ILoveRatties

Bpd = borderline personality disorderNOT bipolar.

Maybe I should contact the person at the DOH to whom the daughter spoke?

Suanna, too bad you are wrong. The suspension was without pay and there was no investigation, just falling over themselves choosing a disciplinary approach to me. No questions asked, period. The suspicious thing is, is this woman had already talked to my manager while her mother was still alive, my manager spoke to me, and all was well. The woman had snapped on a couple of nurses, and kicked other nurses off her mothers' care. We all knew we were dealing with someone not of sound mind. It wasn't till a week or so after her mother's death that she called the DOH. And insisted on speaking with someone 'high up'. So, I get suspended without pay for 2 days, and every move I make is being watched, families and patients questioned after I care for them, every little bit of documentation being reviewed, pretty much hell. I was the one who tried, gently, to point out to the woman that her requests were inconsistent and not in her mother's best interest. Me 'pushing back' in the face of her furious demands infuriated her more and made me the focus of her craziness. I took care of her mother for eight hours, only. But her diatribe to the DOH painted me to be cruel and dangerous. My place of employment is treating me as though I am very likely cruel and dangerous and that they are doing me a favor not to fire me. My policy with BPD or NPD people is to avoid them at all costs, because they either use people or abuse them, and leave chaos and confusion in their wake. Unfortunately, I had already started advocating for the patient before it became clear that the daughter's agenda was all about the daughter. I am contemplating contacting the 'normal' daughter and asking for her support. The one who apologized for her sister and thanked me for trying to help their mother. Unfortunately, the families of BPD/NPD people also have learned not to 'cross' them and try like crazy for peace at any price. I don't know who I'm more angry with: the crazy, hateful daughter or my employer for totally caving to the DOH. It's like they are all of a sudden looking for a reason to fire me. Work has changed like night and day.

I took care of a pt who had a daughter who truely was borderline personality disorder. DeLing w/ her was crazy, as those familiar w/ bpd know. The pt was end-stage and the daughter's vehement; furious demands were contrary to the patient's best interests. Anyway, I advocated for the pt and her needs. The daughter was furious. I only cared for the pt once, as the daughter asked that I not care for her mother. The pt's other daughter was very apologetic about her sisters behavior, and begged that her mother not suffer, which I totally agreed with. One day later, the MDs forced the issue and the family made her comfort measures only. She died peacefully shortly thereafter. The crazy daughter saw me as the family wad leaving the hospital and yelled awful things at me. Well, it turns put that she called the DOH, and the hospital is frantic to satisfy the DOH, and I was suspended for 2 days via a phone call from my boss. I was not obnoxious at all, just tried to sort out the truely wrong demands of this woman. The other sister was completely fine with me and appreciated my efforts to help this family understand end-of-life options. I've been through it personally more than once, and have always been thanked by families whom I have helped through that experience. I am angry that I am the hospital's sacrificial lamb to satisfy the DOH complaint. What, if amything, should I do?

This just in, boys and girls: AGH is going to team up with Highmark and Cleveland Clinic, and all patients with Highmark insurance will HAVE to go to AGH. That is going to cut patient admissions to UPMC facilities by 25%--ooh, cut on the chin to the Evil Empire. This is NOT a rumor. The free flow of money at the UPMC hospitals has come to a very screeching halt. Too bad, since I work at one of them.....

I'm sorry for your situation.

Even with West Penn downsizing dramatically and so many of those nurses flooding the job market, UPMC is hiring nurses all the time. Passavant just underwent a huge hiring period. McKeesport has lots of positions listed. UPMC East will be hiring to staff an entire new hospital. UPMC is plowing money into Mercy, Passavant, UPMC East, Childrens.

Both Hershey and Geisinger have outstanding reputations, all the more amazing in that they are well outside the areas of the 2 huge cities in PA, those being Pittsburgh and Philly. Country living, tertiary facilities.

