NursingAgainstdaOdds

Not speaking to a pt in withdrawal, though there is always that possibility, particularly when they end-up in the ED for 13 hours ... I am talking about a typical highly intoxicated pt who is being monitored in the ED. I also end-up having a lot of these patients dosed with Geodon/Ativan and have some confusion related to how those drugs affect the pt neurologically and what more I can include in my assessment and documentation.

Does anyone have some good resources on assessment and monitoring of intoxicated patients? Like everybody, we have an extraordinary number of these types of patients, and I would like to brush-up my monitoring and documentation. We also have a lot of intoxicated and/or mentally ill patients who receive Geodon/Ativan, as we have a specific psych portion to our ER. I would like to be better at monitoring of patients who have received these drugs, as it is pretty standard fair for the out-of-control and violent patients. Help, advice, resources would be greatly appreciated.

Yep, it's Nursing Against the Odds (see username ). Great read. I wish there were more books on nursing in a similar vein...

YARGH! Insurance companies are so evil! This kind of behavior on their part really should be illegal.

I'm glad you stood up for yourself and your co-workers. Hope your sore body heals-up well, and certain people learn their lesson.

If you are blowing them when you are advancing the catheter, you might try popping the tourniquet first, then advancing. Because you don't do IVs very often, it may be taking you a little longer, and a lot of pressure is building-up in the vein prior to attempting to advance the catheter. Also, is there a way you could go play in another department for a day just working on IV skills?

LOL why on earth did you think it'd be easy? I just went from medical/telemetry to the ED. I am having a blast. I really don't feel the pace is faster than the floor I worked on - the patient turn-over is obviously faster, but the pace is the same or slower. I personally like the fast turn-over of patients in the ED. Keeps me interested. I do have some of that "new grad" feeling, but overall I feel OK. I think learning a new area of nursing is simply an awkward process. Accept it, embrace it, laugh at yourself as appropriate, and ask everyone stupid questions. I don't care who it is, as long as they know where the thing/person I need is located.

Well, the best way I get through long shifts - Don't think about it. Last month, I did a 17 h shift (13 on my floor, plus 4 for a class in clinical on another unit). When I thought of "10 hr to go" or "halfway through", it was just discouraging. I consciously didn't consider time left, time done, blah blah blah, and it went much faster. Focus on the tasks at hand, and move through. This is also how I get through those regular shifts that just don't seem to end.

Hoo boy, that sounds familiar! On my very first day of nursing school, and my very last day of nursing school, and many times in between, my power was shut-off. We had the same issues. We've been struggling since DH and I got married. He's an immigrant, and for a long time we couldn't afford the fees to get his work permit, permanent residency, etc. He wasn't allowed to work. I worked full-time, with a baby and nursing school. I fought like hell through nursing school just to make it. Sometimes our power would get shut-off and we'd stay at one of my parent's houses for a while until we could get it turned back on. (Yes, they WILL shut your electric and gas off in the middle of winter, no matter if there's a child living with you. We've been there a zillion times.) My Mom would call, see our phone had been turned off, and just bring groceries over - knowing we were struggling. (God love her! I never would have made it without her.) Now that I'm a nurse, it is a little easier. Emphasis on a little. We still get shut-off notices and are still behind on rent, etc. Those years of struggle left us with big piles of debt. Now my hubby has a steady job, but he is anticipating getting laid-off any day now. Just when we catch our breath, something else is dropped on us. I am working very hard to get us caught-up. I'm on the cusp of working 3 jobs to do so. I don't know what would have happened to us if I didn't get my nursing degree. At least now I have steady income and many opportunities. We've even recently decided that if my husband gets laid-off again, we're sending him to nursing school too.

I'm currently working a job w/ a 30 minute commute ... often a 45 minute commute in winter d/t snow. I just took a new job with a 1 hr commute, a lot of it on back roads, but the increase in salary and better working conditions makes it worth it. We'll move over that way more when the lease is up, until then, I'll be commuting. My current positions is 12h days, my new one is 8h nights. Can't wait!

When I enter a room to start an infusion, 50% of the time the tubing is turned-around on itself and screwed onto the port. WHAT? How is that even remotely a good idea? Why even bother? Now, I automatically take new tubing in, unless the last infusion was given by myself.

I'd report her ASAP. She needs to be knocked down a few notches - I can't imagine what other sage advice she's handing-out to other patients. Glad to hear your sister went for medical tx. It sounded more like a hematoma to me than a DVT, but who knows from my 3rd hand perspective! :) Hope she heals-up well.

When I was in nursing school, I worked as a nursing assistant, and did a full med pass on 12-18 patients a day. It was an adult home, and they somehow got away with it by "training" the aides to do so (for me this involved a one-page test) and calling it "medication assistance". There was absolutely no difference in how I did this med pass vs how I do med passes now. I had a cart full of meds for each resident, and a MAR book with the orders for each resident. I'd prepare the meds, walk into the room, give them to the resident, and document which meds were given. But, it was, of course, medication "assistance". I think it depends on the state in terms of legality.

We have an MD who will always write "Social Work consult - discharge planning" no matter how many times we tell him Discharge Planners are nurses. DC planning and SW work closely with one another, for obvious reasons, but it is actually done by the DC planners, not the SW. Also, thanks for the reminder! :)

I would LOVE to take public transportation to work. I hate driving. I used to take the bus to work, and I loved the time to myself. Now that I'm an obsessive knitter, I'd also enjoy taking a bus so I could knit on the way in and way home. That would be so excellent. As it is now, I live a 30 minute drive from work and the bus doesn't come out here.

