Heogog53

In the or, I speak for the patient. By reminding doctors that she is allergic to x medications, I am advocating for my patient. If my patient has questions prior to going back to the or, we don't go until the patient feels comfortable with all the answers. When a patient in pre-op has a giant support system, part of what I do is advocate for them and their needs as well as the patient. It's not "Business as usual" per se, but explaining or translating jargon to both patient and critical family members is advocacy. Making certain that a patient, once admitted to the health care industrial complex conveyor belt, with explanations in more jargon, explaining (in an academic center) who all these people are and why are they discussing all this goobldegook. It's is advocacy to explain to a patient and/or families exactly what each lab, test, procedure and surgery are done for, and also explaining that going through with x,y,z tests are over-ordering and that the patient has the right to refuse procedures, tests, labs, surgery until the patient understands the purpose of everything that is to happen One last, but increasingly important aspect of nursing is using applied anthropology with our increasing number of immigrants whose customs are so entirely different from the way most americans live. Simple, true story; I was checking in a sikh gentleman for surgery. He'd come from the floor wearing in turban, as it is essential for a true sikh man not to cut his hair, as one part of honoring his religious beleifs. He couldn't go to the or with his turban on. We discussed it, with the outcome required giving him a box of puffy blue hats, then pulling the curtain shut, so that he would not be exposed by anyone accidentally. He ended up using about 12 hats to make sure that his head was appropriately covered according to his religion. Oddly, most nurses have been doing this partially as ojt. Now it has a a formal name; culturally centered care, a brand new idea(?). These are examples of patient advocacy. Respecting not only what the patient requires, but ensuring that both little and large issues are taken care of to decrease stress, anxiety, being culturally and ethically sensitive.

As a massage therapist, my advice to you is to get hold of a couple of tennis balls. Put two into a a sock. Then starting for a short period of time, every day, roll your foot over the tennis ball. You should feel a "snap, crackle, pop" feel as the faciitis is broken up. Try to increase the time and frequency of the exercise. It will hurt, so be prepared to take some aleve, and drink plenty of water. Another way to get your faciitis taken care of is to see a massage therapist and have he/she work on your feet to break up the stuck fascia. Once that's taken care of, use the tenis balls to keep the fascia moving well. Good luck.

You can look up your state nursing board on line, and see what they have to say about drug testing of any type, and how it/they can be used against you- or if it matters at all. Look under general information. I have been drug tested for years- all of us have- and it so happens that I take pain medication and stimulants. Before I did the test, I brought in all my meds, wrote out all my meds along with how I was supposed to take them, etc. I was extended a job offer. They planned to get me into the following week's orientation. That Thursday before, I get a panicky phone call from HR. Very quietly, as if it were passing secret information in a James Bond movie, I was informed that I had tested positive for ~~~gasp~~~ amphetamines. I went through the whole song dance about why my test was positive. Dead air at the other end of the phone. Politely I asked if my doctor could write something for them. Another moment of silence....and then the people at the other end of the line returned and told me that I JUST HAD to get a hand written copy of 'scrip in before close of business, the next day. It was taken care of in no time. What completely caught me off guard was that there were no questions about the narcotics/other medications, just that BIG ONE. Will you be taking another drug test for school? I'd think so; they like the freshest and newest of tests. If it's negative, the school will be happy with you. If you are in a hospital school of nursing, at that point, once you pass, they accept you, etc, go talk to risk management about your previous test. How long was it? Six months? A year? If risk management accepts your present negative test and the school has as well, then you ought to have some backing from your school. Keep open communication with them. Now, if you test negative and they find about that the test you took 2 months ago was positive, then you will have a problem. If they've offered placement and then take it away, call a personal injury lawyer- first discussion is free, and they'll tell you if you have a case and if so, what to do next. If you don't have a case, they may be able to explain why your error is a problem- and for how long. It may be a year of limbo, but if a lawyer accepts a case on contingency, they you haven;t lost anything. I wish you the best of luck.

