End Game RN

hey travel5o, you too have a great story! I have seen this many times and look forward to every success. By the way, the neuro-rehabilitation doctor referred to wasn't a neurosurgeon. Our guys are awesome!! and we have had some amazing results even after months and months of hospitalization. This young lady I knew personally prior to this accident. It was very difficult to watch her family, her and my friends deal with this. I spoke with the family a great deal during this time. They are a very tight, supportive and loving group! She came to my unit today, I was admitting a TBI post op craniotomy, she was wearing her scrubs and labcoat from her University. She had to go to her clinical later that day. She stayed with me while I admitted the patient and reviewed with her all of the things we need to do when admitting trauma patients. She was great!!! has wonderful insight and critical thinking as well as a wicked sense of humor which I witnessed while recoverying this patient. I know she will be an outstanding ICU RN one day...hopefully in our NSICU. I would like to precept/mentor her if she does come to us. She met some of the staff who took care of her and no one could recognize this young lady. I introduced her to our neurosurgical PA who assisted the attending neurosurgeon and others in the OR, its the first time the two of them met after her successful recovery. He just kept staring at her and smiling. Uhh, they did actually talk to each other. Her story is amazing and I hope she will write about it in greater detail. JACEM 7 15 is an inspiration to me. I hope all of you out there can help her through this stage of her nursing education. This is why I referred her to allnurses.com. Thanks everyone!!!

Just a quick response to the ICU thing..we have a lot of black nurses, male and female from a variety of countries/continents... We have a great ICU internship program that is very difficult and graduates many very well educated and qualified black nurses.There is absolutely no reason that anyone, regardless of his/her racial makeup could not be an ICU nurse, or nurse anesthetist or whatever branch of nursing that interests them if they can graduate this program and are highly motivated, work hard...etc..... So..go for it..if you want to do it, then do it. If your institution discourages, in particular, students of color (God..I hate that term)..move on. There are a lot of places who would be lucky to have you. Most of our nurses who left our ICU became nurse anesthetists, nurse practicioners and in about 15 years, not one has ever failed to complete, graduate and excel in the program they chose, several are now working in our hospital as nurse anesthetists...I'd say, more than 80% were minority applicants and vastly successful. Oh...most of these are my former students..they have truly surpassed me in so many ways. My nurse children all grown up. God I am so proud... Eeka

Hi firechalice, I agree with everything you wrote except "When others see us we are seen as black." Where I work, a very large University affiliated health care system, I don't believe that we see ourselves as being in any particular racial/ethnic group. Until I read your post, which I am copying to give to our staff.. I never thought about this aspect of our interpersonal relationships between ourselves and our clients. I'm gonna ask the opinions of our diverse staff...my God...we come from a dozen plus countries representing nearly every human society on this planet, whether or not our colleagues feel that they are first seen as being black, before they are recognized as being professional nurses. If so, this sucks and we are clearly doing something wrong. By the way..since this topic is about black male nurses...meaning that race has been brought into this..our male nurses..whether they are of African, Carribean, Central, South, Latin American, North American, Middle Eastern descent or from parts of Asia, both ends of Earth's North and South poles, or from the Equatorial areas of Earth...Well....as a rule...our male nurses rock!!!!!!!!!!!!!!!!!!!!!!!! Race isn't an issue with me anyway, certainly not with those I work with. I am so fortunate to work with such a great group of people. I wish everyone would have the same opportunity to experience the satisfaction of working with intelligent, well educated, dedicated professional nurses who offer so much in terms of their lifes experiences, their own history, culture, language, and more importantly, the diverse cuisine that they bring along with their nursing education and clinical experiences. Or..maybe I just like and admire everyone I work with. I do have to mention that like everywhere else we do have specific racial designations in professional organizations that specify which group of people they represent...its a shame, but a reality of our obsession with race..... We're o.k..we all just have to be ourselves and be open to new experiences and lifestyles of others. Remember that we spend a great deal of time with the people we work with..we may as well be a family. Hope this helps.. eeka

