watersnake

Hi,"At will" doesn't sound so bad on the face of it, it is said by some to encourage free market, and I'm all for that...(Yes, I voted Libertarian). Also implied by some authors on employment law to be the result of emancipation of slaves, although no one seems to say this outright. The problem is, it is much the same as the concept of democracy. In other words mob-rule. Give me a republic anyday. You have the right to speak your mind and practice your ethic, just be sure you do it in the closet and wash your hands afterwards. I know. Having injured my back in the line of duty, and then fighting for my rights under Worker's Comp, I am blackballed, and can't even get hired in a bookstore. The "At Will" concept brings about the very thing it is said to prevent. Snake

Hi; Funny how this has been referred to as a 'heretical' position. I seem to remember this Galileo fellow who opposed the Catholic church with his heretical position that the sun revolved around the earth. Fact overcame heresy, though not in his lifetime. Sigmund Freud also had this quality about him. He 'excommunicated' anaylists who disagreed in any form...(note that you can't spell psychoanalysis without using the word 'anal'). I am trying to begin investigating the extent to which the Church of Scien-tology has insidiously begin to creep into legitimate organizations by hostile takeover methods, some of which are quite creative. My understanding is that the organization MADD was successfully sued and that the above Church paid the settlement in return for the organization and name. They allegedly have deep pockets. DISCLAIMER!!! I have no hard evidence, but hearsay. More on this as the facts unravel. I DO NOT WANT to be accused of stating non-factual info, nor to be the starter of a conspiracy theory. However this Rogerian nursing babble reeks a bit of something..... I wonder? Snake

Hi: I have spoken with people of Muslim and Jewish faith who have told me that if they require porcine products such as insulin, it is ok in the interest of health. They may also break a religious fast for similar reasons.---Snake

UK... My wife switched jobs, completely severed a near 20 year association with a hospital, for less pay, to spend more time with me when we had some suspicions about my health. (I was in a great deal of denial) She married me knowing I might be sick. She is the greatest friend on earth that I have ever had, and the best example except for Mom, 85 and going strong, who I know will be in heaven before she dies. Still convelescing on workers comp, but post-neurotomy, no evidence of M/S, hoping to get back real soon. But this is not about me, it's about the love of someone who takes care of their own. No one is indispensible. The hospital will function, and those who get mad, get glad eventually. Someone else will be the 'red-haired stepchild' within the week. Your son will remember your care long after others forget your absence. "We all are partners in this cosmic dance"...Ambrosia Be cool-----Snake

I dig that movie sooo much. Ever see 'Kingpin'? We ought to start a thread on that subject. How many times in old schlocky 1950s giant insect movies did a doctor say; "I've given her a sedative, she'll sleep now. All we can do is watch and hope." Snake

Well, to answer you, #1. look up Rudolph Virchow. His definition stands...although ironically, he was responsible for the death of a high official because he knowingly treated him for the wrong disorder. He was afraid the official would not like hearing the truth. #2. The quantity Pi has been with us longer than Virchow. I still use it in calculation, how about you? Being old doesn't make it wrong, indeed it often gains validity during repeated use. #3. Diabetes can be identified as cellular dysfunction on biopsy, necropsy, and responds (hopefully) to a given treatment regimen. That is science. A lesion may be only a single dysfunctioning cell, believe it or not. This has been investigated in cardiac electrophysiology with profit. My point is, that the DMS (the Bible of Psychiatry) invents "disorders", diagnoses change from pathology to non pathology when the big wheels get together to revise it. Homosexuality was a disorder at one time. Now it is only psychopathology if the person is uncomfortable with it, i.e. 'ego dystonic'. And another tragic example: in the late 1840s, runaway slaves were "treated" by white physicians as 'mentally ill', the diagnosis being termed 'drapetomania' which could be 'cured' by frequent beatings. I agree with you there, I'm certainly glad we don't recognise some of the older diagnostic and treatment methods. #4. Evidence based? That sounds like emperical treatment, although I will look it up. If it can't be reproduced with the same result using similar method, it's not science. It is opinion. There are 3 sorts of lies: Lies, D*mn lies, and statistics. #5. Disclaimer....I love playing the devil's advocate. It keeps my mind fresh to hear different ways of seeing things. "Snake does not necessarily agree with all the viewpoints expressed." Keep your zeal.-----Snake

