SassyRedhead

I think you should go for it if you want to do it. One word of caution though. *If* your 28 years have been at the same facility, be forewarned. You are in that special group of nurses that gets targeted by administration for termination because it's considered a fiscally good move to terminate you and hire 2 new grads to take your place (their logic, not mine). They may not be able to touch you in Med Surg due to your skill, expertise and good reviews. But you may be exposing yourself somewhat by your learning curve, making inevitable mistakes, etc. in a new department. Just something to think about.

I think the OP is understandably upset, and sometimes the written word on a message board may not adequately convey 100% of someone's intentions or ideas, so I tend to give some leeway. Being a brand new nurse is difficult, both mentally and physically. Regarding responding in a stressful situation, there is no way to actually LEARN this skill (and it IS a skill) until someone has observed it, assisted during it and then graduated to performing independently. You don't get dropped from the womb knowing how to function like this. Honestly, I would rather have a new grad be a bit timid and err on the side of caution. I have precepted; I can build confidence, provide experiences and guidance. I can't teach away a bad attitude. I can't help someone that nods their head at me when I counsel them on how to do something, then proceeds to go ahead and do it their own way ultimately doing it completely wrong. I can't help someone that has a complete lack of critical thinking skills which cause the same errors over and over even though we've discussed it previously. I expect a new nurse to "freeze up" sometimes, that's why I'm there to help! Critical thinking skills are a work in progress, I don't expect them to be perfect to begin, they are a lifelong learning project, sharpened with years of nursing wisdom. Passing the NCLEX basically tells me that someone is likely to not kill someone, but it's not guaranteed. I have had very bad experiences with overconfident know-it-alls that tell me how great their clinicals/schools/they were. Notice the word "were" in that sentence. They don't last long because they either couldn't learn from their errors or just plain couldn't get along with Mother Theresa herself. Lastly regarding the stethoscope situation...we've ALL done it, some just may not want to admit it. It takes us all just once and a healthy dose of embarrassment to remember to always check for that problem when we are troubleshooting our equipment. Congratulations, you'll never do that again!Orientation is the time to learn from your mistakes. And, no matter what anyone tells you, every nurse makes mistakes even when they are no longer on orientation. I wish you well in finding your new dream job!

Don't buy into the guilt trip. Yes, you knew your situation, but don't kid yourself. Your hospital probably hired you on an "at will" employment contract. So, they can lay you off at any time, and you can leave at any time. As long as you give proper notice, at least 2-4 weeks, there should be no problem. Be prepared to have them escort you out the door as soon as you give notice because it does happen occasionally. I agree it's not an ideal situation, but you have to pay the bills for your family, it's just common sense. If you don't take care of your family, who is going to? Those that may complain wouldn't dream of mailing you a check for a few months, so ignore them. As far as your experience, it should be pretty easy to justify it by telling prospective employers about your spouse's job transfer. Life hands us curveballs sometimes, but that doesn't make us bad employees.

The fact that they are willing to extend this fool's contract is very telling. No matter how much you like the other docs, how much you like the director, etc., THIS SITUATION IS NOT WORTH IT! You know the old adage...crap runs downhill. Do you really think the docs are going to forego their licensures if a sentinel event or worse happens if it can be pinned on you? They are already looking the other way! I'd run, not walk, away from this place.

I don't have empirical evidence, but having been in the general workforce before becoming an RN, my personal opinion is that nursing is no different from any other profession. People have affairs whether in nursing or other professions. I also don't think nursing is necessarily a predictor of someone likely to have an affair, or more affairs.

I have to give the nurse manager credit for being honest about their reasons for overhiring. I have said this months ago and will say it again, with the "recession" comes a perception that business can do anything they want to employees. Just remember, however, what comes around goes around. While you are hiring a boatload of new grads, be careful that this tidal wave of inexperience doesn't deluge you in malpractice suits. And let's not forget Press Ganey. New nurses don't know what they don't know. When you've played the heavy to the hilt and made all the cutbacks you can, you'll still be expected to make more. Whose position will be expendable then? And, more importantly, where exactly will you work afterwards?

RUN don't walk!! http://online.degree.net/accredited-unaccredited-state-approved-diploma-mill/t-must-university-3063.html Check out page 3 of the captured chat log with the "admissions" counselor.

1) Metropolol instead of Metoprolol (met-TOE-pro-lol folks!!!!!!!!!!!) 2) Orientated instead of Oriented (Or-E-en-ted). Orientated (Or-E-en-tate-ed) is NOT a word! Stop adding syllables! There is no tate in Oriented! It is amazing how many otherwise well educated healthcare folks can't get that one right!

