kittagirl

Think of it this way, if you in your role as a Nurse had a patient who said I know that this is a teaching hospital and everyone has to learn but I am not comfortable with having students in the room when I am in labour would you object or question her? No I'm sure you'd reassure her that her feelings were important and valid and you as her Nurse would work to ensure that she was as comfortable and ensure that there weren't any students in the room. So why should you as a patient get any less consideration? It's your body, and as a patient you are there to have a safe healthy birth not to provide a teaching experience................. I have been unlucky enough to need several investigations recently including several gyne ones, I didn't mind students observing these but refused point blank to allow any students in when I has a lumbar puncture. . . odd yes I think it was because I had experienced the gyne ones before and knew what was going to happen and how I would react, but the LP was my first and hopefully last

Hate to be the one to tell you but these habits will stay for life. . . . I have been off the wards/floor for many years and away from cardiology for more than that but still wake up occasionally ‘hearing’ monitor alarms. Still love palpating veins, think of it as keeping my talents up. When my other half actually feels ill enough to actually complain to me (years of ‘Duh, I’ve gone and worked a 12+ hour shift with worse than that’. . . have taught him not to bother coming to me with any minor issues ) Anyway he prefixes all medical complaints with yes I have been drinking I’ve had xx litres of water in the last xx hours and yes I have had a BM today and it was fine but I still feel…… Someone recently asked me what the funny squiggle was at the end of my signature, had to explain it was where I’d started to write RN before I realised what I was doing. I’m considered the hard assed aunt, as I have been regularly heard to comment its only blood, come crying when there’s bone showing. . . (My sis-in-law hates this, and can’t understand why our nieces and nephews will always come to me first, the fact that I treat them like people rather than talking down to them helps) And I do the ‘if they’re coughing they’re breathing’ and the ‘if you’re telling me you can’t breath you’re breathing’ line. And I still feel stupidly happy that I have weekends and all the holidays off. . . . . .

Hi, I was wondering if someone could answer a question for me about nursing licences in the US and how you maintain yours. Actually the above question is a bit ahead of myself. My question is once you have your nursing licence what do you have to do to maintain it? For example I'm UK based, and to maintain my licence I have to be able to prove that I have completed: 450 hours of registered practice in the previous three years and 35 hours of learning activity (Continuing Professional Development) in the previous three years. The criteria of what is seen as 'registered practice' is actually quite strict How does it work in the US? I've tried searching the net, but you know how it is, they tell you the official bit but what do you actually have to do? Thanks in advance Kittagirl

Ok, how about the time I somehow managed to spill tomato soup all down my bum? Oh and the laundry room was locked and me being a big girl no-one else’s uniform or scrubs would fit, and being the senior nurse on the ward couldn’t go hide. . . . Or how about the time in a 4am delirium, you know what I mean it’s that time of the night you didn’t get any sleep that day, you’re slightly crazed so you talk rubbish, you lose inhibitions . . . I loudly told the other nurses on duty what I could/would, if I had the chance, do to the new junior doc, not realising he was sat behind me. . . . ( oh so fit so very very fit, I know sexual harassment.) Managing to oversleep for a night shift. . . . Asking an amputee to ‘hop’ out of bed. Date a doctor. . . (But not the fit junior one.) Again on a night shift, first nights were never good for me. At the start of the shift gave a little chat about how rude and mean and wrong it was to eat other peoples food /lunches from the staff fridge. (we’d had a little spate of it).Then totally forgot that I hadn’t brought my lunch in ( I normally did, in-fact normally brought extra) and ate/stole one of my colleagues meals and got caught, not just caught but sat eating in front of the nurse I stole from. . . . . . . Guilty but innocent (I really really though it was mine), she forgave me Going shopping after my last night shift for a dinner party ( No, we will have your friends to dinner honey, no I’ll shop it’ll be fine) And coming home with 2 pineapples and 48 rolls of toilet tissue. Nothing else in the fridge. It all made sense at the time. . . . And then sleeping till 7, OH swears I spoke to him on the phone and told him I was putting dinner on and there was 3 courses . . . . Luckily one of the couple coming to dinner was a paramedic and completely understood. We got takeout. Chinese, very good. I realise reading this it makes me sound like a bit of a liability on a night shift, but really I wasn’t when it came to patients, but having sorted patients and paperwork all my intelligence was used up so I was a bit dippy when talking to colleagues. It’s a bit like how you can be so sympathetic at work but at home you need to see bone poking through, or blue lips, or severe haemorrhage before they get more than a ‘Oh Dear, well I’m sure you’ll be fine once you get to school’

