cm8816

Thank you so much for this advice. I will follow it.

Thank you.

I work as a float RN at an acute rehab hospital. I have worked there for 7 years. Two days ago, I had an elderly patient who had had a stroke. He had multiple co-morbidities. The son was in the room. They had been admitted the prior day. In report that morning, I had been warned that family was very difficult. I found the son to be suspicious. He demanded I explain each medication and why I was giving it. He chose the meds to be given or held. I complied with his requests. My patient load was demanding. From 0630 until 1350, I never hit the restroom or took food or drink. We have Spectra-link phones. At 1350, I did go the restroom and then spent 15 minutes in the breakroom eating. Shortly after 1400, I finally sat down on the unit to chart (since I had not had a chance to chart all day). At 1425, I heard a shout from my patient's room. The son had come into the hall shouting, "I need help, he's turning blue". A tech ran in the room, hit the code button. I was in the room within one minute. As the room was filling with the code team and additional staff, the son kept shouting that "I kept calling the nurse and she would not come". The pt was in full arrest and a code was conducted with eventual ROSC (about 15 minutes in). He was transferred to ICU. I was so horrified by the son's false claims that I had a charge RN look at my phone, both missed calls and received calls. There were no calls from that room to me between the time I was last in there (noon meds) and the code. I also took pictures of the missed call and received call lists on my personal phone. This has made me very nervous. I have malpractice insurance. What steps should I take now?

These ******** must all use the same playbook. I had a similar (actually almost exact behaviors) done to me as a new hire in an ICU. I literally tried everything. I was being set up on routine basis. I went to HR finally and HR turned it around on me. I found a new job and left after 2 weeks. I felt that had I stayed, I would be set up in a way to possibly lose my license. I think age has something to do with it. I was older than most of them and I was also better educated. I had heard them berating an older nurse when I first got there and soon, she was gone. I didn't know it then, but I was next. NEVER, and I mean NEVER go to HR. They're not there for you, they are there to prevent you from suing the hospital. My advice, find another job NOW and get out.

Just be thankful you're not one of those who is praised to the sky for bedside manners. I float, throughout my hospital, so eventually I "follow" one half of the entire nursing staff. The WORST nurse I follow is a relentless self-promotor who likes to yuk it up with the patients while giving them the worst care possible. She is praised by patients and administration. When I follow her, I find the fragmin in its package, ungiven. I find the antibiotic hanging and not infused. I have reported all of these incidents to the Charge RN, but because she is so good at B------t, nothing is done. I too am quiet and thoughtful and am never complimented by patients because they only go by the dog and pony show at the bedside. They have no idea who is giving good nursing care and who can possibly be killing them. Keep doing a good job.

Thank you for this information. I didn't know this.

The example I typed is just an approximation. Believe me, there was no way one could deduce the answer without determining several other positions. I would like to know if anyone has seen such questions and if they know how one should best approach solving it. I'm thinking some kind of diagramming might be used.

Help! My head hurts. I applied for a position at Kaiser and had to take an online assessment. It was like nothing I'd ever seen before (and I've been around). The test went like this: The manager calls her six employees every Monday. Lisa can be first or second. Jane cannot be last. Dan must be called after Fred. Tom is called before Jeff. Which statement is true? A. Dan is called 5th B. Jane is called 2nd C. Fred is called 1st D. Lisa is called 2nd This is an approximation. There was a 2 minute per question limit. Surely, there is some way to do this test, maybe with Venn Diagrams? Can anyone give me some input on what this test was and how to succeed at it? I found a similar example online which is why I think it's called a Psychometric Verbal reasoning test. Apparently, it's the rage in Europe. Any input is appreciated!

Thanks, that's what I thought.

Hello, When changing a dressing (and cap) on a Groshong, if there is no "clip" to close the line to air, when one removes the old cap, isn't there a danger of air embolizm? Should one take a kelly clamp to the line before changing the cap, or will that damage the line?

I could not have said this better! I, too am a former IT professional. Have been an RN for 5 years. EVERY DAY I work, I am SHOCKED by the disrespect that nurses show each other, the doctors show, the families and patients show. When one is used to respect in a professional workplace, the change is jaw-dropping.

