correctlywrong

I take an anabolic steroid by injection, and I am an RN. Of course, I am taking it by prescription for a diagnosed medical condition, under the care of my physician.

Let's talk about what YOU can do. 1) Learn from the bad example that was set for you, and when you find yourself in the role of a mentor or team member, focus on how you can do the opposite of what was done to you. 2) Consider whether it is appropriate to approach the PERSON with whom you had this conflict and give them professional feedback on how their behavior affected you. Do you think that this would help them to make positive changes in their future performance? If you decide to give this a shot, consider writing them a letter. Keep your emotions in check and just give the facts as you see them. Use "I statements." When X happened, I felt blah blah blah. As opposed to "When you did X, it made me blah blah blah." See if you can find someone like a counsellor from the school or even a therapist to help you draft the letter. Sincere feedback of this sort is a kind of gift that you could give to the PERSON, which could help both of you to grow as professionals. You may find that addressing the PERSON directly could resolve many of your issues with the situation. Not all people are able to recieve such a gift with good grace. You might determine that the PERSON is not someone that you could consider approaching with feedback at this time. 3) Try to put this behind you as you become increasingly competent and comfortable in your career. You will need months and years before you become an expert, but you don't to be a nervous wreck while you gain the experience that will get you there. Everyone was a newbie once. Just breathe, do your best, and you will be ready to mentor someone else before you know it.

I've decided that my answer is to give the best care possible to the patients and the paperwork be danged. I am less protected if there is an adverse event because my charting sucks. I am less likely to have a patient experience an adverse event if I spend my day at my bedsides instead of at a computer. However, statistics will eventually catch up with me and there will eventually be an event despite my diligence. I can either choose to speed up that date by changing my focus to documentation over patient care, or I can avoid it all together by leaving bedside nursing all together. I've accepted a new position.

On my unit, we occasionally get people that we consider "single shift" patients. It is understood that no nurse should have to have them day after day. Mostly they are repeat customers, so we know from the door that we need to alternate their nurses. It is a reasonable thing to ask for, to share the burden of an especially demanding patient/family. Especially if you keep the rest of your assignment, as those patients will probably notice that they get a more equitable share of your attention on the day that you don't have the patient you gave away. That is what gets me most about the very demanding people... they usually aren't actually accomplishing anything extra for their loved one, but they are taking resources away from others by monopolizing the staff's time.

Nursing is really stressful. Stress does exact a price, physically or emotionally. All people in very stressful jobs are at increased risk for mental and physical health problems, depression included. There are times when I ask myself why I subjected myself to this lifestyle. I want to warn student nurses. "Hey, do you realize that the prize that you get for all the work that you put in during school is to work even harder? The prize for succeeding in nursing school is to be a nurse. Be really sure that is really what you want!" I thought about taking antidepressants to keep my previous job. I could plaster on a chemical smile and keep going, but I decided that it was better to leave. OP says that several jobs haven't yielded the right fit, but that doesn't mean that there isn't a nursing position out there that is the job of your dreams. The reasons that you entered the profession are probably all still valid... just the conditions necessary to appreciate them are lacking. It is possible to find fulfillment and even pleasure in work as a nurse, despite the stress and all the human suffering to which we are witness. SSRI's can be a temporary or long-term way to get through the tough parts, but a good counsellor is a great help as well. Remembering to take care of yourself helps, too. Enough rest, healthy food, time off to do the things that make life worth living for you. A monthly massage is not too expensive or too extravagant, and it goes a long way toward healing mental and physical pain. Self-care will probably do more to restore a nurse's well-being than drugs or counselling. Sometimes self-care means trying again to find a better work situation. It has worked wonders for me.

Maybe you look like someone they didn't get along with once. Maybe they don't like your accent. Maybe they were offended because you ended a sentance with a preposition. Or there was some genuine miscommunication that troubled them. It hasn't happened to me personally, but I have had to take on patients who have requested not to have one of my co-workers back. Sometimes it has been those people with whom I am proudest to work. Always, it has been due to a simple clash of personalities or something else that was really not the fault of the nurse in question. The only really bad reaction I have ever seen from the nurse was to confront the patient about her reasons. That put the patient in a really uncomfortable position. She had felt uncomfortable with a male nurse who reminded her of a former abuser, and his confrontation of her only increased her distrust and general anxiety. If you absolutely need to know the reason, ask the nurse taking the assignment if s/he would mind to ask the patient if there is any feedback they can offer about what you could do better in the future. You may find that it isn't about you at all.

