nerdtonurse?

I see this as a chicken and the egg situation. If you have depression, you tend to have feelings of inadequacy, poor self care, you feel like you're not worth looking after, you doubt your abilities, so I would tend to think these are a symptom of depression rather than independent feelings/behaviors. I mean, everybody has days where nothing goes right, the brief always falls poop side down, etc. However, consistently feeling that way is something along Axis I. If it goes into paranoia ("they're all out to get me") that's going into Axis II. Many people have untreated or undertreated depression, and that includes nurses. I had a grandparent who committed suicide due to depression, and the other was clinically depressed also. They are not fun to be around, particularly when they attempt to self-medicate with ETOH and valium, and I watched the "poor pitiful me" and the "I'm not good enough" and the "you all hate me" stuff all thru my childhood. The simple truth was my grandparents weren't good enough to be my caregiver, weren't adequate to the task, and I think (now) some of grandma's "poor pitiful me" moments were actually moments of clarity where she realized she shouldn't have been my primary caregiver -- but a valium and a beer fixed that. Dad was overseas, mom was working 2 jobs, and mom was in denial that she was leaving me with 2 depressed alcoholics. Borderline personality disorder is different, and those make any shift a living death when you work with them, but depression is anger turned inward; they usually don't do much beside dump all work on you and play Eeyore in the corner. Which still stinks.

Folks, we are NOT paid to get hurt. Unless you've got meaningful security (as opposed to some guys over 80 that you'd worry they'd fall and break a hip), call 911. Tell administration they were threatening other patients and you didn't want that to be in the paper. They don't care about us, so make it about something they do care about -- bad publicity if a visitor or other patient's injured.

One thing I will tell you -- pee before a code, if you know it's coming. And yes, I've looked at telemetry, and said, "everybody who needs to pee -- now's the time." Compressions on a full bladder sucks eggs. I am the proud owner of a 1000cc bladder. We were on a Texas vacation, somewhere between Midland and Abilene and I ended up having to use a large drinking cup. 1 liter, and I filled it up. The family was amazed, and I was kinda horrified.

Unfortunately, I saw this while working in computers all the time -- jobs created for Y2K that disappeared Jan. 2, 2000, disaster recovery jobs that boomed after 9/11 (and the federal money thrown everywhere in the name of security) that were gone when we didn't (thankfully) have additional terrorist attacks, older employees that were put in jobs that they could be thrown out of so that the company didn't have to pay retirement/higher insurance costs/etc. -- "quality assurance" "TQM Manager" and "strategic planning" were all code words for "seeya!" Companies I worked for were bought and sold to the point where I wanted to get a sticker like you'd find on a used car and just hang it on the outside of my cube for my new "owner." The problem's not the President -- the problem is that people have started running hospitals like a Walmart, where customer satisfaction surveys are more important than doing the right thing for the right person at the right time. However, Walmart isn't federally required to give sacks of merchandise every single day to people for free, and apologize i they don't bag it up fast enough. They aren't required to hop through hoops from OSHA, JC, CAP/CLIA, the DEA, state boards of nursing, state boards of medicine, all while the non-compliant schizophrenic is ripping the bakery up and beating on the employees. You wanna save hospitals? Make them follow the same thing that the CEO of Whole Foods does, since we're now a service industry as opposed to health care -- the CEO can only make 14x the wages of the average employee. The difference at my hospital would fund dozens of jobs.

So true. We are so busy taking care of everyone else, checking on everyone else, nobody notices when we're the ones that aren't okay.

*hugs* GrnTea, you're making me sniffle.... We had a "do everything" Momma for a youngish woman with early onset BC, double mastectomy in her early 20's, and for whatever reason, nothing worked -- chemos didn't, radiation didn't, just one of those aggressive killer CAs. Her husband and she had discussed the situation, like you and your hubby, and had decided they were going to not pursue further treatment, but didn't have a POA/DNR drawn up since everyone in the family knew what she wanted. She passed out at her Momma's house, (who knew what the patient had decided), and Momma had her in the unit, tubed and on every drip in the house, calling oncologists who didn't know the score before she even called her son in law at work. Hubby hits the door and is completely distraught, feels he's betrayed his wife's trust in him, Momma's threatening to sue him for custody, i mean I seriously thought I was going to be walking thru news crews on the way to work. The husband begged for the doc to extubate her to prove what the patient wanted. So, after 2 days, he did, and they were all around the bed, Momma waiting for praise, and the daughter whispered, "Momma, let me go..." So she went on Hospice and was with us or a few quality weeks. To my knowledge, she never spoke to her mother again. GrnTea, please, please go ahead and get some paperwork situated, if you already haven't, and make sure copies are on file with your doc, local hospitals, and in both yours and his wallet. I know I've got relatives who would pop out of the woodwork and have me on a vent forever, which is why I have a Durable, and my PCP knows my wishes in writing.

