postmortem_cowboy

well, in all actuality, that was the second patient of 2 that had surgery in a 24 hour period from a single surgeon that boffed both. The other, was a patient that was under anesthesia for over 10 hours in a hip replacement that got botched, the doc, broke the head of the femur off during the course of the surgical proceedure, and didn't have the necessary screws and all to fix the head of the femur, so he decided to close her up, and do the fix and the hip all at the same time once the right materials came in. Upon final count out in OR they came up a sponge short..... so.... they had to reopen her, get out the sponge and close her up a second time. When I came on shift for my night M/S shift, this was the first patient that I had to deal with, patient was 10 hours + under ansesthesia, markedly non-responsive and back on the floor X's 2 hours when I got her. One blown and one pinpoint pupil later and she was down getting a CT and being rolled into ICU. This gentleman was the second mishap from the same damn surgeon, and same day surgical proceedure that I had to deal with... sort of makes you stay on your toes when a couple of surgeries go bad all in one shift. Like I said, alot of things should have happend, and didn't but the patient didn't feel comfortable with speaking to the female nurse about a problem that had arisen since his surgical proceedure. Now it's all too possible that the bleed into the testes happend hours after he'd gotten back and the signs weren't apparent until I came on shift.... he woke up noticed what was happening, and saw a male nurse and brought it to my attention. Very possible that he came back from recovery with little-no visible signs of this at that point and she hadn't missed anything. Wayne.

A few things... #1, why stop at your LVN unless that's what you want to stay forever. At the mid point of the RN program you can always go and take your boards for your LVN, so that when your done with your RN and waiting to take your boards for RN, your already a licensed LVN and can work. #2 there will always be more LVN's out there than RN's, there's fewer RN schools cranking out ADN's than LVN schools. I chose this route in a number of ways. I got out of the service in 96 wanting to be a police officer, went to school and graduated with my AS degree in criminal justice in 2000, over the summer I'd decided to take the EMT course, and got working with an ambulance company and fell in love with the work. After being an EMT for a while, I decided I couldn't do enough in my opinion for the patients that I transported, either by schooling or just licensing, which prompted me to look at being a nurse. I went the vocational route due to the AS degree I already had, and was going to keep going and get my RN done right afterwards, it took me 2 1/2 years to get started on my pre-requisites, the same reason though, although I can do alot for a patient, I want to do more, the more I can do, maybe I can be a great effect on anothers life. Most of us will probably say in one form fashion or another that this is why we became nurses, or the blunt "I like helping people" but most people really can't put into words other than that how they feel or how what this type of a profession makes them feel about the work they do. Wayne.

At least someone understood where I was going with that posting... lol... Wayne.

Tee-Hee! Wayne.

Should have told him to get his testicles out of the boiling pot of water and that might help. Wayne.

Thanks commuter!! Wayne.

..... or smack someone upside the head with yer steth.. lol... ((bonk!)) Ok, so maybe the prayer should have been like this. God, give me the strength and wisdom to help others, heal wounds and show compassion. Also too, please give me the courage not to choke the living **** out of the poor dumb bastards that come into my workplace and open their mouths and say stupid stuff. Wayne.

No, but it's a job, and it's a paycheck, and it's also nursing experience... may not be a glorious job, and by all means I wouldn't want to do it either, but if it's a job that's willing to hire her, should she turn it down or not go and see if they're even hiring? It's not like she's going to be having sex with any of the people going in there... i'm pretty positive of that... and working in that type of setting, you can just about count on every person coming through the door has something that you need to double glove for and at least have the pretense that everyone is potentially a carrier of nastiness, and in other arenas, you don't get that, and find out after the fact that you touched a patient with HIV, or gave a shot to a patient and stuck yourself that had gonorrhea... at least this way, it keeps you on your toes everyday. Wayne.

Not a problem... I think at one point all of us do or will feel the effects of burn out... it's just natural to our profession... Wayne.

Alot of things "should have" happend, but didn't, the story I told was to illustrate that male patients don't necessarily speak to female nurses in regards to these types of things. Wayne.

