Chaya

So sorry to hear the result. He and your folks are lucky to have your caring, insights and guidance at this time

Where I worked they were actually taken down and washed after patients on precautions were discharged and the room was "purged".

Yep. Like they say-ONLY a nurse.

Seriously! Justifiable or not, I feel the training a nurse receives in giving injections is more of a defined quantity: anatomical target areas, sterile/ aseptic technique, reaction and side effects, rationales, etc. I've received many, many flu shots; once from a pharmacist, many time at flu clinics where I've volunteered, or in hospital/ clinic settings where the clinical leaders, Assistant Nurse Managers, or clinical educators performed this role for their unit, administering shots to their staff over 2-3 weeks. If there were student nurses, we often let them give the injection, supervised by their instructor. That being said, I've only had one given incorrectly-BY MY CHARGE NURSE!! I didn't react in time; just watched, stupified as he grabbed my arm midway and gave the injection a good 2 inches below the deltoid. I did comment at the time "kind of low, wasn't that"?, which he shrugged off. I did end up with a warm, inflamed area and mentioned to my ANM that I had had a reaction. Not sure if anything she reported anything in writing; I was not given anything to fill out and did not persue it because it did resolve with no residual effect.

First, condolences on the loss of your friend. I think it important to focus on actual evidence so far as possible for the sake of clarity. (How quickly these discussions become polarized beyond the point where any communication is possible). What was listed as her diagnosis/ actual cause of death? Was there an allergic reaction specifically to the vaccine or were there other contributing conditions? Death in a healthy 22 year should be questioned! The hope would be to learn from this tragedy to prevent others. To do this we must gather as much information as we can and examine it objectively and from all angles. If there is shown to be a clear link to the flu vaccine, is there a specific population group who should not take it, or is is truly risky for everyone? Statistically, do the mass benefits outweigh the risks? If her death was directly related to receiving the dose of vaccine, what were the specific circumstances? Causality must be established and may not be the immediately obvious. Because if the cause of her death is not what we assume we are seeing, the actual killer remains at large to continue to cause illness and claim lives.

Ah, yes, that change of shift dump. I do get it, really. I understand totally that it is necessary to free up space for incoming patients. However-and this should be a HUGE factor with the current emphasis on accountability, continuity of care, and prevention of re-admissions; change of shift admissions specifically create those black holes where there may be significant time lags before an oncoming caregiver is identified. Report may be called to the floor to and from off-going staff who are no longer available for clarification. Critical ( as in Sentinel Event level) information is omitted ( in my experience omitted details have included patient with wound evac device, insulin pumps, life threatening med allergives and numerous patients needing imminent warfarin dosing). You get the idea. When I worked med- surg and we had those meetings about reducing errors and improving continuity of care between care levels I always raised this issue; not because of the inconvenience factor but because it creates a particular point of vulnerability in terms of the increased number of opportunities for errors in the system (as in, "falling thru the cracks"). Ideally, don't create the situations that allow these "cracks"!

Thank you for reminding us what the spirit of Christmas is really about as well as the kind of gifts we should be focussing on. And thank you for the difference you have made over the years both to your patients and to your many allnurses friends who you may never meet in person. Your story brought tears to my eyes.

Never use the "Q" word ANYWHERE! Ever.

So-just a thought but shouldn't whoever the medical caregiver, whether PA or MD, have received/ had reported to them the most vital and timely info such as, for instance the patient received IV medication during the night to correct cardiac rhythm?...

I loved hands-on nursing. However, at one of my last positions, one of the questions posed in the written self-evaluation portion of our yearly evaluations was "what are your career goals and what do you plan to be doing in 5 years. Ambition was valued perhaps more than technique, good bedside manner or staying current with new nursing practice. This was a med/ surg position at a magnet hospital; many of the nurses there were just starting their careers and there was an almost condescending attitude toward those who chose to remain at bedside instead of moving on to become educators, administrators or at leasT advance practitioners.

I wish you the best. You sound like a caring, responsible caregiver. Hang in there.

You would think by now I would know better than to even think there was nothing left that could surprise me...

I became a nurse at 50. For me, it was easier to study than it would have been in my 20's because I was steadier; more focused and less distractable in general than when I was younger. I found I was better able to handle it emotionally after a lifetime of working in a variety of positions with coworkers having a wide range in temperment and personalities. I had also seen and weathered many life events and crisises in my life and those of family members and close friends and I came to believe that nursing was a good fit for me in terms of skills and outlook at this point in my life. Physically, it was more endurance than brute strength; although I did work with many obese patients that required extensive assistance with personal care we were well trained in body mechanics, had mechanical lifts and followed a strict policy of having 2 or more caregivers assisting with transferring, boosts, etc. I also had to become used to 12 hour shifts (but found working fewer days less stressful); had to invest in really good orthotic arch supports and shoes, and keep healthy. Good luck if you do make the decision to go ahead; it can be crazy at times but I've found it very satisfying-and never boring!

