HollyHobby

I cannot think of a time when I saw a patient referred to hospice too soon. I cannot count the times when I've seen patients referred to hospice too late. As an ICU nurse, I define my career as "torturing people to death". This is what I do: I torture people to death. Eighty, ninety, freaking one hundred years old: I torture them all. They suffer and suffer. This is how I earn my pay. It's shameful. But this is what the family wants. They want me to torture their "loved" one to death for their own sick and sad reasons. I have performed CPR on a 95 year old man who was so far gone with Alzheimer's Disease that he hadn't been out of bed for a decade. He didn't know who he was, much less who anyone else was. He was so contracted that his bony knees interfered with my CPR. Of course I felt his ribs break under my hands. I've done many, many horrible and shameful things because the family insisted I "do everything". They say that to relieve their own guilt. Instead of them having to make a decision, I carry their guilt and hold the responsibility for their relative's death on my hands. When 90 year old grandpa dies, it's not THEIR fault. It's mine. I hate myself for this. It's wrong. It's horrible and barbaric and wrong, but I continue to do it. What the family wants is what I have to do. What does that say about me? I am a horrible person for doing these things. I am a criminal, in my mind. I make myself sick.

I went back to college when my youngest (of 3) was 2 months old. It was hard, but I really did appreciate school more and try harder than when I was fresh out of high school. All that being said, I strongly- STRONGLY- suggest you finish your degree and work for at least a couple of years before you even think about having kids. You have plenty of time. Most nurses do have kids, and we make it work, but nursing is not generally a family-friendly career. For one thing, you cannot leave during your shift, even if there is a family emergency. (Or if you can leave, it is only because you have a friend who is willing to come in and take over for you AND your manager approves it: managers probably will not allow this if your friend will get overtime as a result.) Even if one of your children were to be, god forbid, dying... you can't be sure you'd be allowed to go. You cannot leave your patients. It does not matter if you have explosive diarrhea or if your house just blew up: you can't leave because you are legally obligated to stay and take care of your patients. I once scheduled my son's hand surgery 6 months in advance so I could be sure I'd be off, but less than a week before the surgery my boss informed me I couldn't have that night off, after all. So my husband was there while my son had surgery, but I was not. When my other son broke his leg, I had to leave him in others' hands because I had no choice but to go to work. The only other option would be to quit my job, which we could not afford. (You can't just call in sick, unless you work for a place with an extremely lenient policy.) Nor could we pay for the broken leg without my insurance, which ended up refusing to pay the bill for 2 whole years because we did not get permission ahead of time to take the son whose leg was broken to the ER. It turns out that you can't take your kid to the ER without permission even if he has a severely broken bone; I didn't know that at the time. When my mom had a near-fatal MI (heart attack) I could not go to her bedside, because I had to work. That's the breaks. Fortunately my mom didn't die then, but if she had I could not have been there with her. You will work holidays. You will work MOST holidays. When my kids were very small, I could handle this by holding our family holiday on whichever day I didn't work. A four-year-old probably won't know it's really December 24th when he opens his presents or if Thanksgiving is on a Wednesday or a Sunday. When the kids got older, my husband would take the kids to my in-laws and they would celebrate without me, but we always had a second celebration during a time when we could all be together. I missed most of my kids' plays, concerts, sporting events. I tried to make up for that by being available when I could, even when it meant going on less than 2 hours of sleep so I could attend daytime functions. I work nights because nights are more family-friendly than days. By working nights, I could be more available to see my kids as long as I could get by without sleeping. I could answer the call from school, go and get my sick kid and take care of him. This was much easier to do when I was very young and didn't really need more than a couple of hours of sleep. Every nurse who has kids really must have an extremely reliable back-up person because there are countless times when you simply cannot be there. If you work days and your kid gets sick at school, you must have someone else who CAN leave work, pick up your child, and take care of him. Having a supportive spouse is a big plus here, but you must factor in the very real possibility that your spouse will not be there. I had a supportive spouse (I thought). He was the one who decided I would be a nurse. Then, because I worked nights, he left me for a stripper because I was not always there to entertain him at night. You have to have a plan C and even a plan D in case plans A and B fail. I've had two close friends who had a child that died while they were at work, and they were unable to leave work even though their child died. One child died from an asthma attack; the other died when her ventricular shunt malfunctioned. Granted, this was at a hospital that did not have management who cared at all about the nurses. I'm sure that at my current place, my manager and colleagues would somehow find a way to allow me to leave work if my child was seriously ill. Not all places are as good as this. Keep in mind, too, that nurses all too often have crappy health insurance. When you have kids, you need good health insurance. This is something to compare when you select a job. Reading what I've written here, I'd have to say that although I love being a nurse, I would not do it again. Looking back, I should have put my family first, and I was unable to do that. I do love being a nurse, I'm good at it, and it is incredibly rewarding. But every day, I regret all things I missed out on with my kids. I love nursing, but I love my kids more. My kids lost out, and so did I. Most of my colleagues have one child or two. I don't know any who have four or five. If you had that many kids, nursing would probably not be compatible. Of course it would all depend on how lenient your manager is. I'm sure some places are much more supportive than what I have experienced.

