registerednut1221

Thanks. I missed the subforum altogether.

To put it quite simply, I have come to a point that I have to make a change in my job. I work in an LTAC ICU and I love the work that I do, but there are problems on a management level that I can no longer ignore and I see no end in sight. In recent weeks, we've had a few travelers come through and I have found myself envying them in that they are not here to "fix" anything. They don't have to care one way or the other that our management is broken beyond repair. They will work their contracts and move along to the next. I'm thinking I might enjoy this for a bit. I am married and I do have kids (13 & 16), but I'm thinking if I can take assignments within 2-3 hours from home and work 3-4 days in a row I will still be home the majority of the time (and probably be in better spirits to boot). Hubby is supportive and the kiddos are fairly self-sufficient and we have a great family support system. What I'm saying is that the travel isn't going to be a real problem for the family---we're an extremely stable unit. Also, 2-3 hours from home includes Atlanta, Charleston, SC and Charlotte so it's not like I'm really limited there. I'd love to hear from some of you who have done travel nursing. What should I ask my consultant? What should I really prepare myself for?

First let me say that I love Grey's and House, but I know what you mean. There was one Grey's though that the nurses went on strike and that was pretty cool. The place was falling apart. At my hospital we have been blessed with one of the best docs in the whole world. He will help a patient with a bedpan, help pull them up in bed and back his nurses 100%. We're not technically allowed to take verbal orders from docs at my facility, but short of this man telling me to stab my patient in the eye with a fork, if he asks me to do something I'm right on it. I do realize that docs like this are few and far between and this one is set to retire at the end of the year. He and I have talked many times about the lack of respect for healthcare workers (both nurses and docs). He has been a doc for a long time and he says that the prestige that docs use to get is long gone from what he can see. I told him that with nursings beginnings being that it was the job of prostitutes and criminals to care for the sick that I think people still get confused and think we're there working out some sort of community service. I understand the concept of customer service, but at some point this has got to stop. If you go get your nails done and you're not happy that's one thing, but if you are seriously ill, I don't care whether or not you're happy while I'm trying to save your life. I actually had a patient a few weeks ago with a horrific GI bleed. Her pressure was like 70/30. I had her on her head, fluids going in through every port she had and just fighting like crazy to get her pressure up. She was still alert and actually wanted me to stop what i was doing and find her tv remote!!!! I was livid. I told her very firmly that she would have to wait. I said "I'm a little busy saving your life right now, we'll find your remote later!" Well, i have rambled way off topic (I couldn't help myself ;-).

I have worked for over two years at a facility that I love. I love my co-workers. I love the docs. I love the type of care we provide. It's a long term acute care facility and we get a lot of VERY complicated patients. We also have a 10 bed ccu (this is where I normally work). It is always interesting and I have learned so much there, but over the past couple of months we have developed some "management" issues. I'm starting to feel as though it is time for me to move on, but at the same time I feel as though I am being forced out of my "home." We're short-staffed. What's new, right? How about 7 very complicated patients per nurse and no cna? 8 ccu patients for two nurses and no cna. Is it this bad everywhere? ALL of our patients are on contact isolation ALWAYS (facility policy). We've gone to our supervisor, manager and DON with no positive results. One nurse told our DON that due to our heavy patient load we are unable to provide quality care for our patients and there is no time to chart. His response was "When have you ever known a nurse to lose their job over charting?"!!! I have been working 60+ hours per week since January with no end in sight. Now, the powers that be want to further increase our census and we're losing 2 nurses already. The docs are frustrated, pt/ot and the nurses are all at each others throats and management doesn't seem to care. I've been thinking about scheduling a meeting with the hospital president, but I doubt it would do any good. He's as clueless as the rest of them.

I'm not sure how much my opinion will mean on this subject because I have taken Ambien on and off for probably 4-5 years now. Let me explain...I do have insomnia. I have tried all the meditation, sleepy time teas and OTC remedies known to man. I've bought special mattresses and even tried hypnosis. I've cut caffeine completely out of my life. I've exercised before bed, middle of the afternoon, early morning. I've taken warm baths, cold baths. Listened to relaxation tapes...Nothing worked. I can literally go a week at a time with no sleep...not that I don't get tired or sleepy, I just physically cannot sleep. Without sleep, my head aches, I have trouble functioning/concentrating and I get really "snappy." I take Ambien on days when I know I will have to actually get up and function the next day but if I'm off of work for a few days at a time, I skip it here and there. I do also rotate Ambien with Lunesta as to not build up a tolerance. Now, with that being said, am I addicted to Ambien? I guess one could make that argument, but I take synthroid every day so one could argue that as well. I cannot speak for your friend, but it is not the Ambien that I need; only the sleep. I average about 5 hours a night with Ambien and I have no trouble getting up and off to work/school/whatever. I don't think Ambien is any more addictive than any other medication, but I could see how someone could abuse it. I don't NEED the Ambien, but I do need the sleep that Ambien allows me. Does that make sense?

