BrianRN-PsychSup

Hello all, I was hoping to tap into the vast experience and endless knowledge of the membership here to assist in settling a conundrum. The issue is the technique of aspiration of the syringe while administering depot injections. The concern is, is the risk of vascular instillation worth the removal of aspiration step in certain intramuscular sites. Versus the patient not receiving the medication due to the limited release of certain medications such as Risperadol Consta which is only released from the off site pharmacy bi-weekly. E.G. If a nurse initiates an injection into the deltoid muscle, and aspirates trace or more blood, thus rendering the injection unusable. Taking into consideration the very limited availability of the medication. Is it a prudent option to avoid using the aspiration step? Any input is greatly appreciated. Thank you, Brian

"Dude", if you were concerned enough about the propriety of the word for us to see, and had to replace it with x's. How in the world could you even dream of saying such a thing to a pt? We nurses surely have heard the word prick before. However I think that your choice to x it out speaks volumes for how you should carry yourself in your professional practice of nursing. This seems to me like a potential lawsuit type of statement. My extraordinary wife who is an outstanding RN gave me some advice when I was still in training. Imagine saying whatever it is that you are going to say, be it to pt. family or colleague to a group of 12 people sitting on a jury. Who know nothing of our profession. Good luck in your practice. I hope that you remain safe.

OK I assume Dr. .... Unfortunately you have missed what I believe is the entire point of this thread. This is a common occurrence with young, eager and very well or not so well prepared new Dr's. You are not "reading between the lines" for the true meaning of our information and assertions here. This thread and many others like it are meant for your edification. Not amusement. But it is clear from your responses that you refuse to take advise/information from those nurses who would endeavor to make your education more meaningful, less stressful and safer for your patients and your license and ours. Doctor, this thread is aimed directly at you. Please take off your brand new white lab coat and learn. It is not often you will find wisdom like that which is being offered here all in one place. That is all. *(stepping off my soapbox now) platon20 Registered User Age: 33 Received 38 Kudos from 23 posts Join Date: Apr 2006 Posts: 214 Mar 29, 2009, 01:40 AM Re: Tips for New Interns: How To Get Along With The Nurse Originally Posted by trebugRN I work in a teaching hospital, and I would LOVE to leave a list of tips for these wippersnappers! + I am with "your" patient 12hours a shift (often more than one shift in a row) and if I think it would be helpful for the patient to have an order for MiraLAX, simethicone, a suppository, etc., please consider it. I am not the doctor, but I do know my patients. There PD will not work if they aren't pooping....you will learn this too! I appreciate this sentiment, but it should be used sparingly during late night hours. This is an appropriate page at 5 PM, but inappropriate at 3 AM when the morning team will be there in a few hours. It is EXTREMELY rare that a pt needs a stat suppository. + If I call you because the kids BP is High or Low, don't ask if I am sure! Yes I am sure! And NO I don't need to change the cuff -- it's the same correct cuff I have been using all shift, and probably all week. I need you to get up and come see the pt like I asked you to. I cant just take your word for it without at least asking. I have no idea whether you've been doing this job for 30 years or 30 days. I've seen lots of nurses who are using the wrong sized cuff, especially in peds, so thats why I ask about it. Its a common occurrence to use a mismatched size cuff. Agreed about seeing kids that are going south. + If I need to call the Attending or Fellow, it's not a slap in your face - I need to do what's best for my patient. We're all here to learn and you need to leave your big ego at home. Thats fine, as long as you tell me first. Its unacceptable to just call them without keeping me in the loop. Explain why you want to call them and dont be overly rude about it. I understand that there are cases where you need to go above the intern's head. + No, I cannot take EVERY order as a verbal order - it is not safe. There is a Resident and a Senior for a reason. I dont understand what verbal orders have to do with upper level residents. If I write a written/electronic order instead of verbal, then it doesnt make any difference in terms of who is supervising me. The only way my upper level knows about it is if you or I page them. I agree that verbal orders should be used sparingly. + You cannot have the chart for 2 hours. Fair enough. Its ridiculous in this day and age to have written charts anyways.

