miko014

Sorry, vent here, and please don't flame me for saying this..... I'm getting really annoyed reading threads in which the exact same thing is said over and over again! Please please please please PLEASE read the existing posts before adding your own, and know what the original post was about before adding your thoughts! If you don't have time/don't want to read every post in a long thread, then do what I do - just stay out of that thread! Okay thanks, I hope ya'll don't hate me for saying it, but it's driving me nuts. I just finished reading new posts in a 20 page thread, and I bet 100 of those posts say the same exact thing! :deadhorse

Actually that was how we first found out that things weren't quite right...son called in and said, "I just called my dad's room and didn't get an answer, where's my mom?" I was in charge and didn't have the pt, and didn't know anything about the pt other than she was just transferred to us and was not very responsive. I went into the room and there was nobody there. So I went back to the phone and told him I didn't see anyone in the room, and did his mom maybe go home? He said no, not possible. I said maybe she went to get something to eat. He said probably not and could I check with the nurse? So I asked, and she said that the pt's wife had said she was leaving. So I told the son that. He said, "did she take a cab?" I said, "I don't know, she just told the nurse she was going home." So he was like okay thanks. Next thing I know security is calling me asking where pt's wife is. I said how in the heck should I know, I don't know what she looks like, but there is nobody in the room. I tell them that nobody told us anything about the pt's wife and if she can't be left alone then they need to stay with her. Security agreed. Well a few minutes later a little lady toddled up to the station and said, "my son was supposed to pick me up but I don't know where he is." I said, "are you Mrs. Soandso?" She said yes. So I parked her in a chair in the pt's room and told her not to go anywhere. I called security and told them that I found her, and the son came and got her. After that, they started leaving her at night, and the rest is history. I know that people "suggested that they not leave her" and told her that we can't be responsible for her and can't take care of her etc., but I don't think anybody would put their foot down - you know, customer service. I would have put my foot down but I never actually saw any of the family other than that first day. I bet you guys are right - RM would put their foot down for sure.

Well, I think we finally got through to this particular family - THANK GOODNESS!!!!! I think there was some sort of close call as they were coming in this morning, and they finally decided that maybe "mom" shouldn't be there alone. Hallelujah. Can't wait for the next one. But I love the risk management idea - I think I'll have to give them a call next time it happens - because it happens a lot!

Insane! The bracelet should say, "if you find me, call the police and report my stinking family for dumping me at the hospital"!!!!!!!!!!

It's their job where I work too, but they rarely do it, so it falls to us. It can be infuriating at times, because the doc will direct admit at pt and write "continue home meds". They haven't been allowed to do that for years, but they do it anyway. And then we have to call them with a home med list to make sure they agree with everything and then they get mad that we called them when they already wrote "continue home meds". It's a vicious cycle. I would love to know how you got your docs to cooperate!!!!!

Nope, 24/7/365. Yay. Like I said, I don't care if "mom" stays, but I think someone else needs to stay too if she can't safely take care of herself.

We have! They always just brush it off! And it's not like they say, "okay, we're leaving now, but mom is going to stay!" They just leave, and then call later and tell us all that. And when we try to explain that, the answer is, "oh, she'll be fine!" Sometimes they tell us the first time "Mom is going to stay with dad tonight", but then night shift finds out at 2 am that "mom" is confused and incontinent! We tell them that they can't leave them there alone, but they do it anyway. We don't want to actually do the "take them to the ER thing", because they do have an ill or sometimes dying family member to deal with - but seriously. Come on. And the kicker is that it isn't even my patient that I'm talking about right now - I haven't taken care of him! I have helped his wife do a few things, but sheesh! It just makes so much more work for us because we are afraid she will get hurt, and we don't want that to happen.

