rnmi2004

Very tense atmosphere at the moment. It feels like the calm before the storm.

My hospital has put out a plea to the public to make fabric masks for our staff. ? Anyone else working at an acute care facility with this situation? Also would like to throw this out there https://bmjopen.bmj.com/content/5/4/e006577

Nurse managers, case managers, WOCN nurses in my hospital are all weekdays only with no weekends, no holidays. NM do have to be available for any crisis on the unit 24/7 but they can usually manage whatever's going on over the phone. None of these are new grad positions.

This. An inexperienced RN or NP doesn't even know what they don't know. I don't want an NP with no job experience or residency taking care of me or my family, period. I also don't feel I should have to grill each NP that I see as to what their experience level is; therefore, it should be an across-the-board standard that NP's can not practice independently without a residency or previous nursing experience related to their field. If you want people to accept the legitimacy of your role, you need more than clinical hours.

I've never run across that in real life. People who make comments like that are obviously ignorant of what nurses really do. Try to educate them; if they're receptive -- great. If they want to wallow in their ignorance, not your problem.

If the patient doesn't clot off with the bag going in at only 50ml/hr, they don't need a CBI. Your boss is clueless and should be ashamed to spout off nonsense like that. If that is indeed your policy, whoever came up with that rate is also clueless. Nursing is supposed to titrate it to color on my unit. We had a patient on a CBI for a loooong time due to bladder damage from radiation. The urologist had us running 3L NS bags with some med in them (to help decrease bleeding, forgot what it was -- bags prepared by pharmacy) with a set rate -- the problem was, there was no drip rate on the CBI tubing packaging so we had no way to calculate the rate.

Many nurses have already made beautiful comments about end-of-life care. I'd like to address the OP's perception of how the nurse handled this situation. I can't imagine the emotions this poor nurse was dealing with -- it sounds like this woman had been a patient on the floor for some time. However, I'm going to assume that this nurse had at least one other patient to care for, OR would likely have another patient in the bed once the deceased patient left the room. I've been in the position of stepping out of the room of a newly deceased patient as a new admit rolls up. It isn't an easy thing to do. A nurse needs to do what a nurse needs to do to keep it together to finish her shift for the other patients.

I can see how it would be feasible in a small hospital. Many hospitals have inpatient floors too far away from ER to make this work. And what happens if the floor nurse decides the patient isn't appropriate for transfer?

I agree with other posters -- it's nothing new. However, in my relatively short time as a nurse, I've seen some practices come and go that turned out to be based on shaky evidence. Remember beta-blockers for all perioperative patients? How about uber-tight glycemic control? There & gone within a few months. Remember, the studies claiming to show evidence of benefit may later turn out to be flawed or not beneficial to a larger patient population.

Practice will help! I agree, turn the spout away from you to empty, and don't squeeze the bulb until you're done emptying. Styrofoam then a 30cc cup sounds a little more time consuming than it needs to be. We don't charge individually for the urine specimen cups, so I have a hard time believing they're that expensive. If the OP's floor has few pateints with JP drains, I don't see how using specimen containers is going to affect their budget.

Sorry to hear about your father. I hope he's better soon. Thank you for the reminders. I try to acknowledge patients that are hospitalized around the holidays & birthdays -- I want them to know I realize that this is may be an extra difficult time to be hospitalized.

The AC in the IV doesn't bother me-- there are many reasons for it as was previously mentioned. In addition to the ease of access in a dehydrated patient, plenty of admitting dx carry the possibility of a CT with contrast. Abd pain, anyone? If you're noticing a trend in patients being brought up soiled, you may need to write it up. Do you get any kind of report from ER? You might need to start asking them to check for soiling before transport to the floor. I get that accidents happen, but you can tell if someone hasn't been checked on a while. We had a period of time where we'd get pts who had obviously been sitting in stool for a while -- as in dried & crusted to their backside -- and a few write-ups plus manager-to-manager intervention helped reduce this. It's beyond disrespectful to the patient to leave them soiled.

