Witiku

I think I can take a stab at this one. (Punny:clown:) As non trained persons we have no escalation of force rules when defending ourselves and are not held to a higher standard. The concern will be from an evaluation of the aftermath by the police and possibly a DA. They will evaluate and determine if what you did was reasonable for the circumstance. In any case you may be the subject of a grand jury and that will not be a good day. Deescalation and conflict resolution are better tactics If possible. The trained person is held to the higher standard on EOF. Police can kill for the above mentioned knife but generally when ~21', that's the distance a knife can be used to kill before you could draw a firearm and use it to stop that threat. Lookup:Tueller drill or the Tueller Rule. They will not shoot someone holding a knife while on the other side of a glass door. They will for a gun though... see? AFIK, If someone was being attacked with a knife, that's deadly force and a reasonable person can use whatever force up to and including deadly force to defend another life. Best, W

I have to disagree with this proposed solution to increase workplace safety. 'Effective prevention taking the form of discovery and seizure of weapons in all public buildings': I believe to 'advocate' for the disarming of all for the hope of safety will lead to more violence, not less and is thus a disservice to the goal of safety. Not to mention I think it's morally repugnant to seize a weapon from a free person. This is a simplistic solution to a complex problem that removes the best answer to predatory violence and that is protective violence. Yes, violence can be good, remember, the police one calls to handle an active shooter such as the subject of this thread are in fact prepared to commit the worst kind of violence. There are many other legal weapons in society other than police related, why place barriers between them and a potential threat. 'as opposed to armed security as a deterrent': There cannot be enough armed security and generally, I believe a person that is determined to commit harm and arm himself is at least capable enough to slip past that obstacle. Reaction is always slower than action and help is only minutes away when seconds count. (That's an old one but very true.) Also, the true deterrent to such violence is not the visible resistance to a planned attack, it's the unknown that prevents it. Violent crime is down in the US consistently since the passing of concealed carry laws in 48 of the 50 states. Criminals are unsure who is armed therefore confront fewer victims for fear of encountering an armed one. As health care workers we are not trained combatants, we control things, things don't control us. WRT Violence, We tend toward the Feel safe rather than Be safe solution of No Weapons signage to feel safer at work. Fact is, weapon free zones are only free of legal weapons as those inclined to commit violence with them are the same people inclined to disregard posted areas. That help we holler for has been attenuated when we post a sign making a rule only you would follow. Why prevent a trained and proficient co-worker or a visitor from intervening if they choose to? I believe the reason is based on hoplophobia and dealt with by the defense mechanism of projection. that we fear what we cannot control may be the root of the issue.. Please keep in mind, this post is not intended to diminish the good intentions of the offered solution, just my opinion based on ~20 years of Hospitals from the ER to the Helipad and all floors in between, once being injured by a deranged family member and being cased for mugging twice. Workplace security is a concern for me as a manager and it does not include futile No Weapons rules. Best W

I just had a patient sent home to a small home on a farm. Flies by the Millions, Tree Roaches under foot, both solid gloss black and the usual brown, 2". Filth 'German' roaches on the walls, pt's bed and ceiling, little fat mini ones scurrying all over the floor. They were coming down the wall to the tray of cat food, No fear of people. As Carl in Starship Troopers said: "It's simple numbers. They have more." The reason given for not dealing with the infestation(s) was the 75 or so cats might be harmed. :banghead:There were Dozens of roaches in view at any one time. Just Wow.

there is not enough of that in nursing any more. that is all.

It's not you. Every nurse will have these things come by throughout a career. It's likely just life throwing a curve ball to you. Cry no more. T

Change jobs or voice concerns to those that can make it happen. When management makes life difficult, I look for a better job. I've been in control of P&P development for years now because I hate bad policy. These scrtipts are the worst though. To be told what to say to a patient like some mindless automaton.

