luvRNs

Three points for consideration : 1.Caring for ALL patients is ethically a part of our role. I remember during the appearance of AIDS , several of my colleagues refused to care for these patients. This is slippery slope thinking at its' worst. What if the patients were your mother? Your son ? You ??? 2. We now live in a global world. Diseases can , and do, cross boundaries. We need to really explore how prepared we are, and to plan for our response to ANY disseminated disease. It is only a matter of time before there WILL be a global health crisis. These patients are simply highlighting our challenges. 3. These caregivers are AMERICAN. We fly stroke and trauma patients home for care, as we should. This is no different.

agree with music in my heart. DON'T share details here until all is resolved. DO share your pain, and WE will share our support. BTW, my ( system) error resulted in a patient death. New equipment, no inservice, four of us in the room, but I was the one closest to the ventilator... Can STILL tell you the patient's name AND feel your pain...Amazingly , the doctors in the unit were VERY supportive. They told me that ALL of them had been, or would be there some day. Those are the risks in the increasingly complex world of patient care.

how beautifully written, and how painful to experience. I too have been there. What I laud you for is your ability to accept the responsibility for your part AND to recognize that systems errors are at the heart of many of these unfortunate experiences. I eventually became a manager and director during my 45 year career. MY pain and my error made patient safety a priority in my practice. I NEVER placed blame, just looked at what failed in the system. My mantra became " Safe, quality care delivered with passion and compassion". As it should have, the safety came first. Good luck through the resolution of this, and don't worry about those finger pointers. There but for the grace of God go they......

I respectfully disagree with my houtx colleague above. I have also worked in facilities with PBDS and as a director often had to step in to " save" excellent staff who would have been terminated due to PBDS performance. I am a masters prepared nurse with published articles in decision-making. I have to wonder how cueing, past experience ( both as a nurse and in test- taking) come into play. I alsowonder if outdated scenarios create cognitive dissonance in answering situations. i have read, and respect, much of Delbueno's work....her testing program, no so much.

Agree with SDGA about the salary. I left after tenure and doubled my pay. that said, i OFTEN had to cover semesters for a tenured colleague who made 20K MORE than me due to seniority but was crazy. My work load became half or hers AND mine for less pay. I don't see unions OR tenure as the solution. I DO see raises...

Interesting article, but I do see one glaring problem. I am a former Nursing educator who had tenure at a community college. I was appalled when I first began to teach at the limited clinical expertise of some of my colleagues. It gives credence to the old adage " those who can't do, teach". I worked per diem in an ICU during summers, semester breaks, and week- ends. My students we well aware of this, and my hospital colleagues respected me for keeping my skills up and for being a role model for students. My masters degree was focused on decision- making, and much of it focused on Benner's principles. Best practice now supports that 2 years experience or less is at best novice or beginner status, yet we believe this is enough to educate our future professional ? I doubt it.

you got some really good feedback here: vacations, exercise, eating right, and work-life balance. i have a couple more. 1. "pulse check". do you dread going in today? yesterday? tomorrow? if so, you need to change jobs. many people stay "chained" to one job because of comfort level, seniority etc. even when miserable. i used to often kid people about my "five year attention span". because i listened to myself and changed my focus, i got to explore many different sub-specialties of nursing, and loved my time in all. 2. laughter. the harder it got ( and it did get hard) the more i laughed. gallows humor really does help change your perspective. 3. time awareness. a shift is "only" 12 hours (or eight hours, or ten hours) long. it will end...... 4. the power of "no". this is a tough one. as a nurse, we are prone to "rescue". we say yes to everything , even when no is the correct answer. repeat after me..... "no, i can't do overtime", "no, i can't do an extra shift.....or extra holiday.....or extra night". "no, i can't be on another committee" ....... did i use all of these successfully, every time, in my 41 years of practice? no.....and when i didn't use them when i should, i paid. fortunately i did use them enough that, given a choice to choose nursing as i career agian, i would whole-heartedly say yes :yelclap:

Kudos to you for advocating for your patient.You're the type of nurse I would want caring for me Keep going to work with your head held high, and stay above the backlash. When the rank and file discover they can't rile you, and that you continue to be fair and to provide good care, they'll back off. I would not be surprised if you don't have some who are quietly supporting you, and you're just not aware of it. You're a hero in my eyes, and in your patient's :hug:

It does have pros and cons. The cons include: 1. good AND poor performers get treated exactly the same. Can be frustrating if you're really good at your job to watch someone who isn't. 2.difficulty getting rid of the poor performers above. This often puts an unfair burden on those who do their job. 3. organization is less responsive to change. In times of nursing shortage it can be tougher to recruit. In times of layoffs, the most senior STAY, even when they are the poor performers. 4. If you get thje wrong union in, it is EXTREMELY difficult to get them out. Have seen this in two hospitals. That's my take. I'm sure ther are others who feel differently.

