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BedsideNurse's Latest Activity

  1. BedsideNurse

    How is this handled at your facility?

    If a pt demonstrates SI or comes in after SA they are sectioned and automatic 1:1. At our hospital the MD has to write the 1:1 order. The only way these patients don't get a 1:1 sitter before they are cleared by psych is if they are both vented and sedated.
  2. BedsideNurse

    Thoughts on vegetarian/ vegan diet

    Vegans have lower BMI's; less than 10% are obese, and they have a 60% less chance of developing type 2 diabetes....Just as a weight a control mechanism it should be encouraged. But a vegan diet does more than keep people thinner. It stops coronary artery disease from progressing and in some patients can reverse narrowing and improve blood flow of the coronary vessels. This has been proven with before and after cath lab and CT imaging. Vegans also have lower blood pressure. Reducing obesity, diabetes, and blood pressure reduces stroke risk and peripheral artery disease. Other benefits include a healthier gut microbiome, less diverticular disease and less constipation. A lot to consider, but looking at the epidemic of obesity and diabetes that is ravaging this country, the disability and death rates of CVA, and that heart disease is our #1 killer, medical schools are remiss for not teaching that a low fat whole foods plant based diet is what people should be following. Now, obviously you can be vegan drinking beer and eating butterscotch candies. I am talking about mindful eating of healthy food with sufficient calories. All that being said, since I work in a revolving door MICU, much of what we do is procedures and pills, patch work and acute symptom management. When patients can take po we send them what looks like what you'd eat if you had a frozen dinner from the grocery store in 1972, except probably even less palatable. When dietary conversations arise at work I do try to encourage my patients to decrease saturated fat, especially saturated animal fat, and to eat more nutrient dense, high fiber plant based foods. If they've never eaten fruits or vegetables and can't stand the taste or texture we talk about finding smoothies they like, maybe pureed bean and vegetable soups, or how to sneak in a little extra nutrition in their spaghetti sauce and pasta, for example, by adding vegetables and finding spices they enjoy. I also encourage markedly decreasing processed foods, watching their salt, and choosing whole grain options vs. highly refined foods. This kind of discussion is pretty rare, though, maybe a few sentences about it a few times a month, if that. Tragically health care does an absolutely *horrible* job in preventing disease through healthy eating. There are a few glimmers of hope though; there are more cardiologists getting on board, and there is a little more interest in "lifestyle" medicine (which generally includes promotion of a lower fat WFPB diet) amongst internal medicine, pediatric, and family practice docs. Also, Medicare has approved reimbursement for The Ornish Reversal Program, which is an intensive cardiac rehab program that solely focuses on diet and lifestyle changes, and Kaiser Permanente is now working with physicians to encourage plant based eating. I am sure most of us would rather no diagnosis vs "early" detection of illness. We need to start promoting health. Once doctors get paid for patients getting healthy, that's when we will see real primary prevention being taught and practiced. Just my two cents. Don't want to start a war.
  3. BedsideNurse

    Med error . I’m devastated

    Obviously very upsetting, but at the end of the day, if the patient didn't die or suffer permanent disability, it's just unfortunate vs. life altering. Be relieved and learn from it (as I'm sure you have). And I agree with Dy-no-mite Nurse1, distractions and constant bare bones understaffing are really a problem as far as med errors are concerned. Rush, rush, rush, pulled in a thousand directions. Patients First in 2019 means minimal RN staff, no secretary, no transport, and one tech for a whole unit. Any complaints and we are told to huddle and work as a team.
  4. BedsideNurse

    Insulting pay raise

    Health care CEO's and upper management have seen their pay skyrocket in recent years, supposedly because "they have to pay talented people competitively so they can get the best leaders." Well, seems they aren't earning their pay/aren't leading all that well since health care facilities are so strapped they can't hire even enough minimum wage CNA's, and do things like increase someone's pay by 36 cents in 4 years. It is insulting and absolutely ridiculous. I would talk to your boss about it and if they are unwilling to reasonably increase your pay I'd starting asking around to your nurse friends and see where the best place to go is. They aren't demonstrating they value you enough.
  5. BedsideNurse

    Help! Accepted a job but how to turn down!

