edc1951

I do little thqt this govt. wants me to do and would not do anything they ordered but I would surely help in a privae capacity. The govt. can kiss my butt.

since i am sure there are nurses who do not believe the stats here is an excerpt from the national academy of science's institute of medicine's report of july 2006: [color=#231f20] an ade (adverse drug event)arising from an error is considered preventable. it is difficult to get accurate measurements of how often preventable ades occur. one study estimated 380,000 preventable ades in hospitals each year, another estimated 450,000, and the committee believes that both are likely to be underestimates. the numbers are equally disturbing in other settings. one study calculates, for example, that 800,000 preventable ades occur each year in long-term care facilities. another finds that among outpatient medicare patients there occur 530,000 preventable ades each year. and the evidence suggests that both of these numbers are likely to be underestimates as well. furthermore, none of these studies includes errors of omission—failures to prescribe medication in cases where it should be. taking all of these numbers into account, the committee concludes that there are at least 1.5 million preventable ades that occur in the united states each year. the true number may be much higher. the full text of the report (a 4 pg. pdf file) can be found at http://www.iom.edu/object.file/master/35/943/medication%20errors%20new.pdf

graysonret , you seem to be mixing two things. The 100,000 who die from medical error have nothing to do with antibiotics which are related to MRSA. The 100,000 are preventable medication errors that lead to deaths. The 19,000 in 2005 who died from MRSA are yes, related to antibiotics. The fact that antibx have been overprescribed (I have heard a pediatrician say, "I can't keep the ***** off my back if I don't give her the antibx"-even though we all knew that the kid had a virus.) I sympathise with the docs though too. The number of mothers who I know who really think their child was not given sufficient attenton if they don't walk out with an antibx after a sick child visit is absurd. OTOH, when I was in nsg. school they had the strict 48 hour rule. You had a culture done, you waited, you got a Rx depending on the results. But, things have changed because there are conditions that progress rapidly and/or the doc thinks it will help protect the others in the house, etc. This seems to have gone full circle in 30 years as I hear more and more docs saying hold the antibx until you're sure. Not only that but MRSA has now moved into the general population so some of those deaths are people who did not get infected in a hospital. That does not however excuse the fact that nosocomial infections are by far the most common of all infections, UTI's being the most common of them -because sterile technique is not observed during catheter insertions as the most common cause. ALL of this is known. It is known by hospital administrators and everyone else who is involved. But, what happened about 25 years ago? Hospitals went from being largely non-profit enterprises to for profit. Suddenly the "bottom line" is what counts. sent. Administrators are preoccupied with how they will make a profit. They are more concerned with the fancy stuff-the advertising and if the big names come to them, etc. (Like the TV stations that advertise that they "have the news first"-who cares if it's right-it's first!) How do they handle it? They get new drugs to help combat the "problem" because the bottom line is the supervisors really don't want to do spot checks, they don't want to ask the patients on a random basis if their nurse washed her/his hands when they entered the room, they get just as ****** off as the floor nurses when/if a patient demands that their medications be given to them with an explanation. Med nurses sigh and stand impatiently by while the pt. asks the name of each medication that they are putting into THEIR body not the nurse's. No, the supervisor "needs" to be at yet another meetinabout yet another issue or form or whatever, and the med nurse is justifiably nervous that s/he will not finish this pass before the next is due.

And although I am an RN offended by your seming insinuation that it's med techs and LVN's who might be responsible for these errors. The nurse who not once but TWICE gave the twins the massive overdose could have been a RN just as easily as an LVN. As far as I am aware med techs don't give meds and these errors are med errors for which doctors and nurses are responsible. When I was in nursing school we were taught that even if a doctor write the wrong order the final responsiblity rests with the nurse administering the drug.