Ok, OK, befroe I get started, there has to be a disclaimer. There ARE bad days in nursing ( MD's yelling, nurses eating their young, un-ending diarrhea, nasty patients or families, missing holidays etc) That said, being a nurse has been one of the greatests gifts of my life ! Oh, the unforgettable experiences.... Holding a towel to the neck of a cancer patient whose carotid has just eroded, Providing a presence and comfort to him as he died.... Caring for a 22 year old septic primipara in the ICU for two months and delivering her there. Both mother and baby now fine Being there the first time a neurosurgical patient opens his eyes after a months long coma with NO sequelae !! Assisting with the gift of life through organ donation. Rescuscitating patients in an ED with your peers... It' like a beautiful dance.... Witnessing the courage of patients and families over and over again, and wondering if you could be as graceful under pressure as they are... Experiencing some of the most intense shifts imaginable, to the point where you develop and appreciate "graveside humor" Mentoring new nurses into the fold....Oh, their excitment over "firsts"....first patient, first shot, first code... and remembering when you were there.... The constant learning curve. No nurse know it all. Each time you think you do, there's something new and exciting ! There are legions of us out there, all with amazing stories:loveya:

Had this happen twice, and I repsonded both times. Both were "red-eye" flights so I have to wonder if there is a connection on that one:rolleyes: The first was diaphoretic male who passed out. Second was a middle-aged owman with similar symptoms. Learned several things about in-air emergencies. They DO have AED, but in both cases the crew stated they really did not know how to use them They also have ACLS meds and IV's, stethiscopes and BP cuffs. Problem is when someone is in the isle on the floor the drone of the aircraft make it impossible to hear and to assess. Carotid palpatation is best... Things that CAN be done..... contact can be established with on-ground physicians who can direct care. This occurred on one of the two flights I was on. The second is very basic AND helpful. Most common causes of this on flights are dehydration and medication per the flight attendants.Ask about diabetes and provide OJ if at all possible.Assess neuro status ( can be done without equipment)This helped in both cases. One case turned out to be claustrophobia, the other just vaso-vagal. Sadly, never got any acknowledgement ( either thank you or rebate). The best part was on leaving the first flight when it landed. The passenger across from me leaned over, and said " You did a good job there.... I'm a paramedic!!" Of course he never identified himself during the flight

I'm confused.... why did you stay on the unit for 17 years if you really disliked it that much ?

I totally agree. As an older nurse my first job was on a med-surg unit. In those days primary care didn't "exist", and most hospitals used team nursing. Three of us ( RN, LPN, aid) cared for 21 patients. They 'had my back" and I had theirs. The care we provided was superb because we all owned the responsibility . It is sad today to observe staff saying "It's not my job" or "thank God I don't have to do that anymore". when asked to do baths, bedpans or answer call lights. Often those times are the best opportunities for asssessment and for interacting with patients:twocents:

Interesting thread :) I agree that there is more genetics to aging than job. I also agree with fiveofpeep that it can age your hands.That said, there are many positives to balance out the negatives! They include: 1. knowing who are the best doctors in town and knowing who to avoid 2. Not sweating the small stuff.... when you work with life and death daily, it really puts things into perspective. 3. The built-in fitness aspect. When you work in a job where there is a lot of walking, it is easier to maintain fitness than a desk job..... 4. More job security. Yes, I know that jobs now are tight, but after 41 years I've seen many cycles of nursing shortage come and go. With us boomers aging, the job opening will soon come 5. Flexibility for those who like change...... you can change specialties when life gets too predicable. Can go to critical care, emergency, med-surg, teaching, management, school nursing, psych nursing The list goes on and on. Where else can you do that? 6. You are privledged to see the best in people. I continue to be amazed and thankful for all that I've experienced over the course of my career :heartbeat 7. It's often not 9 to 5. With 12 hour shifts you can string days off together and "vacation" without taking formal time off.... 8. The work can be mobile...... tired of one state?? Work in another The list could go on and on, and I'd choose nuring again in a heartbeat

I agree with Hamster's response. My use of the term 'tight control" was misleading. She is correct about both studies. Many institutions are now re-defining their goals based on these, and are now aware that glucose control is not a " one size fits all". What does seem to be clear is that glucose variability persists when sliding scale are employed.

The evidence is mounting substantially that tight control is really the way to go. The key is blood glucose variability. If a hospitalized patient is kept within the parameters, ICU LOS and overall mortality both go down. Still under investigation is what tight control parameters should be, and are they different for different polulations ( like open heart surgical patients vs. medical patients) Hope tihs helps

As a former ED nurse in a level one trauma center, I agree iwth the deep breathing. There is also one VERY IMPORTANT coping mechanism that hasn't been mentioned yet . It's laughter In our ED, the harder the day got, the more we'd do silly things ( or take things out of context) just to laugh. Example: had a wall collapse on a worker at the site of a new Macdonalds and kill a worker two days before he retired. The mood in the rescuscitation was sad and somber and horrible until a tech in the back began to hum "you deserve a break today at Macdonalds".......... Pain is greatly lessened when you're in it together PS. Sorry if I offended.... but graveyard humor does help....

