typoagain 3,439 Views
Joined: Jul 31, '08;
Posts: 76 (45% Liked)
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I have to say it depends on the situation.
I once had a patient who had pain meds ordered Q4 hours PRN for post-op pain. She would set an alarm to go off 3 hours after she got her medication and then you immediately start hitting the call button demanding her pain meds early. After 2 or 3 days the nurses went to the doctor with concerns about her abusing PRN meds. Especially since she never once said her pain was less than 10 out of 10, even two hours after being given the pain meds. She would literally wake up in the middle of the night because her alarm went off and start complaining her pain was 10 out of 10. But if we were in the room when the alarm went off we could reach over and shut it off before she woke up. And she would sleep until her next round of vital signs. One of the other nurses actually tried it. She slept nearly 7 hours.
The doctor said to just give the pain medications and let him know of any adverse reactions. He also wrote in an order for Narcan.
About 5:30 a.m. one morning she was on her call light demanding her pain meds. And so I pulled the meds and gave them to her, just like the doctor said to do. Then when I went around at 6:30 to check on her I found her sleeping. But I was unable to arouse her. So I got the charge nurse to come in who also could not arouse her. So she got her dose of Narcan.
Needless to say she was wide awake in seconds. And she was throwing a wall-eyed fit about how much she hurt.
You should have seen her face when I told her she could not have any more pain meds and why. I also explained that even if we gave her more medication it would not work until the Narcan was out of her system.
Fortunately it was the end of my shift and I didn't have to deal with her anymore. When I came back that night she was giving everyone hell. She kept on demanding pain meds. But much to her disgust the doctor had DC'd all narcotics. He discharged her the next day, without any narcotic pain meds. But she did get a referral to a pain specialist. He also informed her that she would need to find another physician.
I don't know what the laws are in your state. But in my state if you don't report something like this, then you could lose your license.
The nice thing is you can file a report online anonymously and it will give you a case number. If you keep the case number you have proof that you filed a report (to protect your license) and no one has any way of knowing you're the one who filed the report.
I've been an RN for a dozen years now. And I have family member with the type of hearing loss you're talking about.
I hate to say it, but if I was to lose my hearing to that degree that I would be looking for another career the next day.
I'm getting older and half had a very slight degree of hearing loss. Unfortunate that is good electronic stethoscope can overcome my hearing loss. You need to understand, my hearing loss is so slight that you would not notice it in normal conversation. But it is severe enough that I have to use an amplified stethoscope and pay particular attention just to do my job now. I know of way I would be able to provide patient care with a profound hearing loss.
Now there are jobs nurses can do that do not require them to be able to hear at all. But the vast majority of those type of jobs require advanced nursing education along with several years of experience. And then their job is more along the lines of administration with no direct patient care.
How would love to hear some of the things coworkers have done at work that just make you mad and frustrated.
For example, the other day we had a lady who was clearly terrified of needles. Now we all have patience claim they're scared of needles. But this lady was a little different. She came into the ER clearly in pain and flat refuse to let the doctors draw any blood work, or start an IV.
She had abdominal pain but would not allow us to do anything that involves a needle. Try to figure out a diagnosis for abdominal pain without being able to do any kind of lab work or use any kind of IV contrast.
Now I'm not the first nurse involved in taking care of this patient. In fact, I actually asked to take over care for this patient because nobody else was getting anywhere. After sitting there and talking to her for 20 minutes I finally got her to agree to let me draw blood do doing finger sticks with micro tubes just like I would have a very small child. So I went to gather up the necessary supplies.
Now I am a new employee and was oriented to the ER. My preceptor took it upon himself to walk in and try to convince the lady to let him start an IV. She's already told for people know she would rather leave. She had even said she would rather go home and die then let someone stick her with a needle and she was crying when she said so.
When I got back she was signing the AMA paperwork and leaving and nothing I could do to stop her.
. I've been a nurse twice as long as he has I just happened to be new to the hospital. I think he was wrong and out of line.
What do you think?
Thanks for letting me vent. I really needed it.
I've been thinking about this ever since I read this thread a couple of days ago. Today I remembered something. My very first semester of nursing school I had a teacher who told us something before our very first clinical. She said that any time we have meds they have to be within our reach or in a locked medroom. If we left a med at the computer station and walked four feet away from it so that we could not reach the med, and were seen by clinical instructor, we would get a clinical failure for that day.
Understand, two clinical failures and you failed that class AND were dismissed from the nursing program.
Now this is not an instructor I liked. In fact, it was one of the instructors I really disliked. But I guarantee you if she had a rule she had a darn good reason for having that rule.
I've been doing this long enough now that I think I actually know what happens. The fact is the only time anyone gets in trouble for calling themselves a nurse is it they are lying and actually working as a nurse without a license.