I am so emotionally exhausted and think I am just long overdue for a good cry. There must have been some sort of special on crazy families and we racked up. We have one patient with a daughter-in-law that comes in to start trouble almost every day. She goes so far as to make things up like...pt hasn't had a bath in a week, (pt weighs nearly 400#s and has c-diff----she gets a full bath probably 4 times a day because she's in such a mess from the diarrhea) pt c/o chest pain and no one ever came (total BS). She says that a staff member told pt to shut up or she would be locked in her room (it's a small facility and pt's room is less than 20 ft from the desk. If anyone had said that, everyone would have heard it) She actually came out in to the hallway at shift change the other night and started yelling and swearing at the desk! At this point she is demanding that we call our administrator (now mind you that the family had already changed their password at this point and told us that she is to have no information about this patient and they had all been informed that if there were any further issues this family member would be escorted off the premises) So we called the cops, had her escorted out of the building and locked the door behind her. We had to have a guard posted at the door (of a 40 bed facility!!!) to keep this nutcase out. The patient is a sweetheart and is a bit confused so she really doesn't understand what happened, but was still quite upset by the whole episode. As if that weren't enough drama for one lifetime we also have another patient with a crazy wife and daughter who thinks it a good idea to threaten to sue everyone all the time. This poor man is ESRD, COPD and had a big fat sacral decub. We had placed a wound vac (which is the only way this wound will ever heal), but the family wanted the wound vac ripped off and completely changed 4-5 times a day EVERY time he had a bm. Not that it was soiled (because it was sealed) but just because it "seems" nasty. We tried to explain how a wound vac works, but they wouldn't hear of it so we were forced to take the wound vac off and are now watching this decub get bigger and bigger. He was supposed to go for vein mapping last week, but the family didn't understand what vein mapping meant (even after the nephrologist had explained) and threatened to sue us if the patient was taken for this procedure! We had a bed held for him at another facility that takes dialysis patients but they refused it and pitched a major fit saying that they were sure the patient had a concussion from a fall over a week ago at our facility (while they were in the room)...CT was negative just so you know. NOW, after they need our "incompetent" staff to come in every time this man sneezes or takes a deep breath, they have demanded that they are taking him HOME. They can't get him to the side of the bed without assistance and they think they are going to be able to get him in and out of a car 3x's a week for dialysis and they're going somehow manage to change his sacral dressing when bm freaks them out???? They have refused any medical equipment (bed, wc, bsc). 3 docs and the discharge nurse have tried to convince them that they may be trying to take on too much, but they are certain that once they get him home he will be fine??? I could almost understand if they were going home with hospice so that he would be comfortable and enjoy his last days, but I know they are going to get him home and get themselves into a situation that is not going to end well for him. I adore this man and I want nothing more than for him to be comfortable, but this is not a good situation. It feels as though someone (albeit with good intentions) is ripping my child from my arms and there is nothing I can do to stop it. Now, we just sit back and wait for it all to go straight to #@&& and get slapped with a big lawsuit for allowing them to get themselves into the situation they are heading for. Damned if you do and damned if you don't. I LOVE my work and I can't imagine myself doing anything else, but sometimes I just need a stiff drink and a big box of kleenex!!!

Don't give up. I was a horrible student in high school and I didn't even think about going to college until I was 25. I got my ADN through a tech program and am now in the university transfer program for my BSN. Tech schools aren't usually quite as strict on grades as four year universities and college classes (in my opinion) offer an environment that is much more conducive to learning than high school classes. Trust me, I failed BASIC ALGEBRA I in high school so I know first-hand what it feels like to be in your shoes.

ok, dear. First off, to a certian degree, it takes a sick twisited individual to even be a nurse. To deal with what we deal with day in and day out. I'm here to tell you, if I let it all make me feel *sad* there wouldn't be enough anti-depressants in the world to stop me from jumping off a freaking bridge somewhere. I LOVE my job. I LOVE what I do. I LOVE all my patients and their families (even the stupid ones). I do however have to have an outlet to release some of my frustrations so I won't be the crazy lady you read about in the sunday paper that just plowed her car through a shopping mall for no apparent reason. (some people just don't know how to handle their stress. *sad* isn't it?) Second off, I'm sure most non-healthcare people would be mortified at some of the posts here, but I would also hope that they might learn a thing or two about being a patient or a patient family member in the healthcare system. As far as venting on a non-healthcare site...I wouldn't dream of it. For the general public what we do is un-imaginable. It's kind of like that movie A Few Good Men when Jack Nicholson says "The truth? You can't handle the truth!"