While this is not the OP's situation, I guess one of the big issues I have in our particular ICU is that I'm there for the patient first, not the patient's relatives first. Yes, I support the families when I can. But there are multiple, multiple, multiple cases every week where what the family wants is unrealistic, harmful to my patient, and just basically contrary to any standard of compassionate care. I'm not talking about someone who had any kind of a reasonable baseline, I'm talking about folks who are in their 90's and older, bedridden, fetally contracted, so many CVAs they are blind, deaf and only moan, yet we're doing TEEs, and colonoscopies (hello, she's got colon CA that's mets'd everywhere but her nose, but let's stick a tube up there. Oops, now she's perf'd, and now she's going for a resection. Oops, they couldn't find anything to anastamose, so she's got 5 inches of large intestine and 12 feet of small intestine, the stoma is turning black, and she's puking stool. So let's put her on the vent so we can control her airway, oh, now she aspirated on the stool that's coming out of her faster than the NGT can suck it out. So let's do a trach, oops, the trach eroded through her thyroid artery, back to surgery, over and over and over while the poor soul is basically now puking and aspirating tissue that looks like chunks of mildew and has ran the hospital out her blood type on 3 separate occasions). Yes, the poor thing finally did die, but the family refused to let us stop the code so we put the patient on an autopulse for over an hour after we'd manually coded her for 45 minutes until a new doc came in and stopped the code -- the family wanted to leave her on the vent and use the Auto Pulse like an artificial heart, I guess. That's just one, and it's because we've got docs who are all about generating revenue and they will lie to a family in a heartbeat and give them false hope, which is the cruelest thing of all. There's no way I can have any fealty to my patient and be "supportive" as they want to go torture my dying patient some more, and it happens all the time. So, while I try to be compassionate as I can, there comes a point where someone needs to say, "it's time to stop and make this patient a DNR." And as a culture, we tend to do very poorly with that. When I've got a family who is turning my patient's last days into a misery, I'll admit that I tend to go into the room, focus on the technical side of what I have to do, do what I have to, and leave. Because it keeps me from strangling the family members who are crowing "do everything!"

My dad had lung ca. Everyone was like "He's 70, has diabetes, prior MI, hang it up." He was completely insulted when one of the little med students asked him if he could walk from the doctor's office to the hospital (about half a city block). My dad looked at him and said, "I could RUN it." While he was in the hospital after they took out 2 lobes, the only time he got a bath was when my Mom or me or my sister gave him one. They tried to give him an antibiotic he's allergic to. They didn't want him to walk without PT -- well, I'm an ICU nurse, my sister's a doctor. I think we could handle it if he needed to sit, and down the hall we went with a walker. He got his chest tube out in record time, because he both wanted to and had the capacity to get better. I ate up a nurse who suggested that maybe we should think about "quality vs. quantity" of time with my dad. My dad wasn't going to anybody's statistic, and I was going to see to that. I was just tickled pink over how much good my "advocating" did. But I didn't look at the effect on my "patient." Advocating's great. Being your dad's voice and defender is great. But for your own sake, daughter to daughter, make sure you take the time to also just be his kid. Because of what I had to do to make sure my dad had a good outcome, doing my advocating, my relationship with my dad changed. He feels like I somehow took something from our relationship by "taking charge" or "taking over." Even though he did better because of what I did, it's not the same now. He hated the dependence, associates me with it, and it has colored our relationship. If I so much as say, "Hey, Dad, how're you doing?" he snaps. Part of it's fear, fear that the lung ca will come back, and part of it is that our roles flipped, just for a while. My father's alive. But my Dad, the Dad I used to be able to kid around with and burrow into a car engine with, and get dirty in the yard with is gone. He's so afraid of showing weakness, he's afraid to show love because he feels like I somehow took something from him, made him less during that period. I could fix the wrong antibiotic, and the ADLs, and all that. But I can't fix a spirit that I broke when I didn't even realize that I did it.