See, now I thought it was going to go something like "you'll have to do a fingerstick, and his glucose will be high, and you'll have to get the lab to verify it, and you'll need to call the MD for extra insulin coverage, etc, etc... Silly me

Every application I've ever completed has specifically required the names of my supervisor and/or person I worked directly under for each position I've held, independently from names you would choose to use as references. Whether an applicant has only ever held the one position and was fired during orientation or does not want to list one of a number of positions, omitting a job is a huge red flag. Being proactive about clarifying your specific situation is really your only chance to demonstrate owning responsibility for any action on your part that led to you leaving that position.

"If it wasn't written down, it wasn't done." You can't be expected to read minds re: what previous doses were actually given but not recorded accurately (not to mention how future doses of warfarin are based on knowing accurately what dose received caused a given response). If you have a med discrepancy the only safe option is the one you chose; notify the MD for any change in the order since prescribing is NOT in your scope of practice.

"If it wasn't written down, it wasn't done". (I'm guessing you've heard this a time or two). I don't know about your nursing curriculum, but mine did not include psychic divination of patient care delivered on previous shifts but not recorded. You had no way to know what doses were actually given; plus to further complicate the issue, future doses of warfarin would be based on how well the assumedly correct dose regulated coagulation. Even if you had been able to verify that the actual dose being given differed from the recorded dose, this is a med discrepancy and your only safe option was the one you chose, to present the situation with as much info as you could obtain to the covering MD for evaluation (not in your scope of practice as an RN.

I can't remember the details but not long ago saw a couple of studies that estimated that after administrative duties nurses spent like 60% of their time doing actual patient care. So 70-80% would be a very significant improvement. I found that the nursing skill most valued above all others in corporate health care is "time management", meaning be prepared to absorb extra duties and patients above and beyond what is outlined in your job description and what you may feel is safe for your care setting. In my experience staying late to chart, especially if it causes you to consistently clock out late and therefore appears as overtime hours, is seen not as being conscientious but as having poor time management skills. (Just saying!) :)

Look up "Imposter Syndrome"; there's been a lot written about it recently. ( And it wouldn't hurt to watch the classic Wizard of Oz!) The coursework will be challenging but doable. Working in the medical field will help you with some of the basic skills (as long as you are willing to adapt to alternate methods) and some of the time management. Sound like you have the basic stuff, plus some; you just have to put it together. Concentrate on critical thinking, common sense and especially growing a really thick skin emotionally (lots of head trash and bullying out there), then keep your goal in focus. You got this- just gotta go get it!

Also look into whether you need to continue to work full time at your non-nursing job to become vested. You may need a minimum number of hours in each year you work in addition to remaining there for a specific length of time so if you have already accumulated the hours for this last year they may let you work a reduced number of hours thru the 5 year mark. Ideally when you start a nursing position you will be able to concentrate exclusively on that, but walking away from being vested in a retirement plan a few months short of the time requirement should not be taken lightly with the financial shortfalls many retirees experience based on fluctuations in the economy. If the position you are applying for doesn't have a hard-wired starting date (like an internship program) and it's getting to be within 6-8 weeks of your vesting date, you could legitimately state that you are looking to start in October. Lastly, if your current position will let you work reduced hours and schedule them around your nursing position, it may may be possible to have both overlap for a short without overwhelming you.

The denial mind set that goes hand in hand with addiction-of any sort. A patient lying to my face about when they last drank/ used drugs or what they really were eating the last few days doesn't hurt me but giving HCP's inaccurate info could delay or prevent appropriate treatment and ultimately cost the patient their life. This kind of stuff really pushes my buttons. I just wanna say "you're wasting my time, the doctor's and your own-why even bother?"

Scary!

[Pulmonary toilet...] Second that. Can't help mentally inserting "in the" when I hear it. (Ocassionally, but I do hear it used)

I so try to counteract the terror families feel at the term "hospice" and to emphasize that it is a different type of care that is at present more appropriate for their loved one and NOT a timetable for counting down their last days. Attitudes are changing but it's a slow process.

I'm convinced it's the law of averages- if it's quiet it's because all the stuff that usually happens in a typical shift just hasn't happened yet. That being said, I will NEVER use the "Q" word before or during a shift. Nu-uh!