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Cinquefoil, BSN, RN 7,052 Views

Joined: Oct 3, '08; Posts: 198 (36% Liked) ; Likes: 242
Specialty: 2 year(s) of experience in Med Surg, Home Health

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  • Feb 17 '16

    Great topic, TheCommuter.

    Discipline. Now that I am working as a HH RN I feel my LACK of it as a slowly tightening noose around my neck. I could bang out a visit in 15min- 1 hour, soup to nuts, and make lots of money. But I lollygag. I dillydally. I take my time, and I see 3 visits where I could be seeing 5.
    Disciple. As a woman of a certain age, I need this in my life. In what I eat and drink, and how I move my body. What am I doing in my spare time? Reading, AN, junk tv, too many carbs and too much wine.
    Discipline. In what I say, to whom and when. I still say the first thing that pops into my mind all the time. I have to get a leash on it. If you tell me to do something, I will likely do the opposite. I'm a brat.
    Discipline. I used to make a list and bang it out. It's a vicious cycle. The more time I have on my hands the more time I waste.
    Discipline: My house is a mess. Meh.

    Discipline. I need some.
    Maybe later.
    I don't know where all of this went.

  • May 13 '15

    SS, patient here. I'm really sorry if offended anyone ever.

    Just going to try best to clarify some points.

    1.If we say 10/10 while not looking it, is due to preventibg it.
    ex. a Sicklers pension for pain is limited. After a certain point, who we are in and out of pain completely changes on endurance.

    2. If we're distracting ourselves, we do it to managae the pain. If you don't see me in pain, its because We hate writhing, but that is not always controllable.

    3.A lot of us have evolved in different ways, psychologically mainly. We will reserve/steel ourselves if we think we must, usually this is done keep family and self from crying, we do not purposely mean to be rude. Unless the person actually is rude, which is scarce to me.

    4. When you make preconceptions, we suffer, greatly. Yes, there are people who have crazy high tolerance and seems to be pursuing drugs. We as humans who go through dependence may believe we are addicts because of the sheer amount of painkillers to get someone to stop screaming. One doctor paced my room for an hour while I screamed in pain, I could tell he was worried over some reprecussion. That day I wanted to scream at him, but I didn't, I assumed that a minor recieving hydromorphone was serious and gave benefit of the doubts he wasn't doing it on purpose. Perception is the key concept.

    5.We can intensly dislike hospitals in general. After so many hospitalizations, and pain, I'd gotten tired with the judgements, the holding back and perceptually endless waiting times. Pain compresses time! It wasn't the staff's fault though, it was the psychological rebound. I'd get sad every time I went to the hospital, tired of the pain killers, tired of feeling numb, tired of the **** feeling and constipation, tired of being alone, all around pretty much in an emotional pit, caused by the chronic illness itself and the reprecussions.

    6.When it comes to Sicklers, some of tire quickly, this can imprint on personality for a while, or forever.

    7.I haven't been able to sleep, throwing up, etc. as an example, If If an episode sent me to the hospital right now, I wouldn't be a prick, but I have a difficult time staying friendly and showing courtesy. This isn't on purpose, as the pain gets worse, our cognitive functions alter in variable ways. Attitude change, patience, level of thought put into human interaction becomes difficult to process.

    7.Some of us have to rush to the hospital alone. This is never a pleasant experience to anyone involved, we're sorry for that.
    For this reason, some have caretakers, my mom being mine. I become sad myself making her cry. If this happens, I'm not going to be prick (no one derseves it), but I won't be concerned with politeness.

    Please keep in mind, I am just one sufferer of Hb.SS, and all I've written is from my personal experience, another sickler can be completely different!

  • Mar 24 '15

    This is a huge issue everywhere, and not just in home health. ADL's, range of motion, even if some of your CNA's are trained in some physical therapy aide stuff--I believe that would all be billable.

    I agree, and it is sad when trained aides are having to stock and clean.

  • Nov 19 '14

    No one is saying that someone with psych issues doesn't deserve love, they probably need it more than anyone. But someone in the middle of a crisis should not be starting a relationship with her caregiver.

