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  1. RNGummy40

    Being Deposed - Help!

    Dear Nurse Beth, WOW, I too am sorry you are experiencing this situation and am sorry your patient had a negative outcome. You absolutely need an attorney! Since you no longer work for the company, your former employer has no obligation to provided you legal representation. Even if your former employer did provided you legal representation, the attorney would be representing the company and not you as an individual. If there was any evidence of liability on your part, you need to have representation that can review your case under attorney client privilege, and discuss your legal rights. I would hope that you would have obtained malpractice insurance at the time of this incident, or already been covered before the event. Some insurance companies with not provided coverage before or after the event. It they do provide coverage, legal representation and specified monetary compensation would cover you if you were found responsible for damages. Your attorney can also prepare you for any deposition you would need to attend.
  2. RNGummy40

    Is psychiatric nursing a dying profession?

    LOL!!! When I saw your questions it gave me the giggles!!! If only self fulfilling prophecy really worked in this situation, then your worries would actually be a wonderful outcome! The "push," for community care has been happening for over 40 years! Sadly, we are still failing at this great goal because our community has made an insignificant investment in nursing care. NO! Psychiatric nursing is not a dying profession, if anything it should be growing, because our psychiatric community is growing. Psychologists and techs are great but they are not skilled in medications and interventions to manage patients care plans. What is a concern, is that there are fewer nurses wanting to enter the psychiatric field. It is a specialty field that is extremely stressful, can be at times dangerous, and time consuming. Many new nurses entering our profession do not want to work with psychiatric patients because they are not trained appropriately to work with them. They are concerned about loosing their med-surg skills or being injured after just finishing nursing school. What some new and older nurses do not realize is that mental health patients are everywhere. The approach, speech, affect, tone, and mental flexibility of the nurse are skills needed for working with mental health patients. It is psychiatric nurses who historically helped the sick in communities, especially when others had given up. If the psychiatric nursing profession were to really die, then nursing itself would not exist.
  3. RNGummy40

    Med error

    "I followed that order charted wrote TO and reordered new labs everything but transcribing it to the MAR. It was the exact same orders as before. However, we box it off, so you have to rewrite it. I had forgotten to rewrite it in the MAR. So there for I made a med error according to my DON. I asked her why was it considered a med error? She said I gave without orders. But I did have orders, I gave the correct dose. I have clear documentation stating orders but I just forgot to write it in the MAR. Is this truly considered a med error? Should I sign this form? I messed up I own my mistake, but I had right dose, right patient...etc. any advice is greatly appreciated!" The med error is not writing it on the MAR. It you got sick and did not show up to work, how would the nurse working that shift know the specific Telephone order you received and be able to verify the order? Documenting it on the MAR allows all nursing staff to see orders received, verify and validate orders, and use 3 checks before administering orders. Orders do expire, or on a paper charting system the number of administration sign offs are limited and forms need to be rewritten. If the order is not on the MAR, errors will happen. You DON should be explaining why it is an error with more than one sentence. Learning from the mistake is the most important issue.
  4. RNGummy40

    Charlie Gard

    The parents actions to prolong their child's life are normal. It would also be normal for parents to say, "Okay, let him go." The parents are in a state of loss and the irregular cycle of loss is a painful process. As for the decision to prolong the child's life and find a cure. Is it wrong? I find myself on the scales of justice and feel my geminian side clinging to both perspectives. On one hand, the cost and quality of life for the family, the hospital, and the baby need to be considered. At this current time, the decision to treat does affect other patients. Just by looking at the supply and demand factors, it is costly to perform an experimental treatment, and I wonder how many other lives are impacted by that decision. Just the ethical implications of performing the experimental treatment are significant, and would impact the babies current situation, and end of life, especially if a cure is not the final result. As for why the parents would want a cure, who wouldn't? When looking at our healthcare history, there have been many cases of conditions which were thought to be untreatable. Doctors would give their opinions, and thankfully certain people did not just accept what they were told. Whether the lack of acceptance was related to critical thinking, hope, denial, oppositional defiant disorder, or just dumb luck, people around the world are thankful, even if they are ignorant about how such treatments came to be. At the very least, the public is more aware of this devastating genetic disorder, and hopefully current and future generations will be blessed, inspired, and passionate to finding a cure. My prayers are with his family, and all families tied to this terrible genetic disorder.
  5. RNGummy40

