BedsideNurse

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.

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. ?

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. ?

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.

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.

"I'd eat out of dumpsters before returning" LOLOL!

It's unfortunate but I do four hours in 2 different units for my 8 hour shift on a fairly regular basis.; 1-2 times a month, & on rare occasion 3 times a month. The worst I've had as a nurse is 3 units in 12 hours, 1st four in ICU, 2nd four on cardiac step down, last 4 in CVICU. Getting & giving report and charting on that many patients is ridiculous and since every place I walked into had a truckload of work to be done in a short period of time, and two of the units I had never worked on, it was mentally and physically exhausting. So, I do understand your upset. However, unless it's explicitly against your hospitals policy I don't think there is anything to do about it. Also, I've never worked anywhere you could refuse to float (to units you were considered qualified for) without repercussions. :/

That really sucks. We are seeing this more and more now that hospitals see they can get away with it and nurses put up with it. MA just had a nurse patient ratio law on the ballet and I could hardly find a nurse who supported it where I work. Nearly everyone in ICU I asked (and 1/2 of the nurses on the step down unit) parroted the false information being given out by the hospitals and lobbyist groups. Even worse, the general public was confused from being inundated with untrue scare tactic "vote no" commercials and fliers, including (quite unbelievably) a "vote no" endorsement by the ANA, which is really quite outrageous considering I just read a statement by them imploring that that the importance of safe staffing cannot be underestimated. Well apparently it can, since nursing organizations themselves sabotage our own practice. I have been in ICU for nearly 20 years and years back 1:1 or 1:2 was the absolute standard of care. Now it's 3 ICU patients, 2 ICU and one step-down, 3 step down and 1 ICU. Or 2 ICU and if a code comes in you have to pick up that too. No secretary, often no tech. This is how it has been the last 3 out of 4 ICU's I've been at. It's horrible but I don't think nursing has the presence of mind to actually fix the problem. Btw: 2 of those 4 hospitals were union hospitals. Union or not, we need set nurse patient ratios, preferably a national law with *no loopholes about acuity* so hospitals can't manipulate the numbers. Literal numbers only! As far as where you are, I'd try to find another ICU that isn't as punishing. Good luck.

I think it's absolute bs they force nurses to take the flu shot. I'd quit over it for sure if I was pregnant. There is *NO WAY*they can know how the flu vaccine (or any vaccine) may affect that developing baby. No way! It is outrageously unethical to threaten someone into choosing between paying their bills and risking the health of their baby. They roll the dice with that baby because the drug company lobbyists are in bed with our Congress, and have attached federal funding to it for guaranteed profits. I'm an ethical vegan and try to avoid medicines, yet I am forced to have animal products injected on a yearly basis. In recent years I have actually had two scary reactions from the flu shot, but I am still forced to take it. If I could do anything else outside of nursing for the same money I would. It's just infuriating.

I would argue the moral is just don't use them. Those things are DISGUSTING!

(I agree knowledge of such things is important, and maybe that has been your experience with scores of ICU nurses in your 10 years as a CNRA, but you have to know that sounds *ridiculously* pretentious. Just sayin.')

As for why they would allow new grads to be candidates... to be frank, you're a body with a nursing license and you're cheaper than an experienced nurse. Steward is a for-profit system, they're running a business and they want to make a profit. Their goal is not to give you a good learning experience or grow you into a good nurse but to use you to their benefit. --Plenty of money to be made in the not for profit hospitals. Check out the pay and benefits of top management at a moderate to large "nonprofit" sometime. I've worked for both profit and nonprofit and they all skeleton staff and make cuts around patient care and the bedside, so they can receive big bonuses for meeting their budget, reducing expenses, etc..They are essentially indiscernible on the ground.

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

People don't believe it, but I tell them that the wages for new nurses have been near stagnant for the last 20 years. It's ridiculous. As for the BSN scam, I agree.

I thought diploma programs had been pretty much phased out. I wish their were some around me when I was looking to go to nursing school; I would have picked the diploma program and being a new nurse wouldn't have sucked near as bad.

I worked in an acute rehab place that looked great, brand new, lots of "amenities." Then they decided we were using too much linen, and so to try to control costs we had to get a key from the supervisor and walk to the other side of the building to sign out any other linens that we needed if we went over the expected daily amount per patient...and our allotment for washcloths was one washcloth per patient per day. I wish I was making it up.