Actually graysonret it is a true statistic and it has come to light after the incident with the Quaid twins. If you do a little research you will find the reasons that it is not as well known-they are much along the lines of what you suggest might be the reasons for the stats-it is money based but the truth is influenced by how much power those who would be hurt by them have. Having in one 2-week period conclusively documented 17 medication and treatment "errors" on the floor of one unit in a LTC, I have no problem believing them. When you see nurses who record VS they have not taken, have A&O pts. tell you they have not received medications that are charted as given, when you can look at a blister pack that is missing 3 pills when 7 are charted as having been given, chart that O2 filters have been cleaned within the last 8 hours when they have not even been removed from their slots, find orders written to cover known medication errors, it is not exceedingly difficult to conclude that there is a large problem. Remember,the very same congresspeople who might get some support from the constituents would lose much of the support (which ncidentally has more money backing it) from the big execs who run the hospital and for credit compnaies that own them. It's a crying shame but it's true. Sadly, the same attitude that affects the low voter turn out in elections (What difference does one person make?)coupled with the absurd idea that it is more important to "support" fellow co-workers simply because they are "nurses" than to report them is what keeps this from being more well known and proliferating. As I said in an earlier post with the same statistic. In 1981 we had 2 cases of MRSA in the hospital where I worked. MRSA is now in the geeral public and is almost epidemic. The reason is simple: infection control rules, like handwashing have not and are not observed as if each person's life depends on it. Now we lose 50 lives a day (19,000 in 2005) to this largely preventable condition. WE need to wake up. If we are going to allow our fellow "professionals" to cntinue endangering lives out of some misplaced sense of allegiance to them over the patient we are going to continue to have these problems and one day it will smack us in the face when we lose a family member or loved one.

I have just returned to this thread after rereading some of the posts in a thread about a new nurse who was yelled at by the mother who was also a nurse, of a retarded pt. I have to say I am disgusted by some of the comments about this mother and hope I never have to be cared for by any of these nurses but right here I am able to find people I hope would be the ones, since you all know that being the mother or wife of a patient, with all the information we have, is still the scariest and gut wrenching experience. Thanks to all of you for sharing, it always helps to have anecdotes on which to draw when faced with a distraught mother who is also saying I'm a nurse.

