NurseNed

For what it is worth - I found this in a blog written by a comic strip artist/comedy writer. I share it for your consideration. For me, it explained things I have seen, felt and heard in a more clear light than I have understood previously. I think, while with a bit of intense language, given the writer's personal thoughts, feelings and experience, it is a very good explanation and gives telling insights on what may not be a well understood aspect of certain personality developments. Given the intensities of Robin Williams' performances, of which I have been fascinated and awed by many, I think this is an exceptional behind-the-scenes look. Robin Williams and Why Funny People Kill Themselves | Cracked.com One of his Directors commented that the only thing faster than his mouth was his mind. RIP Robin, and thank you for your portrayal of Adrian Cronauer, with whom I served in RVN during his time there and safely laughed my head off while flying my L19D as Shotgun15 in my Sector in the Mekong Delta. thnx, NN

A tactic I have used if I see no visible signs of significant pain/discomfort (including my somatic/gut response regarding their position in bed or chair: I have asked "How are you feeling?" and after their reply, if meds not quickly indicated, often asked, "How are you feeling about how you are feeling?". I have often saved that for post Rx assessment as well. In truth, I have received some "interesting" answers (!). And how we go about it may be as important as the response(s) we receive . . . I have not seen any nurses this insensitive, yet: - I had been Rx'd some Physical Therapy to assess for efficacy of therapy vs manipulation under anesthesia. The Therapist was assessing for range of motion, said he, and proceeded to move my (L) biceps to my toward my left ear and saying, "Tell me if this hurts on a scale of 1-10. He pushed hard. I had sparks in my eyes. I could not breathe and he was lifting my hips against the resistance (along with my trying to decrease the searing pain caused by his "assessment") and managed to barely squeak out "50!". . . . Please see the face past "11" above and instead of tears, draw in RAGE ! . . . (I love that chart - as well as the Samurai Maxim.) He relaxed his push a bit and said, "You can't have fifty." My response, as I gasped for breath was, "THE HELL I CAN'T! ! " and wrenched my (L) arm from his grasp with my right. (I swear, I had been able to breath I would have tried to rip his head off . . .) and yes, he stepped back quickly, and he only being half-again bigger than my size. (Not once did that %#%$ say he was sorry). Just for the record - when having the manipulation a week or so later, my Orthopod said there had been a lot of popping and snapping and my whole upper arm was a mass of purple bruises - I asked him if my shoulder had been "Epoxied" He said, "Close". After the manipulation took 3 months of therapy (at another place) to get my range restored - in which I learned of Iontophoresis vs PO meds. I guess I have taken the long way of saying there is really only one best way to assess a patient's pain: the trial-and-error approach to learning what works best for each patient. I learned well in years past . . . "Puppy love is real to the Puppy" (see Maya Angelou) and have opted for a more eclectic approach. One CPE Supervisor often counseled,"Do or say the obvious". EDIT: All that said, I have often offered male patients the suggestion that they not "wait until they cannot wait" until asking for pain Rx. I tell them that, in my experience (with Hospice too) it often takes more Rx to get it under control than if they deal with it sooner. I have countered the, " ... but I am afraid of getting adicted ..." with: "Our goal is to adjust the meds to the symptoms. As the symptoms diminish as you heal, the meds are reduced as well. We will work this together". thnx, ned