I'm very sorry to hear about the loss of your mother. I don't know about the specifics of her situation, perhaps she weighed 80 lbs and was given 2mg, or maybe it was a terrible med side effect or even a med interaction, we just don't have enough information. Irrespective of that, she clearly was not being appropriately assessed afterwards. In general though, if someone is used to getting PRN Ativan, trying to titrate them down in the hospital without detox orders and a detox care plan is foolish. Also, like Angie stated, getting them to breathe without perceived or actual anxiety is actually a benefit to a COPDer. Obviously the patient's reaction to not receiving the medication would suggest that becoming agitated whether he is physically addicted or scared certainly does not benefit his SPO2. Secondarily, it also sets up an adversarial relationship with you. Give the med, and monitor him afterwards. In addition, knowing your pharma should help direct you: "Ativan (lorazepam) is readily absorbed with an absolute bioavailability of 90 percent. Peak concentrations in plasma occur approximately 2 hours following administration."

My best comeback for that goes something like this: "Why would a nice person like you say something like that?" Then follow with direct eye contact and a long pause where it becomes obvious that you are awaiting an answer, and whatever you do, don't say a word. I would be willing to bet that unless she is devoid of any social graces you will be met by a red face, stuttering and an apology.

I don't advocate any pills, get-thin-quick gimmicks. The best, most solid advice is increasing exercise, encourage activities that people enjoy so it's a part of their daily routine. Usually there is one thing that they can incorporate into their day, even if it is a brisk 15 minute walk daily. Something is better than nothing. I have a problem with "fake" food additives, so I unless they have serious health issues such as diabetes, I don't advocate Saccharine, Aspartame, Splenda, etc. My rule is, if it's manmade, it's probably not that great for you. I advocate complex, whole-grain carbs over white refined flour products. I agree with keeping food as close to the natural state as possible and drinking an adequate amount of water a day. I like the common-sense approach.

Unless it is a psychotropic med like Lithium for which the blood level depends on a balance of water (Na), then I doubt they are "flushing" their meds. More likely, they like the feeling of their mental illness (aka manic bipolar or the voices they may hear with schizophrenia) and are purposely water-intoxing themselves to affect their lytes and therefore their LOC.

If you can dream it, you can do it. Eliminate the negative from your life, and focus on what you have control over. I would say good luck, but I honestly believe that luck will have little to do with your imminent success! You go, girl!!

Thanks everyone who responded. I have a bad feeling about this, and I know if something goes wrong, they will hang her out to dry.

A nurse friend of mine told me recently about how she is expected to carry a full patient load and also be physically taken off her unit (from 5th floor to 2nd floor) for anywhere from 45 minutes to 2 hours to "help with outpatient procedures." She works in a large, well known/regarded hospital system. Personally, I can't imagine doing that. She says the charge nurse helps to look after her patients while she is gone, but isn't she still the one ultimately responsible for the well-being of the patients in her care on the inpatient unit??? I mean, what if someone has a problem while she is gone and her backup is busy with other things, isn't she the one charged with neglect?? What do you think and what should she do?

IMHO, I have found that my idea of disrespect and someone else's covers a broad spectrum. For example, while I do try to greet everyone for the day during/after report, sometimes I need to 'hit the ground running' and don't have time to exchange pleasantries. I don't believe this is disrespectful, but I know others that do. When I have a pt that is crashing, I don't have the time to explain the theory of why I need something done for a pt, I simply need someone to do it quickly. I have worked with NA's that find this disrespectful. Sometimes we need to switch our paradigm to be able to understand what is going on in the workplace, and not be so quick to judge, whether it is aide to nurse or vice versa.

I just thought of something else. Now is the time to sign up for assistance. Don't wait until you are "situated" somewhere. There is no dishonor in asking for help when you need it. Don't wait until later, oftentimes the crisis has passed in the eyes of the government (even though this is usually not the case for the individual.) Get WIC, food stamps, HUD housing assistance/section 8, daycare assistance NOW while you qualify. The biggest mistake we make is saying "I wish I would have known then what I know now." Don't let this happen to you. My girlfriend was a single mom and got ALL of her daycare paid for while she got her degree. That by itself was a huge weight off her shoulders because you are bound to have clinicals at all hours of the day...imagine having to find (or afford) daycare for evening clinicals or even overnights while you do your internship? Don't count on the goodwill of family and friends, believe me, that goes out the window fast with 24-hr nursing demands. Be proactive and plan ahead. I would much rather spend my hard earned tax dollars on your situation than many others, no one would begrudge you help at this time. I hope everything works out for you.

