lindalee

Nursing was so different you would not recognize it. I graduated with a diploma of nursing in 1964. I have worked my entire life in hospitals. My first job was at a county hospital. I was the only RN on two nursing wards. I went between them, being responsible for maintaining the IV's, calling the intern if the IV was infiltrated--indeed we did not start them. We did however do hypodermaclysis where fluids were allowed to infuse into the SQ tissue. A Y type tubing was used, wydase was given into the area to help with absorption and a liter of fluid was given SQ. Sort of similar to what vets do for animals these days. (By the way, it saved many a life) An LVN headed my staff on each unit, she gave all the po meds, and I had to give the IM or SQ meds. We did not give IV meds. The units were staffed with two orderlies on the male floor, and two aides on the female floor. If I remember correctly, each unit had thirty patients. The aides and LVN did all basic care. I assisted when required. Meds were given on time. Patients were not as ill as they are today--The patients on the floors today would not have survived in this environment. My first critical care job would have been in 1965. We had one monitor that was taken from patient to patient. Nurses did not read rhythms. We did quickly learn to recognize NSR and PVC's but we had to call the intern when we thought there was a problem. Renal failure---well it was pretty much a death sentence. Dialysis was in its infancy. You had to be approved by a committee to be allowed to have dialysis--and forget it if you were over 45. You simply died. Renal frost was not at all an uncommon thing to see in those days. We did not ventilate patients--if I remember the first ventilator I used was an old bird machine and maybe in 1966. Most patients did not receive ventilator support even for a brief time. If you had a hernia repair or an appy, you were in the hospital for four or five days. Our MI's were kept on bedrest for 14 days and frequently died on bedpans. No one had multi-organ system failure--if one system failed, you died. I could go on for hours, but believe me, nursing has changed. The legal issues were not even thought of back then. People seemed to be grateful for the care they received and no one though we could keep people alive forever. I have been an RN in hospital nursing for nearly forty years now. Certainly the responsibilities of nursing have changed and increased. The technology has gone so far forward in forty years that nurses working in the 60's would be totally lost trying to work now. I still very much like nursing but miss the ability to know my patients and their families. There was a time when you could educate your patients and really talk to them. These days everyone runs so fast that I feel this is not done. That is a great loss as we have much to teach. I think the little things that we were once able to do (hair wash, take a patient outside in a wheel chair, that type of thing) are gone forever. Somehow those little things I remember making such a difference to patients. We have moved very far forward with our responsibility and technology but the things that made us caring nurses seem to have been lost. Does this make sense? Our patient survive these days where they did not forty years ago, but the personal touch is gone and has been for a long time now. So much has changed and so quickly. Remember that once there was no AIDS, no universal precautions, no critical care areas in most hospitals. There was no air critical care transport, no fetal monitoring, and no computers. Nurses did not always do physical assessments. Our ability to do invasive procedures was very limited. Although our responsibilities and accountability have greatly increased, our respect has not. This is sad because the public still sees nurses as physician handmaidens and that is far from the truth. It has been an amazing field. I am sorry this is so long.

There are ventilators specifically designed for hyperbaric chambers. I had many advanced classes in hyperbaric medicine. The chamber can be life saving in these diseases (including gas gangrene) as it not only oxygenates the tissue but also inactivates the toxins that are being produced. These patients are difficult to treat. We always paralyzed ventilated patients for the duration of the treatment because if they start to breath stack they will have a pneumothorax and can rapidly die. You must be in complete control of their breathing and closely monitor the volumes are they will change rapidly during pressure changes. We had arterial lines in place, used transcutaneous tissue monitoring, cardiac monitors--basically all the normal ICU equipment. A hyperbaric RN attended the patient as well as respiratory therapist trained in hyperbaric medicine and in the use of this ventilator. Some of my scariest moments in nursing were during these very difficult treatments

Don't know but would think perhaps her food is passing through her system too quickly. Would definitely have her checked, the green color could be a bile product--think what it looks like when people have frequent vomiting--is this what you are describing?

If you are talking about management of pacemakers after implantation, there are pacemaker centers where nurses manage the pacemaker patients. There are guidelines about how often the devices need to be checked. The pacemaker can be checked by telephone for basic function using a transmitter. This is done every one or two months depending on the age of the device. The telephone check is done in two parts. The first part transmits the cardiac rhythm; the second part is transmitted using a pacemaker magnet. The magnet rate of the device will indicate if the device is reaching the end of the battery life. The patients come into clinic for a full pacemaker check either every six months or every year. The guidelines vary if the pacemaker is a single chamber or a dual chamber device. Our pacemaker clinic also follows ICD devices. The nurses are trained to check the devices, ensure safe thresholds for pacing capture, and check charge time and battery life as well as other functions. The devices have memories so if a patient receives a shock; they come into clinic where the rhythm before and after the shock can be examined to see if the shock was appropriate. It is a very interesting field--constantly changing as the devices get more abilities all of the time.

It does not matter if you change jobs, nursing does not have great retirement benefits. I have been in the same job (different postitions, same hospital) for many years. Retirement is a 401K that is worth half what it was three years ago. No health benefits at retirement. End of service and you are on your own.

