A&Ox6, BSN, RN 17,663 Views
Joined: Apr 16, '12;
Posts: 603 (52% Liked)
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Psychiatric Nurse/Student Advisor/Writer/Speaker; from
2 year(s) of experience
Never a school nurse, and I'm rocking the pink today.
Rebooting an oldy, but I am missing y'all. Repping my school nurse pride in pink.
(No, I am not back in school nursing, but once a school nurse always a school nurse.)
As a foster Care nurse, I think this is a great idea. In fact, o sometimes feel like my two main roles are psych and women's health
They are not dealing with your clients, they are dealing with their patients.
So you're foster care? All your clients are under 18? All are wards of the state? Not what is being talked about. These kids do not come into the ER ranting and raving that they are in pain and need Dilaudid now. They are minors and need consent to treat, so they will have an adult with them and will be treated as they need to be. They will not refuse treatment. They will not leave one ER and go to another to get more meds. They will be treated appropriately for their condition.
Your taking personal offense to something that is not directed at you or your clients. I do not see anyone saying the ED/ICU is better than any other area of nursing, you brought that up. No, I probably could not do (do not want) your job, and you state you float to the ER but can't do it? Why accept that assignment?
As for this entire post, some people can't read a simple sentence. Tho OP (probably a troll) said a simple headache. Not a migraine, not a bleed, not a six month long headache, not the worst headache they ever had, just a headache. If you work in the ER you have had these patients. The patient that comes in saying "I have a headache that started an hour ago". No nausea or vomiting. No weakness or deficit. No visual problems. No speech problems. Just a regular headache that they have not taken anything for and just wants something for the pain, but for whatever reason has not even attempted OTC self treatment.
Not every headache is an emergency.
The x-ray above, we have no information about. The migraine sufferers, nothing to do with simple headache. Still trying to figure out how sickle cell got into this discussion.
Have your clients with sickle cell disease had over 400 visits for this year alone (come July) for sickle cell pain? Especially when they have resources available to them to help manage their sickle cell pain? When some of the doctors/nurses you work with also work at different area hospitals and see those same patients there too (for the same complaint)? Have your clients verbally and/or physically abused nurses and doctors for following patient treatment protocol for sickle cell pain as proscribed by pain management? Have your clients unhooked their Heparin infusion (for a PE) whence they got the Dilaudid they wanted and walked out of the ED without telling anyone? Has your client ever told you "You either give me Dilaudid or I'll just go someplace else. I'll just go to XYZ Hospital (a local rival) and you'll never know." ? Have you ever caught a client behind the curtain as they are being discharged, ranting on the phone that "Well the ****ing Doctor just prescribed 4 pills. I couldn't get more. Can you tell him that I get him 4 for now but Imma try for more later today?"
If your answer to any of these questions is a resolute "NO" - YOU are truly 'gifted' that you've never had to deal with such examples of chronic patients!
I'm truly sorry to hear that. A colleague was diagnosed with Chiari Malformation (rumor. Don't know the stage) and kinda retired from nursing. She was awfully young! :-(
In other words - a change in your condition from your baseline. Which is something ER nurses look for and also what I mentioned in my comment:
"Both my Mother and her Sister suffer from horrific migraines and headaches. My best friend was almost hospitalised because of intractable pain from migraines. His wife takes a bucket of medication everyday to try and avoid a flare-up of her debilitating migraines. I've ordered a stat head CT by protocol on a young male patient who came in with c/o "headache" against the judgement of the charge nurse and the attending ER doc who didn't think the patient was "that sick" - who ended up being a bleed from a ruptured AVM.
So yeah, I know that "headaches can be serious!""
I appreciate the support but 'floating' ain't the same as 'living'. It would be akin to me 'floating' to your unit every once a while and then telling you how to treat your patients.
What does this have to do with the price of tea in China?!!
NONE of the reasons mentioned here - yes, including those who go to the ER for 'poor health management' - is a problem of the ER! It is an "EMERGENCY ROOM". Not "chonic condition room". Not "after hours room". Not "pain clinic room". Not "I have no health insurance" room!
People think I'm callous for mentioning this but it is reality - no-one who has not worked in the ED on a regular basis has any ***ing idea of ED overcrowding because of non-emergent complaints!!
And last I checked - pain did not kill anyone.
Nobody is "taking it out on" anyone.
ALL my sickle cell patients and migraineurs are offered non-narcotic, alternative treatments backed up by evidence based medicine (as I pointed out in the link.)
More than half refuse, because "that s*** don't work!"
It would help their case if they stopped lying though (about other ER visits, narcotic prescriptions from other providers, pain management contracts they don't disclose) - because we can track most of 'em (especially prescriptions.)
Again: not saying that everyone lies...
As a matter of fact, it would be helpful if the patients didn't keep complaining/threatening the nurse as to "what's taking so long?" "I've been here for 45 minutes" "I ain't going back to the waiting room ***** you better find me a Doctor now!" "How the *** he went back now but my girl gotta wait?! That's ***ed up man!"