Every one of us has different ideals and no one else can ever tell us what is best...we need to look inside for that. I can only share some of my own story. I am not "money-hungry", but I also know the stress of scraping for change every month to try to keep the wolf away from the door. Nursing has offered me many things, among them the ability to provide a decent life for myself and my family. No, it wasn't easy. Yes, there were sacrifices. In my situation, however, it was vastly more important to me to not stand still and be able to provide independence, hope and a "way out" for my family than do anything else. My kids missed me during school, times were rough. But I also knew that times would be roughest for only the X amount of years I went to school. Had I played it safe, I may still not have graduated. Certainly my family would not be in the position they are now. There were hurdles, but nothing that I couldn't conquer. I bet on the light at the end of the tunnel, and I never have regretted it.

My daughter was hospitalized this past year, and was given Morphine IV push (over several days) almost q 30 min due to her pain issues. She had an AC IV site. She claims (months later) to have extreme burning sensations in that deltoid area upon very very slight touch. Anyone ever heard of this? Her MD doesn't seem to believe/validate her.

Absolutely Pyxis can be wrong! Pharmacy staff filled our prefilled saline flushes with prefilled hep flushes!! Also, there have been times when the pharmacy-filled pill packet is missing a narc or a benzo pill because the machine glitched. There are many reasons for Pyxis errors, do your best to keep calm and document the situation for yourself while it's still fresh in your mind. Good luck!

Is there any HIPAA liability in reporting assaults of staff by pts to authorities? Any different litmus tests if pts are in specialized depts such as Psych?? Help plz! Thanks!

re: jhaco on hand off communication: http://www.jointcommission.org/nr/rdonlyres/a6839682-0a43-4053-86fb-923257674f09/0/07_npsg_faqs_2.pdf [2e] what is a “hand-off” communication? the phrase “hand-off communication” refers to a real-time process of passing patient/client/resident-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient/client/resident's care. the information is usually about the patient’s current condition, ongoing treatment, recent changes in condition, and possible changes or complications to watch out for. examples include nursing change-of-shift report; physician sign-out to a covering physician; anesthesia provider or circulating nurse report to the pacu staff; ed staff communication with staff at a receiving facility when a patient is transferred. [2/06] [2e] our nursing staff prefers to audiotape the change-of-shift report. is this acceptable? it is not our intent to prohibit the use of taped reports. however, this method will not be acceptable unless it includes an opportunity to ask clarifying questions and to receive answers in a time frame that is consistent with having complete and accurate information available to the patient’s caregivers when they are providing the care. a process that relies on the option to call a nurse from the previous shift at home if there are questions about the taped report will not meet this requirement due to the understandable reluctance to do this as routinely as the question would be asked if the nurse were available face-to-face. [2/06] [new—2e] is hand-off communication required when a patient moves from an inpatient unit to radiology or other diagnostic testing unit? yes. the information communicated may be limited to what is relevant to the procedure, but it is a “hand-off” and should follow a standardized procedure. at the very least, this will ensure that staff in the testing area know that the patient is there and it will provide an opportunity to properly identify the patient and the test to be done. [new, 1/07]

many people equate stating facts with being "rude", notwithstanding if you sugar coat it and put a stick in it. management knows this but they don't care because they are being led around by the press-ganey nosering because all the "cool kids" are doing it. i swear, it's like a bully on the playground. on the diabetic diet comment above, this is exactly what i was talking about in another thread. and largely, responses there stated that patients have the right to eat whatever they want and whenever they wanted it. the fact is, if you want good nursing care, you can't have it both ways. press-ganey doesn't rate the efficacy of nursing care, it's just another madison avenue red herring.