Hello: I didn't mean to ruffle a bunch of feathers out there. Any offense taken is unfortunate. I have my credentialing also, have 23 years of nursing in many areas under my belt. Never on probation, never counseled in a way that mattered so far as my practice goes, never fired. And I smoke Marlboros, and that's that. And I'm not trying to dazzle anyone. I was mentored by an MD who is one of the most brilliant people I've ever met, and I guess his ways of questioning rather than accepting on faith or conformance rubbed off. Unfortunately, he forgot to get haircuts or buy new shoes and such, you know the type. But he taught me a lot about a lot of things, some of which helps me to refrain from insulting you in kind. I find it ironic that I am criticized by people who don't know that ad hominum and straw man arguments are fallcious. I appreciate any correction if done in a professional manner. My point is this: you can know things, you can know how things act and interact, interperet labs, and we should all be held to that standard based on our skill and experience. So far we agree. Science: Now a baseball catcher, for example, has to know his team mates' strengths and weaknesses, know all the batters he is up against, essentially running the game while being a major participant. This does not make him, or the manager, or the team owner a scientist. A scientist objectively formulates and tests a hypothesis, observes and reports results, and those results must be reproduceable using similar method. We use someone's scientific results, but we do not in the clinical setting use the scientific method. I am well aware that there are research nurses, biomedical engineers, and all that. I am also aware that funding and support might be withdrawn if the results don't come out the way the money man wants. But that's a side issue. Any action or interpretation a nurse takes must be backed up by a doc to whom the nurse reports, who is backed up by standards of care, which are backed up by higher ups and so on. That is not creative scientific practice. It is technical skill. The scientist is the person who developed the test, procedure, intervention or whatever. Using a device developed by someone else does not make me a scientist, for if it did, reading a speedometer would grant us all that title. Art: I think I adequately addressed that in my post. Caring is not an art. It is a verb, an action, an affect. It is something that must be communicated to have an impact. If we agree, however, that the quality of caring is an art, and that nursing is by definition an art and science, then those few in the ranks who truly don't care, and simply do a job are excluded from being a nurse regardless of how well they perform. Also I am yet to know of a true scientist or artist who punched a clock, or was told how to arrive at his own conclusions, or which color of paint to use, except in the WPA days. Psychology and Psychiatry:A disease is defined and continues to be defined as an identifiable lesion or infective process which is troubling and/or threatening to the victim. We have yet to define anything anywhere which accounts for thought process, or thought disorder. As soon as a lesion is noted, it is no longer psychiatry, it becomes the realm of the science of neurology and the psychiatrist is no longer involved except perhaps forensically. To sum that up, give me one example of a reputable medical pathology book that identifies any psychiatric disorder out of the realm of neurology, such as neurosyphillis, tumor, endocrine disturbance and the like and I will be happy to read it. But I'm not holding my breath waiting. I respect your opinions and loyalty to the profession. I admire your zeal. I'm not what you seem to think I am. I love my patients as fellow beings. I just don't see that we have an artistic or scientific leg to stand on, or else we would be more highly respected and better paid. Respectfully-----Snake

Don't volunteer anything. I have no criminal record, but let me say gently that I came up in the late '60s & '70s (ok, early '60s, too).As I have spoken with many nurses and physicians my age on the subject of the good old days, I can guarantee you that some questions require a "modification" of fact (something like what Presidents and congressmen do) in the interest of achieving goals as regards one's distant past. Else there would really be a nursing and physician shortage. OK, I'll be honest. Most of us have admitted that at some time we listened to Bob Dylan... but we didn't sing. (Stick that in your pipe, Clinton).....Snake

