CountyRat

Some posters just do not get it. It is not the job of the recruiter to be fair or considerate or understanding. Her job is to find the candidate who will contribute the most to the hiring institution. If one candidate dresses and speaks more professionally than another, the recruiter does not care why; she is not your mommy or your therapist. She is a business professional who will hire the candidate that presents best. Period. No one owes you a job. You have to compete for jobs by looking and sounding better than all of the other candidates. If you have had personal problems with drugs, changed jobs frequently, or show up dressed badly, that is your problem, she does not give a hoot why. Does that sound harsh? Damned right it is harsh! It is called, "the real world." If you want to stay where you are, stay home and pout. If you want to make a better life yourself, put on your big girl panties, wake up to reality, quit ******** about how unfair it is, and get to work on becoming a winner in a competitive world.

The word "nurse" is a generic word in common usage with many meanings. Protecting such a word legally would be like trying to legally regulate the use of the word "manager." The titles "registered nurse" and "licensed vocational (or practical) nurse" are designations with legally defined meaning as determined by state or provincial government. However, the state does not issue "nurse" licenses because the word is too vague to regulate. It is illegal to represent oneself as an RN, LVN, LPN, etc. if not licensed by the state, even if one does not actually use a formal title. For example, it is illegal for someone without a license to submit an application for a job as an RN, LVN, or LPN, even if they never write the word "nurse" on the application. In that context, they are misleading whoever reads the application, and that is illegal. What bothers me is when workers portray themselves as nurses in a professional context, for example, a receptionist in a doctor's office referring to herself as "nurse." It is the context that gives the word meaning, and in a professional context, use of that term would be misleading. I believe that every patient and family has a right to know the qualifications of anyone providing services to them, especially in a health care context. So, only those who hold an active license as RNs, LVNs, or LPVs should call themselves nurses at work. Out in the world, however, you really can't control what people say in the unregulated context of the street. Not everything that is wrong is illegal.

Lilsnfrn, is there a chapter of the American Association of Critical Care Nurses (AACCN) in your area (American Association of Critical-Care Nurses)? If so, I suggest joining and attending chapter meetings and events whenever time permits. You will establish valuable relationships with colleagues, and also have access to worthwhile educational opportunities. If there is not an active chapter nearby, consider joining the AACCN anyway. Their journal, Critical Care Nurse (Critical Care Nurse) is a must have. AACCN also provides very good conferences and online continuing education. (PS: No, I do not have any financial interest AACCN. I wish I did, but, unfortunately, I will not make a nickel for offering this suggestion, darn it.)

Don't EVER lose that insatiable curiosity. It will enrich your life tremendously. (And, oh by the way, it will make you a better nurse, too.)

I think that Esme's post nails it (as usual). The pulmonary pathology is not pneumonia, it is chemical pneumonitis. Different critter, though a newborn with chemical pneumonitis is certainly at increased risk for bacterial pneumonia after birth.

It would be abnormal for you to not feel the way you do. A lot of good suggestions here, and, posters are correct to point out that sometimes an assignment "break" is best, not only for the nurse, but also for the patient.

Good for you, Paco!

Thank you.

Me? A tyrant? Damn straight, Buba. Now get the heck out of my way berfore you get hurt.

Thank you for sharing your point of view, Annaiya, you make some good points. I do have a different point of view about hierarchies in medicine. From where I look at it, there is a hierarchy in medicine, and for good reason. I do not think that medicine is a democratic, egalitarian institution; but rather, a meritocracy in which authority is granted on the basis of knowledge and experience. If that is true, doctors are at the top of the hierarchy because they have more education and training than other healthcare providers. However, I think that your main point was that all of us occupy positions of importance and, ideally, work as a team in which every team member's contribution is valued, and every team member is shown respect, and I certainly agree with you on that. Just the view from where I sit.

So, I am the medical resource during a campout with my son’s Boy Scout troop. One of my jobs is to secure all medications, and provide them to the scout for whom they are prescribed at the prescriberd times. No big deal; until one of the adult leaders comes up to me in a rage, insisting that I give one of the kids his HS dose “now!” Her reason? “I have [fill in diagnosis here] and I have read everything there is to read about [diagnosis] and I know more than any doctor does about what he needs!” (No, this person was not family, and had only met the kid a couple of days before.) “Well, maybe you do, but the licensing board in this state says otherwise. He will receive his medication on time, as prescribed by his physician.” I saw no reason to continue the conversation. Fortunately, the other adult leaders backed me up, but if they had not, the kid would still have received his meds as ordered. Yeah, I can be a real bastard. Sometimes that is my job, and I do my job very well. Please feel free to flame me to your heart’s content.

The OP wrote that, "Her visitors actually brought alcohol to the room and were drinking, acting out loudly and causing a huge commotion during visiting hours while other families were also having visitors." That is not "having a drink to Aunt Sally." As for hospice, would the family being drunk and disorderly in hospice be O.K.? Not on my watch.

Stunning Canes, just stunning. So real that my palms started sweating and heart rate went up as if I were standing in the OR with you. Please keep writing, and please try to be published (if that is something that you want). You will soon receive a friend request from me because I want to read everything that you post.

I am "just a regular nurse," but because I am a guy, I have often been asked if I am planning to "go on" to medical school, or, why didn't I go to medical school. I usually respond by saying, "because they don't teach you how to be a nurse in medical school." I admire doctors, but I like being a nurse. I used to try to change people's stereotypical thinking, but I do not any more. People are people; I no longer need to change their minds about anything. I am proud and happy to be a nurse, and no longer need to justify it. Just me.

