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LadysSolo

LadysSolo

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Content by LadysSolo

  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.)
  16. I was just thinking, all these administrators/DONs/other hospital administrative types come here asking what the problem is, and we KEEP TELLING THEM and nothing ever changes. We TELL them we need better staffing, and it NEVER improves. Why keep asking if you don't plan to DO anything about the problem? Because they want an answer that won't affect their bonus for bringing the hospital in under budget, that's why!
  17. If they REALLY want to know why mistakes happen, I worked 23 years on an oncology unit. I 95% of the time was doing primary care on 6 - 7 patients, and 99% of the time (I can count on the fingers of one hand I when wasn't) I was giving 2 units of blood to at least 2 patients in addition to giving chemotherapy to at least 2 patients, plus the others were usually immunocompromised, and we had one STNA for the 14 to 17 patients. THAT is how mistakes happen!
  18. Add to all of the above comments (which I agree with, BTW,) documentation is more complex, you have to "click all the boxes" to be sure you get paid for what you do, you have VERY user-unfriendly computer systems, and (just this week in my case) the computer altered my documentation back to a previous day after I checked it and the computer change made it incorrect for the day in question. Try testifying to "the computer altered my notes" if you ever have to go to court and see if it flies - bet it won't even though it is true. And regarding financial index - I personally took a pay cut from being a waitress to become a nurse (although I DID get health insurance, so that is something.) Jut saying.....
  19. I am very sympathetic - I have two home care patients that use a home physician service that recently stopped their pain medications and told them to go to pain management. One is 750+ pounds and the other is 350+ pounds, both minimally ambulatory (hence need of home visits.) How are they to GET to pain management? What are these people to do? No one wants the responsibility any more.
  20. LadysSolo

    A Newly Defined Type of Constipation: Opioid Induced Constipation

    Heck, I knew opioids caused constipation when I was in Nursing school back in 1980. So how is this a new idea? Because some pharmaceutical companies want to market to opioids users "ask your doctor (sic - what about NPs/PAs?) for our great new med."
  21. LadysSolo

    Getting Our Egos Out of the Hierarchy!

    I have also had patients/family members who got their "medical degrees" from WebMD or the like, and those are who I believe the sign was aimed at. I believe it was an attempt at humor. I have no problem with patients/family discussing what they have read (in fact I encourage it) and educate about web sites (I tell them "Joe Blow on the corner can start a web site and say anything they like, so be sure it is a web site from a knowledgeable person or organization.") I can then (hopefully) refute wrong information and reinforce correct information. Just don't attack me with your WebMD degree please. If it was that easy we would not have to be licensed.
  22. I think that often administration treats nurses like they have no clue. We DO realize that facilities need to make a profit (if they are for profit) or at least come close to breaking even (if they are a non-profit) and are okay with that. We only object to the methods used if it negatively impacts patient/resident care. Administration COULD ask our opinions on occasion, or at least act like we have a brain......
  23. There are more: R46.0 very low level of personal hygiene (take a shower) Z59.2 Discord with neighbors, lodgers, and landlord (play nicely people) Y92.72 Chicken coop as place of occurrence of external cause (of what, chicken peck injury?) Z56.4 Discord with boss and workmates W21.12X Struck by tennis racket (?) F40.233 Fear of injury (can we say "normal"?) Too funny!
  24. I did the hanging the wrong patient's antibiotic thing. I had two patients in the same room, both to receive Ancef 1 gm at midnight, I carried them both into the room, and hung them on the wrong patient. I found it at 6AM when I went to hang the next dose. I didn't report it as an error because both meds were the same, just a different person's name on the bag. That's the only med error I remember making, but it was still scary because I am so careful - it CAN happen to anyone.
  25. LadysSolo

    Why I cannot hate the Affordable Care Act (ACA)

    The only reason my great-niece and nephew are alive today is the affordable care act. They were born prematurely (twins,) parents both working but not enough to get insurance before Obamacare. They are alive and well today. And contrary to what people are trying to make you believe, I have been covered by my employer's plans for over 30 years, and I NEVER had a year pass without the costs and deductibles going up.
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