nursedora

There is a big difference between telling the truth without sugar coating things, while being respectful, and being downright disrespectful and mean. I too am chunky, after I lost about 200 pounds of fat, I gained back 50 pounds of muscle, and have the "old lady bulge around my middle." Growing up, as a child I was skinny, my Grandmother was embarrassed about that, since in that time era, being slim and trim was assiated with being poor, being fat, or chunky, was a sign of wealth, so she'd push high calorie foods down me, much to the shagrin of my mother. Fast forward to adult life, when all those calories caught up with me, and I ballooned out like Porky Pigs sister. By this time, society reflects things in the oposite manner, and being over wieght is not acceptable, now we've swung the pendulum the other direction, where being 5ft2in tall, supposed to wieght about 90 pounds. Lets find a happy, and healthy medium. We can be respectful and get the message across, in most cases. I'd also like to point out a former neighbor from my apartment house. This young lady rented the apartment upstairs from me, she was somewhere around 35 years old, had hypertension, CHF, type II diabeties, and arthritis primarily in her hip, knee and ankle joints. Her wt, was 800 pounds. And she was proud of it, because that made her qualify for wealfare SSI disability. Now, remember, I said: "...most cases..." this is a case that needs point blank here it is in your face, "if you don't do this you'll die" approach. This young lady was just plain lazy! Didn't want to work, so found out that by being fat, she could get disability, then along came the other problems as a result of her obesity. A typical meal for her was a package of hot dogs (12) with buns and trimmings, about six hambergers with buns and trimmings, a bowl of macaroni salad, enough servings for six people, a family size bag of potato chips, and three cans of regular soda pop. Now, who's the blame for her obesity? Herself? Her family? Her Dr.? Society? Yes, society, for making clothes that fit a 75 inch waist line. How about the Social worker who "ok'd" her benefits? The little girl next door, age 12, who bluntly told her "You are fat, you need to get off your duff and loose some wieght!" And then this young lady, cried because her feelings got hurt, so she spent an entire day sitting in her oversized recliner, eating cookies and chips and crying about this all day. And her lesbian partner babied her, and let her just sit there! Telling her she loved her no matter what her size is. When this young lady came crying to me the next day, all I told her is: "Ok, you have two choices, you can sit there and feel sorry for yourself, and continue to eat yourself to an early death, or you can get up off your duff, like the little girl said, and loose some wieght." I also pointed out that her diabeties could be reversed if she got healthy. And I offered to work with her on her diet, and an exercise plan, with her Dr's care. The response was that I was not a nice person, and they avoided me for the remainder of their time at this apartment house, a couple months later were evicted for not paying their rent. It's time we become less tolerant of size, when health matters are concerned. If an obese person takes a trip on a plane, and is over a certian size, they are required to pay double fare, is that being polite when the ticket agent has to ask for the extra from that passenger? How about the steward who has to get the seat belt extender so that passenger can be buckled in appropriately? How about the EMT who has to call for extra manpower so they can lift the stretcher into the ambulance? Even the power stretchers are rated for only 700pounds, and recommended that if a pt is between 500 and 700 pounds that the stretcher remain in low position, so extra manpower has to be called anyway. Unless you live in an area wealthy enough to have another ambulance in the fleet that is designed as a bariatric rig. Meaning it has a special stretcher that fits onto tracks with a wench to pull it into the ambulance, and lowers it out of the ambulance, then the pt has to be able to stand to get from the ambulance stretcher to the hospital stretcher. This only touches the very tip of the iceburg, in order to accomodate people of obese sizes that much, it's a chain reaction of what's needed, oversized wc's, beds, most diagnostic tables aren't made to accomodate such sizes. And all because we have to be politicaly correct, and polite toward those who are that obese. We need to, as health care proffessionals, need to tell it like it is, we can be tactful, we don't need to be hurtful, but being honest, and not babying obese people will be better in the long run. The SS department needs to be involved to, c'mon! being fat a disability so they don't have to go to work! And they just sit at home and eat themselves into oblivion! It's going to take everyone working together, all departments of health care. The pendulum can swing the other way just as bad too, so rather than put a number on things, why not just get healthy! One can be at ideal wt but not be healthy, yet, be about twenty pounds over and be healthy. Let's loose the number's game, and go by individual health. And stop being polite about things, and tell it like it is point blank.