Just because a person's good at something doesn't automatically make them a good teacher -- I've worked with people that were blindingly brilliant, but couldn't "dumb it down" enough to tell you how to make toast. Most of us with some initials after our names remember certain professors with fondness -- because the truly good ones were so rare. I personally think that the ability to teach is like the ability to lead -- you're either a leader or a teacher, or you're not. You can learn to be a boss or an instructor, but leaders and teachers are born, not made. And churning out a bunch of instructors who are going for the job because they're looking at summers, weekends and holidays off isn't going to help anybody (the equivalent of the people I went to nursing school with who wanted to be travel nurses and CRNAs, but couldn't pass A&P II). I also think we need to seriously look at what the BSN level classwork is. We're putting in a lot of "management" stuff, at least in the programs I've seen. Let people do what they are best at. If you want to be a manager, go get at MBA or a MPH. I think we need more psych, more patho, more "stuff" that will keep the patient alive at 3 am when you can't get a MD on the phone and your patient's crashing. I'd like to see classes that revolved around labs -- seeing what set of labs means what, not just "oh, Mr. J's K is 2.5. he'll be getting some riders," but what to look for in a patient with cancer that could mean it's mets'd to the bone, or that maybe you need to back off the Diprivan a little on a person who's lipid panel looks like A, B, or C. I can't even get someone to give me a straight and consistent answer on when a person needs to be on reverse isolation -- some talk numbers, some talk ratios of numbers. Sorry, it's been a rough week.

----and wouldn't know what to do in a code if someone's life depended on it...oh, wait, it does. Oh, you're the ACLS certified code team leader but you're not in white? Well, let's get the person who wore white but is so new they can't spell ACLS to run the code....

Sounded much like one of my cousins. However, he didn't have a Viva in his life, just a string of people who enabled his addiction, made excuses for everything he did, made sure nothing, not the DUI, eviction, conviction and jail time, none of that was his fault or responsibility. After multiple suicide attempts (not true attempts, and he would always tell someone what he was going to do, where and when so he could be "rescued"), I believe he accidentally committed suicide when the person he'd told didn't believe him and went to work. She came home, and he'd been dead from carbon monoxide poisoning for hours, his bag for the hospital packed and a roll of quarters was in his hand, because he always yelled at the ER nurses to get him things from the snack machines while he sat waiting for mental health (again), social services (again), or the county sheriff's department (again). Not the sign of someone who thought they were actually going to die. He always had an "attempt" when he wasn't getting his way or had to go to court. My cousin not only didn't think he was worth saving -- he didn't think he was doing anything wrong that he needed saving from. Maybe you helped your patient find his way out when he hit bottom. He decided he was worth saving, and you're what made him feel like that. :hug:

If they pass the nursing program and the boards, they are the most dangerous nurse on the floor. These are the nurses we all know, the ones that we think, "OMG, if I'm ever a patient, please don't let him/her be my nurse." The ones that routinely make med errors and try to blame it on someone else, the people who don't turn their patients, who's patients always manage to get septic. The ones that we all secretly think has probably managed to harm or kill a patient thru sheer stupidity, but we can't prove it enough to report it. They usually manage to kiss up to someone in admin, become the boss's snitch, get some kind of protected position while everyone else on shift with them lives in fear of their license, just by being in close proximity. And unfortunately, I think there are a lot of them out there.

Where I work now, we've got a room in the unit that is our last ditch room -- we will try to move people upstairs before we put a patient in there. For some reason, anybody put in that room just goes bad. Nothing as spooky as 14, but just people don't do well. We all laugh (kinda) and say, "if something ever happens to me, don't put me in there!"

Thanks, Elvish. I needed to hear that today....