Thanks for the quick response. It must be quite an accomplishment to go from such challenging living conditions with a tragic disease to the one caring for the I/M. (tongue firmly planted in cheek) However, I too will be at the only female institution in the state. The nurses each only wear a name tag that states [ First name, RN or LPN]. I saw no system ID. The health care is under contract to UMass Correctional Health. I don't know if that has something to do with it. I was very impressed with the DON and apparent caring of the staff in a challenging environment.

Hi all. I might be working in a state prison per diem in Massachusetts and was thinking about names. I have read other posts on this wonderful and helpful site about the proper way for a nurse in the correctional environment to be identified. e.g. Nurse Tom or Nurse Jones, Mary or Mrs. Smith etc. There is apparently a level of risk associated with the inmate population possessing personal info on staff. However, Massachusetts State Board of Nursing regulations require that a professional nurse be identified by a minimum of first name and level of credential on a legible name tag while engaged in the practice of nursing. Several posts suggest that you should use only your last name and someone even suggested just the title of nurse. Does anyone have any insight into this? The CO's are all called by only their last name. No first names. Thanks for your thoughts on this. Brian RN

I know that this thread is made tongue implanted firmly in cheek. However, A wrinkle free bed does lend itself to patient comfort and less skin issues. I have seen pt's with large red areas with a nice white crease in the center from creases. I am sure many others have as well. And don't forget the value of flipping that pillow whenever you can. The nice cool side of the pillowcase on the head seems to do wonders for patient comfort. Just my 2:twocents: Brian RN

Ask and I will reply the best I can. I am in this business to help. After all.

Glad I can offer some benefit of my experience. Before I even begin anything that might make the pt. uncomfortable, I have had time working with them doing other things. (if time permits). In emergent situations, all bets are off. But most of the time you can develop a sense for how the pt. is receiving your care. I usually start with any pt. procedure with a "this is what I need to do now and this is why" kind of thing. Then, as I said, continue competently and professionally. I have only had two pt. prefer a female nurse and they were both male. Why should I even bother spending the energy to care about that. There are way too many pt.s to care for. If there is a female pt. and she is particularly young or a rape case or some such thing, then I will endeavor to have a female nurse attend to the issue at hand. However, I have said it before. My license say "Registered Nurse" not "Male Nurse". I try to be sensitive at all times. But being a male, I tend to be more factually based and less into the abstract stuff. This can bite you though and I tread very carefully at times. Use your brain and don't allow yourself to do anything as a student or nurse that even hints of inappropriate. Or makes you think, Hmmm, how would this sound on the witness stand in front of a jury of women from the community. I have brought competent CNA's in the room with me to assist as a witness. Competent being the operative word. You may need to find them in three years. I realize that this is not fair. RN's who happen to be female don't have to do this. ( they should) but society has accepted them in this role. I always ask an RN who even begins to question the propriety of a male RN doing something, if this was reversed, would there be the same question? Now I have also run into the reverse. Men who do not wish to have female RNs caring for them . R/T intimacy issues or whatever. You should see their faces when this happens. I have also witnessed one pt. refuse to have a "fatty" care for him. He said, "how can she tell me how to be healthy". Sigh.... Pt's come in all varieties. You will see so much that will make you shake your head. Just hold in the laughter until appropriately out of hearing range. But when all is said and done. Nursing is a great profession. And one other thing. Male pt's with male RN's have been know to toughen up a bit. Under report pain. under report or minimize symptoms. Always ensure the male that you may be caring for that it is important for them to be honest with you about whatever they are experiencing. And ALWAYS believe pt's reports of pain. And in Pedi, ALWAYS pay attention to the parents comments and concerns. Even if the kid looks "fine to you"They know the kid, not you. Brian RN