Wellll..... I was charge in an E/P lab. The fellow I was working with was a Preacher's kid, you know the kind, a little bit of devil there but a great guy. We're getting a little frail old woman on the table, and I notice a bad bruise on her arm and head. I usually keep up a banter to distract pt.s from the situation, on neutral topics. I asked her what she did to herself, and she told me she fell down an escalator. I said "Oh my gosh, was it going up or down?" She said it was going up, to which I responded without thinking, "Man it must have taken a long time to get to the bottom." My partner looked at me trying to stifle a laugh, with tears in his eyes, walked outside the lab and I could hear the laughter. Well that set me off, and I acted like I was coughing, and all those things you do to try to disguise a laugh. Then every time he looked at me during the case, it started all over. Thank God for Versed and amnesia.....Snake

Hi, 77.I was indoctrinated into the art and science song and dance in nursing school. It didn't take me a long time to get hip on that bill of goods. I've stated this before, but here it is again...Nursing has no scientific knowledge base to stand on. We use 6th grade level math most of the time, (MDs study calculus and then forget it) and may do only the M.D.'s good pleasure, or tasks that the medical profession has deemed that we can do so that they don't have to bother with it. And lest one brings up psychology, we can certainly make a psychologist ring a bell every time a dog salivates, but it is not science. It is philosophy, just as sure as psychiatry is. Psychiatry does not treat infective process or a somatic lesion, although that has been the definition of illness since Virchow defined it in 1858. The DMS invents, includes, exclues or modifies what is mental illness or is not based on politics, social changes, political correctness, on and on, at that time. I haven't recently seen any change in the definition of diabetes as a disturbance in metabolism of sugar. Nor of polio being caused by something other than that virus. Our 'scientific base' is the regurgitation of information which is tainted with the attitudes and beliefs of the transmitter. Ironically, I have heard only one M.D. refer to himself as a "technician", which is probably true of nearly all but the non-academic Physician. Art? Art is self expression. It is hopefully fresh, original, and makes an impact on the listener, viewer, or taster. Aesthetics does not have to be beautiful, but it must convey or provoke an emotional response. It is not an ordered set of algorythms, or successfully following a set of orders, otherwise we'd all be artists. If cleaning poop is art, then call me Pablo Picasso. (During his 'Brown Period') In short, we are 'the caring profession'. In other words, subordinates to some, helpers and friends to others. Caring; true caring comes from the heart, the circumstances, and our attitudes. It is metaphysical, and we are metaphysicians at best. Ergo we are philosophers (unless we regard it as assembly line job), and philosophy is only opinion. And even that's subject to change with the times. A philosophy teacher informed me that it has "been decided" that metaphysics is no longer a valid branch of philosophy". Sorry, have to reject the art and science sacred cow. ----Snake "A first rate soup is better than a second rate painting"--Maslow

Hey, Zs. I have been associated for a lot of years with women in Health Care. And dating, marraige, et.c. . Let's face something here, first off, for all the sensitivity we can muster, I can't name you a man who understands the subtleties of a womans thought, affect and behavior. We have in some ways not crossed the Neanderthal stage. WE HONESTLY DON'T KNOW that sometimes we have said something offensive, or failed to pick up on what you have said, or even that you were trying to get our goat. With the great majority of us, it is not intentional. Lemmee level with you on something, sometimes guys get together to compare notes as to what they did to upset the damsel. Occasionally, someone has some background knowledge of somethiong going on with them, but for the most part it ends up..."You got me...". We also mark our territory by leaving socks and underwear near beds and bathrooms. Instinctive as the goose flying south. Hope this helps....Snake

Hi, Some people are looking for validation of their spiritual belief in a stressful time. I see no problem here. I will pray with a Jew (is that the politically correct designation? No sarcasm intended.), a Taoist, a Catholic or anyone else excluding satanism, which I've not had dealings with. Should this happen, I will leave and allow the satanist to do what they have to do short of sacrificing a young virgin (if a young virgin is to be found in my area). I just usually claim to be a mongrel crossed with Methodist and let it go at that. If people want to talk about all their money, and all the stuff they own, that's fine. Sometimes you can really draw some interesting experiences out of such people. I don't recognize the "VIP" status. We's all just folks when we take off our "uniforms" be they clothing or surroundings , or social strata. Let the VPs give them a fruit basket or something if they feel the need. We also have several deluxe suites bordering on penthouse where none but caucasians shall enter...except cleaning people, and a nurse to wait on them hand and foot. Politics?, I vote for the man, not the party. Consequently I usually vote for the Liberatarian party, or against the incumbent if I haven't that choice. Stirring the stew makes the scum come to the top, and God knows our 2 party system of career politicians could use a wake up call by introducing some diversity. It would probably even benefit Health Care. Just another 2 Cents----Snake

