creating_wellness

Oh yeah. Good times. When I had knee surgery several years ago, I was very comforted by the gentle, kind, patient understanding and care I received. Two thumbs up. Inspires me to this day. I definitely can relate to anyone who has bladder distention from being unable to void post spinal anesthesia; it's the weirdest feeling. And oh, the pain after knee surgery.... oi. Deep deep bone pain, shooting up and down the leg. And the fun of taking all the scheduled Vicodin you can but then puking it all up. Then, recently I had an IUD inserted by a woman who, as she introduced herself, closed her eyes when she shook my hand, then proceeded to say that she suspected I could have gonorrhea/chlamydia because the test wasn't done immediately beforehand (hellloooo lady, how about asking about my sexual history first, rather than jump to conclusions... maybe asking a few questions would have made me feel comfortable enough to tell you that I had a full STD workup after I was raped a few years ago, and have since not been exposed to risk... you'd think a practitioner about to do an invasive procedure like that would establish trust first. You'd think.) She redeemed herself because she went slowly, described what she was doing before doing it, and asked if I was okay. And, she wrote a cute prescription to be "spoiled rotten" and an Rx for a hot fudge sundae, "walnuts p.r.n." So it wasn't completely horrible. But, I wish she had looked me in the eyes and asked "do you have any history of trauma I should be aware of before beginning this procedure?" (oh, to clarify: we decided to go ahead with the IUD placement, and to also do the G&C workup, and that she would follow up if there was a positive result.) Remember, when you are out in the world practicing, that there are many women (AND men) who have survived sexual assault as adults or as children, but still carry some triggers and psychological wounds with them. Do not assume. It is okay to ask directly. It shows that you are open to discussing the information as it may relate to their care. I kinda wish I had spoken up to this practitioner and told her my history, but the urge to just get it over with was stronger. I never mentioned I was a nurse, either. I'm not angry at this practitioner, really; because how could she have known that was something I needed if I never spoke up? I guess my point is this: Especially in the realm of reproductive health care, let's work together to grow awareness of traumatic sexual histories and how they can impact patients during intimate/invasive procedures.

Hm... I don't see the ethical dilemma here for the nurse, to reference the original post. There appears to be an ethics violation by the doctor in this case, by not informing the patient that VBAC, in certain cases, *may* be a viable option for the patient. A C-section is major surgery, and has a higher chance of causing harm to the woman than attempting a VBAC. It is NOT practicing medicine without a license if a nurse informs the patient of her rights and of the existence of alternative choices. Nor is it an ethical dilemma. The nurse can further cover him/herself by saying "It is up to you to inform yourself, to ask questions of your doctor, or to switch doctors if that's what you decide." By making it very clear that the nurse is not recommending a specific course of action, that is not practicing medicine. Rather, that is fulfilling a primary nursing obligation of patient education. Sometimes, it is enough to simply say "Tell me about your feelings about having a C section." Perhaps this hypothetical patient (except.... not hypothetical in the original poster's case...) only wanted to be understood and listened to, which could have lessened some anxiety. :) Now a comment aside: I am a newly licensed RN, and I also work as a birth doula (DONA trained). I walk the line of not practicing as a nurse while I am practicing as a doula, which means: no vital signs, no physical assessments, no speaking for the client. As a doula, however, it is my job to say, "Let's take a minute here and review the risks and benefits of this option, so you can give your informed consent or dissent." It depends on the situation. Sometimes it is more diplomatic to say, "Do you have any questions about this procedure, before it is performed?" or, "This would be departing from your birth plan. Are you okay with that?" But really, what it comes down to for a birthing woman is having that constant, loving support. I've been amazed at the times when my clients departed significantly from what they originally wanted, but felt satisfied overall because they felt respected and involved in the decision-making process. Because I do home visits prenatally, am there for the entire labor and birth, and then do home postpartum visits, I get a chance to really *see* a woman, to understand how things are for her. I'm excited to start practicing as an RN, and at the same time, I wouldn't give up being a doula for anything.