@Suanna, I LOVED what you said about shingles!!! About a year and a half ago, I had the misfortune to develop the shingles. I thought it was a fibro flare, so I fortunately went to see my pain doc. He asked about the pain, then told me that he was the wrong one to be seeing for this...because, he said, you have shingles!!! However, he gave me a prescription for Dilaudid(4-12mg q 4-6 hrs) as well as famcyclovir(SP?) to prevent eruption. I went to see my GP, who then followed me for the remainder of the time...and kept me out of work for 5 weeks to make absolutely sure that I didn't develop any OTHER neuropathies.... Yah- anyone with shingles and no pain meds- KARMA!!!!:yeah::yeah::yeah: A long time ago I had 2 sinoscopies in one year. My doc believed in doing those cases under MAC, not general anesthesia. The first post-op medication I was given was Percocet....which did NOTHING. The next thing they gave me was IV morphine which did the trick, but I was so nauseated they had to give me Phenergan(Told you- LONG time ago). Between the MSO4 and the Phenergan, I was stupified and remembered the anesethiologist coming in and asking- Hey, why is Helga still here? I had been the first case of the day- and was still there at 5:30 pm. The next time, The anesthesiologist and I had a long talk about post-op pain meds....He felt that PO wasn't worth it, and instead of Morphine, he gave me IV Dilaudid. I discovered that Dilaudid was THE BEST pain med for me. Post-op, since I had to wait on a ride, I spent the whole day just resting quietly, was easily rousable to voice, responded correctly, etc, but if left to my own devices, I just slept comfortably....:redbeathe Big difference between the two pain treatments- and from that time on, I made certain to tell my surgeons and anesthesiologists that Dilaudid was the best pain med for me, for severe pain. I got THE LOOK, but once I explained myself, it was OK. However, when I ended up in the ER in tremendous pain from a paralytic ileus, and told the nurse that IV Dilaudid worked best, the INSTANT reaction was a shift from sympathetic nurse face to tightened up pruny faced "Oh ****, here we go again, a drug seeker" face. I understand that the ER gets all kinds of folks who are drug seekers, but if one has a board like, rigid abdomen that can't be touched, who then proceeds to vomit explosively, I'd hope that the "drug seeker" label would be put aside ASAP. I told the nurse that I'd had the med for surgeries at that hospital, he could look it up in my old records, that so and so were my docs, etc.... He did his job, placing the IV, then moving me to a different room after I vomited prodigiously, but instead of helping me clean myself up, he just tossed a clean gown and towels at me and left. My daughter had to clean me up, then go ask for warm blankets and the like. The attitude was icy and mechanical. Finally, after getting the OK to treat me with some powerful pain med IV( it seemed like hours, but I really have no idea), and then watching my body relax, my vital signs change, etc- only then did he treat me with the slightest positive attitude. What do you do with nurses like that? I was obviously in distress, unable to rest or stay still, then the vomiting, etc.....and he treated me with contempt for asking for the one med I knew would work.... I've had a total of three paralytic iliuses(?). The next time, the nurse was far more relaxed about the whole thing, but once again, it wasn't until I went through the explosive vomiting that something was done. I was even moved to the row right in front of the nurses station on a cardiac and O2 monitor so they could give me Fentanyl for immediate relief- and what a blessing that was!!!! The last time I had an ileus, I stayed home, took some PO stuff, stayed as NPO as I could and as still as I could until things started to move along again, because of THAT first nurse in particular. If the ileus hadn't started to resolve within a reasonable amount of time, I would have reluctantly gone to the hospital for treatment, dreading the way I'd be looked at and treated. So, for an RN to ignore a report of pain, or to fail to assess the patient's pain level properly because of their own prejudices, is simply abhorrent to me, both professionally and as a family member or patient. It's a throw back to the days when the docs would be stingy with pain meds, because of a belief that giving more than this amount of pain medication indicated that the patient was a drug seeker, or morally incapable of controlling him/herself, or the belief that it should only take X amount of medication to do the job. In this day and age, when medi students and residents are taught that there is a huge difference between treating acute pain and chronic pain, and that having Pain Services is just as important as any other consult service for patient care, you'd think that all nurses would eagerly embrace a more progressive attitude as well. To not instantly respond to a report of a patient's pain, in my opinion, is like ignoring a report that the patient's vitals are changing rapidly, or that there is frank blood in his/her urine. It is an URGENT matter that needs to be taken seriously and treated rapidly. Sorry about the rant.....I've seen every attitude in the world towards patients whose pain isn't cared for properly or recognized as an equally important part of vital signs as BP, HR, O2, and Respirs. Thanks for putting up with the long read....