    And to play devils advocate, what if he contacts her, she feels completely creeped out, but because he knows so much info doesn't feel she can turn him down? He is in a position of power here, that's why it's wrong. He may have felt a connection but she may not have.

  • Jul 20 '14

    Quote from BostonFNP
    Just because you may "doubt" it doesn't mean it isn't true. That's why studies are done in the first place, because gut feeling isn't the way healthcare should be practiced.

    It's the scientific process.
    I know this is sounding like a broken record, but correlation between two pieces of data does not always equal causation.

    There are many variables to consider. Hospitals with a higher percentaage of BSN RNs also tend to be in big cities. They have more funding, better staffing ratios, better equipment, better access to specialists, etc then their counterparts out in the sticks.

    The hospitals that have a higher percentage of ADNs and LPNs, on the other hand, tend to be rural..... which makes sense when one considers there are huge swaths of isolated areas where community colleges might be the only access to higher education.

    Now, I'm not saying the degree a nurse possess has no impact on patient outcomes. That would be insane. But anyone who has worked in healthcare knows that a hospital's monetary resources, its access to diagnostic equipment and to specialized physicians all play huge roles in patient outcomes.

    We know that areas underserved by universities will also be areas with lower percentages of BSN prepared nurses. These areas also tend to be less cosmopolitan and less affluent than areas with high percentages of BSN nurses. So, in addition to having fewer BSNs, hospitals in these areas will also have less funding, less equipment and higher nurse-patient ratios.

    My question is: Is it really fair to conclude ADN nurses provide unsafe care as a result of their education, when they statistically tend to be working with fewer resources and higher ratios than their BSN counterparts? Doesn't that skew the data, at least a little?

  • Jul 20 '14

    These studies were done primarily when ADN's with years of experience in the field started going back to get their BSN's in order to move into management positions. I believe sincerely, that when an ADN with years of practical experience goes back to school, he/she will come back to the profession with more innovation and creativity and perhaps more zeal for the the profession. However, I believe that in the years to come when these studies are repeated, they will find that having a BSN outright does not improve outcomes. I am a novice ADN practicing, and working toward my BSN. I can tell you that I have not learned ANYTHING new yet. Just more about what I already learned in my most excellent education as an ADN. It is nice to have the review, but to pay for it and be denied chances at employment for it, no.

  • Jul 2 '14


    I won't comment on the time management thing, because even though you could probably trim some fat off your night, ie..back rubs, chats with patients, I think your problem lies in the shift itself, and the metabolic disorder. How can you even be fully functional when your body is crying for sleep?

    Between the rocky marriage, lack of sleep and metabolic disorder, I'm afraid you could be heading to burn out. You have a lot of negatives on your plate with those three issues. Do you do anything positive for yourself? Who fills your glass at the end of a shift?
    Taking care of yourself is first and foremost THE most important thing you can do for your patient.

    Your hospital staffing sound a lot like a facility I endured and I burned out to the point of leaving the profession. I should have left prior to the 16 year mark, but I didn't and it harmed me. Can you switch to a different floor and shift? And if not at that facility then quit and move to another that has a day shift position?

    You sound like an excellent and caring nurse, which is what gets us in trouble with burnout.

    See my quote below.... (((hugs)))

  • Jun 12 '14

    The best thing that the OP can do for the nurses that are being taught is that we are 2 people. A nurse, and a person outside of being a nurse.

    In nursing practice, it is always best to have a content of character--and to smarten up. It doesn't matter one bit if you find obese people repulsive, or any number of other health conditions that require the assistance of a health care TEAM. One can go home and tear any patient to shreds on their own time.

    However, moving forward, if one has an obese patient, who is bedbound/can't move well whatever the case may be, then as nurses we need to advocate and speak up for the patient--PT/OT (as how in the world are they going to go home and be able to do a thing for themselves) dietary to talk about eating (as obese people can't just stop eating calories--there's a whole science behind it that a dietician can speak with them about) and equipment needed at home (discharge planning--OT).

