Pudnluv

God bless you burn nurses! I know I couldn't do it and I am glad you are there.

We were intubating a pt the other night and the pt on the other side of the curtain was complaining that no one had been in to see him. When his wife told me they were going to leave, i replied, "so leave". I told her it was absolutely her right to leave if she wished and that we were not going to hold them hostage. She told me they were upset that no one had been in to see them (EKG was done, IV inserted and pt placed on monitor at time of arrival). I explained that non breathing pts had priority over pts who could breathe well enough to complain. I don't remember if they left or not. Also had a family member who kept complaining to other staff members that no one had been in their room all night. This was after I had spent a good 10 or 15 minutes in the room for the umpteenth time. I confronted him directly and all he could do is stutter. I tend to get a bit crabby at about hour 10 of my 12 hour shift.

We do much the same. As one of the designated "Ebola" hospitals in my state, our guidelines exceed the CDC guidelines. We have a special room (negative pressure) for the patients and we have converted another room for doffing. We use three people for both donning and doffing, one to get in and out of the gear, one to assist and one to observe. We have added a cowl to our gear and an outside waterproof gown. No skin is left uncovered. We are also limited in the time spent with the patient (no more than 20 minutes, I believe). We started working on Ebola preparedness a couple of months ago and now have mandatory training every 30 days. I feel much more confident with all the precautions we are now taking.

I just tell them flat out that we do not give narcotics. I also tell them that people with chronic pain will NEVER have a pain level of zero. That is an unrealistic goal and taking more and more narcotics, will only exacerbate the problem. Then I ask them, knowing your pain level will never be zero, how much pain can you live with and still function? If you are up, walking, talking, playing basketball and working, then you are living with your pain. I find that the people who really do have chronic pain conditions are more willing to try alternative methods. The bull*******s will just continue to ask for narcotics.

The photo Huffington has was clearly taken before all the toes were gone. The picture in the Denver Post shows all the toes on the right foot have been removed. We only see one side of the story, but from what I can see, there is clearly negligence involved. I've been in corrections for about a year now (part time, I work full time in the ED) and here are some things I see in my facility...... 1. Hiring new grads with poor assessment skills. I'm not saying they are bad nurses, they just lack experience and I have seen many develop really good skills as they gained experience. 2. Sick call slips not answered in a timely manner and lack of prioritization in answering the slips. 3. Medical records staff pulling inmates off the schedule to be seen in clinic. (This one really ticks me off). 4. Not having the proper equipment. 5. Having to pull teeth to get someone sent out to the ED. Personally, if I had seen someone with bleeding toes and necrosis, I would have sent him out. Sometimes it's better to beg forgiveness than ask permission. I'm sure that not all facilities are like that, but as with anything, there is good and there is bad.

I would think they would tread carefully. They have already been found guilty of unfair labor practice. The last thing they would need to is a suit claiming a hostile work environment.

There is no nursing shortage and there hasn't been one in years. There is however, a staffing shortage. Hospitals are cutting back on staffing, so more and more nurses are working short staffed. Adding to that is that the patients being admitted are sicker and sicker as admission guidelines are changing, and only the sickest people get admitted. Health care has become more about the bottom line than patient care. Go online, look in the paper, you will see quite a few job openings for nurses. Actually apply to those jobs and many will be told that they are not hiring right now. Hospitals use this ploy to perpetuate the myth of the nursing shortage to justify the continuing practice of short staffing. Talk to hiring managers. They will tell you how many times they have to jump through hoops to get a position filled. Many hospitals are enacting hiring freezes, wage freezes and are even laying off nurses. Back during the time of the real nursing shortage, a nurse could pick up the phone, call a nurse manager and boom! land a job. There were sign on bonuses and job fairs every week. Didn't like the job you were in? No problem, you could get a new one and be working within the week. This is not the case any more. Competition is fierce. Many are on the job hunt for months at a time. Many new grads are struggling to find that first job. It is definitely not what it once was. Nursing is a great profession if that is what you want to do. But the days of going into nursing because it was a guaranteed job and big money are long gone. Nursing has become like so many other professions. With so many hospitals trying to cut back on spending, nursing is the first to go. With so many new nurses out there vying for the same positions, hospitals are in a position to offer lower wages. Eventually the nursing shortage will come around again (it always does), but don't be fooled, it is not happening today.

