nursingpower

Girl it's not worth it. This conversation has gotten personal. We don't need to use our personal experience to prove the research is correct. It's embedded in our countries history and current events. Some people will never understand which is why the problem of disparities in Healthcare continues to exist. In fact why racism against minorities in general continue to exist. All we can do is put the information... The statistics and research out there. No one can dispute that AA women and children have higher mortality rates. No one can dispute the perceptions of minorities. Some people are actually listening and applying it to practice. Measuring outcomes are the only way we can see change. I'd like to add that most people here have accepted the research. Hopefully that's representative of our nursing population.

This is not bashing. She specifically spoke on maternal childbirth mortality rates. In general studies show that the profession of medicine and nursing have not effectively closed the gap, especially compared to white women. Our country doesn't do much to address healthcare, racial and educational disparities. In regards to how African American females are treated. Research support biases by doctors and nursing. So the application of ludicrous in this situation shows exactly why it will continue to happen. It's not just prejudice. It's racism, which implies a much larger impact...ie mortality, infant mortality, pain management, quality of life, disability, ability to function. So much research supports this, it should be common knowlegde https://www.washingtonpost.com/health/is-bias-keeping-female-minority-patients-from-getting-proper-care-for-their-pain/2019/07/26/9d1b3a78-a810-11e9-9214-246e594de5d5_story.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/ https://www.heart.org/en/news/2019/02/20/why-are-black-women-at-such-high-risk-of-dying-from-pregnancy-complications

It seems to be dependent on your facility, level of nursing training, availability of staff physicians and policies. I am at a large hospital and the only ones are 1-1 are patients on devices (ECMO, VAD, IABP) and high acuity d/t instability. Sometimes they may do 1-1 if they have extra staffing for road trips and end of life patients (to accommodate family and processes). They also try no to give back to back fresh cases (within 2 hours of each other) despite mechanical ventilation status. Its rare but it can happen. It is possible in one day that I can get 2 patients out and get 2 fresh cases before I leave, again this is rare and we compensate by having a great team. The surgeries we get: valve repairs, aortic aneurysm repairs (ascending, descending w/spinal drains), CABG, congenital defect repairs, myectomies, and combinations of these. 98% of our patients are intubated upon admission and we attempt to extubate ASAP.

I will keep this short as possible. I am in my last semester for my AGNP program. I am with a physician who is 65-75 yrs old. During my rotations the doctor enjoys talking about so many off topic nonclinical subjects its draining to me. His staff, residents and other NP students warned me about this. Many people just redirect him but they don't have to be around him for 8 hours. For us that do we suffer. I just try to learn as much as I can and make the most out of my learning experience but the excessive talking is affecting my motivation and attitude about attending the site. One example... I told the doctor I needed to leave by a certain time which by the way he agreed to do partial days. I work full time. Some days I have class and many days I need to get home and get things done to properly manage my time for studying, sleep, homework, school projects, and household chores. I decided this was my last patient to leave on time and I waited 30 minutes to present to him as he talked about politics and how bad piracy (in the seas) is the worse its ever been. I ended up leaving 45 minutes later than I wanted. During clinical days, I prefer to discuss things like assessment findings, differential diagnosis, disease processes, assessments and plans. For the most part we talk about these things but I feel I have to sit there in between the important stuff and be forced to listen to the election/politics, religion, history (War with Britain, civil wars, rise of the Roman empire), cooking, government conspiracies, just to name a few. I am looking at my Preceptor evaluation form and its asking me for feedback. I would like to say something but not come off mean, disrespectful or unappreciative but I have like a 85 hrs left and I dread going because of this. It is affecting my learning experience and I personally thing I could be having more beneficial medical related discussion that will help me advance. 1. Is there anyway I could tell him without being offensive or just suck up the last 85 hours and get it over with? 2. How can I provide constructive feedback or should I just not mention it?

I don't know. I feel like ICU nurses can pretty much work anywhere if they are oriented to the unit. It just can't happen the other way around though.

a lot of people forget the whole glucose metabolism piece. Great point!

Exactly. In this case, some continue to support disregarding physician orders despite knowing that the next BG level was worse. It seems very clear that the patient should have gotten the 2 units.

I think it's more important to treat hyperglycemia as the physician orders state to prevent worsening hyperglycemia. The patient's blood sugar went from and untreated 159 to 228. Don't seem that beneficial to the patient.

Yep, your rationales explain why the patient's next BG level was 228. Go figure. I hardly think getting D5 1/4NS constitutes as as diet. Again...the patient's BG nearly doubled because the patient wasn't treated the first time.

