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guest1048932's Latest Activity

  1. Without going into too much detail, we are convalescing a patient from the hospital for the next few weeks at my care facility, and she wants someone to be by her side 24/7 and attending to her every whim. Her family does not want to pay for a private carer. We've assured her that her needs will be met, but told her that she needs to do all her activities of daily living, except bathing, on her own as per her OT care plan. She is capable of doing these, but she rings a minimum of twice an hour for us to fluff her pillows, remake her bed, help her change her clothes, or help her drink some water. We've explained many times to the family that there are other people we have to look after too, so we cannot spend all our time with her. I've been firm, and stuck to the statement that, "Everyone here is receiving care and we are working hard to attend to their needs too. We will help you if you need it, but we cannot spend an hour doing things that you can and need to do on your own. I will be back in another hour to check on you." So far, it's not working. Does anyone else have any suggestions?
  2. guest1048932

    Is this insubordination? How do I deal with this PSW?

    She doesn't have access to the medical charts, thank God, beyond what is on a flow sheet in the kardex. All of the charts are electronic, and she doesn't have a passcode. She has access to the Kardex, and that is not a HIPPA violation as it gives her need to know information as it pertains to her duties. When it comes to her picking apart nursing assessments, it's always because she has watched a nurse do something and is tattling. I shut this PSW down the other day by asking her, "Oh? Nurse ABC did it wrong? How do you know? Please, walk me through the correct way to do that assessment as laid out by the nursing regulatory body of our province and our policy and procedure manual." When she said she couldn't, I said, "You don't know how to do that assessment correctly, so you cannot tell me whether a nurse did it right or wrong, nor are you qualified, licenced, or even legally allowed to do that assessment. You need to focus on your work and leave nursing work to the nurses." I'm finding that by not giving in to her requests, and reminding her that she is not qualified or licenced, is putting a quick stop to her. Shutting her down at the source is very effective, and my director is on board with this new plan of reminding the PSW of her role, reminding her that nurses have to be licenced, and ignoring further comments from the PSW. As for Doctor's orders, as a courtesy, we'll tell our PSWs that someone is on antibiotics (watch out for diarrhea!) or has had a medication change. These changes are in the kardex too. While the nurse is monitoring that patient, the PSW has been asked to report changes they notice, like changes in bowel habits, ease with ADLs related to decreased pain, and the like. It's not an assessment by the PSW and it is always guided by the nurse (ie, "let me know if Mr. B has loose BMs"), but it helps the nurse catch things in addition to the care the nurse gives. Unfortunately, the PSW I posted about takes very medication change as an opportunity to rip apart the doctors and talk about why doctors don't know what they're doing. Now when she starts into a rant about doctor's orders, I just talk over her and cut her off with a firm, "I didn't ask you for your input on the medication, thank you." and then I just ignore her. This has so far been effective at shutting her down and we haven't had a medication rant in about 5 days! She is getting a bit better, and I have had her write down her questions and hand them in to the director instead of me. I have yet to see any action from the director, but the PSW has improved and isn't tattling all the time. I think part of it too was that she spent a great deal of time writing down her questions and got sick of her own game.
  3. guest1048932

    Is this insubordination? How do I deal with this PSW?

    Oh nursing gods. The thought crossed my mind, but the PSW I work with has much better grammar and online etiquette.
  4. guest1048932

    Is this insubordination? How do I deal with this PSW?

    Woah woah woah! I'm not showing someone the ropes here. This PSW is asking me to teach her tasks that cannot be taught to a PSW because they are protected actions. It doesn't matter if the PSW can do them competently or not, what matters is that the PSW doesn't have a licence to do the task. If she does the task, she can harm a patient and potentially lose her job. I'm not whining about having to show someone the ropes, I'm asking what I can do to keep my patients safe. Experience does not equal a licence anymore! I know a lot of nurses used to be trained "on the job" many years ago, but it's not that way anymore. Even to be a PSW where I am you need a minimum of two semesters to get your certificate. I'm not afraid of this PSW doing a better job than me either.She is not allowed to do the job I'm doing because it is illegal for her to practice nursing without a licence. This is a very real crime! If I screw up at work, my licence is on the line in addition to any additional charges that may come with an error. I am held accountable to a higher power than just my employer. Yes, anyone can be taught how to do a task, or learn it from a video on YouTube, but if a PSW does something that is a nursing protected task and ends up in a court of law, saying, "I learned how to do it on YouTube" holds absolutely no value. While I may have watched YouTube videos in school about various things like wound care and assessment, I also went to lectures, had multiple opportunities to do the task in clinical settings, and many, many evaluations on whether I was doing things correctly. During my four years of university, I was receiving constant feedback about how to improve my skills to get me to where I am today. I'm glad YouTube and watching various nurses makes these tasks look easy, but I assure you, there's more to a dressing change than just slapping a Mepilex on a wound. The fact is, you may think you are practically a nurse, but without a licence, you are not a nurse. Practically a nurse is not a nurse or even a designation, just like practically a pilot is not a pilot. I'm not saying that to be mean, or flaunt an ego, I'm saying that because you should be proud of your job as it is. You do a lot of work and are an important part of the healthcare team. As for changing briefs, just because a nurse can't do one skill perfectly doesn't invalidate their ability to do other skills. Similarly, I don't rate a "good" or "bad" PSW based solely on one skill. You sound frustrated and I get that, but you're way off base here. I'm sorry that you think my post is dumb, but I can't change the way you feel.
  5. guest1048932


