redshiloh

My staff tells me they feel like they are being called to the principal's office, even when they have done nothing wrong!

OK I'm glad someone else mentioned this staff members reaction and thought it suspicious. Based on what you wrote, I am thinking there's more to her story. Did you verify the patch?

I don't know if CCU has openings here at Audie Murphy VA Hospital, but if you can get in here it is definitely a better deal than civilian. RNs here get good benefits and the pay is competitive. I also know the nurse manager over CCU and she is terrific :)

Are you kidding? That's the fun part :)

Since your patient is a quad, could he have needed quad coughing? Or had they instructed not to do so because of the trach?

The locality survey is usually in the first part of the year.

From what I have heard from nurses from other facilities, nurse/patient ratios are a problem everywhere, depends on your area. For spinal cord injury our ratios are 3-4 on days and eves dependent on acuity. I have been with the VA for 12 years now. What I can tell you is that for RNs it is a real good deal. You start earning sick leave at 4 hours every 2 weeks and 8 hours of annual (vacation) time every 2 weeks upon hire. They do a pay locality survey every year to ensure that we are competitive with hospitals in our area. What is also really good is that we are not slaves to insurance companies and our docs can give patients what they need.

Thanks for the help! Are there a lot of meds for immunosuppression? He gets unhappy about taking meds (he does take them, just does not like it)

My fiance is being evaluated for liver transplant. What I would like to know is what to expect (providing we get a liver) in the SICU and post op. Yes, they are giving us education, but I would like to hear from the nurses who care for this type of patient-the real story. I don't do med surg/critical care, so any help is appreciated!

We had a psychologist on staff that said she could write a book about the staff. She told us we had staff with borderline personality disorder, early dementia and a variety of enabling personalities. Today, my personal self diagnosis is wacko, because I was actually considering becoming nurse manager.

I had something like that happen once. I was at bedside with a doctor that I wasn't real crazy about and this normally quiet demented elderly lady asked him to *&$# me real hard. I lost it right then and there.

I work with SCI patients both as a nurse and educator. A great web site is http://www.spinalcord.uab.edu/. I use this site a lot. We have quads that have been married a long time(one actually 45 years). With good care, luck and health his life expectancy is pretty much the same as you and me.

When students and nurses write to this forum obviously needing advise and support, why do some of you use it as an opportunity to flame this person? I've written to this forum for advise before and gotten the same kind of judgemental/critical comments. It makes people not want to use this forum for fear of flaming; kind of like I'm afraid is going to happen now. Sometimes we just need someone to listen without passing judgement. To the original poster: I've been in your shoes before and feel for you. Please don't let the negative posters get you down. All I can tell you is not to give up. Look to your fellow students for help and support and for feedback. I have a group of master's level students to thank for supporting me when I had the same problem.

We have a similar situation on our rehab unit. This is what we have done with some success. First, I got the nurses to document EVERYTHING in notes and since we have electronic records, identify the doctor as cosigner to make sure they read it. Second, I went to the interdisciplinary team and asked for help and support. Then we had a meeting with the patient (actually it has taken several meetings) and discussed what was expected in rehab and that his behavior was disruptive. You are rehab, this means that the patient has to DIRECT care that he is unable to do (and politely) and this is what has to be ingrained in the patient. SO FAR our patient has been better. Now, the family's behavior sounds like you really need to get the staff to call security when they become disruptive like that. Your patient 'firing' all the staff is staff splitting. I feel for you...this has been very hard to deal with. Good luck!

Be very aware of patients who come in with 'spider bites'. We just discharged a guy who had 'spider bites' all over his body. They all cultured MRSA(ca) pos. My SO has had many MRSA infections. They come on fast and get worse quick. They are very painful. The last time he was infected they ended up doing an I&D in the OR. Treating the infected patient can only be part of the cure. The family must be treated prophylactically with bactroban oint nasally and PR BID. This is really scary stuff.