Many, many years ago... O.K I have two I can write about. All the players in this drama are dead or have moved on. GSW to head..several intracranial procedures..head resembling a rotting halloweeen pumpkin ..meaning the top of the head collasped inward, you know, where you would put the candle inside the pumpkin??? This required several dressings each day...rather gross since the brains inside were liquefying and it was beyond disgusting..the smell was like the large animal disposal dump..but less bearable if you can believe that. One large chunk of liquefying tissue oozed over the cranial opening and like ectoplasm..seemed to consciously crawl...slithering...drip by drip over the side of the head onto the surface of the bed. Observing this as dispassionately as possible..all I could hear in my head was the refrain from The Wizard of Oz..."If I only had a brain" This was unpleasant. And a horror for this poor person's family. Despite our best efforts, it was impossible to hide the extensive decomposition. The next case was a patient who had a massive intracranial hemorrhage, an aneurysm, was pregnant, emergently delivered of a beautiful, viable fat baby in our ICU. She became brain dead. Family couldn't cope despite massive support from so many services and our staff support for the family. She turned green, I mean like that green alien woman from Star Trek who was hitting on Captain Kirk...The family thought that we weren't keeping the patient clean since she smelled so horrible, like the first case above. Well, I decided to fix that. With one of our physicians..we throughly washed out the cranial cavity with sterile saline..suctioned everything that came out..the liquefied malodorous tissue, rebandaged the head with a full head dressing..almost impossible as she had no skull just above her eyebrows...missing skull extending around her head about the same level as her eyebrows..her head had caved in just like the patient in the first story...there was absolutely no odor left...Threw out all the the containers with the contents of this wound care..used an odor neutralizer. Washed and dressed the patient and wrapped her up warmly since she would essentially become whatever the temperature of the ambient air around her was... and brought her grandparents back in. It was tragic and horrifying. Like the first case above, I remember all the details of each of these patients and their families. For the record, both of these events occured during the time when many families simply refused to believe that their loved one was irrevocably dead..all because the patient was on a ventilator, supportive medications for blood pressure...whatever...still had a heart rate/beat..some degree of a blood pressure..generally minimal blood flow detected by cerebral blood flow study...some families would become angry and agressive when approached about the futility of continuing care.. In the second case the grandparents and some other family members repeatedly told us that "Like Lazarus, Jesus will heal her and we all should just be patient".. Now that was hard. I did offer my opionion at that point...I said "God does what He thinks is right..we can accept this or not, either way..its God's decision". I also told them that "prayer is important, even necessary..asking doesn't guarantee we'll get what we want..but perhaps if we're lucky, we'll have a better understanding of God's will if we don't." Usually I'm very patient in these situations..but in this particular case..I simply had to respond to the complaints that we were all "Godless heretics" and "non believers" I also told them that "many of us are Christian and we grieve with them". In the end, the family and our staff were o.k. with each other..In this case, it was the family, even more that this patient who needed nursing care and cultural understanding of their particular religious beliefs. They only needed to know that we cared. Actually, thinking about this subject, I believe I could write a couple of dozen of these stories without even trying. Well, hope you like these Eeka

It was brief, but to the point. In the final analysis it did what it was supposed to do without all of the bells and whistles we had come to expect. It was, then it wasn't. Had a wonderful recognition ceremony for everyone..i.e. exceptional nurses in a variety of areas, then of course, nurse of the year for the facility and other categories...all really nicely done. It was funny and fun and sweet. But then...it stopped and we all went away, bewildered???? I entered the nursing exemplar contest..submitted 3 separate stories..all were well received, one of these 3 was chosen..another 16 people also submitted their exemplars and we were all recognized and this was also very nicely done...I really enjoyed the presentations and meeting everyone who were being recognized. Our hospital administrators were pretty cool and we met our new CEO, a woman who is also a physician. I found out our hospital will be publishing or making a "book" of our exemplars..I'm not sure how this will work out...I submitted several of my exemplars, written for my hospital, to allnurses.com for 2007 & 2008..One of them was over the top :imbar. I think these are also going to be included. By the way..one of these I sent to allnurses.com was entitled "Who Knew?" the dark side of nursing... I reworked it, BIG TIME, renamed it "Reflections through the looking glass" and submitted it for 2008 and won again.....second year in a row. Clearly this rather creepy exemplar (I had a bad year!!) had potential. This was nurses week for me. All in all..we know who we are, we have our friends and colleagues, our own cheering section for what we do each and every day. Our patients and families generally care for us as much as we do for them. I am so very fortunate to work where I work and am blessed working with such a great group of people. My only participation in these events has been the exemplar writing. And its been rewarding. Can't wait until next year, I've already resumed writing..have nearly 30 years to catch up on. O.K Bye for now. Eeka