This article is very oversimplified. In my previous job, I was targeted because 1) I had a BSN where most of the RNs did not 2) I am a second-career nurse 3) I am over age 50 4) I have a fairly ugly burn that covers one hand leftover from childhood. Because of the scar, I'm familiar with schoolyard bullying. But I worked successfully and bully-free for 25 years as a computer analyst. It was only in nursing that the same bullies from my childhood reappeared. When my direct and polite confrontation of the bully did nothing, I took it to my nurse manager. She was able to turn the situation around on me. I was relatively "new" (one year in the job) and the bully had worked there for many years. I ended up finding another job within 2 weeks of that ordeal. By the way, the same group had just bullied another over-50 RN out of that job. I won't wax poetic about justice or injustice. But I can tell you, when nurses wonder about their declining status and their ever-worsening work conditions, they should look at themselves and consider where this lack of respect originates...it's coming from the way they treat each other. Until that improves, the nursing profession will not improve.

Anyone who has ever reared a child or trained a dog understands that kindness works better than the hostility and anger you seem to value. I have mentored using kindness and I can assure you, the preceptee is educated BETTER than when having been beaten over the head with a stick. No, I don't discuss recipes or go for drinks, I am just plain kind to the learner.

Thank you, I'll read these books. Unfortunately, the doctors in my hospital put off the DNR conversation until it's too late or just never have it at all. Recently, an RN was reprimanded for suggesting to a family that it might be time for the DNR conversation with the MD.

The place is one huge clique. The manager is the one who reprimanded me for "not wanting to take direction", and since that time (my last day of orientation), she has clearly expressed her dislike for me. But, I see my main two errors of the case, first, failing to ask why the daytime dopplers and second, not calling the MD immediately when the Charge Nurse started interfering in the care of my patient. The Charge Nurse would have reported me for again, "failing to take direction" had I tried to stop her on my own, without backup from the MD. Thanks for you advice. I need a sane sounding board. I hope to be gone from their very soon.

I am just finishing one year as an ICU nurse, have 4 total years experience. The Charge Nurse has been a nurse for 31 years, only a little more than 1 year in ICU. I work nights. I have been previously reprimanded for "not wanting to take direction", that is, not wanting to follow a Charge Nurse "suggestion" when it was clearly wrong (I refused to give meds via an NG tube when I could not hear the air bubble and no xray had been done.) By the way, I have known since the reprimand that this hospital is not the place for me. I've been trying to wait one year so I can go somewhere else that isn't so crazy. The patient had come in the evening before, septic. Hypotension. DNI, and son was going to make a decision about DNR after consulting with the nephrologist. Dementia, 83 y.o. Less than 5 ml/hr of urine. On neo and levo, a bicarb drip, NS @ 200 and heparin drip (one MD thought she might have a PE). Lactic acid of 7 and going up. On that first night I had her, I had titrated the pressors until she had a decent BP on the monitor. During the day, the day shift nurse apparently no longer could get a BP off the monitor and started doing a doppler systolic on her. She also started cutting back the pressors. She gave me no reason why she did this and I failed to ask (my error). I had hoped to see some mention of this in the chart. The Charge Nurse, as soon as the shift changed, started barging in, upping the pressors with "hope you don't mind me just barging in". Soon, the levo was at max and the neo was 2/3 of the way to max. There was a BP reading on the monitor. Charge Nurse said, "we've got to get a reading on the monitor". By midnight, the pt's HR was 125, up from the low 100's she had been running all day. She was losing ground on the pressors. I had had enough and called the MD (which I probably should have done as soon as the Charge Nurse started making adjustments to the pressors). The MD was furious, stating, "If the doppler systolic was good enough all day, why would you want to raise the pressors". I got an order to cut back on the pressors and just do a systolic doppler (which had been between 90 and 100 all day and was now 92). Her HR started to go down. I titrated down very, very slowly on both pressors. At 0400, she started to brady down very, very quickly and coded. She was resuscitated after epi and the MD called the son and son agreed to make her DNR, comfort care only. As soon as the pressors were taken off, she expired. Please give me your input to this.

You could be describing the place I left last summer, a Federal place. I tried every tactic known to elicit cooperation from one CNA who refused to help me in any task, was insubordinate, and openly slept on the job. When I complained to the Charge Nurse, she took the side of the CNA since there had been a prior incident in which a Charge Nurse was demoted for "picking on" the CNAs. I kept a log of the CNA's actions (most often, inaction) and wrote it up to the Nurse Manager who did not act on it and who was decidedly cold to me afterwards. I left the place since I worked nights on an Oncology floor where most patients needed total care and I would have 6 patients and no CNA help. I purposely sought out a spot in ICU for my next assignment so that I would not have the CNA issue again. I would tell you to be careful, very, very careful. This is the same situation that bit me hard. Best to ignore the CNA until you can leave. Sad, but true.