    It really grinds my gears when I have to do inservices. The worst one I had was when we had someone come in an do an inservice on teamwork and they spent half the day handing out giant gold star stickers and saying things like, "Look who's a team PLAY-A! High five!" Cringe. No, just no. She was like the proverbial mom trying to fit in with her teenage daughter's friends. So. Much. Cringe.
  6. guest1048932

    Obsessive resident/Please help.

    First, you need to tell the resident that her behavior is inappropriate. If she is making inappropriate comments or saying things that make you uncomfortable, tell her to stop as soon as she does it. Tell her it's inappropriate and that it is making you uncomfortable. Whether she is cognitively intact or not, you need to say this and then redirect her. Don't say you're too busy, she'll make a reason for you to see her. The next time she makes up an illness, express concern for her need to pretend to be sick, and say that if it happens again, you will have no choice but to notify the doctor and have her assessed. Also do a little detective work: is it only you that she has these behaviors with, or has this been increasing with all staff? Second, document the behaviors, your actions, and her response. She may seek you out because you make her feel safe, or you remind her of someone. The illnesses she's making up may have to do with her feeling like something is wrong, but she's not sure what. She may need some reassurance frequently, so try saying, "You're fine. I have to check on a few other people but I'll be back once I'm finished, ok?" Her behavior may be repetitive, but try redirecting her and reassuring her. You need to document her behaviors so that other nurses and staff are aware. This will also help you see what works to mitigate her behavior. Her care plan may need an update to deal with conditions, such as loneliness or boredom, that may be influencing her behavior. Third, get your director and other nurses on board and make a plan that will be implemented to handle this resident's behavior. You may need a physician, geriatric psych, or behavior support to come in an assess her. Be professional, but firm. When in doubt, look to your director of nursing or director of care for guidance. At the very least, make your supervisor aware of the issue you have.
  7. guest1048932

    Trigger Warning!

    Hear hear! Part of recovering from a trauma is learning to resume your everyday life with those triggers present, but you are always working to eventually be able to cope with those triggers present. This may take weeks, or decades, but you're always working at it. Excellent article by the way. I read it a while back when a friend and I were talking about trigger warnings. After reading the article, it stuck with me that some students suggested that a subject (rape law) not be taught because of the potential to cause distress. Not that it WOULD cause distress, but that it had the potential to. What about the people who actually were raped?! Those people I can understand being excused from class, but we're supposed to feel upset by rape, even if we've never been raped. That's not being triggered, that's called being compassionate and sensitive. By cutting out teaching a subject, we are sweeping an issue under the rug and inviting ignorance. We are not fostering a culture of sensitivity.
  8. Excellent point Bearcat-RN! I've worked with some really unpleasant people, but sometimes you need to step back and look at it from a different view. Just because it hurts to hear doesn't mean that someone is being mean. I was pulled aside as a new RN and told about something I did wrong. The person was blunt, told me what I did wrong, and out of the goodness of her heart, walked me through how to do it properly. I learned from that experience, and this nurse and I work together well. As for the OP: Kindness is nice, but in the end, I will always take honesty over kindness. Imagine if you messed up something really badly, and a nurse corrected and covered up your mistake for you. Instead of telling you about your mistake, the nurse told you, "You're doing a great job! You're so smart!" You don't learn from your mistake, in fact, you gain a false sense of security and confidence. This is so dangerous, because then you get into a matter of, "Well, I've always done it this way and no one has told me it was wrong."
  9. I see that you're very frustrated with this, and that has come out strongly on your replies. Here's something to consider: Read things over a few times before replying. It's ok to feel offended, or like someone is rude, but emotion does not come out over the internet. I personally did not find Ruby's reply to you at all rude. Read it again a few more times. Try and read it over as calmly as possible the last time. Those words were not meant to be offensive. Remember, these nurses are truly trying to help you out and give you some good sound advice. In fact, they have given you good sound advice. In terms of your job: You do not have a lot of experience in ICU. I'm not saying this to be mean. You have had three jobs in 15 months, not 15 months of one job. I've heard it takes a minimum of two years in one position (no switching!) to learn the ropes. It takes 5 years of working the same position on the same unit to get truly comfortable with things. Like another poster has said, you have 6 months of experience in three different units. While that does add up to about 15 months overall, you need to stick to something longer than a few months to gain any sort of confidence. You need a minimum of two years. Don't keep switching. You may be a jack of all trades at the end, but a master of none. Lastly, it sucks being a new nurse. It sucks trying to make friends on the unit. As a general rule, many nurses don't make friends at work because they just want to come in, work, and go home. They don't want to have lots of friends at work because they don't want to talk about work at home (or home at work). I learned this the hard way when I complained at my workplace (two months in!) that "No one wants to go out for dinner on our days off, and they don't want to do anything outside of work!" One of the nurses took me aside and said: don't take it personally. We see so much of each other at work that we don't want to see each other when we're not here. It's not you. We've also found that by distancing ourselves, we don't get sucked into rumours and all sorts of other things. Separate work from home life. You'll be a better nurse for it.
  10. guest1048932