A) Because nurses as a group are a herd of idiots that constantly take the sword for admin instead of looking out for our own profession and ultimately the patients. Take the nurse ratio law in MA that just failed. The ANA didn't support it, all sorts of nursing organizations rallied against it. The ONLY group that put out anything pro ratio law that I saw was the MNA, and I thought their effort was mediocre at best. We were inundated with ads from the NO camp/hospitals, lobbyist groups, etc...But we saw almost nothing in the way of support for the nurse-patient ratio law on social media, TV, in the mail, etc...I did see craploads of nurses on TV and on flyers and billboards telling me I should vote NO on the ratio law because nurses need to keep their flexibility and rigid government numbers are dangerous. Anyone who works at bedside knows that is complete and utter nonsense. As I said, the MNA said they supported it, to their credit they did put some effort with a postcard in the mail, and a few commercials right before election day, but actually disgruntled, overworked, overwhelmed, and understaffed nurses are their bread and butter, so it probably behooves them for nurse-patient ratios not to exist. So who knows? At least they pretended to support it. Most nurses where I work told me they were voting NO. (This just pisses me off so bad I can't even stand it). We had a real opportunity to make a significant change for the good, improving working conditions and improving patient care, and we turn it down. Whatever...Another reason I'll be glad to get out of this profession. Other professions look out for themselves! Not nursing. As a side note, before the election the hospital higher ups came around threatening the staff that if the ratio law passed the hospital could very well have to close it's doors and we'd be out of a job. Now the ratio law failed, and just the next week on, surprise, looks like we are shutting down after all anyway. So at my hospital nurses voted no so they could keep their jobs, but I guess it's like "J/K." Jokes on us! Like I said; a herd of idiots.

"Watch your numbers, but just jimmy the rate up or down until they look good." Maybe it's a good thing I didn't go into nursing education.

I was in the ER years back as a patient and it had been a difficult afternoon to say the least, and one of the staff came over and asked me if I was or could be pregnant. I'm like, no, well, I don't think so... but I'm married; so there is a possibility I guess. A little while later the doctor comes back and rather awkwardly congratulates me on being pregnant, and turns back around and says, "You really didn't know you were pregnant?" I was laying there a little bewildered because I totally didn't know. Lol. Anyway, I guess it is better to be safe than sorry, especially if you aren't being that careful. Hopefully you can get a test super soon and usually there are at least a couple days of hospital orientation stuff where you aren't on the floor.

Thank God I have insurance through my husband because I see people I work with having to see some of the same physicians that come into the unit to see our patients. Who in the world wants to get a colonoscopy from someone you see 1-2-3x a week at work? One nurse who had to get a lump removed from her breast ended up recovering after hours in our unit. OMG. Unfortunately with the insurance offered at the hospital it's pretty much unaffordable to go any other route, and there is NO privacy. Just horrible!

I have to agree. I was at work the other day looking at the holiday schedule. I'm working Christmas, Thanksgiving, and New Years Day. It's like okay, whatever, penciled it down. But then I was talking to a tech who was bummed out she was missing trick or treat with her kids, looking at pictures on her phone that her husband was taking as he and the kids were making their rounds. I felt bad for her. The were so cute! After she walked off I started thinking about all the Halloweens my husband went on out by himself, and then the years of other holidays I've missed out on, thought about all the weekends and summers spent working crazy hours when other people were enjoying time with their families, heading to Sunday Morning Church, or at least just sleeping next to their spouse on a regular basis. Now my kids are 17 and 18, and they are in school all week and gone working on the weekends, so I don't even see them much every other weekend. My husband has to work a lot of overtime for his job right now so we hardly see one another some weeks. Looking back I feel like a lot has been missed out on because of my career choices. For all of it I don't have much of anything to show for it...a few pocketfuls of stories maybe. This fear I've always had about working outside of the hospital has left me looking older than my years and pretty regretful when thinking about the scheme of life. I recommend staying put.

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Computerized charting was supposed to free up nursing to spend more time at bedside, but as usual we have been and continue to allow our practice to be totally sabotaged. Nurses are either running around like chickens with their heads cut off, or glued to the computer. This is the new normal. I've had older patients patients notice and comment on the change they've seen in nursing. :/ A friend of mine is an RT that does home care, vent set ups, assessments, follow up and CPAP's, makes more than me an hour and has almost no paperwork. She says her paperwork is inconsequential to her day/ like super quick in a couple minutes per patient, not even an issue. So respiratory therapy in the home has figured out how not to strangle the therapists, but nursing can't? (Sigh...)

Sorry not to be helpful, but just thought I'd comment. When I worked in California whatever the ratio was for the floor, that was the number of patients we had, regardless of whether or not the patient was downgraded or their status was lower acuity. So in ICU 2 was 2, even if one patient was downgraded and you were waiting for a step down bed, for example. They could not triple you up. Seems to me that if what your manager is saying is correct, hospitals could manipulate the ratio law with such regularity they could essentially nullify it. They could mix a small M/S unit with a tele unit and tack on a patient to every nurse on the floor, or add another pt to every ICU nurse as soon as a pressor was turned off or as soon as they were extubated, etc... The possibilities for exploitation are endless. I live in a state that circumvents the ICU ratio law on a regular basis, using bogus acuity tools and triples, and occasionally quadruples up, ICU nurses with patients that "aren't that sick" or ICU but "fine" on a regular basis. It's so wrong. (And, unbelievably, I don't think the MA ratio law is going to pass due to misinformation and nurses taking the sword for admin--as usual--when faced with the opportunity to improve the number one factor in what kind of care our patients receive, that greatly impacts the quality of life for nurses on the job as well). We'll see what happens but it doesn't look good. Anyway, 4 should mean 4, PERIOD! Hopefully someone who works in CA can chime in with something helpful for you. Good luck! Keep us posted if you can.

Apparently a very, very, very long time. Unfortunately. :/