MrRacer98. I've also gone through cripling burnout. 2007-2008 I was absolutely exhausted. Managed to do very well at work since all my energy went to being the best I could be. Personal life revolved around horses, minimal human contact outside sick people, devasted families, etc....I made myself completely available to anyone who felt a need to talk to someone. Friends, neighbors..patients, families, former and current...name it. It was exhausting. It became an obsession, a compulsion to help people. Couldn't stop doing this. I finally hit rock bottom...picked myself up..you have to be willing to look at yourself from another person's perspective, even if you don't like what you see..first step to changing your behavior is accepting who you had become and making a conscience decision to change it. Still tired, but happier..still am available to some patients and families, but I am more careful in who I choose. I thank God for my co-workers/friends actually who have been my safe harbor in the storms of my own making. I love each and every one of them. I Hope you find a place like this, people like this, a new life like this. There is hope but you have to be willing to move on.

Great responses!!! I especially like Perpetual Student's reply. My family, some of my friends also have something similar in mind. Government can't control everything, it will fall apart in favor of family, community, regional, cultural, linguistic and religious influences. Perhaps something like this would forever alter the landscape of America. For example the States on our Southern border falling to countries to our South. Who or what could stop this if we are in the midst of a worldwide pandemic and the peoples to our South come North believing that we could help them. Frankly I wouldn't blame them for believing this. Just thinking of the larger picture. No one, nor no one government can offer safety and security in the face of a pandemic. A massive bureaucracy is what it is, fat, lazy and self important. It's toothless if we don't support it. Would I work?? Sure, but for my own reasons. What?? are they going to arrest every health care worker who for some reason or another cannot or will not show up to work a pandemic?? In the end, it must be the individual who chooses what they will do if this does come to pass. People will die, some will survive, society will experience enormous challenges, loyalties will change and all of these things we take for granted will in all likelyhood be changed forever. By the way..what about all of the thousands of other flu related deaths that occur every year, world wide???It seems that H1N1 has killed immunosuppressed individuals/medically ill individuals. Sounds like a normal flu season, but out of season. This is promoted as scarier since it is a variant we have not experienced until now?? or just not identified. Just be careful, be reasonable, be professional and plan your strategy when balancing family responsiblities with your health care facility's and community needs. Be yourself. Most of all, be safe. We'll be o.k.