I'm so frustrated with people dumping their elderly family members at the hospital to spend the night with their ill family members!!! We have had a string of this lately, and there is nothing we can do about it, because they don't tell us that they are leaving! They will call up and "check on" the family member and not even ask about the patient! I'm not sure all that makes sense, so let me give you an example: Elderly confused man is patient - he's not a full code and probably won't make it out of the hospital. His wife, who lives in a facility somewhere (not assisted living, a full care facility) comes in with the family to visit him. Fine. The family wants them to be together as much as they can, and are afraid he might die and she won't be there. Again, fine. BUT they all sneak out at night and leave the wife, who is not safe to be on her own, in the room! Then later they will call and say, "how's my mom doing, did she take her medicine? Make sure she eats her breakfast!" EXCUSE ME?????? In my opinion that is elder abuse, and I am tempted to take her down to the ER and let them decide whether she should be admitted or not, and what to do with the family! And the most recent one gets confused at night! We are too busy with our actual patients to be watching out for all these family members! I have no problem with them staying, but if they are going to stay and are not safe to be alone, they should have a family member with them. I would NEVER abandon my loved one like that - what if something happens? What if she falls??? We have told these people that we are not responsible for their family members, and that if they can't be left alone, someone needs to stay with them. The response is always the same - "oh, she'll be fine!" Anyone else have to deal with this??

We still give both - lantus as scheduled and SSI, but the SSI is on a q6h schedule rather than the pt's normal. If they have been running high or low, then we will adjust the lantus, but not based on just one or 2 readings. Obviously, if the BS is like 30, we're not going to give it, and if it's 500 we're going to change things. It's really a critical thinking and pt-dependant thing, but lantus won't bottom out the pt's sugar - or it shouldn't. At least, that's what they tell us where I work.

Maybe they just need a juice box. j/k j/k!!!!

I think that for the most part, we can see well enough with the lights dimmed. If not, we can always flip on the low lights - or turn them all the way if we need to. I think it's better because it really does give the sense that it's night time, time to sleep! The only falling/tripping I would worry about would be if there are cords or anything in the way in the pt's rooms - but those would be darker anyway if the pt wants to sleep. Of course the risk is always there, but there isn't supposed to be a bunch of junk in the hallways anyway, so if we do what we are supposed to do, then we should be fine.

Hmm cool, thanks for the replies. I happen to be on the pro-dimming side of the argument, haha. We just have to flip on the bathroom lights in the visitor restroom so that people can see down that hallway, otherwise it's darker than normal, but not so dark that you can't see. I can see the "it makes me sleepy" argument, but some people are fighting it tooth and nail. I think my side is going to win, though! It seems like once we turn the hall lights out, the patients seem to use their call lights less and are generally calmer. I guess it's true - they feel like it's night time if the lights are low.

Hi there - just want some opinions on this. We have recently started a new...not policy really, just thing...where we dim our hallway lights at 9pm. We did this in response to pt complaints of too much light in the hallways. Apparantly we were one of the only floors in the place who wasn't doing that already. The lights are not off, just dim, and the stations, break rooms, conference rooms, etc are still fully lit. I won't say which side of the debate I am on, but some people really like this and others say it is unnecessary and unsafe. What do you think?

Ah yes, I found it. I'm all for discussion on this topic, but it seems like we are talking about 2 different situations. Half of us are talking about the above quote, and the rest are talking about calling a PCP who has nothing to do with the hospital admission and is not on call. Also, she said it was NOT 2300 yet, so it wasn't exactly the middle of the night. I'm all for not calling at night unless it's absolutely necessary, but there is a difference here between what happened and what some of us are talking about. And also again (haha), some of the docs I work with have a cell phone or pager that is used for work only, and do not give out home or personal cell numbers. That way, they can just turn those off when they are not on call. If they don't answer, the nurse calling should be able to figure out that they are calling the wrong person. Might help if it's at all possible and this is a frequent problem.

I thought she said the doc she called WAS the admitting doc.

