Helori

I like the phrase, I've used the phrase and will probably continue to. To me it doesn't mean you ignore either the pt or the monitor simply that all the monitors and technology in the world is not a substitute for a good and thorough assessment. That being said I've worked CCU long enough that if I was on a regular floor I could have the most stable looking pt in bed in front of me and I'd still feel twitchy not being able to see their telemetry rhythm on the bedside monitor or an arterial pressure even a cvp. Just the thought makes me nervous lol. An example is a pt I had with a horribly low hgb. Her sat was 100%. Despite the fact that she was practically gasping for breath and getting more lethargic and confused in front of me the resident thought she was fine cause her sats 100%. I finally had to explain to him that all that meant was that the 4 hgb molecules she had left in her body were 100% saturated! Not that she was getting enough oxygen! I went over his head to the fellow and surprise surprise the pt ended up tubed. Trying to be a cowboy or not asking for backup when you need it has nothing to do with the phrase. It's just a good reminder that pts don't always follow the rules. They can look a lot sicker than the numbers indicate they can also be a lot more stable than the numbers show. Monitors and assessment go hand in had for good care.

I probably would've signed and added the note that "I will toilet pts when I answer the call bell when I do not have other pts requiring a higher level of nursing care at the same time."

Yes but there is implied consent. If you have to hold a person down to take blood and insert a catheter you'd better have a court order or something to back you. But like brillohead said if you say I need to take some blood and urine and they willingly pee in the cup and stick out your arm their consent is implied.

Does your hospital do out patient cats as well? In our hospital we have a holding room where the out patient sheaths are pulled and any admitted pts from the tele floors go there for the sheath removal then back to the floor for their bed rest. Any icu or ccu pts have their sheaths pulled on that unit. Although lately more and more of our docs are doing radials which is awesome for both the patient and the nurse :)

I live 20 minutes from work so I never get the option of calling out due to weather but I live in Canada and life doesn't stop for snow so I've driven in plenty of snowstorms. What I wonder is if it wasn't work, if it was something personal something fun would you make more of and effort? What if you had tickets to a concert in another city would and a big storm was predicted would you go the night before to avoid the storm. would you still complain about paying extra money for a hotel room? What if it was Christmas and you whole family was getting together grandma, grandpa, mom, dad, brother, sister, nieces, nephews, aunts, uncles and cousins and the driving was bad. Would you drive slowly and carefully and try to make it or would you call and say maybe next year the weather's too bad. What if your dad had a heart attack and wasn't doing well would you drive to the hospital then? And when you did would you be glad that the nurses in the unit made the effort to get in to work and the unit wasn't dangerously short staffed? I've driven in all these situations and my thinking is if the weather isn't bad enough to make you miss something that is important to you personally, something you want to do, then it's not bad enough to let you out of your responsibility to make it in for your shift.

When I have a pt that talks a lot and takes a little more time I usually save them for last. I know you're probably always busy and have something that you need to do but if you do his meds last at least you know that somebody else isn't waiting on their meds.

Was the pt on tele? Because in our CCU when we have a pt having a lot of runs of VT we often give 1g of Mag even with out a previous level. On VTers out docs like levels better than 1 and I've never seen that on a pt who hasn't had Mg replacement. So even if they have a 'normal' level previously we replace. It really works wonders!!

It's the same at my hospital. We can still wear jackets and longs sleeves but jackets must come off before going into patients rooms to provide care and long sleeves must be able to be rolled up to your elbows for pt care and hand washing. It's actually one of the few rules applied equally to Docs and nurses. Docs can wear suit jackets or lab coats while at the nurses station and on rounds but not for exams or procedures. Most residents and fellows who have the majority of pt contact now just wear scrubs with a lab coat. Some consultants still wear street clothes but when they actually touch a pt sleeves are rolled to the elbow and ties come off or are tucked into shirts.

I think something like day surgery or school nursing would completely stress me out. When I was a new grad I was saying that a pt made me nervous because he was so sick. He had just about every diagnosis under the sun...easier to list what wasn't wrong with him than what was. A Doc told me that he preferred pts like that because if something does go wrong it's not unexpected. After working 13 years I totally agree! The pts that make me nervous are the healthy ones because if something goes bad it goes REALLY BAD!