NewJA, I thanked you for your honesty and willingness to reconsider your career in nursing because you are questioning whether you can fulfill your first desire. I too have become very upset by the changes (mostly negative) I have seen in the past 30 years but will tell you about my career because it is really a question of finding your niche and always doing what you know is right. It is about asking when you are unsure, reading and discussing and ignoring those nurses who may feel that you are trying to be "better than" them because you seek to gain knowledge. Believe me, they exist and will try to wear you down. Remember, you may be perceived as a threat to them but you will be legitimately liked and trusted by the patients to whom your allegiance and high standards are owed. I started at age 26 in nursing school and did a Associate degree. At that time ('76) there were still quite a few non-diploma programs which had already started to be phased out I chose not to do a BSN, thinking I'd work on it later. 30 years later and that later has never come. Just before I graduated I was offered a job as a school nurse at a boarding school. I took it. I was the only nurse for 130 students at a school in the mountains of NH. My first 3 months were trial by fire. Not only did I resolve after the first week to take only rectal temps leading to some humorous situations with teenage boys dropping their pants to try to embarrass me. I grew up with 3 brothers. It didn't. (To get out of class, students would drink hot coffee and then come upstrairs complaining of feeling sick:-)) In that time though, I was also faced with several students who came to express problems with drinking, questions about their own sexuality, parents who had waitied until they were away at school to announce their impending divorce, allergies, broken bones... I spent A LOT of time reading. I didn't have the 'net or co-workers but I had a wonderful doctor in town and, on several occasions, I called school nurses of other boarding schools to ask their advice. The next year I went to another school that needed a school nurse who could also teach a health course. There was another nurse there and we took turns in the infirmary and I designed and taught the health course. I did not think the old How to Brush you Teeth and Wash your Hands was what these kids needed and covered subjects like sex, suicide and drugs in addition to healthy eating and living. It was a success and made a requirement for graduation. But, enough of my research into my future made me realize that getting at least 2 years of hospital experience under my belt was necessary and I moved once again to a city to pursue that goal. 2 years on a med/surg floor and I had tons of experience. I worked in a teaching hospital with a group of interns who were the best! We had the only isolation rooms, a city with a very diverse population so lots of experience learning cultural attitudes, codes, nursing home patients and family members of the city officials, etc. The hospital was a Harvard teaching hospital and many of the attendings were also great. Another nurse and I instituted a program where the docs had to endure ALL of the tests they would do to a pt. This included the ol' gyny exam, even for the men. We just left them in the stirrups, pants off, draped with a paper drape and temp cranked down, for 1/2 hour. They got the idea. After those 2 years I was offered a job in home health and eagerly took it as one of the biggest frsutrations I had was seeing pts. given information that was intended to empower them to keep themselves healthy and being too stressed and tired to learn it. They would get home and forget it. As a visiting nurse I got to go in and work with them on it. I did a lot of on call work and changed dressings and foley caths and did manual disimpactions so often I would dream about them! I also got to work with one of the first Hospice organizations as our agency's laison. I also got to work on a committee that redesigned our paperwork to make it more "user friendly." Then, 2 years later, I went to the Middle East to work as a volunteer in Lebanon when that country was invaded by Israel. It was a war, we had no water at times, we had no medications, we were under bombs and I saw people of all ages and stations in life dying. I continued after the war ended working for a relief organization supervising programs in health clinics and hospitals that were being started or restarted. I learned how to sterilize instruments by covering them with alcohol, lighting them to burn for 3 minutes and then cooling with sterile water so the surgeon could perform the 20th operation of the day. This surgeon is now rewriting the entire war surgery manual for the International Committee of the Red Cross. After a year, I moved to Cairo to teach at a nursing school and work as assistant matron of nurses in a new hospital. Once again, in addition to becoming proficient in Arabic which I'd started to learn in Lebanon, I learned how to teach nurses to maintain infection control techniques even in the absence of what we take for granted over here, how to teach doctors who were used to treating nurses as servants to work with them (BTW, about 60% of my students were men so this was not a sexist thing). I got to see a hospital which had been one floor of an apartment building grow to a three floor free standing institution with a kidney dialysis unit, cardiac care and a staff of nurses and doctors who took pride in their work. 3 years later I returned to the US. I had worked as a volunteer for the past 4 years and though I was richer for the experience than I could ever have imagined my pocketbook was bone dry and I had just turned 35. It was quite a culture shock when I got back to the US I was faced with the waste and disregard for health that seems to pervade our society on all levels. I stayed with my mom in FL for a few months and then returned to my first hospital in MA for the first year. For personal reasons I then chose to move to NC and change to pediatric nursing. However, 6 months of working with school age peds pts. mostly with cancer and I realized that was not for me. The kids were amazing and I learned so much during that time especially chemotherapy and working with CF, liver transplants and HIV pts. but I when I was offered a job again by a home health agency I knew it was where I belonged and accepted the job. For the next 3 years I went from visiting pts. and supervising home health aides to home health aide supervisor. It was during these years that aides needed to become certified (previously there was just training) so I got to teach the certification classes. I had found my niche. I LOVE home health aides. They have one of the hardest jobs of anyone and they get paid ridiculously low wages. They often face the same things as LTC nurses but are all alone. I found that teaching and working with these (mostly women) was what I was good at. However, I then had to move back to my hometown (in the USVI) for 3 years and ended up working as an office nurse for an allergist. Once again I learned a lot and 3 years later I moved back up to the states to marry my first love (23 years after we broke up.) I went back to work as a home health side supervisor but a year later, at the "old" age of 44 I was pregnant with my first child and because I was working in NYC, I chose to take a position with our company doing discharge planning at a hospital where I would not have to spend all day riding buses and the subway with my ever growing belly. When my son was born I took some time off and then returned to work for 2 years, as a visiting nurse/aide sup, before the family moved again. This time we were in a rural area where childcare was non-existent and I took some time off. However, because my father in law also lived in the area and was a retired surgeon I continues doing some nursing usually helping out with family friends who needed care. Then we moved again 4 years ago and after choosing to wait until my son started middle school I returned to work in a LTC. The worst! The pt. population was wonderful but I have never heard such complaining as I did from the nurses. My floor was a short term stay and rehab floor so the patients were largely A&O but the heavens forfend if one of them dared to ask for something that a particular nurse found inconvenient. Were there good and caring nurses? Yes, but even they seemed to have adopted the idea that it is not OK to report when a co-worker has not done what is right. In my time there I saw a nurse record vital signs when she had not taken them (unless he was really able to remember 12 TPR and B/P after doing a med pass at the same time as she was supposedly taking them, documentation that tasks had been performed when a quick investigation would show they hadn't. Meds recorded when not given and when the A&O pt. reported it being told by the nurse that "she's full of s***", the list is sickenly long but when I realized that administration was more interested in passing the yearly inspection and would go as far as altering records and hiding the truth I left. Now I am back where I love my work-I teach, I get to write pt. and HHA edication manuals and I am working per diem so I have time for my family and can do a lot of work at home. In 30 years I have seen some of the best of human nature, the best of doctors and nurses and I have seen stuff that makes me wonder what kind of nursing instructor would have allowed some nurses to go beyond the first semester. (Sadly, I know...when I was in nursing school one of the top students cheated on almost every exam.) I know that many of my co-workers, especially at the LTC, had lousy home lives and were sometimes the only wage earner bt too often they were more interested in their time off and pay than the work that pay was for. Through the years what has gotten me through is the realization that there are many places and areas of nursing. Had I to do it all over again I am not sure I would have gone on for my BSN but in this day and age, I would. My best friend from the first hospital is today a Psych NP and does fantastic work. She loves her job and it is what kept her sane as she went through a divorce from her husband of 24 years. (It is also repsonsible for her finding her new love and her self worth, due to the work she does, led to a relationship that is based on love and respect. She and I share that since we both know that we have always tried our best to learn and to grow while staying true to our first goal-caring for the patient-whoever, wherever, whatever s/he may be. Good luck. There really are many roads to follow and don't be afraid to leave one if it isn't going where you need to go.