What in the world? I was standing in the storeroom on North Wing - and it was huge. Unlike the cramped space on our floor that had obviously been an old broom closet, this was a complete patient room that had been turned into storage; the old callbell light was still over the door. The bar with the code blue button, the connections for the callbell, suction and O2 were gone, and replaced with racks. The racks held everything from the ortho equipment we needed to put trapezes on beds to microscopic supplies for babies, and the floor itself was covered with the big pumps for the cooling blankets, wheelchairs, and folding cots. It was perfectly organized, neatly arranged, and looked like a photograph from Gracious Nursing Magazine. I kept thinking Paula Deen was going to pop out of the bathroom with tea and cookies. Our small storeroom looked like a wreck, half opened packages; crates pulled out and sat on top of other crates so you could get to what you needed, nothing like this study in perfection. "Chuck, did you guys just clean in here or something?" Chuck, the male LPN on the floor, had asked me to come in with him to get some things for the rooms he had, and he was busy loading his arms up with 4x4s, IV start supplies, and was grabbing things as fast as he could. I looked around for an empty box to load the stuff in, and started out the door to go get a copier paper box. "Don't leave!" Chuck worked even faster, with a touch of something in his voice I didn't like. I pulled out the front of my scrubs, and used it to hold the alcohol pads and other things he was trying not to drop. And he was being oh so careful to put everything back into order, even as he grabbed things at as fast as he could. "What's wrong?" Finally, with almost a moan, he just grabbed several boxes of jelcos and practically pushed me back out of the storeroom. I turned to look at him, and he was sweating. "Are you okay?" "Now I am," he said, scrubbing his face on the shoulder of his scrubs. "Damn, I hate that place." He walked off, and I trailed behind him, holding my scrub full of supplies, wondering how someone could be claustrophobic in so large of a space. We went into an empty room, and began restocking the supplies. It was a time of low census, and the few of us working were doing a lot of housekeeping, stocking wound care carts, rooms, just doing all the things you need to do but so rarely have time to do. "I didn't know you were claustrophobic." He cut his eyes at me. "I'm not. That's what used to be North 14." The blank look I gave him told him that meant nothing to me. "You know. The room where the patient died." I choked on a laugh, he was obviously upset about something, but... "Chuck, someone's died in all of these rooms." He slammed the drawer shut and went to the next one. "Yeah, but not buy throwing themselves out of the window." "WHAT?" He cut his eyes at me again, and I noticed his hand shake just a little as he put some Salem Sumps into a stack. "I forgot, you haven't been here but a few years. About 4 years ago, some woman was up in there with something fairly minor. Gallbladder, appy, something like that. Well, her husband decided that was the exact time to tell her that he wanted a divorce. She'd still be in the hospital for a few days, he could get moved out, clean out the banking accounts, whatever." I had put everything down, and was passing him jelcos. "Sounds like a real piece of work." Chuck nodded. "Yeah, sounds that way. Anyway, they got into a screaming match that you could hear from one end of the floor to the other. Last thing she screamed at him was something along the lines of 'I hope you drop dead, you SOB. I hope you drop dead.'" My mouth fell open, "Oh, God, don't tell me he did." Chuck shook his head. "Worse. You know you can see the corner from that side of the hospital. Well, the guy gets in his truck, starts down the road, and gets T-boned at the intersection. Wasn't wearing a seatbelt, got ejected, and the truck rolled over on him." "Ewww....squish." "Pretty much." He propped against the cart for a minute. "Everyone that was free went running outside, of course, when they heard the crash, just left a few people on the floor. Nobody knew it was North 14's husband or that she was watching from the window." Chuck looked at me, and I realized, this guy was serious. "So, later that night, the wife is all upset, saying she killed him, he must have been distracted after the argument, you know. They give her something for her nerves, and along about midnight, they hear her screaming, "Get away from me, stop pushing me." They hit the door just as they saw her feet going out the window. She fell down on the air conditioners and that was it for her. Nobody was in the room, they had a clear shot to the door, so nobody knew who she was screaming about." "Oh, man, poor thing must have had a nightmare." Chuck ran his fingers through his hair. "I'm not so sure. Well, that's when bad things started to happen, anyway. If we put a woman in 14, everything was fine. If we put a man in 14, the TV wouldn't work, the suction canisters would pop off the wall, the bed would lock in an uncomfortable position. Male patients would report the room was freezing. And sometimes, they'd ask about the female 'patient' that came in their room and was staring at them from the foot of the bed. It got so bad, they finally turned it into a storeroom." I put my hands on my hips, "Okay, that's just crazy. Are you saying it's haunted or something? I'm not believing it." Chuck shook his head. "They told me when I got here to never go into 14 alone, and to never, ever leave it messy. Well, I don't believe in ghosts, or 'haints' as my grandma called them...at least I didn't...." He sighed. "I went in to get something, and felt like someone was watching me, you know? That feeling you get when someone's looking at you from behind. But nobody was in there but me. So, I grabbed my stuff, knocking a box over. All of a sudden, it's like cold water was poured down my neck, and I turned back around, and that box was back upright." "Damn, Chuck, send her to my house to tidy up." I burst out in nervous laughter. I don't believe in the restless dead, but this was making the hair on the back of my neck stand up. Chuck frowned, and we left and started to the next room to restock. "I'm not crazy. There's something in that room, and it's not just supplies. That's why we always go in to get supplies with a female nurse or one of the women get the supplies. That patient's still in there, and she's still angry. Angry at men. Angry when one of us goes into her room. Look." The callbell light over the door to North 14 was on. Chuck signed. "That light doesn't attach to anything, the wire's just coiled up in the box, I cut the damn wires myself one night. There's no electricity. There's no switch. There's nothing to turn that light on with."