In the jail, I am surrounded by correctional officers. Inmate movement is monitored and boundaries are clearly established. Also, every inmate is searched before entering (although I am sure some get away with contraband). In the ER, people just come in from the street. They are patients first. They are not searched at the door and we are not accompanied by security when we go into rooms. As we are dealing with patients, we must be careful not to offend. Certainly boundaries can and should be established, but not in such a way as to offend the patient. I am sure that violence against nurses occurs in corrections also. It occurs in every aspect of nursing. It just seems to me that corrections has a few more safeguards to prevent it. I'm still loving the ER though. And loving my jail time.

I have been a RN for 20 years and have worked in various settings. After spending 11 years doing med/surg/telemetry, I moved to the ED, which I absolutely love. Recently, I decided to take a part time job at the county jail (I still work in the ED), and I love it. In some ways it is like a breath of fresh air. I see many of the same people that I see at in ER, but usually they are a little better behaved in the jail setting. I don't have to worry about press ganey scores if I say the "wrong" thing. I am a big stickler on boundaries and personal space, and I am able to make it perfectly clear without worrying about offending anyone. Also, we have had a rash of violence against nurse in the ER, and so far, it appears to be a bit safer at the jail (sees ironic, doesn't it). I also find that there is less physical stuff at the jail, and at this point in my career that is a plus. It is nice to go home in the evening without that horrible feeling of frustration that the happens when I work at the ER. I'm not quite ready to give up the ER just yet, but I can see me making a move to full time corrections in the future.

I know in our ER we have had inmates come in due to mental health issues. If they are having a psychotic break, this is a mental health emergency and should be evaluated by a medical professional. There have also been a couple of times we have had to admit these patients to our mental health ward to get their medications under control. When they are discharge, the sheriff is called and they are escorted back to the jail. If you are truly concerned about the headbanger, send him out. Say you want him evaluated for a head injury (which is reasonable). When he gets to the ED, they will medicate him and/or restrain him. Once he has calmed down, he will be sent back. At least this will take the burden off you, especially if he has the potential to seriously injure himself.

I just started working in corrections, but still have my job in the ED. We get a lot of fake seizures in the ED. One thing I usually find, is that the fake seizures are usually preceded by some comment like," if I don't get my pain med, xanax, ect, I will have a seizure." Then lo and behold, when we tell the patient they are not getting the meds, voila! seizure! One night I had I had a young girl tell me if she didn't get her morphine dose, she would seize. I left the room only to be called back by the tech and sure enough, she was flopping on the bed, eyes rolled back. I called another nurse in (he also works in corrections) and very loudly asked him how to perform the "Oklahoma Seizure Test". He responded back, while doing it, that if you rub the instep of the left foot, the right arm will jerk. Interestingly, we got just that response from the young lady. Needless to say, she did not receive any pain meds and was discharged home. Later that night, I had another young lady do the same thing. She was actually not the patient, but a visitor of the patient. She would have her seizure,and her girlfriend would coddle and coo all over her. She passed the Oklahoma seizure test also. Then whenever I tried to discharge her, she would do the staring blankly at the wall and become unresponsive. I finally got tired of it and used an ammonia capsule. Not only did she become fully responsive, she jumped back about 3 feet (she previously state she couldn't walk), yelled "***", grabbed her coat and ran our the room.