DisneybearRN, most who have "been there done that" have done just that, been threw the low paying positions just to get the experience and their foot in the door of that sought after position. No different than Dr's who do volunteer work in programs such as the "Dr's without boundaries" so they can resume build, and in most times, do something for the good of humanity, rather than always looking for the price tag on things. If you start off at the top of the ladder, you have no place to go but down. As far as paying back loans, there is the six month grace period for majority of loans, or the payment plan of making payments while still in school, means you have to work fulltime and go to school fulltime, making many sacrifices to obtain your goal, but if you really want it baddly enough, you'll do it. You'll find a way to make it happen. Experience is the thing on the resume, not how much you made, or expect to make, that goes on the application for the job. But in order to get to the application process, you have to build a resume worth HR's time to read. I can hear many scoffing at "volunteering" about now, but what looks better on a resume? That you volunteered your time, did a missionary trip, or some such, or sat home by the phone waiting for that gem of a position to be called for? And what pays back the loans faster? Doing some volunteering, and work yourself into the job, or sitting by watching everyone else go to work? Many prestegious hospitals are doing this same program, mostly to see if you have what it takes to be part of their team.

I'm wondering, the program is "residency" training, so, and forgive my question here, but, does this mean they will provide housing and meals, in addition to the training, and this wage? If so, then adding it all up, it'd be fair.

All over again, I feel you missunderstand my post, I'm looking for guidance on how to deal with a friend who has BPD, I've not had much experience with this in all my nursing career or life in general, and don't know which aproach is best to "be there" for my friend. At first impulse, I want to tell her to stand up and be strong, and stop being a snivling crybaby, then I wonder if that approach will send her off the edge. But then if I play into her and sympathize rather than empatize with her, and allow her to cry about every little thing, am I doing her more harm than good? Keep in mind too, I was raised as a Navy BRAT, and crying over stuff, showing weakness was not allowed, you stand up strong for what you believe in, and look your adversaries straight in the eye, don't coward down to anyone. Save the crying for the privacy of your bedroom or shower. When my friend is in her depressed phase, she expects people to feel sorry for her because she's crying, or that she's having a rough go of things. And she comes to me during this time more so than when things are going good for her. I'm not an athiest, I do believe in the power of prayer, at the same time I believe in the God given talents of Dr's, us nurses, and therapists to do their part in the healing process. And friends as well. But speaking as a friend rather than nurse, I'm at odds on what to do, or how to handle this. As a nurse, it's easy, I follow Dr's orders for treatment rendered in the clinical setting. As a friend, it's a whole 'nother ball game.

Cherybaby, What is best from your friends? How is it more effective or positive for your friends to be supportive of you and your BPD, and or now drug addiction? I have a friend who has BPD, and it's something new to me, and I don't know much except the text book definition, and having taken care of a few pts in the hospital a time or two with BPD.

Even as remote and rural as some of the places I worked in Appalachia TN, and in New York State, I never had to put anything in my mouth to obtain a sputum specimen. Either the pt coughed it up first thing in the morning prior to eating breakfast, or it was obtained via a sputum trap on the suction, either wall or gomco (R2D2) suction. And we did "deep suction" to obtain it. Yes, nursing, RN and LPN did the deep suction back then, the '80's and '90's, rather than calling RT for every little thing. In order to assist the pt to cough it up, we'd do "cupping" sounded cruel to the pt but it worked, have them lay on their side, and "cup" your hands and rythmicly "pound" on the pt's rib cage for about five to ten minutes, then have the pt turn over and repeat the process on the other side. Then when the pt sat up, all the "gunk" was loosened up, and fairly easy to cough up. If the pt was in a weakened state that they couldn't cough up anything forceably, then we'd have to resort to the suction trap.

So, what's the difference? An RN who is asked to help out by toasting the bread so the toast isn't soggy from being covered in a steam box, or an RN who doesn't know how to do the job she's trained for? Let me explain my "vent"... A friend of mine just got home from the hospital, was in a prestegeous teaching hospital, her nurse was an RN who emphaticaly exclaimed she graduated top in her class, and had experience, and didn't need anyone telling her how to do her job! My friend is an RN, as well, my friends Mom, who was with her, is an RN, however, work/live in a small community, considered "Hicksville" by the folks at the so called prestegeous hospital. What took place that caused this RN to get up on her high heals... My friend had half her bowel track removed, and long story short on that one, had to be nourished via TPN, via a Subclavian IV. This nurse in question, set up her IV TPN, first off, didn't bleed out the tubeing, and when she was questioned on that, exclaimed: "Oh, don't worry about that, the IV pump is so modern it will take care of the air in the tubeing." Then, she pulled the TPN fresh out of the frige, and hung it cold, about 38 degrees F. When asked about that replied: "Look Mrs. J, I don't need you questioning my every move, I do know what I'm doing, I DID graduate top in my class!" Well, long story short on this one, my friend started turning all sorts of shades of blue then maroon, and started having all sorts of trouble breathing, and could feel some heart palpatations. Good thing her Dr was entering the room about this time,helped her Mom put my friend on her side, put the bed in trendelenburg position, and massaged her back, and kept her talking to keep her alert, and got her threw the crisis. The RN who graduated top of her class? Well, nothing all that much took place, no dicaplinary action, no remediation, no suspension, nothing except being assigned to another unit at least during my friends stay in the hospital. So, I'd be cureous, if an RN can't properly hang TPN, then how in the world can an RN properly toast a slice of bread? Shame on dietary for thinking the RN's are capable of doing such a task!