Myself and the nurses I've worked with in triage have routinely called security to keep the peace. Do you think that is appropriate behavior?
That sounds very much like an ED appropriate patient.
Emergency Department overcrowding is a serious problem!
Emergency Department staff SUCK at treating chronic conditions. We are neither equipped nor trained to deal with them!
Just because Primary Care sucks in our country, doesn't make it an Emergency Department problem!
For the rest of the mill - everyone would like to see me as a callous monster. That I don't care about people and their pain.
I reiterate the point I made in my original post - "would you like the nurse taking care of your Father or Grandmother, to also be responsible for 5 other patients? Or would you prefer that the nurse be able to hand off her patient load momentarily so that s/he can pay undivided attention to your loved one in their hour of crisis?"
Almost NOBODY thinks about the ER and wait times - until they have a loved one who needs to be "seen NOW!"
*** happened to "patients"??!!! Yes, it is why I highlighted the term!
Can't shorter nurses just have a tall patient sit down for HEENT?
chronic[/I] conditions are sent to the ED - the place least equipped to manage it appropriately.
Pain - especially chronic pain lacking any changes/acute presentations - is not an emergency.
Re: female condom, I worked women's/ community health clinic for a year and still can't recall a time that we ever gave any of those away. I honestly would have no idea how to use one myself if needed. Many of our clients find the cost prohibitive compared to a male condom.
According to my friend who does NGO work in Africa around sexual health, female condoms are more popular there to prevent HIV.
As a migraine sufferer, I too take issue with the title of this thread. I have had migraines that caused me to temporarily lose vision, migraines that caused syncope, migraine that seemed like a hallucination as well as other status migrainosus.
However, due to the current attitude towards young females with migraines, it took many years for chiari I malformation to be diagnosed. I also have had psych consults called when I came in for left sided paresis and syncope. Only after I was psychiatrically cleared was any bloodwork and imaging done.
The interesting thing is that my migraines respond only to infusions of magnesium and dexamethasone. I cannot take any opioid due to anaphylaxis, I have to be careful about APAP because of liver functions related to overmedication as a teen by a doctor, and I can't take too much NSAIDs due to multiple bleeding ulcers.
I am lucky that I have not had a migraine emergency in almost a year, but I think it is very important to remember what a headache could be:
Concussion (delayed symptoms)
Thanks for starting this week's WILTW thread, A&Ox6.I'm another member of the ranks of the vertically challenged. I stand a whopping 5'1 and a half inches tall. Over the years I've learned that shortness has few advantages.
Taller people are more likely to be hired than us shorties. Short people have less body surface area and slower metabolic rates than tall people. Generally, height is an indicator of a society's health.
I am honored to be filling in for our beloved ixchel's WILTW thread once again.
As I continue adjusting to my new job as well as reaching the halfway point in my assessment class for my MS PMHNP progeam, I am glad to have this opportunity to reflect on what I have learned. I also really enjoy seeing what we can learn from each other and how our varying nursing roles result in varying weekly lessons.
I attended the third of my sexual reproductive health trainings this week, and learned a lot of new information about adolescent brain development and the translation of said development in various activities and education needs. I found it really interesting to learn a possible cause for the impulsivity, thrill seeking, and at times promiscuous behavior of many of the teens with whom I have contact.
The brain goes through a period of development during the adolescent period (ages 12-26) after which both the limbic system and prefrontal cortex ate completely developed. However, these two systems do not develop at the same rate. The prefrontal cortex develops more slowly than the limbic system. As the limbic system seeks pleadure, risks and reward and the prefrontal cortex is involved in logic and decision making, it would make sense that during adolescence teens seek thrills and rewards at a rate at which the prefrontal cortex cannot keep up.
As a student in a MS PMHNP program, I had a midterm in a OSCE environment and was required to conduct an H&P on a standardized patient. As I had used standardized patients in my RN to BS P
program I thought I knew what to expect. The experience was good overall.
However, I am short, barely over 5 feet. The standardized patient was 6'8". I had difficulty with the HEENT component if the exam because I could not reach the SP's face. This struggle got me thinking about how I would address this in an actual clinic. I had never encountered this issue (possibly because of the do I if setup). Any ideas?
This week I found out that female condoms are still in use and provided to our clinic. We found this interesting because none of the nurses, PNPs or MDs have been using them in practice. When we got a new drluberyofcondoms from our DOH, there they were. We all has to figure out how to use them because we have not seen them or used them in quite some time.
What did YOU learn this week?
I would probably say that it is a great thing to have. Just make sure that you have a protocol that allows you to use it in an emergency even without a patient specific order.
I am a foster care nurse, and unfortunately some of these stories are an everyday occurrence in my line of work. I think that one of the hardest things for me was a kinship foster mom who cared for 6 of her grandchildren, all removed from their parents for shaken baby.
While that sounds low compared to NYC hospitals, I think that is pretty standard gor outpatient. You will work days, no weekends and get great experience
Also wanted to add that at my current, non-hospital job, I carry my personal and work phones everywhere and answer calls, texts, and emails as needed.
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