Undecided7

Maybe introducing that many platelets all at once would have caused clotting??? I do know they are VERY expensive, like $1000 a bag in my area, but I've had homeless people get them. Many docs are afraid of lawsuits because these patients need money, they can't pay the bill, but if they win- to doctor and hospital pay them! If he was really worried about being discharged maybe he should contact a doctor, the state welfare office, and a lawyer.

It's common practice for the police to get a BAL, especially after a single MVI. If he didn't do the paperwork for arresting her then- it would have been later. In fact, the doctor would have (at least in some states) been REQUIRED to report her to the DMV. It was HER actions that will cost her money. It may not be ethical or moral in some people's eyes. Perhaps it isn't a specific law. Will she be fired or lose her license for sharing legally relavent info with an investigating officer? NO. Too bad. I guess that nurse has lost that patient's trust- or maybe she was too drunk to remember. Whatever the case, at least one life was saved that day and maybe more. Let me give you another example. Are doctors agents of the state as you put it? I passed out last year- just once- just for a moment. Unfortunately it was at work. I was checked out and sent home- no biggie. Then came the letter from the DMV. The doctor was REQUIRED to report any syncope or seizure to the DMV and my license was revoked for at least 90 days and until a doctor verified I was okay. Thankfully I was. I thought it SUCKED. I had to take the stinking bus! But what if I passed out driving and killed someone? :uhoh21: She may not be a nice person, but in this case, she may have actually not have committed an unethical act according to law.

Why on earth would nursing always be a female dominated profession?? It seems like at least 1/2 of the new grads in our area are male and probably a third of the CNA's. I work with AT LEAST 2 males (either RN or CNA) on my unit every shift. Yes, they give bed baths and everything else a CNA does too. If a person has a problem with that and I don't have time- they wait until the next shift or it's a major code brown- they just get changed regardless of gender. Learning history is important and it's important to learn from past mistakes and attitudes. That DOES NOT mean we have to live in the 1800's. I realize healthcare and medicine has changed- well, do you really want to go back to a time without most of our medications or equipment? Now days, we tell the doctors what to order half the time. In my job it's important that what we wear be COMFORTABLE, NOT CATCH ON ANYTHING OR POSE AN INFECTION CONTROL RISK, AND BE EASY TO CLEAN- I have to kneel on the floor, work with body fluids, clean up the room, lift, bend over, etc. I am NOT going to give some old guy a thrill (or a heart attack) by wearing a white skirt!!! :angryfire Furthermore, as a college educated professional, I do NOT need to be told what to wear! If there are RN's out there (or LPN's) that come to work with their belly hanging out- obviously that is inappropriate but otherwise.....don't tell me what color or style of scrub set I should have. Geezz...... For those of you that feel you have earned the right to wear white scrubs and a cap- go for it. The rest of the staff MAY laugh behind your back and think you are in a time warp (I'm just being honest) - but if it makes you feel better and more important, more power to you. :yelclap: I'm proud of my degree, the fact that I save and improve lives, the fact that I connect with people- and I feel good in my comfortable scrubs, tennis shoes, and pony tail. This isn't meant to be a flame, but honestly most of the old style uniform loving nurses ARE older and will soon retire. When that happens, don't expect the caps and white skirts to make a come back. And don't be surprised when a young man hands you a bedpan or your medications. Welcome- to 2006!! :balloons:

