Logan

Hi, I'm no "young buck"... but the argument that the pt. is a "pervert" is pure nonsense. How old is the pt. again? How many of you puritans condemning him remember yourselves and your 'aches and desires' at his age? Yes, it could be argued that he was "masturbating" and as such it's not a very 'appropriate' activity to be engaged in in a hospital (or "anywhere" as many folks believe...) Me? If it wasn't urgent, I'd leave the fella undisturbed for a few minutes (or let him know through the crack in the door that I'd be back shortly if the issue was urgent). Upon follow up, I'd break it to him as gently as I could that while I understand his natural masturbatory impulses; he has to reign in his impluses while he is in the hospital. I've followed a similar policiy for females too. Frankly, in a nation like ours, I'm surprised something as trivial as this is even an issue... thanks, Matthew

Hi, Here's a twist to the title of the thread: something that I DID say to a patient and I haven't been "reprimanded for" (... yet). Every once a while, I pick up extra hours in the Emergency Department. John Doe was one of our "frequent fliers" (a morbidly obese man with mulitple, multiple, multiple abdominal complaints and demonstrated drug seeking behavior). John Doe had visited us over 156 times last year - and it was only mid October. John Doe had an unpleasant personality (to say the least) - he was always very abusive, very unpleasant, extremely unco-operative. I tried to make excpetion and give him the benefit of the doubt that 'he's sick/he's in pain/he has chronic health issues/he's frustrated' etc. I was always respectful, addressing him as "Sir" and tried to be as pleasant as possible. Anyway, this time around his persenting symptoms and complaints persuaded the docs to admit him. I summoned help to facilitate his transfer to the floor. As the CNA and I were getting him packaged for transport, he started cussing and abusing (as he usually does) - about the ED in general (bite the hand that feeds ya, huh?), about how long it took for anything to happen (Gee! I'm sorry! Maybe I should've let the 45 year old mother of 4 suffering from an acute MI die while neglecting the 76 year old grandfater of 16 suffer permanent damage from the stroke he was having), about how we wouldn't let him eat anything (well excuse me mister "I've been puking for 3 straight days and can't keep anything down and I have severe abdominal pain"!), about how "incompetent" we were and didn't know "jack **** about anything" ... and so on and so forth. Then he started cussing out the CNA - "That ***** doesn't know what she's doing man! She don't know jack ****! A bunch of incompetent, lazy people here! It takes forever to ge..." His Mother was sitting right by the bedside - and she didn't say a WORD*. I'd had more than enough... "John! That's enough!! Do you use that same potty mouth to kiss your Mother?" "**** you, mother******! You don't know jack **** about my Mother! You just think you kno..." "Really John?! Is this the way you treat people who are trying to help you? Because I won't put up with it. I won't have you abusing us. I won't have you abusing me. I won't have you abusing the CNA - she's been nothing but NICE to you. And no, that sort of language is not appreciated around here! Watch your mouth!" His Mother was still at his bedside. She didn't even raise an eyebrow - much less reign in her son. Not really surprising, since he subjected her to the same verbal abuse whenever he was in our ED. It was a family dynamic I couldn't fathom.... "**** you man! You are all a bunch of lazy mother- who don't know ****! Incompetent, lazy ******** who know jack ****!" "Well Johnny boy, you ain't going nowhere then" I said as I stopped the moving stretcher and placed it under lock. I wasn't angry. I wasn't ****** off. I was waaaay beyond all that. I was just simply too damned tired. I'd had enough of abuse. "Since we're all a 'bunch of lazy mother- who don't know ****!', you're more than free to walk out of here and find someone else to help you. Because you know what Johnny, frankly; we are sick and tired of being the target of your repeated abuse. We've tried time and again to be as nice as we can given the circumstances but you just don't give a ****. I don't know what you're ****** off about and right now, but given the way you abused the CNA and given your attitude towards me and our staff in general - I frankly don't give a damn. You've been this same, disrespectful, manipulative, disrespectful self for as long as you've visited this hospital. For you to call us 'lazy' and 'incompetent' is pushing the limits... Since you are convinced that we are 'incompetent fools', I'm lowering the side rails on your stretcher - you're free to go to where ever the hell you choose..... because if you think any of us are going to hang around and be abused by you on a constant basis for whatever reason strikes your fancy - mister, you're ******* nuts!!!" I lowered the rails and walked off. His Mother stood mutely by. I informed both the ED attending and the admitting Doc of the situation. To the ED attending's credit - he backed me all the way. That was last October. Although John Doe has maintained his 'frequent flyer' status, he has always been on his 'better' behavior with me since then. Oh he still cusses. He remains unco-operative. But he is nowhere the disrespectful cretin he used to be. Thanks, Matthew