Hmm...I didn't read it as the pt's PCP - I read it as whoever was on call for the pt that night. And also, the OP clearly states that it was NOT 2300 yet, so I don't think that's the same as waking him up at 0300, and even if she did, I still don't think that calling the person who is on call for this pt is inappropriate. Yes, there are nurses who call docs for inappropriate reasons, but that doesn't mean that every nurse who calls after 5pm is a nutcase. And luckily for me, where I work I hardly ever have to deal with docs yelling at nurses. But if they do, I don't have a problem letting them know that it's not okay. All that said, there are very few med rec related questions I will call a doc with, but abx and pain meds both fall into that category. As stated previously by someone else, of course it matters why they were taking the abx and also how far along in the course of the abx they are. But working with oncology pts, I would not have let abx wait - assuming that this wasn't the last day of the tx or that they were prophylactic or for something very minor. Also, time of day matters. 10pm? Sure, I'll call. 2am? I think it can wait - I'd just leave a note. Just my .

No!!!!! You shouldn't apologize for calling a doc! You're doing what is right for their patient, and if they don't want to be on call for their patients, then they should arrange to have a resident or partner cover them. Antibiotics are important, that's not something that should wait till the am, and you did the right thing by calling. He should have ordered them on admission - if he had done a med review with the patient he would have known that they needed them and ordered them in the first place. I absolutely do not tolerate docs yelling at me or any other nurses and I have no problem telling them that. I try not to yell back, because when they are screaming at you and you are calmly telling them that is not appropriate and you are just doing what is right for their patient, they tend to realize how stupid they sound. I also sometimes remind them that if they would have ordered it in the first place, I wouldn't have had to call them. If they do it frequently or do not apoligize, then it's time for a write up. Unacceptable. I love the part about asking them if their mother would be proud of them - that's classic!!!! I might just have to steal it !

SSE, $4.95. Knowing where to put it? Priceless.

I was a little confused too...I didn't know if you were saying that you also listened to the order from the physician for a TO, or if you are checking off every order written or otherwise. I like the idea of 2 RNs listening to the order, but we can't have 2 people listening to the same line at the same time on my unit, so that would be a lot of repeating on the doc's part - not to mention the fact that it would be tough to hold another RN down long enough to get that done. We just do a "read back" with the physician before we hang up. We do chart checks for the shift you worked - 4, 8, or 12 hours. Basically, the unit clerk takes off the orders, the RN verifies that they are correct, and signs them off. The next shift comes on and double checks what the first RN signed off - we actually catch quite a few mistakes. So if you are working a 12 hour night, you would go back and double check all the orders signed off by the 12 hour day person - make sure labs are in the computer correctly, meds are transcribed correctly, consults are called, etc. It can be annoying, but it's effective, and I think it sounds a lot better than doing it order by order. Also, the RN checking the chart is actually taking care of the patient and so is more able to tell whether or not the orders are appropriate. Hope that makes sense!

That stinks that you're so allergic to the latex. My facility is almost completely latex free - there are just a few supplies that still have it. Even our BP cuffs and band-aids are latex free. I, however, have a reaction to the nitrile gloves, so my employer buys me vinyl ones. Yay me! I never had a problem with latex. I can tell you this, I was ready to quit over the rashes I would get from the nitrile gloves, so I can't imagine how you are dealing with the latex issue. Is it really worth putting your health in jeopardy just because you've been there for 4 years? I think I would be looking for another facility that is latex free, and I would state my reason for leaving as a latex allergy - I don't think anyone would hold that against you. But that's just my opinion. If you really want to stay, do you have an employee health program that could help you figure out how to avoid supplies that contain latex? Good luck!

I was referring to the situation I described - you took the part of my post about the adult I was talking about and made it about the kid. I said that a gentle reminder is often all that is necessary.

We let them walk out, but we chart that we offered a wheelchair and they refused it. Just a CYA policy for the institution, I believe.

