JRD2002

They are all 8 hour shifts and most of the ones offered to me were for afternoon/evening hours. The schedules require you to work every other weekend. They also have some split shifts where you would work half your time in the AM and the other half in the evening. The schedules that are available are the ones that have been vacated recently so it is possible that other shift times could open up. The schedules either rotate days off or you will have a fixed day off so in either case you would be able to figure it out ahead of time.

Any updates about working for this company?

IsisC has good advice...although I wouldn't bother with a head to toe assessment and just do a focused assessment on whatever problem the patient is having. Part of calling the MD is anticipating the outcome of the call. Before calling you should ask yourself is this a problem that needs to be solved now or can it wait? Try to think of possible causes for your problem and then assess your patient to see if any fit. After identifying the problem and possible causes start to think about possible solutions. Out of the possible solutions are there any that might not be appropriate for this patient? What data would be needed to come to a decision on a course of treatment. The more you talk to doctors you will begin to identify things that they frequently ask especially if you work in a specialty area.

I am guessing there is no rationale for that order and that the resident misunderstood the directions of his supervisor. Usually when no one can come up with a reason for doing something (nurses, MDs, pharmacists) it is usually because it is wrong.

I am also curious as to how they did it. I assume that since it is a mental health facility that more precautions are taken than most facilities to prevent suicides. I suppose it is a "if there is a will, there is a way" type situations. Sorry you are having a hard time dealing with this. Like everything use it as a learning experience and take something away from it so that maybe they at least didn't die in vain.

This should be on a recruitment flyer for your hospital...I'm packing my bags right now!

Thanks! Also a big thanks to those of you who constructively contributed to the post!

I am aware that this is a very controversial topic but am really just interested in learning more about the subject. I can make up my own mind about the morality of assisted suicide so everyone try to leave your opinions at the door. In the words of Joe Friday, "Just the facts, ma'am."

I just finished watching a Frontline documentary called "The Suicide Tourist" which followed a man that was diagnosed with ALS and was seeking assisted suicide in Switzerland. I found it very interesting and learned quite a bit. I was under the impression that a medication was administered to the person but it is actually poured in a glass and the person must drink it on their own. The only thing that the facilitator can do is to hold the glass if the person can not hold it on their own. In the documentary it also said that there are three states in the U.S.A. that have physician assisted suicide programs. Is anyone familiar with any of these programs? Or perhaps has worked in one before? I highly recommend watching this documentary. It is available on Netflix right now.

Can't tell you how many times I have gone into a patients room when they were sleeping and needed to wake them up only to realize I can't remember their name. Usually I try to peek at their name band. At least 50% of the time this scenario ends up with the patient waking up with me hovering over them...awkward to say the least.

........only if you limit your practice to nursing management/administration. Now it all makes sense...

It is most facilities P&P to change a Foley every 30 days. You gotta get over that fear about talking to jerky doctors especially when it is a safety issue with a patient. Chances are that if a urologist did come and place the Foley he would still be having hematuria. Sometimes there is just nothing you can do to avoid it. I just now realized you are a student which really helps explain why you are beating yourself up so much. When we start out in nursing we are focused on helping people so much that whenever you have to cause pain to a patient it makes you feel like a scumbag. You changing the Foley caused the patient to have some temporary discomfort and some bloody urine. If you had not changed it the patient could have developed an urinary tract or bladder infection or even worse his next Foley change would have to be done in the OR when they surgically remove it. You are also going to have to learn to leave work issues at work. You can't make it in nursing when you go home and obsess over what happened during your last shift.

I hope we never go to bedside reporting but I have been hearing that the main advantage for doing it is to involve the patient more in their care. There was another thread on this recently and they had some good points about some of the challenges of doing bedside reporting. To me it seems like the idea of a bedside report was come up by people who are too concerned with patient's perception scores and that haven't practiced bedside nursing in a while. It always amazes me that the people who no longer do patient care are implementing changes that affect current practice.

I would probably have gone ahead and replaced the Foley without talking with the urologist. Just because they had to consult one for Foley placement the last time does not mean that the patient will need a urologist every time it needs to be changed. Also if you did call the urologist they would probably want to know if you had attempted to place it and what problems you encountered. If you told them that you had not even tried I think they would probably be a little upset. I understand feeling bad about causing some hematuria. It occasionally happens and I usually feel bad about it myself. Hopefully though with a little irrigation and some time the bleeding won't be too severe. Don't beat yourself up over it.

It sounds to me that even if you did advocate for your patient more that the hospital administration and the MD would have still discontinued the order. You did the right thing by investigating the medication more to help you make a more informed decision. I agree with an earlier post that your facility needs some education on DVT/PE prophylaxis. Lovenox has become a very common medication in the acute care and rehab setting. From your post I really feel that DVT/PE should have been a primary concern since the patient is obese, was bedridden for 3 weeks, and is beginning rehab. I would also be concerned that even if they were given Lovenox therapy they may not have been given adequate dosing. In high risk individuals I frequently see orders for Lovenox 1mg/kg q12 hrs. You said they ordered an 80mg injection stat after PE became a concern. This would be adequate for a 176lb high risk individual. BTW I read your other post too and giving two Lovenox shots at the same time is perfectly acceptable especially when dealing with higher dosages. I believe the highest dose in a syringe that my facility carries is 90 mg. BTW your coworkers sound like a bunch of nitwits when they tell you something and have no evidence to back it up.