I just seen this after I typed my reply. So this could have been prevented had they treated the first hyperglycemic event. SMH. Poor patient was hyperglycemic all day. Wonder how many days of this is going on.

159?? Fasting glucose? That is high for a fasting glucose. 1. What does the orders say? If the physician orders state to give 2 units for 159 you should give it. YOU ARE CORRECT! Sliding scales are designed to treat hypoglycemia despite diet. Sliding scales are not to treat for future food intake. It is to bring a person BG back to a normal range. ITs FOR CORRECTION. We will never know how much a person will eat! Think of it like this. Say normal fasting BG range is from 70- 110. Anything above 150 is abnormal. THAT'S A MINIMUM 40 POINT BUFFER RANGE! (150-110=40) 2 units of insulin given at 110 or less may cause hypoglycemia. With that being said, your preceptor and charge nurse are implying that 2 units will make someone with 159 BG hypoglycemic? That means they will drop more than 89 pts to get below 70 (159-70=89). Also many ppl are not symptomatic until their BG level is about 50 (average). My fasting BG was 59 when my PCP checked me. (I was NPO for cholesterol studies) I was hungry and had hunger pains but I was driving, walking conversing just fine. So considering that, it's no way 2 units of regular insulin with drop a BG by 100 pts to cause symptoms where you would have to return and treat. I've work in an CVICU for 6+yrs. We use sliding scales for diabetics and non diabetics who are having stress hyperglycemia. We give 2 units if they are 150-170. I've never seen anyone get hypoglycemic getting 2 units when starting out >150. NEVER. 2. Why do we treat hyperglycemia? It places them at higher risk for infection in addition to increasing the risk of damage to blood vessels end organs. Maybe you should provide some research to your preceptor and charge nurse about treating stress hyperglycemia and the use of sliding scales. Furthermore they are telling you to go against physician orders based off of ignorance and fears. So the patient suffers from hyperglycemia because of it. Did the physician orders state, "Hold if pt has no appetite"? If they want you to hold it, you should have the preceptor/charge nurse call the physician to obtain and order to not give the medication to cover yourself. They have to have a better reason to go against a physician order than a low appetite. That's for holding ANY MEDICATION. Any nurse who feels the need to hold should call the physician and clarify the order or get orders to hold. But I feel your situation. You didn't feel like arguing with them. I know you can't wait to get off of orientation.

Just what I was thinking. Also InspiredbyNavy, as a nurse you will have to tune in not ignore. Pay attention to detail and gather all the information you can get before you make a decision. In my opinion had you truly felt that "it wasn't your business" you would have never made a post about it. There is just not enough information from your account of the story to even comment on it. When you become a nurse, you will learn that a 5 second snapshot of a nurse/patient interaction means nothing. Especially when you purposely didn't hear the situation. I work in a CVICU and I will yell at my all the time if they are doing something to me or to themselves. Safety first.

After careful consideration I've decided to reply to the OP. I can careless what anyone else think of MY OPINIONS. I work at a very large Magnet/teaching Hospital. Upon my hiring over 4 years ago and in orientation I read the personal appearance/professional policies. I've followed those policies for years and management seemed more focused on infection rates, patient satisfaction scores and staffing. Ya know, things that affect how much money we bring in. I followed the rules consistently. No acrylic, no chipped nail polish, long hair pulled back, No visible tattoos & piercings, white shoes, clean white uniform that I ironed before wear daily. I took it upon myself to be conservative. Light make up, black/white solid undies. Etc. At work I've seen, unnatural hair colors, tattoos everywhere except the face, long acrylic nails, chipped polish, stained uniforms, ear bars, eyebrows loops, facial microdermal piercing (stud removed), microdermal piercing on the forearms, wrinkled uniforms, colored shoes (supposed to wear white per policy) and hair unrestrained and falling all over patients they bend over. I thought so much for policy. Now I see that they are hiring people with the tattoos and piercings. I'm sure people hide these things during the interviews but they continue to work. I don't know what corner of the closet some of you live in but patients of ALL AGES have tattoos and body piercings some offensive. Women come in with nail polish (pulse ox?), wigs (can't remove pre/intra/post op.) Physicians have tribal or other arm/neck tattoos. I've never seen a patient turn away not one tech, RT, RN, MD because of a damn tattoo. We have patients from as far as the middle East at our hospital. People from all across the US. I used to think certain things are unprofessional but since the hospital doesn't care to enforce their policies. Oh well...

I thought the same thing. Then I started liking comments for some reason.