I wrote about my horse in a posting in this forum yesterday. I performed MDT on complicated malignant melanoma lesions on her tail. We observed, accidentally I might add, that the little monsters made noises while chomping away at the necrotic cancer tumor. One young man who was helping me pointed this out by calling me over, then lifting our mare's tail up to my ear and told me to listen. It was an odd juicy sound, nasty black liquid leaked from the recommended white knee high womens hose I had acquired along with the maggots. The entrapped maggots, within this stocking, secured above and below the area being treated remained where I had placed them without any problems. This was lightly, very lightly wrapped in kerlix thus allowing the maggots to breathe and not be squished with a tooooo tight dressing. This dressing absorbed the nasty drainage that resulted as the maggots ate their way through the necrotic tissue. This kerlix dressing had to be changed first twice daily X's 2 days,(supersaturated) then once a day X's 1 day. On the fourth day I removed the final dressing. Whoa...I am so convinced. Ultimately it was the noises that got to me. It was so funny. I was well pleased with the results. We had one incident on the last day, this was the scheduled day to remove the final dressing. I received a frantic, near hysterical phone call at work (hospital) with my partner yelling that all of the maggots had escaped and there were thousands of them. I calmly informed him that there were no more than 500 and they don't breed. I learned they were still within the stocking, they only fell out of the wound bed since they had consumed their fill of nasty tissue. I explained this and asked them to leave well enough alone, only re wrap another kerlix dressing around the tail with the stocking and maggots and I'll be there in the evening. Well they did. My friends squashed the absolute crap out of my little friends attempting to guarantee that there would be no more maggot escapes. This was what I found to be gross when I unwrapped this dressing later that evening. For the record, I could not find any reference to MDT being used in the equine species to deal with necrotic malignant tumors. There was one documented use in a young horse who suffered a snake bite and nearly died as a result of severe tissue loss, infection and associated airway complications. MDT was successfully used in addtion to other well established medical/surgical management in this unusual case. Other uses for MDT in horses were for infected hoof wounds, some from complicated laminitus. Some Vets will use this.There is documentation of MDT being used in small animal Vet practices. I don't recommend this for the casual curious horse lover with medical/nursing experience. This is time consuming and exhausting and nothing to play with. You will need help, its a 24 hour nursing responsibility and it went on DAILY for me for months on end, key words, daily, farm, large sick animal, twelve hour shifts followed up with equine care then back to my real job the next day. This is a labor of love with no real guarantee of success. In this way I believe this use of MDT is more complicated in its application to this species when compared with humans. Challenges include dressing a tail that can wave about with significant strength and coordination and keeping the maggots within the dressing on/in the area being treated. We did this rather well. I believe I would enjoy performing this therapy on human patients. In conclusion, this is a great therapy with a wide variety of applications from human to other mammalian species. Oh, forgot to mention in my first posting that when our mare's tail was amputated and cross sections for pathology and cultures were obtained, we found several of our maggots had gotten trapped in the center of the diseased tail, dead of course. Talk about eating yourself to death.:chuckle End Game, RN