I think it is a totally wonderful thing for a male nurse to be a school nurse. One must be careful to avoid the appearance of misconduct, but this applies to everyone, everywhere. It's a great thing for kids to see that gender roles are not black and white anymore (and black and white aren't black and white anymore either, another great thing!) Let's move on into the 21st century.

We do a head-to-toe assesment every four hours. If the patient goes to CT or surgery or some other procedure, there is an additional assessment when he gets back, even if his primary nurse is with him during that whole time. Doing an initial assessment takes priority over just about anything else. I don't think it's safe to give a med without first doing a basic assessment. If time is tight (and it usually is at the beginning of the shift) a mini-assessment might come first, followed by a more thorough one. This is an ICU. On the regular med-surg/tele floor, they do one complete assessment at the beginning of the shift, then a focused assessment every four hours after that. No matter what, even if you work just a 4 hour shift, a complete assessment must be documented at the beginning of the shift. I'm not sure how any sort of care can safely proceed without first doing an assessment, even if you don't actually have time to document the assessment until hours later.

Safe staffing levels. Without this, nothing else matters. Then, make staffing good enough that nurses (and aides) can actually pee and take those legally mandated things called "breaks". After that, everything else is gravy. :) Without adequate staffing, even if your hospital is the taj mahal, your nurses and patients will be unhappy, unhealthy, and possibly dead.

I think that on pretty much any unit, there will be at least one nurse who is a report beast. A dear friend of mine is like this: she's a bit OCD and demands a rigorous, lengthy, detailed report. Heaven help the new grad who doesn't anticipate her questions or instantly know all the answers. Even the more experienced nurses hate giving her report, but the newbies are outright afraid. Since she's a friend of mine, I know she's not the monster some people think she is, but I can see how they've come to that conclusion. Even when report is somewhat standardized, each nurse will have a slightly different approach to giving/getting report. I try to adapt a bit to the style of the particular nurse I'm reporting to: some want more information, others will get bored and wander off. I used to work with one nurse who only cared whether or not the patient had been bathed. Nothing else mattered to her. I once said to her, "Did you miss the part where I told you this patient coded three times? And I had to give him ten units of blood products? Hell, no, I didn't have time to give him a bath!" All that being said, you will learn with experience to recognize the big picture. The details will come together to paint a meaningful and concise picture of what's going on with the patient. Some details are just details; the same kinds of details on a different patient could be crucial. Some nurses (like the one you described) are just jerks, possibly as a cover for their own insecurities. Criticizing you for the thyroid medication was a jerky thing to do. Criticizing you in front of patients/families is never acceptable and I agree with the others here that you should call him out on that privately and assertively. It sounds like you are already doing a great job and it speaks volumes in your favor that you're willing to improve even more. You will become a shining star, while that jerk will always be just a jerk. One piece of advice: when giving report, always end by (together) going over the new orders that have accrued during your shift. On my unit, this is mandatory. This way, you're sure no orders were missed and the oncoming nurse is clear about anything that needs to be handled. Our docs have a way of sneaking in just before shift change, writing important orders, and sneaking back out. You don't want this to reflect badly on you.

