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Former ER nurse and home hemodialysis now just hom

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  1. Dragonnurse1

    The Nurse Empath

    I worked in the ER for just over 9 years and I cannot tell you how many times I could feel what my patients felt. I felt the fears, hopes and desperation of so many I lost count in the first year. I could "feel" the frustrations of my fellow nurses and knew when they needed to de-stress. When I would leave work after an uneventful night I would just sit for several minutes, then throw on some music and head home but after a bad night I would get the others to gather and let them vent about the night. I talked them through the events until they felt relaxed and then we would head home. I would hold those tears until I was alone, allowing myself to feel all the emotions that I absorbed all night, analyzing each one and putting it into a little cubby hole until I was once again on an even keel. Being an empath is tough and can be a help or hinderance depending on the setting. Feeling what your patient feels and their family/friends feel can be overwhelming but it can also help when the problem is emotional at its core. Overdoses that are doing it for attention, for example. When you walk into that room and feel the smugness of the patient and the desperation of the parent you have more ability to know how to treat that patient. Or how to tell a family that their daughter succeeded with the gunshot to the head and be prepared for the families emotional needs. I finally faced the fact that I was an empath while in nursing school and had to do my psych at a VA unit with veterans suffering from PTSD. I was warned that they would not talk to me because they would not talk to the Doctor. Funny. By the time I was finished with psych every instructor in the school was pressing me to go into psych nursing and I said NO. From the beginning I intended to go into the ER where the "feelings" would be easier to deal with as so many of the patients were quick turn arounds and the more serious patients I would have more time with but only for one night. Being an empath means you "feel" the other persons feelings and in a few cases their pain. Being an empath means you have to have a balanced attitude and a good control of your own emotions. Being an empath can be difficult but having a child that is an empath is just a pain in general. I talked my oldest son out to going into nursing, one of the reasons I did was because he is an empath too. He has not yet had the experience of not only feeling the other persons emotional pain but their physical pain and I hope he never does. Of course it gets interesting when either one of us is in a bad mood as it always ends with both of us upset or doing silly things to try and dispel the others bad mood.
  2. Dragonnurse1

    If the government legalizes marijuana in the US...

    There are some that are allergic to weed as well. I know several people allergic to the smoke from weed and most of them are also allergic to latex. It is a cross that I am trying to find research on but there is not much out there for me to review.
  3. Dragonnurse1

    Pain patients being denied their medication!

    OP had a regimen that was working for her. A regimen that was arrived at by her first doctor that was a pain management specialist. In comes a new doctor who is NOT a pain management specialist and throws out all the work done to get her to a livable state. So she did have a pain management doctor who retired. The CDC did not say to throw out effective treatments that include opiates but to work up to them if necessary, to use the lowest dose possible, to dispense immediate release and not the long acting or extended release and to use urine drug screens at least yearly. Before a patient is accepted into pain management we have already tried all the other treatments, physical therapy, TENS units, radio wave ablations, steroid injections, muscle relaxers, Gabapentin, and others. When we go to pain management we are desperate and feeling more than a little isolated by the very things you wrote. We are not numb, we are not pain free, we are able to get out of the bed and take care of our family, cook, clean, take showers, and for some able to work. We are tired of the stink eye we get when our scripts are filled, we are tired of all the world thinking we do not deserve pain relief. Been there, done that, got the t-shirt multiple times. I cannot walk into a physical therapy room now if I wanted to - latex. I had nerves relocated to help reduce the pain - moderate relief. I have had ablations on nerves without success, I still have pain bad enough that making it to the bathroom is an olympic sport for me. I started with 5/325 and now am on 10/325 4 times a day. I take Zanaflex for the muscles, I am no where near pain free. Tried TENS and other stimulating units but no more - allergies. I have had 2 surgeries on my c-spine but no surgeon will take me on now. Disks in the lower back collapsing, one nerve pinched off now with another going - no surgery in my future - latex - I am too risky now. We have had a short discussion on the next step up and I refused. I do love the fact that so many people think buprenorphine is not an opioid, not addictive and safe. It is highly addictive, recommended for the opioid experienced only and is currently being doled out like Oxy once was. I also love that a medication that has been on the market since the 80's is not generic yet with no sign of generics show up soon and no insurance coverage. Middle of the dose is just over 500/month out of pocket. "We need to rethink our pain". Just how is someone supposed to "rethink" pain? What happened to pain is what the patient say it is? "Maximizing multimodal therapies as well as holistic approaches need to be explored and tailored to individual patients" and that is what pain management doctors do, they find what works for each individual patient and I do not think the CDC and DEA should be in that mix. "If you need opiates, I'd argue your pain isn't being managed and you need a better workup". A better workup? You are sent from the office of the best neurosurgeon in town to the best pain management doctor in town but I need a better workup. I had 4/5/6 fused, a few years later we had to stabilize 2/3 to the previously fused but this time it had to be plates and screws. Recent MRI shows l2/3/4/5 collapsing on themselves due to disk deterioration with one nerve pinched and another being pushed out of place. A better workup? Well we have not done an MRI on any of the thoracic areas where there is pain but I am not talking to the doc about that yet. I feel for the OP. I am in the same boat but my doc is willing to go to bat for me to keep my medications. Moving to patches is a no go, I react badly to the adhesives. She needed to be sent to a pain management specialist when her original doctor retired. The lack of understanding and compassion for people in chronic pain within the medical community still astounds me. I have also seen the change in doctors and other nurses in regard to pain management after they are suddenly hit with the same type of pain others live with, they seen to always come back more willing to sit and listen to their patients, try treatments that may be outside the box but they are always more willing to provide better pain control than before. I do not know because the OP did not address this but I have never been high, numb or even pain free since 2005.
  4. Dragonnurse1