We have hospitalists that come down and do the admission for all patients. Once the patient gets to the ICU, the ICU doc takes over. So it is up to the hospitalist to make the initial determination, although the ED doc usually is the one to make the recommendation when he/she first calls the hospitalist. Also, sometimes it is floor policy that determines where the patient will go. In the case of the OP, the floor would be well within their right to refuse accepting that patient. I've been in that situation where I felt my patient should go to the ICU, but the doc insists that the patient can go to the floor. I gently let him know that if the patient goes to the floor, the floor will surely call a rapid response and then the doc will have to go running to the floor and the patient will end up in the ICU anyways. This usually gets them to change their mind, especially when they see it happen.

Everyone makes mistakes. No one was harmed. All you can do is learn from this. I am willing that you will become a "house expert" on the use of the pumps and blood administration. Don't lose sleep, just don't do it again.

Not sure, but I don't think snow shoveling is in a RN's scope of practice. I am willing to bet that having nursing staff going outside to shovel snow, without providing proper equipment is an OSHA violation. Is the facility providing proper footwear? I believe that there are regulations in place that dictate what kind of footwear and outer wear needs to be worn when working outside doing manual labor. Also, I'm pretty sure the health department would have a fit if they knew patient care staff was being sent outside to shovel snow and not taking care of patients.

I would love to see the breakdown of a CEO's daily work day. While I am sure that the majority really do work hard, I would like to see what they do day to day to earn their enormous salaries. We had a CEO that came to work every day at 4am. He started in the parking garage and walked the entire hospital, talking to staff and listening to the different issues the staff had. He also got things fixed and taken care of. He went home sometime around 6 or 7pm. His salary....$250,000./yr. He was the lowest paid hospital CEO in the area. I believe he worked hard for his money. Our hospital was taken over by another hospital, I have since to see a CEO making rounds through the building.

I love the idea of hospitals being transparent about their nurse to patient ratios. In this day of technological advancement, it really wouldn't be difficult. I believe all hospitals should put on their website the nurse to patient ratio for each day and each shift. It should be the real numbers, of the actual staff member and the number of actual patients he/she has. I know many hospitals would try to get away with the old, "well, 3B has 43 beds and we have 55 staff members. What they would fail to mention is how many are per diem, how many are on vacation or sick or on leave. No, I want to see real numbers. Actually, in a competitive marketplace, this makes a lot of sense. It allows for competition between hospitals. The consumer can choose which health care facility he/she would rather go to by compiling all the data and making an informed choice. The hospitals with better staffing and better outcomes would be the most desirous, and they would be the institutions that make more money.

We break our holidays into two groups, 3 summer holidays and 3 winter holidays. Everyone must work 2 out of the 3 in each group. A sheet is posted and you pick your preference from 1 to 3, with 1 being what you most want off. The list then goes by seniority, with every effort being made to acomodate individual requests. Christmas Eve and New Years Eve are not considered holidays, but if you are scheduled to work Christmas you will most likely get Christmas Eve off, and the same goes for New Years. If you consistently ask for the same holiday every year, you will probably be rotated off at some point. If too many are scheduled for a particular holiday, the most senior will get it off and therefore may only be required to work one of the holidays. These are union rules.

What an amazing gentleman! How fortunate for you to have met him. It is people like this that make nursing so rewarding. Not only can we touch another person's life, but they can touch ours as well. Thank you for sharing such a beautiful story.

To the OP.......welcome to our world. Gender discrimination has been around for a long time, and as a female, I deeply offended by it. You should be able to go to your job, and do it without being constrained by your gender. For many years, women were told what they could and couldn't do based soley on our gender and not on our abilities. How many female doctors were dismissed by patients because they didn't think a girl would be smart enough to take care of them? How about female cops our female firefighters? I am sure they face the same kind of discrimination every day. Way back when I was a kid, I wanted to be a paramedic (Emergency was my favorite show), but at that time, women were not allowed to become paramedics and firefighters, so I became Dixie instead. A choice I am glad I made. It has taken women (and we are still fighting) years to find equality in the workplace. It doesn't happen in a day or even a decade. This is what you, as a male, are finding in a female dominated profession. Change come slowly. Now to your original dilemma. In emergent situations, it should never matter if you are male or female. The care of the patient is at stake and saving a life is more important than saving dignity. We have had many situations that were not emergent, where a male nurse is chaperoned by a female nurse. This is for your protection, (we had an incident). Conversely, I have seen male patients who refuse to be touched by a female, mainly for religious reasons. As far as trauma goes, if I have to cut the clothes of anyone, I do. If a particular piece of clothing can be preserved, we certainly try. I have never afforded differential treatment to anyone in these situations. It is unfortunate that you have to endure gender discrimination. No one should have to. Like I said, change comes slowly, and not without prejudice. Hang in there.