SMH.. Lol. I'd have probably Googled this before asking.

In our ICU we pull mediastinal and pleural chest tubes. They teach us while orienting in the unit. Only difference is that if we have mediastinal and pleurals, we are to pull the mediastinal chest tubes 1st.

I make sure I take my 1 hour lunch break every workday. In 3 yrs this happened less than 10 times I know for sure. When I take lunch I LEAVE THE UNIT. Play games on my phone, call friends, browse the internet. When I leave work if I had a stressful day I am able to "offload" to my hubby, who is very understanding or other RN friends. Any issues I have with management or coworkers I take directly to them at the time it happens so there are not lingering problems or hostility in the workplace. Some days off I sleep all day if I want. Some days off I go on mini vacations and excursions. I do know that the majority of ppl that I KNOW that hate nursing are those that work multiple places in short periods of time (unstable), always work overtime, can't seem to stay out of trouble, lack the personality it takes to get along well with others, drug addicts/abusers, and those that are accident prone/negligent.

SMH & LOL

LOl. I typed the "off" next to the colon Mon: off and it made smileys

I don't even like working 3 days in a row...lol. I know a Nurse Practitioner who will work 6-7 days in a row just to have more consecutive days off in which she does in conjunction with her vacation requests. So assuming its a 40hr work week. Five 8 hr days. Week is from Sunday to Saturday. Working every other weekend. 1st week: Sun:off Mon:off Tue:8hrs Wed:8hrs Thur:8hrs Fri:8hrs Sat:8hrs 2nd week: Sun:8hrs Mon:8hrs Tue:8hrs Wed:8hrs Thur:8hrs Fri:off Sat:off 3rd week: Sun:off Mon:off Tue:8hrs Wed:8hrs Thur:8hrs Fri:8hrs Sat:8hr This schedule allows the 40 hrs and two days off per week. At the same time they get 4 consecutive days off. Now some people don't want to work that many days in a row and especially not every week. So I can understand that. I currently do two 8's and two 12's day/evening rotation e/o wknd. I just switched back to this after doing three 12's day/nights e/o wknd. 8hr days are nothing to me. I don't like doing 3 12's but will do them to get them out of the way.

I looked a little side eye at this too. The correct spelling of the President's name is Obama. Also the correct term for it is The Patient Protection and Affordable Care Act. "Obama care" was originally a slur made by Republicans who opposed the President's healthcare law. So that may be how you inadvertently introduced politics into this conversation. I am certainly not taking sides. Republican/Democrats both have great ideas. The hard part is compromising for the greater good of the majority. Even that's hard because the majority may not even know what's best for themselves..lol. Either way I think you should educate yourself with with the Affordable Care Act and the American Nursing Associations role in supporting this Act. Nurse.com I know some subjects are sensitive but you certainly don't want to offend people by speaking of things you may not know much about. Maybe you have to be a nurse for a while to understand some of the struggles in regards to patient care/needs.

I will say this. Where I work we are praised for being PATIENT and SAFETY ADVOCATES! Nurses are encouraged to voice our opinions as individuals and as part of our NURSING INSTITUTE. I also find it very telling that a nurse should be told to keep his/her mouth shut in the face of danger, injustice and unfairness. Fly under the radar, keep your mouth closed, avoid attention, PRETEND TO BE GRATEFUL, don't complain or irritate management??? Sounds like SLAVERY to me. Nursing is too good of an occupation to even be compared to something like slavery. So so sad if anyone believes that that is what nursing is about.

I am sorry that happened to you. I am very curious to know what that hospital listed as the job description and about the work hours when they advertised that position you applied to. Next time when you interview these are some questions you want to ask. Don't just take any job just because you are trying to get one. Know BEFORE you take a job the min/max hours. Overtime policy. Scheduling rules/policies. Attendance policies. Are you able to self schedule? If not how is scheduling done and by who with what as determining factors. It just seems like you were taken advantage of but then again I only have one side of the story. All I know is that the hospital I work for has policies in place. Including a employee complaint/grievance policy. No one is exempt when it comes to hospital wide, employee policies. We can always go to HR who will assist with ensuring the policies are being held. That's here in Ohio. I can't speak for Cali. Anyways, be happy that you don't have to work for such a place. If they are treating you like that and you just got there it can only get worse. Anytime you work somewhere that your patients/nursing liscense is a risk YOU take initiative and leave. That probation term should be a two way door. If you don't think they are a fit you should be able to leave too. Either way this is a learning experience for you to pay attention to the "small print" and know what to ask during interviews.