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smf0903, RN 12,924 Views

Joined: Sep 7, '13; Posts: 820 (69% Liked) ; Likes: 2,649

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  • 9:00 am

    At my doctors office, and at many others there are signs that say "No cell phones" or "no cell phone use". I would start putting those signs up and then you have grounds to tell the patient they need to put it away, as it is not allowed in your office. People have no manners and shame on the patient's mother for not teaching her social manners!

    Annie

  • Sep 8

    Quote from smf0903
    Our policy is to send them out the damn door. Many healthcare facilities have been sued for "accommodating" racist requests from patients. We are fortunate that we have doctors who don't put up with that BS, they will discharge faster than you can blink an eye.
    THIS is what needs to happen. And I completely agree with JKL that management needs to have and enforce a strict policy about this. It is the ultimate in poor leadership to let charge and staff nurses deal with this on an ad hoc basis.

  • Sep 7

    I'm very confused about this. Was it the patient or the family? You don't mention the patient at all, just their family.

    And this is where the family is under the impression they have all the power. I'd escalate the situation until management escorted their butts off the premises and told they would be charged with trespassing for coming back onto the property.

    The patient can then either transfer to another hospital or sign out AMA. They can be another facility's problem.

    If they are disruptive, call security.

    Things need to change where families think they have all the power over us. They don't run the show in the hospital. We do.

  • Sep 6

    You whats even more outrageous ? When nursing management backs up the outrageous complaints even when they know some of them can not be fulfilled.

  • Aug 27

    Quote from TriciaJ
    It was his karma to get that raw potato. The ones who complain the most end up being the ones that stuff happens to. If a dinner tray is ever late or missing, for sure it will be for the patient who's guaranteed to make the biggest fuss. Kind of a Murphy's Law thing.
    I had one patient who was very particular about certain things, right down to the color of the Tums I had to pull from the medselect. On my second or third day with him, I got an earful because he didn't like the type of whipped topping on his jello. The doctor heard about this in passing and remarked, 'If he's reached the point where he's complaining about the food, he's well enough to go," and discharged him.

  • Aug 22

    In theory, it should be the overall situation that "gets" the right up, not specific people, but if you were to identify responsible parties it would be both nurses, the MD, the facility.

    Just as concerning as the bad infusion set-up is that a patient on max pressors with apparently only one peripheral IV site wasn't going to get a central line for "a few hours".

  • Aug 16

    I find these cases interesting. I can't seem to form an opinion about what patients should be "allowed" to request ...but I know that I'd rather not take care of a patient who had an inherent dislike of me from the very beginning.

  • Aug 7

    Quote from AnnieOaklyRN
    I think this is poor judgement because unless the patient wishes to be hospice or has an order for no hospital transport, 911 should have been called!!!

    This patient was clearly deteriorating from her baseline, and that warrants a trip to the ER for intervention BEFORE the patient gets to respiratory failure! She was more then likely in need of medications for bronchodilation and BiPap, thus a Non rebreather isn't going to solve the underlying cause of the hypoxia and hypercarbia. Please call an ambulance sooner rather then later next time, as long as the patient does not have an order against it.

    It is very unlikely that a non rebreather caused the patient to worsen, it was that you did not recognize her need for further treatment in a hospital setting sooner. I know this sounds mean, but you need to work on educating yourself more on recognizing patients that require treatment outside of their home.

    Annie
    It kind of sounds like the patient was already in the hospital, at least that was my take away. 15L for that short of time would not cause hypercapnic failure, it sounds like her condition was worsening. With sats of 65%, I would have done the same, and then called the doctor and the RT immediately.

    I've worked with intensivists who swear hypercapneic failure due o2 is a myth, and I've read evidence which supports it.

  • Aug 6
  • Aug 6

    Cowboyardee, my thoughts exactly. When I first saw this was simply a sinus rhythm, I thought it was a joke question.

  • Aug 6

    Quote from Kaisu
    What I see is a short PR interval. I've never seen that clinically, but a google search reveals Lown-Ganong-Levine Syndrome.
    Thats not a short pr interval. PR interval starts at the start of the p wave, not the end of it. And lown- ganong Levine is pretty rare (as far as I know) and not really diagnosed by the presence of a short pr interval in isolation but by a short pr interval in a patient having bouts pf unexplained tachycardia.

    T waves are borderline peaked, but in absence of other issues or irregularities, I'd just call the rhythm sinus bradycardia and not give it too much more thought.

  • Aug 5

    Quote from AceOfHearts<3
    I'm not sure where you work that running a vasopressor through a peripheral site is ok other than for an extremely short amount of time. I've done it for less than hour before, but with the risk of extravasation it's not something I like doing. Having a patient on a vasopressor is one reason why a central line is clinically indiciated/necessary at my hospital.
    The critical care literature does not support your hospital's indication for central lines with pressors. Do you need a good vein? Yes. Reliable access? Yes. Central line? No. But if that's your policy, do it. I run NE routinely for hours through peripheral IV's.

  • Aug 5

    I just recently started a new job as an ICU nurse at a large facility in California and some trends I've noticed over the years have stuck out to me. It worries me when I walk into a new facility, especially in the ICU and see all new and inexperienced nurses. Every new grad I meet wants to be a CRNA or an NP. And after 8 years, I found myself in the same boat. But I started to wonder what it's going to be like in the future if no one stays and gains experience? It's great that people want to advance their educations, but I feel that we've done a disservice in some way by not encouraging people to stay at the bedside. In part I blame hospitals for crappy ratios, caps in pay and lack of ancillary support.

    This is just a random thought in my head that I felt like getting out there. What do you guys think?

  • Aug 5

    Quote from mtmkjr
    There will be a lot of frustrated nurses down the road then, because the market can only handle so many CRNAs... No way are all the ICU nurses going to find their way out through that route.
    I think that's where the super-competitive admissions comes in. I've known a few pretty disgruntled ICU nurses who have applied to CRNA school for years without getting accepted.

    I wonder if a lot of it has to do with burnout in the ICU. It can be pretty stressful and exhausting (mentally, physically, and emotionally) to care for such sick patients. It may just be an inherent part of the specialty, although hospital factors like crappy ratios and unsupportive management certainly don't help.

    I do agree that it's a pretty concerning phenomenon (especially when you work night shift and nobody on the unit has more than a year or two of experience).

  • Jul 31

    Quote from smf0903
    It says not to use patient's eye, can I still keep using my own eye to activate??
    Quote from Davey Do
    Yes, you may use your own eye to activate the locking mechanism on Safety Needle Shield, smf0903.

    But be sure to follow the caution as stated on Kitiger's letter opener!
    Quote from Daisy4RN
    Or, maybe your coworkers eye would work better!
    Quote from smf0903
    There a select few I wouldn't mind capping my syringes on
    Attachment 27219


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