much as you want, you need to decide which is more important to you. Debating to your heart's content or keeping a low profile, thus minimizing the risk that you alienate people who you might want/need to view you in a favorable light. This is true no matter which career you choose and no matter what political views you hold.

  • 13
    xoemmylouox, Kitiger, 3ringnursing, and 10 others like this.

    My husband took a picture of me when I first got back to day surgery and I was grimacing and crying in pain. As my head cleared, I looked around and saw that I had a blood pressure cuff on but it wasn’t attached to anything, in fact, there was no monitor in the room. Not once was my pain level assessed or not one vital was taken.
    I don't work in the U.S. so I guess policies might differ, but here if you need to be continuously monitored you should remain in the PACU and not be allowed to return to the floor until certain respiratory, circulatory, neurological and urinary output criteria are met. We also won't release the patient to the floor until pain is under control at VAS 0-3 and at least 15 minutes has passed since the last iv opioid administration.

    Generally speaking, I'm not overly concerned by the fact that a patient isn't on a monitor once they've left the PACU (assuming they are stable) but the fact that your pain level wasn't regularly assessed and reassessed (and treated) and that your vitals weren't checked is in my opinion unsatisfactory.

    OP, I'm very sorry you've experienced this and I hope that you have healed well after your surgery.

    My whole point of writing this is to voice my experience with post op pain control. I feel that sometimes it can be inadequate due to the nurses’ misconception of the role of anesthesia and pain control in post op care.
    Undertreatment of pain is one of my pet peeves. I think that many nurses are afraid of respiratory depression and tend to undertreat because they are afraid to harm their patients. But I also think that there's an unfortunate attitude present at times. I've even seen it here on this forum where members have expressed an opinion that many patients have an unrealistic expectation of how much pain one should have to experience efter surgery. The attitude is something like; surgery hurts, don't be such a baby, grin and bear it. I don't agree with this attitude. Pain can and should be treated to a degree where the patient can comfortably function.

    I think that some nurses believe that the undertreated pain is only temporary in nature (a short-lasting nuisance) and that it can't have any negative long-term effects. Not true. Undertreated pain comes with a host of unwanted effects and can actually lead to persistent postsurgical pain that can last a lifetime, which of course will affect quality of life. (All surgical procedures can result in chronic pain but some carry a higher risk of that complication, for example; cardiac/thoracic surgeries, breast surgeries and amputations). Treat your patient's pain!

    To completely understand the human body's stress response to surgery and the harmful effects of unrelieved pain, one has to commit many hours to studying. (A good place to start for those who are so inclined might be the HPA axis ( hypothalamic–pituitary–adrenal axis)).

    In short unrelieved pain triggers and prolongs the endocrine response; ie the release of various hormones such as (but not limited to) cortisol, catecholamines and glucagon. Insulin levels decrease. The increased endocrine response in turn initiates a slew of metabolic, cardiovascular, respiratory and genitourinary effects. What effects can you expect from unrelieved pain? Well, cardiovascular effects like; increased heartrate and cardiac workload, increased systemic, peripheral and coronary vascular resistence, increased oxygen consumption and hypercoagulation & dvt's. Respiratory effects; decreased tidal volume and decreased functional capacity. Increased risk of infection, atelectasis and hypoxemia. Also many metabolic effects; hyperglycemia, insuline resistence and muscle protein catabolism. And of course; urinary retention/decreased urinary output and fluid overload. (I'm too lazy and tired to look up the proper references/sources so this is from memory, but I think I got it right).

    Surgery and postoperative pain is a humongous stress on the human body (surgery is traumatic). We have the power to if not remove, at least minimize the amount of stress inflicted on our patients.


    Please, just treat the damn pain!

  • 10

    Quote from DesiDani
    Please share how your employee handled the situation and how you dealt with it.

    Did you mean to write employee or employer? I'm just wondering if what you're interested in learning more about is the managers/supervisors/the bigwigs' perspective and how they've dealt with situations when a member of staff has received threats or if you're wondering if we (the underlings ) feel that we've been supported by our employers when we've been threatened?

