P B and J, ADN 4,178 Views
Joined: Nov 30, '10;
Posts: 119 (34% Liked)
; Likes: 127
3+ year(s) of experience
Even if the patient is not an alcoholic, a cocktail or a glass of wine isn't necessarily inappropriate. Why do people lose their right to enjoy a favorite beverage simply because they are in assisted living or even a nursing home? Assuming it's not going to harm the patient, what exactly is the problem here? Nowhere is it stated that the nurse has an order to get the patient hammered.
Apparently, we are to give him whiskey along with his evening medications. This worries me since alcohol interacts with so many medications.
It doesn't seem right as part of my nursing duties to be giving patients alcohol.
We needed a stethoscope (They recommended the Littmann classic IISE, it's what they sold at the bookstore on campus but the VA bought me a Cardiology IV), a pen light, bandage scissors, solid black or white waterproof shoes without mesh, a laptop (we take tests on our computer proctored in class, a lot of the courses are hybrid with an online component, and we chart on our laptops after sims), and like $2,000 in books
Don't you know that sunglasses are so much cooler than boring regular glasses? Are you bigoted against cool kids? Are you taking your memories of being uncool in high school out on this oppressed young man?
Using ONE meter between MULTIPLE patients is a disaster waiting to happen. How are you QC'ing it? They are not meant as multiple pt devices.
Im an APRN in dialysis units and this is the reason we can't keep glucometers in our units: they are not meant for more than one pt and there is no way to adequately disinfect them.
You could say you've done additional research and found the local rates are significantly higher than you are being offered and originally said would be satisfactory. You want the opportunity and to learn and grow in this position with commensurate pay and that you need to revisit the wage negotiation
If they question why the delay in determining competitive rates, you could tell them that you've since learned how to perform better search using the best variables and criteria.
If you're not asking for above and beyond the current rates, they may be disappointed if not irritated. Just be sure to consider which positions you're making comparions, some clinical staff do make more than entry level mgmt.
Last week I hit a milestone.
I fit into scrubs. The tops and the bottoms. I paraded around the living room checking if I could bend and turn. I wanted to know if there were bulges showing or some unsightly side effect. Nope.
I'm no movie star but I'm wearing scrubs. I even had my mom take a picture.
It was an awesome moment.
They were Koi size 5x.
3...2...1...Remove your jaw from the floor. Wiggle it around to see if it works. All good? Alright let's move on.
The last time I was able to fit into scrub pants and bottoms was nursing school in 2012. They were 4x but I believe a very generous 4x. I had used black yoga pants with scrub tops for years masking the problem when all I wanted was a smaller derriere and pockets.
I have come to the conclusion that a nurse needs three things to survive a shift.
1. Pens. Many, many pens.
2. Coffee. Lots and lots of coffee.
3. Pockets. You can never get enough pockets.
I did everything I mentioned in New Grad No More...Continued including entering, getting through and passing nursing school over 300lbs. It never stopped me from achieving my dreams. But it is keeping me from my optimum health.
At my heaviest I got to 346. If I sneezed I'd be 350. This was also around the time I landed my dream job. I was 320 when I got in and the stress of being the new kid on the block had me packing to 346.
I woke up one morning and said aloud. I'm going to die. It's may not be today. It may not be tomorrow but I'm smart enough to know...I'm asking for trouble.
At work, I'm your short as stilts on a potato and round as I am tall RN ready to meet your every need. I'm knowledgeable. I'm quick. I'm willing to learn what I may not know. I work well with my team and I am passionate about my patients. I dance, I sing, I smile. I work my assets off all night and I go home exhausted at least 36 hours a week.
I get the job done. I love what I do.
I have perfect blood pressure, A1C's and labs. I have no disabling pains that prevent me from rolling out of bed and doing what I need to do. I am also very aware of the risks and pitfalls that await me if I continue on in this manner and this weight. My body will eventually turn on me and diabetes drive, hypertension way and bypass avenue are all ahead on my journey.
I've put my foot down. I'm doing something about it.
I have been fortunate to have coworkers and managers who saw past my size. They saw my capability. They saw my drive, confidence and attitude. They believed I was worth the position and able to carry through. I have won over my patients and proved that I was able to meet their needs without hesitation.
And I've lost about 40 lbs since August of this year. I've chosen a sugar free and low carb diet. After years of experience in dieting and gaining it back I have learned that my body responds very well to this combination.
I still have a long way to go, but I'd like you to walk this journey with me.
As nurses we are educators. We learn twice as much as we teach and this for me is one heck of a learning curve. I'm looking up and researching what makes weight harder to lose, the proper nutrition to adopt, pitfalls in addiction, exploring obesity as a disease process, how to aid your patient and maybe yourself (and more).
I think my experience may help others have an insight into obesity and the physiological, psychological and pharmacological implications of this condition.
The truth is....