It's been 2 years since I withdrew. For those in the same shoes, you can't let it ruin your life. It took a while to recover from what I truely believe was PTSD, and I could have stressed out over the debt. I'm past that now. You will not become homeless as long as you can work as a nurse. True, because of the debt, I will not be leaving my kids much of an inheritance, nor can I pay for expensive colleges. I regret that alot. But it's water under the bridge. Can't be undone. You just have to come to some kind of peace with it all. Your life is NOT OVER, you will be happy again, you will adjust to having a huge student loan debt, you will work full time until you drop, lol. But every day I go to work happy to be doing something I enjoy and am very good at. I appreciate the collaboration and respect given and received. I have never for one second missed the OR nor doing what CRNAs do. They can have it. Money isn't everything. Each to his own. It's vital to let everyone know that choosing a professional direction because of the $$ is a bad idea. At least it was in my case. I never thought of what CRNAs do as the pinnacle of nursing. I always just saw it as another specialty. I thought I would learn how to do it, then do it until I retired. But with all the BS SRNAs are put through, I think that it helps alot if you want to be a CRNA more than anything else in the whole world and if you really hate bedside nursing. Neither of those applied to me. Plus, I already had an APN role I enjoyed. I thought I needed the big bucks. I'm living without them.....

The question being asked is not about schools that do not require the GRE at all, but those that waive if for people who have already taken it. two thoughts 1. just why should one be required to retake the GRE if you have successfully completed an MSN program. 2. why make it a matter of deciding where you go?? Unless everything else is equal, just study for the thing if you are required to take it and pass it again.

I'm going to stand by my "pretty clueless" assessment. In no other Advanced Practice role education would this subject even come up, let alone having been condoned for decades. When I envision APNs, I think of mature people with true self-respect and a love of nursing. I think of nurses who respect other nurses and who delight in mentoring younger nurses. There are a whole lot of forces at play in the OR in ACT practices. It's a hard place to be an APN. CRNAs give a great anesthetic, with all that entails. They do things that other nurses are not allowed and are not able to do. They know alot about their specific area of practice. This is just the beginning of Advanced Practice in nursing. I saw VERY FEW CRNAs who ever showed one iota of being anything other than good administrators of anesthesia and survivors in the OR culture. What a practitioner thinks of him/herself is very evident in how he/she treats students. I think I can safely say that there is no other APN role with this reputation of treating students horribly AS A PART OF THE CULTURE.

It's been a while since I posted to this thread. I agree with the person who said that hazing is condoned and perpetuated because of political reasons. That hits the nail on the head. It has everything to do with the need CRNAs have to be seen as being as good as MDAs. An extremely insecure group, in that regard. I think the only place any self-respecting CRNA would work would be either in private practice or in the military. I was surprised at how little self-respect CRNAs in ACT practice had. And really shocked by how much they kow-tow to MDs, both surgeons and MDAs. They are obsessed with 'looking good' to MDs. And I was never around so many nurses who hated nursing. And who totally dissed non-CRNA nurses. And those people with no true sense of their role except as it was valued by MDs tell each other all the time that they are the 'cream of the crop' as far as nursing goes. I consider them pretty clueless as far as advanced practice nursing goes. ILoveRatties, RN, MSN

