Pinky89 6,519 Views
Joined: Jan 10, '13;
Posts: 22 (50% Liked)
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I was recently in IR with my patient and had a situation that left me a little confused and upset. I'm hardly ever in IR, so I'm not sure what standard procedure is down there, but I just wanted to get some feedback from people who work there often. Not much I can do about the situation now, but I just wanted some feedback.
My patient had an extensive lower extremity DVT that extended into the abdomen. We went to IR for an IVC filter and an EKOS catheter for tPA to the area. The procedure took ~4 hours total. When I arrived with my patient, I was handed a lead apron that only covered the front of me. I noticed everyone else had more lead attire on (like the kind that covers the front & back, neck, as well as a lead apron skirt), but I didn't think much of it or really think it was an issue. I was in the room the entire 4 hours with the IR nurse pushing meds and helping with patient-care.
Towards the last 30-40 minutes of the case, a guy who worked in IR came into the room and told me I was making everyone outside the room who could see me through the glass nervous. I was confused and asked why? He proceeded to tell me that my back was not protected and that every time I turned my back to the machine/table I was being exposed to radiation. The IR nurse who I was with the entire time was right there and heard this conversation. She quickly said she didn't realize I was given a lead apron that only covered the front of me. She went out and grabbed me the correct lead apron that everyone else had on. Then she said that usually they are supposed to educate people about turning their backs to the radiation but that she "forgot." She just kind of laughed it off as an "oops" moment on her part, like it was no big deal. She said that as long as I was 6 ft. from the table that I probably wasn't absorbing that much radiation anyways. Meanwhile, I had just spent the last 3.5 hours doing all sorts of stuff in the room, including being at the table administering IV medication.
This whole situation just left me very confused. I'm of child bearing age and was in that room for quite a bit of time. I feel like if it wasn't a "big deal" the guy wouldn't have come in and said something to me. I was also upset that the nurse said I was supposed to be educated but that she "forgot." My question is, should I be worried about what happened? I feel like I wasn't given the proper attire or education that I should have been given to safely protect myself from the amount of radiation for the period of time I was down there.
I work in an adult ICU where I had the privilege of caring for a wonderful patient for 3 days in a row. She was the kindest, sweetest woman, who unfortunately had something terrible happen to her. Despite the unfortunate circumstances, her positive attitude and spirit were inspiring. Her family was just as wonderful. I grew close to her and her family over the 3 days I worked.
On the last day, I transferred her to a step-down unit. After my shift was over, I stopped by her new room to visit her and her family. I wanted to check on them, make sure they were doing ok, and let them know I was thinking about them (I was going to be off work for a few days and didn't know if I'd ever see them again). After saying my goodbyes, hugging the patient and her family, and stepping out into the hallway, the husband pulled me aside. He thanked me for the exceptional care I had given his wife, told me I was a great nurse, and wanted me to know how much I was appreciated. He started to tear up and so did I. It was an emotional, touching experience. He went to shake my hand, and that's when I felt it....the folded up piece of money in his hand. My heart sank.
Immediately, I told him I could not accept his money. But he insisted. He wanted me to know how truly grateful he was. Again I told him I would not accept it. He wouldn't listen. Defeated, and not wanting to make a scene, or be disrespectful, I put the bill in my pocket and walked away. When I got to the elevator I was so confused. I wanted to cry. I felt guilty and ashamed. I wondered if I had done the right thing by stopping by to visit her after my shift. I convinced myself that if I hadn't stopped by, none of this would have happened. And worst of all, I felt alone. I didn't want to tell any of my co-workers in fear of being judged, getting in trouble, or worst of all being fired.
I took the bill out of my pocket when I got to my car. $50. The whole drive home, all I felt was sadness. I replayed the previous scenario over and over again in my head. What I could have said. What I should have done. When I got home, I put the $50 bill on my kitchen table. I decided that I wasn't going to spend it. I couldn't even think about spending it. I looked at it over and over. The guilt never subsided. A few days passed, and that's when I decided what to do.
