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Content by htrn

  1. I can spot a kidney stone a mile away, an no, I don't think any of us think someone coming in with a kidney stone is silly. They are incredibly painful and do require intervention sometimes. Don't ever feel bad for going to the ER for that. Heather
  2. I am the "nurse in the family" and really love being there for family members when they go to appts, referrals, etc... There has to be a business opportunity out there for this. What do you think? Consdering putting an ad in the local (very small town) paper for a "Healthcare Facilitator" - get to know patient and family, go to doctor appts to make sure concerns are addressed, all questions asked and answered then follow up with patient and family at home. Is there a way to bill for this type of thing or would it all have to be just private pay? Anyway, just a thought. You always have such wonderful responses and insight and I appreciate your comments. Thanks
  3. I am a staff nurse at a rural hospital that suffers from rampant horizontal hostility - not only condoned by management, but rewarded by management. There has been a 20% turnover rate in the past year and I would attribute most of the nurses leaving to this hostility. My question is, what can I do to get management to end this problem? Is there a program to end this problem? How do I approach management and tell them they need to address this issue? Are there legal implications for the facility if they don't address the problem and do something to stop it? There is lots of research out there about horizontal hotility/lateral violence, but not alot out there about how to stop it. Any suggestions would be greatly appreciated. I like what I do and feel strongly that we need to have a good hospital in this rural setting, but I don't know how much longer I can work in this toxic environment. Thanks.
  4. htrn

    Professionalism write up

    Help - was written up for "unprofessionalism" & then terminated for the same write up a few days later (with no other incident). Termination aside, I am dealing with that in another venue :-) I am looking for courses, books, seminars, on-line classes that I can take or study that would prove that I am proactively trying to correct this problem. Have no idea how to address this with applications for other jobs or how to address this in an interview. Would love to say that I have done X,Y & Z to address this concern - but don't know where to start. Thanks in advance. Allnurses is a life saver.
  5. htrn

    Professionalism write up

    I admit that I suffer from a congenital lack of a filter that is worse at sometimes than others. This is what I want to be able to able to show significant personal growth on and am just not sure how to do it. There is also a general concensus that, because I have been upset and vocal with administration about a certain issue pertaining to patient care, that it was a way to shut me up. I got a written warning that was very specific, and is very embarrassing, but did not negatively affect the patient. I was not given an opportunity or a plan for improvement and had not had another incident before being called in and terminated. The incident occured 20 days before it was even brought to my attention and 24 days prior to termination. Was I wrong - yep. Do I want to fix the problem - yep. Do I need direction on where to start - uh huh.
  6. htrn

    Passed CEN!!

    congratulations! I'm studying to take mine as well. Any advice or study techniques you would be willing to share would be greatly appreciated. There are some questions I look at and just scratch my head and think - huh? Is that really a word or did they have Jonny Knoxville help write this book.
  7. htrn

    Seeing Psychiatrist hurt job chances in this market

    Congratulations on going to college - very hard work once your married, esp if you have kids. Don't worry about anyone finding out about marriage counseling, medications prescribed, seeing a psychiatrist, etc... It is illegal for future employers to ask and for your health care providers to tell. As far as them guessing at a diagnosis based on your medication list - they can try, but so many medications are used "off label" that it would only be a guess on their part. I am, however, more concerned about your husband wanting to go to a psychiatrist for marriage counseling "just in case anyone needs medication". The psychiatrists are not marriage counselors - you need to see a psychologist or a social worker that specializes in marriage and family counseling. They are trained in referring people they feel may need medication to their primary care provider or a psychiatrist if meds are indicated. His comment really looks like he feels that you are the problem and if you get on meds his life will be wonderful again. JMHO. Nursing school sucks under the best of circumstances. It's demanding, stressful, hard work with extremely long hours. But it's also so worth it. I hope your husband gets behind you to support you through school and I wish both of you the best of luck with marriage counseling.
  8. htrn

    sundowners in young adult?

