blondeoverboard

the expectation for the wounds is not to heal them but to minimize progression and prevent infection. neither of which has been done in this case.

i am a hospice nurse who is caring for a 56yr old woman with MS & Dementia. the pt is bedbound, malnourished, with pressure wounds to her left hip and buttock. in early september she was admitted to the hospital for replacement of a her PEG. the family revoked hospice services in order to have the PEG replaced. when the pt came home the family called to have her readmitted to hospice. 2 weeks later, when i found the other agency's folder under a pile of linen, i discovered the pt had also been admitted to home health for wound care and OT(forget for a moment that she cannot participate in therapy in any meaningful way). i notified my DON and contacted the home health agency for coordination of care. the home health nurse began making daily visits. at the time i began providing care the wounds were small to moderately sized, unstageable due to necrotic tissue and slough but responding well to santyl. i was told by my DON to defer wound care to home health. it made me very uncomfortable but i did. today i saw the wounds for the first time in several weeks. they are much worse. the hip wound is significantly larger with increased necrotic tissue. the buttock wound shows evidence of tunneling and there was purulent drainage on the bed pad. there is swelling around the wound. it appears to be infected. i discussed my concerns with the pt's daughter (she is disinterested on the best of days) and was told the home health nurse would be out this afternoon and she would tell her about it. i also reported it to my DON, her response once again was that the wounds are the home health's business and she does not want "to appear that we are looking over their shoulder." my gut tells me this is BS. i believe that if i see a pt's condition deteriorating i am duty bound to report it. i also believe that if the family were to decide to take legal action, as a licensed person in the home i can be held responsible. what do you say? thanks, debra

as a hospice nurse i've been with many, including my own father, who have deathbed visions. i have seen the peaceful and the terrified. i have listened to the confession of an elderly man who killed another as a young teen. the impetus of the confession came the morning the man awoke to find the victim sharing his bed. i've begun to have these visions myself. now and then the dying appear to me in my dreams to tell me they will be going soon. often that person will die just days later. my personal belief is that we forget that those things that we can see with our eyes and lay our hands upon are not the reality. having served both laboring woman and the dying i cannot but see the connection between the two events. at those moments we are open and vulnerable, raw and aware. passages that must be traveled alone.

prior to leaving my last position i had a daily headache. it started when i opened my eyes in the morning and was in full swing my the time i hit the time clock. i was nauseated most of the time and boiling over with rage that i took home with me. i was nasty to everyone i came in contact with. i loved what i was doing but hated the place i was doing it and the people i was doing it with. i kept at it because i didn't want to look like a failure, though i realize now i was the only one making that judgement. i considered going on medication to control my anger but thought the better of it. for me, no job should drive you to any sort of drug.. prescribed or otherwise. the day i decided to leave, the headaches went away. in almost 2 years time, i haven't had one since. no job is worth risking your health over. there are so many ways to do nursing perhaps there's another way out there in which you'd find more fulfillment without the stress.

platon20 has a point... the idea is things you want to say, not things you did or should say. the poster that was corrected made it clear that the comments were made to the physician. we are professionals working in a stressful field. i don't disagree that we're often times spoken to inappropriately and treated with a lack of respect. however, at no time does it give us the freedom to be disrespectful, rude, or condescending. sarcasm has its time and place. in the example provided it was neither the time nor the place. there's a saying that goes "when someone throws a stone at you, you throw back bread." taking the highroad isn't always the easy choice but it is always the right choice.

"6. Remember that often the question asked isn't asked to see if you know the "correct" answer, but more to see your thought process in coming up with an answer." excellent point. nursing involves critical thinking. you may not always have the right answer but show me you can think the problem through and you're steps ahead.

accidents will happen. we do the best we can with the best of intentions and still, accidents happen. from what you described it sounds like you did what you could to ensure her safety to the best of your ability. it also sounds like you acted quickly to get her the help she needed. in all likelihood you will heap the strongest punishment on yourself by wondering about all the couldashouldawoulda's. as the saying goes, "you can't unring the bell." be gentle with yourself and learn from the experience.

you're welcome. good luck!

it's been my experience that it doesn't bother the family as much as you might think. if you lay the head of the bed back, it doesn't appear as wide open. however, short of bandaging it closed, i haven't come across any tried and true method. if family does ask, i make an attempt but i also explain to them that it's a natural thing. that's usually all they want to hear.

be honest. don't pretend you know it all. no one expects you to. there are nurses with years more experience that understand that we never stop learning. tell them why you want the job, stress what you can bring to the position and let your love of your profession and critical care speak for itself. if something comes up in the interview that you have no experience with, say so but also make it clear that you seek out information. often times half the battle is not knowing the information straight from the book but, instead, knowing who your resources are... you know, the old "it's not what you know, it's who you know." as someone who has sat on those panels (and the only LVN on the unit) the applicants who didnt get a second glance were the ones who either a) came across as know-it-alls who couldn't be taught or b) kept appologizing for their lack of experience. we've all been there. my guess is that, once you calm your nerves, you'll do just fine.

the d-ring is for the chain that they will run from your station to your pants. the chain is 3 links short of reaching the bathroom and breakroom. it never reached the cafeteria, no matter what they might tell you.

southernbee... you know there's a pill you can take for that, right :wink2:

how about your code status :trout:

"well no sir, i'm not a neurologist but i do believe the patient is having a seizure. why? well, because he's flopping out of the bed, peeing on himself and ohhh yea, you were the one who stopped his prophylactic AED's this morning so how bout you shut your yap and gimme the lorazepam order and i'll let you get back to sleep."

time management is a big part of the crush you're feeling. what stood out to me was your comment that docs, and ancillary are eating up your time. the docs i can understand but pastoral care, PT/OT/speech/rad, etc should be able to function of their own accord. when i start a shift the first thing i do after getting report is pull up my patient's labs and flag everything that is abnormal. is it new? has it been this way for some time? if the sodium is 120 today and it was 118 yesterday i won't call but if it's 120 today and was 135 yesterday you can bet your butt i'm on the phone. if you have multiple patients with the same doc, review all of their charts and make one call. the doc will appreciate not getting 50 calls and you'll have "extra" time. are you making use of your resources? your unit clerk, nursing assistant and charge nurse are there to help you out. one of the first things i did when i stepped on my first unit (neuro icu) was identify the power players and strike up a relationship. it never hurts to have a more experienced nurse to turn to for advice and some tricks and tips. also, visit with the education department in your facitily. ask for a refresher in those areas where you feel weak. that's why they're there. how are your assessments going? do you feel comfortable in your observations or are you second guessing what you're seeing and hearing? carry a note pad and, as you do your assessment, make notes. dont leave your charting until the end of the day. a little bit here and there throughout the day is much more accurate than trying to remember everything that happened 12 hours later. follow a head to toe assessment pattern and apply it to each and every patient. it's easy to become overwhelmed and frustrated (i did my share of crying too) but when you know where to go for the information and help you need... the job gets easier. the fact that you're asking for help is a good strong sign that you care about the quality of care you're providing and have a desire to improve. you'll get there.