NextGen

I have been a nurse for 7 years, worked 5 in acute care and the last 2 in Acute Rehab. Patients are being discharged from acute care much sicker than they were 5 years ago. The theory behind Acute Rehab is that patients are medically stable when they are admitted. So the unit is staffed for medically stable patients. That means the unit has 2 RNs only for 8 patients and when we get a PCA when we get a 9th patient. The problem is that Acute Rehab is admitting more and more patients who are not medically stable but have been discharged from acute care. Our doctors are not medicine doctors, they are PM&R docs. Acute care is like closing time at the bar "You don't have to go home, but you can't stay here". In your state, where do patients go who still need medical management but are being discharged from acute care? Are they going to a facility that medically manages them? Thanks.

My patient's large and deep wound has been intentionally left open. She was transferred from the surgical unit to my unit without adequate wound care orders. The wound is continuously seeping yellow exudate. Yes, all doctors have been called. In the meantime, what type of dressings have you seen used for open deep wounds? I am very concerned that infection will set in. I've searched some of the wound care literature and have not found specifics. At this point in time, I do not know why a wound vac was not placed. Thanks!

My patient was put on a vent during a pneumonia episode and has not been able to be weaned off. Now she is on my LTAC. Her O2 levels are always good. She has coughing spells and periods where she feels like she cannot breath. Nursing and respiratory have tried EVERYTHING and have been unable to resolve this or figure out what triggers it - we have tried repositioning vent tubes, anti-anxiety meds, deep breathing exercises, scheduled albuterol etc... Some days/nights she is comfortable and does not have any issues. Anyone have any thoughts on alternative therapies that might work? Thanks in advance!

This is an example of a poorly trained nurse manager. She does not know how to (1) investigate a complaint made by a nurse about another nurse, (2) differentiate between staff gossip or targeting another staff member, (3) find out if the complaint impacts patient care and (4) how to address the situation, if needed, with the person being complained about. Management is a skill that can be taught. It is not a skill that people are born with. Unfortunately, nurses are promoted to a manager's position without any training or prior proven successful management skills. If you have a union, take it to your union rep. If you do not have a union, do NOT take this to HR if you want to work at this hospital. HR will go back to your manager who will then target you. Once a person makes it to a manager's job, rarely are they removed from the position. I wish I had better news for you. Poor to mediocre managers exist in every profession. The rare excellent manager is a blessing to work for. Good luck and happy holidays.

A cautionary tale: Children are not always the best medical POA. Appoint someone who is able to listen to medical advice and understand it. My mother-in-law appointed her daughter as her medical POA. She spent her last 3 months of life in and out of hospitals and nursing homes. The daughter made terrible decisions that were against the advice of the doctors and nursing staff at both facilities. This caused my mother-in-law to spend her last few months in a tremendous amount of pain. She could have had a peaceful transition with the help of hospice. But the daughter refused to listen to anyone except herself. Make sure that your medical POA can listen to medical advice, is able to understand or ask people who do understand to explain what is being said AND asks you what you want. This person can have a lot of input into how you end your life.

You were in the military. Have you considered applying for a nursing position with the VA?

Can you just keep me till after Thanksgiving?

I agree with your thoughts and advice. All you can ever do in life is what you believe is the right thing to do. You are so very correct about how middle mgmt operates. I went to my manager about an incident and kept the conversation patient oriented. I did not name other nurses, just stated that there were interventions that could have made the patient more comfortable. The manager told the individual nurses that I tattled on them which painted a big target on my back. The manager encouraged gossip and used the "divide and conquer" method of management. I eventually left that hospital. BUT I was proud of myself because I did what was right for the patient. None of us can control what other people do or how they behave. We can do what is right for our patients and ALWAYS protect your license.

Hers is an answer to this question that is well received: I am looking for a hospital that has a stronger emphasis on patient centered care

What I have found is that lateral violence has been inbred into the hospital culture for a very long time. If you are the nurse or aide who speaks up about unfair treatment to your manager or to human resources, you are targeted that much more. The largest part of the problem is promoting nurses into management positions that have not been trained in management and have no management skills. Therefore, they "manage" based on the same bullying, gossip and targeting of employees that they saw their managers practice. The sad part is that the bullying is rarely about how a patient was treated. As someone who worked in corporate environments for 20 years before entering the nursing field, I was stunned to find the hospital culture so entrenched and hostile with no protection for employees against unfair disciplinary measures. If the hospital was your first job, then this environment is normal for you. It is very difficult to change the culture of an organization. Just be prepared for the response if you are the one who tries to effect a change.

While I understand not wanting to write papers, the articles that you research to write those papers is important. You have a choice in how you get your BSN. You can write meaningless papers just to "get it done". Or you can research articles that are meaningful to your current (or future) nursing practice and write a paper that is meaningful. The point of online education if for you to learn on your own. Whether or not you do that is up to you.

I work night shift on a busy med-surg unit. Often, our senior patients get confused at night. These are patients who are not diagnosed with Alzhemier's or dementia and are not confused during the day shift. Does anyone have creative solutions that have worked on how to handle these patients without restraining them or medicating them? Like a lot of you, we rarely have anyone who can sit with the person all night. Thanks in advance, NextGenRN

In EPIC, go to the blank field (or search area) in Patient Summary and type in "ED Encounter Ed Only". This will bring up all the emergency department information on a patient you could ever need. My hospital used EPIC for years before someone stumbled upon this area.

I found out the hard way that if you complain to a manager about just about anything, you are tagged as "not being a team player". Not being a team player has become the euphemism for complaining about anything in the hospital environment. After working in corporations for 20 years, I followed my heart into nursing. I enjoy bedside care. But is has been disappointing to find that managers are more worried about "managing up" than the care of patients on their unit. As long as no one steps up and voices their concerns, nothing will change.

We are in a profession that is constantly changing due to new technology, advances in our understanding of medicine and new protocols. We will be learning new things every day for the rest of our careers. So, think of the certifications as a way to keep you engaged in the learning process.