I found a non-profit organization that dealt with the same condition that she unfortunately had to experience. Then I made a donation in her honor using the money her husband had given me. Instead of keeping the money, and feeling guilty, ashamed, and sad, I decided to turn this experience into something positive. I knew that the patient and her family wouldn't want me to feel upset, and I wasn't going to let myself be upset either.
Put in the same situation, I would have told the husband that if he wanted to thank me, he could write about his experience on our hospital survey. I would have told him to recognize our unit and our nurses as the best. Because we are.
Sometimes being a nurse can be a thankless job. We provide our patients with exceptional care despite hospital-wide budget cuts and staffing shortages. We come to work early and leave late. We don’t always get breaks. Sometimes we don’t even have time to use the restroom. We apologize for things that sometimes aren't our fault. We get can get spit on, bit, kicked, and be manipulated by patients. We work in high-demand, high-stress environments that would break the weak. We are exposed to all types of bodily secretions. We are advocates for patients who don't have family. We speak up for those patients who society has given up on; the homeless, the drug and alcohol abusers, prisoners, and gang members. But when it's all said and done, we have the honor and privilege of caring for patients and their families at their most vulnerable time.
I don't know about you, but I think our job is pretty awesome. And while I'm still uneasy about receiving money from my patient's husband, I know that he did it because he wanted me to know how much I was appreciated. How much nurses are appreciated. Because we are the heartbeat of the hospital. And we make a difference each and every day.
We tape ours to the ETT securement device, not the actual ETT.
"The new Grad of today mostly BSN track are the worst nurses on the planet."
I find it hypocritical that you start your post expressing your disapproval of RNs who make comments that are "unprofessional" and "rude," then you make a generalized statement about new grad BSN nurses being the worst nurses on the planet. As a graduate from a BSN program, I find your comment offensive and rude. It shouldn't matter what school you went to, whether you have a diploma, ADN, or BSN degree, or how many titles you have following your name, what matters is that the patients get the care they deserve, and that we all work together to make that happen. Isn't that why we chose this profession?
Pinch the skin really hard while you inject. Patients always tell me that my pinch was worse than the actual shot and that I give the best shots! It really works
On our busy med/surg unit we give report to the oncoming shift in the hallways, usually at the med carts or where ever we can find some room. This can be frustrating at times (especially on day shift) at shift change because family members, patients, and basically anyone who needs a nurse at that moment sees us in the hallway "talking" and they think it's an appropriate time to interrupt us. Last night one of my patients was a one day post-op right hip replacement who was a 2 assist with a walker to stand and pivot to the bedside commode. The aid and myself got her out of bed twice together, so we both knew her very well and how she ambulated. Later that night this patient needed to use the bedside commode again and the aid wasn't available so I asked another nurse to help me. This time, I felt the patient did very well and could have gotten to the bedside commode with only 1 assist. Fast forward to shift change and in the middle of report, the patient's call bell goes off and the aid goes in to help her. The aid pokes her head out and asks if I can come in to help her get the patient to the bedside. I explained to the aid that I felt she was capable of getting her up with only one person because the last time I was in there she did very well. I have worked with this aid many times and I know her capabilities (which is why I felt she was able to do it without me), so I didn't think it was necessary to break away from report at that exact moment to help her. The aid was very irritated with me and went back in the room to help the patient, only later to approach me and say that what I did was wrong. I explained to her that the last time I got the patient out of bed she did better than before and I felt only 1 assist was necessary.
Was this wrong of me to tell the aid that she was capable of getting the patient out of bed? Maybe I should have interrupted the report to help her, but I really felt she was capable of handling the situation while I finished report.
We recently upgraded to the IV pumps in the picture. Have had nothing but problems with the pumps beeping constantly about air bubbles (when there are clearly no bubbles to be seen) or high air pressure, when the IV flushes perfectly fine. The only thing these pumps are good for is giving me more exercise because of the amount of time I spend running around to shut them up! The company apparently added a valve at the end to help "fix" these problems, but I have yet to see a difference. Has anyone else experienced this?