Wow, I work med/surg with a lower ratio (1:4/5) WITH aides & I can't even imagine being on a tele floor with no aides AND having to do your own lab draws. Many cardiac tele patients are admitted with orders for Q8/6 hr enzymes. The time you're spending drawing would really add up & take away from routine patient care. It sounds unsafe! The other members saying this is the norm for them, what is your charting like? I can't imagine the amount of charting we are required to do with that many patients, and no aide, AND no phlebotomy. I think that is ridiculous and I'm not sure how anyone would ever be able to leave on time. I would think the amount of incidental OT would start to add up & not be much of a cost saving.

Do you have a patient relations department that you can call? We have had more than a few patients that have had a behavior contract drawn up & enforced.

God forbid there's a shortage of all forms of IV Dilaudid... I think our patient population would suddenly drop!

I love your pain scale! I can see it being very useful for teens & young adults. I found this free article from a search on pubmed that might explain why she would have had surgery on both sides... http://radiology.rsna.org/content/233/2/361.long

Check out this article... http://www.ahrq.gov/downloads/pub/advances2/vol4/Advances-Miller_93.pdf Especially this bit:

If I had the day off, I would consider standing with the strikers. If I felt the company in question were being unfair, I would not use their services or product. I would not screw my current employer, co-workers, and patients by not showing up if I were scheduled that day. Your union's job is to obtain & enforce a contract that protects your rights in exchange for your union dues. They've done their job by getting a decent contract, you do your part by paying dues. Your employer expects that by agreeing to certain concessions, they should in return have workers that show up when scheduled. If the hospital has done their part and follows the contract and they still feel that they may have to deal with employees not showing up due to a strike, I doubt your next labor agreement will be so cushy.

Do you ask about suicide attempts or suicidal ideations on every med-surg patient? That seems odd to me. We have a question about stressors, but we don't specifically ask about suicide. IMO, if your hospital's policy is to open this can of worms with every patient (and I'm not saying it isn't an appropriate question to ask) then they need to give each nurse additional training on how you are expected to handle the various responses you are going to get. They also need to have 24/7 resources available in-house to respond promptly to even the patients with questionable responses, like yours.

Or maybe the patient was standing on his head?

What makes me cringe is reading that you only change tubing Q 4 days? I'm pretty sure our policies are evidence based practice, and don't even keep peripheral IV tubing up longer than 72 hrs. My facility has very, very low rates of CLABSI. Central lines have tubing changed Q 48 hrs, Q 24 hrs if it is running TPN or an intermittent infusion. We do not access a central line without using chlorhexadine scrubs (not alcohol) and clean gloves, even just for IVP meds. We also do a Q 7 day drsg change with biopatch. Don't forget to mask the patient and any others present in the room during the procedure.

Pull his finger? OK, seriously 12 days is a long time to not even be passing gas. I agree with the position changes. At this point, anything oral isn't going to get to the part of the intestines that needs to be encouraged to move along. Reglan helps with stomach/ upper intestine motility, so that probably won't help either. What about an old-fashioned soap suds enema? Is the patient taking a lot of narcotics? I'm not sure if it will help this far post-op, but maybe a dose of Relistor might help get things moving.

Most of our rooms have chairs, so I sit on them next to the bed. If the chairs have "walked off" or if they're full of stuff, I have sat on the bed before. There are just some times when your interaction with the patient isn't the same if you're towering over them. My clinical instructors told me not to, but they also told me not to throw dirty linens on the floor when changing the bed.

I totally agree with the comments that you need to check the baggage at the door. I work with too many people that air out their dirty laundry while the rest of us are trying to work. Or they are arguing with their family members the whole shift -- with multiple phone calls or texting. These are issues that should NOT be dealt with at work! Patient care suffers as your co-workers are trying to pick up the slack. Look at work as a break from whatever issues you have going on outside of work. Put it out of your mind for your shift. Don't take any personal calls during your shift, don't text -- not even on your break if there is even the slightest chance that it is going to affect your ability to do your job.

I also have a supportive husband (and awesome kids) so it works out well. I see my kids more working nights. We eat dinner together as a family every night, I can help them with their homework, etc. It will be OK! My co-worker has an incredibly insensitive husband who does not get that she needs to sleep during the day. None of us can understand it. He will wake her up for the stupidest stuff. For her, it isn't working out so well. She's considering switching to days, even though she'd rather stay on nights.