I feel for you, OP. My first job was nightmarish and I usually cried before work. Due to limited options, I worked there for a total of 7 years. I thought my experience there was the norm. Eventually, I moved cross-country and now work at a place I love. Better yet, my previous experience makes me appreciate every single day how good I have it now! Think of it this way: the longer you stay where you are, the happier you'll be later on. This job will serve you well, I promise you. Since you're stuck where you are for the time being, there are a few things you can do to make it less awful. First and foremost, try to see the positives in those mean old battleaxes. (Before I get flamed, let it be known that I'm verging on battleaxe territory myself.) It's easiest to lump them together and slap a label on them. Instead, try to see each nurse as the individual she is. Try to see what it is that makes each one special and valuable: I guarantee you that each one is special and valuable. Nurse A may be a whiz at interpreting 12-lead EKGs. Nurse B may have phenomenal IV skills, and so on. Keep in mind also that each one has a world of life experience in addition to nursing experience. These people can teach you wonderful things. If you approach them with assumption that they really do have a lot of wisdom, you will find that you will get better results. Sincere compliments (not patronizing or flowery) will do a LOT to open doors. For example, if Nurse B is very good at starting IVs, go to her. Say something like, "I've noticed that you are really good with IVs. When you have time, would you mind teaching me your technique?" Never say, "What should I do?" Instead, make it clear you've thought it out beforehand and say "I think I should do this because of this, but I'm not sure. What would you do?" Show interest and respect. You can win a heart by asking questions, by thanking people for their help, and trying to help them whenever you can. Feel people out. Try to see what makes them tick. Just like you, they face trials and pain and triumphs. Just because they're older doesn't mean they don't struggle like you do. If you can get them to talk and you are willing to listen and empathise, you will have allies. Some of my best mentors have been "battleaxes" who seemed hostile to me at first. Because I honestly respected them and cared enough to see them as humans, humans with phenomenal skills and knowledge, I was able to learn from them and develop strong bonds with them. Look more closely for the positives and you will find them. Even in a horrible hospital, you will find amazing nurses and you can have enriching experiences. Instead of crying when you go to work, take a moment to wonder what new and good thing you will learn that day.

ICU. I get to do a lot of patient/family teaching. When my patient is too gorked to be taught, there is family who benefit greatly from teaching. I really enjoy my interactions with them. I tend to see my patients as integral with their family/support group. I have to support all of them, not just the actual patient. I don't think ER nurses get to know their patients well, except the frequent flyers, and even then their contact is limited. Their job is to get them just stable enough to transfer. The ER nurses I know say they prefer this: they don't want to be stuck with the same patients for long. They don't want to have lengthy conversations with the family about what's going on and why and what it all means. They have lives to save. This doesn't mean ER nurses are insensitive or dismissive: their job is to patch them up and ship them out so they can take care of the next poor soul who comes through the door. In critical care, you keep the patients longer. You have time to build strong bonds and since you have so few patients at a time, you spend a lot of time with them. "Organized chaos" also describes critical care. You max out your critical thinking skills. You have to think fast. Anything can happen at any time, and it often does. Exciting things happen every single day. Pretty much every decision you make can mean life or death, but you're not in it all alone because you have a backup team of other nurses to help you. When the worst does happen, there is no better feeling than handling an emergency competently and smoothly. You get the drama PLUS the interpersonal connections with your patients/families that you don't get in the ER. I have total respect for ER nurses, but they are a slightly different breed: if getting to know your patients is important to you, I don't think the ER would fulfill you.

When a nurse (or anyone else, really) is confronted with an error she's made, the natural reaction for many is to become defensive, or to try to blame someone else, or to minimize the error. It takes some courage to accept the situation and own up to it. Not too long ago, I made a med error- no one was harmed, thankfully- and the next nurse discovered the error. She properly wrote me up. I did not take offense to the write up; I deserved it and I didn't think for a minute she wrote me up for personal reasons. Even if she HAD done it for personal reasons, I had to accept that an error occurred, I was responsible, and I deserved the writeup. When talking to my boss, I took full responsibility for the error and added that I would use this as a lesson in the future. I was expecting to get a bad eval because of my mistake. To my surprise, that med error (or rather, my forthrightness in taking responsibility for it) gave me gold stars on my yearly eval! My bosses were impressed that I was honest, didn't try to "get out of it", and used it as a way to improve my practice. They said that my willingness to admit my mistakes makes me very trustworthy. I can see how having less-supportive bosses would cause nurses to tend to hide/protest errors. Or perhaps this nurse, unbeknownst to you, has a pattern of similar mistakes and is already under scrutiny. Maybe she's a perfectionist who can't bear to think she's as human as the rest of us. In any case, you know you did the right thing. You really couldn't do otherwise without sacrificing your own integrity, and of course you have a duty to your patients to ensure mistakes are kept at a minimum. This was a med error plain and simple and even though it didn't harm the patient it must be written up. Remember that a major reason for filing incident reports is so process problems can be identified; if you can't tell where or why mistakes happen, you can't fix it to make errors less likely. Your colleague's reaction is unfortunate, but you are not responsible for her feelings: she is. Maybe after she calms down a while you could approach her and explain you were not targeting her personally and that you really do admire/respect her (if this is true). That would be a nice thing to do, but again, she's a grownup and her feelings are not within your control.