That interviewer was a total puppy's mother. . . . . . It is so horrible (and hard) to try to sell yourself without sounding big-headed and then to realise that it was all for nothing. As said earlier, nursing goes in peaks and troughs and someday you may be the person in the seat interviewing that new grad, knowing that you and your facility really need someone with experience and be the one to give that new grad constructive advice rather than be a b***h. Every experience is a learning one. Saying all that I really want to go and let that interviewers tyres down, give you a big hug and some serious cake, trashy TV and wine therapy. . . . . .

Sorry I haven't had a chance to look at all the pages, but here are some of my current favourites Current house rule! Do NOT get between the woman with PMS and the Chocolate!!! Personal favourite: Who died and made me the Queen of Nice? (You get between me and the good stuff I will bring you down and when you whine I will reply with above) You can't make a silk purse out of a sow's ear If it's wet, dry it. If it's dry, wet it. Meetings are indispensable when you don't want to do anything. People who enjoy meetings should not be in charge of anything That one only opens his mouth in order to change his feet (a Irish-ism!) All money is tainted, tain't none of it mine. (And another) It's not that the Irish are cynical. It's rather that they have a wonderful lack of respect for everything and everybody. (And again) Never put off till tomorrow what I can put off forever Everyone is wise until he speaks. Always forgive your enemies. Nothing annoys them so much. God is good, but never dance in a small boat Get down on your knees and thank God you're still on your feet If you are lucky enough to be Irish, then you are lucky enough. ( have you guessed I'm Irish yet?) As you slide down the banister of life, may the splinters never point in the wrong direction. Good laugh and long sleep are the best cures in a doctor's book. An Irishman is never drunk as long as he can hold onto one blade of grass to keep from falling off the earth. May the road rise to meet you, May the wind be always at your back, May the sun shine warm upon your face, The rains fall soft upon your fields and, Until we meet again May God hold you in the palm of His hand In order to find his equal, an Irishman is forced to talk to God. May you both live as long as you want, And never want as long as you live. May the Lord keep you in his hand and never close his fist too tight What the little ones see, the little ones do. Beauty won't boil the pot. It's no secret if three know it The moon is none the worse for the dogs' barking at her.

I grew up in a large family, I won't say we were poor, well we were, but as kids we didn't know, everyone was in the same boat. BUT no one smelled, my God my parents would have died of embarrassment, poor is one thing, dirty is a whole different kettle of fish. As another poster said a basic bar of soap is not expensive! She's working I'm sure whatever debts she may have; there is always 50c for a bar of soap. I 'm also engaged, my partner is Indian as in from India. I've learnt to cook a lot of traditional foods, and yes there are times when I've eaten a big curry the night before and I'm rushing around the next day I can smell the spices been sweated out. I have to say I'm paranoid about it, but I think and my co-workers agree that it is not an unpleasant smell, and trust me, my co-workers would have no problem with tell me if I did smell unpleasant. I never smell like a damp mop!!! In fact living a very culturally mixed area I can't think of any culture that actively dis-encourages washing. And most incorporate washing as part of their religious life i.e.: as a Muslim you must pray 5 times a day and you must wash in running water before praying. The same with those of the Hindu religion, who will ask to wash in running water, particularly before eating. And in the Sikh religion washing and being clean has an important religious significance. Even if there is a prohibition against using deodorants, (never heard of that before, except from my very 'hippy' green niece, and then she & hubby use natural soap that contains Tea Tree oil, they both work out doors as landscapers and they don't smell) there is a big difference between the smell of clean sweat and that of a 'wet mop' There are very few conditions that will cause an offensive body smell and the majority of them are genetic, and I doubt that any one would get to adulthood with out been aware of their condition. However I did once work with a doctor who STANK. He had been on the ward for 2 weeks (I was on holiday) and on my first day back I went with him to see a patient. I have to admit I had decided to have a word with him in private as soon as I could; however the patient in question got there first. A lovely Downs Syndrome gentleman who had no problem in stating loudly 'You smell!' This poor doc was mortified, but his excuse was (this was a 35+year old man, and educated man) that his Mum was on holiday and he didn't know how to use the washing machine.............. Bless!!! I think that your supervisor is really just been a coward. That's their job. It's part of managing people. At the least they could send out a general memo about cleanliness, and then it's a subject that could be become a discussion. I.e.: have you seen this, gosh I use XXX deodorant, I find that it last all night even on a really busy shift, what do you use? Or I'd hate to think that I smell bad, I'd want some one to tell me wouldn't you.......................