Great post! As a new nurse, I found all of your points on the list helpful! Thanks
Wow I am so sorry you are going through this I am also new to med surg, but I had a 10 week orientation. I didn't even start caring for three patients until my 4th or 5th week! It seems as though your unit does not have an adequate orientation that includes weekly feedback and positive encouragement from a preceptor? Maybe you could inform your nurse manager that you haven't even had any evaluations or anything checked off yet, and ask how you are supposed to care for 4 patients without proper support? Do you have a preceptor?
From experience, the first couple of months starting out were the scariest, most stressful, longest months of my life. I don't think there was one day that I went home without worrying about possible mistakes, or what I could have/should have done in certain situations. Just absorb everything you see like sponge...good & bad. That's what I do and I learn so much. About asking questions..don't ever stop! I think people got frustrated with the amount of questions I asked during the first few weeks and honestly, as long as it kept my patients safe, I didn't care who got annoyed. Asking questions is the best way to make sure what you're thinking, or doing is correct. I too also became easily distracted and when multiple things were happening, I had a hard time prioritizing my time. You'll learn as you work more what needs to be taken care of first. I don't how it happens, but things just eventually start to click. You'll start using your critical thinking and stuff just makes more sense. Trust me, it takes time but at some point it happens. Keep your head up! You just need more support and more confidence in yourself and you will find things become much easier. Find someone you can confide in, find a good brain sheet, and keep asking questions. Good luck!!
I really struggle with giving report and thinking about it gives me anxiety when the shift is coming to an end. I feel like we never got really good practice in nursing school and were basically just thrown into it once we started, expected to know exactly what to say. I also think some nurses get frustrated with me when my report takes too long, which usually happens because I don't want to miss anything important. I know there was just a recent thread about it, but I'm looking for advice about how to make my report more concise and thorough, while leaving out useless information that I think is important (which really isn't). How do you remember everything? I feel like I write so much stuff down and then when it comes time to give report my mind goes blank, or I accidentally skip over something I wrote down. I usually spend the entire car ride home after a shift beating myself up over what I could of/should of have said and what I could have left out. Any advice would be much appreciated! Thanks in advance!!
I inserted an NG tube and checked for proper placement, both by auscultation and pH. Both confirmed it was in the stomach. The doc ordered the NG to be hooked to suction, so immediately after checking placement I hooked it to the suction. I completely forgot that before anything happens with the NG tube it has to be confirmed by x-ray for proper placement! Luckily someone else caught it after it had only been hooked to suction for about 30 min. I felt so stupid, but was relieved when the x-ray confirmed it was in the stomach. I'll never make that mistake again!
I scrubbed in on open heart surgery during an OR nursing course in nursing school and I was allowed to put my hands around the patient's heart at the end while it was beating. Pretty cool!!
I've been working with Epic since I started my job a few months ago and I love it. I've used a few other charting systems through my clinical rotations, including Powerchart (which I didn't like), and I found Epic to be the most straight forward and easiest to maneuver. Once you learn where everything is and some of the shortcuts for finding information fast, it's great.
Thanks so much for your response and encouragement! Honestly, every day gets better and better. I feel so much more competent/organized than I did when I first started this discussion. It's amazing how much you learn in such a short period of time. I get flustered very easily, and it's hard for me to think straight when I do. Your advice about stopping and taking time to think is very helpful and I should do it more Thanks for your insight and advice!!
Thank you everyone for all of your input! Reading all of your comments has been very helpful. I'm happy to know that others have heard of this practice, as when I asked some of my co-workers they had no clue what I was talking about! Obviously the most important thing is following the policy of our hospitals (which I don't believe mine has a specific policy for or against using a separate IVPB tube), but I did ask an IV therapy nurse what she thought and she said I should use a dedicated line for each IVPB, so I guess that is what I'll do until I'm told otherwise or any evidence-based research is done. This would certainly be an excellent evidence-based practice project for our unit if there were more evidence to support it!
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