One night working a M/S unit, I had a CNA come to me and tell me one of my patients had gotten up with her assistance and the foley "dropped" out of her, to my dismay and utter disbelief, it sure had, how I don't know but nonetheless there it was balloon still inflated on the floor. This happend around 2 am. I scoured the chart for a foley order, pre-op, post-op nothing. The charge nurse scoured the whole chart looking for anything resembling an order for an indwelling, nothing. I had to call him, but I figured I'd wait until a more appropriate hour to call and get the verbal over the phone, at six fourty-five, he answers the phone with "what the f*** are you calling me for?" I simply explained the situation and stated I need a phone order to put it back in. He said he wouldn't give such an order and it was in before so I should put it back in and called me a name less than nice from a physician. Now... irregardless of whether he was willing to sign the phone order or not, I still wrote it in the chart. If he didn't want to sign it after telling me to put it back in (and quite frankly the patient was a few days post-op anyhow so he could have opted just to leave it out, which was why I called as well to see if he wanted it still in) If he decided not to sign it, he'd have lost his priveledges to the hospital, so doctors yelling at nurses, nah doesn't really bother me, I don't lower myself to their level if that's the way they are going to choose to be, I just get even, and they find out later that wasn't something they should have done/said. Another time I'd had an ER doc yell at me in front of patients, big no-no with me, if you want to yell at me fine, do it out of sight of others... he quickly found out that doing so got him no special treatment, i'd play dumb with him and make him go get his own stuff for sutures, or bring the wrong stuff when he didn't specify, etc etc... like size 6 sterile gloves for a man that wears an 8... I promptly got an apology from him, but alot of that came from we had to work together quite often. That and I learned that no matter what docs are under a lot of stress, take what they have to vent with a grain of salt, then later if you really want to see if they meant it, ask them an off the wall question, like did you see the game last night, if they just look at you dumbfounded, you know they meant it, if they chat you up, you know they didn't and were just having a bad day... understanding yer docs is a big thing every nurse should be aware of. Only thing is as a new nurse, you have to learn by trial and error. Wayne.

There's also a good thread on male patients that I'd just responded to here in the male forum, where male patients respond easier to male nurses and females with females as well... could do a paper on that, watch the thread and see if it goes anywhere... or how many instances that thread gets of people who have had this type of thing happen to them. Wayne.

Your welcome, anytime! Trust me, anything that will make you more "appropriate" for the floor your seeking to be a part of, do it. You won't regret it and the hospital will take that as a sign that you are serious about moving to ER. There was a time that I was the only ACLS nurse on the M/S floor, and that's including all the darn RN's on the floor as well, and none of them knew how to run a code successfully, and I did, how does that look... when an LVN that's ACLS certified can tell them, "push this med, push that med now"... and they don't know their butt from a hole in the ground. We had mock codes one night, and none of the RN's knew what med came when and how often do push them... I kept answering questions when none of them knew what to do... showing off? nah not really, but showing up the others that should know what do is what it was. Wayne.

Well my opinion is, it doesn't matter how old you are, can you do the job and be effective at it, some old nurses who've been doing it umpteen years can't, so who's to say that a young kid with everything going for them and the newest schooling can't? If it were that hard no one would be able to be a nurse. You guys will do great! Just keep at it, don't give up and never let anyone put you down just because you are young and know what it is that you want to do with your life. You have to grow a thick skin in this arena in the first place, don't let something petty like the number in the age box deter you from doing a wonderful job of caring for the sick/dying. Besides, if your a good nurse, it don't matter how old you are... it just matters that you can do the job and do it well. Wayne.

I wholeheartedly agree. I've had male patients that would totally open up about their concerns and also have had female patients that wouldn't. Case in point, one night I took a M/S shift, had a post op patient X24 hours for a hip. I'd gone in to do my H2T assessment when he pipes up "I need to tell you something that I didn't feel comfortable telling the female nurse from days." Well it ended up being he was bleeding away from the opsite and into his groinal area (I think I invented a new word there) and his testicles were really swollen and black from the seepage of blood into the area. Now, as a guy, yes it's much easier when it's something like that, but if it's having your tonsils out, nah, shouldn't make a difference. When I was an EMT I had a male patient uhm... how do I put this couthly "stroke his thing" in the back of the ambulance. Now i'd told him to stop on several occasions, but due to the fact that the guy was mentally not there, he just kept going, even my attempts (gloved at that point) to stop him went unnoticed and he disregarded it until he was satisfied with the job he'd done and the outcome (sorry punn wasn't intended) he'd wanted to achieve. It's human nature though to be more comfortable about things of a more personal nature with same sex. And yes i've gotten that look after being called "doctor" and corrected the patient/family that "i'm his/her/your nurse" of oh... he's gay... and just for the record, no i'm not. And that's another complaint of mine, what does being gay have to do with being a nurse anyhow? like that means something? Like gay people are only nurses, they can't be construction workers or drive dump trucks or something, but a guy is a nurse and the wheels churn... "he's gay"... preposterous!!!! People watch too much damn TV. I've also on the other side of the fence had female patients that requested me in particularly simply because I was a man. And even for catheterizations. I had a post op female one night that was in for hemorrhoid surgery, and she'd had a straight cath PRN, ended up cathing her like 5 times in one shift. The next night she was still there and not able to push on her own, and she'd asked the female nurse especially for me if I was on shift. So it goes both ways. (punn not intended) Wayne.