It can and the reaosns are psychological because you are being subjective as well as objective. Consider if you saw a woman beaten and then administered care to her. Would you not react differently than if she was brought into the ER with the same wounds. In these situations it is best to BREATHE take a moment, remind yourself not to panic and the proceed with the wound. It is hard though because that kid is also wanting Mommy.

Thank you cyndiangel13. As I just said on another thread we "older" nurses ARE always willing to learn new information. This suggestion is excellent for me, as one of my jobs is teaching home health aides. They work all alone with pts. who often were too stressed to learn what they bwere told in the hospital and will take some time to learn all the new stuff. This is something the aides can not only do but work with them to master. As for Mschrisco. YES! How true. I also suggest if you have computerized orders that when you check them you put a big cross in the blank area. I worked in an LTC and had a very bad experience-not with a doctor but the head nurse. I had done the 2nd check of a heparin order which was then ignored by the med nurses. The order was for 10 days and the med was given for 28. I found the error when I was doing the monthly update and wrote an incident report. Luckily the pt. had, during the 10 days, been ordered on strict bed rest so the heparin was OK from a safety perspective. But, to cover their butts the incident report was destroyed and the head nurse wrote an order on a page dated three days after the original order saying to continue it. I quit after that as there were just too many things wrong with that. But, for the 2 weeks I was had left, after I had double checked all orders and signed, I put a big X in the rest of the space so no "orders" could be written. BTW, this nurse did not even sign the "order."

While everyone has room for new knowledge, new nurses have room for a lot more than those with experience. That's what experience means. If what you say about the mom is how you truly feel I say have at it. Please don't ask advice from or listen to the nurses with more experience that just MIGHT be more concerned with their pts. safety than your ego. Please don't because your concern about YOUR feelings and YOUR importance will block out understanding that the more experienced nurse has seen too many patinets and nurses suffer because the person charged with repsonsibility for the pat.s care and well-being just didn't ask...for advice, for help, for anything. A new nurse who thinks she has more to teach than to learn is just as obnoxious as a new doctor who thinks his degree makes him/her better able to deal with a question than an nurse with years of experience. YES, we all can learn and frankly we "older" nurses welcome and want to learn what the new ideas and approaches are. We have full time jobs, families and years of CEU's behind us but that does not mean we know it all. But, when we know it and we tell you because we have just seen you demonstrate your ignorance of the fact or approach, we are doing so for one reason-to protect the patient. The fact that it can help you become a netter nurse is what's in it for you. And once again, read the stats-when we kill 100,000 people every year just in the US alone because we have made a preventable error then she and every other pt. who enters our facility has every right to be scared and protective.