    I haven't really received any threats that I considered truly scary in my nursing career. Because of a previous career, I'm quite accustomed to threats and have reached a point were the "heat of the moment" kind of threats don't faze me. Sometimes I think I've depleted my lifetime adrenaline supply I don't have the energy to get scared, I lean more towards annoyance or anger. Probably not entire healthy, but it is what it is.

    People who are under a lot of emotional strain, or those under the influence of alcohol or illicit drugs can spout a lot of crap. Even people who are normally relatively well behaved can act out of character when they are scared, frustrated or experience loss of control (due to for example illness). I'm not saying that being sick and scared or being drunk/high makes it more acceptable to threaten others (it's not), my point is that I seldom perceive these threats as genuinely frightening.

    I have on more than one occasion responded with a "put a cork in it" to promises to slit my throat or similar, when I've felt that the person was merely acting out/trying to provoke a reaction and that they wouldn't even remember the threat they uttered the next day, or for that matter recognize me if we met again. I've only been genuinely scared on two occasions, neither have been during my nursing years. The reason they scared me was that I knew that they had the means and definitely compelling motivation to carry out their threats and the threats were more "long-term", rather than acute in nature.

    These days I seldom encounter threatening patients or family members but it did happen on a semi-regular basis when I worked in the ER. Most of the times I found that talking to and listening to the offender would be enough to calm down the situation. When that didn't work or wasn't a suitable/feasible approach to the particular situation we had to call security or the police. I have restrained and placed a patient under arrest after he attacked a physician and on three separate occasions (if I recall correctly) given witness testimony to the police when patients have physically attacked coworkers or threatened them in a manner that was serious enough to warrant a police report/arrest. I think it's important make it clear to those who really cross way over the line (and I'm not referring to patients with dementia or TBI or similar), that society doesn't tolerate that kind of behavior even if the perpetrator happens to be a patient.

    I have always felt that I work in a supportive/zero tolerance environment.
    I've never had a manager who thought that violence against healthcare professionals is acceptable and I wouldn't accept one who did.

  • 6
    h00tyh00t, HermioneG, Irish_Mist, and 3 others like this.

    Quote from spotangel
    I turned around and looked Ms. Carpenter in the eye and said, “Put that knife down now.” They both stared at me and slowly lowered down their weapons.
    Once she lowered the knife and turned to grab the phone, I moved away from the stool I was sitting.
    Ms. Carpenter was in no way deranged or mentally unstable. She was a bully and like all bullies backed down when confronted. Her MO was always to get people out of the apartment and once the cops showed up, she put on another face. I have had situations with psychiatric pts when I always stand ready to take off at a moment's notice! She was not one of those.
    (my bold)

    Oh, for crying out loud...

    Your original post certainly conveyed a lot of drama with a liberal use of exclamation points and words and phrases designed to paint a picture of a situation fraught with peril and emotions running high.

    Now you're saying that the mad, knife-wielding Ms. Carpenter wasn't at all unstable (I beg to differ, fetching a "wicked-looking" knife to threaten another human being with is neither stable nor remotely normal), and that you knew all along that all you needed to do was to confront her and she would back down.

    This raises several questions. Why were you in such a hurry to complete the task and why did you flinch, hoping this was just a bad dream if you were so in control of the situation?

    Why did you ask me in a previous post to explain which way I would have turned for safety, towards the knife or the weight?

    Quote from spotangel
    Macawake , just curious, which way would you have turned for your safety; towards the knife or the weight? The wall was behind me and the pt's legs in front.
    I certainly interpreted your question as meaning that you felt you didn't have an obvious solution to this problem. Wasn't that what you were attempting to convey? Why ask me if you knew all along that you could have just told the "bully" to back down?

    This latest addition to your story really begs the question; if you could easily have put a stop to this earlier, why on earth did you allow the procedure to continue? You chose to let an individual who had previously had an intimate relationship with your patient and who you knew your patient was afraid of witness a very personal procedure and stand a few feet from her exposed genitals, brandishing a knife. Why on earth would you make that choice? I honestly don't think you protected your patient the way we are expected to.

    I'm curious, if the ex-lover had been male instead of female, would that have affected the way you chose to handle this situation? In my opinion it shouldn't, the gender of an abusive partner/ex-partner doesn't make a difference to the victim. They are both scary and capable of doing psychological and physical harm.


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