    Trigger Warning!

    I think in our struggle to make people aware of triggers, it has lost its merit. This is very unfortunate.
  11. guest1048932

    Trigger Warning!

    I've been "triggered" at work, if that's an appropriate use of the word. It sucks, yes, but you have to learn how to identify your feelings, address them, and not let that carry over into your patient care.
  12. guest1048932

    Trigger Warning!

    I think the issue here isn't being sensitive nor is it saying a single sentence. As you can see by reading the comments, there is a time and place for saying "trigger warning". I have no problem accommodating someone who genuinely needs this, but the difference between someone who genuinely needs a trigger warning and people who need to be coddled is this: People who actually need trigger warnings work with people to identify triggers, face them, and then eventually, they are able to identify and cope with triggers. Saying "trigger warning" before saying something that could possibly hurt feelings or giving constructive criticism is not an appropriate use of "trigger warning". It desensitizes people, and makes people who actually need trigger warnings look unvalidated. When all you do is say "trigger warning", but then don't teach these students how to address certain triggers, you're building a future where people just say "Trigger warning!" and then do absolutely nothing past that. What's the point of saying "trigger warning" then? What are we supposed to do for these students if they are triggered? How are the students supposed to respond to these trigger warnings? I am all for trigger warnings, but use them appropriately and with an action plan.
  13. guest1048932

    How NOT to write an incident report

    Ah yes, I think someone has to talk with her and remind her that one should never use sex positions when filling out incident reports! Otherwise, reading her incident reports might become a bit like reading the Kamasutra!
  14. guest1048932

    Things Patients Have Taught Me NOT To Do.

    1. Don't remove your 24f foley (with a 50cc balloon still inflated....YIKES!) yourself. It will hurt. There will be blood, and painful surgery to repair your shredded urethra. 2. Don't chew up pills and inject them into your sore arm. It does not "get the medicine working faster". 3. Your nitroglycerin rectal cream for your anal fissure and sublingual nitro spray are not interchangeable. Similarly, your nitroglycerin ointment goes on your skin, not under your tongue "like your spray". 4. Don't try and pop that that "weird giant cyst" on your belly button yourself because it's not a cyst. That stuff coming out wasn't "infection", that was poop. You lanced your umbilical hernia. Congrats. And my personal favourite, as told by a colleague of mine. 5. Putting insulin into juice doesn't "dissolve the sugar". I get that you don't like needles, but you can't just empty your Lantus pen into a Coke and call it "diet Coke". That's not how it works. Back to Diabetes Education Classes you go!
  15. guest1048932

    Trigger Warning!

    Really? What is the world coming to that we have to give trigger warnings before we say something that might hurt someone's feelings? I think it's great that we are being sensitive to others, but having to say "Trigger warning" is taking it too far. I find people are so easily offended these days that you can't say anything. If people are so easily "triggered" that they can't function without trigger warnings, maybe they need professional counselling so they can learn to cope with, address, and manage the feelings that come with triggers. Or, maybe I am in the wrong and have completely misread and misunderstood trigger warnings.
  16. guest1048932

    Scope Of Practice Question

    It was my understanding that regardless of the role you are in, if you are an RN, you are held accountable as an RN. I would raise concerns with management over this "policy". Your nursing standards should at some point state something like "RNs practicing as RPNs or unregulated health care providers are held accountable as RNs. RPNs practicing as unregulated health care providers are held accountable as RPNs". This is one of the nursing standards regarding "other work" where I'm from, so I suggest you look at your nursing standards and bring this to managements attention STAT. Basically, don't turn a blind eye or deaf ear. Document as an RN, know that you will be held accountable as an RN, and talk to management about this unsafe policy. Protect yourself and protect your patients. Best of luck to you!

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