I think if everything is going "normal" then for the most part a fairly silent birth is okay. As a nurse however, we have to communicate not only with the patient but with other staff (unless it's a home birth I guess). If there is complications then they need to realize there may be verbal communication in the room. Let me just say, that kid is going to hear a lot of words and messages in her life- the words said in the first few days are nothing compared to what she will go through the rest of her life. Besides, wouldn't you want to fill her blank slate with positive things? How about having mentally healthy parents instead? As far as religion, yes nurses do for the most part respect a patients wishes. That does not mean we don't have an opinion. There was a young women at our hospital that died a few months back. She and her husband were Jehoves Witnesses and she was giving birth to a 4th child. The baby was fine but she had a MASSIVE post partum hemorrhage. Instead of allowing the needed blood transfusions and STAT hysterectomy; the husband let her die. Now he gets to explain to his 4 kids why they are going to grow up without a mom because he didn't want her to be impure or whatever. I'm sorry. That's not divine. That's not spiritual. It's not morality or respect for the almighty Lord. THAT IS JUST PLAIN STUPID!!! :uhoh21: I'm sorry if it seems offensive to some, and as required, the nurses and doctor respected his wishes and let the patient die. But believe me, that doesn't mean they don't think the couple was FREAKING CRAZY!!! I hope is was worth it.

You mean she was discharged HOME while still disoriented somewhat and needed help finding her way around? And this was a previously functional women with no hx of dementia? That is certainly malpractice. I don't think it's your fault, but maybe the ER doc likes court or has really good insurance. :uhoh21: I don't work ER but can you refuse to discharge someone?

I am considering taking a FMLA leave at work for depression and anxiety until I'm stabilized on my medication. I work in a critical care setting and I know my thinking processes and reactions are very much affected and getting worse. My doctor has been changing my meds to see what will work but so far no luck. I have a lifelong problem with it- I've been on about various meds for 20 years but it's scary in critical care. I know I do very well when things are working. My question is, do I tell my manager? If I file for a leave- the hospital is going to know that I have a mental illness that can, at times, impair my ability to work. Could they fire me for that? Could I lose my license? Would it be better just to quit or change to per diem until things are better and pick up later?

Don't do it. Trust me. Forget all these positive hopeful posts. They are trying to be nice and encourage you. If you want the truth- you will SOOOO regret it!! :smackingf I'm sure there is something out there- just keep looking. How about being a lab tech? You'll have to go back to college just like nursing and it does make decent money. Radiology techs do too- I had one nurse in my class that graduated with a BSN in nursing and decided to keep her current job as a nuclear med tech because she made more and it was easier! I'm assuming you want a decent paying job that requires a degree- otherwise you could be a Wal-Mart greeter or something. The world is wide open to you actually- there are MANY options. Why on EARTH would you torture yourself with nursing? Very few people will be BRUTALLY honest with you because no one wants to totally burst your bubble. I mean, if your heart is SET on it- go for it by all means. I wish someone had sat me down when I started college and REALLY talked to me about nursing and what it would do to my life.

I'm right there. I started to have tears well up in my eyes in a patients room and I he was whining about one thing or another and I was trying to tinker with his 3 IV pumps- I had the strong urge to sit on the nasty dirty floor, put my head in my hands and just cry like a baby. I keep having these thoughts of going into the med room and just shooting myself up with insulin or going home and just overdosing on pills. I can't get help here because the mental health system is WORSE than the acute medical care. If patients really had ANY idea- they would take their chances at home. Maybe it's not the same for other people but no one seems to be too concerned when I start crying at the nurses desk or begging people walking by (other staff) to shoot me. Speaking of which, we had a lockdown last night because there was a shootout in the parking lot. I was going downstairs (by the main doors) and someone said to be careful because it's by where the shooter was last seen; I said, "Good- maybe I'll get lucky and I won't have to come back up."

Everything is not always so black and white/right or wrong. Of course, check the policies and drug info if not familiar. Some drugs have to be given diluted, some slowly over a period of time, some don't mix and others do, etc. With most things though- it's just up to the nurses judgement in a way. Patients, IV lines, drugs, and situations vary and sometimes there is no stated RIGHT way or WRONG way. You'll get more comfortable as time goes on. I know in school, things are different. Once you get out of school though, you'll become more comfortable with "real world" nursing.