Update..Geez, this particular issue has totally captivated me as it marches right along with what we are experiencing. This has me fired up!!! Not all change is good. The only good thing about bad change is that hopefully you can learn from it and move on. Managed to clock in two minutes before 0700. Several meetings today..I found other things to do, kept busy. O.K, here is the outcome of these unplanned staff meetings..05/13...ready for this? If a physician or other health care professional brings a patient's chart/MAR, whatever into a patient's room, is observed doing so or somehow forgets to take it out again, and this is observed by management, the NURSE assigned to that patient will get a memo since we are the ones who are required to educate all staff about this policy and to police others who may violate this policy. Nurse Storm Troopers. always wanted to be one of those. O.K. what about this one. wash your hands with soap and water for 20 seconds, dry your hands..or use purell to cleanse hands, shake until dry, then proceed to either perform patient care or leave the room. as soon as you enter the next room, right after this hand washing/cleansing routine, you must repeat the entire hand washing/cleansing you just completed 10 seconds earlier.. or you get a memo if observed not complying with this.. Another one...if a patient arrives from the OR, Trauma Resus, Recovery, ER...from another facility...what ever..after 1800 hrs..no matter what is happening, you must admit this patient, perform all necessary assessments, vital signs, maybe even transport patient to another area of the hospital for surgery, tests, procedures after intubating and placing invasive lines...complete computer generated forms for admission assessments, Braden or Morse scales, may both..can't remember which one, communicate with the family and of course meet all of their needs, including social work evaluation, counseling for those who are overwrought with the situation...name it..winning lottery numbers, we have to do this..and complete everything before 1923 hrs. We do have a very supportive group of colleagues. We help each other all of the time, but even with this level of assistance, some of these requirements are unrealistic and simply insane. Patients first..the rest can wait. Or you could get a memo. I get all of the issues and agree whole heartedly with observing and following policy and procedures, chains of command such as administration of medications, right patient, consents, proxy, right procedure, right time, right body part, right Karma, before any and all procedures. This is a safety issue for all patients. Big Duh.. But this too has become another thing to threaten the staff with... You'll get a memo..Ooooooooo:banghead::banghead::banghead: I am a firm believer in following policy and procedures. I am a strong advocate of patient and family rights. Signatures need to be fully legible..NO PROBLEM like that one. F/U with results of pain medication, document fully before and after response to medication and patient's impression of effectiveness of medication..This is absolutely necessary and again, no problem for nursing. ETC................................................................ GOT THIS AND AGREE 100% Many of these requirements, issues, directives are logical and necessary to promote safety, quality of care to our clients. On board with that and teach it myself to the new staff. But..then we get to how it is presented... three or four memos, your screwed , record of counseling, get another group of memos..remember someone left a chart in your room and you were not present 'cause you were actually working with another patient or transporting another patient off the floor... BOOM.. memo #1. Record of counseling, I think three total..on top of the memos. Unpaid three day suspension with this all on your permanent record. Actually I'm not sure at what stage of these disciplinary measures we get fired. AND WE HAVE A UNION. Morale now sucks rotten eggs in our unit. We were talking amongst ourselves and pretty much came to the same conclusion.. Someone or group of someones have lost their minds. Much of this is not at the immediate supervisory level, but is directed from above.. I spoke with some of "MY PEOPLE" I do have some of those..I explained my fear of alienation between physicians and nursing staff as a result of nursing being asked to police physician behavior and report it if necessary. I spoke with a few docs today and to a good friend, an ARNP for one of our teams, what the problem is, what we need to do to avoid conflict, being turned against each other, simply by not bringing the stupid chart into the patient's room. Take off lab coats, don't touch the patient until dressed up like a giant yellow condom with gloves (I triple glove).:chuckle I AGREE WITH ALL OF THIS, JUST DON'T THREATEN US. WE'RE HAPPY TO COMPLY ALL BY OURSELVES, REALLY:confused: Not being a "Gusano" and having had a mother raised in Nazi Germany with her own stories to frighten me with, I simply will not cooperate with reporting others, my Docs, my colleagues to those who could care less who gets hurt or how the discipline of the miscreants will affect the morale of the rest of the staff. I think this is all that organizations fault..not to diminish the importance of this regulatory organization, we need oversight!! we need objective input !!!so we can continue to strive to be the best that we can be..but whats their name again?? I can never remember their initals. You know who I'm talking about. And they are very powerful and scary... You don't encourage loyalty through fear and resentment. Difficult day again today, one more day then I am free until Tuesday next. I sat after clocking out at the station in the back of the unit..once seen by one of my associate nurse managers, I was told to go home, why was I still here..said very friendly of course. He really is a cool dude but he must follow the party line. I replied that I had nothing waiting for me at home, I was lonely, have little human contact outside the hospital and at least I had someone to talk to here. Most of this is true so it sounds good. Fell asleep driving home again tonight. Stopped and parked near a favorite Cuban restaurant, apparently fell asleep woke up approximately twenty minutes later clutching my keys and purse, ready to get out of the car. Took me a minute to figure out where I was. Good place as any to pick up a home cooked meal and hang out with my friends at this restaurant. A large Cuban coffee and dinner, I was awake and I'm still awake and writing this at home. I hope things get better. Bye, soon it will End. We'll see where things go from here.