I asked a patient post left leg above knee amputation to ' hop out of bed’ so I could change the sheets !!!!!! Luckily she had a sense of humour

No no no no no no no no no no no no no no Get the idea? no no never thought I'd hate not having the patient contact, but working in a clean happy area with GOOD pay and people who treat me like an adult not a mushroom............... I love my job!

I was a ward nurse for 18 years and over half of that on nights. I left for 50% health reasons. My Hospital brought in internal rotation, that is I couldn't just work nights, which wasn't too bad when we were doing 12.5 hr shifts but when they started bringing in early/lates/ twilights and nights I couldn't do it. I can work 6,7,8,9,even 10 12.5hr nights in a row but ask me to go from mornings to afternoons to nights in no real order........................ The other 50% was frustration at the current situation, at the current state in the NHS and then I went for an interview on spec and they not only offered me it but also offered me salary wise well over what I had asked. Sadly and I know they're are some who will condemn me for it but the money........, oh the money. My partner and I have been together a long time he supported me all through nursing school, emotionally and financially, we only have the house that we have because of his salary. Now we want kids and it's looking more and more like we need to either go the fertility route or adoption. But even with that if nurses still had the power to do their jobs that they used to i.e.: to NURSE, not fill in paper work, I'd have stayed, we would have found the money. I miss it, but I don't miss the stress and the pressure and the harassment and that's from management. I do miss true nursing, helping people.

wow I had always heard that you didn't get much paid holiday time in the US but never really realised it. Anyway it is about the one thing the NHS get right in regards to nurses. over here it's On appointment 27days + 8 (the 8 are bank holidays)=35 after 5 years service it's 29 + 8 = 37 And after 10yrs service it's 33 + 8 = 41 it's normally calcuated in hours and it refers to 7.5hr days. the working week is considered to be 37.5hrs. When it says years service it means in any NHS hospital etc, and if you leave the NHS you retain the holiday ie: work for 5 years leave for a year or two if you return you go back to 29 + 8. It's about the only thing I miss.......................

Can't say that it is valid or not but have never heard of it before. The University of Dundee is real and quite well known, what would worry me is the "celtic-scholar link", if that makes sense. This is the web site for the university of Dundee http://www.dundee.ac.uk/ have a look on there. if you go in to the nursing section and then distance learning it does do the course you want (i think) but the web page looks very different. It does give some e-mail addresses and numbers to get more info. Sorry this doesn't flow very well but it's been a very long day.