>>>>> Find a new job. What a loser of a manager. I sometimes would love to be banned from my unit--LOL What a holiday it would be. Seriously, people who manage like this are incompetent and you don't need them. Allow her to fill your shoes while you are banned--and go find a job where you will be respected and treated like a professional. You don't need this, no nurse does and the sooner you vote with your feet the better off you will be. No job is worth being treated like a slave and you should not tolerate the lack of support for even one minute more. I would also write a letter to personell, risk management, perhaps the nursing director outlining how management is treating their front line staff, and exactly why you left. JMHO

Pension, medical benefits??? Not at my hospital. I have always contributed to my 401K and also into a 403B but with the market where it is, I should have played more and saved less. I don't mind so much saving for retirement but by keeping our salaries so low, they have limited our ability to contribute adequate amounts to retire. That is a major problem in my opinion. After all someone making 100K a year can save more than someone making $50K and for sure we are worth more that we are paid. (Think about the difference of 10% of 100,000 (10,000) and 50,000 (5,000) savings. Obviously few of us can maximally fund retirement accounts. With costs of living so very high if we are to fund our own retirements we need an income adequate to allow saving without doing without owning homes, and an occasional vacation. I still think people view this as a woman's' profession and compensate it accordingly. Most nurses I know are single parents and are unable to own homes, take nice vacations and do things they might enjoy--much less trying to fund retirement. I am sure the administrators have adequate retirement benefits.

>>But how else can the ivory tower folks justify their jobs. It seems they put on a new form or alter an existing one practically daily. I think that is a requirement of their employment.

There are other ways to handle excessive sick calls and no need to punish everyone who gets sick. Give me a break. I rarely call in sick, but if I do I sure don't plan to be punished and would really develop a bad attitude if I were forced to make up my sick day. Sick time is a benefit of your employment and you have a right to use it when it is necessary. I no longer work weekends, I took my current position with that as a criteria. (I worked every other weekend and holidays for 32 years and paid my dues) Nurses are exposed to illness constantly and will get sick. It is a hazard of the job. While I agree that 5 weekends out of ten is excessive, you must realize that people will get sick and do not deserve to be punished for that. I think the mental stress of nursing and the difficult physical work at times can cause physical/mental illness. Over work and excessive demands on us is a major problem in this profession and that alone is enough to cause illness. Please try to be supportive of your fellow nurses. I am sorry you have to pick up the slack but perhaps you were blessed with a very strong constitution and don't get sick. Wish that were the case for everyone but it isn't so. Children do get sick and their parents do have to take care of them. In our culture unfortunately there are many parents raising children alone without a support system. Would you have them leave an ill child unattended so they can work? You have no children and probably have never been in that position. My son was a severe asthmatic and let me tell you; sometimes I simply had to be at home. He is grown now and I am rarely absent or ill from work, but that wasn't the case when he was younger. You are allowed to use 1/2 of your sick time for an ill child or family member without fear of reprisal. (This is either federal law or California law, I am unsure) You are also entitled to family leave if you need it. This is federal law. Family leave can be used one day at a time if necessary once the paper work is completed. You must first take care of your personal family; your job should always come second. Sorry, this really made me angry. I agree that people are out there whom do abuse sick time and party---those people need to be punished but that is rarely the case in my 35 years of nursing. I think that the nurse needs to be respected as a professional, if she says she needs to care for her child/family member or is sick that day she should be believed. We trust her judgment with other peoples' lives; do we think it is any different with her own life or her families? Jobs are easy to find and we need to take care of our own first. I personally would not work for a manager with this attitude.

My son is now 30 years old. The only time I did not work full time in nursing was the first three years after his birth. I had practiced nursing for about 7 years before he was born. Let me tell you that after that three year lapse in practice I was scared to death! I took a refresher course--probably much to the instructors amazement. Yes, I was the only one out of practice for that short a time, but it did help me. It took about six weeks working full time to really feel I was back in the grove to practice safely. Hang in there, you will do just fine. Equipment and faces change but the basic principles are the same. You will get comfortable again, give yourself time. Welcome back. We need you.

This is the first time I have replied to this group. This topic is one I have pondered for years. I am an RN, started practice in 1965 so I have seen many changes and taken care of thousands of patients. I spent 17 years in the Neuro ICU, left that environment 3 years ago. My parents health failed and I simply could no longer manage all of the problems with them and the death issues at work. The toll on me was awful. Dad died rather quickly, just six months after entering a nursing care facility. My mother died a very slow death from a progressive dementia over 5 years. I watched her lose everything that made her a person. She eventually lost the ability to eat. I did not allow a feeding tube. It took nearly 3 weeks for her to die after she quit eating. That was the hardest thing I have ever had to do, although I knew it would have been her choice and was the right thing to do. Knowing how very difficult this was for me with all my experience and knowledge of my mother's feelings when she was able to express them, did help somewhat with understanding why families cannot make a decision to stop treatment when it is obviously no longer helping. My mother died without a bruise on her body. She looked younger than I did by the time she died. She was in a coma and looked extremely peaceful for nearly two weeks before she left us forever. I still at times have nightmares that I caused her to die by withholding the feedings, but by daylight I know that I did the correct thing for her. It was really pretty awful, I was able to help patients at work when in pain but could do nothing for my mother to help her pass over. There were orders in place for medication if she struggled but she did not. You can believe though that while sitting there I really wished I could have given some medication to help her let go. My family was very supportive through all of this but my brother was very grateful that I had to make all the decisions. He said he would not have been able to withhold the feeding tube. The way we were called and asked daily really tore him apart. We got a call about three days before her death. The RN wanted to do a CXR. I asked why? She said I think your Mom has developed pneumonia. I asked what a CXR was going to do to change her care, she got very quiet. I immediately called her physician who was very upset that I had been called (yet again) When we arrived that day we got a formal apology from the nursing director. Yes, I am in favor of assisted suicide, but could not be the one to assist. I also think nurses should not question families daily about decisions that are in place. This situation is difficult enough without feeling like you are being questioned every time you visit. My mom had asked me about 7 years before her death if I would help her end her life if she ever had to go into a nursing home. Thank God I told her I could not do that. I am almost certain she knew she was starting down a dementia pathway. She never wanted to go into a home, but that was not to be. She was full care for five long years.