chimama

It is naive to think that a career ladder is a recruitment/retention tool.It is a stressor to the staff and a creation of ivory tower nurses who live in the land of NANDA.

So sorry for your error.Don't beat yourself up. I have to ask, because I have noticed a tendency to take things at face value lately, was the mis-communication information out of the ordinary? I have noticed lately that some nurses are not questioning factors about their patients the seem unusual, when doing so can prevent an error. For instance, the other day a nurse reported to me that a patient had ac/hs blood sugars, and had had two sugars greater than 250, but had no insulin coverage ordered. Immediately after report I checked tha chart because this struck me as very unusual and found that a transcription error had been made when the pt was admitted and the ss insulin had been missed from the hospital ( I am in an LTAC). I noticed on another pt that the sodium tablets on the mar were designated as prn...how odd. This had been there for days on a pt with SIADH and when I checked the order was 2gm tabs po tid. I just want to encourage nurses the check out what may seem odd, even if it has been checked and double checked. It may prevent an error such as this.

I worked several areas at this hospital and enjoyed them all except the CV unit. The doctors were EXTREMELY rude...and this was the opinion of the ER docs also.It is a beautiful hospital and the staff is very nice.I worked everywhere but the CV units...I refused to work there and I have never refused to work anywhere.Just depends on how you react to working with hateful physicians.

I have drawn buckets of blood in the past 30+ years! I am the one the Phleas come get when they can't get the blood.I am not overqualified, undertrained, or "bad" at drawing blood.

You poor thing! In the unit I work new grads are given about 6 months of orientation and I have precepted for as long a three months because the grad felt she needed it. I think your manager is taking a HUGE risk having someone so inexperienced, even if you are real good,alone on shifts. I think you have been done wrong and should try to find another job.

Why do we care so much about all this? If I am in an ER and a patient tells me he has a migraine and needs Demerol, he should get Demerol. If he says he wants Torodol, he should get Torodol. Why should I get my panties all in a wad about drug-seekers?If a hospital wants a three narcs in th ER policy then you're out that is OK too. I just don't get all the passion and prejudice this issue creates. I guess what I am trying to say is why should everyone be so suspicious of people with pain complaints?Why do they care so much about the validity of the pain? Just treat it.

I totally know what you mean there! I work NICU and I hate it when a parent says...usually during CPT on another baby..."Does that hurt the baby?" I so want to say "Yeah...we are into hurting babies. That's what we're all about" (you idiot!)

I just stopped at a horrible looking accident and there were TONS of people helping. They seemed to be doing the right thing...the girl wasn't actually injured in an acute was, ie bleeding, LOC,ect.I stayed for a few minutes till I saw all was under control then silently slipped back to my car and left. I will always stop, but will leave as soon as I can see that the situation is stable.

If patient advocacy is the issue then why don't we name names and places?Who was this doc? Where did this torture session take place?Does stating the truth with names and places violate some kind of forum rule?I have always wondered why don't we just say who did it and where instead of all these vague references.I would like to know who I need to protect my family from. The names of sexual predators are published...why not the names of patient abusers? :uhoh21:

They won't let us drink at work anymore!They take all the fun out of everything! :rotfl:

I have been DON in three LTC facilities. The only thing that is going to change the "culture" of where you work is for you to be able to pay your staff more and start over. That is not going to happen. LTC is a lose-lose situation.You will have no life as long as you are there and when the state comes in they will treat you like a criminal who only went into LTC to abuse and neglect the elderly. I advise people to never go to a Nursing Home. Go on welfare and keep your loved one at home.Do something, anything but a NH. And you should turn in your resignation today. You are in for a miserable time untill you do.

Don't think of the situation as a long drawn out death. Think of it as the rest of your patient's life.They are living right up untill the moment they die.You can establish a relationship and a trust with them so that you can assist them in acheiving their death in the manner they choose.And you can always reassure them that nothing is written in stone...they can always change their minds.No one knows how to die.We just help each other along the way.

I really don't need a pain scale. I know this is probably blaspheny but I just ask "Are you hurting" and assess my patient and give them pain medication if they hurt. Why do I need a scale? Am I not going to medicate them if I get a low number from a fresh post-op?Am I going to get someone having an MI less MSo4 if they say it is better but still hurts?Do I really need a crying little kid to point to a smiley/frowny face to know he/she needs something for pain? And how about my Spanish/Mong/and non-English speaking paitent?When I have an alert English-speaking patient and can give either a pill or an injection I ask"Do you want a pill or a shot?"Why do we make everything so complicated?