Try 29, 30, or 31. I think we, as a profession, use much larger needles than necessary. I give IMs in the deltoid on nonobese individuals using what my facility considers a SQ needle, 25g, 5/8inch. If the deltoid is well defined, under only a small amount of subcutaneous tissue, why would I reach for a 21g 1.5 inch? Sure, that might be appropriate for a leg/glute/obese patient, but otherwise it is just thoughtlessly cruel. Edited to add: Incidentally, 25g for a SQ! And I have seen some nurses reach for 23's! I use TB needles for most of my SQ, and I would use it for the purpose you describe.

Actually, according to Watchtower Magazine, they are very strong proponents of finding alternative/synthetic blood products. Their issue is that they feel the bible tells them not to consume blood, that it is an abomination. So, blood transfusions are right out. That doesn't mean that they don't want treatment, just that they feel that the available options are forbidden.

I signed on for a similar contract. Some days, I regret it, but I really had no other choice. I sometimes jokingly refer to myself as an indentured servant, but that is essentially what it comes down to. It does add some extra stress every step of the way, to know that you really can't fail, because the consequences are now that much higher. At the same time, what I did allowed me opportunities that weren't available to me otherwise. I basicallly couldn't have gone to nursing school or gotten medical care that I needed without the funds that I obtained this way. It can be a good deal. Just think hard before you accept it.

The great thing about heparin is its crazy short half life. You can turn it off for a few hours and the patient's ptt will normalize. I have seen a patient get a 10x overdose of heparin with no negative outcome. The woman who died of spinal hematomas had an allergy to heparin, as in her it induced thrombocytopenia. Unless someone has that problem, once they have survived the first few hours after the heparin drip has been stopped or decreased without negative consequences, they can probably be expected to have no further risk of adverse effects from the event. We really do have to take what we do seriously. We are putting very potent substances inside other people, and errors can have life-altering or even fatal consequences. And yet, we cannot help but be human. Do your best to check yourself, but never be afraid to have someone else check you. And if you check another person's work, really be critical and expect to find an error every time. Most people see what they expect to see, so if you are expecting to find errors, you will be less likely to miss them than if you just nod your head and agree without really examining what you are looking at.

Our hospital has a specialty unit where patients come to have seizures on purpose, while on 24 hour EEG monitoring and closed circuit TV. What I learned from the nurses there: Protect their head! Have suction set up ready to remove excess secretions, so that they don't aspirate. Apply O2, preferably by mask. You don't need a NRB, but it doesn't hurt. A plain mask with the flow cranked up high is a good thing. It is not uncommon for people to have brief periods of apnea during seizures, and it will probably pass before the code team arrives. If not, they may get intubated and win a trip to the ICU. Don't try to restrain the patient or hold them down. You won't stop the shaking, and you risk causing them musculoskeletal injuries. Protect their head! If they aren't in a bed, get a pillow under it somehow. (Why do people seize in the bathrooms!) It is amazing what a person can bite through when their jaw clenches in uncontrollable spasms. Don't introduce anything fragile into their oral cavity. Intubation equiptment and maybe a yankeur as needed are the only things you should dare put in their mouth. Expect incontinence. A couple of milligrams of ativan is your friend. Now you see why everyone in the hospital should have an IV access until DC.

Most common causes of fever post operatively include anesthesia reaction (rare, early), atelectasis (common), DVT/PE. Two or three days after surgery, pan culture. First 48 hours, it is something else.

Management that isn't above taking an assignment when needed. Even occasionally, when not needed, to keep skills fresh and to find out first hand what the problems on the unit really are. Nurses that aren't above team work, with each other and with other staff. Don't walk past the kitchen to ask an aide to go there and get your patient a pitcher of water. I don't care what they told you in school about how you need to learn to delegate. Part of learning to delegate is learning when to do it yourself, to demonstrate to your staff that you aren't asking them to do anything you aren't willing to do, too. (Note the repeating theme.) Aides should know that when an RN asks them to do something, it is because they need to have it done, now, and correctly. We have RNs who will go out of their way to find an aide to do something that they could have done more quickly on their own, because they think that getting their license means they don't have to do certain things anymore. Aides that hustle rather than hide. If you spend more time to walk up and down the unit complaining about how many complete baths you have to give, rather than getting busy doing the work, you need a new job. If you have to be asked more than twice to do something for one of my patients, there is a problem, and it is that management doesn't work enough shifts to know who the troublemakers really are and to get rid of them. There are nurses and aides on the list and everyone but the manager knows who really works and who hides out and makes more work for others.