Oh yeah, and to answer the first statement... lol... yes there are cheaters in every class, but like you said, they are only cheating themselves, they are the ones who spent a year cheating off someone elses test/exam, homework etc etc etc, that get to boards and fail miserably. A "friend" i'd made in my class had told me "thanks for that" one afternoon after we'd just taken a test, as I wasn't aware of what he was talking about he'd told me he cheated off my test, I promptly had my seat moved and started watching my test more readily and the people surrounding me with lingering eyes. These were also the jerks that didn't get to take boards right away because they had "issues" with their child support and being behind on payments, which the board of nurses doesn't like either. And Gardena Memorial is the same way, 4 hallway chairs and 11 beds and they're going through 100+ patients a shift now... that's alot for a small ER such as Gardena, but there's almost always 2 docs on at all times. ER is a very different floor, your not calling doctors for orders, you have one right there, and if an admitting doc needs to be called, the ER doc does it for you usually. The waiting room is always full tilt and people complain about this or that taking too long, and someone's not being cared for, but with no new hospitals opening up (and this is another issue that ER's deal with) they get innundated with everyone's problems, and dummy me, ER's are for emergencies, not runny noses that can wait till the morning to see the pediatrician. Once you make it there you will see, trust me you will see. lol... Wayne.

Advice meaning? need to narrow it down just a wee bit... lol... And yes i've worked the ER at Garden Grove hospital, East Valley hospital in glendora, Chapman Medical Center and also Gardena memorial which is right next door to compton, so alot going on there. I'm actually going to go back to gardena here hopefully soon, and this time around not as a registry nurse, but as a staff nurse. If you want to be successful in ER. There are a few things you need under your belt. First and foremost, a little bit of experience, don't go to ER first thing, it's a battle ground, give yourself a few months of M/S (I know i know it's a boring ass floor but still) or DOU, or something other than ER first! Let you get yourself comfortable with having more time on your hands to prep things, so that when you make the move to ER, you know all the tasks you will have to accomplish like the back of your hand. Does no one any good to have a doc say this patient needs an IV, foley and IM demerol and you take 30 minutes prepping their foley just to not be successful. Get it? There will be some time you will need to get adjusted in the feel for the job, it's very different from nursing school when your on your own and out amongst other nurses. #2, get an IV and phlebotomy class, and start poking and never stop, you'll suck at it at first, we all did when we first learn it, but don't stop poking... keep starting them and staring them and drawing labs, that's the only way you'll ever get good at it. #3 Take ACLS, you have to know what's going on during a code, every ER has to be ready for a code to walk in the door, if your not ACLS certified, you won't be of much use other than a doorstop. #4 Take some telemetry classes, find yourself an EKG class and get that and possibly 12 leads under your belt, if you can see and understand what the EKG is telling everyone and not have to ask, ok so what's wrong with this patient you'll be much more worth while to an ER. Being able to run and spot problems such as MI's on 12 leads is important too, damn near everyone that's medical coming through the door of an ER is going to get one, and if that particular ER doesn't have an EKG tech, guess what, your low man on the totem pole and you'd better start learning how to run one, and show off a bit of your knowledge and be able to spot an MI in the mix. Combine all those things with your license, and you should have no problems with handling ER as an LVN, there are some things you'll have to learn, splinting, and particular meds to ED, but that comes with getting into the floor and doing them and seeing it all. The one biggest thing, throw in as many IV's as you can, that's the most difficult part of the whole thing. It's an art, and you'll do it over and over and it won't "click" and one day, all of a sudden it will and from that day forward you'll never have another problem. Case in point, I really sucked at putting in IV in old people, young people I could hit anything on, but the old one's nope. It wasn't till i'd taken registry at gardena and had to drop 30 or more lines in my own patients every single day and offered to other nurses to put in theirs (ie I took the initiative to make myself good at it) that I not only made alot of friends, but also got pretty damn good at finding veins and dropping 14's and 16's in arms. Take from my experience what it took me so long to learn, benefit from what I had to learn the hard way. My first LVN shift in ER was actually scheduled as a M/S shift, the supervisor came to me and said... "you have any experience in ER?", my answer was "well I was an EMT for 2 years and had been in and out of ER's but not as a nurse, no not any experience"... her response was "good you have more than anyone else in the hospital right now so you're being moved to ER for tonight"... so some of it is fate as well... and I'd only been a nurse for a couple of months when that happend, but I got a few strong months to get solid on my skills on my own as well to sink/swim in ER without making myself out to be too much of an ass. Wayne.