Just for the record, I am a retired US Army Veteran (1965-2000) RVN and DS. I was a Hospital Chaplain (Yes I was not authorized a weapon - yes I hated it, I felt unprotected) (and Nursing Student - yeah, they razzed me, but I learned important stuff) in Desert Storm. In my experience at Desert Storm, there were some who tried to get pregnant to be sent home - we were already "Short". It did not work. They acquired other "Command attention". However - Yes Desert Storm was different than the Afghan-Iraq-Afghan decade (again IMO, and as Chaplain I was involved in several of these situations, as well as other types of Judicial and Non-judicial situations, by Command directive) 1. The female was sent home, not as punishment for her activities - but for the sake if the fetus, as well as for the attending issues of pregnancy. The combat theater is simply not set up to handle that. 2. When the pregnancy occurs in persons who have their spouse back home, there are UCMJ issues in play as well. Conduct Unbecoming has many ramifications a well. 3. And yes, the Commander decides which to pursue. Re: Distraction? Not Professional? Those are contradistinctions. You did not mention our (males') socializations as Protectors. That too may come into play re: distractions - also having next to nil to do with "Professional". While I am at it - when did "Professional" come to mean one is a robot? OK, never mind - this is a subjective mine field. End of subject. - - - - Personally - If a woman wants to go for it. Fine. 1. Just go without preconceived notions of special treatment. 2. Count the cost, personally, collectively and corporately - and please know that dragging a 180 dummy x number of feet during a PFT is way different than dragging a wounded soldier plus "Full Battle Rattle" any distance while bullets, looking for you, are flying around. Let it be also noted here - In any Military Theater of Operations, All are expected to be Blood Supply for others - it is on your Dog Tags for that reason too. Perhaps it would be good to read this, from a female Marine. Some advice on women in combat from a female veteran « Hot Air And yes, I have been in combat, in Vietnam '66-'67, both as a Army Aviator ("Spotter Plane" (L-19D with rocket pods)) pilot and on the ground in fire fights. Yes - adrenalin does help one do extraordinary things - sometimes good, sometimes not. Please - enough with that "Double-Standards epithet - there are none for whom "double-standards" are not implied and applied. And yes, while the kids (if you are not into your 70's, you are one of the kids . . . ) in there today are not in the same circumstances as we were in "My Army" - some better, some worse, some much worse. (All combat veterans have some version of this . . . :-) Each theater has its own brand(s) of lethality - only variable is the probability. That said, IMO, active combat is the most horrific circumstance one can experience, and the only thing I found helpful was to try to keep myself convinced - "It only happens to the other guy... he has it worse than I do". I have long believed - since I was approaching 18 (1958 - OK?) that all 18 y/o's should pull military service, delayed only by College ROTC Contract, which then incurred an additional obligation. - - - - - To all I can only say, May The Lord Bless and Keep you, and may you always give your best. thnx, ned

I find myself seconding what each of the previous posters have said. One must go into Hospice with eyes and ears open. I have been fortunate to have been a part of 3 good (patient focused) hospice agencies in two states. I know of others not so. I have seen some change, IMO, for the worse. An agency must do business well in order to stay in business - so that patients may die free of anxiety, pain and fear, and their families find coping, support, healing and Peace. As a former Pastor who had parishioners on hospice and Army Reserve Hospital Chaplain who served in Desert Storm before becoming an RN, I found it helpful to realize that the patient's family was in a curiously similar position to a pre-surgical patient anticipating an amputation. The Family unit was going to lose an integral member. Realizing too, that the terminal patient and each person directly involved in the care and caring, was at a different place in the anticipatory grief process - and the more they were able to talk about how it was being for them, the better they were able to cope. It was my experience that the patients' physicians depended upon us Nurses to communicate the needs of the patients. Two books I found helpful in my processes along the way were: Final Gifts: Maggie Callanan and Patricia Kelly, and Feel The Fear ... and Do It Anyway: Susan Jeffers, Ph.D. Hospice Nursing is, IMO, a high calling, a significant responsibility and a remarkable experience not many are given. An important discovery for me was that, with the teams of which I was a part, was that the borders between disciplines would "become blurry" PRN. The commonality was what we liked to call, "The Hospice Heart". To my mind, one of the most precious things a Hospice worker can hear are the words, "I don't think I could have made it without you." I wish you well in your journey.

Well - in this one instance, I was making a visit to a patient in one of the more "difficult" facilities I visited - yup - with the State Surveyor in tow. A couple of the NH staff did not make the connection and began giving me a hard time about me seeing the patient when it was not convenient for them. Long story short: The surveyor identified herself, invited those staff and their supervisor, ADN and DON into the Administrator's office, and advised them all regarding the law, whose patient this really is, regardless of domicile, and unless they did not want her to make a quick phone call to get an impromptu survey of their own underway, they had better "fix this here and now ...". The looks on their faces were studies . . . . ! She went on to add that the hospice staff was not only essentially "free help" for the facility, but with hospice charting in the facility's chart, it actually made their NH charts look better to them, the surveyors, for their own surveys in the "coordination of care" arena at the very least, especially if charting shows notification of Hospice for changes in patient status and appropriate followup charting in both directions. This surveyor had not done surveys in this facility for a few years due to focusing on home care and hospice, but the administrator and DON did remember her. She finished our little meeting by saying " ... seeing evidence of good team work makes me very happy ...", looking at all of us with what I took to be her best shark-grin. We got the picture. They discovered Hospice helps them in other ways: supplies, doctor calls, meds and trying to be available as a friend in need. Life was better after that and being able to relate this first hand experience to the proper people in my other facilities helped too as well as being able to bring some of my Army Chaplain skills into the mix. thnx, ned

(Quote)Originally Posted by leslie :-D View Post you'd think that all of us would get that... but tell that to the gazillion, filthy, feces-crusted foley caths i've seen. leslie Double bad imagery for which I have two words: Write Up ! If I have to correct them the second time. I have seen UTIs progress to a nephritis. I often told folks working for me to treat patients as my family if they cannot treat them as their own. If they cannot give quality care and/or call for help when they have trouble, they can go hang. I determined early on that I would not suffer a write-up because I had not taken prompt action when I found sub-standard care. The patients' feelings will be fine if they have quality care with respect for their choices, plus they will get well more quickly, in the main. I have had female patients ask for me to be their nurse when they had refused other males. (I did almost always ask for female assistance "if only to help the patients keep their filters clean",) Ok, yeah, and for CYA for me as well.

