What have other nurses done that have freaked you out? - page 58
What have other peers done intentional/unintentional to freak you out? Good or bad. Happy or sad. On my FIRST day as an LVN, (LTC) a res was screaming in her room as I was walking out to leave. I... Read More
Jul 5, '10Quote from twotrees2I find your post to be VERY interesting. I am a CNA/nursing student working at an ALF. We have a resident with severe dementia (she really doesn't belong in this facility). She is extremely anxious and is often "wild". She also is constantly rubbing her back. She often lies on the couch and moans and groans. There are also times she is hardly able to walk due to her back pain. I really feel bad for her because it sucks that she is in pain all the time. I have repeatedly mentioned to the administrator that she really should be prescribed SOMETHING for pain. Yesterday, I mentioned it yet once again when I observed the resident sitting on the couch with a pained expression on her face. The administrator has decided that there is no need for any kind of pain meds because the resident is faking it. Riiiiiiight.unfortuantley many nurses dont feel poping pills is a good thing even for chronic pain - i live it so i have no trouble at the first sign ( rubbing knees, groaning mildly , anxious, as clues need to be deemed from the dementia who wont just say i have pain) giving pills -perhaps they relate the sympoms to "just the dementia" instead of taking a closer look?? i dont know but many a day i come in and have to get my dementia patients who have "been wild all day" to a comfortable level where them they will be ok again. just a theiry
Now, I am wondering if her extreme anxiety is caused by her chronic back pain....
Jul 9, '10Quote from TheCommuterThis saddens me to the core....it sounds like acceptance of the worst possible care....if it is a time factor...then why was one of the CNA's sitting behind the desk reading a paper....and to say that pain and anxiety are non emergent is short sited.It greatly helps to place one's self in the shoes of the CNA, especially a LTC CNA. I work at a nursing home, and each one of my CNAs is assigned 12 to 15 patients each. They simply do not have the time to sit with one patient for an extended period of time when there are other call lights that need to be answered in an expedient manner.
In addition, most LTC facilities suffer from high employee turnover and attrition rates, so the DON usually won't bestow severe punishments upon lazy staff members. The DON is just happy that a warm body has arrived to fill the necessary shift. In addition, there's typically not enough quality time for most LTC nurses and aides to devote to non-emergencies such as panic attacks and screaming. Few, if any, procedures are done by the book in LTC. You'll learn as you spend more time in your new LVN role.
To just accept and resign yourself that nothing is done by the book is totally depressing to me.
We all must individually strive for excellence especially with this frail and vulnerable group...IMHO and yes I have worked LTC as an NA,RPN and RN. I know specialize in geriatrics and ER.....
Jul 9, '10Quote from CrazierThanYouThis is so sad.....since when does an administrator make medical decisions....who is the charge nurse and where is the doctor. She would likely benefit from some regular analgesic and topical analgesia depending on what is causing the pain. She may even need an x-ray. Continue to advocate for this patient.I find your post to be VERY interesting. I am a CNA/nursing student working at an ALF. We have a resident with severe dementia (she really doesn't belong in this facility). She is extremely anxious and is often "wild". She also is constantly rubbing her back. She often lies on the couch and moans and groans. There are also times she is hardly able to walk due to her back pain. I really feel bad for her because it sucks that she is in pain all the time. I have repeatedly mentioned to the administrator that she really should be prescribed SOMETHING for pain. Yesterday, I mentioned it yet once again when I observed the resident sitting on the couch with a pained expression on her face. The administrator has decided that there is no need for any kind of pain meds because the resident is faking it. Riiiiiiight.
Now, I am wondering if her extreme anxiety is caused by her chronic back pain....
Jul 9, '10Quote from gentlegiverwow i wonder if she ever got any urine return???LMFAOOOOOOOOOOOOOOROFL!!!!!!!!!!!!!!!
Jul 9, '10Quote from Bat NabasYou start............I love reading about others' mistakes as much as we all love telling about others' mistakes! Would anyone be brave enough to tell us about a mistake they have personally made, and what they did if anything to rectify it? It's harder when it's yourself.