I think the OP significantly overstates the patient assessment and intervention done by OR circulators. I spent a year as a SRNA and, believe me, it is the CRNAs who have that major role. The surgeons do the surgery, the CRNA takes care of the patient, the scrub techs hand off instruments and supplies to the surgeons, and the circulators do something else. I think they take care of the environment--assuring that everything goes smoothly. The OR is like an alien world, and the OR RN assures safe passage for the patient. They are keeping track of the big picture. They have to know everything about the big picture that can go wrong, how to prevent it and what to do if the **** hits the fan. The CRNA monitors all the vital signs, gives meds, intubate, oxygenate, etc., etc. including induction, maitenance and emergence from anesthesia. The OR RN doesn't write a vital sign down nor track any of that during the surgery. They assure proper and functioning equipment, supplies, assist with positioning at the beginning and throughout the case. You can say 'go-fer' but that's insulting and incorrect. The OR RN is not sterile and not doing the second-by-second monitoring of the pts condition, so is free to be able to move around the room and leave the room to get things, etc. I wouldn't like to have a non-RN keeping track of the big picture during my surgery. All I know is that everyone in the room was aware when there was a newbie or an incompetent circulator running the room. It affected everyone else. All the roles are necessary in the OR. It is sort of like being a coordinator. Assuring that things run smoothly. The CRNA, scrub, and surgeon are very very focused on their own thing during surgery--the OR RN is free from that, but does what no one else can do--pay attention to the big picture. What they do is important. The best OR RNs might look like they are doing nothing, but that is because they have it all under control. For sure, it is a unique specialty in nursing. The OR nurse doesn't need to do much of the hands-on patient things. Someone else is doing them. No one develops much rapport with the pt--the contact is too short-term. The pt is usually asleep and if not, the CRNA is at the pts head doing the talking, touching, reassuring etc. No, it is not like bedside nursing--that kind of nursing is for the bedside. The OR calls for caring for the patient in another way--but it is just as much nursing.

Gilli, I sent you a PM. Please read it before you decide.

There seems to be a real hiring slow-down in Pittsburgh. The stock market slump affects hospitals capitol improvements but the decrease in Medicare reimbursements affects the daily operating budgets of the same hospitals. This seems to be a time to take any nursing job one can get, and be happy about it......There will be little picking and choosing on the part of the job-hunter--its now a sellers market. I have not been working for 1.5 years, going to fulltime grad school then dropped out, I have 30 yrs experience, and I'm having trouble getting back in. AGH is mostly just hiring casual staff. Except there are like 6 positions posted in the coronary step-down unit. I've worked CTICU forever.....but will probably be spending most of a year doing floor nursing....if I'm lucky.... NOT a great time to be a graduating student nurse.....I feel for you guys. Hopefully my man Obama will get this economy turned around.

Wow. This kind of thing is always a team effort. Two or three nurses working their butts off at this bedside for hours. I am amazed that he suffered no MOSF. Whenever I interview nurses for CTICU positions, my main question is, 'do you like adrenaline rushes?' Perfect example of why that is crucial.

This is not a school thing--it is a clinical site/individual CRNA-MDA thing. Many clinical sites have students from more than one school. So many of you want to think that it is 'some schools', and that if only there were a list of programs to avoid, all would be well for the wannabe-CRNA. Instead, you should be asking yourself how you would/will cope with what is PERVASIVE. The best advice I have for coping 1. Understand that your future depends on staying under the radar--be 'a' SRNA, not 'that' SRNA. 2. Do not go into any clinical day without knowing the particular quirks of the CRNA & MDA you will be working with that day. 3. Utilize the simulation lab, if your program has one, before starting actual clinical. The less bad you are when you start, the less hazing you will get. If your intubations are smooth, and if you appear calm, you will be far ahead of the typical new SRNA. 4. Take a little notebook with you in the OR, and note "pearls and pitfalls' that you are told during the day. This is also a good way to get the info you need on different CRNAs preferences, re inducing, gas preference, maintaining, emerging, etc. 5. If you tend to be anxious/'nervous', do not drink coffee in the morning. Some people even get a script for beta blockers to blunt the fight/flight response. 6. Get your head around the fact that you will be supervised every single moment, that someone will be breathing down your back every second. Every move you make will be subject to criticism all day long. They are quick to criticize, less likely to give you the space to self-correct. You will want to say 'give me a chance'--won't happen. I'm talking about things like how you put EKG leads on, how you tape IVs, tape eyes, talk to the pt, every little thing. Even after you've been in clinical for months and months. That's all I can think of for now.