    In general, nurses should learn that no patient at no time should be embarrassed to seek health care. And to push judgements on any patient for any condition (ie: lazy, dumb, undisciplined....and DON'T even get me started on the molester reference) is not good practice. Period.

    We take care of people who have a loss of function. Our goal is to get patients to their highest functional level. Regardless of one's personal beliefs on the condition of the patient.

  • Jun 1 '14

    The poll should have another choice-"call the MD,clarify the order"

  • May 31 '14

    On certain weekends during college I would spend the entirety of the time that the library was open studying; I would get there at 9am and not leave until 11pm, and still I thought this wasn't enough, especially if I had an exam that week. I got good grades (not great), I was no over-achiever compared to some of my classmates. That's not to say I wasn't academically competitive, I was and I still am. I honestly think it's the only thing I have ever been competitive about.

    On my last day of clinicals in my last semester on the last week of college, I made a mistake A BIG ONE.

    I was on the Labor and Delivery unit for my preceptorship. I was just getting over a cold so I almost got sent home that day, but I insisted that I wasn't sick anymore and it was my last day so I really wanted to stay.

    I had a high risk patient with maternal Diabetes and an STD. She was already in labor but the possibility of an emergent c-section was high due to her risk factors. We had to infuse an antibiotic quickly so that the baby wouldn't get an infection on its way out of the birth canal. She was also allergic to penicillin which prompted us to use a different antibiotic than usual.

    My Preceptor (RN) gave me the bag to hang, she said "just open it wide up." The antibiotic we were supposed to use was 100mg of Unasyn, the bag that the pharmacy had sent up and put the patients name on was 100units of Humilin (a fast acting insulin). I hung the bag only checking the patients name and birthdate. Neither I or my preceptor checked the name of the medication, and there was no electronic medical record at the time. This resulted in the patients' blood sugar dropping to 40 and an emergent c-section. In the end neither the mother nor the baby were injured in any way, but that's not to say this error wasn't damaging.

    I was initially told that it would just be a ding on my record, nobody would even find out....

    On the morning of my pinning I got a text from one of my instructors saying "hey did you check your email?" Of course I hadn't since it's the week of graduation and everything is done already. So reluctantly I opened up my email and it stated that I would not in fact be graduating, and I would have to repeat my last semester due to this one mistake. I finished reading the email, and when I had finally realized what it entailed, I screamed... I cried bloody murder so loud my roommate thought my mother had died or something. To me it was the worst thing that could have happened, and to top it off my boyfriend at the time broke up with me that same day. I felt like I hit rock bottom, things could only get better from here, right?

    Despite having the worst morning ever, I did in fact walk the stage that night, and as soon as I started the next semester, things were starting to look up. During my final semester I got to precept under my idol (the president of the nursing program at my college) in a pediatric oncology unit, I participated in the California gubernatorial debates, and I presented my research at the pediatric society of nursing conference in Las Vegas. It was an exciting and challenging time in my life.

    After I graduated, I spent 5-10 hours a day for a month (yes every day) studying for the NCLEX (the RN licensure exam). When I took it, the computerized exam shut off at the minimum amount of questions: 75. And two weeks later I found out I passed the test.

    As a kid you are told that you should "work hard, go to college, and get a good job so you can be successful". And there I was; I had worked hard my whole life towards being a nurse, and now I was...sort of. So after getting my license I started applying for nursing jobs daily. In the mean time, I worked as a waitress at Outback Steakhouse.

    I probably applied to over 200 jobs over the course of a year. The amount of applications per day that I was submitting would wax and wane depending on how I was feeling. After months of applying for nursing jobs, and not hearing back from any of them, I got really depressed. No one wanted to hire me; I was living in my parents' house, working a job I could have gotten out of high school, and realizing everything I learned as a kid was a lie.

    I didn't understand why nobody wanted to hire me; I graduated cum laude, did extra projects, and even had a job working as a student aid in the nursing sim-lab. How was I not a prime candidate? What's so awful about me that you can't even give me the time of day to respond to my email?

    I often glorified the past in my mind; I missed college, when everything was exciting and challenging, and now that was all gone. I was at a stand-still. I realized I was never going to get a nursing job in California; not as a new grad anyways. This was my defining "now what?" moment.