There was a different ethic in the last generations. There was a feeling that the company would take care of you and that you just had to work hard and be a loyal employee. There are people who retired having never called in sick, and that was the norm. But there were also people who gave that level of commitment to a company and got only grief in return. I know that many think of healthcare as being different than other industries, but many hospitals are corporate endeavors at this point. Even those that are non-profit send out memos justifying running hundreds of millions of dollars in the black and the biggest perk most employees ever see is a free ice cream in the cafeteria. (ahem, UPMC). The younger generation has wised up a little. Yes, we call off when we are sick, or even just too tired and disgusted to make it in that day. I've been working every shift pretty close to burn out. If a day comes that I figure my mental state is going to make me an unsafe nurse that day, I will do my patients, colleagues, and the facility a favor and call off. They have no problem mandating extra 12 hour shifts to us to cover their staffing short falls, while refusing to use agency staff or travellers to lighten the load? I have no problem calling out sick when the load gets too heavy to bear that day, physically or mentally. And I have learned that administraton does somehow find replacement when they are forced to do so, even though that nurse wouldn't have been available to help our understaffed unit if the call off hadn't occurred. Have I mentioned that my nurse manager has never had an assignment in the entire time that I have been there? The one time she sort of helped out, she refused to pass meds, perform assessments, or chart. Her reason was that she hadn't staffed in so long that she didn't feel safe doing those things. I am not sure what exactly she did do, but whatever it was, it was apparently so taxing to her desk-job-softened feet that SHE called off the next day, to rest. And I should feel guilty about my 2 or 3 call offs a year? It is unfortunate that the older generation was taken so advantage of, but their work ethic was developed in a time when they thought they could depend on reciprocity of loyalty between them and their employer. If it really still worked that way (if it ever really did!), then I would be far less likely to call off as well.

I am in a similar position. When I am ready, I will tell them that I will work out the next schedule, as our schedules are made in four week blocks, and then depart. As for why you are leaving, the official reason should always be something along the lines of "I appreciate all that I was able to learn and do on this unit, but that it is time to move toward a new opportunity and new challenges." You definitely want to phrase your choice as a shift toward something rather than an escape from a bad situation. What is appealing about the new job? Is it going to be in a specialty that you have been interested in? Will it have a different patient population? What about it is different from your old job other than the new management/setting? Talk that difference up as something that appeals to you. Definitely be sincere and only say these things if you mean them. Fair warning: There will be personalities at your new job that you clash with as well, so if that is you biggest reason for the change, think hard about whether you are actually going to fix that problem by changing the cast of characters of your coworkers. You end up in the same position again until you are able to develop strategies to deal with problem people.

I've been at Presby on a med/surg floor for a couple years and I make $23+. I like overtime, and there is a $10/hour shift bonus on top of that for picking up shifts on particularly stressed units. Which I take ruthless advantage of! =) I grouse about it, and some days are better than others, but there are a lot of good things about the place, besides the money. Presby gets the most acute cases from the surrounding area, but you will get to work with the best and brightest on some of the most interesting cases.

You need to go to employee health right away. You don't need to tell everything about the circumstances surrounding your needle stick, but you need to have it on record that you were stuck with a needle that may have been contaminated with blood from a HCV patient. If you do contract HCV from this stick, you will want to be financially backed up by your facility. Liver transplants can be very expensive. You will want to be able to prove that you contracted the virus on the job. Also, what others have said about staying within your scope. A hard lesson learned.

You are never liable for someone else's actions. You are only liable for your own action or inaction. If you are in a supervisory role, you are liable for supervising them and seeing to it that they perform the actions that you delegate to them appropriately. If you see others exceeding their scope, you may be obligated to report that, and could be held liable for not doing so. But if you do fulfill that obligation, that should end your liabliity. You are not responsible for the outcomes of their acitons. Job hunting isn't a bad idea, but you can also attempt to defend in place. Can you bring your concerns about scope of practice violations to the facility's director and advocate for change? What is the worst thing that can happen, that they could fire you for attempting to bring operations in line with regulations? (Actually, in my opinion, the worst possible thing that could happen would be that they take your concerns seriously, but put you in charge of organizing the necessary restructuring. There is no greater punishment for a whistleblower than being cursed with corrective resonsibility. ;-P )