    To the nurse who was belittling and condescending to me today

    Oh my Lord!!! Rudeness and disrespect over a patient missing prune juice, LOL!!!! Stop the bolder from forming like in the movie, "Indiana Jones and Raiders of the Lost Ark." (yes constipation is a serious problem, just a joke to lighten the situation.) I am sorry you went through that experience. We appreciate you! We thank you for the hard work you do! We are excited you will be joining our profession! Congratulations on getting an A! I think that people who forget that to treat others as they would like to be treated, makes it hard for everyone. Everyday I go to work I tell the dietary staff, house keeping, maintenance etc, that I appreciate the work that they do! It feels like crap when you feel like you are taken for granted. Do mistakes happen, yes! I have weeks were I am desperately trying to prevent my suicidal or psychotic patients from getting metal utensils. Do I feel upset when an error occurs, yes. Do I feel like snapping, sure. BUT, I know snapping will not solve anything. Taking three steps back and you usually can see the system errors that occur. Are individuals, individually responsible, yes! But one can't just assume intent or awareness.
  6. RNGummy40

    Expensive stethoscope for student?

    When I started nursing school, I found a Littman Cardiac II stethoscope on sale and bought it. I wanted to learn which sounds I was hearing and I wanted to do as best I could. If you have one, use it and learn. If people judge you, that is their problem. You have a tool that can optimize your clinical experience. One word of caution: stethoscopes are like pens! People can easily pick up and take your stethoscope and use it, and then it's gone. Take care of your investment.
  7. RNGummy40

    MD was angry I questioned him.

    Dear ella2990, BSN, RN, You did your job! There may have been may factors why the MD was upset with you, BUT who really cares? If the physician was concerned about psychiatric boarding, then do his job, and assess his patient! He needs to complete an H&P for starters! When do psychiatric facilities accept patients without an H&P? The patient was confused and had an elevated lactose level, that not an excuse! Any nurse can perform an assessment on a patient confused (whether or not the patient is violent). The untreated medical concerns the physician initially refused to address, would prevent any psychiatric facility from treating the patient. I have not worked with any psychiatrist or psychiatric nurse practitioner who would throw caution to the wind and prescribe anti-psychotic with the rhythm abnormalities the patient presented with! Psychiatric facilities and hospitals in general are trying to prevent QTC prolongation when administering anti psychotics and your patient did not seem appropriate to treat. In addition the potassium and lactate levels, would just complicate treatment. From reading your post, I wonder if your facility has an ASAP team? At my facility, that patient would have been ASAP'd. That doctor would have had to answer to the House Supervisor, Unit Manager, the Critical Care Nurse, and Respiratory Therapist, oh and SOCIAL WORK!!! NOW, looking back at the discharge plan the MD had in mind. Lets hypothesize, and say you did allow the patient to discharge with not interventions, complete assessments documents, but abnormalities documented. Who would be the nurse signing off on the discharge? Who would be the social worker? Who would be the Doctor? If the patient coded in transport, if you could get a psychiatric facility to accept, even after giving a nurses to nurse, who would be responsible? You deserve a significant acknowledgement of the great work you did and if your facility has a anonymous reporting system, you should be reporting what that doctor did.
  8. RNGummy40

