jeannet83

Did I spell that right? Hey, have any of you run across this one? The other night I was in triage and I had a nicely dressed lady come in to ambulatory triage. I asked her what brought her here to the ER tonight. She whispered back something which I could not understand. I asked her to repeat herself. Again, quiet whisperings from the patient that I can't hear. This time, I got close to the patient and said, "I am sorry Ma'am, I did not hear you". This time I hear it: "I have a cockroach in my ear!" Whoo boy! Was this true? Got her back to one of our last available rooms and yes indeedy, there was a cockroach still moving about in her right ear! Our ER docs couldn't get the roach out so we had to call ENT to remove it. Although the patient was somewhat freaked out, I thought she handled it better that I would have!! As to the previous comment of "immaturity" of posters in relating stories: Try dealing with these situations without talking about it- one could go crazy! Thank goodness there are folks who can deal with these hard situations! We all have our different talents no matter what they be. Jeanne:)

I guess that is the thing that blows my mind is that you always work extra shifts for them and now they don't give you the benefit of the doubt especially since this is the first time that this has happened to you. I have to admit that unless a new system was instituted such as the one described above using a triplicate system were everyone gets a copy when you sign up for an extra shift, I would be tempted to sign on with an agency or per diem with another institution to do my extra shifts. I would definitely talk to the DON to voice my displeasure over the situation. I would also let her be aware that you don't want anymore warnings in your file and thus may feel a need to pick up extra shifts elsewhere. Good luck and keep us posted! Jeanne

Julie, I totally agree with Gwenith in that you should proceed very carefully. I was reading the other posts and without knowing the actual situation that you want to report, it's hard to recommend whether or not and to whom to report an ethical concern. (And I am not suggesting that you do tell us what the situation is! :) unless you want to). But my point is that it has to be something really serious that affects patient care or a nurse's ability to provide patient care for me to report it. For instance, the unfortunate case of the elderly women with the PEG tube is just that, unfortunate; there is nothing inappropriate being done there. Often, withdrawal of therapy however cruel it may seem, may save the patient years of suffering. The episode of your DON sleeping with a relative of a patient: totally unethical but not something that I am going to slit my throat over by reporting it to the Board of Nursing. It's got to be something serious like drug or alcohol abuse affecting a coworker at work, a coworker stealing narcotics, or physical or verbal abuse of patients. Again, I do not know what the situation is but it sounds like you are not in the most supportive environment. I know that you are a new nurse (Congratulations!) however it may be time to send some feelers out for other job possibilities if this is behavior that is obnoxious but not necessarilarly reportable to a Board of Nursing. Just my thoughts. Good luck and keep us posted! Jeanne

Julie, In my opinion, I think alot has to do with how comfortable you are with your supervisor. I've been a nurse for a long time and have had many different supervisors. There are some that I would feel totally comfortable going to with an ethical problem and certainly there were others that there would be absolutely no way I'd trust that supervisor to handle it in an appropriate manner (ie. let's just sweep it under the rug). Now of course, most supervisory people are going to recommend that you go to your supervisor because they are thinking about how they would feel if they had a Board of Nursing approach them about an issue. But , what you need to think about is taking care of YOU in this situation and resolving this ethical issue as promptly as possible AND especially if there are patient safety concerns at hand. As for negative publicity for the hospital or embarrassment on your supervisors part if you went to the Board of Nursing, to that I say, "Why?". They should be THANKING you for resolving the potentially ugly problem that is occurring in your work place, whatever that may be. Good luck to you and cya (go to the Board of Nursing). Jeanne

Karoline, amk brings up a good point. It will just have to be a question that you ask in your interview as to what type of acuity they are expecting to put in the CDU and what happens if a patient starts to turn sour. In our facility, we have strict rules about who can and cannot come to the CDU. For instance, absolutely no ventilators, no unstable patients, no comabative or agitated patients, no one-to-one patients. Plus if a patient gets worse, they go right back to the ED promptly. I would ask the interviewer what kind of patient population they expect, what would happen should a patient suddenly worsen, who would be the medical person in charge (ie, will there be a doctor or NP covering patients in this unit or will it be each patient's own PMD). Also ask if they have written guidelines yet for this unit and if you may look at them. Each place is different as to how its CDU is run so I think it is worthwhile to go to the interview and check it out. Good luck with the interview and keep us posted! Jeanne:)

Karoline, amk brings up a good point. It will just have to be a question that you ask in your interview as to what type of acuity they are expecting to put in the CDU and what happens if a patient starts to turn sour. In our facility, we have strict rules about who can and cannot come to the CDU. For instance, absolutely no ventilators, no unstable patients, no comabative or agitated patients, no one-to-one patients. Plus if a patient gets worse, they go right back to the ED promptly. I would ask the interviewer what kind of patient population they expect, what would happen should a patient suddenly worsen, who would be the medical person in charge (ie, will there be a doctor or NP covering patients in this unit or will it be each patient's own PMD). Also ask if they have written guidelines yet for this unit and if you may look at them. Each place is different as to how its CDU is run so I think it is worthwhile to go to the interview and check it out. Good luck with the interview and keep us posted! Jeanne:)