As a Fibromyalgic, as someone who had a long term peritonitis that was missed for ?years despite my complaining of the pain, etc, I can say with great authority that there have been many times that I have been in a far amount of pain and not realized it until I assessed my behavior; as the pain got worse, the shorter, crabbier and meaner zI became.....whe it was poointed out to me or I suddenly realized it, then I had to decide how much pain I was in and take the proper amount of pain medication to control it enough to simply behave like a "normal person". I've seen patients who were histrionic about their pain, stoic to the point of lunacy because of the fear of addiction, and all points in between. I see a doctor who manages my pain. He has been audited 18 times by the state because there are several docs on the panel who disagree with his pain management style. He has never been found to have over prescribed, none of his patients are addicts, but the docs who give him the most trouble are surgeons. As an OR nurse, I find that extremely troubling; most surgeons are ok with treating post op pain liberally for the first few days to a week, but then there is a big push on to wean off of IV meds to oral meds, and then to reduce the strength of those ASAP. These surgeons are apparently some of the older docs; the new residents and docs I've worked with in university hospitals are much better educated at learning to use the pain service- first the acute service and then- if needed, somewhat reluctantly, the chronic pain service. I'm grateful that more docs are starting to realize that cultural differences give rise to misinterpretation of how severe the pain actually is; once again, culturally competent care raises it's head. If it's hard for the docs and some nurses to recognize pain being SUBJECTIVE AND WHAT THE PATIENT REPORTS for Americans, think about how hard it must be to recognize pain in the cultural melting pot that the US has become..... Pain is pain. It requires assessment and treatment. When I worked in critical care, if an LPN came up to me, reporting that her patient was in pain, could I give the IV med, I never questioned the initial request, but I always confirmed with the patient what the pain level was, so that the LPN and I could agree on what pain med to start with. So, yes, the RN is a lazy person, is certainly no longer a patient advocate(if ever was one before) and needs to be reminded that pain is what the patient states it is, and requires treatment. Kudos to you for being that patient advocate that you are. Sincerely, a nurse whose been on both sides of the bed, as patient, family member and nurse.

When I started in the OR, years ago, after 4 months, they gave us our wings.... There used to be a few BASIC things to get set up after the patient was drapped and the tables drawn up; connect the suction, connect the cautery pencil, the cautery pad, pour warm saline and water and put the kick bucket in a convient location for catching sponges....I'd forget at least one thing. I certain remember climbing under the drapes to apply a cautery pad any number of times. The surgeons, most of whom were cranky, did the "chop, chop" routine that was supposed to get me to hurry up(which only unnerved me more!). About bloody messes IV's- I had a friend who could get IV's beautifully, but she always made a huge mess. Always- no mater how hard or easy the stick was...All she could do was tell the patient that she was a messy sticker but SHE ALWAYS GOT HER VEIN. Most of the patients did just fine with that explanation. As to the tourniquets- I can't tell you how many times I see CRNA's, anesthesia residents and anesthesiologists forget to take it off- especially if several people are trying to get a stick on a patient with no veins....... In the OR, there is never a day when someone will try to throw something like suture onto the sterile field and WHOOOPS-it goes sailing over the table, falls off the edge, etc. We all try to be careful, but hey- it happens. It will always happen- there will always be some niggling little thing waiting for you through out your career- and the "whoopsies" will get smaller and fewer in number.