    Patient is a sex offender with a tracker on his ankle

    "When I received shift report for my very ill, bed-bound patient, the RN giving report pointed out the tracker affixed to his anklet. She had admitted him a few hours earlier and did not know the details and there was nothing noted in his chart. Before she left, she looked online and he is a convicted sex offender (lewd and lascivious with a minor under the age of 14). Is it appropriate to add this new information (pedophilia) to your shift report? To his chart?" The short answer is that subjective and objective information needs to be assessed and documented related to Sexual Aggressive Behaviors. It absolutely should not be ignored and not left out of the patient's chart for a variety of factors. The patient first should be assessed and asked a variety of questions including: Why is he wearing the ankle bracelet? What is his legal status? If he admits to being a sex offender, then what is his level (I, II, III). Do they have a current parole officer? Does the patient have a legal court order limiting their contact with minors or individuals? When was the patient's last offense? Do they have support group? How are they managing their behaviors? If the nurse cannot acquire this information, it should be communicated to social work for follow-up. Barrier's for discharge are significant. SNF, AFH, and Psychiatric facilities have specific assessment requirements for admissions criteria. Level three sex offenders are usually not accepted for admission due to the severity of criminal activities and number of repeated attempts. Please do not assume that just because an individual has been listed as a level one or two sex offender, that they have only committed minor offenses. The criminal acts may be significant but fact checking is required. Using public police records, or court sites to verify information is not breaking HIPPA. Every state has guidelines on keeping track of sex offenders, including police following specific rules on reporting to the public whether or not a sex offender is entering a community. This information should be in the patients chart, and not just in verbal form. How are you maintaining UNIT safety if this information is just by word of mouth. If you have minors on your unit, how would nursing staff consistently know if a patient was not supposed to be in direct contact with such minors? Is nursing staff aware to educate visitors to monitor their minors at all times? If the patient is being truthful and acknowledges that they are not to have contact with minors, how is their nursing care plan addressing that issue? Not making it part of the care plan can easily allow errors to occur, that can harm the patient, not just staff or visitors. In addition, the ankle bracelet is a legal tracking device. If the patient elopes (in the case of having a restriction from discharge order), law enforcement would want to know if we were documenting whether or not the ankle bracelet was still in place. Being a sex offender is a mental health issue so to just ignore that medical concern makes no sense and leaving it by word of mouth during shift reports allows assumptions, and incorrect information to be formed and passed on.
  9. RNGummy40

    Methadone worse than heroin....ideas?

    Dear Maevish, RN, Methadone is a synthetic opioid and it is used (as others have already have mentioned) as tool to assist patients with sub-stance misuse. Unfortunately, this tool is not well understood by all patients and all medical practitioners. Methadone is unique and complicated, that is why the safety concerns related to prescribing and managing it's use are significant. Methadone specifically inhibits the "CYP450 chain family" responsible for metabolizing it. In addition, methadone doubles it's own half life with each consecutive dose! These are two different affects and their is no other opioid that performs these two actions at the same time. This "brilliant" drug can cause significant problems for people on it and the education and training around it is not consistent. The protagonist and antagonist reactions whey prescribing any additional medications can significantly impact the patients health and well-being. Methadone's job is to attach to the opioid receptors, lock on, activate, and block, other opioids from activating receptor sites. As AussieRN36, brilliantly described the tight rope of symptoms methadone is trying to prevent the patient from experiencing, this drug is not perfect. I have sat and listened to doctors at pain conferences, argue different opinions on how to treat pre and post surgical patients suffering from sub-stance misuse. What I have learned is that Methadone and even Suboxone are not iron clad in holding on to receptor sites. High does use of Heroin can unlock binding to receptor sites which presents an additional safety concern. The Substance Misuse problems related to opioid abuse also include the negative physiological outcomes from chronic use. Hyperalgesia can occur within 2 or more years of chronic opioid use. The damage to the person's nervous system can magnify or create a chronic pain state which can be improved by reducing and or removing opioids from the patients regimen. In addition, side effects of sudden death, QTC prolongation, and respiratory depression are always a concern that may or may not be discussed with the patient. When I have worked with patient's with co-occurring disorders and I give them methadone, I never think methadone is going to SOLVE there problems. I educate my patients that it is a tool to help them make better choices for themselves. I remind them that their futures are never locked in dried concrete, but are like play-dough! Knowing why they are using is a very important factor, and their maybe one or more reasons why they use, but they need to consciously know why and what it means to them. I always think of Maslow's pyramid and how can are my patients lacking in their basic needs. It's amazing how many patient's experience an loss of control when they are in the hospital, so close to death's door. When and if they make it through their treatment, they usually admit that they have anxiety about leaving because we provided a structured and safe environment for them to stay clean. More effort and resources needs to be in gaining access to housing, working, and reducing access to street drugs. I do not believe allowing more access to drugs will help, if anything it will allow more people to hide what ever pain or neg experience they are feeling. I do feel drugs should be more affordable, and do I think pharmacist should be used more in the medical system. I believe when methadone is just the primary focus of patient's treatment plan, we as medical community are failing to adequately treat. Education, specifically informed consent needs to be provided. Patient's need more mental heath and addiction specialists available, as well as providers in hospitals and in the primary clinics. Opioids were used with little understanding of their effects and future impact, and now we are dealing with those consequences.
  10. RNGummy40