Hi guys, I can only relate my experiences here. Hope it helps. Only two real glaring instances stand out of gender bias during my school career. One was described above. The second one was during my second clinical rotation. It was Med/Surg. I was assigned to a 34 year old female who was 1st day post op following a urethral sling procedure to address incontinence R/T her two live lady partsl births. I had performed all of the usual a.m. care and even assisted her with cleaning up the dried on blood on her thighs left over from the procedure. She was due to be D/C that afternoon. SHe was due to have lady partsl packing removed and I asked her if she felt comfortable with my observing. She said "of course, you are a wonderful nurse". Well I went out to the RN who was to do this procedure and informed her that I would like to observe and she immediately said "you have to ask the pt for her permission" I informed her that I had and of the positive response. I then went to update my instructor. Who had no problem at that point. Well then the staff RN comes to me and says "She doesn't wish to have you there for this procedure, sorry". I think that it was the RN who was uncomfortable. But don't say anything. After the Pt. is safely D/C home the room mate says to me, you know when the nurse came in here and asked her "you really don't want a MAN to see this, do you?. She then said the pt. said "I guess not". I approached my nursing instructor with this. She asked the staff RN about it. She then returned to me and supported the staff RN stating that she didn't think that the pt. REALLY understood what you would be seeing. I said well, I have already seen "IT". I helped her to wash up. What a B***h. She just said that I needed to be less sensitive. I did my clinical paper for that rotation and peer presentation on "Gender Bias in Nursing". It was 48 pages and included research from 11 sources. And the instructor had to read and write a comment on each section. (hehehe) I sure learned from her that day. You will be asked and expected to perform intimate procedures on pt's of either gender. I always approached each situation with the pt's comfort and safety as my top priority. I always approach the procedure matter of fact-ly. I just say something along the lines of " I need to ________, oK? Then just go about my business, confidently, assured and only exposing what needs to be at the time for as short a length of time as is required for the procedure. If doing something very intimate now and the pt expresses discomfort, I ask a female colleague to trade off with me for whatever it is. I do her some favor or just throw it into the "bank" There will always be something on a male that my female counterparts do not wish to deal with. However this is a very rare occasion indeed. Usually a cath on an under 40 -something. Or some such thing. I am really usually too busy to take such things personally. I guess what I mean to say here is, you will be faced with the gender thing more often than you wish. If you approach the pt. as a genderless, non-sexualized person thing. (If you know what I mean) You should be fine. Just be professional and appropriate in your approach. Your biggest issues will be raised by your peers. Just remember that men were nurses long before women. If you keep it in perspective you should be fine. Oh and DOCUMENT EVERYTHING as soon as you can. Do not wait for a "free minute later" that will never come along. Good luck in your nursing career. Brian RN

I had an excellent OB instructor. Consequently, I had a very educational experience. Although there were a few instances of duality amongst the staff RN's. I enjoyed working with new moms and the babies. I had the best time in the nursery. Gave some first baths and the like. Rocked quite a few to sleep and participated in newborn assessments. My children are all older teenagers now and that was a real treat. The duality smacked me in the face the one time that we had a floppy newborn brought running down the hall with new peds resident and RN in escort. This was a non special care nursery. Well, everyone tried to get this kid going. They were setting up to place an umbilical line and the new resident was fumbling with the kit. Two nurses had no luck inserting peripheral IV's. Well, I asked if I could try as I had been a paramedic for 22 years and thought I could try. My instructor just gave me the go ahead nod. I was able to place two ante-cubital IV's first shot each and was able to suction out the mucous plug as well. The O2 sats rose right up to 99% and the kid pinked up beautifully. The nurse manager of the unit was in attendance and asked me to apply for an open slot there. The other nurses gave me the verbal pats on the back, etc. it was kind of cool. Then, as the shift progressed I was able to take care of the first bath and assist with initial assessment and vaccinations and the like. Then, just after I returned from the mothers room where i brought this now stable baby to feed, I related to the nurse manager who was almost throwing a job at me, how I gave some initial instruction on breastfeeding and assisted in placing the infant for her first feeding. The mother asked me to help her with this and the grandmother and child's father were in the room as well. All listening intently. They thanked me profusely as well. The nurse manager looks at me and says, you should not be doing that. A female nurse should have done that sort of teaching. :trout: You could have knocked me over with a feather. Well, I came in the next week and there was a lovely card for me and ( I understand) a note to the nurse manager extolling my competence and how they appreciated my teaching them and the assistance I gave their baby. I learned that another nurse told them of how I had assisted with the resuscitation. You will see some very cool things. I performed assessments and only was questioned once if I was going to leave the room by a father. To which I said no, I am here to care for your wife and child. Nothing else was said. My instructor was very cool though. When she asked a mom if she minded a student working with her, she never once asked if the mom would mind a male nursing student. Just a nursing student. I have experienced the other as well. So this was refreshing to say the least. Just relax. Be very understanding that this is a "womans" experience and don't be insulted if someone does not wish to have you care for them. You don't know the patients history related to abuse, etc. There are too many patients to get hung up on just one or two. Sorry this was so long. I hope it helps. Brian