Gosh- this may sound mean but you have to be just plain STUPID or BLIND to connect a NIBP cuff or SCD to an IV or tube feeding to a CBI and so on. I mean, you would have to be paying NO ATTENTION whatsoever. In that case, maybe these people shouldn't be in nursing. :uhoh21:

I had a chapter 7 bankruptcy in when I was in nursing school and I've never had a problem getting a job- despite having to sign all those forms giving permission to check credit, etc. Either it wasn't checked (by 4 different companies) or it didn't matter. I also had changed jobs a lot and moved around. The other thing I find interesting is I have NEVER had an employer call ANY of my references. I'm guessing most employers may go off their impression from your application and interview unless they suspect something is up. Maybe they assume that if you consent to a backround/credit check that it must not be that bad.

I work in an acute care hospital, but I have refused to touch patients like this when they are very combative. I will give them IV meds (where I can stand a foot away from the patient and use a distal port) and perform care that does not involve direct contact, but I don't get paid enough to be injured. If the meds and restraints (we aren't allowed to use the hard restraints) are not effective in protecting my safety and the doctor and family don't want to give more sedatives or stronger restraints, then I don't put myself at risk any further. This may sound cold, but I would rather his/her skin break down from laying in waste than have my teeth knocked out. They are at the end of life (and at that point with end stage ALZ, the sooner the better), and I'm still a viable member of society. I will do what I can SAFELY with what I am given but I'm not a martyr and I'm going to protect myself and my health first- otherwise my other patients won't have a nurse.

In an ideal world, the mother would be interested in learning about the negative health effects of smoking- to herself and her children. Armed with the new knowledge, she would either quit (and have anyone else in the house that smokes quit) or at least not smoke when the children are present. She would talk to her children about smoking and encourage them to "just say no"- and her kids, seeing what she has been through- will listen. This is NOT that world. I'm pretty sure the mother has heard the news that smoking is bad. If she cared, she would get help and at least smoke outside or away from the kids but her smoking is more important to her. She most likely smoked when she was pregnant and she probably lets the kids smoke too! I knew kids in first grade that smoked- thanks to their parents- even grade school children that drank alcohol- but that's another thread. You could say something, but I'm pretty sure the mom would just be mad and have a few choice names for you once she gets in the car- and of course, in front of the children. :uhoh21: I guess you have to go with your gut instinct. Does she seem receptive to you? Does she seem interested? You could always try but after a few times, you'll probably give up like everyone else.

All the hospitals in my area use "code 99" instead of code blue- but I think everyone knows what that means anyway, like "code Red" or "Dr. Red". "Dr. Rush" is for a security problem. Anytime there is a loud announcement over the PA at 3am and it's repeated 3 times and then it's announced, "Dr. Red is now code green"- people know it's not a REAL doctor. The room numbers are NOT announced however- only the unit and then staff are directed once they get there (or follow the crowd). I've only seen neighboring patients hanging around in his/her doorway to get a peek but they are quickly told to go back to their rooms. I would not hesistate to call security if another patient was interfering with a "code" or loitering in the area- it's a violation of HIPPA and a general distraction. So far I haven't seen that but I do work nights so there are less people up and about. The bottom line is I don't think it matters what the codes are called- as long as the STAFF know what they mean (and sometimes they don't) (What is a code orange again??-- I know I learned in orientation 5 years ago...)

Maybe I'm the only one, but I use the FIRST name unless asked to do otherwise. As a 30 yr old married women I personally HATE being called by my last name or called Mrs. or maim. It just seems fake, inpersonal, and insincere to me. I also can't stand sales or customer service people that are over polite. Just talk to me like a normal person. I find people more approachable when they don't try to be all politically correct. I also find it comforting and caring when someone calls me "hon" or "honey" (unless it's being used as a sexual or condesending term- and YES, I think most people can tell the difference). I haven't had any complaints yet and I seem to connect with most patients and families. I have had a couple older patients that wanted to be addressed by a formal title and I respect that too. I have to be honest though- in my experience the few that do have a problem with that are more closed, icy- not usually full of joy and love. It takes all kinds and I'm not saying that's wrong- just an observation. I think that respect and professionalism is measured in how we treat and what we do for people, not really by what titles we use.