    Therapy dogs and Allergies

    The dogs can pick up on sugar levels, seizures, cancers, an autistic child about to have a meltdown just to name a few. A seizure dog will alert the patient to get into a safe place or even on the floor, they will stay with the patient observing the breathing, licking the face to encourage the patient to come around, go get the medications that are needed. Glucose dogs will alert the patient his sugar is changing and the patient can test, ask the dog to go retrieve juice from the refrigerator if needed. Anxiety dogs will get as close as they can and start licking their patient, nuzzling for petting which will encourage the patient to relax. All of them will leave and go find help if things go badly or bring the phone so the patient can call 911. These dogs are groomed often, receive more frequent vet checks, and are often breeds that have very little danger. There are even dogs trained to smell out allergens and keep their charges from being exposed. Service Animals are serious when working, will not engage with people other than their owners, extremely well trained and very, very expensive. On average 20,000 dollars per dog. I am sure that the school would make arrangements to keep a child with a dog allergy out of the same class with a student that requires one. Now if we are talking about group therapy dogs I am sure that any student that is allergic to dogs will be excused from having to attend such a therapy session.
  5. Dragonnurse1

    BSN bump in pay?

    Exactly. ASN or BSN same pay ents the BSN means you can move into management easier. We got 50 cents for PALS, 50 cents for ACLS. If you got your TNCC or CEN nothing and if you went through WMD training, Burn Care training you got nothing but the label. I worked with a lot of new grads both ASN and BSN and I really hate to say this but every BSN that tried to come into the ER when I was working never made it. They were either moved to another area or left the hospital. Deep South RN here too. We were all ASN's in the ER, some took the bridge classes and left to move into the management areas or to do case management. But both BSN and ASN started with the same pay.
  6. Dragonnurse1

    What Does A Graduate Nurse Do?

    I was in the last group of pencil and paper NCLEX takers. We all had to wait until the test was offered but we all signed up for the very first chance to take the exam. Actually we signed up for the test before graduation. Ours was 2 days, 4 testing periods and 6 weeks of waiting. I graduated on a Friday, started working as a new grad the following Monday. I think we had to wait about 4 weeks for testing. I worked with a lot of people in the ER that were in nursing school after me and they were the first ones taking the computer form of the test. Every one of them took the test within 3 weeks of graduating, every one. No one took "time off" before the test. The knowledge was fresh in their minds with no chance of work experience effecting their answers. School is the ideal but work is the reality. Get the test over with as soon as possible. That way there will be no sudden snags for you and your license will be yours sooner. I would have loved being able to take the computer test as those 2 days were sheer hell. Our school had 100% passing rates but my group had a 98% - there was one girl that went into delivery during the 2nd half of the first day. Medics in the hall, she is screaming she is going to finish the test but the baby had other plans. We also had one male that decided to not show for the last section on the 2nd day. He had finished 3 sections and just did not show after lunch - never found out why. I fear the longer you wait the harder it will be. Just do it ASAP.
  7. Dragonnurse1

    Pain medicine to drug addict?