It does happen. And people are prosecuted for that.
Sadly enough, it is left up to the local district attorney to prosecute. All the all the board does is make a referral. Many times people are fired from jobs where they have been working claiming to be a nurse for several months and are never prosecuted. That is, until they've done it 2 or 3 times.
I just find it very difficult to believe there are so many long-term care facilities that don't check to make sure a person has an active license when it is so easy to do!
Oh don't get me wrong, they get mailed if they use the title RN or LVN. The states mail's out a list to all nurses every quarter of people who are in trouble and being prosecuted for just that.
What they let them get away with doing is saying quote "I am a nurse." As long as they don't say "I am an RN" or "I am an LVN" they let him get away with it.
I don't know about you, but I never introduced myself to my patients as "I am your registered nurse" Instead I just walk in tell them my name and say "I am going to be one of the nurses caring for you tonight."
1 milligram every 6 hours. I would never question it. In fact I'm wondering why so far between doses? Is it an elderly patient or do they have some disease that will keep them from metabolising the drug. Do they even stock vials of 1 milligram dilaudid? The smallest I've ever seen was 2 mg.
If they do it with one med, they will do it with others.
If you charge that the patient took the Med then you are saying in a legal document that you witnessed them taking the Med.
Say you went to a patient left them at their bedtime bedside in for 3 days in a row they drop the pill on the floor and it rolled under the chair they were sitting in and was never taken.
For three days because of your carelessness they did not get there digoxin.
When they go into afib, develop a blood, clot, and then have a massive stroke it is 100% your fault.
Or she tries to pick up the pill and knocks the cup over. The pill then rolls across the table to her another resident suffering from dementia picks it up and takes it. Then if something happens to the second president you are responsible.
There's lots of ways patients could die because you did not watch someone take a pill.
If I have to walk across the room and turn my back on a patient that edd goes with me.
Besides, there's too many Druggys sickos out there who will swallow anything simply because it looks like a pill on the outside chance it might make them high.
Yes I would have written you up. In fact I would have seriously considered firing you
I begin my career with seven years in pediatrics. Then I transferred over to the ER at the ER directors request. Lo and behold we got a new er director shortly after that. A year and a half later I did what many of us do, I quit my boss and went to work at another hospital.
The new hospital has an extremely busy er that handles a large number of trauma cases. It's a nice facility that's only 10 years old. And it has a great team of nurses. But the local economy has been booming and the bottom line is they just do not have the resources to handle the volume they need to.
Then last week we had an incident where I had three patients, all of whom were ESI level 2. I had one patient going in and out of a fib. Another in afib who had just had a stroke. And another with an altered mental state that we could not figure out what was causing.
I was fine until the 3rd one got sent to the ER and they brought me in and auto accident victim with a head injury.
My teammates stepped in and gave me a ton of help but we very nearly had an error made that could have been fatal to one of my patients. Even though I had a lot of help it was still my patient in my responsibility.
After several days I've decided that was it two years in the ER was enough for me. I liked having a license.
I met with my boss and turned in my notice. 2 hours later I was interviewing and offered a telephone nurse triage job at the same facility.
I think it will be a very good career move due to other things going on with my family. Plus it is something I have actually considered doing before I ever went into the ER.
Now my question: what do I need to do to get ready for this new job that starts in 3 weeks to make myself the best at doing the job?
In my state, Texas, you can call yourself a nurse if you work in a doctors office. You can do this with even wirhout getting a high school education much less any further training. It is an old old loophole the doctors used to use to get inexpensive help in their office. Legally the doctor is responsible for everything they do. And they are working under the doctor's license not their own.
I run into it all the time and I hate it.
I generally respond by asking them for some quote advice on a topic that I am sure they know nothing about. I do this using the biggest most technical terms I can find. I love the look of utter confusion and stupidity they get on their face.
My favorite is "I have a patient with cholecystolithiasis and they're asking for dietary recommendations. And an embarrassingly enough, I am drawing a total blank.
Can you think of any?"
if you don't want to work nights, holidays and weekends, then basically you need to get out of nursing.
You are going to need a lot of experiance before you get anywhere close to the hours you want.
As for the money, if I quite working nights, weekends and holidays withthe same exact job I currently have (like they would ever allow that) I would ben up taking about a $250 a week pay cut.
I have a co-worker that went the D Ramsey route big time. She went on a working rampage for 3 months and pain off $48K of her mortgage in three months.
For the next 6 months her husband worked 2 jobs.
They not only paid off their house-along with ever other bill they had. They ended it by taking their 2 kids and all four grandparents to 3 days at Disneyworld and then 5 more days on a Florida beach.
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