edrnbailey

Basically this nurse placed her own religious beliefs onto the patient and refused to render care. How would she feel if the roles were reversed.

You can not refuse treatment to a patient based on your own beliefs. This is no different than making a patient receive treatment against theirs. As nurses we are our patients advocates. It is not our place to pick and choose which treatments or beliefs we will uphold.

$1.00/hr equal $2000 a yr. Is that enough difference for changing your life and schedules? This is only something the two of you can decide as a family. If it is more about the progression to management in your career then you will need to sit down and have a discussion about where you see yourselves as professionals and a family. Only you can make those decisions. I've worked with couples before that managed to separate their personal from their professional lives very well and some who couldn't. Again it's the individuals involved that make or break the situation. Best of luck!!

All of which is very true. I may not even listen for bowel sounds if chief c/o is unrelated.... This was my humble attempt at making a funny... (obviously not the best) in an attempt to return to board to a lighter more positive tone... but you are right there are some who think this is the most important information of any you may give... but then it takes all kinds... :0 ps I ask more when i'm the triage nurse cause I'm always thinking are they gonna need the room with a DOOR? (We have some rooms that are simply curtained off and others that have a typical door.) Constipation= door

I started my nursing career on neuro/neruosurg step down unit. It taught me everything I know. Neuro is a field that is either loved or hated, there's no in between. These patients are challenging. The brain/spinal cord controls the rest of the body, so your s/s are often vague and diffuse. There's no chest pain with shortness of breath, get an EKG... it's a STEMI.... Often times the clues are subtle and sneaky... The most obvious or well known s/s for neuro changes are LATE signs... A true neuro nurse will pride themselves on picking up the subtle clues before that. LOL. A change in awareness, increased agitation, increased work of breathing, little things that will make alarms go off in your head. I once called a neurosurgeon with the c/o that "something's not right with patient x, I don't know what but something's wrong." He was an ICH with crank and evac, md ordered a repeat CT and he had started rebleeding. We caught it early and after another surgery he went on to a good prognosis. Those are the things that make neuro difficult but also the things that make you love it. It's hard physically and mentally demanding work but remember you are doing what only a handful will admit to actually enjoying or being able to do. It's a special group and you will grow as a nurse exponentially from the experience whether you stay there 20 years or 6 months.

I worked on a neuro step-down unit for 4 years before transferring to the ED. And I thank God everyday for that experience! Those years and the patient's there taught me to prioritize and good (great I think, but don't want to toot my own horn) assessment skills. I learned that with enough team work you get through anything. (we only had 3 nurses for 28 beds on night shift and no secretary or tech after 11pm) Did I mention it was a neuro unit??? LOL. I found that as the ED nurses got to know me and me them that if you took report in a timely manner, whether when they called or you called them back, let them actually give report, and helped with the transfer of the patient to the bed (went in the room and assisted moving patient) or even just were polite with a thank you and you're welcome, they were much more likely to be understanding when you were swamped and needed a few extra minutes to catch up on the code yellow, 3 previous admissions, or the bazillion new orders that the late rounding physician just left you with. The same is true if you reverse the roles.... Trying to start the antibiotics on the patient in the ED when you know they don't have them on the floor, giving them that extra 10 minutes (when you can) before rolling up the patient, starting that extra IV site, or God forbid helping clean the patient who was incontinent while you weren't looking or were care for the other 5 patients in the ED that are yours makes it a lot easier to get help when you are busting at the seams and need to move a patient up NOW!. All you have is admission orders and vitals. Your nursing notes are nowhere near complete but you need the bed double STAT.... Those same floor nurses may say sure bring em on, you can give me the details when you get here and just bring up the notes when you can.... Pay it Forward.... One day you may be the one to reap those rewards.... We are all nurses. We ALL care for the patients. Different ways, different skills, different areas, same job. When we finally learn that it's not a competition but rather a group effort to provide the best patient care (the reason we are supposed to be here anyway) nursing will truly ultimately finally grow as a profession.