Bottom Line: Nursing School and the resulting exams, including the NCLEX-RN, are not about school. They are about other peoples' Lives. Become the Nurse you want to attend you. Medicine, even Engineering and Architecture, Building Trades and Auto Mechanics, as well as others, are all about the safety and well-being of others. If a person is not willing to meet that criterion - please don't go there.

If I recall correctly, for my class graduating Spring '93, not only were we the last class to take the NCLEX-RN on paper - 390 questions of which 300 were NCLEX-RN questions for licensure, and the remaining 90 were questions which were being tested as whether or not they were good test questions to be used in future tests. These were mixed in, throughout the entire test, since every years' NCLEX-RN was different, as we were told, so no one other than the designers knew which was which. We assumed that meant they were at least rearranged and included some of the newer questions each year - all of which amounted to a Comprehensive Exam for your license. As an "Exit Exam", we had a final NLN Exam which was itself comprehensive of the various NLN exams we had taken throughout the entire BSN Program. That was the exam which the school used to clear us to take the actual NCLEX-RN. We were offered the opportunity to take a computerized Beta Test of the NCLEX-RN, as the first class to be able to take the test for record. We asked what does it mean? We were told, " ... if you do really well you will finish early (comparatively) and if you do really poorly, you will finish early ... ". We all decided since our entire preparatory time had been focused on the Two-Day, Four-Session approach, we said, "Thanks, but no thanks." The one good thing about the old paper test was, if you couldn't figure out the answer to a question, you could skip over it and most likely find something further on which would be a help in answering the skipped question(s). It must have worked because I passed on the first try. I understand going back to fix a previous answer is not an option now. Wow! Memory Lane. Good Luck to all of you, both in your learning times as well as in your testing times. Remember: Comprehensive means from Day One - of your Pre-Reqs.

This is from one who is now retired (PTL) (from several career paths, including nursing, which I blended into one that fit me), and in looking back, as others have said, yes, schools can misuse the exit Exam. However, the Exit Exam might be known now, in practice in times past, it was known as a Comprehensive Exam, (which has been the basis of moving from Grade Level to Grade Level as well as from subject to subject, in Europe for centuries) meaning it was designed to assess the level of knowledge retained from all phases of the progression though the curriculum, which is the basis for the NCLEX-RN. In my nursing school years 89-93, each subsequent class' final exam also covered material covered in the previous classes, because in real-life nursing you cannot "get it and forget it". When a nurse walks into a patient's room, or in my case, a patient's home for Home Health / Hospice, he/she is expected by the patient, family and physician to be "bringing all in". How else can one make a comprehensive assessment of the patient and his/her history, as well as manage the on-going case progress? How can you, in reporting to the physician regarding you findings and recommendations to the physician if you do not view the patient and environment comprehensively? Truly, If you are not willing to pursue nursing in this mindset and commitment, I wish you well in whatever you may choose, but Nursing is not for you. One of the most problematic areas I continually encountered, both as a Field Nurse and as a Field Nursing Supervisor, is how many of our number were just trying to skate by, doing as little as possible for patients and their families. It is difficult enough just trying to do the best, most comprehensive job one can without making mistakes, teaching and encouraging proper patient compliance, without adding conscious negligence into the mix. To try to keep myself on my toes, I always tried to consider my patients as my immediate family - even the Dragon Lady/Man" types - because that is how I want to be treated, as if I were their only patient. Please, think hard and long before making other career decisions - the same principles of competent and prudent practice apply elsewhere as well. As I think about my advancing senior years, you can bet I will keep a weather eye out in order to eliminate the "just trying to skate by" doctors, nurses and nonclinical personnel from my health care team who seem not to have my best interests at heart. We were taught that the patient is the leader of his/her health care team - and so I am and shall continue to be. Apologies for the long post (putting soapbox back into retirement.)

CONGRATULATIONS!