    Gross Things Patients Do

    With psychiatric patients, their is no end to the creativity they may display during a shift. One patient added vomit to their drinks and food, then attempted to eat the creations they made. Another patient may have been watching a make up commercial, their was "BROWNIE MIX," all over her face, and they were trying to lick their fingers. There once was a patient who drank their urine, and attempted to let it age before doing so. Nothing really shocks me. If anything, I am surprised at other people when they become shocked.
  11. RNGummy40

    Another 'is it worth it' question for RNs

    Dear SolDanz, When I started my nursing program, I still remember the advice my nursing instructors gave to us that first day of nursing school. "We strongly advise that your do not work." Only 45% actually graduated from my original nursing class. Some people worked, I myself took out loans and committed my self to nursing (that's a fun pun!). I know that some struggled, some got A's, some got B's, and some just passed. While grades are important, something to consider is whether your can easily apply your knowledge to direct patient care. Some students who did great on exams could not, and some who did great on the floor had trouble with their exams. Depending on the program you could be in school 5 days a week, and clinical hours could be during the day, evening, or noc shift depending on available times and locations. The possibility of last minute changes in your program can come up and again, you have to be committed to completing the work. You passion for wound care is awesome and it is a realistic goal. I would recommend going straight for your RN because it will take you less time. As a RN you will be able to assess admissions, discharges, review meds and form treatment plans, which is required to assess, diagnoses, plan, implement, and evaluate wound care patients. You will need to know pharmacology because medications can affection the healing rates of wounds, meds can cause skin problems, drug interactions can promote or inhibit length of stays. Yes the RN degree is a generalist degree but what does that mean? If you study hard and study more than just what is assigned to you by your instructors, your RN degree may be more than just a general degree. Learning for life, not just the class is something to consider. When I applied for a psychiatric nursing job out of nursing school and was interviewed, I knew my drugs and side effects. I could recommend nursing interventions for specific psychiatric diagnoses and was able to provided appropriate medical interventions for specific scenarios. I got the job because I was prepared. RN programs are inconsistent with training depending on the area of nursing practice. Pediatric, Psychiatric, Wound Care, Cardiac, and ICU rotations may be limited if non existent. Definitely get subscriptions to ANA and Nursing 2018 magazines to keep up with current topic and issues. Consider getting a student membership to a nursing wound care organization. Free classes can be found and you can find great resources if your text books are not clear. Another thought to consider, if you had to work, you could try and get a position in a wound care clinic. Even if it was a clerical position, you could still be focusing on what you want to do and it would be a good experience. Another part of wound care is understanding the supplies needed to be used on the different types of wounds. Cost is a big factor and knowing which companies to order from and which insurance plans will authorize payments, will get the best and affordable products for your patients. That would be great knowledge to have. Good luck and much success!
  12. RNGummy40

    I Have a question

    I hope the surgery is successful and that your husband has a quick recovery. You certainly can make the request but you and your husband should be talking with the doctor about this before even going to the hospital. Before your husband is placed under anesthesia, chances are he will need a Foley placed in his bladder. Chances are it will be a female nurse inserting the catheter. After surgery, in the Post Anesthesia Care Unit, you may have female nurse assessing airway, tolerance to anesthesia, checking vital signs, signs of internal bleeding, urine output and catheter placement. If dressing changes are ordered, a female nurse maybe assigned and required to assess for healing, signs of infection. You should be taught how to perform dressing changes absolutely, but the nurse is skilled and licensed to catch medical concerns and report them to the Doctor. Preparing your husband with this information would assist him in preparing for the procedure and future healing process.
  13. RNGummy40