Woooman nurses???? Historically speaking, woooman nurses have been the dominant sex in the field til recently. Now 1 in 10 nurses is male. There would be why wooooman nurses have a higher sue rate than maaaan nurses. When the ratio is 50:50, then let's speak about comparable historical patterns. However, since this is the 2000's and men are becoming far more visible, the article should not have used "she" as an exclusive pronoun. I am, by the way, a Female nurse or a woman nurse, but never, ever a wooooman nurse.

I've done OR stuff for a long time. It's funny, but for some people, eye surgery gets to them, others can't stand podiatry, others cope with a chewed up leg but can't handle and anal case. Most everyone I've met in the OR, med student, RN or ST orientee, RN, LPN, SST students, OR staff, and the docs, too(some admit it, most won't) have all had at least one surgery when that person got the hot/cold sweaties, dizziness, nausea, etc, and either ends up passing out or backing away and sitting down sometime in their career. Sometimes more than once! A friend of mine got pregnant with twins and passed out every day for the first three and a half months of her pregnancy- but never had before or since! I've caught any number of surg tech, RN, medical students and residents! The best way to help yourself is to make sure you eat breakfast the day of shadowing; low blood sugar will help you pass out every time. If you do feel the hot/cold sweaties/dizziness/nausea, sit down ASAP, even if it's on the floor. Let the staff help you; it happens enough that most of us just try not to make YOU feel embarrassed. And if you do pass out the first time in the Or, that doesn't mean that you aren't cut out to be an OR nurse. It means you had a vaso-vagal response. And there have been some pretty awful cases that made everyone in the room kinda weak in the knees...

I'll copy your message, cos the moderators will remove your email- and I'll get it back as soon as I can tomorrow...

I'm glad there is a policy in hand that clearly defines who can and cannot give propofol. A long time ago, conscious sedation consisted of giving some versed/valium, a little bit of narcotics, one nurse to monitor the patient, the other to help with the procedure. During a "conscious sedation bronch", the nurse I was working with was extremely new at giving the meds, very uncertain and the doctor made her nervous. He asked for 2mg of Valium(no Versed then) and she gave 2 ml, which was 10 mg! This patient being a COPD'er, he instantly stopped breathing(I'm sure that most of us would have anyway) and suddenly, in a little tiny "local" room, which wasn't set up for suction, Administering O2 and the like, we have a respiratory arrest! The doc is screaming at the nurse, who is in tears and I'm calling overhead for a crash cart to be brought to the room. I actually remember hearing someone else on the overhead speaker saying, "Did she just call a code for her room?" and my instant response back confirming that WE HAD A CODE situation. What a freaking mess that was! The room had previously been a small "junk" room. It had been cleared out to be used for LOCAL cases only. Somehow the doc had pressured the coordinators to get his bronch moved in there, a patient who was too ill to be done in that room. Luckily for the patient, getting him to the PACU and bagging him for a bit was all it took. Bronchs were never again done in that room, suction and O2 were installed, the nurse quit the next day and the doctor went along with his life... But that was CS in the 1980's. I wouldn't dream of pushing propofol instead of an anesthesia professional. I have given propofol while assisting an anesthesia professional.

Me, too.

Have her consult risk management at her hospital. They'll put a quick stop to it!

This is an excellent article on the present state of nursing legal issues. I would like to dispute the nurse's complete responsibility in regards to knowing what equipment works, is broken, etc, as in most hospitals there are also others involved in the care of the patient. If those people, such as CNA's, transportation team personnel and others don;t report the problem to the correct departments as well as the charge nurse about an equipment failure, how can the NURSE be the only one who is accountable for such issues?