Hey Squid. I did forget to tell you that my BSN-RN was my Fourth College degree. I carry all of it and use all of it, even in retirement. Hoist anchor! All Ahead Full. Belay the naysayers' crud - they will need you someday . . . . :-)

Hey, Squid ! (I am Army(Ret.) Don't let anyone tell you what you cannot do! I started nursing school at age 50 and didn't bow out (retire) until age 68. Only you can set your limits. All those things you mentioned that you have been told why you cannot be a nurse are just so much Barnacle #$%&*! I was seen as a nurse, (and as a doctor by a patient who could not hadn't the female physician who was seeing the patient with me . . . go figure). As an "Older" male, I think the Profs treated me better than the younger female student set. And, as such, I could add the wisdom of my age and (on-going) military experience to the mix. (I was not the oldest in my class, just the 3rd . . .). FYI: Protect your boundaries and RESPECT theirs. (I am just saying.) That, and the fact that they found out I was also a practicing Army Chaplain as well. (Desert Storm came in the middle of my nursing school time. Yes I took a ribbing from many of the hospital staff, but I was also invited to learn stuff I would not have if I were just "Chappy". You will have patients, both during school and after, who will ask you to leave because you are male, as well as to replace a female because you are male. BTW: Unless you are built like Hulk Hogan, do not hesitate to ask for "Lift Help". Let nothing stand in your way, especially others' problems and your own internal bilge. Diplomatically insist on proper respect from physicians, nurses and patients. Study hard - a "B" is minimum passing where I come from, except on Medications Math where 100% is minimum passing. Put yourself on the receiving end of the medications math. You can do this, Swabby. I am in your "Amen Corner" Email me if you choose. You are one year wiser and more experienced that you were. Nursing is the most multi-faceted profession next to ministry. There are areas of specialty just for you. Not all of them will make you puke. Incidentally - in the OR, I discovered if I fascinate myself with the process, I don't get "woozy". (Save empathy for the patient's pain until back on the floor.) You can dissociate yourself from what might mess with you by really focusing on the patient's process - works for me, and the patient. Pitch all the regrets off the Fantail - you will find that you have gained something in this past year that would have been a stumbling block a year ago. (Been there-Done that). Again; Good Luck and "Move out with a Purpose". Hooah-Oorah -Ooyah, or whatever fits!

You were set up to fail, as has been stated. I speak from experience as an agency nurse who had only promised to be there (LTC) for 3 days. Each 3-11 shift had less coverage than the night before. Had I taken the 4th night, as asked, I would have been where you were. What you experienced was not Nursing, but Politics. You were "Scape-Goated". You have received good advice from your peers - advice gained from experience you did not have. (Like my first week in RVN. You THINK you know what you will do when you get shot at - but don't until it really happens). As your peers (I am now Retired - PTL - so I have said the ones still in the slots are your peers) have said, you must take care of yourself as well. I have been blind-sided by people trying to cover-up their wrongs. Fortunately I had good backup: A good physician and a couple of Really Good nurses. The fact that you said you were "rehired for the FLU SEASON" should tell you something: A: Get your Flu Shot early as you can. B: Don't go in "blind" -aka- Hello, you will be short-staffed again, but wiser. . . . C: Keep this group with you - they sound like a wise group. D: Stand your ground with management,assertively, when you truly believe you are right, and with the proper tact. E: Call for help when your situation is unsafe for your patients as well as for your license - Do you have your own Liability Policy? Facilities' policies are worthless on your behalf (no I am not plugging any, but I have mine as well as my License even in retirement. I could get a call or "a wild hair" (an Army thing . . . ).) Good Luck to you,and always think of yourself first - (Can I provide Safe Nursing Safely?) If not - make some noise. Remember: if they "take you out, how will you help anyone? Hmmmm. Wisdom begets Nobility - rarely vice versa - too painful, as you have discovered. PS: Please get good counseling support from somewhere, your Holmes and Rahe score is almost off the scale.

My response to these folks: "I have learned by comparing the two professions (and I did consider Medical School in 1980), Medicine and Nursing, that Doctors do not take care of people, Nurses do. Doctors are focused on combating disease and repairing injuries. Nurses provide the care for people during these processes which is focused on the persons' actual recovery. The two professions work hand in glove together, but without the combination, collaboration and cooperation of the professions, neither will accomplish their missions. thnx, ned moore

I was 62 when I looked at MSN-NP from Univ. Phoenix. It said you can do this in 5 years (and $15K). I thought what would I do with that at age 67? When I got to age 67 - I saw how much I could have been doing ! Yup: coulda-shoulda-woulda! Don't put off all you can do - it is a bitter pill, looking back at the good that could have been . . . I still spent the $15K anyway - on other stuff not as good. May your steps, your studies and your service be guided by the Ultimate Healer. Sic 'Em! Stat. thnx, ned