Jul 9, '10Quote from JessicRNNot mine, but we dilute in at least 50ml and hang it as a piggyback over at least 15 minutes.Promethazine is buffered with acetic acid-sodium acetate and has a pH between 4.0 and 5.5. That is stronger then some chemotherapy medication. Because of this too many accidents just like shooting acid into a vein. This drug has been banned by ours and every facity I know of due to the danger.
Jul 9, '10Quote from BlackheartednurseAren't they compatible? I don't think this is a mistake. There is a thread right now in one of the ICU boards on here that discusses options for drips if you are running out of access.1. A nurse running dopamine and dobutamine for unstable patient in the same IV line.
Jul 9, '10[FONT="Lucida Sans Unicode"]Before I begin...in case anyone is wondering, I have posted several of my own really dumbheaded mistakes on here previously.
One time a nurse took it upon herself to access a Tunneled Dialysis Catheter to draw labs. She didn't have a Nephrologist's okay, and she was neither a Dialysis nurse nor an IV-certified nurse. And she proceeded to attach a CLC cap on the end with a PICC extension.
Oh, but it gets even better!
So after she accessed said Dialysis Cath (using instructions from THE INTERNET, not our internal intranet that specifically states who may and may not touch such access), she drew the labs and left it at that. The patient was admitted with a substantial DVT and a Heparin drip was ordered. The IV team hadn't been able to obtain access earlier (and phlebotomy couldn't stick the patient, hence this nurse's BRIGHT idea).
Now, if I had taken it upon myself to mess with this patient's Dialysis access, I at least would have started the Heparin drip in it, right? (I know, it's not right AT ALL, but is logical when using her thinking).
But no...she didn't notify the doctor or even the charge nurse of the situation! I know one of our awesome surgical residents could have had an EJ in this patient in NO time and wouldn't have even needed consent for it.
Yeah, I'm really glad I wasn't the nurse following her that night. I'm also really surprised the nurse following her didn't strangle her. I admire her restraint.
Jul 9, '10Originally Posted by StNeotser View Post
Day shift nurse gives report saying she doesn't understand why newly inserted foley isn't draining. I said I'd take a look. Foley did not drain because it was inserted into rectum.
Jul 12, '10I once returned a page for a surgeon while operating- nurse from the floor wanted to communicate the results of an obstruction series. Report that there was a confirmed obstruction. Wanted to know if (s)he should feed the patient. Now, I'm not a med/surg nurse, but I know that confirmed obstructions should be kept NPO with NGT. The look on the surgeon's face (obviously I can't give an order to stay NPO) was absolutely priceless. Good thing I didn't have the speaker phone on, because the nurse would have heard some rather unsavory language.
Jul 12, '10Quote from MattiesMamaWell, you could be right, and you could be wrong. There is NO truth to the rumor that every COPD pt. is a CO2 retainer, no matter WHAT you were taught in school. When in doubt, give the Os! orders are for the usual, and perhaps this nurse just might have known this pt. better than you did, and was walking away to arrange transport or to call the doctor. My point is, just because she did not discuss it with you does not mean that she was ignoring the situation. or, perhaps you are right and she was a total screwup. Either way, his death probably could not have been prevented. It was pneumonia, and COPD pt.s are at high risk. Not all deaths are causable, or preventable; as you will learn as you grow in this profession.During my psych clinical, as our CI was giving us a tour of the facility, a man who was in his wheelchair in arm restraints wheeled himself up to our group and asked if any of us had a knife. One of my classmates, trying to be helpful I guess, said "no, I have scissors though" and proceeded to take his bandage scissors out of his pocket and hand them to the patient. Luckily my CI intervened and plucked them out of his hands before he could do any damage.
This same guy was my partner during one of our first clinicals...we were giving AM care to a male patient who was a new admit and a bit embarrassed at the whole process, so my classmate assured him "it's ok dude, we have the same equipment, and Mattiesmama has seen her way around her share of penises!" :smackingf
(He graduated last week-god help us all!)