Hey I'm in the same boat-- I live in Michigan in a metropolitatn area that's rather saturated with smart professionals. I graduated in December, got my license in February, and have applied to over 30 jobs with no luck so far. (Well, ok, I got a call from a recruiter for prison nursing, but I decided I could not deal with that.) Just this morning I got a call from a rehab center for an interview, and I'm totally excited. I think whatever your first job is as a practicing RN, you will learn sooooo much. Interacting with people like we do will develop so many transferable skills. If you later go into acute care in a hospital, they will probably view you like a newbie, because you're not accustomed to the hospital pace. That's what I hear a lot, at least. As with so much in nursing... I just tell myself to "suck it up" and that some day.... some day... I will be at a good place in my career, with a good work-life balance, good income, feel respected & competent.... yeah. :) I would have to think very carefully before I accepted OR turned down this offer... my big worry is that I've just applied to a fantabulous new grad ER internship and am waiting to hear from them. I really hope I don't get into the bind of having to respond to the rehab center before hearing anything from the ER internship!!

In southeastern Michigan, the average starting wage for a new RN in LTC/Rehab is $23-24/hr.

In nursing school, I drew on my work experience in customer service at a restaurant. I would give this pep talk to myself to set my head straight: 1. Get your stuff done quickly and quietly. You are there to pass nursing school, period. Put your school work first. 2. THEN ask questions, and make sure you prepare first. Look it up. 3. Do helpful nurse aid type stuff if there's down time. 4. I practiced these phrases: "What else can I get/do for you?" "I'm a student nurse, here to help your nurse take care of you today." "I haven't yet seen [a certain procedure], could you notify me if there are any opportunities to observe today?" 5. Clarify with the staff: what you can / can't do, how long are you there, what you'll do for the nurse who has your patients. 6. Keep your enthusiasm and energy for learning, even if your fellow students call you an "overachiever" (like my classmates did... but hey, who graduated magna cum laude?? me!) Hope my pep talk works for you too! Good luck.

Hey, I can totally identify with a lot of what you're saying. I'm a new nurse as well, out in the job market, and I'm trying to figure out how to present myself with as much class & maturity as possible-- without looking too big for my britches-- and to stay humble without looking like I lack confidence (even though it's kinda true that I do lack confidence at the moment). I think the core of the issue there is a gap in trusting ourselves, which makes us turn to other people for approval/validation/definition of who we are. And, since we can't control what other people think of us, that can develop into a no-win situation until the locus of control lies firmly within. ("we" being a "universal we" here.) I am a big fan of therapy. I feel like most people, throughout the course of their life, will encounter something that challenges them to the point where they may need to seek help in dealing with it. I see a therapist to work through past trauma and dysfunctional childhood crud. I wonder if part of the issue here for you is that working so closely with your coworkers brings up triggers about family relationships? Sometimes group dynamics pushes buttons in exactly the same way that family conflict pushes our buttons. Perhaps seeking out an employee assistance program would help get out some feelings that you might be pushing down? It seems like others are interpreting your behavior as passive-aggressive. Sarcasm is a tricky one, because it's like saying "Hey I'm angry at you, and I'm going to joke about it, so it doesn't seem so serious." I believe that if anyone is exihibiting passive-aggressive behavior, there are valid reasons to be angry-- but in order to cope, the anger had to be pushed down. Maybe the framework for healthy conflict just isn't there (often the case in the workplace!!). From my own point of view, whenever I'm around a certain kind of older woman who is controlling or critical, it triggers past emotions from dealing with my mother, when I was powerless to express my anger. It took a lot of work in therapy to bring that to light, and to find a healthier way to deal with it! :) I had some regrettable work problems in a past job because of difficulty communicating with a certain supervisor. Live and learn, though. Trying to transform those regrets into a more benign remorse. I hear in your story that you are self-reflective and willing to change, and it seems like you're also aware that these tendencies are just coping mechanisms that aren't working anymore. And hey, we're only human, EVERYONE has a few undesirable coping mechanisms. "Change is uncomfortable, but so is staying the same."