    My friend, Colleen, who I went to nursing school with, was living in Hawaii, and she had just gotten a job in a new-grad nursing program at Hilo Medical Center. I saw this as my opportunity to get out, even if I couldn't get a job at the hospital right away, at least I knew they were hiring nurses in Hawaii. And on top of that I was tired of waiting around in California for "my life to start." So I dropped everything, and bought a one-way ticket.

    When I first got to Hawaii, I got a job as a waitress at a local restaurant called Cronies. Even though I didn't have a nursing job yet, the change of scenery made me happy; I had minimal responsibilities, no one to call home to, and plenty of time to spend on the beach.

    After about a month I got hired at a clinic, it wasn't the ideal nursing job, but beggars can't be choosers right? The job was only going to be part time, so I kept my job at Cronies. And thank the flying spaghetti monster* I did, because I actually only ended up working at the clinic for about a week. I got hired on Monday and fired on Friday. They gave me a lot of silly reasons why they fired me that mostly added up to "people don't like you." It hurt my feelings that people didn't like me, but it hurt even more to think that if I couldn't even keep a stupid clinic job, how was I gonna keep an acute care job? It was worse than if they had not hired me at all.

    Once again I felt like a failure, I felt incompetent, stupid, not-worthy and I was a stranger in a strange land. I felt so bad I was paralyzed; I couldn't get myself to open a computer and look at a job application for months. When I finally did, I got hired at a long term care facility. Four months later I got hired at Hilo Medical Center in their new-grad nurse program.

    I have now been living in Hawaii for over 2 years, and I just completed my first year of acute care nursing. The most important thing I learned during this time was that failure is an option, in fact it's likely, but I also learned that I have the strength to get back on the horse and try again, bruised and battered as I may be.

  • May 29 '14

    Quote from Dranger
    Yup everyone gets a gold star like first grade or little league
    This is why I suggest developing a more mature perspective. I have no intention of going tit for tat, so I'll just stop there.

    OP, none of us meant to make you feel worse about making that one mistake. We all make a mistake, it's true. When it comes to scrubbing the hub, however, there are ways to make it into as natural routine as not forgetting about your pants . It's very unlikely that your patient will suffer serious adverse outcome from that single incident. Nurses do sometimes omit (or shorten) scrubbing in emergencies where every second counts. There are, however, neutropenic patients, for whom you should always always keep aseptic technique when accessing their central lines.

    I think that about sums up this thread pretty well, minus the petty arguments...

  • May 26 '14

    Ok, I'm getting sick of this.

    Nurses: calm down and stop being so hard on yourselves!

    I don't think the problem is that we are all secretly "Nurse Ratchet". I think the problem is that many nurses are really nice people who are extremely stressed out.

    I saw a nurse almost in tears the other day because she felt bad for "being a *****" to someone who was being blatantly disrespectful to her. Everyone who saw what happened looked at her like she was crazy because she didn't actually say anything rude to them at all.

    If "Ok, thanks, bye" is out of character for you, you must be a saint.

  • May 23 '14

    Multi-dose bottles of meds.
    One nurse would give meds to all pts.
    The med room was stocked with many, many multi-dose bottles of meds.

    Isolation meant the pt did NOT leave the room.

    Isolation meant double bagging everything - a "dirty" nurse inside the room would hold out a laundry bag while the
    "clean nurse" held out a second laundry bag. The dirty nurse would put their laundry bag into the clean laundry bag. This was repeated for garbage. Meal trays were 100% disposable. I still say we should go back to these practices!

  • May 22 '14

    I am speechless. That policy seems overly strict and in the case of your co-worker it was implemented in a horrendously insensitive way. If my job told me to come in two days after my son died in order to receive a write up, I would no longer have a job because I would have a freak out on them! I can't believe that!

    My heart goes out to your friend. I can't even imagine the pain she is going through. So sorry for her that her managers are being total butts at a time when they should be doing everything to make her life easier.

  • May 22 '14

    I agree with Nurse.
    I would definitely be looking for another job. How Heartless. Please give my condolences to your co worker