    MrBlueSky you were correct and you did just as you should have done. The "day nurse" however, seems to have been substituting her personal decisions for the physicians written orders. She was wrong not you. It is a strange world when a nurse will decide to treat someone different just because "they are drug users". While I have never been a drug "addict" I was afforded the benefit of being a chronic migrainer when I was young. I had my first one at 17 and they continued for many years and I was in chronic pain due to bad disks in my neck (discovered many of the migraines were not migraines at all but pinched nerves in my c-spine), all of this before I went to nursing school. I had my neck surgery during school and being older my migraines eventually stopped. In fact I would get shots for my migraines at the same ER I eventually went to work for. As a result most of the Doc's on nights would get me to review charts for the "migraines" that presented. I could pick out the real from the act but most of all I could see the little signs and most Docs trusted my judgment. However there was one Doc that would not for any reason give narcotics for people with back pain. He held fast to his beliefs right up until he went down and had to have back surgery. Then he realized how prejudiced he was toward "druggies" and narcotics in general. Just because someone was an addict does not mean they deserve to suffer post surgery. I admitted an alcoholic one night for an ortho doc and in the mans orders he wrote "2 beers with meals". I was shocked and he told me he was going to operate to save the arm but he was not going to treat his alcoholism so the beers were to prevent the DTs from starting. Drug addict, or any other kind of addict, should be treated for the pain now, today not treated less because of what they are. Treat the body, the whole person, treat them like a human being and if the doctor has ordered morphine and the patient is still in serious pain you give the morphine period end of sentence. Pain in the US is under treated as it is but allowing pain to go unchecked with an order written is cruelty. We saw a lot of sickle cell patients, one of note was know to use street drugs too but when he came in in crisis, intractable pain, dehydration the fact that he used street drugs did not stop us trying to treat his pain. Before I went off duty I had given that man 34 mg of morphine, 34! He was still talking, crying, unable to be still. I gave days report and the oncoming nurse made a snarky comment about the amount of morphine that I had given - the Doc coming on heard her remarks and they disappeared into the nurse managers office. I did not see her again for several days. Seems she had to go to a class for a week for "refresher course on pain medication when dealing with a drug user who is also a sickle cell patient". You were right, the day nurse was wrong and you stand your ground when advocating for your patient. You might be saving or changing their life for the future.
  8. Dragonnurse1

    "When Minutes Matter" - Thank You Emergency Nurses

    Thank you! Even though I am no longer working, thanks latex allergy, I appreciate your words for ER nurses. We always felt like the Red-Headed stepchild in our hospital. Thank you again for your most kind words.
  9. Dragonnurse1

    Three Things Everyone Should Know About the NCLEX

    I was in the last group of the pencil and paper testers. 2 days 4 sections and 6 weeks of waiting. So sure I failed. The results always came on a Saturday. Opened the envelope and sat crying on bed in total relief as I had passed. Those taking the test today are lucky.
  10. Dragonnurse1

    Inclement weather conditions...mandatory to work?

    I live about 172 miles from the Gulf coast. During Hurricane Opal I was scheduled to work. Opal was so large that we were going to get Cat 1 - 2 winds here. I was an ER RN and my husband was a cop. He drove me to work fighting with the van all the way there and went home to stay with the kids. I worked. If he had been called out he would have taken the kids to my parents. We had no pre plans for Opal, we did not get notice days before she hit that she would impact this far inland. We made our plans with about 8 hours notice. The hospital had no plan in place. We did not get hurricanes here. Everyone in the city was scrambling but I never even considered that I would not go in, that thought never crossed my mind. I have 4 kids. I took extra clothes because I did not know when I would get home. The kids understood that we were essential to help other people. That was in 1995. Then in 1998 damned if it did not happen again with Hurricane Ivan.
  11. Dragonnurse1

    Accepting verbal orders from another nurse?