Breathe. It depends on the disinfectant in question, but if it was at an effective concentration level, I would think that most pathogens would have been destroyed within minutes of hanging out in the solution. If it was bleach or CHG, then almost anything short of prions would be toast within about 10 minutes of soaking You did the first round of testing. Good. Now just follow up with the protocol and get tested again in a few months. The risk of infection from the scenario you describe here is not very high at all. As for a needlestick while flushing a picc... that is more concerning. OP says that it was the lumen that had not been used for blood draws, but presumably people have been drawing back to confirm that each lumen has a blood return, at least once per shift. Therefore, I would anticipate that there could be some virus present in that port. Again, from what is described, it sounds as if the infection risk is lower than if the stick had involved blood to blood contact, but I would still recommend following the facility's protocol regarding blood borne pathogen exposure. Follow up testing should be performed within 3-6 months, just to be sure. AND ADVOCATE LOUDLY FOR NEEDLE FREE IV ACCESS SYSTEMS! We don't even use blunts anymore, except to withdraw medications from the vials. All of our access ports are now luer locks, greatly reducing the opportunity for needlestick injuries. God bless you both. I've had a stick, too, this past year, and waiting to get my follow up tests done has been excruciating at times, even though my risk, like yours, is quite low. Any risk is still frightening with some of the diseases out there. PS. I would be far more worried about HCV than about MRSA. If your immune system is present at all you shouldn't get enough colonization from a needlestick to go septic with MRSA. You're more likely to pick it up by not washing your hands often enough.

There is always an exception, isn't there. As opposed to tipping health care professionals as I am, I have to say that in the situation you describe, I can see why you chose to accept. I can't say for certain that I would have done different, though my first thought on how to handle that would be to try to slip the bill back into one of his bags, if possible. Or to donate it to charity myself, if that weren't possible. One thing is for sure... I would have charted it when I got back inside! Even though it was only a dollar, dementia patients are known to forget that they gave something away, and when they can't find it later, they can come to some unfortunate conclusions about what happened to it! I had a patient once who accused her grandchildren of stealing money from her when she had given it to them and forgotten that she had done so!

Absolutely, positively not. People often have strong emotions about the person who provides care to them and their family, and want to express their appreciation in ways that are not entirely appropriate. I am already being adequately financially compensated for my services (or if I am not, that is a matter for me to address directly with my employer or contracting agent in a formal negotiation.) There is moral/ethical hazard in accepting a financial tip. If someone offers a gift of nominal financial value, such as an inexpensive food item, or a handicraft, I will accept those with great appreciation, as to do otherwise would be rude. If someone is adamant that they want to give me a financial gift, I advise them to contribute to a charity relevant to our mutual interests, such as the American Heart Association, for instance, if they or their loved one has experienced a stroke or MI. I tell them, quite honestly, that the greatest gift that they can give to me is to do well and extend kindness to others in turn. I do shamelessly direct them how they can verbally/in writing express their appreciation to administration, if they so desire. (Those comments helpeed add up to a very favorable review and a sizeable raise this last eval... earning me far more than the few dollars that the patients offered me as a monetary tip.) Everyone with whom I have taken this approach has responded positively. While I do overtip excessively when I am a customer in certain settings, I don't feel that it is at all appropriate to cheapen the nurse/patient relationship by engaging in a custom more appropriate to waitress/patron.

I have given out motrin and tylenol to staff before. Usually from my own supply, but once or twice from the pyxis when someone was in excruciating pain and I didn''t have my stash in my locker. Motrin is one thing. Narcs are another. As others have said, report this. For your sake, and hers. If she does have an addiction problem, reporting her convo with you could be the first step to her getting some help. And it will protect you and your patients.

You can book a hotel room via one of the online services such as Priceline for very cheap. I got a two night stay in the Hyatt on the waterfront in Philly for under $100. You could probably arrange a similar stay in a quiet, comfortable location near you for around that much, or even less. It will be a small price to pay for protecting your health while your unwanted visitor is at your house. You and you husband have issues that you need to address, preferably with a good therapist. But in the meantime, you have options. Stress is always going to be present. Coping means figuring out ways to lessen its impact. Always remember that there may be a creative solution to what seems like an unsolvable dilemma.

There is a difference between being adequately medicated to address pain and being sedated. Admittedly, you shouldn't drive on opiates. But I was not aware that signing a consent required rapid reaction time or quick reflexes. If the patient is able to understand what is being discussed, as evidenced by return verbalization, and is oriented and not confused, they ought to be able to consent. Recieving pain relief is a human right.

With a picc, the tip of the catheter is in such a large, turbulent vein that anything that was infusing is typically swept away within seconds. Waiting a minute is generally more than enough time. Flush, waste 10cc, and draw labs. And then flush with at least 10, preferably 20cc of saline, with a pulsing, stop and start approach so that you thoroughly clean the line before you replace the fluids. The steady flow of the running fluids is not as effective at flushing the line as a turbulent, stop and start flush. As for lung sounds... many of my patients couldn't sit up if they wanted, and I don't feel that hearing the posterior bases is important enough in a stable patient to justify making them have to flip all around. Then again, I am in a desperately short-staffed acute care setting, and I just can't spare the time to do everything the way I learned in school. It is a shame, but cutting those kinds of corners on the stable people allows me enough time to provide adequate care to the others.