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  1. "If a patient with known and proven beyond reasonable doubts CHF chooses not to follow salt-free diet, it is his business as long as he is informed about what happens as a result (no improvement in his condition doesn't matter how many miracle pills he is taking and eventually death). Now, if that patient is in health care facility, has an acute CHF exacerbation directly related his refusal to follow salt-free diet, has direct provider order for that diet and still demands salt, would it be ethical to allow him to, essentially, aid to his disease in the name of keeping him "satisfied"? Or, even more, try to influence provider into dropping the diet order and not providing salt-free food at all under the same premice (recently witnessed practice in LTC)?" I have witnessed in LTC because of state regulations, if diabetics want pancakes with ice cream topping for breakfast, lunch, and dinner, the facilities have to attempt to accommodate these requests because the LTC facility is their home, and if they were living in the community and that was what they wanted they could have it. In theory I agree, but often these people are not cognitively capable of making appropriate decisions, hence the LTC facility. So why are they allowed to make inappropriate meal choices? If their guardian signs off on it, okay, but otherwise, I don't think unwise decisions are appropriate. If they wanted to go outside in only their underwear in 20-degree below zero weather, should we allow it? If they wanted to drink bleach, should we allow it? It is their right, because they want to do it, correct? Competent adults are allowed to make bad decisions, but not all adults are competent (even some who have not been declared incompetent.)
  2. And I try to treat my patients the way I would like to be treated, I show my patients their lab work and explain it to them, I explain how their bad choices are impacting their health, I explain what their meds are and the side effects and benefits, and am ignored regularly. I frequently think it is a shame I care more about my patents' health than they do, when they come in and expect me to "fix them in spite of themselves."
  3. If someone doesn't want to participate in their own health care to improve their health, it is much cheaper to go to a hotel to get customer service, room service, clean linens, room cleaned for you, etc. Then they can take what meds they want, whenever they want, and eat whatever they want.
  4. I took care of a patient a while ago who stuck in my mind. She was to be going home that day, and I was assisting with her AM care. I was still in her room, and she asked me to do some of her care for her. I asked her if she was able, as she was going home. She said, " of course I can, but it's such a LUXURY for you to do it for me." I didn't think we were there to provide LUXURY services for people. If you can't do it, of course I will help you. But if you can, you should (promoting independence, ROM, dignity, etc.)
  5. LadysSolo

    Knaves, Fools, and the Pitfalls of Micromanagement

    The hospital where I used to work was going to cut our staffing per request of the board. I decided to buck the system (there were a group of us but the others backed out) and went to the board meeting and challenged them to come work with us for a day to see how it really is before they cut us. One person agreed. He made it for 4 hours and left saying "I don't know how you do it with the staff you have, there will be no cuts!" And there weren't. Sometimes you have to ruffle a few feathers and granted, I knew when I did what I did I was risking my job. But I did not lose my job.
  6. The "shadowing nurses" idea was done at one hospital where I worked. The hospital board wanted to cut staff, and we asked if one of the board members would follow one of us for a day before they made the decision. The board member made it for 4 hours, and said "there will be no cuts - I don't see how you do it with the staff you have!" A success in my opinion!
  7. LadysSolo

    My trip to the ER

    Oh, much worse - I ignored it until it went up my whole forearm. (I tend to not take very good care of myself.)
  8. LadysSolo

    My trip to the ER

    I also take care of feral cats (anything too wild to be placed in a home by our local rescue agency)in my horse barn. I was bitten by one of my house cats (who was feeling very macho one day) and so I got to forego the rabies treatment but still got a raging cellulitis. The only thing worse is a human bite (more bacteria.)
  9. LadysSolo

    10,000 RNs Face Nursing Board Each Year!

    I think sometimes it is recommended the person NOT talk about it so the Board of Nursing can't subpoena people to testify against the nurse in question. I would talk about it after the fact, especially if it wasn't true. Patients and their families can be VERY vindictive!
  10. LadysSolo

    Projecting Optimism: Creating Positive Outcomes

    You have to explain things in "people language," not "medical speak." I explain things to patients in "people language" as much as I can, and they seem to appreciate it. Example to a patient about to have an angioplasty - "it's kind of like snaking your drain to remove a clog." They get the picture and aren't afraid. Or doing wound care on a large wound using collagen to a construction worker - Asked if he used scaffolding, he said yes, and told him the collagen was like scaffolding for his tissue to grow onto. He got it. When you explain it in their world, it makes things better.
  11. LadysSolo

    Documentation: Your First Line of Defense against Malpractice Claims

    I am told by my employer that I document too much. Having had to give a deposition once, I now document so any attorney looks at my documentation and decides it is not worth it to sue me. I will NOT shorten what I believe is necessary documentation (I also want to be able to look at my notes if I ever AM sued and be able to remember who it was.)
  12. LadysSolo

    What Nobody Told You About Graduate School

    It was worth it. When I did it it was with relatively low expectations - I would continue until either the money or brains ran out. I also was a single mom, working full-time, going to grad school, and during it just to add to the fun decided to build a house and move! And I finished. The only thing I would say is that if I had know in the beginning of my career that I would go on, I would have worked harder in my undergrad program (all of you RN students pay attention if you think you MIGHT go on to a graduate degree.)
  13. They wanted to CUT our staffing once. We asked a board member to follow us for one day to see what we did. The board member made it for 4 hours, and left the floor saying "CUT your staff?!? I don't see how you do what you do with the staff you HAVE!!!!!" The hospital was only posting part-time positions for awhile (anyone remember when UPS was doing that about 12 or so years ago?) Our hospital thought it was a Great idea. I had been there long enough to know who to drop information to that it would get "carried" back to the powers that be efficiently, so I "dropped" that we were talking union. Suddenly, full time positions were being posted again. Imagine that?!?!
  14. You make it work because it's all about the patients. I got out on time about the same # of times I got lunch - you could NO WAY keep up your charting under the circumstances, you make notes on the paper on your clipboard so you can chart later. I also am extremely anal about things, and very organized. I also used to joke that my patients were "well-trained," I would check into everyone's room about hourly, and they could ask me for what they wanted then (cut down on call lights), and their families got used to it too (I worked 5days/40 hours/week) so it made things better. I also knew from friends that it was no better anywhere else, so I stayed where I at least had good co-workers.
  15. There were two nurses on the floor, one other one plus me. The poor STNA and the nurse on that team (either me or the other nurse) had to do it. So (obviously) breaks and lunch were out of the question, but we still had to clock out for lunches (mandatory) even though we never got them. In all the time I worked there, I got lunch approximately 10 times (as best I can remember.) But it was a pretty good place to work in that we all worked together and "had each others' backs." We had a good crew. And our afternoon supervisor was good, she felt for us even though she couldn't do much. But if we were having a totally disastrous night, she would "turf" admissions to another floor for us (because we didn't complain unless it was a total disaster.)