Hey RainDreamer, I don't want you to think that I believe everything is bad here. So many others employed throughout this hospital are absolutely some of the best people I have had the honor of working with. I have had wonderful relationships and experiences with those in administration. I have invited several of them, many times to sign on to this forum. I think this would be an eye opening experience for them, not that they need this personally, but only to see how things are in the nursing world as a whole. Everything seems to be happening locally..that is, within our division and/or our ICU. Changes such I have described are happening elsewhere as well but I have not heard any complaints or concerns from others in our facility regarding these changes. Perhaps because the approach is different in those areas. We have never had this happen like this before, it began approximately 2 + years ago and has slowly evolved into its current form. What it is exactly I can't say. Just that not all change is good, especially when it is perceived as being dismissive, disrespectful, judgmental and dictatorial. Those who may have read other postings I've written know how respectfully I write about our ICU and our "family". We are a great group of people who are simply tired of the latest fads in nursing. I must state again that I would not be who I am (this is a good thing) without having had the good fortune of beginning my professional nursing career in this facility. I have outlasted many administrations..they come and go...move on...what ever. Many of us remain and just do what we do best. Yes I am dreading going to work tomorrow. I wish that I didn't feel this way. Feeling this way is alien to me. I'm going to try my best to actually be on time, without shaking as I swipe in. I am going to hide (in a professional manner that is). This too will pass, I hope. If not, there is still the rebar in the truck idea. (Chill guys, just a comment). I am so exhausted!!! Maybe if I could get my circadian rythym back in sync with my working life I would be in a better mind set to keep all of these "changes" in proper perspective, ignore idiotic directlves, and give other "suggestions" a fair hearing. Just trying hard!!!!!!!!Look, its 0035hrs. I think I'll actually be in bed before 0130. Good luck to all of you who are going through all of these changes and the challenges these changes bring to all of us. Perhaps this is the End, perhaps not. I'll see how things go then decide. Good luck to you all, and Good night.

Just to let you know that I fear returning to work Thursday. I'm sweating thinking about this. I've already begun anticipating all the weird stuff that has been happening lately in our unit. On my days off, from the hospital that is, I'm spending half the day in bed after I have woken up, praying that this day does not pass so quickly as it seemed to do the day before. These are the days I have ear marked for the farm. I've been late to work several times this current and pass month. Waiting for a memo. Lately (the last few months) I hide in my patients rooms and hang out with the family/friends. I only go out to help another colleague and flee from any approaching "boss". All of our unit beds are in private, enclosed glass rooms, some have one wall. You could say that this over supervision has improved the quality of care in that it is more desirable to hide in our rooms then to be found in the nursing station and have it implied that we are not doing anything. Having computers in the rooms has facilitated our hiding as we can get a lot done while avoiding detection. Cat and Mouse..who wins? who is the cat? who is the mouse. It seems to shift back and forth in this passive aggressive game of Us and Them. Its now 0313 hrs on Wednesday morning. I'm sitting here at the computer having a majory anxiety attack about Thursday. Wish me luck!! Hope some hospital administrators are actually reading these posts, it actually would be a good idea if some of them would join allnurses.com. I told all of my people, including "chiefs" about this forum, even gave my "name" that I write under. Perhaps I'll here from one of them. Gotta dry off, still sweating thinking about tomorrow. End Game RN