Yes, FroggyMaMa, I agree. If I'd known that the market for PT and OT's is as hot as it can be.....but you have to have a young body to do the job. Mine's kinda broken. Was the question about sounding so bitter and what job am I doing now addressed to me? Well, if it was, I'm sitting at home doing nothing, collecting workman's comp checks, have had five job interviews and the only one to consider had NO benefits, terrible hours and only paid a max of $27.00/hr. HOWEVER, I also have a W/C lawsuit in process, so no one really wants to hire me based on that alone. There is always an excuse.... Nursing is a love/hate business for so many of us. The nursing part, the patient contact part, is usually great. the politics of a hospital aren't pretty and every hospital has them. Traveler's I've known have said that they like to travel, because they would not, could not be affected by politics much or at all. Now, when I got out of school, traveling nurses didn't exist! Wouldn't have done me much good anyway, because i got pregnant right out of school...ah well. I have bitterness toward a system that treats a hurting nurse like a malingerer, that won't elect to send someone for a second opinion without the danger of a lawsuit. In this state, there is a cap of 250k no matter how badly you've been hurt, etc..... I miss nursing. I miss nursing with a healthy body. I deliberately caught a patient who was falling off an OR bed, so she wouldn't suffer any injuries(and she didn't), but now I'm a nonentity to my own hospital system. THAT'S my regret.

I'd like to give a sincere round of applause to the CNS's who state that they want to be ADVANCED PRACTICE NURSES, not med lite.... I gave thought to becoming a PA, rather than an NP. I looked into both, but it seemed to me that a PA generally makes more money than an NP- have no idea why. I'd think that an NP who HAS TO HAVE an RN already, just to start with, would be considered the better prepared. Perhaps, however, I wasn't looking at it properly; once again, PA's started out as MALE(this is a biased view, based on my experience, so please take no offense) and therefore got more $$$$. I would also like to say to the APN's that I do hold y'all in considerable esteem. I've spent most of my career as an OR nurse, and have watched the very best CRNA take better care of most patients than a boatload of senior residents and attendings. While most of the attendings and CRNA's at my facility have a very collegial relationship, while most attendings are more than willing to teach a CRNA new skills, or supervise those who've attained a certain mastery and now need to be "checked off" formally, there are a few crapheads out there on both sides of the anesthesia machine. At one time in my life, I considered moving up to L and D. However, at that time, the term 'nurse-midwife' was enough to send MD's into a rage!!! Then doula's came to be recognized(amazingly enough) and somehow the fight to kill off the NM's started to moderate. Once again, my bias- and in a different state. It took me quite awhile to figure out what a CNS was. None I knew was familiar with the term, but then, CNS's don't show up in OR's often. I thought about becoming a CNS in Pain Management until someone I spoke with about the whole idea of what to pursue to be useful in pain management was to be a CRNA- period. That was discouraging. Now this may be a form of heresy, but in the olden and much more olden days, there were women known as healers, who knew some very practical pharmacology and general curative practices. Healers, in this country and many others, were exclusively WOMEN. I think most nurses are healers of some sort- why else did we get started in the first place? As to making diagnoses, etc----I've met some awesome nurse diagnosticians who weren't even NP's(not sure they existed at the time). Sometimes I wonder why we are so limited in our scope of practice when we have the example of a field medic or a MASH unit surg tech who does stuff that would be a huge violation of scope of practice in the civilian world? The best surg tech I ever met was a guy who served in a MASH unit in Vietnam- he could open, tie, suture, repair vascular tears/bleeders, amputate, close with the best of the surgeons- and frequently did when the unit was busy. So why can't a nurse with enough skills be both a nurse and a diagnostician? What is wrong with that concept at all? As a mere RN, I unfortunately accurately diagnosed several members of my family's medical issues- and was correct every time. It's sad to be able to have to turn to one parent and report the bad news about the other. T'any rate, I do salute those APN clinical specialists. There are so many people contributing to patient care on so many levels. Thanks to all those who patiently explained the how's and why's.