This is the second time in the past 3 weeks that we've had a family that was just adamant that the nicotine patch we have put on their family member was the source of all their problems. 1st patient was a young (30's) severe drug/ETOH abuser that had drank and drugged himself into MVR and a pacemaker and was now on a vent. Nooooo, it couldn't be drug/ETOH withdrawl, it had to be the freaking nicotine patch. His mother SWORE he only smoked a couple of cigarettes a day and that there was no need for that patch. 2nd pt is a middle aged deaf/mute drug & ETOH'er who decided it was a good idea to get absolutely tore the ***** up and drive a car. So, now on top of all the issues she had before let's add a closed head injury! BUT do you want to know why she's really so squirrly now??? According to her family, it has got to be that @#$%% nicotine patch. I spent about a half hour trying to reason with the daughter that this nicotine patch was the LEAST of her mother's problems. Daughter's reasoning was that "Momma don't even remember the wreck, I doubt she remembers that she smoked." I tried to explain that her body remembers and that we were slowly weaning her off the nicotine. She wouldn't hear of it and wanted the patch removed IMMEDIATELY. Whatever. I took it off, charted it and put a note for the dr on the chart. It said..."Patient's family insistant that nicotine patch be removed. They are confident that this is the source of all her problems. I removed it at 2154. PLEASE call me if this fixed her." Dr actually got to the chart before I left that morning and nearly peed her pants when she read it. There was a comedian a while back that would do a joke about stupid people. He said life would be so much easier if stupid people just had a sign on their forehead so we could identify them and not even bother. He said it would be like "You see, this is how it's done...Oh, my bad. I didn't see your sign. Nevermind." I'm all for it. I think this would save me a lot of time.

A few months back, our facility tested EVERY employee that has any contact with patients for MRSA. It's a fairly small facility but still that was around 100-150 employees. Out of those, only 13 were positive. This is a LTACH where the majority of our patients have already tested positive for either MRSA or VRE before they even get to us (extended hospitalizations/long term antibiotics/immunocompromised...you get the picture). I was completely shocked that the number was so low (and that I wasn't one of them).

My nursing school buddy passed out cold while we were watching a circumcision. I still give her a hard time about that one!:rotfl:

Let me clarify this with these are my "work" best friends. These are the gals that I love to work with and we make an awesome team at work, but we've all never really hung around together outside of the hospital. We call and warn each other about the day they/I'm/we're facing tomorrow and vent here and there. But that's about the extent of it. I did actually work with one of my best friends once upon a time right after graduating from nursing school. Nothing went horribly wrong or anything...I just wouldn't recomend it.

I am doubly blessed in that I have not one, but two best friends at work. These are the girls I would jump in to the deep end of the ocean for and I know they would do the same for me. We have worked the trenches together and, no matter how bad it gets, as long as we're there together, we know we have it covered! I think I'm a pretty darn good nurse, but I know working with these two makes me that much better!

Ok, we (I) spend a lot of time venting about our jobs, our hospitals, co-workers and patients. I personally think that it's healthy to "get it all out" (though obviously there are some here that would adamantly disagree with me). There have been many days that I have asked myself why an otherwise sane person would keep going in to a job where they're expected to do the impossible on a daily basis, take crap from patients and family memebers and subject themselves to a lawsuit every time they walk through the door. Here's why I do what I do... I work in a LTACH. Some people think we're nothing more than a glorified nursing home, but truth is we get the sickest of the sick. A lot of times our patients are only there because there is nearly no hope of survival, but the family refuses to change their category status. We have an occassional cat 3 or 4, but mostly our patients are cat 1's. We deal with families that are irate that their 90 year old mom who is s/p cabg, on a ventilator and a cardizem drip didn't get up with physical therapy today. Our patients often stay for months before moving on (one way or the other). I once had a supplemental nurse that I was orienting ask me "Why do you stay here? How can you do this?" I pointed to a lol on our ICU unit who was, at the time, all but completely comatose, on a vent and was seriously at death's door. I told her I stay here because if you hang around long enough you might just get to see that lady walking in the hallway. I stay because you never know and I have to see how it ends. I fluff pillows, I get coffee, I beg the kitchen to fix something out of the ordinary in the hopes that my patient might eat more than 10% of their meal just this one time. I have gone on my lunch break to get crazy stuff like buttermilk for a patient that was craving it or air freshener for a new ostomy patient. I have dragged patients in thier bed and on a vent so that they can see the sun and feel the wind on their face for the first time in months. I have been at the bedside the moment a family has realized that their family memeber wasn't going to make it and I have provided them with whatever support they needed as they sat by the bed and watched their loved on fade away. I have held the hand of a patient as they take their first steps. I have held the hand of a patient that has just been told they will never take another step. I do it because someone has to. I do it because I am capable of doing things for people that they never wanted to have to ask someone to do and I can help them retain at least some of their dignity. I do it because, even on my worst days, I can't imagine myself doing anything else. I do it because I love it. Why do you do it?

I had a patient who had refused her colace for DAYS (and had not had a BM in about as long) tell me that she was consitpated and seriously asked me "Whose your 'digger'?" OMG! I told the doc of this incident and told him that even if my job depended on it, I absolutely REFUSED to go "digging" in this nasty woman's @$$. Hey, I'm here to help and I'll do pretty much anything BUT you gotta draw the line somewhere!