boggle

I always felt that " not given at scheduled time" or " nurses judgement" needed some follow up charting to explain why. Sigh, more work. (i always wished for an option to click on that said " meds arrived on time, given late because patient in bathroom. )

"The way we've always done it..." is a dangerous basis for nursing practice. I think we nurses have been bedside researchers and scientists for decades, but now we finally have easy access to studies that support what we do....and we can cite it too. I commend you posters who are seeking out the answers from manufacturers and infection control studies. Please share your results with us!

Also, does anyone know how to post the image of the dvcipm.org pain rating tool here. I didn't know how to attach it to my above post. thanks.

delphine22, I agree that verbal description can be helpful with the pain number rating system. I've heard so many patients say they just don't know what number to say. Where did you get you verbal descriptions? Are they a particular standard? ive been working with some returning veterans who are using a multi image and verbal description scale. It's from the the Defense and Veterans Center for Integrative Pain Management (dvcipm.org. The pain rating scale listed under the Clinical Resources tab, as well as others.) This is getting favorable reviews by my hospital, and is beefing considered as an additional pain assessment tool.

OP, I totally understand your dilemma with poo. It's a visceral reaction. I've been in bedside nursing for decades and can comfort, and clean a patient through any mess the body can make, But if I HEAR the sound of RETCHING.... I'm done for....I start retching too. (Why must the ear be connected to the stomach? Some cruel joke of evolution? ) While you explore your career options, I recommend those strong MINTY BREATH STRIPS like Listerine brand. They come in pocket packets. Two of those in your mouth are so overwhelmingly powerful that your eyes will water, and all sense of smell will be side tracked. It may help you get through the tough times. (It's really so strong and unpleasant that it may side track your emotional response too) I feel for you with your dilemma. Don't let any embarrassment or worry about it get you down. Just let your caring shine through. Good luck.

I do not want my well being (life?) put at risk because the nurse is left to guess what that squiggle on the order sheet says. Really now, if the doc was the pt and I said this is the med/dose I "think"your doc wrote.....? Sometimes I think they are covering up for not knowing how to spell...... So PRINT already

Forgive my silliness here, but I've been with a group of preschoolers all afternoon. I just felt like blurting out, " ABG time isn't for another 15 minutes. It's quiet time now. Heads down on the mats everyone". Sorry, couldn't help myself :)

Your hands are clean, but the faucet handles are dirty. So grab a dry paper towel to turn off the faucets. A wet towel or bare hands just allows the contaminants on the faucet to deposit themselves right back on your hands.

With the "pt satisfation scores" emphasis put on pain rating and relief, I feel we are pressured into the quick fix ( no pun intended) of pain meds. We are rushed as it is...now also pressured about how the floor rated this month. With that pressure, I see less time spent, ( less time available too), on other measures to control pain and increase pt comfort. Pain is real, but made worse by fear, anxiety, muscle spasms, ..... I long for the time to stay a minute or two with a pt, after medicating, to reassure, to teach and explain what effect to expect, to see if adjusting position would help, and all those other measures that really lead to a comfortable pt, and a Satisfied Customer. Chronic pain is awful. A person's own goal may be to get down to a 3/10. At a 6/10, you may not see a wince or frown. You can't judge by the way they look. Just listen to your pt please, even if they don't look like that frowny face on the pain scale page. I know I am much more emotive, emotional when I have acute pain then when dealing a chronic pain issue. Acute pain...I get scared and feel vulnerable. When in acute pain, i get the eye roll, she's overacting look. When my chronic pain becomes an issue, i get the skeptical look and questions. I don't show that pain much. Don't take it personally. Just treat the pt. Thanks for letting me vent a bit here.

I have tactfully removed a roommate, directed to an activity, while administering enema, fecal disimpaction. The resident being cared for was totally oriented, and was embarrassed enough to e to go through the procedure. Sparing the roommate from the odor, and the roommate from further embarrassment seemed the kindest thing to do at the time. Hmm, after rereading this, I guess enemas/ disimpaction isn't really considered "routine" care. It just feels like "routine" for some residents on some days. Boy we need more hydration and fiber around here. :)

Back to the question of how to assure the meds are destroyed so the patient in pain can obtain a new prescription......OP, how did this work out? Pain clinics nationwide must face this same dilemma .

You have been on a long and EXHAUSTING journey! Each step of your journey has been challenging. That, plus your ongoing sadness makes it understandable that you'ld have trouble seeing the future. So many of us have traveled the same rocky path. Please go to the counseling center at your school, today. (You've already paid for it as part of tuition). You have strengths that have helped you through trials before. Let the professionals help you keep moving forward. My love and prayers are with you.

Oh, and there's nothing like spilling a cold drink in your lap to keep you wide awake for the ride! :)

I rotated to nights for a month at a time, then back to 2 months of day, for many years. The one hour commute each way was always a challenge. The singable, foot tapping music did help, as others suggested here. A crunchy snack worked very well, like popcorn or pretzels or such. That really saved me. It was rough on the waistline though. Wish I had thought of the cup of ice to crunch. I wish you safe travels.

Annmariern.....I'm speechless

Many times we resorted to washing feet with shaving cream after repeated soap and water washes just wouldn't cut the smell. Left those puppies fresh as a daisy.