Well, lots of good info from this thread. I appreciate it. Overall, I think the policy they have in place is ridiculous, and unfair. I understand the need to "come down hard" on the people who always have a reason to not be at work, and call-in excessively. 4 call-ins in one year is not excessive, especially when you have a 3 year old and work with sick people all the time. And no, I really don't want this job that bad. I'm interviewing for several other positions next week. I can't wait to say "Adios", for this reason and many others.

In our case, it's because my husband just started a new job and is in the midst of his probationary period. He literally can't call-in. I have sick time, why shouldn't I use it?

The verbal warning is the first step in the process. It essentially means for the next "offense" I can receive a written warning. I did have to sign it, and I know I will have to sign something this time. We have no union.

They do give us sick time. I'm being written-up for using it, essentially.

We're having some issues related to absenteeism on our unit, which resulted in our director auditing the attendance of every employee on the floor, and subsequently meeting with each and every one of us to discuss said attendance. I was given a "verbal warning", which I had to sign, due to having 3 call-ins over the last year. Yesterday, we had to take my 3-year old to Urgent Care, as it was evident he had bilateral conjunctivitis. I had to call-in today, because there's no way he could go to daycare, he needs antibiotic eye gtt TID, and has been spiking fevers of 102-103. I know from my meeting that 4 call-ins = a written warning. (At five, we lose our yearly bonus and are suspended for a couple days - it goes on from there.) My question is - is this legal? I know my call-ins were illness-related (either my own or my 3 year old). I've gotten sick a lot over the last year, thanks in large part to working in an incredibly high-stress medical/telemetry unit and being exposed to every bug out there, which I then take home to my family, of course. I've been wading through FMLA, and it appears to me that illness would be covered, and I shouldn't be penalized for it, right? Advice or information? I didn't find anything specific to the healthcare field in FMLA, which is the usual excuse when my employer does things like this.

It is my understanding that anyone, can be sued for anything at any time. Don't Good Samaritan laws only protect us from being held liable, not from actually being sued? Frankly, I cannot live that way. If I am in a position to help, I will. I will not let an over arching fear of being sued prevent me from doing so.

Thanks for starting a great thread! I felt really lucky this year. I had yesterday off, spent it with family, and then went worked 1230-1900 today. We split our shifts on Christmas, which is such a blessing! It was actually kind of nice to see my co-workers and wish one another a Merry Christmas. I cherish all the little things we do for one another to make the holiday shift a little easier. (I was kicking myself for not bring a "morale elevating box of donuts" on my way in!) Several sweet co-workers, patients and family members brought us poinsettias, cookies, and cards, which warmed my heart. The nurse who left me report wrote "Merry Christmas, Bridgette" on our report sheet, and it made my day.

May you heal from this event ... may you dream, hope, and be blessed in the future. My heart is with you. ------ You can still be a mother! Be it in a "traditional" way with some further precautions, as mentioned ... or be it to children already born who desperately need your love. No one should be deprived of this extraordinary role we mortals may fulfill.

Recently, some hospitals local to me were sued for automatically deducting lunch breaks from workers who were unable to take them: Hospital employees sue over unpaid lunch time

Ours are not particularly fair. As has been mentioned, the assignments are made based almost entirely on room number and total number of patients. Some people really complain if all their patients aren't in the same block of rooms. We are a medical/telemetry floor, so sometimes this does occur to have the telemetry and medical groups balanced-out where they need to be. As a fairly new CN, this alone presents a pretty significant challenge sometimes. Myself, and other nurse-minded CNs, will try to balance it out somehow if one nurse has an extremely challenging patient or patients. The reality is, the unit just does not have enough staff to really spread it out as we would like. We have no choice. For many challenging patients, keeping them safe and their needs fulfilled is a team effort. Many nurses on my floor do not see it this way, but there are many who do as well. I was covering patients for a nurse on lunch recently, who stated just prior to leaving "they're all fine, they shouldn't need anything". Four minutes later, I'm in a room of hers, with a patient sobbing uncontrollably because her pain was out of control, her sopping-wet dressings were dragging on the floor behind her. I quickly went and retrieved her IV pain medicine, but upon returning discovered she had no IV. I started an IV, gave her pain medicine, changed her dressings to both LEs (bilateral cellulitis) and helped her back to bed. She was not an easy stick, and I was quite busy with my own 7 patients, but this was clearly necessary, eh? Upon her return from lunch, the patients primary nurse yelled at me for starting an IV in the AC (she had no continuous fluids, just intermittent ABX and pain meds) and for applying the wrong kind of dressing to the LEs (what is wrong with Kerlix and gauze, I didn't figure out). Another nurse I work with will answer my call bells if I'm tied-up, and come ask me where my MARs are, so she can give pain meds or whatever to patients who need them. She's the first one in the room when a PA goes off, and will always help me when I'm up to my elbows in stuff you really don't want to be up to your elbows in. I adore working with her, because it is such a team environment. She has taught me a lot about what it means to be a great nurse. Sorry to hijack! I think overall, with the challenges we face and the way the system is set-up - the most important thing is to work together to take care of these patients.