There is no excuse for rudeness? That was not rudeness on the part of the mother that was pure fear. She heard a nurse who would be responsible for her son's life and care while she was gone tell him something that indicated that he might have to suffer unduly because of her inexperience. She had every right to come to that hospital and expect that she could leave him in good hands. I am not saying that this nurse or any other was bad because she phrased something wrong or could have shown a little more undertanding of the pt.'s limitations. I am saying that instead of taking exception and being hurt by the mother's reaction that she can learn from the incident. And just in case there is any question about whether I am in management-no way. I can't stand working around alphabet soup. Yes, I was an inexperienced nurse 30 years ago-I started as a school nurse, on my own with 150 kids in a boarding school for 2 years. When I went to the hospital it was the nurses who were experienced and who were trusted by the patients to whom I turned with questions and for advice. You'd be surprised how helpful someone can be when they are recognized for their experience rather than looked down upon because the new nurses think they are old fashioned. What pts. complain about these days is not that their nurse isn't current on the latest trends but that they are ignored or treated as if they are a bother. They have to worry about whether they are going to be the victim of a medical error and many of them, because many nurses are so ready to tell them how hard their work is, actually don't ask for what they need because they don't want to bother the nurse. That to me is a crying shame.

First of all careinc. your post was not up when I posted (maybe it came up while I was writing. Yes, I am an older nurse (57), been at it for 30 years in 7 states and 4 countries and all areas in the hospital, LTC and home health. As much as I want to support my fellow nurses I am frankly more concerned with pts. and I will not deny that I feel that nursing has come downhill in the past decade or so. Even at this site reading some of the comments that some think are witty sickens me. I know there re good nurses out there and I know that many nurses (like diarygirl) want to do better. I don't think it helps them or their pts. to sugar coat things. If you do a good job you should be told and when you don't you should be told. What was said to the pt. was not appropriate for him, his condition and it was not correct. What is wrong with saying that? If you learn to take criticism and learn from your mistakes, even when the lesson is hard, then you will become one of the trusted nurses.