Long time, no time. working 24/7.Missed you!!! Read some postings as a guest. Yes..to everything. Do this, go here, do that, be quicker, threats to address problems of staff members poor time management. "What do you mean you didn't have a break..lets talk about it.." "Why do you spend so much time with families?" "You let that family manipulate you, its your responsibility to control your patients and familie..." "be more compassionate..take time to communicate with your patients" "We provide a service, and we must always think in terms of providing excellent care" We have a policy of scripting, you must.."and then we are "educated" on how to introduce ourselves to our clients. When finished providing our "service" we are encouraged to ask the patient or who ever if there is anything else we can do and we hope we provided excellent service.... I wanted to resign Saturday, June 7!! I am over all of this b...s...! I have had it. Considering how much I Love my ICU, my "people" representing every aspect of a large hospital, I feel as if we are simply cogs in the wheels of a large health care facility. We are not people, we are tools. It is amazing how those who don't work in the trenches, so to speak, have no idea what it is we, the people, actually do. Hour long staff meetings where no one wants to say anything :zzzzz since this inevitably leads to another 30 minute lecture. Then some wonder why we are behind. Physicians who can't find and RN because we are sitting somewhere, often times like dummies, glassy eyed, mind numbed, wondering when this unscheduled staff meeting will ever end. Lately I just walk away, I have stopped caring, not about my people or my patients and families..oh no... We recently completed some sort of survey to find out how we feel about, well, just about everything. Last years was a nightmare..asking the same questions over and over again, sometimes the same questions, just written in different ways, over and over and over. AND THIS WAS MANDATORY. And this is abuse!!!!!!!!!!!!!!!:angryfire This is the first time ever in my professional life I replied in the negative to nearly every question, or just mildly negative. My colleagues state that they did the same thing. Last years insulting survey contributed to these responses. One more Magnet Star reference and I will detonate. I sing a little song. It is generally greeted with laughter:yeah: I'm a Magnet Star, I'm a Magnet Star No matter where you are no need to travel far 'cause now we're all Magnet Stars How old are we???? I am in crisis. personally and professionally. I just want to be the nurse that I am and that has worked exceedingly well for me over the last 28 years. I am in no need of a novice administrator telling me how to be a member of the latest fad in nursing. I AM NOT A MAGNET STAR..I AM AN INDIVIDUAL, I AM A PERSON, ABOVE ALL I AM A NURSE!! I will miss morning break and lunch if it is indicated. I will continue to be available to my patients and families 24/7 while they are still in my unit. I will continue to buy food for them and give them my dvd player and movies. If I want to go to a patient's funeral, I will do so. No one can tell me how to be compassionate. I am a seething cauldron of emotion and love trying to understand and feel the pain and fear my patients feel. I cried all day yesterday because of the death of two patients and the expected death of a third. two were mine. Their family's were mine, their pain was mine and their loss was mine. No one can tell me how to do anything different. Yes, they all have my cell phone number and I do speak with who ever calls me. I am crying now as I write this As I have written here in this forum before.. I am what I do, I do what I am. When those who want to improve the quality of care of our patients and by extension their familys understand what I do, accept it, perhaps embrace it, then I will accept advice from my "betters". I don't need to do any overtime. I refuse. We were informed that once we clock out, we need to, as quickly as possible, leave the floor. Get out and Get off. Do not pass GO and God forbid you forget something and have to come back, you'll be questioned. Lately no one is observing this. We all just seem to hang out and speak with our friends/colleagues. We wear uniforms/scrubs of our choice now..clean and neat, shoes clean. Heck..maybe I'll buy a teletubby color scrub. :chuckle Passive resistance has grown. Discontent and anger hum softly just beneath the surface. Bad things were done to two excellent staff members who had the misfortune of getting sick. What is happening? I feel like the bewildered characters in the strange movie Pleasantville, as change occurs, not necessarily bad, but in such a way that the affected black and while characters could not adjust to the speed of the change. I fall asleep :zzzzz driving home from work, oncoming headlights seen through my closed eyelids are the only indication that I have fallen asleep driving. I once woke up asleep in my truck in my driveway after work and had no memory of driving home. I pull over to the side of the road and take a catnap just long enough to get me home without causing an accident. I am exhausted and yet can't seem to get to bed before 2 a.m every night. Here I am at the barn writing this and its very late, 0110 hrs. I still have to drive home, but I am wide awake at this time. So..what to do... I'm gonna do what I always do..take care of those that God chooses to put in my hands and just do the best that I can do. Fads rise and fade then go away. Some come back another day. :chuckle I've started provigil. Eeka End Game, RN P.S Hey, won nurses week 2008 exemplar contest. Submitted two. Won't go to Utah this October (prize). I don't travel well. Not that far for two days. My horses will miss me. P.P.S Got a baby bull calf..so cool!! Hes really little. Never had a bovine before. Not everything is bad.