75 questions and passed!! Boy was I ever sweating bullets!

As a nursing student, I watched a few circs, learning about the different methods. It was optional to watch. A few students who felt disturbed by the procedure opted out, which was fine by our instructor. I was pretty disturbed, but I also felt it was an important learning experience. I will not have my future children circumcised. BUT it's an extremely personal choice that each parent should make for themselves, and I would not presume to judge another parent, who, out of love for their child, is doing what they think is best. I agree with many of the previous posters who have discussed how we as RNs must prioritize the client's beliefs and feelings and withhold our own strong feelings on certain issues-- that's a primary component of culturally competent care! Now, for me personally, it is a bit tricky though-- since this is a permanent alteration in a human being's anatomy that is being decided for them. It affects their future sexuality, but it depends on how the man decides to feel about it, when he is an adult-- either way-- and there is no way to predict how this future adult will feel about a decision made about his body when he was an infant. It seems like this issue ALSO falls into the spectrum of advocating for your patient to encourage elective procedures to take place when the patient himself can elect them. (Oh jeez... that Sex in the City episode about the "sharpei member" comes to mind... AND now I've got the mental picture of a video from psych class where a classmate decided to do a very graphic presentation on female genital mutilation in Africa, complete with screaming five year old girl and unsterile tools and no anesthesia... and NOW I'm thinking about an ex-boyfriend who's intact, and very happy about it...::snaps out of it:: ...back to being 'serious'...) I digress. As I was saying, on the other hand, as with any other patient who is not legally or clinically competent, these decisions-- which are never easy-- fall on the patient's guardian. As healthcare providers, we must respect that, and endeavor to provide unbiased information. The trouble is, at the intersection of medical & sexual politics, and the status quo, it becomes difficult to find unbiased information for both options. Does anyone have a good source? I can empathize with the original poster, because it is a difficult moral dilemma to be in.

nice thread! my 5 facts: 1. tension pneumothorax is the creation of a one-way valve into the pleural space where air enters and does not leave, which collapses the lung-- can result from complicated pneumothorax or chest trauma: must be treated immediately with needle decompression (also called needle thoracostomy; where 3" needle catheter is inserted perpendicular to chest wall in 2nd intercostal space, midclavicular line; should hear rush of air). early signs: tachycardia, tachypnea/dyspnea, hypoxia. late signs: tracheal deviation & jugular vein distention. 2. side effects of corticosteroid therapy: short-term: elevated intraocular pressure, elevated blood pressure, mood swings, fluid retention. long-term: calcium loss from bone, increased risk for infection, thin skin, easy bruising, hyperglycemia and suppressed adrenal gland functions. tell patients to stay hydrated, inform providers about steroid use esp. when going to surgery, and protect from infection. 3. addison's disease = hypocortisolism a.k.a. adrenal insufficiency. addisonian crisis (syncope, n/v, hypotension, hypercalcemia, convulsions, fever) can result from sudden withdrawal from cortiosteroid therapy, or when someone with the disease has surgery. 4. cyanotic congenital heart defects: tetralogy of fallot, and transposition of the great vessels. acyanotic include patent ductus arteriosus, ventricular septal defect, atrial septal defect, and coarctation of aorta. 5. cpr for child age 1 to 8: a. establish that victim does not respond. b. witnessed: activate emergency system after verifying unresponsiveness. unwitnessed: activate emergency system after 5 cycles of cpr. c. look, listen, feel. then open airway-- head tilt, chin lift. d. give 2 breaths, verify chest rises. e. check pulse-- carotid for child age 1 to 8. f. compress center of breastbone between nipples with heel of one hand, 1/3 to 1/2 depth of chest, at rate of 100/min. g. compression:ventilation ratio = 30:2 single rescuer; 15:2 dual rescuer. ...and a fun ekg game: http://www.skillstat.com/ecg_sim_demo.html