Krissy, I've been an rn 23 years now, and have expeienced or seen the same sorts of behaviors. Personally, I speak to any and all with respect for their humanity, but you must draw the line sometimes in a firm manner. This does not mean you join in bad behavior. I have smiled with my arms crossed looking them in the eye, started singing an appropriate song to the situation, asked them to talk to me later when they are a bit distanced from the situation, quoted Shakespere, replied at length saying absolutely nothing (that's a great strategy if you are quick thinking), walked away, et.c ad nauseum. I have reported the incident to my super on rare occasion...but I have not attacked or abused nor humiliated another person (except in defense of the helpless)....and believe me, I'm no angel. I'm a load to put up with sometimes. God gave us a great gift in exchange for self awareness, and knowledge of mortality...a sense of humor. Reflect on this, and capitalize on that gift. Good luck. (What was it John Wayne said? "I wont be wronged, I won't be insulted, and I won't be laid a hand on. I don't do these things to others, and I require the same...") Snake P.S.---- Lawyers only complicate matters

Hi, I do conscious sedation for an endo lab, have done cardiac E/P requiring 360 J shocks previously and have had little problem with pt.s remembering. Docs need a better understanding of c/s, although lo and behold, a few trust our judgement. It has been my experience that more than a few docs don't know their patient. Example: a terminated ERCP. The patient rushed to RR for code due to VT. I pointed out that the patient had an implated defibrillator that was doing it's job overdrive pacing. The doc didn't know. Another example is a doc who was performing a colonoscopy and couldn't understand the anatomy he was seeing. I advised him that the patient had a history of partial colectomy, and had to read his H&P to convince the GE of the patient's history. He was viewing an anastomosis. These things make the nurse unpopular for pointing them out. ASA score done correctly are a good index to start, meds regularly taken, and simply asking the patient their experience with painkillers and the like. Let them vent their anxieties, annswer questions, help them to feel at ease. I used to play Tai C'hi music in the background with low lights and soft verbal suggestion, as well as accupuncture point stimulation. It is controversial as to the power of suggestion, I think it works. I have probably put over 2000 people under sedation. That being the case, my gut helps a lot. I use the Ramsay scale and shoot for about a 4. This is an objective scale and has justified my practice on a few occasions. Some will tell you that if they are on antidepressant/antianxiety drugs they require more painkiller. I have seen nurses just start pushing heavy doses on this class of patient. Wrong! Don't assume anything and start pushing. I usually give a test dose of 1-2 versed without the patient knowing, and observe results as I attend to other duties. Titrate to your desired level carefully and according to policy. I realize that the physician thinks they should be well sedated in 5 minutes or so, which is a violation of policy on most patients. Or they expect that one can just keep pushing drugs after they start the procedure. Getting through the sigmoid with an ill sedated patient is extremely painful, especially if a loop forms. Remember that extreme pain is just as dangerous as oversedation. Read the literature. I prefer Fentanyl, less side effect, rapid response and recovery, more controllable, less instance of nausea. Why the docs are so hung up on Demerol, I don't know. If you read c/s literature, there is little or no mention of Demerol, fentanyl and MS being the preferred agents. You can't use MS in an endo setting due to the side effect of causing or exacerbating colon spacticity. When you have a patient with an MS implanted pump you have this dual problem of spacticity and delayed reaction where they are difficult to arouse post procedure when everything catches up. IMHO, practitioners should be familiar with the Ramsay scale and utilize it to achieve optimal sedation without going beyond your constraints of how deep a nurse can take a patient. There will always be the occasional patient that just won't go down for reasons beyond me, given that they were honest on their history form. So you do the best you can. My 2 cents=====================snake