MDT for my beautiful horse Background for my questions. Require information from burn and wound care staff. Sorry so long, want the information out there so you know where I am coming from. My 7 year old mare, a grey Andalusian PRE has severe tail pyoderma with complications involving extensive bacterial and fungal infections. She has also developed an extensive Melanoma tumor of her tail. The lower third. This tumor is necrotic with foul black liquid draining from tracking wounds within this mix. Effectively used recommended treatment for the infections and tunneling wounds and above described drainage. I researched this from numerous veterinary sources from the internet and textbooks.Success came in the form of tremendous slothing of necrotic tissue exposing some nasty tissue but noticeably cleaner. I read about maggot debridement therapy and finally called Monarch Labs, obtained maggots and applied them after preparing the site. As per several articles I read within three days we removed the dressing and found beautiful pink tissue. The concavity of the lower aspect of the tail was now 90* % filled with this viable granular pink tissue. Horse now "happy" and more alert After initiating all of the wound care provided over the past three weeks as described above. The maggot therapy being the last. Today I used Ethezyme 830 ointment on remaining grey-black necrotic (but very soft) tissue at the top of these lesions, used duoderm gel on the healthy appearing lower aspect of the tail and wrapped it all up in a neat package. Need to re-educate my people and partner about not squishing the maggots while I was at work (panicked when maggots became visible through loosend dressing) they were proud when showing me how tight they applied a new dressing (ARRGH!!!) I was informed that the treatment was disgusting. Question: Has anyone out there utililized MDT on their burn patients or patients with extensive infected wounds (trauma, bed sores, tumors...etc..? Read a hundred or so articles on these treatments and medications and biotherapy but I would feel better if I could get feedback/advice from the experiences from others. I realize this is equine, but hey, we're mammals aren't we? Got graphic digital photos from the beginning to today. I will submit this information to Monarch Labs and continue maggot therapy after I convince the guys not to murder my new friends. FEED BACK PLEASE!!! Thanks; End Game RN

I love precepting. When my orientee is through, has consistantly done well, I reward them with nursing tools, you know all of the stuff we like to keep in small plastic boxes,or decorative small shoulder bags. One nurse to this day uses old fashioned tin lunch boxes with a superhero on it. It is so cute! I have bought lunch for my orientees upon completion. One orientee had experience with horses in her country of origin, I offered her to ride one of our horses and finished up with a late lunch to Shorty's Bar B Q. At this time, after eighteen months with us, she signed up to be a traveling nurse. Shes young, single and was still living at home. I told her if she wants to do something like this, she should do so now before she settles into a routine here in Miami. Expand her horizons, meet new people, etc...She was an excellent orientee!! There are those who simply can not make the transition from school to the ICU program, or from a med-surg floor to the ICU program, its important to have a good relationship on both sides when this is being evaluated. Some just need the med-surg experience and develop organizational skills and continue to develop their communication skills with patients', families, co-workers representing all health care worker classifications, as well as developing relationships with all nursing management staff on the floor where they are working. If a preceptor and orientee relationship does not appear to work out, we speak with both of them, and get another preceptor to work with this "student" We are not hostile towards the new (potential) staff member. They are encouraged to become a part of "us" As a rule we're pretty laid back when working with students. I have had only two orientees dismissed in 28-29 years of nursing practice. Others may leave on their own, knowing that they needed more experience than an ICU program with clinicals, classes, exams. Some we didn't mesh..and we worked out another plan for their orientation. Overall, the advice and support given to you by the people who posted their thoughts about this, I would listen to. It is time to cut your losses and move on. 11g may have been a little harsh, but this does speak to the truth, which lies somewhere between your "truth" the preceptor's "truth" and the actual "truth" Its important to look at yourself objectively. Believe me when I tell you from personal experience this is not the easiest thing to do. Good Luck, learn from this and accept this as an experience that helps you grow as a person and professional. End Game RN

Hello out there I appreciate the input. It was excellent!!! I had a lot of fun writing this. Thought adding "Hit me with your best shot" would get a quick response. I'm a very strong proponent of free speech. I do not tell people what to do or what to say or think, only an opinion that it is better to be kind when speaking about someone we don't know. Not all of these posts were insulting and judgemental, many were compassionate and had legitimate criticism. I was not addresing those who offered reasonable commentary, just those who seemed to mock this person. We are as a rule a very compassionate group of people who chose this profession because we felt it was our calling. It helps to love what you do, and the bonus is that we are paid for something we love doing. With respect End Game RN