Being "nitpicky" Hmmmm. Experience has taught me, yes, being nitpicky in nursing is a requirement. Good pt care is all about details. And being nitpicky is being detail oriented. And if my 20+ years of experience has afforded me the luxury of being able to get my pt assignment done and be able to sit down for a few minutes, then stop being a crybaby about it. Instead, take a lesson, and work more efficiently. How do you think us older ones got to this point? It doesn't matter if we've been with the same facility for that length of time, or if we recently changed and are the low one on the totem pole, our experience has taught us how to work efficiently. Yes, we have this experience, but 20 years ago, we didn't. We were once newbies too. Take a look at the Chrystaliss if a butterfly. What would happen if we helped the strugling new butterfly emerge from it's cucoon? In 20 years you young nurses who are complaining us older nurses aren't helping you will thank us for making you strong by not picking up your slack that you perceive as eating you up.

Speaking as an LPN, and who has been in charge of orienting new nurses, that's NURSES, RN's, LPN's, BSNRN's, all sorts of alphabet soup behind names, an experienced LPN can very competently orient any new nurse to the unit to which they are experienced in. As far as the tasks specific to RN's, you will be oriented to that with an RN. And there are some facilities who utilize LPN's, and do "inhouse" training, for example in some states LPN's aren't allowed to start IV's, however, in that particular facility, they are allowed to, so they are "IV certified." And have taken the training to be certified to not only do IV sticks, but administer IV meds etc. Is that LPN also an EMT, more specificaly an advanced level EMT? If so, they, in most states, are more trained than an RN, and some facilities respect and honor that as well, and have provisions for that LPN to assess/document findings typicaly thought of as an RN assessment. As far as the glove issue, how old is this LPN? I'm from an age, that when I first started in the health care field, we didn't wear gloves, only washed our hands before and after each pt contact, wore gloves only if they were included in packets, such as a foley catheter kit or suction kit. That may explain why she didn't wear gloves only a couple times. Not defending her not wearing gloves, but explaining why she may not wear gloves, or is it a test to see how you will react? Either way, like in other posts, keep it shut, that's the LPN's quirk, not yours. But major point, don't rock the boat! You go snitching every little detail to the Nurse Manager, DON, Nursing Supervisor, etc, you will soon see how miserable that LPN can make your life. You start doing the "I'm better than you because I'm an RN" attitude, you won't have any respect from that LPN when you are the charge nurse of that unit. And the older nurse, LPN, or RN who know's the ropes, can and will make your life miserable, and you will then be put under the microscope and the least little thing you do wrong will be brought up front and center. So, as in another post, vent your frustrations in this forum. Think twice before you blow any whistles. Take a good look at the entire picture where you work, what is the reason why that nurse doesn't wear gloves? Stand back and look at all the trees, rather than just the forest. I'm also in wonderment about something, you seem to have issue with being oriented by an LPN, what is your issue if your BLS or ALS/ACLS CPR class was taught by a CNA? Or someone simply from the community? Do you want only RN's to orient you on everything? There are loads of people out there, who aren't RN's, but have training that far exceeds your RN training. Do you know what to do when you see a STEMI on a 12 lead? I do. And I'm only a "Lowly LPN" right now.

Wait a minute, you are only 28 and are burntout already? Yikes, what's it gonna be for you in 30 years?

BurntoutRN, don't be so surprised to see people who are in their 60's or even older still working. There are many reasons why, for me, I'm planning to keep on working into my 70's, I have to, my long term financial budget doesn't allow me to retire any earlier. And yes, I do love my work. Just as I grow older, will be a little bit slower, won't be able to pull the 18 hour shifts back to back to back to back... I won't be able to lift and tug on the patients like I did when I was in my 20's and 30's. But, age does have it's advantages. See the multiple posts on older nurses going back to school etc.

