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  1. TrishJK

    Student caught stealing....

    Interesting for me watching how it has been almost unanimous amongst the responders - who all appear to be from the USA - that this young woman deserves a harsh punitive response. There have been precious few posters who have shown mercy, compassion, a lack of self-righteousness, some kind of demonstration that there might be extenuating circumstances etc.... what is shocking to me, as a mental health professional from another country, is: 1) how overwhelming your reverence for the "almighty dollar" appears to be - for the loss of $114 a career is to be lost (and I am not interested in hearing about how dangerous she is to patient safety - that's a furphy to justify your "cut off her hands" responses) 2) what is such an indecisive person doing in such an important position of authority to be coming onto a gossipy site like this to ask how to behave in such a weighty matter? The OP would perhaps benefit from some quiet reflection and some stand-up-and-be-counted decision-making of your own. Use this as an opportunity to grow as a teacher and supervisor: think through the issues yourself and then advise/discuss the matter with your own supervisor
  2. TrishJK

    Help w/lovely 87y/o male with - Cdiff

    This is probably silly, but have you thought to remind people to wash their hands thoroughly with soap and water (not alcohol based cleansers - which apparently don't do such a good job with C. diff because of the resilience of the spores). Also, it can't hurt to throw some white vinegar in the washing machine with his clothes and sheets; and all over the bathroom for that matter. You haven't said how advanced the dementia is - but, assuming he's no longer competent with ADLs - is someone ensuring his fingernails are clean and short? Finally, gastrolyte or similar is probably a good idea to keep his electrolytes balanced. Hope this helps.
  3. TrishJK

    Caring nurse turned Raging *****

    Hi Lola I agree with Moogie (Hi Moogie). Here are my suggestions: 1. Time management skills - learn how, fast. 2. See a doc to check for any underlying conditions. 3. Learn how to set boundaries - all that overtime suggests a need, here. 4. Stress management - e.g. relaxation and mindfulness exercises - need to practise daily - if you don't learn to de-stress your cortisol will kill you! 5. Sit down with your best friend or a notebook and figure out a) where/why it is going wrong for you (you then know what else you need to change) and b) where you want to go in your life and in your career in nursing. You can then work to a plan. Take control sooner rather than later, Lola. Best wishes Trish
  4. TrishJK

    Borderline Personality Disorder on the Behavioral Unit

    Hi Thunderwolf Great article - thanks muchly. I have just discovered two great theoreticians/clinicians on BPD: 1. Dawson, D & MacMillan, HL 1993, Relationship Management of the Borderline Patient, Routledge Taylor & Francis Group, New York, NY Dawson is really big on the tactic of having the BPD solve her/his own problems by deflecting - "I don't know, Sally. What do you think?" This serves several purposes: not getting the therapist sucked in to the current psychodrama; helps to focus the interaction on the BPD as a competent adult; gives practice in objectifying and thinking through issues etc. Dawson also recommends the use of the uncomfortable silence as a place which encourages what he calls "switching" - where the BPD goes from acting out oppositional and other unhealthy needs to beginning to think how she/he can solve the current problem (empowering). Dawson's key theses are summarised in this article. 2) Marsha Linehan's work is illuminating in suggesting ways to work with BPDs. Linehan developed dialectical behaviour therapy (DBT). DBT uses validation and dialectical change-based strategies to help BPDs learn new ways of coping. This reading list was developed by Linehan. Thanks again for a great primer, Thunderwolf. Best wishes Trish
  5. TrishJK