LONGGGGGGGGGG reply (you've been warned) Several years ago I required a spinal tap. At the time I was a nurse I was working at the hospital in to which I had been admitted, and it was a teaching hospital. I was asked at the time if I minded if the House office (i.e.: most junior Doc on the pole) did my tap, under-supervision from the Senior House officer (2nd most junior). In the spirit of teaching and knowing the Reg (senior doc, one step down from consultant) was stuck in A/E (ER). I agreed. They attempted the tap six times over a 90-minute period. Right the reason I bring this up is the differences ME: -I gave consent not only that -I gave informed consent -After the second attempt they said they were going to stop and get the Reg i.e. they acknowledged that they needed guidance. -I was the one who insisted they continue (the results of the tap would determine care, and if it was -ve I was out of there) -The nurse assisting expressed concern that I was consenting due to 'peer pressure' i.e.: was an advocate. When I explained my reasons she was still concerned but happy I knew what I was consenting to. BIG POINT : I was aware compliant and helpful, it still bl**dy HURT like HELL. BABY: -Unable to consent -Parents not informed, did not give consent. Although another poster did comment that it may have been discussed with the parents. But IMO if one of my family was having a tap I'd like to be around to hold a hand etc. But maybe they couldn't cope with it. -Unable to express pain clearly due to age -Unable to refuse due to age -They did not acknowledge their failure, it may have been as simple as a bad position but until they asked for help .................................... As for Silas's comments -since you weren't responsible for the patient, I would say that you don't really have anything to report.So if I witnessed someone abusing a patient if it's not MY patient I shouldn't worry. Sorry it doesn't work that way. -It just does not seem that this is the type of situation where it is a nurse's place to try and get a resident in place for doing his job. If the patient was in imminent danger of suffering serious side effects, then yes, she should intervene. Otherwise, she should continue assisting and do her job--nursing. Two things here, first while I'm sure there are some nurses out there who take joy in putting residents in their place, they are few and far between, most of us are to busy doing our job. As regards patient in danger of side effects: well if they weren't experienced in doing taps, would they know or recognize the side effects? As I said this procedure HURTS.............................. And they are inflicting it on a one-day-old baby????????? And only giving sugar water. I was on opiates by the end of it and still in pain. Secondly my job is not doctors assistant it is NURSE. And expressing concerns about a patient's treatment is a part of my job see below. NMC Code of Professional Conduct ..(Nursing and Midwifery Council November 2004) states that as a Nurse I am ' personally accountable for ensuring that you promote and protect the interests and dignity of patients and clients, irrespective of gender, age, race, ability, sexuality, economic status, lifestyle, culture and religious or political beliefs. It also states that 'You must act quickly to protect patients and clients from risk if you have good reason to believe that you or a colleague, from your own or another profession, may not be fit to practise for reasons of conduct, health or competence. Five attempts indicates a certain lack of competence to me? -This whole "advocating for my pt." is bullcrap, it's just another doctors vs. nursing turf war again. You're in a teaching hospital, for God's sake. Let the resident's learn and let the attendings teach. You get more than one or two tries on procedures and you're allowed to make mistakes. Get over yourself.I have been in Nursing for over 17 years now and have never seen this 'doctors vs. nursing turf war' I have seen Nurses who on occasion are a PIA towards Doctors and go out of their way to second guess them. In the same way I have seen Doctors assume that Nurses are there to run around after them and tidy up their messes. In other words I have seen a small minority act unprofessionally, not exactly a turf war. The only people that I have come in contact with that believe there is a 'turf war' are the unprofessional ones. Now maybe you feel that you have been unfairly treated or that the Residents in OP post are been unfairly maligned, but as a Nurse I really don't care the patient is my prime concern, not teaching, not 'turf wars' not someone's ego.

'Do you have a stat box in which you keep a few doses of things you might need quickly? Like potassium, benadryl, antibiotics, narcan, things like this?' In nursing homes, No they don't. In a case where a patient/ client went off in a nursing home it's off to A/E (ER) they go most nursing home only have a GP round 2 a week

fultzymom: As I said above in an acute site we have a doc on site 24/7 in the community ie: nursing homes etc, the GP are required by law to provide a 24hr call out service, they can either do so themselves or employ a locum agency to do so. As an aside even if a order was made over the 'phone nursing homes over here do not have a pharmacy and would not have access to any new medication orders. This is really educational, Ladybugleaqueen: LTC= is that Long term care? Are your patients are rehab or are they chronically ill?