    Thanks - things getting better with an increase in meds and new behavioral mod program. :-)
  9. Have any of you ever heard of a young adult (18) having sundowners? This patient has several psych dx (bipolar, pervasive developmental disorder, explosive personality, and cognitive delay with IQ ~ 75). It seems like 4-6 evenings out of the week she has bizarre behaviors - requesting to be "put into an institution", running away, lashing out and hurting family members and pets, destroying property etc... Was just wondering if anyone else has ever seen this called sundowners? Thx
  10. How does your facility secure your crash carts. We have several crash carts, one in our ER Trauma room. They currently have the breakaway red locks that are numbered - so if the number changes, you know someone has been in the crash cart. Our crash carts do have meds, but no narcotics or controlled substances. Do any of you have different locks on your crash carts? Combination locks, keyed padlocks, etc... and is there a real need for those types of locks on crash carts. Thanks everyone. HST
  11. htrn

    Bicitra in labor?

    We had on anesthesiologist give bicitra and reglan to anyone getting an epidural - and if they refused the bicitra he refused the epidural. They all get it for c-sections though. Had one woman on mgso4 ready for epidural and MDA was standing next to bed when I gave her bicitra - she had been clear liquids only for a couple of days - she puked bile all over him That one did get her epidural :):
  12. htrn

    How do you secure crash carts?

    Just wanted to give everyone an update on the locked crash cart situation. Our carts are now locked with a combination luggage style lock. We have a bolt cutter mounted on the back side of the crash cart incase someone can't get it open. We have run multiple codes from the locked crash cart. Things have actually worked out just fine. We have had no real big problems getting into the cart in a hurry when needed and it seems everyone has been doing very well about restocking the cart appropriately before locking it back up. I hate the idea of it, but I have to say it has been working out.
  13. If I were on a plane (and that's a BIG if:no:) and If I were still sober by the time I got on the plane (an even bigger IF:D) and if there were an emergency that I was needed for:eek:, then I would absolutely help out. But, I hate dealing with airlines and airports and security, so if I can drive there in less than 18 hours, I'm driving. I figure if they insist I be at the airport for several hours before a flight, I'm gonna enjoy myself at the bar But I do make my hubby crazy by insisting we stop at accidents if EMS has not arrived to offer assistance - while on our 18 hour drive we took to avoid airlines, security and airports :p
  14. What is the requirement to report injuries that are the result of a crime/domestic abuse? If you have a patient that tells you she was physically assaulted, but then says she doesn't want you to report it, is it mandatory to report it? If it isn't mandatory to report it and patient goes home to be shot and killed by same hubby, is the hosptial, nurse and/or doctor liable for not reporting it? If it helps - this is in Wisconsin. Thanks
  15. htrn

    Have you ever had a pt that you knew in real life?

    I too work in a small hospital in a very small community. Most of my patients are people I know and more often than not, I'm related to them through my husband. They are often suprised to see me, but like so many others have already posted, happy to see a familiar face. As for word getting out that I took care of someone in the ER - my husband will come home from work and say that so and so stopped in and told him I was there nurse. They're always shocked that my husband had no clue :-)
  16. htrn

    Does allnurses.com make you a better nurse?

    Yes. Allnurses gives me a forum to ask and answer clinical questions, or atleast point me in the right direction to find the answers. It also gives me a forum to seek support during trying times at work, advice on how to deal with specific situations at work or with patients and it keeps me informed about nursing news around the country/world. It is a wonderful resource!
  17. Days = Administration around/lurking and watching, phone calls out the wazoo, family asking/demanding, doctors, pharmacists, 2 meals, baths, therapies, social workers. IMO, too many distractions from actually taking care of patients. Evenings = Admin (and most other office types) gone by 5pm, one meal, visitors, HS cares, sundowners. Nights = no office types :-), no meals :-), rare family/visitors/phone calls :-). Pt load usually a little higher, but fewer "tasks", usually a much "tighter crew" - you are forced to be a team player and help each other out due to lower staff numbers. It is also an opportunity to do a really good assessment and review the chart to, possibly, find things that may have slipped through the cracks because of the pace on other shifts. I can't tell you how many times one of us on nights has said "did anyone notice ....." and that one little piece is the missing link in that patients care. Oh yeah, and you are forced to be a good critical thinker. It depends on the type of person you are. I am a night nurse at heart, always have been, always will be. Some people just can't adapt to the hours and get physically ill. For other nurses, it works well because they have children at home and they can be there for them after school. Evenings is hard if you have kids. Many people think day shift is the best shift because it is "normal" hours - I just don't see it. :-)
  18. htrn