    I got offered an office job as a newer nurse and I turned it down because I wanted more clinical experience. Luckily I did turn it down as I am sure I would have been an awful office nurse without any experience. I would probably be an awful office nurse now, with lots of experience, come to think of it... but I say if you are feeling that bad about it don't do it. At least feel good going into a job, you know? Maybe you can find a nurse internship for new grads at a local hospital? Or ask and look around for a place that has "decent" staffing ratios that seems to have a thorough nurse orientation process...Some places offer more support than others so it's worth looking into. If you keep in touch, ask some of the people you graduated with about opportunities they've seen out there. The good news is there are a lot of choices in nursing. The bad news is nursing homes, rehab centers, and hospitals are pretty overwhelming too (and at times can be downright harrowing), but you usually have any least one nurse friend to go to as another set of eyes, to ask questions, figure things out with, or whatever. I know school nurses and home care nurses are often in that same lone-star boat. I think that can be a tough gig when you are new, although not impossible. I would just tell them a succinct version of the truth and be done with it. They haven't invested that much into you so it won't be that big of a deal, maybe a little awkward on your end, and disappointing on theirs because they need someone ASAP as of yesterday, but that's their problem, honestly, not yours. Be professional about it; try not to sound wishy washy or apologize incessantly. Employment is a two way street and it needs to be a good fit for both parties. That being said, be pleasant and genuine sounding and be sure to tell them you appreciate their time and consideration. You want to walk out feeling good if possible. Practice this conversation before you have it.
  6. BedsideNurse

    Considering CRNA School ?

    And the prep and application part is the easy part. Even if I was smart enough: I am way too tired and lazy.
  7. BedsideNurse

    Mandatory Uniforms

    You are right about the color coding. If nurses are relegated to all white the older patients seem to know who the nurses are, but aside from that, patients and families still don't know who is who. (...You really don't think scrubs look appropriate outside the OR or specialty units? Hmmm. I'm curious about that. 20 years ago this might have seemed to be the case, but now almost everyone in the hospital world wears scrubs these days, don't they?).
  8. BedsideNurse

    Patient-Nurse Culture Matching

    Yeah, so, the answer would be to...what?. From the suburbs--not allowed to work in inner city hospitals, German immigrant--automatically unfit for practice in the U.S., Chinese--to work in predominately Chinese areas only. There is an endless list of ways we could divide people up. Talk about discrimination! Trying to match culture to patient population is a very bad idea in my opinion. Anyone can give good care, anyone can give bad care. It depends on the individual nurse.
  9. BedsideNurse

    Nurse Staffing Ratios - Going before Massachusetts voters in November

    Here's the "what planet are you on" non endorsement of nurse patient ratios by the MA ANA: "This is the wrong path for Massachusetts, for patients and for nurses," said Diane Hanley, President of the ANA Massachusetts Board of Directors. "This proposal undermines the flexibility and decision-making authority of nurses and puts rigid mandates above patient safety, clinical nurse input, nurse manager's discretion, and every other consideration in a hospital." HELLO: we don't have decision making-authority when it comes to patient assignments, or even much, if any, flexibility, hence the need for ratios. Mandates are all about patient safety, and nurses at the bedside nurse know this. What a bunch of nonsense. Anyhow, I looked over Save Patient Limits and it looks really good to me--although, isn't PACU 1:1 now? Also, whatever ratio laws are passed they need to be written in a way that ensures hospitals won't be able to undermine ratios with bogus acuity tools. We almost always have 2 patients, and often have 3, yet our acuity ratios for ICU consistently show the nurse patient average to be 1.2-1.4 patients per nurse (whatever that means, right?). The ICU nurse patient ratio law in MA has been made meaningless by hospital work arounds. It's extremely disappointing and is certainly detrimental to the care of the patients.
  10. BedsideNurse

    MD vs DO

    All other things being equal, if I had to choose between an MD or a DO I would pick the DO.
  11. BedsideNurse

    Mistake on orientation..please help

    Well, that's a bummer. You didn't reschedule right and she didn't pay attention. I'm sure you'll be more careful when reschuduling meds and she'll be more careful looking over last doses and such...But if Tylenol x2 doses q6 vs q8 is the worst thing that ever happens than count your lucky stars. There are worse things. Important to be correct in what you do, but it was an honest mistake and at the end of the day a sandbox order. Don't waste too much energy beating yourself up. You'll be more careful from now on and no harm done.
  12. BedsideNurse

    Why Do We Continue to Harm Patients?

    Agreed...Nursing programs, especially BSN programs, need a total overhaul.
  13. BedsideNurse

    Why Do We Continue to Harm Patients?