Maybe this is a situation where the difference between the UK and the US can be seen. (I'll admit that I'm assuming that you're US based) 'What if the doc is not present but you need an urgent order, such as pain or fever Rx or even a laxative or something for sleep or itching?' On an acute site you get the on-call doc to prescribe it. There is a medical doc on call 24hr on site to deal with situations such as this. In nursing homes etc, most in my area are trying to bring in 'care bundles' otherwise they would call the patients GP on call who are obliged to either visit or refer on usually to A/E (ER). Neither the nurse nor doctor would have any protection as regards a verbal order in this area Or what if the patient needs an ice pack or heating pad for comfort? Why would I need Dr to prescribe that? That would be a nursing decision. AS for a transfer from a nursing home to an ER, again that would be a nursing decision. But I do feel I really have to comment on your 'hope for the best', how can that be considered best practice? If the doctor is being paid to give his/ her opinion make a decision why aren't they there? AS for doctors secretaries I never have and never will do a doctor's documentation for them. Not my job. Nor do we have unit secretaries, the most we have is a clerk that would only work office hours and is there to stock/ order nursing stationery, answer phones, make out-patient appointments and file nursing documents. It is drummed in to us from the day we start nursing school that if it is not written down it is legal/ never happened. It is drummed in to us again by our unions that they can not and will not protect us, if we give a medication that was not prescribed. I have witnessed a nurse lose their licence over this, yes they were possibly doing what was best for that patient, yes it was witnessed by another nurse, and yes the doc did come up to the ward the following day to prescribe the med, however in the mean time there had been an audit of the patient notes, this was picked up and as I said the nurse lost their job and licence. This was a experienced nurse, no harm came to the patient, every one had the best intentions, but they did something illegal. That was the stand of the hospital and their union. So for the convenience of one doctor, thousands of pounds in training cost lost and the a good nurse gone

I can't access the clips but this is an issue that I feel very strongly about. Death is a natural process and will come to us all, sadly in some ways like childbirth it has been taken over and made a medical issue. My Father and our family were fortunate enough to have him cared in his last days by a palliative care team that ensure that he was comfortable, pain free and dignified. He died in his own bed my Mum lying with him with the rest of the family close by which is exactly what he and she wanted. Any and all possible equipment and drugs that we could have need was in the house, in place before it was required so there was never any need to rush around looking for things. And despite having 2 daughters who are trained nurses there we also had a 24 hr pager number if we had any issues, the only time Mum had to use it the nurse carrying it was at the house in 10 mins. From the minute he was first diagnosed as terminal and expressed a wish to die at home there was never any problem. As it should be. The above all took place in Ireland, where there is still much less stigma and fear surrounding death. In the UK where I currently work it is so sadly different. Despite what patient’s wishes might be, they rarely died at home, the set up and services just aren’t there. There are very few palliative services available with community nurses been expected to take this very difficult role on. As they are not allowed to carry drugs on them if it is the weekend and the patients GP will not attend the patients house to deal with acute pain patients regularly end up in the ER and by then are to ill to be moved again. If they are in hospital when they are diagnosed there is next to no info or support offered to allow them to go home. And back to the main point, DNR is rarely discussed. I recently took report on a 80+ patient who was riddled with Ca, it was everywhere and it was clear that this patient was not long for this world, irregular breathing pattern, difficult to rouse etc however they were still for Resus and not on the Liverpool pathway………………. When I spoke to the doc he felt it was inappropriate to discuss Resus etc with the family at this time, my reply (and it was in private out of patient ear shot) was ‘Well when is it appropriate? When they stop breathing? When we can’t feel a pulse? When, because of your reluctance to discus this, we legally as nurses have to put out a crash call and start to bag this person? Do you want to talk about it before or after we rip the patient’s night shirt off and send 200 joules of electricity through them? (I can be a sarcastic cow when I start) After we got through him threatening to make a complaint about me and me laughing at him and bring his boss the Registrar in to the conversation. We went a spoke to the family who were honestly surprised that (a) we need to ask this question, i.e.: it was clear to them that their loved one was dying their only concern was that it be pain free. And (b) that this had not been discussed before that patient had been in several days everyone knew the diagnosis……………. I do wonder what if anything is taught about end of life care in Medical schools. Liverpool pathways = The Liverpool Care Pathway (LCP) for the dying patient has been developed to transfer the hospice model of care into other care settings. The LCP provides guidance on the different aspects of care required, including comfort measures, anticipatory prescribing of medicines and discontinuation of inappropriate interventions. Additionally, psychological and spiritual care and family support is included. The LCP replaces all other documentation in this phase of care and is applicable in hospital, hospice, nursing home and community settings. The LCP is a key recommendation in the NICE guidelines for supportive and palliative care. It is an NHS Beacon project. http://www.mcpcil.org.uk/liverpool_care_pathway