DZcarrie has all ready gone the the higher up people. A state reported complaint along the same lines will be obvious, and administration is always thinking along these lines. Certainly she should do all she can for the betterment of patient care. If the state can change things, then she should report it. She just needs to know that there can be serious repercussions. I don't mean to sound like I support non-action. It is just that here in TX the Dept. of Human Services rarely if ever actually effect an improvement. Knowing what the concern is would make it easier to brainstorm a solution.

I worked in a hospital that used Neurontin by the bucketfull and have been for many years skeptical. My mother has post-herpatic neuralgia from ocular shingles and thinks it helps "a little". I am still not sold on its effectivness and suspet a placebo effect.When I was doing geriatric nursing I had many patients who could not tolerate it.The jury is still out as far as I am concerned..

I understand your frustation and concern but know this...no reporting to the State,esp. in Texas, will be anonymous.What are you concerned about? How has the chain of command failed you? Have you gone to the corporate level? I only ask because what you do may profoundly affect your career without correcting the problem.

They probably won't take you on staff without a no-fault clause. It means there will be monetary penetalies for either you or the hospital to be hired away from an agency unless it is stated that it will be ok.

In GeriPsych nursing you need to be aware that your patients probably have underlying health problems exacerbating their mental/behaviorial problems. Medications are , not more important, but must be used very carefully and reviewed often. Family dynamics and end of life issues factor in, as well as loss of independence, depression, and dementia. I find the area fascinating and appreciate nurses who have the patience and compassion for this field of nursing.

Travel but look at your contract. Demand a no-fault clause in case you want to go on staff. Travel is a great way to assess a facility or area.There are many NICU travel contracts out there.

Heving been both a family member in the room during a code (my sweet daddy who unexpectedly went from being perfectly healthy to dead) and having family members in a code (NICU and ICU) I have to say that being there and having them there is, in most cases, better for the patient and the family. Of course there are exceptions to every circumstance, and blanket policies must have flexibility...ie a hysterical or drunken family member.

I have been an RN for many many years, the last few as a travel nurse and many as a agency nurse. I have seen ,repeatedly, nursing management and hospital administration make stupid decision after stupid decision the make their staff feel unvalued and leave.It is a source of constant amazement to me. One particular...I have seen charting system after charting system be decided on with no discussion with the staff who will be using it.It seems that now the management is focused on "accountability" (as if civil and possible criminal charges and the loss of your ability to lose your income and earning ability is not "accountability " enough )and tries to ultra standardize everything untill the medical record is bascially useless to communicate information about the care given. I have seen these systems implemented time after time with the staff screaming NO! to deaf ears.Nurses are given 1/8th of an inch do do this critical charting that "isn't done if it isn't charted"Or a "wonderful computer system" providing only Y/N input to record crucial observations. No one ever talks to the staff. On one assignment a hospital spent who knows how much on a beeper call system that everyone hated. No one asked the staff how they liked it and after a few weeks the beepers were in the drawers. One place implemented a "Clinical Ladder" that involved hours of extra-unpaid-work on the nurses part .All the nurses with husbands with benefits just went pool status, and many nurses quit when the MANDATORY note went up. Why don't nurse managers and hospital administrators talk to their staff and listen to their staff instead of deciding like Mama and Daddy what is best for all.One thread I recently read was about "scripting". How insulting can you get? Self-direction is an excellent idea but I have only seen it implemented in scheduling, and that is alwzys with mind-bending regulations about weekends and holidays.I am at the end of my career and I thank God even tho I love being a nurse.Maybe if self-direction is truly implemented and nurses were really empowered instead of pretend-empowered nursing will become a more attractive job and nurses can experience some of the contentment in their jobs that IS possible.

I love the ones who come in because they drank 1/2 bottle of vodka and vomited! Always said I should trach a "what to expect when you drink to excess" class in my community.LOL

No it is not possible to "titrate" paralytics!!!Your should never ever ever use paralytics on anyone who is not intubated. Eventually someone will be killed. This sort of thought process is like giving someone sterile water iv to correct hypernatremia...SCARY