Count me as another boring person. There's nothing wrong with that! However, your husband is giving you a huge red flag. It sounds like he has expectations that are not being met, and from there it is a short road to the D word. Communication is key. You need to find out what he needs in order to be happy. It would not be fair of him to expect you to fulfill his every whim, but you should consider a compromise that will suit both of you. When you're in a marriage, both partners by definition have an obligation to take the other person's needs into consideration. Again, I'm not saying you should just do whatever he wants you to do: then you'll end up being the one who feels hurt and resentful. Try to find out exactly what the problem is, and work together to find a solution that respects both of you.

I cannot imagine why the surgeon would be angry at you for not calling about the BP. First, the BP was fine on your shift. Did he really expect you to call normal BPs to him? At night? Second, since the surgeon wrote the labetolol order, he was obviously aware of the BP issues. Once a doctor writes a PRN order like that, you generally don't call to tell him about having to use the PRN order unless of course the BP (or whatever) was totally out of line from the previous values OR the doc specifically wants you to call. Otherwise there would be no point in writing a PRN order at all; you'd just call every time you needed labetolol and he'd give you a one-time order every time. That's just silliness. For a surgical patient like yours, I would probably have called that critical hemoglobin to the surgeon. Even though the hospitalist wrote the lab orders and even though you called the hospitalist with the result, I'd still call the surgeon too. Sometimes it all depends on what doctor you're dealing with, what time it is, whether or not that doc is in a good mood, and the phase of the moon. It is better to be safe and call, but again, it never would have occurred to me to call about that blood pressure. I would have called the hemoglobin and mentioned the BP trend at that time, but I wouldn't have called the BP alone. Surgeons tend to be control freaks. Often, even though they consult the hospitalist to manage the care, they can't stand to not be in control of everything. Sometimes, a doctor gets a bug up his behind and wants someone to blame for it. In the future, with this particular doc, you should call pretty much anything abnormal to him. No doubt he'll be mad about that, but you'll be covered.

You might want to check your hospital's holiday pay policy, too. I've worked in 3 hospitals, in 2 different states, and I've never received extra pay for working holidays.

I work at a hospital where we have a wound care RN, phlebotomists, but no IV team. We used to not have phlebotomists and we drew all our own labs. I strongly support having a wound nurse. This is almost a separate field, where specialized knowledge is extremely useful. The wound nurse has up-to-date knowledge of treatments as well as knowledge of the myriad products at her disposal. This is a full-time job, just learning and utilizing this specialized training, and the results speak for themselves. She knows best what should be done for each particular wound; she can prescribe those treatments to us and we can carry them out. She doesn't have to actually perform every dressing change, but her wisdom is a great benefit to the patient. Having a phlebotomist is a convenience in most cases. Often, I'm very busy and it is a great help for someone else to come and draw my labs. (I still have to keep an eye on the situation and often, I have to call and request that the phlebotomist come to draw those scheduled labs or just send me the labels so I can get them myself. In the time it takes to make that call, I could have drawn and sent them.) However, being able to draw labs is a pretty basic nursing function; every nurse should be able to do it. Also there are situations when it is actually more convenient for me to draw them. Certainly if the phlebot is busy working a code, I should be able to draw my own time-sensitive labs instead of complaining that phlebotomist is late. If my hospital did go back to not having a phlebotomist, I wouldn't complain. In our case, the extra cost isn't really justified. In other places, that phlebotomist could be gold. In the same way, starting an IV is a basic nursing skill. I can understand that in a large, busy hospital, it's easier or more time-saving to have an IV team. Where I work, the med-surg/tele nurses often call our ICU requesting help with an IV start. Often, I go up there to help out with an IV stick and the IV is easy. They just don't have time to do it. I'm happy to help them out. There are also times when we ICU nurses call the ER for assistance for an IV start. We do this as a last resort, because we all feel like dufuses if we can't get the IV. If the ER nurse can't get it, that patient will get a central line. My hospital is not large enough to warrant having an IV team. If we did have one, they would sleep about 24 hours and 55 minutes per day. I can see how they would be valuable in a very hectic, short-staffed environment. Another maybe-not-needed ancillary department is EKG. Where I used to work, we did all our 12-leads ourselves. Where I work now, a nice lady comes in the morning and does them for us. Every nurse, particularly every critical care nurse, should be able to do a 12-lead EKG.