Thank you for this. I crawled out of that hospital on Saturday feeling like scum. I considered not even going back. I had not a single moment of peace when I was off. But wait....there's more. The incident happened Saturday. I was off on Sunday and worked Monday night. Turns out, the nurse to whom I gave report and to whom I stated that I felt the the tube placement was questionable ended up getting intimidated into starting a tube feed and giving meds in that tube. The xray I had ordered came back within one hour as "questionable OG tube placement, needs clinical verification". The MD came to the floor an hour after I had left, furious that the TF was not going. He looked at the xray and ordered the RN who had relieved me to "push it down another 5 cm" and start the tube feeding. Notice, however, this was all VERBAL, no written evidence of his order. She started it and within 6 hours, it was discovered that the tube was now curled in the patient's mouth, draining into his trachea and/or esophagus. And my preceptor....she not only changed her tune (she had originally agreed with me that it was not possible for us to verify location of the tube), she sided with the other nurse writing in her patient notes that she had felt it was in the proper place! She is no longer my preceptor. Thanks again for your much needed support.

I have 3 years experience on an Onc floor, but I'm new to ICU. Last shift, a newly intubated s/p cabg (2 days) pt was intubated and an OG tube was placed @ 1500 and the MD said it sounded like "it is in the right place". At 1730, I was expected to give meds via the tube. I heard no air bubble in the R abd, a faint bubble midline. When I drew back on the tube, I only got frothy, clear fluid. In all the NG or OG tubes I've used, I ALWAYS got some kind of greenish gastric fluid back and ALWAYS got a clear sound of an air bubble in the R ABD. I questioned this to my preceptor (she has one year in ICU) and she too questioned the placement. She suggested I order an xray to confirm placement which I did. I did not give the meds. Another, more experienced nurse came to listen and said she "thought the bubble sound was OK". This nurse has never been helpful to me, indeed, she has exuded hostility for the 6 weeks I've oriented on the unit. She reported to the Charge Nurse that I "refuse to take direction" and the Charge Nurse reported that to the Nurse Manager. I was called on the carpet to explain my behavior. The nurse manager said it was "common" in the ICU to get back clear, frothy fluid from a pt who had not eaten in 2 days and that "if the tube had been in the lungs, the pt would have been desatting". I would appreciate feedback from you folks.

What a wonderful service you have performed by posting these concerns. I am a second-career nurse who lived through the nightmarish decline in IT. I supported a family on my own by in my 20-year career in IT. I saw first-hand how our government drove down fair salaries to nothing by the steady increase in H1B visa workers, willing to work for 1/2 the salary. I cannot count the holidays, weekends and 60-hour weeks I worked, not for overtime, but just to keep my job. Once my son finished college, I chose to change to nursing, not for the money (since I still was earning more money in IT than I do now in nursing), but to get satisfaction from my livelihood and to try to make some difference in the lives of other people. Can you imagine the horror I had when I saw that nursing was indeed being targeted just as my previous career had been targeted? All matters that you have put forward, I have seen on the job and seethed quietly as my fellow nurses seem unaware of what's happening. I have recently changed jobs because the former job required me, the R.N. to be responsible for 8 patients on a med-surg night shift in addition to assuming ultimate responsibility for the care of 8 more patients assigned to an LPN for the shift. One of my nursing school instructors told the class that nurses cannot afford NOT to be a member of ANA. After reading your excellent post, I am joining today. Thanks for this wake-up call.

Exact same situation here. Every chance to take a shot and it is taken. I'm a second-career nurse and I've had the opportunity to mentor new hire computer programmers (my previous occupation for 20 years). I never made them feel small, only encouraged then to try a different way in the future when mistakes were made. Anyone who has mentored previously, or raised children, or trained a dog knows that slamming, terrorizing, and belittling is counterproductive. So why is that the story on nursing units?????????????

I too, am at the 6 month mark and quite discouraged. I am on a busy med/surg unit, night shift. We are going to team nursing where the RN (me) is responsible for 10-13 patients while the LPN gives meds to these patients. The LPNs have quite a negative attitude toward a brand-new RN "supervising" them...most of whom have 15-20 years experience. I feel that I will be putting my license in jeopardy. I am thinking of trying to find another job where there is no team nursing. What do you think?