    Errors arise from the absolute panic nurses are in trying to get everything done. Often units have no secretary, and there are one to two techs for an entire tele or med-surg floor, and one of them may have to be a sitter....ICU is lucky to have techs, even when taking 2-3 patients, frequently with multiple admissions & transfers, answering phones, dealing with families & visitors, + passing meds, turning and suctioning patients + giving other basic nursing care, and God forbid if you have someone who is trying to circle the drain. Rapids, code blues, outrageous charting requirements, and if you've drawn the short straw, charge duties so you can deal with patient assignments and staffing issues. It's way too much everyday. Change has to come from the top. All this is upper management squeezing the life out of the supervisors and unit managers to have bare bones staffing, regardless of staff feedback and the negative patient care effects. Somehow, CEO's are going to have to actually start believing that on the ground hands on care makes a difference in patient outcomes, and they are going to have to actually want good care for the patients, at least want it enough that they are willing to pay a little more to get it. As we can see, for now, they are not. We all hear about "patient care is our first priority" at the orientations or occasional pow wows, but we know it's just bs, because if they actually believed "Patients are #1" or whatever, they wouldn't leave one tech and 5 nurses for 30 patients. That's sh*t care and everybody knows it. If one patient goes bad it's a disaster. Pt outcomes and satisfaction suffer terribly because we just need "another set of hands" to help us. No one is lazy; we just want to be enabled to give proper nursing care to all our patients if we bust it for our entire 8 or 12 hour shift. Anyhow, because of staffing, instead of practicing Nursing Excellence, we are more often than not practicing Seat of Your Pants Nursing, mainly putting out fires and barely keeping the head above the water. That means rush-rush-rush, & by necessity nearly ignoring some patients while dealing with the other needier ones, with very little time for double checking, reassessments, and thinking things through, and hence the perfect storm for errors. Then when someone makes an error that we get dinged for, everyone swoops in so this "never happens again." What happens then? Instead of looking at the root cause and giving the floor more HELP, they add more processes, checklists, and paperwork to an already overwhelmed nursing staff. Now management is coming back in with that ridiculous and insulting "huddling" crap they had going years ago. Yeah, we are woefully and potentially dangerously understaffed, but we are supposed to just huddle, and if we work together as a team, then we can get through it.... Like it's just us not working as a team or putting our heads together that's the problem. Scripting, huddling...my head is going to explode. A long and meandering answer, but in a nutshell, in looking at error prevention, it's generally all about staffing.
  14. BedsideNurse

    Why do some nurses hate it in others pump at work?

    I had trouble with my milk supply & I had to pump at work if I wanted to continue to breastfeed, and since my first son tolerated no formula, it was really a dire situation. It'd take 10 minutes to run to the bathroom, wash up, grab a drink, maybe get a small snack, then get my supplies together. I'd pump for 15-18 minutes, quickly put everything away and get back to work. I never took more than my 30 minute lunch. Honestly it was hard enough to leave the floor for a full 30 minutes and I never really took full lunches before that, but out of necessity when I was nursing I needed to. I did my best to nurse right before I left the house, and I'd nurse as soon as I'd get home, but I'd still have to pump once at work or I'd have issues. So it was rush-rush-rush to pump then back to the races trying to catch up after being gone for 30 minutes. It certainly wasn't a restful break. Anyway, the government puts these laws into place and then hospitals respond by punishing the other nursing staff in implementing them. I'm not sure what the answer is, but especially if you had several nursing moms on a unit, I can see how this would get pretty old. Nurses are stretched to capacity now and it's no small favor to have them holding the fort down every time they come in while people are off pumping. Women are encouraged to breastfeed for one year, and some people do it for longer. That's a lot of fort holding. Also, supposedly we should be supporting and encouraging breastfeeding mothers. If everyone around them is pissed and they feel resented, or they feel like they really just can't leave the floor because of further burdening the staff, then that isn't really supporting breastfeeding now is it? And then there are always the system abusers...It sucks. :/
  15. BedsideNurse

    LGBTQ Patient Care?

    I get that things are getting confusing, especially now that we've went from "you're born that way" to "you are whatever you say you are, and it's fluid." regarding orientation and gender, but I honestly doubt anyone--including grade schoolers--needs to have words like gay and bisexual defined. My kids are in high school and they've been inundated with gay and trans EDU near daily since about 4th grade. But even for the older nurses, unless they live under a rock, (and maybe even then), I think we all have that down. Just sayin.'

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