Today the county run nursing home in my area became privatized. The new owners want to turn the facility around to make a profit. The way they state they will do this.....cut benefits to workers. No more paying into the state retirement system, retired workers will no longer get health benefits and the health insurance premiums will double. This facility also has a union. Problem is, the union contract is with the old facility, not the new owners. The way I see it (and I'm no business major), the best way to make a profit is to have a good product. You can't build a car with only 3 people on the line and 50 managers running the place. Same thing in health care. You can't cut direct patient care staff and expect to deliver good health care. Most corporations are top heavy. If they cut just 3 of these "top heavy" positions, they could probably hire and extra 5-6 new nurses. This translates to higher quality care which translates to more people recommending your facility which in turn leads to higher profits. It really isn't rocket science.

I think call time in the ED is a good idea. At least it would be a good idea in my ED. There are times when we are short and having an on call person would be wonderful. You only have to be on call for 2-3 days a month and you get time and a half for coming in. It could be worse. Being mandated at the end of a 12 hour shift is much worse. I live in a state that also makes it illegal to mandate nurses to overtime. The NYSNA really rallied together to push the legislation through the state legislature. Maybe you can try contacting your state nurse's association and see what they are doing to stop mandatory overtime in your state.

I see the same people over and over again also. The ED is the landing pad from many frequent flyers. Is it frustrating? Sometimes. Am I going to teach these people anything? Probably not. So what? There are many others that I will help. Nurse Jackie once said, "You will meet people on the worst day of their life." This is so true. If you can make someone smile or laugh, ease their pain for only a moment or give them a little bit of comfort, then you have made a difference.

I love nursing. I love my job. I've been a nurse for 20 years and I have never wanted to do anything else. I work my butt off every shift, but I wouldn't have it any other way. I work in the ED and we work as a team, nurses, physicians, techs. As far as lack of respect, I don't allow it. Maybe it's because I've been doing this job for so long, but I do not allow anyone to be disrespectful to me and I'm lucky to have managers and physicians I work with back all of us up. I find it disheartening to read so many negatives about this profession. Yes, I know the reality of nursing is much different then what we were all taught. To all the potential nursing students out there, keep the faith. The work is hard and there will be days when you will wonder why are you doing this, but in twenty years, I can say that those days are fewer than the days that I am glad I am a nurse.

I think it is a good idea for nursing as a profession to standardize it's education requirements. It elevates nursing from being just a career choice to being a profession. The way it is now, one can become a Registered Nurse from a diploma school, an Associates program or a Bachelor program. All will come out of school, take the same licensing test and begin pretty much in entry level positions. To be lawyer one needs X amount of years of education. To be a doctor, one needs X amount of years of education. To be a pharmacist, one needs X amount of years of education. I believe nursing should be standardized too. I feel all new nurses should have a bachelor degree and the associates programs and diploma programs should be phased out. I know that may not be a popular opinion and many will say "I don't want to go to school for 4 years to become a nurse", however, if that is the requirement than to be a nurse, you must complete the required education. There are no shortcuts for doctors, lawyers, engineers. To be any of those, one must complete the required education. I also believe that by standardizing the required education for nursing, we would help eliminate many of these diploma mills. These so called schools are geared for the already licensed registered nurse who wants to obtain advanced degrees. Education is good. Advancing one's education is always good thing, no matter what reason one is doing it for.