I'd say prob. 10% of SRNAs have only good clinical experiences, incl. reasonable pimping, helpful feedback, friendly and supportive CRNAs/MDAs. I'd say prob 10% have really horrific experiences. Finally, I'd say that half of SRNAs experience what I have described, but maybe not at every clinical site. I and other SRNAs have noticed how quickly CRNAs forget about it after graduating. Like with childbirth--the worst of it is forgotten fairly soon after delivery. Like with everything else in life, you hang on as long as you possibly can. If you are lucky, you'll get a little break every now and then from the abuse. Then it's easier to hang on. Some people either can't or don't think they should have to tolerate the abuse. I can say for sure, though: if one did not accrue such large school and private loan debts, and if the pay was less than it is, there would be a lot less people turning themselves inside out to tolerate it. There are many applicants for every student slot; people are glad to get in. People want to be able to earn all that money, and will put up with just about anything to succeed, especially with all that debt. Complaining about it as a student will only get one worse treatment or forced out. So the truth is that SRNAs are powerless and desperately compliant. And the OR doors are closed. Unfortunately there is no limit or boundary put on those CRNAs/MDAs who are, at best, nasty jerks. Some are nasty jerks by nature, some are nasty jerks because they were treated like dirt during their student days, whatever--you are totally at their mercy. There are a whole lot of them--for sure 50%. You can wish and hope that this is reality just at certain programs, or in certain parts of the country. Undoubtably there are some programs that are worse than others, and some parts of country that are worse. But, it happens everywhere. There absolutely must be stringent standards, appropriate pimping, and acceptable expectations. I am not advocating easier didactics, or anything like that. Just wanting to be treated with the minimum human decency. Treated like an adult. Treated like a grad student who is PAYING for the education. Hope for the best; be prepared for what I describe. You think what I describe must be the exception. I'm telling you it's not. And I can pretty confidently state that no one tells incoming SRNAs that this is the reality. It's like the elephant in the living room, or the shameful secret hidden in the basement. But believe me, students vent about it to each other, all the time, all across the country.

No one has ever survived brain death. This is not persistent vegetative state. What if your child were critically ill and there were no available beds in the ICU, and your child, who was neither brain dead nor cardiac dead when they needed ICU care, died? And one of the ICU beds was occupied by a dead body? If a family does not 'believe in' brain death as death, is refusing a second brain death workup after a first one comfirmed brain death, the patient should be moved out of the ICU. On the vent, or off the vent. With compassion. When nurses say things like we all have read about people who have 'survived' brain death, that tells me that they believe there is brain death, which is almost death, and that there is cardiac death, which is real death. How can people who think that way assist families? I read about the conflicting vews different Orthodox Jewish teachers have of brain death. One said you can only be brain dead if you are decapitated......You can't nor should you try to convince people of anything. That being said, I should not have to care for dead bodies while the families wait for the heart to stop. The courts in all 50 states support the definition of brain death. So it's not a legal question.

Brain death isn't something that's just 'used' in organ donation. If a patient has a massive stroke, or suffers massive traumatic brain injury, and if they show no signs of brain function, it is perfectly legal and acceptable to do brain death criteria. If the pt is found to be brain dead, they are pronounced dead. Period. Times beyond counting I have said, "Your father is dead. If you want, we will wait to turn off the ventilator until all your family members get here." Brain death = death is not legally open to interpretation. Now whether or not a family wants to donate organs of a brain dead individual is something else entirely different, and can be subject to all kinds of cultural and religious norms. In the old days, there was no way of having the heart and lungs kept going with machines or transplanted. So there was no differentiation between cardiac death and brain death. One always meant the other. However, now, heart and lung function can be supported until maybe their intrinsic function returns and people can survive cardiac and pulmonary 'death'. There is NO surviving brain death. When there is no blood flow to any portion of the brain, that is it. A ventilator can make the chest continue to rise and fall, and the heart can be forced to continue to beat until the total physiologic collapse that results from having no brain function happens. But a heart can beat when it is being held in your hand totally disconnected from the body. Is that life? In the old days, a beating heart symbolized life. They didn't know anything about the master control function of the brain. However nowadays, as cardiac death becomes more and more relative, brain death is more and more clear. We all know people who have survived Sudden Cardiac Death. However, nobody survives when a brain scan shows global no flow.