Hello: I would advise you to remember a few things about nursing in general: Few of us are alturistic enough not to want to make a good living. There is nothing wrong with this. We can care and profit without being inconsistent. Now comes the problem. We have little or no scientific base with which to serve as a standard within the nursing profession. Ergo we are called the "caring profession". Most of our scientific base consists of what we have adopted and incorperated from the field of medicine. Don't worry about that, it's Biblical. I recall that there was a woman who told Jesus that 'Even the dogs get the crumbs that fall from the master's table'. We are mainly (so-called) advocates-(don't even go there if you like being paid), care givers, comfort givers, and to sweeten the deal, our duties continue to expand as we are delegated tasks that MDs have decided that they can pass off on us. Examples would be conscious sedation, monitored minor surgical procedures, pharmaceutical titration and the like (for which they are paid). This allows the docs more time to take on more patients, thereby giving us more patients. Makes you feel kind of special, to be so entrusted, doesn't it? Who needs more salary when you can become suddenly so much more talented and able with a mere word from the medical field? (Given, 3 nurses must fly to Chicago for a week to get trained to argue and impliment the proper semantics and inseviced on inservicing the staff; with said insevices mandatory attendance on your own personal time). In a way I can justify the ones who have designated nursing as an "art and science" as somewhat correct, at least on the science part. (The last art I remember was a wonderful Jackson Pollak consisting of a full Italian dinner including Chianti with my body, beard to shoes, serving as an easel). I maintain that we are far more a philosophical field than a scientific field, if we take time to examine ourselves honestly at all. Philosophy is philosophy, and therefore opinion, until it becomes proven fact, in which case it becomes science. Ideas and suggestions, i.e. creative thinking, are overwhelmingly un-welcome. "Don't reinvent the wheel" as a physician once told me. I had found a certain sequence I used intraprocedure which worked better for me and had no effect on his part of it. Unfortunately, we have or take little or no time to know ourselves, our belief system, to cultivate our minds, and no objective standard with which to compare and define competent/incompetent. I understand that we do have corporate "missions", policy and procedure books and a modicum of passed-on science as stated above. Most all of the math the average nurse uses is about 6-7th grade level. I suppose given your question, a "competent" nurse consistently follows policies and procedures, makes no drug errors, checks armbands, and can regurgitate the mission statement to JACHO inspectors upon request. We are ill trained if at all, concerning the discipline of ethics, which, given our position in the health field should be an ongoing learning process which we put into practice. Psychosocial need intervention is not a moneymaker. This being the case in practice (lofty as our ideals may be), we are left with the follow-ing standards which I do not claim to be an exhaustive list: 1) Don't rock the boat, do as you're told. A little grumbling about how poorly a fellow employee does the same thing or that it isn't your turn is allowable if it doesn't waste time. Usually the phrase "blah blah, blah...my license on the line...blah blah" (fill in your own blanks) can be said ambulatory, thereby maintaining efficiency. 2) Make the patient feel as though the corporate structure they have entered is the greatest place in the world, and great harmony exists between you and your co-workers. 3) Keep in mind that you are replaceable. 4) Follow the chain of command in case of variance. 5) Stroke the MD's ego (remember, he is a customer), stroke the boss's ego and make them look good without taking credit. 6) Don't bother yourself or others with ethical problems. The upper ranks will take care of you. Ethics are something beyond your understanding. Remember that any administrator or MD can resolve any ethical problem on the spot better than Kant, the Pope, Hobbes, Wittgenstein and Descartes with one arm tied beyond their back. Work faster, do more with less, thank God for health care becoming an industry, and smile, smile smile. After a few years, if you maintain these principles, you will find yourself acclimated to some of the most terrible situations and solutions, knowing that you had no power to solve it or to intervene, and you kept your mouth shut. Then you will be able to like what you see in the mirror, and sleep the sleep of the innocent. Ignore that little voice you keep hearing now and then, it's just your conscience messing with you. Remember, you could always be flipping burgers. =================snake