mechai44

I stood behind a physician as he attempted to explain why the medications this particularly patient was told he "had to have" didn't work on the patient. The patient asked, "You told me in the ER that this would work but it hasn't. Why didn't it work like you said it would?" The doctor looked squarely at the patient and responded, "This is why we call it 'Practicing Medicine'. Any other questions I'm certain the nurse can answer at this point" and he shook his hand and walked out of the patients room while my brain swirled trying to prepare for what I anticipated to be the patients questions!

I think it's important, too, to consider those patients who are AAOx3 but are impulsive whether from a concept of wanting to move their inpatient stay along by doing more, trying to do more because they feel better, or impulse control issues related to a disease state or other condition. I've had patients on the inpatient rehab unit where I work who are exactly that. They answer all of the questions perfectly throughout the entire shift but dink around when it comes to impulsivity. Good luck with this issue. I wonder if printing all of these responses out and taking it to HR would help at all?

I am a BSN nurse with CRRN and WCC certification. I have 5+ years of bedside nursing including several years now in a hospital on the acute rehab unit and as a med/surg pull. I am in the early stages of planning a move to the Chicago metro area. I was hoping for some general info from my colleagues here on allnurses. Are the facilities there fully transitioned to the pay for performance format where patient satisfaction scores produce bonuses? Are most hospitals in Chicago union or non-union? What pay scale would you imagine I might expect? Are hospitals there pushing for bedside BSN's to continue on to Masters or Advanced Degree programs? I am currently in the Philadelphia metro area at a small community hospital that is union. Thank you so much for any information you might be able to share with me. I truly appreciate it! Mechai44

Go for the BSN if you can. I just read in a nursing journal that some states are considering BSN nurses only. http://news.nurse.com/article/20100222/NJ01/302220003 It may be more specific to certain areas of the country so keep that in mind, however, it sounds like the climate is changing. I live in the Philadelphia suburbs and one of the major hospital chains here just shut down to BSN students only leaving all of us ADN student nurses with super slim pickins. They are also making their current nurses without BSN's finish their degrees within a set number of years much like the article above and any management level BSN's have to go for their Master's. Best of luck in whatever you choose!

Our instructors told us we could only use a ponytail. They said that banana clips, barettes, boby pins and other "clips" could be used as weapons against us by delirious or aggressive patients. They also told us no scarves, head bands, etc. It was a pony tail only and we have to figure out how to make it happen or get a shorter hair cut.

Let me tell you my story, Folks. I worked as an office manager for a pcp practice for adolescents for 5 years. To my recollection we never had a patient with MRSA or even a staph infection cross our threshold. And, as a manager I had little to no physical contact with the patients - no wound dressing, no nothing unless I shook their hand or gave them a hug or something. I am an otherwise healthy 37 year old woman with no chronic conditions. I have never been hospitalized. I have never traveled outside the US (although the CRNP I saw twice in my pcp's office kept asking me that). I resigned my management position a year ago to pursue a nursing degree. In the past 4 months I have had 3 different CA-MRSA skin infections. My physician feels I must be colonized even though my nasal swab came back negative. Add to it that my physician really isn't sure what to do. She's only ever seen 1 other case of MRSA in her practice. I'm assuming then that folks are taking it to the ER's instead. I've done some searching on line to try to better inform myself. Here's what I've learned through my own experience: it's everywhere and getting worse; the decolonization process can include using a product like Bactriban in the nares 2x's day for 10-12 days along with using Hibiclens in the shower 3 days straight all over your body and then 3x's a week indefinitely; Hibiclens is OTC now, by the way; I've been taking Bactrim for the treatment of my wounds which on one hand seems successful but again I'm on my 3rd infection in 4 months so perhaps not; MRSA can colonize in the nares, throat, axillae, and groin. I had my nasal swab done and that came back negative and my throat swab results are still pending. I will tell you that I did the nares Batriban treatment between infections 2 and 3 and still managed to get infected again even though my test results were negative so I'm unclear about it's effectiveness. I have a dear friend who is a physician in Albuquerque and she says they see it all the time. It's just happening and it's going to continue particularly until we get more public information out there for the community to be informed. We need to be able to tell people more than "good hand washing". We need to be able to instruct them about laundering, cleaning their bathroom surfaces or kitchen surfaces, about keyboards and cell phones as potential host sites. There have been some news reports about airplanes, gyms, physicians stethoscopes and grocery store carts being covered with this Superbug. Why then aren't there clearer guidelines out there about how to try to manage it within a persons life? I found your website in search of better information and I'm thrilled I found it! If anyone has any additional info I would be so grateful.