Hi, Karoline! Alot of larger ER's have Clinical Decision Units or CDU's. They are used for patients who are being admitted and are awaiting a bed to become availabe and/or for the 23 hour observation patient. It sounds like your CDU is really being used as an observational unit for folks being observed for 23 hours or less. I think the name CDU comes from the fact that the patient is being observed for 23 hours and then a clinical decision is made as to whether the patient can go home or is to be admitted. Alot of observational patients are chest pain patients who are going to have treadmill tests done the next morning and if they are negative they can go home. Or you may have the nausea/vomiting patient who needs a little more time for hydration and control of vomiting. I find observational patients alot of fun generally. A CDU which is purely devoted to the admitted patient awaiting a bed assignment and can be a whole 'nother matter. Alot of times they are more sick, have lots of orders to be taken off and there is the constant shuffling of patients in and out of the CDU as patients arrive to await a bed and as patients leave as they get beds. Sometimes it is slower if the "house" is totally booked up and there are no admission beds available. But again, it sounds like your CDU is going to be more like an Observational Unit which would be alot of fun to work in. Hope this helps! Oh, and check out the Emergency Nurses Forum as there is a current thread there on Clinical Decision Units. You may get more info from that also. Jeanne:)

Hi, Karoline! Alot of larger ER's have Clinical Decision Units or CDU's. They are used for patients who are being admitted and are awaiting a bed to become availabe and/or for the 23 hour observation patient. It sounds like your CDU is really being used as an observational unit for folks being observed for 23 hours or less. I think the name CDU comes from the fact that the patient is being observed for 23 hours and then a clinical decision is made as to whether the patient can go home or is to be admitted. Alot of observational patients are chest pain patients who are going to have treadmill tests done the next morning and if they are negative they can go home. Or you may have the nausea/vomiting patient who needs a little more time for hydration and control of vomiting. I find observational patients alot of fun generally. A CDU which is purely devoted to the admitted patient awaiting a bed assignment and can be a whole 'nother matter. Alot of times they are more sick, have lots of orders to be taken off and there is the constant shuffling of patients in and out of the CDU as patients arrive to await a bed and as patients leave as they get beds. Sometimes it is slower if the "house" is totally booked up and there are no admission beds available. But again, it sounds like your CDU is going to be more like an Observational Unit which would be alot of fun to work in. Hope this helps! Oh, and check out the Emergency Nurses Forum as there is a current thread there on Clinical Decision Units. You may get more info from that also. Jeanne:)

Cotjockey- Ditto for our facility Jeanne :)

This was a pretty gross story, maybe not as bad as the others! Quite a few years ago, I was working in a trauma/general surgery ICU. At the time, I was doing permanent weekends and was working with a great group of people. Anyway, my friend Jan asked me to come in and help turn this poor elderly trauma patient who had hip surgery s/p a MVC. Well, the hip was quite swollen, inflamed and red and definitely looked infected. Jan must have had some kind of premonition because as I and a fellow coworker turned the patient towards us, Jan yelled "hit the deck!" (which was pretty funny considering Jan was an ex-Army nurse). The next thing I knew, Jan was on her knees, the hip wound burst open and signicant amounts of yellow pus and sh*t went flying and spattered on the wall and curtains. Totally gross and thank God for Jan that she "hit the deck" at the right time! I shudder to think what she would have looked like had she not dropped. Needless to say, the patient made a quick trip to the OR. Yuck! Jeanne

Love Haldol IV!! (Well, not me personally!:chuckle ) We use it alot for agitated patients, mostly those requiring restraints. Jeanne

Hi! We have two different areas that are subacute. One is right in our ER and is also called CDU or Clinical Decision Unit. It is ideally for patients who are waiting to get an inpatient bed. Total patient capacity is up to 12 patients with each nurse having 6 patients each. The other unit is also part of the ER dept. but on another floor. It is called the Observation Unit. It is ideally for patients who are OBS (not admitted but 23 hours or less). Holds 12 patients also with same RN:pt ratio. We have some travelers who work with us but basically everyone in ED has to go to these units. Travelers are not forced to go there repetively. Some people actually do like to go there but most are not too fond of it. Hope this helps! Jeanne :)

Eric, in my facility in NY state, you could be a psych tech while going to school part-time for your BSN and get your tuition paid for part-time course work. I agree with the other folks, if you want nursing, best to finish this semester and switch to a nursing program. Or if you are not sure, check with your area hospitals and see if they have openings for psych assistants or psych techs to get some hands-on experience. Good luck with your endeavors! Jeanne

I think of nursing as caring. So i guess the opposite of nursing is not caring. Devoid (?spelling) of caring. Apathetic Just a thought-Jeanne :)

I have an interesting suggestion for you. First of all, in order to get into CRNA school, you will need to do at least a year of critical care, maybe more. Why not during that time, take the graduate course in pharmacology at a nursing graduate program near you. That shows your initiative to learn more. Maybe that class will even transfer into the CRNA program you go to. If not, at least you have a jump start on your graduate pharmacology as, yes, it will be very important to CRNA degree. Good luck! Jeanne:)