I'm assuming that by 'order' do you medication prescription? Here in the UK, if it ain't written down it ain't legal. While, yes there are certain situations that I will accept an 'order' over the phone it would be on me legally all the way no matter who else hear wittnessed it. In view of that I always taught my students never to take a verbal/ telephone order. Greyer area as regards care directions, eg; D/C a cath or I can't think of anything else right now yes we would take verbals, though a lot of the time I have to admit I would tell the doc what we intended to do and they would go along with it.

That is a brilliant idea, so easy and simple, hopefully it will spread. The pharmacy I use has started including a description of the pill on the outside of the bottle. "This an oval orange tablet with ER123 on the side." I think it's a great idea and I hope it spreads.

Actually my 'official' title the one on my contract is Nursing Sister. It's still quite common over here in the UK and in Ireland. It harks back to the time (medieval) when all health care was provided by religious orders

It happens, you're human, we all are and mistakes happen. When I 'had' students I never judges them for making a mistake but did for the way they reacted to it. The ones that were breezy and 'oh well you caught it no harm' set all my alarm bells ringing. (what would they have done if I hadn't caught it, what will they do when they don't have someone looking over their shoulder? ) The ones who fell to pieces, less so, but still worried me.( Mistakes happen how will they cope if they make another one, and they aren't a student and don't have some one to pick up the slack and deal with their other patients?) The ones who admitted their error and did all they could to rectify it, like you, got a big thumbs up. You acted in a professional responsible manner, you acknowledged your error and acted on it, that's what I want from anyone who nurses me anyway. As said earlier it's happened, learn from it, and don't beat yourself with it.

Don't you just want to yell sometimes JUST DO YOUR BL**** JOB OK ! Drives me up the wall, and how often is it something small that in the time they've argued it they could have done it! Some people are so busy telling everyone how busy they are they never do anything..................... But I have to say your ONCALL pharmacist was way out of line and I hope he gets all he deserves.

I've been on it for well over a year with no side effects but as Heloisea3 said we're all different.......... Personally one thing that really helped me was drinking more water, thought it was an 'old wives' tale but I was at the point of trying anything. Kept a close eye on how much I was drinking, which was a lot less than I thought! and really increase my intake. Thankfully for me this helped a lot...... Did lots of the other bits too ie: weight loss etc but the water started helping quiet quickly. Good luck........

Me too Me too I cannot 'hold' immunity to rubella. I've actually had it as a child twice, and had the vac three times, as a baby, as a teen and when I started my training, recently had it checked due to family planning reasons. Knew, but didn't absorb that they were checking it, picked up my results at work and was discussing them with my boss whose a doc. She got all in a flap as it appeared from my blood that I'm never been vac'd. Had to explain it all to her too (Had previously spoken to Occupational Health and legally I'm covered as I've had the vac) Anyway I work in research (no pregnant ladies near me) but my boss keeps looking at me thoughtfully and ‘hmmmmmmmmm ing’ Getting a funny feeling that I might be giving a blood sample today……………… She’s got that look in her eye She's now reading this over my shoulder claiming that she wasn't in a flap (she was!)

I had to smile when i read your post, I'm a clinical research nurse and a large part of my day is taking blood samples. Today so far I've tried to get blood from 5 people and not one success...............................................................:angryfire :angryfire So don't worry you're most likily better than you think you are and just focusing too much on it. Calm and breath and I'll take my own advice too. Any one feel sorry for my next patient........................