    How long is orientation for nurse new to ED?

    I went from 5 years OB/NBN experience to the ER of a critical access hospital. I didn't even know what a GI cocktail was. I got 3 months of orientation and have done well. That said - there are things that I have never seen or done, that I know I will have to deal with. That's just part of working critical access. I have good docs and good back up in the form of ancillary staff and tertiary care centers I can call for help when I need it. I have been known to call the big tertiary care center to talk to their pharmacist in the middle of the night about giving a med I have never given and can't find answers for in my drug books. Good luck - and the most important thing to remember after your ABCs are who to call for answers if you don't know them.
  19. htrn

    VBAC: new insights

    I am not so sure it is the hospitals driving the no vbac rules - I am wondering if it is liability insurance for the hospitals that is driving this (alarming) trend.
  20. htrn

    advice from Mom's working overnights

    Sleep is #1 or you are not going to be good for anyone. Dad takes the kids to daycare on his way to work, and in my case, picked them up on his way home. I don't keep any phones upstairs at all. Get a noise machine - something for white noise to cover the phone when it does ring, the neighborhood dogs barking, the doorbell, etc... Get light blocking window shades. You can get them at wally world pretty cheap. Create a routine that you stick with, like if you have to go to Dr., DDS, etc... make those appointments either right after work or after you tend to wake up in the afternoon. After your last night shift before you days off - take a short nap during the day and then go to bed with your family. It would be better if you could stay on a night schedule on your days off - but we all know that won't work with a family :-) Make sure they schedule you several shifts in a row and then give you several days off in a row - none of this on 1 noc, off 1 noc, on 2 nocs, off 1 - will make you CRAZY!! My husband knows that if there is an emergency - he has to come home and wake me up or send someone to wake me up because I won't hear a phone. Another option is to have a cell phone that is ONLY used for an emergecy that you keep in your room. Keeping mine on Vibrate doesn't help me. I always hear it and then can't find it and the battery goes dead and I can't even call it to locate it. Anyway - good luck. I've done it for years.
  21. Ours go to the M/S floor as ER OBS followed by the ER MD or OBS by a PCP. We do this fairly often as it's not fair to patients to keep them on these uncomfortable cots, no bathrooms, no TV, etc... for more than a few short hours. That, and we don't have the room to keep them in the ED for 12-24 hours. Things like R/O MI's with low risk factors, n/v/d that need hydration, short term pain control, etc... BTW - we are critical access as well.
  22. htrn

    Now I've been the patient

    Congratulations - and I'm so sorry. The nurse manager of the unit really needs to know how you were treated. You posted something about hoping that your patients never feel the way you did - it seems to me that you can ensure that future OB patients in that unit are not treated the way you were. Good luck and, again, congratulations on the new baby!
  23. htrn

    Drug overdose situation.....

    seems like someone is either trying to get help with homework or is looking for answers for potential board questions
  24. htrn

    Question about something that happened

    Just remember, it is so much easier for them to throw us under the bus than to admit their own or their colleagues mistakes :-)
  25. htrn

    Your CALL LIGHT privileges have been revoked!!!

    This is why I do not work Med/Surg!! I will repeat, the dazed and confused scare the hell out of me!! I love labor & delivery, ER, sick kids and babies - but the dazed and confused are REALLY SCARY!!

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