Hello, I find this post disconcerting at best. I am interested in a position at MCI Framingham. I have a friend who works in the HR dept. at UMass correctional. She is telling me how great the people are there and the benefits and all that. I have no prejudices about working with incarcerated people. In the ER where I worked many of the Fram. IM's were brought in for Tx. The CO's kept telling me how I should apply there. That they needed the help. So I am of two minds here. 1) Run away, they are trying to sell it too hard. 2) Could the negatives I hear be just "sour grapes". I have been in a private psych hospital as a nsg. sup. for about 8 months. It got VERY BAD. Dangerous and scary. We were forced to admit pt's that were way too violent and (dare I say) crazy. Long Hx of assaultive Bx towards staff etc. Are way understaffed. e.g. 1 RN and three MHW's on the acute unit and 1/1 in the "non acute" units. No security staff at all. I was on Nights covering a staff RN shift and was kicked in the chest by a female when we attempted to move her to the acute unit. The MHW's and RN Supv. just stood there and stared in amazement. Then, not one would stand up when I reported it to mgmnt. The Supv. said that she didn't notice me getting kicked, flying back 6 feet, landing in a chair and sliding in the chair another two feet. ( I am kind of a big guy and kinetic energy is amazing) Run away, quickly. I do not want to jump out of the frying pan into the fire. I would appreciate any more incite onto UMass before I delve in. You can PM me if you like. Thanks, Brian RN.

I am sorry that you had this experience. I can only advise you to communicate with your manager about this and your concerns. It is sure to get back to him/her. They should be able to work with you. The ADA requires "reasonable accommodations" be made where possible. A reasonable accommodation here could be not having you do these kind of trips. Good luck, Brian

Hi Karen, While I do not have MS. It plays a major role in my life. My wife was diagnosed at 19 years old. At the time she asked the doctor to not tell her what it was, if it was bad. So for 5 years she went along not knowing. Until she was in the ED for a migraine and the resident blurted out, so how has the MS been affecting you? What a jerk. So fast forward through two college degrees, one in fine arts and the other a BSN. She is now 44 and continues to work in nursing. Her disability was kept in check with early use of ACTH and methyprednisolone. Then came the ABC drugs. Then Cytoxan to knock immune system down. Now she just takes once a month gram of IV methylpred at home. She did not tell anyone she worked with about her Dx until about 7 years ago when she really had an appreciable ataxia. She has worked in psych the whole time. She works for the State and they have been fantastic to her. She did not have any "really visible" body disturbances until after we had our daughter almost 6 years ago. She subsequently developed gait issues and has been using a scooter to get around most of the time for about 3 years. Before that she was using a "walking stick" (never, ever call it a cane:) ). Then to one Canadian crutches. All of the time she just keeps on smiling and doing her job. When her position changed and she began running her own clinic, the higher ups ensured that it was built around her abilities and needs. It does not even click to many that she is in a scooter to get around. As soon as she speaks, her expertise supersedes any apparent shortcoming. Someone put a name sign on her door that reads "Karen RN, Just ask me" She is the go to person for many people. Sorry if this is too long. But, I guess my points are: a) If she had told people about her Dx early on, I know they would have treated her differently. Her manager was the only one who knew. I don't know if she would be where she is now if she had. b) Don't let a DX get in your way of continuing your dream career. Nursing is amazing. Don't slam the door on yourself. c) Examine opportunities in areas of Nursing that don't require whatever physical deficit you might be experiencing. d) Never let the Dx "win". My Karen doesn't ever do this. e) Again, be very careful who knows about this. Asking for help is always an option. Remember, we all need help with patients now and then. Good Luck, Email me if I can help more. See my profile. Brian RN