I had a similar situation a few years ago when I was a new grad. I had a pt in his 40's severely brain damaged after a MVC and had been living in a NH with a g-tube for years. He was on our Med unit with asp. pneumonia and had been on O2 and triple IV abx for 3 weeks. He was a DNR, no intub., no ICU. So even though he was getting worse everyday there really wasn't anything else we could do. The night I looked after him it was my first time with him. I walked into his room after report his family was at his bedside and he was very restless and in obvious resp.distress. His BP and Sat's were low (don't remember how low) and he was febrile. I upped his O2, gave tylenol supp, and called the MD to inform him that the pt was still spiking temps even after 3 weeks of abx. Doc ordered a 4th IV abx, like that was going to help:confused: . When I went in to give the abx I asked the family if anyone had talked to them about palliative care, of course no one had. I explained to them what it was and they decided that they wanted to do. I called the doc back and had him come up to the floor and talk to the family. It was decided to d/c all meds, iv's, g-tube feeds, everything. I gave the pt morphine at that time and he settled down. But a couple of hours later he was in distress again. I checked his sat, 69%. I thought that if I gave him more morphine I would kill him and didn't know what to do, so I asked the family. I told them that his breathing was really bad and that the morphine would probably make him more comfortable but could also supress his breathing. They wanted him to have morphine and I gave it. I left his room shaking, I thought I had killed him. In nursing school we'd talked bout situations like this in ethics and I always thought that I was ok with giving pain meds if the pt needed them, but to actually do it scared me. He settled down after the morphine. And I continued to give him morphine every couple of hours the rest of the night even though he appeared comfortable (I wanted to prevent him from getting into distress again). I never once checked his vitals, we weren't going to do anything about them anyway. Toward the end of my shift I went in to say good-bye to his family, his mother, brother and sister were asleep but the SIL was awake. I told her I was off for a few days and that I would be thinking of them, I knew he wouldn't still be there when I came back. About 10 min later, the pt's mother came the the nursing station and found me. She hugged me and thanked me for what I had done for her son. Then about they called the nursing station to say he wasn't breathing. (everybody dies at change of shift ) Some people probably think I killed this pt. I actually count this as one of the proudest moments of my nursing career. I made helped make him comfortable which is what he and his family wanted and needed. I no longer think that I killed him. It was the illness that killed him, I just made him comfortble when he died. (sorry for the long post)

This poem was posted in the nursing station of the hospital where I use to work and it was really nice to read when you were having one of 'those' days. I'm "Just A Nurse" I'm "just a nurse." I just make the difference between life and death. I'm "just a nurse." I just have the educated eyes that prevent medical errors, injuries and other catastrophes. I'm "just a nurse." I just educate patients and families about how to maintain their health. I'm "just a nurse." I just make the difference between dying in agony and dying in comfort with dignity. I'm "just a nurse." I'm just the real bottom-line in health care. I'm "just a nurse." I just make the difference between pain and comfort. I'm "just a nurse." I just make the difference between healing, coping and despair. I'm "just a nurse." I just work in a major teaching hospital managing patients who are involved in cutting edge experimental medical or nursing research. I'm "just a nurse." I'm just a professor of nursing who educates future generations of nurses. I'm "just a nurse." I'm just a long-term care nurse. I make the difference between staying in one's own home and going to a nursing home. To the student nurses...don't you want to be "just a nurse" too?

I was just talking to my father, my grandpa is scheduled to be d/c'd tomorrow with the catheter. He's walking on his own, doing stairs and feeling great. Now let's see if I can remember all the questions: Athomas91, I was worried and frustrated and at the same time trying to reassure my father & grandma that everything was fine and a cath wasn't a big deal. I didn't expect them to keep him in the hospital just because he couldn't pee, but I was hoping that they would look into why he was having the problem while he still had to be there with his knee. At the same time I didn't want to be one of those family members that the nurses warn each other about. Why is it sometimes so hard to be just a family member and not a nurse? Thanks for understanding that. Sunnybrook83, he was on morphine for the first day or so but since then has been taking T#3's. I don't know what was in the spinal. Thanks for the good wishes. Sproutsfriend, SproutRN & Ctbsurf, he needed an enema after surgery but I don't think he's had any problems since then. I work on a neuro floor and had thought of CES but figured it was a pretty remote possibility and it wasn't accompanied by any loss of sensory or motor function, although you three seem to know a lot more about it that I do!!! Pasgasser, thanks for the info. Anyway he's got a referral to see a urologist and a home care nurse will be visiting for his dressing changes so that's already set up. I figured it was nothing I just thought of all the patients I've seen who had trouble voiding after spine surgery and wondered if a spinal could cause the same problems. I guess now I just have to trust his doctors and nurses to do their jobs and just be a granddaughter!!! :) Thank you all!!!

That was the first thing I thought of too, that he probably couldn't pee lying in bed. But since then he has been up walking (with assistance) and they have stood him up when he's trying to void. But he is a very private man and I guess it's probably not surprising that he would have trouble peeing with 2 people watching, I know I would!! Thanks for the good wishes!!

Thanks, that's pretty much what I figured but wanted to know for sure. It just ticked me off that they wanted to d/c him without investigating the problem and just let the home care nurse take care of the catheter. Today is the third time they've taken out the cath and had to re-insert it because he couldn't void. He's never had a uro/prostate problem before. I just wish the hospital was doing more to find out what is causing the problem, as far as I know they haven't even sent a urine C&S.