It looks like the POC has to include these meds as if we don't provide them, they will not be sourced by the family and we'll loose the pt. Management wants to know what meds we will cover for any Dx so I guess I'll have to get a formulary and Med Use Guideline started. I may have to create a Policy using drug classifications with examples, by each med will be impossible. We all know though, that if a med is ordered, and the MD wants it given, then we give it irregardless of the policy and cost. Thanks for the replies, very helpful to know I'm not totally off here. ___________________________________________________ Just Thinking out loud. Technically, for a pt that has an Admitting Dx of Lung Ca, Hx COPD, Smoking and Arthritis with opiate Tx. It looks like these pain meds are not hospice provided as tehy are not truely related. (But try telling that to an MD that the pt goes to see about pain while in a Hospice and see how that goes over.) And there is a case to be made that the previous COPD maintenance meds are not the hospices' responsibility. (Again, try telling that to an ER doc when your Lung Ca pt is in the ER for SOB.) But, as I can't seem to make anyone truely understand, these are related and the referring MD could just as easily have offered all these Dx as why they are appropriate for Hospice and then they would be all ours no matter what, if we took the pt, as if we would refuse to care for him over this. Personally though, as a clinician, I can't remove the time component from the equation. Those same health issues that were unrelated to the actual Cancer, are now co-morbidities going to exacerbate the Cancer symptoms and impede comfort. Also .. what Shrinky said. How are you to separate the Lung cancer SS from the COPD SS from admit onwards? The prudent thing is to include these complicating Dx and meds into the POC for the patients sake. [/stopping thinking outloud] _______________________________________________________ Thanks!

Actually I can believe you could have been failed arbitrarily. There were many such fails in my school. Some were given two fails for no other reason than being men. They're quick to choose someone to fail, there has to be a number fo fails to keep the image up. If everyone passes then they might be seen as an easy school. [Thats what they said in private.] One man they failed twice threatened legal action on them personally and they took back one fail to let him go through. It's hard to justify a fail if you have the grades and meet the objectified standards. They failed at least 10 nurses that year. Many were ousted as they were not nurse material, i.e. Psychotic or 'off', Male and Female. Some were given enough rope to hang themselves and they did, others were just diismissed out of nowhere. The best thing you can do is object in writing citing clear examples of how this action is based on things unrelated to the established standard. Prejudice has no place and Opinion has little place in the decision to harm you. You may have legal rights so seek the help of an attorney and get a truely objective opinion. Think "Righteous indignation" and act to save your career, your patients need that spirit.

How did this turn out? Interesting mix of pain meds and where was the pain reported to be located?

For a public forum and generally, the details aren't as important as your reaction to the events. Sorry you are having coping problems. Good that you are getting help. Sounds like you're carrying around some weight that is not yours to carry, as the error was not in your control. Best to you.

I like white scrubs. The throwback to earlier times is not a bad thing either. I sometimes wear the black bar too. Older patients like it. Don't do it on peds.

Not an unusual happening in nursing. Were the two fails warranted? Is there an appeal process?

I've been a manager of nurses and other HCWs for years, This pre-aranged phrases stuff is a form of people control that I'd be embarrassed to implement. Maybe I just don't get it but it sounds unprofessional and it's demeaning to make a registered professional do this. JMHO Back to my cell.

Hello Hospice Nices, I have a dilemma and need opinions on it. Picture: New hospice, low census, skeleton staff, I'm an RN wearing many hats to control costs and help out as much as possible ... It seems there is some confusion on what meds are covered in Hospice but I've always used the 'related to the symptom management of the admitting Dx' and a good dose of common sense as a guide on what to provide. Well that blew up in my face today over the cost of some breathing meds. Case: New patient referral, released from hospital with a minimum of information. Dx: "Lung Cancer". Pt is not well off financially. Pt is at home and calling for us, I get there and find him in a pain crisis, discover he was on Fentanyl and scheduled Oxycodone for Arthritis and both are out. On top of this, the pt is on 5l O2 by mask and has a Hx COPD with nebs and puffer med use. The pt is a current smoker and can hardly speak due to SOB and pain. Well the referral source wrote scripts for new respiratory meds, steroids by inhilation and PO, as well as antibiotics for Pneumonia and no pain meds or direction for pain management. Question: What meds should the Hospice cover here? Thanks, Looking forward to any opinions.