This is off a stand up glass thingy I bought a few years ago in nursing school, it made me think, this is the kind of nurse I really want to be... Nurse's prayer As I care for my patients today, Guide me Lord, each step of the way. Send me your wisdom from above, To perform each task with faith and love. Help me give comfort to all I ssee. Lord, I give my thanks to thee

May all the wishes of luck be with you!!! keep your nose to the grindstone and don't let up, it may seem like it's too tough sometimes through the year you'll be going to school, but it'll be like yesterday when you look back on the whole year and say "god that went so fast"... Wayne.

Not a problem Tina, always glad to help out a fellow nurse. There's just a fine line between rude and stern, watch that line and don't step over it. If you can look at the situation objectively from an outsiders perspective and see that the patient is attempting to drag you into silliness, then you'll see their actions in a whole different light, took me a while to be able to step back out of the situation and be able to look at it that way, but it really works if you use it. We aren't maids, however alot of patients will think of us in that light, they need to be corrected. We aren't babysitters... nor are we adult babysitters. None of us should be asked to do things outside of our scope of practice, however sometimes we are, and sometimes small gestures for a patient is an okay thing, but it's when the line gets crossed from a nice gesture to being owed that gesture and it goes outside the scope of what it is we do. There's alot of things we aren't, and a punching bag for any patient or relative is definately one of the things we aren't. Wayne.

Be thankful you found your calling early, it took me going into the service, finding one path that looked right and following it for a while to realize that it wasn't where I wanted to be in life. By choosing and sticking to your schooling, you will show a degree of maturity that far exceeds your peers from high school. Trust in the fact that you are entering a great field that helps others and you will have a lifetime of being able to enjoy your job, even if at times it aggravates you. Because the alternative is "do you want fries with that?" lol... Dude, just cause your 18 doesn't mean your not a grown up, it just means your young, but there were very few of the younger one's that were in my nursing class that made it out of the first quarter of school, simply because they were young, stupid, and didn't keep to their studies and didn't care, and obviously you guys aren't those types of students. Once your licensed, it won't matter how old you are, it'll matter what you have in your head and in your wallet (ie license) Any reference to your age is just either jealousy that you did it early, or jealousy that you were able to do it early and reap the rewards earlier on than the rest of us. I just wished I'd known at 18 that this is what I was meant to do, I'd be in a very different place if I had of. Good luck to you all, 18 or 50... Wayne.

Yeah but the only problem with that school of thought, is that you'd be memorizing answers, not being able to think on yer feet, and that's what nursing is, being presented a situation and being able to think your way logically through it. If all we did was memorize this answer for that particular question, it wouldn't do any of us any good and we'd all suck at our jobs. You must be able to be thrown any situation, and look at it objectively and say, ok, deal with this first that second, or this med is for ___ and you'd give this much, however many pills, this much of an injection etc etc... Being a nurse is very fluid... I say that because from moment to moment your priorities can change, what was important and needed to be taken care of two seconds ago may have changed and now your dealing with a totally different issue, and it's not because we knew this answer to that question... it's because we can think on our own and say we need to fix this and stabilize that first, then do such and such. Priorities priorities priorities, what will kill the patient always goes first... everything else goes next and from highest degree down... Wayne.

Touche` and duly noted and thank you for agreeing.. lol.. oh yeah and tag yer it pagan! Wayne.

I'm old and a nurse... does that count? Age does have alot to do with the maturity level of what we do, but frankly, out of the 30 students that were in my nursing class, over 3/4's of us were all over 25. Wayne.

One thing i'd suggest, the more questions you expose yourself to, the better off you'll be... think of it, they can only ask you so many questions, if you've seen or had contact with 90% of the questions in one format or another that they can/will ask, your ahead of the game. However like the other poster has pointed out, knowing your content and being a "prudent" nurse, and having some common sense truely helps out. My boards shut off at 80 something, can't remember exactly how many but I passed and I thought for sure i'd failed when I took it. Have confidence in the answers you choose, if you know your stuff and have common sense you can figure any question that the board can throw out at you. Wayne.