I would much rather do NICU than adult ICU but I have a stupid concern: my hands get a little shakey at times (maybe a side effect of some meds). It's not like I have noticeable tremors or anything- I think I'm the only one that even notices- but with premies, everything is so TINY. I'm wondering how essential it is to have have rock steady hands?

You definately need to get out of there but first you need to find a replacement job. Try to gather all your strengh and energy and "hit the pavement" with any possible time off- try online too! Look into MD offices, school nursing, home health or hospice- basically ANYTHING but LTC and ACUTE hospitals. Once you are hired, personally I would not give a 2 week notice. You never want to go back there and I would hope any future employer would understand if you were honest about those conditions- it's inhumane. I was fired from a hospital (for not being a "good fit") and had no problem getting future jobs. You still have your license- so far:uhoh21: ; so protect it. I wouldn't waste my time talking to management. If they cared even the slightest bit, you would not be in the position you are in now. Listening to their empty promises or suggestions will only waste your precious time that you could be spending getting another job! DO IT NOW. TODAY!!!!! Good Luck!!! :icon_hug:

Sometimes I fill out the AMA papers beforehand to have it ready- just in case (especially if they've been threatning to leave). I'll happily answer any questions within my scope but if someone doesn't want the treatment- it's not my job to "talk them into it". Assuming they are over 18 and oriented- I figure I'm a nurse, not a prison warden or professional psychologist. I don't always agree with a patient's decisions, but that's irrelevent. For instance, there was a mom in our hospital that delivered twins, then had a severe hemmorhage. The pt. and husband were Jehoves Witness (?) and they refused blood no matter what. Now the father can explain to his kids someday why he let their mom die when she could have been saved. To me the man (and women while she was awake and alive) was TOTALLY irrational, if not just plain stupid. That's my belief though. Sometimes, you just can't save everyone- especially the ones that don't want to be saved.

I don't work in LTC, but I think with ALF you can't just send them somewhere without the patient/family approval. It's like he lives alone as a free man but you are there to "assist" him as needed. They aren't really "patients" per se. Since he has an altered mental status and ALZ, the family has the right to decide what if anything should be done to further his life. If he was home alone and no one took him to see the doctor or to the hospital, what would happen? He would just sit in his filth for weeks. Well, the same thing can happen there. If he doesn't want to be changed and the family does not want to force the issue (while providing for staff safety), then I guess he will just get septic and die. I would not risk getting hit, bit, spit on, scratched, etc. If he refuses and family doesn't want restraints- that's it. What they really need to do in this case is take him home (the family's home), make him a CAT III, stop all his meds, and let him go. Meanwhile, they are the ones that can smell and watch him decline because they are the ONLY ones that can do something about it- legally.

If the doctor doesn't want to follow ACLS/current accepted standards of care and there is a poor outcome, isn't that kinda asking for a lawsuit? I realize amio is expensive, but if someone needs it- chances are it's not going to be a huge expense compared to being in the ICU, invasive interventions, etc. At that point, would a family member say, "Please use the less expensive/less effective drug first??" I guess what I'm saying is that if it were MY family member and the old doc didn't feel he needed to stay up on current standards- I would sue. Now, if there is a good reason why it wasn't used and in that particular case lidocaine WAS appropriate that's different. We as nurses have to take CEU's and recertify, etc. What if we said, "Oh, well that's how I did it 30 years ago! Why change now?"