    Running into former patients

    If I saw a patient that I provided care to, if I did not have concerns I would only acknowledge them if they initiated contact. I definitely would not have a drink with any of my patients. You are definitely taking a risk, consuming a dis-inhibitor with a former patient. I have heard of and see about a handful of bad out comes when coworkers have had to change their contact information, block patients from facebook, or file a police report. It is more difficult when I am with friends or family and I have to ask them to trust me because I recognize a high risk patient and I can't tell them why. I wish my experiences were just isolated to Psychiatric Nursing. One coworker was stalked by another patient after a med-surg length of stay, thankfully they were able to arrest the patient before the situation escalated.
  14. RNGummy40

    Student nurse dismayed by bedside nursing attitude

    Dear New Gal, I think the answer to your last question includes a lot of factors. Students entering nursing may want a good paying job, fewer work hours, respect in the work they do, ability to be challenged in skill, the option to socialize with others, or they may have no clue. The virtue of taking care of another human being may not be their first priority when entering the nursing practice, a sad thought. New nursing students may have a complete academic plan in their heads and that includes as few back bending moments over a patient as possible. Some nursing students may hate the site of blood, fecal matter, vomit, or snots and seek a position after graduation away from those colorful moments. Some students may have none or minimal bedside experience before entering nursing school. The day's of Florence are in the past. I was very surprised to read that teaching compassionate care in nursing has increased and that nursing programs around the world have had to adapt to the cultural change. When I went to nursing school, the focus was on critical thinking, but now that includes compassionate care? In my opinion, the indirect forms of communication have minimized the human experience and interactions needed to learn and maintain compassionate thinking and behaviors. Med-Surg nursing is hard work!!! GOD BLESS my fellow nurses! It is total care, with high capacity, and high acuity. The nurse to patient ratios are high, the involvement in team dynamics are high and turn over between admits and discharges can play like a ping pong table. The balance of managing patients care is at times difficult with the expectations of charting, and the expectations of the patients. Hospitals are now focusing on a customer service approach which can be a conflict with medical care. A nurse may be expected to take on the role of house keeper, fireman, bodyguard, chef, hair stylist, or plummer. Questions as to who is right frequently comes up: Is it the patient, doctor, management, or nurse? The answer to these questions can create headaches during your shift and unfortunately, responses are not always given in logical non biased terms, but illogical and biased. Education is not always consistent or available depending on your facility, which magnifies the headache. You are correct, that nursing is about giving the best possible care. The struggle with nursing is providing the best care under safe conditions for the nurse and the patient. Decisions are not always made by nurses, or even by doctors. Med-Surg nursing a great foundation for clinical practice.
  15. RNGummy40

    Nursing Ethics Question!

    Hi Michelle. If I were you, I would be reporting to the Canadian Medical Association and the Canadian Nursing Association. There are so many Ethical Violations in bribing a patient in order to promote and maintain medication compliance, it give me a headache thinking about it. When I first read your problem, I decided to look at the Canadian Medical Association Ethics guidelines. http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD04-06.pdf When prescribing a medication, the patient needs to be provided informed consent. Informed consent involves the patient being educated about side effects, benefits of treatment, alternatives to treatment, treatment interventions, necessary follow-up care etc. An argument could be made that the patient is not receiving informed consent. The patient could say, "I am being given money to take a drug and no one told me anything about the drug." Of course the patient could be lying, but is their actual teach back shown and documented that the patient really understands. The patient is knowingly using money for illegal drugs, crack! Medical professionals are actively giving money to a patient and know that patient is buying drugs with the money! You are promoting a habit, a habit that affect the medically prescribed drugs uptake, half life, and impaires the patient's mental status. If the patient insisted on drinking alcohol with each medication administration, would you document and administer as the patient wished? The physician and the nurse must disclose financial bias when providing medical treatment. If you, or the doctors have any financial incentive towards prescribing a medication, and you are bribing a patient, if the patient had a negative outcome, how would you show that your judgement was not compromised by the financial incentive? How is your treatment team providing consistent medical care? If the patient was hospitalized for an infection, would you expect other medical professionals to bribe him to take his antibiotics? Are you setting a standard of care that is not the standard? If it was a child, would you give them money? I believe you are correct to not agree with this treatment plan. If you coworkers support this practice I would hope management would not, and if they do, finding a new place to work at would be your only option.