Sorry for both of you. This is an unprecedented time for nursing employment. I can suggest a couple of things that will help you become more competitive. first, polish interview skills. There are many sites online that can help you do this. Same for your resume or CV. A poorly written one can be rejected out of hand even if you are Florence Nightingale Be flexible.Don't expect to walk in and get the day 9 to 5 job. You may need to do nights or week-ends until the market eases. The good news....... it WILL ease. Many of us boomers are retiring. Good luck!

interesting thread...... don't let go of personal baggage from the past. life experiences are what makes us unique and can enhance our care of others:redbeathe here's my experience. several years ago i experienced a severe traumatic fracture of my pelvis. it required 3 surgeries, months in a wheelchair,and going home with a foley in place. prior to the accident, i thought i knew and had done it all as a cns in critical care. how wrong. i learned much about patient safety after several 'near-misses'. i learned a patient is more than physiology and body parts, and the emotional responses to illness truly need to be addressed as well. my experiences were chronicled on this site in an article called "murphy's law revisited". i am a better nurse for it and my patients benefit.......

A few thoughts ..... If Rob is as valuable as you say, then you don't want to lose him by maintaining the status quo with other staff. It sounds to me like the other, older staff are the problem. Many nurses have not had assertiveness training. Teach Rob the techniques of assertive feedback ( describe a behavior, identify the result using "I " or "I felt like", explain what is expected and in what time frame, and what will happen if those expectation are not met " I will have to go to our manager if theses behaviors continue". Even more importantly, role model the behaviors FOR him if these isd opportunity. MAke sure you re-recruit him by letting him know how valuable he is. ALSO make sure you deal with your low perfoming staff that are truly the problem:argue:

As a former open heart nurse, sounds like the physician needs to be called. Two reasons to call; If the hematoma is actively draining then what is the patient's coagulation status? The second concern is that there may also be an underlying infection here.

INTERESTING topic.... Here's a cautionary tale..... I was an assistant head nurse on an open heart unit. My mother-in-law had a PTCA catheter break off in her right coronary artery during a failed PTCA. The open heart surgeon asked me to go with him when he explained risks/benefits for the surgery; essentially she could refuse the surgery and go home with this piece of catheter in her right coronary artery ( which could embolize at any time) OR she could have open heart surgery with all the risks. He then said, "well, I'll leave you towo to talk". At the time, the relationship between my husband and his family were distant, so we were not close. She looked at me with horror......"what should I do???" Everything in me wanted to say "Have the surgery". The surgeon was truly gifted and I had absolute faith in him. Something in me made me pause. With with tears streaming down my face, I reviewed the risk and benefits of BOTH options with her again. I also told he that as much as I wanted to tell her what I would do, I could not, because it needed to be her decision. She opted for surgery the next day. About one hour post-op, she arrested. Despite agressive rescuscitsation attempts she died..... at the age of 50. I was SO relieved I hadn't pushed my opinion on her. I would have had to live with that for the rest of my life.I think of her and the situation every time I get tempted to 'advise'..... You just never know when a strange outcome may occur:uhoh3:

Love this !! when I was a nursing director, I used to introduce myself to new staff as "Cxxxxxx, otherwise known as "they". When you hear people say 'they' it's often 'me'. I want you to associate a face with that name, and to feel free to question me when you disagree with something "they" said to do"

Agreej cole45. Have always employed these Studer concepts in my admisitrative practice and they REALLY work. Overall the program is a good one if you 'filter' the knowledge and adapt it to your circumstances.

Have now worked in 4 hospitals employing Studer principles. Here are several observations: 1. Must come from the top down, and the top must REALLY support the principles. Many at the top don't....just give it lip services. This DOES mean rounding and visibility. I learned ( and fixed) so much from doing rounds.... 2. Scripting is a weak point. You can't force-fit language, It must be what's comfortable. 3.May work for the short term, but cultural change is a long-term commitment. As administrative attention wanders, so do the Studer principles. Change is then not maintained. 4. The pillars work. As a former nursing director pre-retirement, I used the pillars in monthly reports. My goals were printed on them as well as the manager's aligned goals, metrics, progress and action plans. As a result my managers were always clear on what was expected, and what their progress or challenges were. For my part, I tried to be a barrier buster for problem sreas. 5. Reward and recognition work. Sent flowers to one charge nurse after an extraordinarily horrendous night shift. She cried and said no one had ever sent her flowers in her life !! 6. Getting low performers off the bus is critical. If you do any one thing, this is the one to do. It is really true that 20% of your employees get 80% if the attention. THe culture will not change with them still on your unit. Yes, it's hard. 7 Re-recruitment also works. Everyone likes to hear they're valued. These high-performing people will support you through thick and thin. Have used these principles in MANY work settings,, always with success. Hope this helps, and enjoy the ride