I'm glad to hear you thinking about infection control here as well as keeping nasty smells out of the resident's hamper. I think I hear you identifying 2 main concerns here (in addition to coworkers doing their own thing)........the condition/ cleanliness of the hamper, and the concern that the washcloths will be contaminted for further use along with any laundry it touches in the hamper? Does your facility have any written policy on handling laundry? There is likely a policy, just not know or being followed by the caregivers. The infection control nurse needs to hear your questions and concerns, ang take action to educate the caregivers and enforce the policy (before the facility gets cited by inspectors). Facilities I've known line the hampers with a plastic bag. Laundry is removed from the room in the bag, and a new bag is placed in the hamper. The facility's linen and washcloths were put in separate hampers. Facility's linen got the heavy duty bleach/ disinfectant treatment in the laundry. That kills everything.....the linens are safe to use again. The resident's own clothing was washed as regular clothing would be, but also had the hot water and hot dryers. Clothing soiled with feces would be put in its own plastic bag and washed separately in the laundry dept. Best wishes to you.

Whoa! I hope you are working in a facility that is emphasizing a culture of safety. (I thought that was part of the national reform of healthcare and safety?)Please ask your supervisor or nurse educator to talk to this person, Soon, about errors, that med errors are usually part of a multi-system problem, not just her error. This is not a blame thing anymore, or at least it's not supposed to be. Nobody "writes some one up". They report "safety or medication occurrence" where the system didn't work. (I've written a few occurrance reports about my own errors myself. It doesn't feel good) There are usually many, many factors that lead up to a missed dose or med error. If you don't identify these factors, MARs never get improved, med delivery never gets improved, data supporting importance for more nurses per shift gets missed,...you get it. Apparently the nurse you work with doesn't though. Good luck

The above post by FMFCorpsman, and many others offer great advice. I've also found myself working with old coworkers or techs, but now with them as my supervisor!!! People grow. You will too. I did want to offer advice to you to keep up your observation and assessment skills while working as a tech. Remind yourself to pay attention to the findings that go along with the patient's diagnoses. No you can't pull out your stethoscope, but you can still observe color, ease of breathing, VS, changes in ment action, LOC, etc. Keep practicing your analysis skills. Pay attention to what you hear the nurses say about the patient that helps you fit the puzzle pieces together. Most of what you do in nursing is analyzing data, planning interventions, intervening, analyzing again, and on and on....At least you can keep practicing a bit of those skills and keep learning while you persue other job opportunities. It may even give you a more positive feeling about getting through your days in the job you don't care for. Sorry for all the trouble you are going through. Keep on learning, and keep positive.

OK, just a bit if a rant here, ...guess I've had my fill of disrespect for the role and importance of the nurse lately. I feel wearing our full names and credentials are part of being a professional. I totally understand the exceptions in some mental health and a few other speciality units. but otherwise, it's, "I'm Jane Smith, the RN who will be with you this shift.". Yes, I often interact with patients by my first name if they wish. In school, our instructors often referred to us as "nurse Smith", to emphasize the professional title. Yes it's a bit clumsy, doesn't have the same flow as "doctor", but it did distinguish us from the rest of the crowd in scrubs. It has been a long road for nurses to get respect as a profession, and professional names are part of it. We don't call the physicians by their first names, "hey Bob, have you see these labs...."And don't get me started on folks who wear name tags backwards but never clarify their role, leaving ( or leading) the patient to believe they were the nurse when they really were a Medical Assistant or tech. If your badge flips, Fix IT, Pin It!!! Ok, rant over, but profession standing tall!

Calling double gloving a "Technique" is really confusing to all, especially to nursing students. A few years ago, I searched all over for some reference to support double gloving to better protect the caregiver, Infection control sites, NIH, you name it. I couldn't find anything, ...BUT... I think it all comes down to the quality and fit of the gloves you use. If your facility has lousy gloves, shame on them. Raise a fuss ...... OSHA anyone??. You would think it would be far cheaper for a facility for you to use one pair of good quality gloves to get a task done than multiple pairs of ones that rip and shread. Sigh.I can see the point of the convenience of stripping off one dirty glove and having a clean one on underneath when handling messy cleanups though. Wish I had thought of that earlier.

If you can, find a recent nursing physical assessment or nursing skills book. Most of them have a list in the back of common nursing phrases and statements with translations from English to Spanish. You could use the same phrases, just translate to your desired language for teaching.

I agree with the poster who stated police should be involved. Money missing from a purse is a police matter. A bp cuff?...well, I wouldn't call police on that one, but probably would for something of greater value, especially if taken out of my bag or coat or locker. I would definitely write up an incident/occurrence report about any of my or my patient's items that come up missing. Hopefully someone in risk management will pay attention to the growing pile of incident reports. Maybe trends and patterns will be identified. Good luck, Levelee, .....and write your name on everything and keep what you can under lock and key.

Have you been involved in the nursing field during those 20 years? If not, you have a lot of material to cover. So much has changed. To begin, I would suggest you get ahold of the most current skills text and med-surg text you can find, and become familiar with Nursing Diagnosis and Nursing Process (Carpenito or Ackley& Ladwig). Become very familiar with whatever texts your students will be using,too. Good luck.

I think for those of many of us who chose caring professions, we are deep feelers. We hurt and beat on ourselves as deeply as we care and give to others. Our culture? our upbringing? who knows? You must stop ruminating over your errors, (and you/we will make errors), and forgive yourself. Can't let it go?... then take care of yourself, take yoga, pray, see a counselor...whatever it takes to find peace.