kanzi monkey

When you had the flu, how was it diagnosed? (Apologies if this has been asked before, long thread, don't want to get caught up in any ill-activities against an already-dead horse...)

"Shared" conversations are often not linear if you expect actual communication to happen. Of course patients need to be re-directed at times (we all do)-- but sometimes addressing simple interruptions in the moment can help everyone refocus. It depends on the situation, and of course if it's not a simple question both the doctor and the nurse can help to redirect. If the nurse also needs redirection, the doctor I'm sure can help to refocus the conversation. Basically--no reason for anyone to not be decent to each other. I don't know if you are addressing me with the "nurses not knowing what the whole discharge thing is about" but that is not what I said. I have known more than one nurse to not have a clue how a patient is getting from point A to point B (in one case letting a patient get wheeled down to the hospital lobby without knowing if someone was picking her up) just as I have seen doctors and residents failing to know how patients left, or even where they went. I don't see this often, but it does happen--so why not take an opportunity to answer a patient's question about it (if that can be done quickly), and then get back to whatever else was being discussed?

Hypertensive emergency suggests end organ damage with SBPs over 180 (ie, heart or kidney failure, focal neuro exam, etc) Your patient had post op pain which was likely contributing to the htn (though i wasnt there, so can't be certain, obviously). Managing with the patient's own home BP controlling meds and pain medication is completely appropriate as a second step (the first being quickly assessing your patient for other frank cause of acute distress, which you probably did) If your institution's policy is to page a provider with lower parameters, well, now you've learned them. ;-) No harm done.

It's great to know that you care how a patient is going to travel when they are discharged. That shouldn't ever be called "unimportant" by nurses OR doctors. Simple question, simple answer, that doc should just be even the *slightest* bit flexible when it comes to having the opportunity to participate in a SHARED conversation about discharging a patient from the hospital (which is an area that often times an awful lot goes wrong--its nice to know the patient, the nurse, and the provider are all on the same page about the transportation) Seriously. Doctors are not above knowing their patient feels secure with their discharge. A great number of my patients do not have the capacity to comprehend their plan and many of the nurses that I work with don't realize that it is all of our responsibilities to make sure our patients get out ok. I have followed more than one of my patients to the lobby or parking lot to help them trouble shoot a poorly conceived train wreck plan.

It's a good lesson because this kind of thing is going to happen ALL THE TIME. On every level. When you are a nurse, you will have similar interactions with providers, who may have similar interactions with their attendings, or with the PCP or specialist, etc, etc, etc. Communication is a constant flow. Some people are great at it, some people struggle, most of us are in between--and we all vary in our own abilities depending on the day. In the hospital, everything that happens to patients from admission to discharge (and beyond) depends on communication and collaboration. My approach is to try to start my day with the assumption that everyone I encounter has a predictable, if not similar, goal. Every time I interact with a patient or colleague, I try to make sure I am understanding where they are coming from (because I will act on those impressions, so I don't want to be wrong). Sometimes I might not get that clarity very easily--for example, in my role as hospitalist NP, I sometimes find myself between multiple consultants who aren't in agreement about something, and my job is to sort through that information and come up with a plan for a patient. When I am feeling challenged by this I need to take a step back and re-work the problem. (there are clues that I need to re-direct myself--if I find myself, for example, asking a question more than once or twice, I am "clued in" that I need to approach something differently) In your case, you absolutely have the ability to take ownership in your situation--when you are talking to the patient for the second time, for example, that is a clue that you are missing necessary data and you need to take a step back, look at the information that you have (a patient is asking for something, the nurse isn't providing it), and the information that you DON'T have (why isn't the nurse giving the patient what he is asking for). Then you have your question. You ask the nurse--if she doesn't think that you need to know, then you can tell her that she needs to speak with the patient. If she tells you and you feel comfortable relaying it to the patient, then you can solve it that way. If you don't feel comfortable telling the patient, you make a plan with the nurse so that you can tell the patient that his nurse will explain shortly. The most unpleasant experience is when you feel you are not on the same page as the team you are working with, and you are confronted with questions that you can't answer without making someone look bad. If you get to that point again (we all do even when we try to avoid it), apologize, sincerely, to the patient "I just don't know the answer right now, I think you need to speak with your nurse, I will go get her for you, please understand of it takes a few minutes". Or something. Then tell the nurse "please speak with Mr. Patient as soon as you can, as I can't help him with his current request" Or something. Keep the flow, ask questions, take control.