    Never pull a narcotic without a written order. Never take a "verbal order" second-hand Never push a medication someone else has drawn up in a syringe. And never let someone else waste leftover narcotics you pulled. Simple rules to go by. Simple rules to keep your license safe.
  12. Dragonnurse1

    Starting out in ER?

    Straight to the ER from graduation. 2 whole weeks Orientation, well sort of, 1 week hospital in general and 1 week in the unit followed by being a "floor" nurse in the ER for patients being held for rooms upstairs. Then to nights and on my own. Sink or swim, I decided to swim. My first night was my first overdose, a weird one that no one had ever seen before and not a single experienced nurse stepped up to help. By the end of my first year the night nursing supervisors would tell the floors to call me for things if they were busy and by the end of my second year they basically stopped coming down for deaths asking me to handle them. I spent 9 years, 4 months and 17 day on nights and left only because I developed a Type 1 Latex allergy. Success is up to you! Be determined, be confident, ask questions and keep on learning and expanding your own knowledge. I was always told "the only stupid question is the one you do NOT ask." But also learn to say NO when asked to work extra shifts. After the second yes administration expects you to say yes every time. Even in the ER we develop a "speciality". Some nurses become the Ace IV starter, some are better at burn patients, some at cardiac patients and others, well we just are "Jacks of All Trades and Masters of None". In my ER on nights we had one nurse that was the best at Cardiac but not great at trauma, we had one that could ewal anybody while talking non stop. We each had strengths and at least 1 weakness mine was starting an IV on any child younger than 3 - nope nope nope call NICU. One other thing the ER is unique. Most often it has two speeds - 100 or 0. You could be empty only to find yourself swamped an hour later so you have to learn to Move, learn the protocols so when you move some of your movements are on automatic pilot, re access the triage patient while placing them the room in case there are changes, and keep Wintergreen handy for the really bad smells (for your coworkers in case they need it) and if you can hear the patient coming up the elevator from the ambulance bay screaming at the medics it is NOT an unresponsive patient, which is what you were expecting.. Debrief every morning after a bad shift, our group would meet on the parking deck after a tough night and talked through everything, cried together if needed and then we went home. It is a roller coaster fueled in equal parts by adrenaline and caffeine. If you really want it DO it. Remember what Yodo said "DO or DO NOT, there is no TRY"
  13. Dragonnurse1

    I Should Be in Jail

    I too had a Munchhausen's by proxy but here I was able to call child services immediately and the child was removed from the mother. A 3 yo that called me a M*****F***** and his mother thought it was the funniest thing she ever heard. I was trying to numb his lip for sutures. The PA sutured him without numbing. A 13 yo that was shot in the head because he would not give up a 25 cent bag of potato chips. A 15 yo frequent overdose attempt but after his 3rd round I knew his grandmother as she was my Mom's hairdresser and his other grandmother worked upstairs in our hospital. His language directed at his father could make a sailor blush and he tried to leave the ER. Yeah his head got pinned to the bed as he was told his butt was mine. I had called his grandmother down and she was glad I did what I did. The child never made another attempt again and finally turned out OK. The 11 yo that had been discharged from a Children's Hospital earlier that day post cardiac shunt and while driving home the shunt tore loose. The parents accused us of not doing our best because they were Hindu's. There were others but not related to the family For me it was mostly teenagers between 13 and 19 that pressed my buttons. All children are hard when they are in the ER and as nurses it hurts to see them hurt or be hurt.
  14. Dragonnurse1

    Why Do Nurses Quit?