I work at in an ICU (nights) in a small hospital. We started using hospitalists several months ago, and it's been overwhelmingly positive. Our hospitalists are very approachable; they are never grumpy when you call them at all hours or when you have to call them repeatedly. They've all been trained to put their orders directly into the computer system, so this saves a lot of time. When the patient arrives in the ICU, all I have to do is give the hospitalist a call and he comes right over to see the patient. Our hospitalists are all new doctors, so their practice is current. (No order for pureed bacon down the NG- honest to god, I used to work with a doctor who routinely ordered that.) They aren't burnt out yet, so they're pretty enthused about what they're doing. If my patient is going south, I can simply call and say, "I want you to come and look at this guy. I think he's fixing to die" (actual quote from me) and he will be there within a minute. Since they haven't been steeped in the nurses-are-worthless-scum school of medicine, hospitalists will listen to what the nurse has to say. If I know that my patient needs such-and-such, I don't have lick to the doctor's shoes to get it. He will actually listen, and if I'm right, he'll give me what I need. (And if I'm wrong, he'll be polite and explain his reasoning: he won't scream and throw things.) The only downside to hospitalists (aside from any billing/financial issues; I can't comment on that) is that they are new docs. They tend to be overcautious in some situations, which can make a heck of a lot more work for the nurse. An example of this is a certain doc we have who feels compelled to order a full lab workup every two hours on every DKA patient. And I must call him with all of those labs, and he never changes a thing based on those labs. I could have told him exactly what those labs would be, just through my experience and watching the clinical course, but by god we have to draw a whole panel and ruminate about it and do nothing new. This doc is insecure. By then end of one night, with a DKA patient (who was very sick but in no way at death's door) I had called this doctor at least 15 times (per his orders). He'd called ME at least 20 times. Finally, I told him I was just sick of talking to him, and I didn't want to hear from him again as long as I lived. I assured him I was joking, and I said it in a joking manner, but in a way I meant it. I kind of just wanted to shake him. :redbeathe I do think the patient benefits greatly. Usually, the attending doctor is infuriated when you call him at night for admission orders. If he's not enraged, he's too sleepy to give you anything to work with: "just monitor him and I'll be there sometime before noon". Hospitalists won't do that to the patient (or you). They don't care if it's 2am; the treatment starts right now. Overall, I'm very pleased with our hospitalist service. I used to work in a big teaching hospital where we had residents available at night, but that was not as good. The residents were too exhausted to even stand up most of the time, much less think. And they had just about NO experience. They were the first person you would call, but usually you'd have to go up the chain of command to correct inappropriate/dangerous orders. With a resident, when you have to go over his head to correct his dangerous/inappropriate orders, he naturally hates you. (I had one resident order massive fluid boluses on an end-stage renal patient and I could not talk him into a more appropriate course of action. I had to call the renal doc- who was horrified by what the resident had ordered- to get the orders changed, and that resident hated me forever.) I've seen our hospitalists being a bit excessive, but never dangerous or inappropriate.

I also need to say that when I have (adult) JW patients who need blood, I do not argue with them. I do not in any way try to convince them to accept a transfusion they don't want, even when the result is my patient's death. That is their right, and I respect that. I obviously don't agree with their reasoning, but I respect their autonomy and their right to make such decisions. I also have patients who fervently believe that if they sign an organ donor card, we will murder them and steal their organs. (Really.) I don't argue with them, either. There is always an elder standing in the corner, making sure I don't sneak in an unauthorized blood transfusion. (Or, more likely, to ensure that the patient doesn't weaken and accept a life-saving transfusion.) That man watches me like a hawk, because I am a "worldly" person and therefore I am influenced by Satan. (Really: they believe that.) He usually asks me, "isn't she getting her Epogen?!?" and is outraged when I say yes, but Epogen is not going to prevent death when the patient is actively bleeding out. If you refuse blood, and you are an adult, I will not ever, ever try to give you blood. Not to save your life or for any other reason. Nor will I tell you your beliefs are stupid or wrong. I really do understand why you believe what you do because I have studied it, I've actively learned about it, so I know why you refuse blood even though I think your logic is faulty. I will never tell a patient what I think of his/her beliefs because it is not about ME. I am a nurse and my job is to take care of my patients, not to force anything I believe or don't believe onto them. If I cannot do my job, for any reason, then I should not be there.