Implementing this knowledge is a lot harder than it looks.
It's going to be just like my career journey...
One bite at a time.
Very soon I will not need to Suck it in and I look forward to it...
Won't you join me?
I admire her will to want to be a nurse and not really be a nurse. Too bad she didn't do it the right way.
I've assisted the physicians with the culture, and it is indeed a sterile procedure. Otherwise they wouldn't have special kits for it.
My BFF (also an RN) had a loop recorder implanted to try to capture a pesky arrhythmia that had been dogging her for years. The last one had scared the crap out of her because her vision telescoped down like she was about to have a LOC (or death). She had also been alone. Although severe while happening, the events occur very infrequently - maybe once or twice a year.
She was awake for the procedure which was performed via a local. She received no empyric Rx antibiotics pre or post-op, and a number of questionable occurred things before/during/afterward breaking the chain of asepsis that I won't go into.
When she became febrile on post-op day #2 she returned to her cardiologist's office for a wound check - more bungled things happened I again elect to skip over for brevity's sake. It was now at this point he finally Rx'd an antibiotic. He never got a culture of the drainage - he didn't feel it was necessary.
Less than 24 hrs later: the incision began to pop open, and she woke up with a huge hot, red patch surrounding the dressing on her chest. It felt like a lit cigarette had been stuffed in next to the device, then sewn back up. When she called her cardiologist's office to tell him how sick she felt and to share some of her concerns he dismissed and poo-pooed her. Already feeling like death warmed over, she began to cry because he continued blowing her off - instead of applying empathy to a frightened pt, he unkindly suggested she "do something about her anxiety".
He also snottily claimed the device would never work it's way out.
The following morning her PCP referred her to the ER - she was admitted.
The incision had dehisced, the device nearly extruded itself, and she started oozing yellow purulent drainage from the site. She had a pocket of foul smelling pus surrounding the device after less than a week S/P insertion that smelled like an exhumed coffin. She became septic - her blood cultures were positive for staph. Oh, did I mention the culture of the incision site came back positive for MRSA?
She just came home yesterday from a 5 day hospital stay with a PICC line and vanco infusions (which look pretty cool - like small balls).
Now her dance card for the next month or so is occupied with numerous MD appts (cardiology, infectious disease, wound care, et. al).
Could all this have been avoided had the MD just listened to my BFF's concerns and acted sooner? Or maybe if he had he done a whole lot of things differently before/during/after making that first incision? Dunno, but it certainly couldn't have hurt though.
This is a slightly different scenario than your average, garden variety I&D, however it makes me believe one can never to "too sterile" while performing any invasive procedures.
And just for the record: If it were me or my son, I'd prefer sterile gloves - please and thank you.
The good news? After reading the device an "event" had been captured and recorded in less than a week after insertion!
Old-school RN here. Studied for Boards (before they were called NCLEX) while traveling West in a wagon train, fighting dinosaurs along the way. Cut my teeth in several ICUs, when Swan-Ganz catheters were becoming all the rage. Have seen trends and treatments come and go, the pendulum of nursing practice swing first one way then the other way.
Background: I worked in IR (Interventional Radiology, which included staffing the Cardiac Cath Lab) for 21 years. Most recently (past 10 years) I work exclusively in Cardiology: Cath Lab, Stress Lab and Cardiology Case Management.
Current Issue: Two recent encounters blew dust off a few dendrites, and got me wondering about the practice of transporting cardiac patients from either the ICU or tele unit to various procedure areas.
Patient with NSTEMI (non-ST-elevated MI, the "less" dangerous form of MI) and +chest pain in the past 24 hours arrived via bed to our Cath Lab. He is not on a cardiac monitor. Say what???
Repeat: He is not on a cardiac monitor. His accompanying nurse reported "the doctor said he could go unmonitored."
Waiting for my next patient to enter the Stress Lab, I heard a familiar beep-beep-beep and turned toward the door expecting to see a gurney roll through, patient attached to the monitor, RN in attendance.
What rolled through the door: Nuclear Med tech pushing a wheelchair, on which sits a patient with the transport monitor in his lap. Beep-beep-beep. No RN.
My question: WHO is monitoring the patient???
And now I ask you, gentle readers:
One of my fellow nurses- let's call her Jane- was overheard complaining loudly this morning. She had received feedback from a physician that one of her chart notes was "unacceptable." She went on to say that she didn't understand why her note was unacceptable. I asked Jane to read aloud the note in question:
"Patient was inappropriate."
"What's wrong with that?" she asked, explaining that this particular patient had been rude the day before, yelling that it took too long for Jane to retrieve her narcotic prescription. The patient had, apparently, shouted a few choice words at this nurse while exhibiting some threatening behaviors.
Jane's documentation, however, did not reflect that.