I see this from a different point of view. Part of my duty as a nurse is to provide services that are at least equivalent to the standard of practice in my community. This is rarely possible in a restaurant. There is no privacy, no other personnel to whom I can refer the enquirer, and no resources with which I can properly assess him or her. I would be providing substandard care, which could actually harm the patient. The best service I can offer this hypothetical individual is to refer him or her to the treating provider.

Figure out who the best nurses are in the unit, watch and listen, and follow their examples.

Another comes to mind: “it takes my nature,” meaning that the patient was prescribed a beta blocker, but it impaired his sexual performance, so he stopped taking it. I have most frequently heard this from patients whose blood pressure is consistently “Patent Pending” over “Get the crash cart!"

I once heard a CPR trainer (who was NOT a nurse, I hastily add) define three classes of heart disease as follows: "Angina" (he even got the pronunciation right. It is the last thing that he got right.) "A fit" which he defined vaguely as what I think referred to a myocardial infarction; and, last but by no means least; "Siezure" by which he apparently meant cardiac arrest. The next time I needed to recertify, I took a CPR class sponsored by a different group. Oh, and the other gaff that I have sometimes heard is a mispronunciation of the word angina that refers to a structure in a completely different organ system than the cardiovascular. I have also heard a woman refer to her "menstruater," which, in the context of the discussion, referred to her uterus. At least that one makes sense.

Congratulations and best wishes. What an adventure lies before you! I am sure that you know that the year will be hard, full of doubts and victories and discouragement and fulfillment. You are going to find out that "nurse" is not a job we do; it is something that we become. The good times and the bad times combine to initiate us into being nurses. Savor the adventure, and God be with you!

Thank you for sharing your story, and telling it so well. It is the best article about nursing that I have seen in a while.

When asked to talk about general medical stuff, I have no problem. I also have no problem saying “I don’t know.” However, the issue here seems to be when an invisible line is crossed and the other person is actually requesting professional services. I have a big problem with that. In a casual context, my usual response is, “that’s very interesting. Please disrobe and lay down on this table and we’ll look into that.” Usually brings out a little chuckle, and a change of subject. Obviously, I would never say that to a lady around my own age, as it would come off as a very impolite suggestion, which is not my intent. I would also not say anything so flippant to someone who is anxious about their health or the health of a loved one. Context is everything.

It is a fact of life; try not to let it upset you any more than you can help it. People are peole and they are not going to change. Trying to change them will make you crazy, because they won't, and cause you to be disliked, which does not help anyone. When I could, I would jot down notes during report that included things that I thought I might need for the patients that I was assigned, and check to make sure they were available ahead of time. If they were not, I would work on that problem ahead of time. This is not possible when the shift is totally crazy and there is just no time, but one can usually do it, and it is a great stress reliever and time saver on those occasions when it is possible. Last word: When you have to go foraging about to find some missing supply, get more of that supply than you need, if you can, and put one or two back in your unit's storage area so that the next nurse will not have to repeat your treasure hunt. No, others will not start doing it too; you cannot change others so do not expect to, but you will be doing the right thing and, in some small way, reducing the level of tension and frustration for others, which can only make life better for everyone, including you.

And, the reason nothing happens is that there is usually no clinical significance to being early or late (within reason, of course). Most meds (please note: I wrote MOST meds, not all) work as well given BID as they do given q 12 hours, as well given TID as q 8 hours, etc. Get your post-prandial insullin and pain meds on board on time, then pass your others. Again, there are exceptions, but you are smart and well educated. You know which meds are time critical and which are not, and if you do not, a pharmacist will know.

Good comments above, here are mine for what they are worth. Don’t “scream for help.” Yeah, I know, I’m being picky about words, but seriously, in in any emergency, you have to minimize your own stress response. How do you do that? Good question; glad you asked. You do that by acting calm even though you do not feel calm. Take a deep breath (yes, you DO have time, as discussed below) and call for help in a clear, slow, controlled voice. You will be faking it, but that does not matter. Behave as though you were calm, and your behavior will change your emotion; which works better and faster than trying to control your emotions directly. Really, this works. I agree with moving the patient to the floor if transfer to bed is difficult or time consuming. You do not know, initially, what is causing the crisis, so the safest thing is to supinate the patient because it facilitates circulation. Since lowering a heavy patient is easier and faster than lifting that patient, I go for the floor. Better to use gravity than to fight it, whenever you can. You might be able to save those IV, arterial, and pulmonary lines if you can put the equipment or pressure bags that they are running on the floor too, but that depends on what kind of equipment is in use. If you carry a couple of straight Kelly clamps (which I suggest) you can clamp them, disconnect them and position the patient. Yes, I know, that is dangerous, both in terms of sepsis and clotting, however, losing access in a crisis is also dangerous, and, once the patient is back in bed, you may be able to use them (and, trust me, you will probably need every line you have). It is a risk/benefit decision that you just have to make on the fly. MOST IMPORTANT OF ALL: Do not allow yourself to get frantic by trying to do everything at once. Do not become agitated because it is taking what feels like a long time to position the patient. Your sense of time will be distorted. Again, ignore your feelings, concentrate on doing the one, next, necessary thing, and do not try to rush. Bottom line: if the patient dies in the 10 – 20 seconds it takes for you keep things under control, you could not have saved that patient anyway. I am sorry for how harsh that sounds, but it is true. If you try to manage everything at once, you will quickly loose control of everything. Taking it one thing at a time gives your patient the best chance possible.

Wow. I just finished watching this video at http://www.youtube.com/watch?v=eZo4hbGJjVI, and what a breath of fresh air. Unlike so many of the rants currently in circulation, this statement that is calm, thoughtful, free of accusations and stereotypes, and referenced to factual information. It is also emotional compelling without a hint of hysteria. Please take 5 minutes to view it.