I do one week on, one week off. I'm on the east coast. I think there are a range of options out there, you just have to find them. Nothing is unheard of, really. Sorry your life decisions are being questioned by strangers in an online forum. Lol, only in nursing... *sigh*

Yes, but would you be willing to prescribe it? It does take a lot of effort and time to tease out the right treatment for patients with pain who are also opiate addicted (not just tolerant). I think it's irresponsible to say "pain is what the patient says it is" and just give the patient what they want. I do not prescribe that way and I become frustrated when a nurse who is caring for my patient tells me "8 out of ten says he needs more pain medication" without providing assessment details. Setting an alarm or writing down scheduled times meds are "due" are not good techniques in pain management. If a patient is controlling when the next dose is, they are perseverating on the drug, not on how they are feeling. This is an addictive behavior. This is not a judgment--helping people with substance abuse disorders who also have chronic pain is very tricky and requires commitment, time, some compromise, and compassion. And it is an ongoing process. Giving the drugs just because it is safe in that moment, and the mentality that "there's no way to know WHAT the patient is truly feeling" is not helping these patients.

Your facility policy is then mandating that its sick employees risk exposing others to their illness (ie, the flu in an outpatient clinic waiting room or ED or urgent care, etc). There is also the cost to healthcare in taking time and resources for evaluating people for things that can be treated symptomatically. There is literally no logic to this. It is 100% counterintuitive, and the people who enforce it should be ashamed of themselves. Or, if they are really that confused about why their system is foolish, they legitimately should go back to school and voluntarily relinquish any health care license or certification they hold until they are successfully re-educated.

But don't go see your doctor! Don't infect people in the waiting room or waste the office time for a note. You are sick. If your job requires a note, then management needs education about limiting sick exposures and appropriate use of healthcare dollars! Hydrate. Rest. Get better soon!!

A patient...a human being died. Ummm, congratulations that it turned out great for you? Maybe you should work on phrasing? God forbid you come off coorifice...

Some people are DNR but not DNI (thinking of chronic COPDers for example). Who comes to the RR? We have an ICU doc, pharmacy respiratory, and hospitalist. Everyone can look at the patient together and see if there is a non-CPR intervention that can help the pt through that particular issue.

If there is a case report I don't know about it. I won't look into it because this was my patient and this was a while ago. I think you understood my point, however. This thing, no matter how unpleasant, happened. However, to put all logic and reason to one singular incidental case is, well, illogical and unreasonable. Health care providers, in particular, should understand this; vaccines--both receiving them, and educating others about them--are fundamental to nursing. Fundamental. This is not a gray area.

How about this plan: 1. Volunteer to receive specialized training for instituting and following CDC implemented protocol for Ebola victim care. 2. Have necessary equipment and on hand CDC specialist available for any/all complications/questions/concern for breach. 3. Take care of an ebola patient, then institute 21 day voluntary quarantine from the moment you stop caring for this patient. And be paid full salary/wage during quarantine. Additionally, be paid a significant bonus for making this sacrifice/contribution. Yes, I believe this quarantine is necessary and I am appalled that it has not been implemented.

I do blame the second infected nurse for flying on a commercial airline 2 days after the ebola patient she cared for died. That makes no sense. I blame her and I blame the hospital. I blame the hospital for not recognizing the urgency, for not having protocol, and for having 76 health care personnel come in contact with the man who died. Seventy-six. And now they are getting on PLANES.

I don't. He was a few years into his diagnosis and I helped him through a complication. The history was documented in our EMR, however, and it was chilling. Understanding how histories are taken and diagnoses are made (especially of rare events) will always lead me to question a diagnosis when I am caring for a patient. However, when the documentation points to one thing, and you are treating something entirely different (wound/osteo), there is no point in challenging the clear disposition (paraplegia) regardless of the diagnostic cause. However, in retrospect, I do wish I had more info. Sort of. It was my patient, I am not a researcher, I don't have permission, s/he has privacy. Not my business. And also, I was busy (confess) Knowing that GBS has been linked to vaccine (though perhaps not meaningfully--I don't know, I'm not bringing data) allowed me to say "ok. This happened to this person. I know it is rare. Just because I am seeing it doesn't make it more common" (havent we all seen lots of one in a millions?) My point in sharing was to say--so what? Sometimes really bad things DO happen even when there is virtually no risk. There is still virtually no risk to having a flu shot. Virtually is not literally. And we don't have to be irrational when faced with uncomfortable truths. Science supports vaccination in every way. However, 100% of everything involving life has some variation. If we decline vaccination, we are way more likely to contribute to more death and more suffering than we are to have anything more than a sore arm if we get the shot .