As nurses, we need to chart specifics, and we also need to be objective. This is straightforward when we are describing, say, a wound that can be measured with a ruler, or a patient's report of pain as "burning in nature rated at a '6' on a 1-10 scale." But when it comes to behaviors, things get a little more difficult. A patient's wrath can evoke a negative response within the nurse that makes it difficult for him or her to remain impartial. Also, nurses may lack the precise vocabulary to explain the event.
Jane told me that she had felt threatened by this patient, describing her as angry and inappropriate.
"Okay, Jane," I said, "what specifically did the patient do or say that made you think she was angry?"
"She started yelling. She was talking loud and fast."
"So you could chart that the patient's speech became louder and faster. What did she yell at you?"
Jane repeated some choice four-letter words that had been addressed to her.
"Great, I would have charted those verbatim. Use quotes. What about her stance? Did she get closer to you, point, stiffen up? What gestures did she use? Did she threaten you?"
Remember that the chart is a legal document and, as such, can be considered evidence. An accurate, unambiguous description of behavior, statements, stance, and gestures will stand on its own in a chart review. If you ever need to testify in court, the specific words will speak for themselves.
The same goes for what patients say over the phone if you are a telephonic nurse: chart specific words in quotes, tone of voice, or change in tone if that occurs. If words are slurred, chart that.
Don't use subjective words such as agitated, upset, verbally abusive, aggressive, angry, or, as Jane did, inappropriate. These are ill-chosen because they are interpretations of behavior, not precise narrative; being subjective interpretations, they mean different things to different people. Instead, chart specific behavior, actions, and appearance. Some examples are:
"Patient stated 'It took you too darn long to bring me this prescription.' Patients voice became louder and faster. Patient stepped within 12 inches of this writer and pointed finger in face. 'Tell Dr. Smith that he's a terrible doctor! I'm never waiting this long again!' Patient declined offer to speak with clinic manager and left building without further incident."
When I first started in our emergency department night shift, I noticed that the 2-3 students were largely ignored for the first half hour or so during shift change. They stood nervously by the desks, repeatedly adjusting their coats and book bags with a look of "please tell me what to do!" on their faces.
I looked around at the day shift staff, busily getting report on the sick, critical, violent, or the repeat pts that they will be taking over on, so busy that having to explain things to students was just not possible at that moment.
So I took over and made a whole structure for them which was heartily accepted by my coworkers. On student days, I try to wrap things up early and give a quick orientation. I give a few tips on NCLEX, on how to stay cool in crazy situations, and what to expect for the day, and what to do when an ambulance arrives with a pt. Then I pair people up with the most patient, coolest and toughest 20+ year vets and go home. I usually get told how the students did when I get back to work that night. It's almost always great news. The evening students are always paired with me.
When it hits the fan at the wrong moment, I still have been able to get them in on mega-codes, help ortho MDs reset bones, start CPR, explain the critical nature of XYZ patient, and why that walking/talking pt will be sent to the ICU. Even with varying degrees of receptiveness, students have almost always been amazingly well mannered and willing to dig in. Except once.
One day last semester, a pair of students came down and I noticed increasing amounts of boredom/irritation as I went through my (now well practiced and tailored) orientation when I was interrupted in my talk about megacodes.
"I don't want to see that, and I definitely don't want to DO that. Just tell me where to stand while they do whatever they have to do and I'll wait until it's all over," she said dismissively.
I was floored. I asked her if she had intention to work as a nurse. She answered that she did, but not in any situation where she would have to do anything dirty or see blood. In fact, she planned to get her NP as soon as possible so she could just write orders and walk away. Her friend agreed.
When I asked her why she was in the E.R. rotation, she said that it was only because she had been assigned to it. I could only think about the other students who would have loved to be there and what a waste of everyone's time it was for her to have even been there at all. I couldn't help but think of what a waste of time it was for me to have just spent the last 20 minutes telling them anything at all since it had clearly been thrown away before I even spoke.
To tell you the truth, I was completely upset. I remained upset for almost a week. I spoke to my coworkers who said that many times they will avoid having a student because of that very attitude. I ended up going home and thinking that I didn't know if all students secretly felt that way. If so, why was I putting so much effort into them?
Just before the winter break, I spoke to an instructor and asked her opinion. She gave me great news. It was this, "Just send them back to their instructors and pop an email to the school."
Huh. So with the semester ending, I dug back into work and stopped thinking about it.
This semester the students started to arrive again. I watched them stand a fidget for a moment before my instincts took over and I started to cautiously orient them. My fears were immediately dissolved when one asked "Do you think we might get to do CPR?"
Thank God for the kind of students I look forward to seeing in my department.
We are inbound to your facility with two patients involved in a MVC with multiple injuries...
If the faculty knows who they are they can check their answer sheets to see if they all match, too. I like the "There's a lot of whispering and page rattling in the back row-- it's so distracting. Could you please ask them to stop?" approach.
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