The bottom line is, all of us have given experiences of area's that are least stressful for us, area's we've worked in, or are working in at present. All area's of nursing have their stressful moments, their drawbacks, and what is stressful for one, may not be stressful for another. So, spread your tiny wings and fly youngun'! Try other area's of nursing, and decide for yourself. Also, remember, that one shift over another may not be as stressful, however, may pose it's own stressors. It's those stressors that are the variable. What is your level of competency? Are you better with hoards of people breathing down your neck such as the case on a typical day shift, or are you comfortable with managing with limited suport staff, and some cases none, only your phone to call 911? For myself, I look at night shift as less stressful. I like home health because to me, it is less stressful, the stressors for those two area's for me? Night shift in nursing home is, limited support staff, you are, for the most part alone, you are fighting sleep if you don't do well working nights. However, if you handle emergencies well, then the advantages out wieght the stressors. Homehealth nursing, the bigest stressors I find there are scheduling, and dealing with the "turned tables" of going into a patients home, some things I see in the homes, make it hard to deal with, whereas in a hospital or nursing home, it's not acceptable. And there is a lot of driving involved with homehealth, unless you don't mind driving, it's something to deal with, and it's an added vehicle maintanance for the extra miles even when gas mileage is paid. I don't mind the driving, but am finding the increase maintanance is starting to get stressful, more visits to the mechanic than if you have a job where you travel a few miles, there , then home.

Streamline2010, how do we start a lobby? I'm looking at another 20+ years to work, I'm 52 now, and know I won't be able to afford to retire, so will work till I can't anymore. Don't know what I'd do if I were forced to retire, won't be able to afford to. Other option would be private duty, the young ones don't want to do that, it's not exciting enough for them.

Maybe, loosing this simple bit of formality, is part of the crux of the downfall of the US society as a whole. Look at countries that are surpassing the US, what do they do differently? What I can see is, they have the gentile politeness we've opted for casual. They wear for men, suit and tie, women, conservative business attire, we wear whatever. It's all about image, and how we refer to people, if even the lowest staff on the totem pole were to be refered to with a title, it makes a big difference in the morale, makes everyone feel important rather than "just..." What if we were to turn the clock back, and go back to a more formal time? They say history repeats itself, so rather than repeating the ills of history, why can't we make a consious effort to repeat history that was possitive? Why not make things, even the simplest of things, a special or formal occasion? I can remember as a child, I was raised in an average home, Father was a blue collar worker, a forman at a gravel pit, Mother self employed as a cosmotologist, yet, we did things that are unheard of today, we "dressed" for diner, And the table was set formal, with the "good" china, and linen table cloth and napkins for the evening meal. It was the norm, for every day. I remember asking my parents why we had to be so formal, and was told that one never know's what the future holds and "...you may one day be invited to a high formal function..." What was done in the home was training for what we may encounter in later life. Children were raised with manners, to keep silent till spoken to, and yes, we were still allowed to express ourselves, just weren't allowed to "but in" on conversations. Adult friends of the family were "Aunt" and "Uncle" and teachers, college professors, Dr's, Nurses, had title. Everyday social when speaking to folks, such as the grocery store clerk was "sir" or "ma'am" It's the little things that make a big difference. I know this is a bit off subject, but what environment we are raised in determines, for the most part, how we act in our professional life. And something as simple as refering to collegues and professors by title is a form of order, order makes for a smoother runing environment. By the same token, if we are to reform and call professors by their title, then students should be refered to by title as well, it's a two way street. And on that, when I was in college, I was refered to as "Miss M..." by my professors. And, back then, it was the norm that students refer to class mates as "Mr." or "Miss" and last name.

Here is another anecdote from my past that may help put things in perspective for when students are out in the real world... When I first started in nursing, I worked in a small rural Apalachia hospital, one of the Dr.s was a neighbor of mine, my family and his would "neighbor" have cook outs, visit, borrow a cup of sugar, that sort of thing. So, we were on first name basis. During my first couple weeks of being employed at this small, but very proffessional, hospital, I was walking down the hall and Dr.H was coming toward me, I said, with a cherry voice: "Good morning Jimmy!" and was immediatly snatched by the nape of my neck and brought to the nurses station for counceling by the Nurse Supervisor, who told me that "no matter how personal you know any of the Dr's you WILL refer to them by their title and last name." Then was told to get back to work. So, giving your instructors that same respect in school gives you the habit of giving that same respect toward the Dr's and other professionals when you go out into the work force. I know today, even the Dr's are more casual, prefering to be called by a pet name or their first name. My being an "old fart" I'd kind of like to see some of the old fashioned habits come back, starting with how you refer to your instructors, co-workers, Dr's, etc. I don't care what hospital administrators try to do, as in making hospitals more like a resort, or such, but if we start using basic titles toward each other, dress more professionaly, we may end up with smoother running units. I'd be curious to know what the patients opinion is, especialy the older folks who remember when Dr's wore a suit and tie, with a white lab/overcoat, Nurses wore white uniform and their cap, And when we talked to the Dr. it was "Dr. Jones..." Or to a co-worker nurse, it was "Nurse Jones..." Housekeepers/janitors were "Mr/Mrs. Jones" And the casual first name references was reserved for at home if neighbors, or outside of the clinical setting.