True story: I once cared for a patient with transverse myelitis directly linked to a flu shot. It was horrible. These things happen to few. The flu kills many. I get my shot every year, including while I was taking care of that patient. Science lays the foundation of our trade. It is grossly irresponsible not to own this.

The urologist clearly behaved badly. Maybe it was stress, but she needs to figure out how to control her frustration. I think that, based on the scenario you described in the OP (and the fact that you prefaced it as a vent thread!) was enough information to put together your entire meaning: we work hard. We face challenges. We work as a team. Things often dont work the way they are supposed to. Most situations are only partially under our control. Therefore--we should always be decent to each other. Understood. I agree and sympathize. :) I'm also sorry that you had to go into so many details to defend your OP in what is such a frustrating and COMMON workplace scenario. Kan T

I shrieked when I read this and scared my cat

I threw away a pillow once. The universe was glad. Also, side note--one day as i was wandering the halls outside the burn unit I happened to cross a chair sitting ominously next to the wall. A sign was haphazardly thrown upon it. "DIRTY" There appeared to be not even a speck on the cool green vinyl upholstery. *shudder* Done gave me nightmares...

ID behind my ID (Infectious Diseases)

This was my experience at a large teaching hospital as well. At my current community hospital, RTs are everywhere. It's a totally new experience for me. I think it's great, for the most part, though there are a few times when I've questioned their assessments (these are for non-vented patients). I love the collaboration--particularly the instant ABGs. I don't love the "hands off" for nurses when it comes to less complicated respiratory stuff, like spirometry teaching/observation/reinforcement, applying CPAP or bipap at night (mostly because a lot of my patients refuse when initially asked to put it on, then the conversation ends with RRT documenting "pt refused"). I also think that chest PT is a basic intervention--at the large teaching hospital (the only place I'd ever worked before), we all participated in a little chest PT--including PCAs that felt comfortable with it and demonstrated good technique. I think there may be more specialized respiratory care at the community hospital, but I can't say that the care is "tighter" or more effective than the constant barrage of teaching, ambulating (which nursing can easily get rest and exercise sats), spirometry, and frequent poundings on the back that nursing (and some aides, and some providers) incorporate into their patient interactions. I would rather participate with general pulmonary hygiene (because this gives me a great pt exam) knowing that the skills of the RRT are being used to assist with the vents and get the ABGs. At my last job, all nebs/mdi's etc were given by nurses as well. I actually don't remember the names or faces of the RRT at my last job...

How in the world was that not gracious? I am above nobody. But I am very busy when I am at work and I must prioritize my responsibilities over those which can be taken on by someone else (ie, writing admission orders vs getting someone tucked in-which, by the way, you can delegate too, if you are too busy). And yes, I will do what I can to see that my patient is comfortable. Most people do this. It is absolutely inappropriate, however, for a nurse to suggest I do a task if I am telling her a patient needs something. If I am telling the nurse about it, that means I cannot do it myself. If you want to insult me for not being gracious, or think that I am not a team player, so be it. I'm at work to take care of patients.

This really doesn't make a whole lot of sense if you think for half a second about what THAT person may have on their own "to do" list (which you are not able to help with and they will not ask from you). We all have work to do and we all have to figure out how to manage our task flow. Every single person working in a hospital will be asked to do something that they aren't able to do right at that second. Write it down and get back to it, or delegate it to an appropriate person (or, if you are really in a pinch, ask someone who doesn't look busy if they can help you and be gracious about it).

Agree with everything here. Trust me--that doctor wants to know about this. Most likely she will never forget it and this will help to inform her practice and teach others. I'm sorry your daughter and family went through that experience.

The situation in West Africa is grim because of poverty. Additionally, there are very real cultural differences at play--people infected with the virus go into hiding and seek out traditional healers due to suspicion of Western medicine. I heard a report 2 days ago that the "quarantines" are not really effective (minimally guarded houses where infected people stay which are open to visitors not always wearing protective gear, etc). If people have different beliefs about what the virus is and how transmission works, you are going to have a problem with containment. If you have minimal resources to enact containment protocols that we all know to be justified,these measures won't be in place. Medical personnel are at a HUGE .risk over there--they can't enforce containment on their own, unfortunately they at some point will get exposed. It is really sad and I honor them for what they are doing. I dont believe we are "introducing" an apocalyptic bug by bringing infected people to American hospitals. I don't have any doubt that the virus will be contained in the very controlled environment. As far as how significantly the virus is spreading in West Africa, however, if it isnt contained, the globe is small, planes fly, yes it will spread. We need to be vigilant, especially on the frontlines, but even in primary care. Ebola on the radar. Not what you expect to walk in the door, but it's a zebra that can't be missed.