This one is more sad...at another clinical, more recently, I took a patients O2 sat and it was in the low 80's...alarmed, I notified the charge nurse who said she would take care of it. About 20 minutes later I went to check on him and he was unconscious, barely breathing, and starting to turn blue. His O2 was on at 10 L/minute and he had COPD. Thinking she had made a mistake I turned it back down to 2L (which were his orders) and sent someone to get the charge nurse again while I tried to arouse him, and did a quick assessment on him-his initial RR was 8/min and his O2 sat was 66 but they started to climb as soon as I lowered the O2...The nurse came in and proceeded to ream me out for changing the oxygen flow, paying no attention to the patient who was having retractions and struggling for each breath right in front of her. I tried telling her that he had serious crackles in both lungs (you could literally feel all the junk that was in there, it was vibrating...awful) but she ignored me, put him back on 10 L, and walked away. I was at a loss-so I just ran to my CI and told her what was going on-and she proceeded to open a can of whopa$$ on the charge nurse and within like 2 seconds a code was called and he was transfered to the ER (which was ACROSS THE STREET, mind you, not a difficult transfer by any stretch) He was promptly diagnosed with pneumonia (duh) and died a couple days later. I was a basket case after that one-I've had patients die on me before but I still feel, to this day, that his death could have been prevented.
Jul 12, '10While travel nursing I had some interesting situations dumped on me:
1. CNA accidentaly shut of the heparin drip while clearing pumps for I/O's. I came in a good hour after the fact to start my shift, RN never called MD to figure out what rate to restart it at. She was "busy" and "never got around to it." So, the heparin had been off for well over an hour at this point.
2. Walked into somone in bed, ceased to breath. Apparently, pt. had arrived to the unit from the ER like that and the nurse on the unit was battling the ER nurse on who had to do the paperwork (since the pt. was never technically admitted to the unit). Unit RN refused to admit the pt. just to D/C them as ceased to breath, was so busy running around gathering evidence that the pt. had ceased to breath prior to leaving the ER.........she left the body and paperwork for me to deal with.
3. Was called into a room once by an RN (years experience RN we are talking about here) cause she couldn't figure out why the connector for the IV site didn't work right. She was trying to hook tube feeds up to the IV, cause the pt. was on TPN before during another stay and that was where it went. She insisted I was teasing her and "being old fashioned" when I explained you could not do that. Then got mad when I informed her I would refuse to pick up the pt. if she did do it.
4. Had a nurse insist I was being "jaded" and was not "pt. focused" because I refused to give tylenol #3 to a liver failure pt. He had been complaining of pain and she called the doctor, got the order but hadn't had time to give it, so I was supposed to. Why on earth would I want to call and get a different med? It'll just make him wait longer, such a jaded nurse I was.
5. Was called a "know it all" and was told I didn't follow hospital policy BY A CHARGE NURSE when I refused to follow her advice and cross my hip replacement pt's legs "to promote blood flow".
6. Was told I was "a meany" by a nurse when I tried to point out to her she could not give all the meds/interventions the doctores ordered. Why? She called FOUR.............4.......doctors with the same issue all at one time. Told them all about the pt's C/O constipation. So, doctor #1 called back, ordered colace and enema. Doctor #2 called back.....was not told about #1's orders, and ordered magcitrate. So on so forth for four doctors. In the end, she was going to give well over 1000mg of colace, three enemas, magcitrate and dolcolax PO.
I also knew a nurse when I was a CNA who routinely gathered her meds, marked them as given then tossed them in the trash. Couldn't be bothered with "those old bitties who take forever to swallow one pill and have tweelve to take."Last edit by eriksoln on Jul 12, '10
Jul 19, '10Quote from adrienurseJust remembered another
I had a resident on my LTC unit whose husband was in a wheelchair because of a stroke (but who still lived independantly in the community). He was visiting her in the evening around 8 pm. All of a sudden I hearing protests and a scuffle down the hall. Agency HCA was trying to undress him to "get him ready for bed".
I don't usually comment on such old post but that is sooo funny lol gosh! part of the reason I never worked agency I like to know the place I'm working at.