Went into a patient's room today - the son(patient) is a pleasant man in his 40's with mental retardation. The MD's removed his epidural today and he still has a chest tube. I tell him, "Ask for your pain medication when you need it. If you don't need it, it would be better not to take it." Right before this - Mom had told me she was going to go home at 10 pm. But after I said this, she became irate.....she said the following. "New nurse's don't know anything. I have been a nurse for a long time. A nurse kills 2.5 patients in her career - that's a statistic. Nurse's don't have the corner on dealing with pain and doctors don't overperscribe what patients can have. I am glad that when I am old, I won't have to worry about being in a nursing home because you young nurses will take care of me to where I don't leave the hospital." I really tried not to be baited by what she said. I commented that she had a dim view of her professions future, that I WILL give her son pain meds when he asks for them and needs them. She demanded to know my last name, and when I asked why, she said, " I only take down the full names of people I don't think are going to give good care to my son. His father died 6 years ago and he's all I have left." I was stunned that someone would have such a dun view of our profession! And after I was just trying to give the patient some options! So I had the doctor talk to her and I wrote a note detailing all this and put it in the chart. The intern said that she said she was just tired andgrumpy and she knew she was out of line. So There you have an older nurse's view of where our profession is going. Have any of you ever seen research data to collaborate her claims that a nurse "kills 2.5 people in their career." ? OK I have quite a few reactions about what you describe. First is dismay at what seems to be the loss of the ability of nurses to empathise.(Not just from what is missing from what you say but from the replies.) This woman has lost her husband, she has raised a MR child who is now an adult with a medical problem in the hospital. He must have something major going on if he has a chest tube. So, without considering that she is a nurse and has a very good idea of what can and does go wrong, I see a terrified mother. Whether our children are MR or "normal intelligence", whether they are 40 years or 40 months old, when they are in the hospital they are our "babies" and we will protect them while being scared that we will lose them. Did you have any idea of what might have gone wrong since he came into the hospital. Whether it had been smooth sailing the whole way or not she was stressed and likely working on little sleep which increases that stress. Secondly, she was correct and in this case it is difficult to believe that you would have made the statement you did to a MR person. It would have been better to tell him that with his epidural control gone his pain will be controlled a bit differently. He is to call you at the first sign of discomfort. That is when you deal with whether it is too soon and when you assess how strong the pain is and work out how to deal with it. Does he understand pain the same way as you? There are varying thresholds for pain among people, that are affected by gender differences, age differences and cultural background. Telling anyone, especially someone who may not understand that he CAN call you if he feels he needs to and not when it might be what you consider pain, is not the best approach. Yes, you do not want him to become addicted, you do not want to risk his having problems getting off pain medications, but that is your job to work with himand the doctor to find a suitable level of relief. Consider if this patient was still MR but his mother was not a nurse but someone who left and told her son, now remember what the nurse said, don't go asking for medication just because it hurts a little. What happens then? Have you ever seen a patient rip out his IV and chest tube because he is in too much pain? I have, I worked in a war zone. Third, yes, the mother was correct about stats. I do not know about the 2.5 specifically but at least 100,000 people die EVERY YEAR in the US from human error in health care settings. Yes, ladies and gents, we nurses and doctors kill more people every year than die from auto accidents, breast cancer and AIDS through medical mistakes that happen because of human error. We have allowed MRSA to grow from a relatively rare occurence to an out of control problem killing 50 people, 85% of whom acquired it in a hospital, everyday. And 1 in 10 patients (that's 2 million every year) will acquire a new infection while in the hospital. The rate in ICUs is 30%. My advice to you if faced with this situation again is to: take a deep breath and look at the person in front of you. Ask yourself what s/he might be feeling. Rather than seeing an attacker or an enemy see the person inside who is scared and is attacking out of fear, not a desire to hurt you. Then honor that person's pain by recognizing them. Thank them for pointing out the error you made and rephrase your statement to say what would have been correct. In this specific case, I would have accepted that even with your 5 years experience, this nurse may have had more than you and after dealing with that situation ask for her insight and experience to help you help her son and your future patients. Not only have you honored tis woman's pain, fear, relationship to her son and experience but you have defused her anger because you have recognized that she is a person and she is scared.

I had a pediatric Hispanic (migrant worker) patient once who was diabetic. He kept coming in for admissions with his blood sugar out of whack (way high) and the powers that be kept doing nutrition referrals. This was in NC and some of the people were not as "accepting" (they were rampant racists) and began to start blaming the family, their "ignorance," etc. The fact that there was a Spanish interpreter with the nutirtionist was all they regarded as being needed. What was finally pointed out was that the foods the nutritionist was reviewing were traditional "white" foods. This family ate rice and beans as a staple of their diet and had never been given any guidelines to amounts. I have subsequently come to learn that Mexican/Central American natives tend to have far more efficient digestive sytems (centuries of having limited food supplies and having to subsist on less) What has happened as they move to this culture is that they are eating more and more often which is leading to higher obesity rates. I don't know how much info there is out there but this is a topic you could tackle. Communication (both ways) about diet as related to complications, especially diabetes, I would guess has a trove of information. Another patient I had was out of control. I kept asking her what she had eaten between lunch and dinner because her BS was high and she was being given a hospital diet. Her family had visited and I was sure she had eaten something. She finally admitted to eating watermelon but felt she did not need to report it because it was "cold" Somehow she had determined that the only foods that counted were the hot foods/meals she ate. We went a long way that day figuring out why she had had so many problems!

Kelly this list is great. I'll add a new one I learned the other day which seems to work-If a patient has not had a BM and feels constipated (Ca pts very often are) have the massage the area between the lower lip and chin (about halfway between) for 3-5 minutes. If they are too weak or out of it you can do it for them. Also, for pts who may be confused but are going home, suggest to home caregiver that they keep a calendar and mark when pt has BM. This gives them an idea if/when they need to give a laxative and when they do NOT need to. It seems that there are a lot of little old women who get a kick out of laxatives and will use any excuse to get them:-)