Hi, Will this stupid thread ever die??!! :banghead: thanks, Matthew

Hi, I'm not a hospice nurse. The "dying patients" I usually am involved with are the "actively trying to die" type. So take my post with a grain of salt. ????That statement alone just confuses the heck out of me. I just can't comprehend the rationale behind that statement. I mean, it's a dying patient. They're on hospice care. I know we aren't actively trying to euthanise them - but if comfort care isn't a priority in hospice - what else is??!! Hospice nurses - if I'm wrong, please correct me! thanks, Matthew

Hi, I used to work on an ortho-med/surg floor before I switched to pediatrics.I admit that I'm stumped. I've had some pts. come back post-op with epidurals in place for pain control. But I've never heard of "spinal wash". Perhaps you could ask an anesthesiologist? Or the surgeon involved in the case? Sorry I don't have any answers for you thanks, Matthew

Hi, I think you did a comendable job - given the circumstances you described. I've responded on one scene myself (a four car spin/wreck on I-90). - Safety first! And that means YOU first! As someone already mentioned, the last thing EMS needs is another patient. - Call 911. Don't assume someone else has already called. It can't hurt to make that extra call. - Don't try to be a hero. I'm serious. Stop and think before you do anything. It's better to spend the extra 10 seconds to think than to jump in gung-ho and make a bad situation worse. - If EMS/First responders are on scene - defer to them. Remember, they're trained for this. You're not (this applies to physicians not involved with trauma/ED too). When EMS arrives on scene, identify yourself if you have to but back off ... unless they ask for help/assistance - they already have a hard enough job to do. And if they ask you to do something you are not comfortable with/feel you can't handle, let them know. They won't think any less of you, but they will accomodate and re-prioritize as needed. - As someone already mentioned - probably the most important thing you can do is be the "calm voice". Try to reassure victims. Anxiety exacerbates symptoms. Often just knowing that they are not "alone" has a calming effect on pts. Try to get a 'body count'. Meaning? "How many people were travelling in your car?" - Even if they are "walkie-talkies", try to get them to calm down and lie down (preferably on a straight hard surface) and not move. It's not uncommon for walkie-talkie pts. to have neck/back fractures and they could potentially exacerbate them by movement. - Lastly, If at all possible try to get baseline estimates - pulse (weak, thready, bounding, irregular etc), resps (shallow, deep, irregular etc.), mental status (passed out, babbling, incoherent, hallucinations etc.), seat belt/airbag status etc. Pass this info onto EMS when they arrive. It helps health care providers gain a better picture of what to look for. thanks, Matthew

Hi, This is the closest thing I could find relating to a "Spinal Wash": http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2052491 Hope this was of some assitance. thanks, Matthew

Hi, Given today's hi-tech world (and it's only going to get more high tech in the future), I would consider marrying the two fields - such as RN-informatics... Or some such. I do also; partly echo the poster above who said that 3 months seems to be an awfuly short time to give up on nursing. It's a vast, varied field. Maybe floor nursing isn't right for your friend (just like how I realized that working with adults wasn't right for me) - but there's TONS more to nursing than floor nursing. Thanks, Matthew

Hi, Horizontal violence? Me thinks you doth protest too much.As Gila already pointed out, profering medical/legal advice is against the Terms of Service of these boards. It's one thing to seek support and commiserate - it's quite another to seek legal/medical advice. Frankly, I don't know why anyone would want to listen to advice offered over the internet - there is no way to verify or back up any claims made. How can you check the credentials of the person offering advice? I mean for all you know, said person could be a 18 year old art student with a vivid imagination and great BS skills. It is for similar reasons that Doctors don't offer medical advice over the internet. Lastly, I'm sure the owner of this website is concerned about potential lawsuits resulting from "advice" given here. All that being said: I think this is good, appropriate counsel. Talk to professionals in real life.thanks, Matthew