Offtopic, but in keeping with the above. I think there are multiple factors for diabetes. The attached, for example could be a factor. (I would have just linked it but it was in the middle of a longer article.) By ANDRÉ PICARD, from the July 6. 2002 issue of the Globe and Mail, with a report from Avis Favaro, CTV News - Copyright © 2002 Bell Globemedia Interactive Inc. All Rights Reserved SHARP DECLINE OF NUTRIENTS IN OUR DAILY FOOD Today's Foods Lack Yesterday's Nutrition Fruits and vegetables sold in Canadian supermarkets today contain far fewer nutrients than they did 50 years ago, according to an analysis conducted by The Globe and Mail and CTV News. Vital vitamins and minerals have dramatically declined in some of our most popular foods, including potatoes, tomatoes, bananas and apples, the analysis reveals. Take the potato, by far the most consumed food in Canada. The average spud has lost 100 per cent of its vitamin A, which is important for good eyesight; 57 per cent of its vitamin C and iron, a key component of healthy blood; and 28 per cent of its calcium, essential for building healthy bones and teeth. It also lost 50 per cent of its riboflavin and 18 per cent of its thiamine. Of the seven key nutrients measured, only niacin levels have increased. The story is similar for 25 fruits and vegetables that were analyzed. But Health Canada refused to comment on the findings, saying the debate was an academic one. The academics, for their part, are intrigued, but not alarmed. Modern farming methods, long-haul transportation and crop-breeding practices are all believed to be contributing to the drop in vitamins and minerals. Phil Warman, an agronomist and professor of agricultural sciences at Nova Scotia Agricultural College, said there is no doubt the nutritional content of food is different today, due to the emphasis on producing cheap food. "The emphasis is on appearance, storability and transportability, and there has been much less emphasis on the nutritional value of fruits and vegetables," he said. Dr. Warman said crops are bred to produce higher yields, to be resistant to disease and to produce more visually attractive fruits and vegetables, but little or no emphasis is placed on their vitamin or mineral content. While there is little evidence, anecdotal or otherwise, that the changes are resulting in major nutritional deficiencies in the general population, Dr. Warman said consumers should care about the issue because it is the nutrients, not the appearance, that give food value. "I care because I want to eat a product that is as high in nutritional value as possible. Otherwise, I would eat sawdust with nitrogen fertilizer," he said. Tim Lang, a professor at the Centre for Food Policy in London, England, agreed. "It's an issue of consumer rights," he said. "We think of an orange as a constant, but the reality is it isn't." In fact, you would have to eat eight oranges today to get the same amount of vitamin A your grandparents got from a single orange. And you would need to eat five to get the same level of iron. However, the amount of vitamin C has increased slightly. Dr. Lang said declining nutrient levels may prove to be a health issue because we are only beginning to understand how important micro nutrients are to disease prevention. "The argument that it doesn't matter because we overconsume is complacent. ... Nutrient density might also be important." Alison Stephen, director of research at the Heart and Stroke Foundation of Canada, said the biggest nutritional problem is that most Canadians do not eat anywhere near the recommended five to 10 servings of fruits and vegetables daily. But she is not unduly worried about today's consumers failing to get their required vitamins and minerals. "A lot of our foods today are fortified — milk, bread, apple juice, cereal," she said. In other words, grains and dairy products are far more important sources of essential nutrients than they were in the past. To conduct the analysis, The Globe and Mail and CTV examined food tables that were prepared by government researchers in 1951, 1972 and 1999, and compared the nutrients available from 100 grams of the given food. The results were almost identical to similar research conducted in the United States and Britain. The U.K. research was published in the British Food Journal, a peer-reviewed, scientific publication, while the U.S. data have been published only in alternative-health journals. According to the Canadian data, almost 80 per cent of foods tested showed drops in calcium and iron; three-quarters saw drops in vitamin A, and half lost vitamin C and riboflavin; one-third lost thiamine and 12 per cent lost niacin. But some experts said the explanation for the decline might be found in testing and sampling methods. Len Piché, an associate professor of nutrition at Brescia College in London, Ont., questioned the accuracy of the numbers, saying testing methods were not great in 1951, so we may only now be getting a true idea of the nutrients in fruits and vegetables. "Did they really go down, or do we just have better techniques for analyzing those nutrients?" he wondered. However, Dr. Piché said the issue is one Health Canada should examine. "If there's a problem, I'm confident the government will take it seriously and do the necessary research to address it," he said. In the analysis, the biggest loser was broccoli, a food that epitomizes the dictates of healthy eating. All seven of its measurable nutrients declined, notably calcium, which fell 63 per cent, and iron, which dropped 34 per cent. Broccoli is often cited as an excellent source of calcium and iron. Cathy Bakker, a graduate student in vegetable physiology at the University of Guelph, has done research showing that the more fertilizer used, the lower the vitamin C content of broccoli. She was not surprised by the drop in nutrients but said food growers are catering to public demand. In her study, the vegetables grown with less fertilizer contained more vitamin C, but they were less firm and green, making them less attractive to consumers. "Consumers want a broccoli that's all nice and green and firm, not one that's all wilty," she said. ------- I now return you to the regularly scheduled topic. :chuckle

Thanks Miranda. This gal is a frequent flyer here and we have done so much on so many occasions to attempt to accomodate, special dietary consults, talking to docs, etc. Every meal is at best unpleasant or at worst an all-out meltdown. I totally understand about her perceived lack of control and I really do empathize. It's one of those situations however that as you attempt to accomodate you get hooked in for more and more "exceptions" to the rule. This time around she totally denied that she had diabetes, although she has been on meds for years. Doc d/c'd all meds, put her on a general diet and her BS skyrocketed, doc re-educated and restarted meds/special diet, nursing is supporting. Pt still angling for extras/special favors. We are all just trying to do what is right. As I'm typing, I'm dusting off my nursing books to try to find some answers.