You are thinking of persistent vegetative state. That is not brain death. People do not 'wake up' from brain death. You do not 'diagnose' brain death. You verify it. The criteria are strict. It is not gray--it is black and white. Of course, nobody would go to a parent and say, 'I, ummm, think your kid is brain dead, We are going to pull the plug.' You do the criteria. If the child is brain dead, you tell the parents that the child is dead. And of course, this would have included a blood flow study. My point is that you don't need permission from a family member to do the blood flow study if the other tests indicate brain death. If the child is dead with a beating heart and on a vent, you ask about organ donation if it is an appropriate option. If the family does not want to donate, then you tell the family that you will be turning off the ventilator and the monitors, and proceed to provide end of life care to the patient and to the family. I speak as a person who had a nephew suffer brain death after a MVC, went throught the whole thing. I have been a transplant coordinator and have worked with families and donors for years. I have been a CC nurse for a very long time. A lot of these posts show that there is a lack of knowledge in this area of brain death = death. If a patient came into the ER DOA, you wouldn't even think about going out after failed resuscitation and giving the family false hope, saying that he's sort of dead but maybe the heart will start to beat again, we just have to give it more time. The family may want that. That doesn't mean you do it. You may protest, saying, well death is clearcut, brain death isn't. That's just plain false. Deal with brain death the way you do with cardiac death.

Great post, WitchyRN. I am a firm believer that it is each persons right and responsibility to set boundaries regarding how they let others treat them. However, there are some situations that make this extremely difficult, being a student, being on orientation. I heard a circulator say once to a surgeon who threw an instrument at her. She said, "Doctor, please aim better. I want to be able to sue you for everything you've got. And don't believe I won't." He never misbehaved around her again. Immediate feedback is the best deterrent. This all being said, there are docs with whom I've worked for years and really respect. Sometimes they lose it if a pt is circling the drain or whatever. I am willing to give them the benefit of the doubt if it is a rare occurrence. Just like you would with friends or family. But re: the doc who regularly acts like a toxic jerk, immediate un-emotional, rational feedback is the way to go. If you work in a place that reprimands or punishes you for dealing with it that way, work somewhere else.

A patient can have brain matter oozing from a wound and NOT be brain dead. There are specific criteria used to determine brain death. Response to ice calorics, apnea test, brain blood flow scan, EEG. Definitive is no brain blood flow. You do not have to get permission for any part of the brain death determination. This is not an ethics issue. Now, if the patient is found to be NOT brain dead, then there is the issue of what to do, withdrawal of treatment, etc., etc. which is more suited for ethics input. The situation you describe is extremely unfair to the family.

This is not a matter of 'not letting go--poor family'. Sorry, but dead is dead. You don't have to ask a family if their loved one is dead. Brain death = dead. Period. Why have to check twice? And you don't have to get a family permit for brain death criteria. Why would this be allowed to go on? Is it a tiny hospital in the boondocks, or something? A family doesn't have to agree with you about this. You tell them: 'so-and-so is dead. I am very sorry.' You tell them to say their goodbyes. You turn off the monitors and vent. You do not need permission for this. It is not a Terry Shiavo situation. The patient is dead. It's best to be a broken record: "He is dead." Never differentiate between brain death and death. They are the same thing. I have found that when the medical professionals don't have this straight in their own heads/minds/heart, it can be very confusing for families who are looking for the last little bit of hope.

Just keep telling yourself that......