Hi, At my old job, I was routinely subject to 7-8 pts. per noc. With one CNA/Tech for 36 pts. I'm a "half breed" - but other than me, every other nurse and tech on the unit was born and brought up USA. This was good ol', midwest USA. Cornfield country. So what's your solution?Stop 'importing nurses' till nursing education in the US catches up to demand? You yourself said that "American nurses won't work in deplorable conditions such as I saw yesterday" - would you rather that those patients have no nurses at all until a solution can be arranged? If you were a patient on that floor - would you care if your nurse was "imported" or "american born"? Do you think that foreign nurses are subject to lower standards to aquire a license and are paid less than you are?thanks, Matthew

Hi, I'll be blunt (and I'm not doing this to put you down or call you an ill informed idiot or what have you. I sincierly meant that) but, Most of us nurses can't begin to judge the scenario the OP presented with. The simplest explanation is that "we were not there". The OP mentioned that s/he: "loosened them everytime I went there, at least four times.' Now I don't know how many ICUs/ERs you been to - but this is a strict NO-NO. You do not, I repeat, DO NOT; loosen or in any way alter a restraint on a patient. I don't care if you're a family member, the family doctor, a student nurse with the best intentions or a nurse with 47 years experience - unless you are the nurse or the physician responsible for the patient, you do not mess with the restraints. Period. After several posters expressed their shock and doubts regarding the scenario, the OP took his/her time to state that "The nurse was in the room. I told her I was loosening the straps and that they were too tight. I told her I was a nursing student and she observed me loosen it." This raises several more questions: Was the OP a "Nursing student on rotation in the unit?" If s/he was a nursing student on rotation in the unit, wouldn't the nurse assigned to the pt. already know? Even so, doesn't it seem a bit strange that a nursing student would be assigned to their own parent during clinical rotation? Never mind the fact that s/he was still in their "first year"? When was the last time you saw a 'first year nursing student' assigned to clinicals... much less the ICU? To me, the big picture says: A first year nursing student found irregularities with the restraints on his/her father when s/he visited him in the ICU. S/he decided to take matters into his/her hands without consulting the nurse on duty (I'm sorry, but I don't buy the whole "The nurse was in the room. I told her I was loosening the straps and that they were too tight. I told her I was a nursing student and she observed me loosen it." story one darned bit). The pt. might have had complications post ICU stay with his hands - and I won't rule out the fact that grossly incompetent ICU nurses might have overlooked his restraints ... but I find this very unlikely (think about it - was the pt. in restraints for just one shift? Was it the fault of just one nurse?). But rather than consult their PMD about causation or remidiation, I see a thread here about "restraints too tight". Uh-huh... thanks, Matthew PS: Using "Wikipedia" for a source is usually not a good idea since it is unsourced information. Just an FYI.

Hi, To answer your question:It depends on the symptoms/problems the pt. presents with. Example: If your pt. presents with a BP of 90/50 and you're ordered a nitroglycerin drip - your calculations say 1.5 ml/hr (based on 50mg Nitro in 250ml of dilutant). Would you start at a rounded-up rate of 2 ml/hr? Or start at an approximated rate of 1.5 ml/hr? (or even 1 ml/hr for the first 5 mins. till you can figure out the effects of the drug?) Thanks, Matthew

Hi leslie, Thanks for the clarification. :) thanks, Matthew

Hi, If nothing else, you must be commended for the following: Such openess and approachability is refreshing to see in a teacher. As you can probably imagine, I had some really difficult teachers. Don't get me wrong, technically and theoritically they were more than proficient... but their method left a lot to be desired. thanks, Matthew

Hi, I'm not sure I agree with earle58's view of us being the servant of the pt. I'm a professional who provides a vital aspect of modern health care. I am no body's servant. That said - I agree with her wholeheartedly with "we are humans first". Mama Logan always said that "rudeness is the product of a weak mind". I deal with rude people like I deal with any other problem - with calm confidence, determination and direct action. Stand up for yourself. Don't 'degenerate' to their level. Respond with courtesy and professionalism. If amicable, direct attempts don't work, don't play into their game. Take care of yourself first and the world will take care of itself. thanks, Matthew