I'm pretty sure you have a right to remove a visitor if he/she is a threat to pt. safety- ESPECIALLY if you have already told them. Also, we don't have many, but I love it when a patient is being manipulative with narcs and the doctor says, "Okay then... D/C all narcotics. Pt. may have Tylenol Q 6 hours as needed" Or even better (if they are stable) D/C home- instructions: stop doing drugs. Refer to NA. Also, when I have a drug seeking patient, I always dilute the medicine in lots of NS and give it slowly at the highest port. My job is to reduce pain, not get someone high (I don't get paid nearly as much as a drug dealer). They are getting the same dose of medication, it won't burn going in, side effects are reduced, and sometimes it last a bit longer because the peak and trough are not quite as pronounced.

I have had a couple of patients/families who refused to leave after being discharged by the MD. Assuming the patient is medically stable and nothing major has changed; I have called security to escort them out. What they do after that is their business. There are patients that may actually need the bed for medical purposes. I had one mom that didn't want to leave because she just needed "one more night of rest" before going back to her family. I suggested she rent a room at a hotel somewhere- the service and rates are cheaper. As for venting about Medicaid- I do realize bad attitudes have nothing to do with wealth or even education. I understand we get paid by our hospital and they get paid by Medicare (which happens to pay better than the HMO offered to us as employees). HOWEVER- WHERE DOES MEDICAID MONEY COME FROM?? Part of it comes out of my check- and I have WORSE medical coverage- which I have to help pay for out of my check too!! I have nothing against people getting some extra help when times are tough or if they really don't have an option. There is a need and purpose for it. It's For BOTH of those reasons (my taxes and people with genuine need) that the ones that abuse the system (and it's not that uncommon) evokes such intense emotions. :angryfire

We have to have an MD order- ER or not. Of course, the ER doctor can give the order but some won't- they would rather wait until the pt. was up on the floor with a primary doctor. Also, some tests cannot be done through a port and some meds are not compatable and must be given in separate IV's. The nurses may not work with them a lot and be uncomfortable risking the port. Sometimes it's just easier to say you don't know something or you can't do it rather than deal with an anxious and persistant patient or family member at the time. In an ER- there usually isn't time to debate the issue and ultimately it's up to the doctor (unless you have standard orders which also count). I think had the patient been admitted to the hospital, the port situation would have been addressed then.

I'm sure you will do a fine job with a little review and the mom can probably teach you a lot also, but I have to ask- why? If you have cared for adults all your life why suddenly take on a 3 year old with multiple and complex issues?? I would have just told the family that I wasn't a peds nurse but I'd refer them to the appropriate places to find one and wish them the best. Although you will probably be okay in the end, it does sound like you are putting the child and your license at risk. If something happened and you told the court, "well I've never taken care of a child in my life but I asked some basic questions on the internet..." not good. Why is this particular job so important to risk that? :uhoh21:

Where I work the RN's are 90% Philippino and at night, I'm the only "token white girl" on my unit. They talk in their language to each other so who knows what they say. Anyway, I don't live in the south and couldn't. I see your point and I would really suggest you at least move to a "blue state" where things are a bit more socially progressive. I unfortunationally don't either and I've even noticed discrimination- against males, blacks, Philippino's sometimes, even whites. People that are racist are not usually friendly, positive people- period. I've worked with some Agency black male RN's and they seem to do okay (maybe they just don't say anything) and we do get Agency black (and white) male CNA's. (We have a lot of Agency). I've had people request someone else to care for them/bathe them and the thing is, I'm overworked as it is- usually don't get a lunch, so I just tell them okay- but you won't get a bed bath or sheet changed, or fresh water and juice, and if you need a bed pan- hold it till morning when someone else comes on. In other words, NOW is the time to GET OVER IT. I can't change people's antiqued attitutes but I will not enable them. If they won't take their meds from you or what not, I would just write REFUSED. And that of course would include pain meds. The thing is people like that need to just get over themselves and realize this is not NOT 1950 anymore and they are lucky to have a nurse at all with today's greedy coorporations. Also, IN GENERAL, I have noticed black and hispanic patients are much less demanding and "needy" than White's and Asians. I have nothing against any of those people, but that's just my observation from MY experiences in MY location. Thank you for addressing this issue.