Right on! I had a nurse who got ripped apart by a family the other night, and she was so shaken and upset that she had to leave the floor for awhile and I had to change the assignment midshift so that someone else could take over the care - she was afraid to go back into the room. The family member claims to be a nurse (we think she's really a CNA - she doesn't know basic things like how to check NG placement - she yelled at that nurse for "putting all that air in her (pt's) stomach!" and several other things). If she really is in the biz, she should know how things go and that she can't have someone instantly when she wants them - we are not ICU. That's what happened when she snapped - she said she needed to speak to the pt's nurse, and that another nurse couldn't help her. So we told the nurse, who was in with another patient doing a task that takes some time, then told the family she would be in as soon as she could but she was with another pt just then. As soon as she was done, less than 10 minutes later, she came out of that room and headed for the room that had asked for her. She stopped on the way to plug in her computer cart (the battery was dying), and the family saw her in the hall. This one particular one who is the "nurse" and who is causing 95% of the problems and seriously interfering with the care the patient recieves, came out into the hallway and chewed her head off in the station. She threatened to sue, told this nurse that she was sick of her ********, she was going to call everyone under the sun and report her behavior, etc. I wasn't there at the time, I was on one of the other pods on our unit and had no idea any of this had happened until a few minutes later. The nurse came to me in tears, completely shocked. She didn't do a thing wrong - the family is unreasonable. I paged the house sup and stayed with her till she was calmer. Then I changed the assignment and went to talk to the family - the house sup was behind the station reading the patient's chart. The family came out of the room while I was headed that way and demanded that I send the nurse that she had just spit out into the room. I told her that that Nurse A wasn't going to be with them anymore and that Nurse B would be taking over but she was still getting report and would be available shortly. Before I could even offer to do anything, introduce myself, or get any other word out of my mouth, she started screaming at me too. Luckily the sup came around the corner and took over just then so I didn't have to deal with them that time. They behaved for the rest of the night, but I told the sup that if she did that again, I wasn't going to mess around - I would just call security and let them lay down the law. She was being disruptive to all the nurses and the other pts by screaming in the hallway every time she didn't get what she wanted immediately! Sorry for the long tale - the moral of the story is: I won't tolerate that kind of behavior. Sometimes it just takes a gentle reminder that we are very busy and taking care of many people and we really are doing the best we can. Other times, it takes more than that. Either way, it's not going to happen twice on my unit (at least, not while I am there). Our jobs are hard enough, we should not have to deal with that kind of abuse. Plus, if I screamed at the kid at McDonald's the way that person was screaming at the nurse, they would have called the cops on me so fast I wouldn't know what hit me. Yes, the hospital is a high stress environment for them, but it is for us too, and I'm tired of everyone making excuses for irrational people. If they have a true problem, they should address is correctly and like adults, not by throwing a tantrum and making threats.

I don't know a lot about that, but I don't think it's the pump that is the problem. I know that at least some Baxter pumps can be used for blood, but it depends on the tubing that you have. If you use the wrong tubing, the pump will crush the cells. If you have the right tubing, you're good to go. We have a version of Alaris pumps where I work, and we can run blood on them. I don't know if all Alaris pumps can do it, but I know that if you need to run it faster than 999 ml/hr then you need to do it by gravity or rapid infuser. Sorry, I don't know which version of the pumps we are using. Hope that helps!

I guess it doesn't make a difference who the manager likes, as long as they treat everyone fairly. When the "in crowd" starts to get perks that others don't get, that's when it has gone too far. My manager definitely crosses the lines of the boss-employee relationship sometimes, but she has worked with some of the nurses on my floor for over 20 years, and they were friends before she got the manager job. She's definitely unconventional about the way she runs things. We always joke that we are a great big dysfunctional family. But hey, it works for us I guess. There is a lot of yipping and back-stabbing that goes on around my floor, some directed at the manager. We had a big problem awhile back with her playing favorites, and the truth is that she didn't realize she was doing it. She works really hard now to make sure that she doesn't, and I think that for the most part she is pretty fair. All that being said, I used to think she hated me, but she didn't. Does she love me? Maybe not. But I'm pretty sure she likes me. ...But then, what's not to like??? :monkeydance: j/k j/k!!!