    GinnyMI i agree with you. I graduated in 1993 from an ASN program. Our school had 100% passing rate back then and when I started working I had already had 3 semesters of hands on in clinicals. Just before I had to give up nursing I had a new grad from a BSN program, who had to have her orientation extended 2 times, fall apart when her patient arrived literally. The call was for an unresponsive patient, I was helping her set up and once again walk through what was going to happen. The patient arrived and we could hear him yelling at the medics that they were "killing" him with the O2 mask, that he could ******* breathe on his own (he was still in the elevator while we were listening to this). This was not an "unresponsive patient" and she should have been glad but instead she broke down in tears. Because she was going to have to work him up basically by herself as another patient, a GSW was 2 minutes out and I was going to have to take that one. I was in the bay next door if she had questions but she cried. She had been on orientation for 12 weeks and still was afraid of taking a patient like the one I described. When I graduated I had the required 1 week introduction to the hospital and safety orientation plus an additional class on 12 lead EKG. I had 1 week with a "preceptor", who was the charge nurse, and then I went to nights. My first night, my first overdose was a pyridium overdose and not one nurse with experience would come in to help. The Doc and I were plowing through his books to see what to do. I was pushing methylene blue on my 1st night after a 2 week orientation. I worked 9 yrs, 4 months and 17 days. When the hospital wanted everyone to go to 12 hour shifts I stayed on my 8's. 12's did not work for me with 4 children at home and the youngest was barely 2. They learned very quickly not to call me to come in early except on certain conditions, the Doc's referred to me as the A team. I had a good school, I had lots of hands on in clinicals including ICU, I was taking care of patients not customers. I was an ASN. Not one of the BSN's made it on nights in the ER while I was there - not one - and we tried to help. Everyone of them were so frightened of hands on and said that their hands on during their clinicals was non-existent. Some of the best nurses were ASN trained that went back for the BSN later because they wanted to be in management. I had no such desire as I enjoyed the direct patient care. Also we had Patient Care Techs (PCT's) and housekeeping in the ER. We had transporters (unless it was a unit patient) and surgery came and got their patients. The insane desire to get ER stays down to less than an hour was just that insane. Our overall turn around time, even with the holds, was 2.5 hours. Not bad when you are 25 behind when you arrived to start the shift and you were ER of the day for the entire city. RN's NEED support personnel. They need the Unit Clerks to input the orders, get rooms, call for supplies, and get food trays from the Cafeteria when holding a patient for a room. They need housekeeping to clean the rooms and pull the linens. Hospital administration should not be busy buying top of the line SUV's for the department heads nor should they pay themselves and the department heads mid to upper 6 figure salaries while nixing pay raises for the rest of the staff. I still miss the work but I am glad I do not have to work with the way things are going. I can never return to work due to Latex allergy but I was not ready to quit, I watched the turnover, except for a core group of 5. I became a nurse at the age of 40 but I had been the "family nurse" for much longer, for me and the other 4 in our group nursing was a calling it was not just a job.
  15. Dragonnurse1

    Seasoned Nurses VS Newbie Nurses

    Nursing school is to nursing as law school is to the practice of law and the police academy is to policing. School gives you the basic knowledge, the outline if you will with some parts written in stone but it is only a starting point. Every facility in this country has protocols and often those protocols are very different, in fact in my city the protocols between the two major hospitals are quite different. Every ER runs differently with the desired results being the same stabilizing patients or in some cases saving their lives then moving the patient on to the floor/unit for further treatment. My first day working the Nursing supervisor told all the new grads - school is the ideal but you are in the real world now and now you learn. My first day in the ER my preceptor was also the day charge nurse and he told me with each patient he sent me to care for - go take care of this and if you get in trouble call me. So many things that day were the basics from school, ng's, foley's, dressings and so forth. Unbeknownst to me he had other nurses watching from a distance and my second day he handed me a burn patient to work with one of the most difficult ER physicians we had. After the Doc complained how I was doing a dressing I turned to him and told him he had given me two different sets of instructions and I was following the one the burn protocol listed. He left the room to calculate the drip rate which I set while he was gone and surprise we had the same rate and that Doc often requested me to assist him. Now to make a longer story short, yeah too late, I took school, hospital protocols and my own extended learning and created my style that got me sent (the only nurse sent) to more advanced teaching such as WMD training, Burn training and Chest Pain Center training. I never openly corrected any of the "seasoned nurses" but they would ask why I did certain things. Example why I pushed methylene blue on an overdose patient. My Nurse manager had to pass on compliments from the physicians and I was often asked to come in to take care of certain kinds of patients. Fire medics wanted me to teach them to start an emergency IV on burn patients in less than normal places. I never corrected, inferred or suggested that the more "seasoned nurses" were not "up to date" as what is "up to date" today may be out of favor next week but what I did do was watch them, listen to them and discuss the nights patients. It should never be "seasoned" vs "new grad" in a place like the ER it should be about all working together exchanging information. discussing the new, comparing with the "old", helping write new updated protocols for the unit and designing tracks to help with keeping the flow through the ER running as smoothly as possible.