    The culture of nursing - Professional behaviour & conduct

    Hi Rachel Zana2, HouTx and Emmalou have said more useful stuff than I could think to say. I went back and checked out last year's comms. You got some t'riffic advice there, too. So, as requested, here goes again - apologies to the three above - you have probably already said it: 1. Remember the universe wasn't created in one semester. Slow down. If you run the whole time (from experience to experience) you won't really appreciate any but the most shocking/toe-stubbing moments. And, as you discovered last year, your metaphorical charging around upsets the locals. 2. Keep a small notebook in your pocket so that when you feel that almost uncontrollable urge to interrupt with your oh-so-important question you can consider stepping away and jotting it down for reflection/research and/or later clarification with an experienced nurse. This will depend on the situation and all those variables already identified. Learn how to exist in the moment without seeking validation from others that you exist. 3. You are the future of nursing. You are an important person. You are a valuable person. You are being given a huge privilege by very sick people and very hard working nurses - the opportunity to learn from others' experiences and to practice so that you can make mistakes safely. I applaud your desire to be as good as you can be. Regard this semester as an opportunity to hone your judgment skills. I sense your fear that you will receive more criticism than praise - and that this is your personal valley of the shadows. You have a huge hunger for approval. If you are not careful, it will continue to be your undoing - in nursing, in life, in general... Learn to make a steady, quiet inviolable centre, Rachel. Learn it sooner rather than later - and spare yourself this continuing world of hurt. (Consider signing on with a private psychotherapist who can help you to build it). People will not remember what we said. People will not remember what we did. People will remember how they felt when they were with us. Sometimes the best we can be is quiet and present for someone else - learn how to be quiet, Rachel - so that you can really learn what's going on around you. If you can really learn what's going on and then respond appropriately, you will make the kind of difference that people remember because it mattered (and coincidentally, get the kind of recognition that you crave.) When I was an oncology patient I felt very, very physically sick. Early on after my surgery, if my oncologist had stood at the end of my bed and said "You're cactus, babe." I would have said "Thank God." That's how physically sick I felt. There was a young nurse there who was assigned to look after me. She thought it was all about her. She had no idea that I even existed as more than a praise and gratitude machine for her. She spoke loudly, she moved loudly. Her keys rattled loudly. She smelled loud! She bristled with a sense of dramatic self-importance ("Look at me - I am Flo Nightingale reincarnated. And I am sexy - just like those gorgeous nurses on tv.") If I had had the energy I would have told her to go away. If I hadn't been scared that the quality of my care would deteriorate even further, I would have told her to go away. I dreaded hearing her coming. She didn't notice that I was in pain and too sick to say so. She didn't notice that the sun was reflecting off a picture hanging on the wall right into my eyes and I was too sick to turn over without help. She didn't notice that my mouth was dry but I was too sick to sit up to take a drink. I told her I was lying in a puddle of urine and she was hugely irritated that I wanted her to change the sheet. I used the very last of my energy to ask her to wash her hands when she tried to change my SPC without doing so first. She stormed off in a huff and I didn't see her again - thank gawd!! I will never forget her - and I love to tell the story of her complete incompetence. She made me feel that I didn't matter; that I was a nuisance. She terrified me. If I ever see her again - I will happily tear her a new a-hole. Good luck, Rachel. You can do it.
  6. TrishJK

    Need Help for School!!

    overview from australian government here and/or here suggest you answer this after doing some reading from the above links like everything else, depends on the nurse, the treator, the circumstances in general. could you be more specific? depends on years experience as well as qualifications, hours of work, employer (eg govt or charity not-for-profit or private for-profit), state etc. interesting article covering lots of the issues here.... otherwise, suggest you google "nursing pay rates in australia" very - desperate shortage of nurses australia-wide - especially in rural areas. do you mean apart from the satisfaction of a worthwhile job done well? tax concessions on salary is the obvious one. good luck with your assignment
  7. TrishJK

    Elderly patient left on bedpan for days

    It'sa beatup. I do na believe't.
  8. TrishJK

    I'm back!

    Congrats, you go-getter you! Wow. That is verrry groovy.
  9. TrishJK

    I love nursing.. not sure if nursing loves me

    this sentence appears to be the crux of your problem: whoever told you the patient didn't want you for a nurse is NOT your friend. Stay away from this person. You are so upset you're not expressing the problem in terms others can readily understand. Do an SBAR on it OK? (State the Situation; briefly describe the background; briefly give your assessment of the problem; recommend what needs to be done next). By the way, what needs to be done next is to 1) stop beating yourself up. Are you the first perfect humanoid on the planetoid? 2) Calm down. Take a deeeeeep breath. Go for a long swim. Sleep for 8 hours. 3) Get over it. Say "wot the hell, I did my best. Next time I'll do better because I'm a good person." Repeat this enough times until you stop feeling the need to beat yourself up. By what you've written, no great harm was done. Buck up, babe. Chill. ps. where is your spouse? Why isn't this person saying what I'm saying? Where is your best friend, ditto? best wishes Trish
  10. TrishJK

    Outsiders finding great jobs in health care industry

    Priceless - more proof that it's ok to consume people in the same way we consume stuff: and he's not even just from the retail trade - he's from FMCG - fast moving consumer goods.
  11. TrishJK

    Have you ever had to supervise your friends?

    Wow! That's brilliant, Diane - so succinct and yet so comprehensive. I am taking a copy of this! Thank you.
  12. TrishJK

    Have you ever had to supervise your friends?

    Poor you, Scrubby. Bummer and a half. how did you land yourself in this fine mess? I agree with the other poster. Surely you can get out of this awful supervising-of-soon-to-be-ex-friends job? Good luck Trish
  13. TrishJK

    People you "know "coming to your unit for care

    2ndwind you're a comedy writer! I'm laughing - and oh yeah - I can see it - and Act 2 is where RN rushes off to tell all the other RNs ENs MOs cleaners, kitchen staff and anybody else she sees, her delicious new goss.
  14. TrishJK

    People you "know "coming to your unit for care

    It's not the face to face meetings that bother me so much.... I guess you'd just be happy to turn the other cheek, eh? having said that, I'd rather my fellow nurses didn't know I was officially crazy ...er... that is, if I was, which I'm not - officially anyway.... you get my drift
  15. Are nursing students paid for their labour on clinical placements in the US? In Australia we "volunteer" our time in exchange for the chance to gain experience under a preceptor. It has a really medieval guild flavour.