Deekie

In our LTC facility we have standing orders from all physicians for bowel regimen. MOM 30 cc PO PRN for constipation and Dulcolax Suppository PR PRN for constipation...this standing order is only good for 72 hours however, and the charge nurses' responsibility is to get a permanent order for any usage over 72 hours. I have found that 30 cc of MOM in 6 oz of warmed prune juice is a miracle for many bowel problems. I usually have to give only one dose ( good old brown cow ). One thing I recommend to my chemo, radiation therapy, and Parkinson's patients' physicians is daily Lactulose of at least 15 cc PO qd as well for maintenance. That particular regimen has done much to assist with bowel maintenance. The chemo and rad tx patients are usually on pretty high dosages of narcotics and ... well the Parkinson's patients just have so little peristalsis, that the lactulose seems to help. I like the idea of the nurses more closely monitoring the BM's though. I know I did as a charge nurse, but I think sometimes that particular task drops to the bottom of the "to do" list when things get hectic ( which is always ). Im thinking that putting it on the 'nursing measures' MARs might just be the answer to remind nursing staff to check more closely. Thanks for the idea!!! Deekie :-)

During my last semester of nursing school I became totally stressed out and couldn't sleep at night. I would have nightmares about forgetting how to do CPR or not being able to figure a drip rate in an emergency situation. My nursing instructors assured me this was a perfectly normal reaction for most doctors and nurses at the end of their education. Needless to say, I didn't believe them. I had 3 fellow students, all around my age ( 45 ) at the time with whom I could not even discuss this. We had become friends throughout nursing school. Worked on Honors Colloquium projects, etc...but still...I just could not imagine they were having these feelings. I graduated 2nd in my class and the insomnia became worse. I was scared to death to take my boards and scheduled them for 3 months past graduation under the guise of needing time to study. The fears increased, my insomnia increased, the nightmares increased when I did sleep...and of course not once did I study throughout this time. I took my boards and walked to the parking lot and vomited because the computer shut off after 75 questions ( of course in my mind it was because I had failed). A little over a month later I got my results and had passed, but again this did little to diminish my fears. Basically what happened is that I vegged out. I would only apply for jobs that I knew I was not qualified for and would never even get the opportunity to interview for. Eventually after a year when I finally started running out of money, I decided to relocate. I put out 8 resumes to hospitals and LTC facilites where I was going to relocate. I had 8 interviews and was offered 8 jobs. I took the best of the offers and started as a Medicare Charge RN in a skilled bed facility. In January I will have been there for 3 years and have just been offered, and have accepted the position of ADON. It took me 18 months to get over my unrealistic fears though before I could make those moves. Now I know that I'm a good nurse but I still have days when I constantly second guess myself, when I see another nurse and think " Why can't I be that good?" Understanding has come however, that we should always be questioning our decisions, worrying that we are not the best nurses etc. The day we quit doing so is the day we should probably consider getting out of the field, for it is the day we close the doors to betterment and learning Deekie

i'm new to this forum, but have been internet friendly for many years. mea culpa for the length of this letter but would like to have people know a bit about me before i start my rant!! lol. if you make it to the end then thank you for listening!!. i you just can't wade through...i understand. i graduated from nursing school with a bsn at the age of 45,( i am 49 now), so terrified by my lack of knowlege that i was barely capable of applying for positions most of the time. this was no one's fault but my own lack of confidence in my ability ( btw i graduated #2 in my class with a 3.98 gpa). that was not said to brag, as i had absolutely no confidence in my ability to be the kind of nurse i had always wanted to become. i saw the negativity of the profession throughout clinicals and yet i still felt i could not live up to my ideal as a professional nurse. ( and yes, i truly believe that many nurses do eat their young...one of the few species with this peculiar characteristic). trying here to make a long story short and not succeeding. i decided to move out of state, sent out 8 resumes to ltc facilities and hospitals, gave them the dates i would be in the state and available for interviews and received responses from all 8. i interviewed for all 8 supervisors and was offered positions by all. boy did my confidence level go up within a 3 day period. i was like a kid in a candy store!!!i chose ltc because it interested me the most. i started out on day shift as a medicare charge nurse in a 92 bed facility. yes, there were days my don made me cry...i'm sometimes positive she thrived on it even, but i survived and learned and finally realized " i am a good nurse" "i am becoming the kind of nurse i always wanted to be". luckily i had a very understanding, patient adon. i even eventually learned to "suck it up" when my don took her frustrations out on me. i stood up for my cna's and lpn's when necessary and i think i have gained the respect of my peers and management. in fact, i was just promoted to adon and am still gasping in amazement at the possibility. yes, i ***** about the nursing shortages, but i also try to accentuate the positive side of nursing ( too many to enumerate). my point here is this: #1). tim, when i initially read your first post it angered me a bit. then i chilled out and tried to think about what you said. things calmed down. tim, you sound like the kind of don who will get things done to me. #2.)as to degree status, when i was in the bsn program i thought that was the only way to go. that it would make me a "better" nurse. but i can honestly admit that i've learned more from lpn's than anyone in the way of procedures, techniques, med passes etc. i also realize that there are many nurses who feel that in order to "professionalise" the career, only bsn's should be offered. we are going to professionalize this career right out of this world if there are not position and degree differences. we will never be doctors or lawyers and we might as well face it!!! i think most of all we want our profession respected. i'm not going to complain about pay...i'm not going to complain about working short, or working 60 hours a week, or even about unappreciative staff, residents, management or family members. finally, i am taking issue with a statement i just read made by rn4peds. and i quote "ask your self the following questions: are you providing constructive input or are you whining (which is what i'm hearing here)? are you happy with yourself? i find that most of the time nurses criticize when they are not. these nurses usually don't take care of themselves; overweight/obese, high dysfunction at home, and undereducated or close-minded individuals. i would like to nursing to be seen as true professionals and to do this we must start by expecting more educationally by having a minimum standard of a 4-year degree (with clinical/didatic covered thoroughly). why should we expect less? would we of physicians? " you are of course entitled to your opinion but the degree of animosity you hold toward others who do not have your "level of education" appalls me. your attitute that "most" people who complain are overweight, dysfunctional, and undereducated is such oversimplification that i certainly hope i never have the terror of working with or for you. if you hold your co-workers in such disdain, how in the world do you function on a daily basis? vent on brother and sister nurses, the sanity you save may be your own. deekster!!!!