Stargazer, Never discount the need for last BM even as an ED nurse.. when working up acute Abd pain and or n/v this part of the assessment is important to ED nurses also... We all remember our first acute or significant CONSTIPATION patient and what we and the patient endured to provide relief..... :w00t:

" I told her I would feed the patient his breakfast and make sure the meds were reconciled so she wouldn't have to do that." In actuality most ED nurses would love to have the time to feed their patient. I don't when I've had the opportunity to spend quality time with a patient actually getting to know them or giving 1:1 care without feeling rushed. Those are some of the little moments that remind me why I became a nurse to start with and are occasionally missed. Believe it or not some of those menial tasks and ADL's are envied and not discounted.

The intent is duly noted and appreciated. For some all they can see is the negative. They must justify their own negative thoughts and attitudes by pointing out others. Food for thought.... if the only way to build yourself up is tearing someone else down then who really is torn down in the end?

There is NO excuse for ANY patient speaking to you this way. You are an educated professional. The size of your hips, buttocks or any other body part is irrelevant to your ability to give care. It is time we nurses stopped making excuses for bad behavior. It plays a large part into turn over in emergency nursing. It has everything to do with respect. Unfortunately in this setting we see a population of patients that have become increasingly demanding with a sense of entitlement. They have the expectation that we are there to serve instead of treat. Previous posters were correct when they state that this type of patient would not go into a bank and verbally abuse/assault the employees there. He knows that if he behaved or spoke in that manner then he would be held accountable for it. Not so in health care. Some feel as if there are no repercussions for their actions. They are the patient. We have to treat them so in a twisted logic we have to tolerate the abuse/assault. This comes from many misguided tools to gain patient satisfaction. Reimbursement is tied to keeping the customer happy. (I don't when my patients became customers but they did, which is kinda funny since I work in the not for profit hospital that sees most of the indigent care which means they're not paying anyway). HCAPS and Press Gainey scores have erroneously made patients feel that they have the right to demand care and treatment and we HAVE to render this; including free medication, food, drink, phones, blankets, work excuses for the entire family, etc., etc. Some of their demands are ridiculous in nature. When you add a lack of self respect or respect for anything else in the mix then you have the verbally abusive and insulting patient. (BTW if you had told this same patient that he needed to lose weight or was obese he would have been insulted and or filed a complaint against you.... it is definitely a one way street.) There has to be a stopping point. It is not OK to treat any person in this manner. Do not quietly ignore the behavior or make excuses for it. While remaining professional, quietly but clearly inform him that it is not appropriate for him to speak to you or any other staff member that way. You will be glad to address his needs, what ever those may be, but you will not tolerate being treated like that. Most of the time that works for me. Some even offer an apology when they realize just what they said or how they acted. For those that continue, inform them you will return to the room when they are more in control.... and LEAVE!!!! Make sure the patient is safe i.e. side rails up and call light in reach, not in acute distress-- consider ABC'S (airway, breathing, and circulation) and LEAVE. Do not argue, coerce, cajole, excuse or anything else with this patient, just leave. Take yourself out of the environment. Return to the room in 10-15 minutes and re-evaluate the situation. If the patient continues with his behavior... repeat, only this time either call security, charge nurse, house supervisor, etc to go with you when you return to the bedside. For your protection and as a witness if nothing else. I believe swapping or changing assignments should be a last resort. Patients in the emergency setting do not get to dictate which provider is caring for them whether it's the physician or the nurse. Another patient may actually suffer unintentionally because of this. Each nurse has a patient assignment, and the assignments are based on experience and acuity, and those patients' care should not be altered because of one person's bad behavior. If the behavior escalates to verbal threats and/or physical violence then you have the the right and should file criminal charges. Regardless make sure you document EVERYTHING!!!!!!!!!! Be as specific as possible including quoting the patient, and what measures you attempted to rectify the situation (yourself and following chain of command). Make sure you keep your own notes as well. An addition resource is the ENA website. They have conducted studies and research (some is ongoing) on nurse violence and have many pamphlets, articles and other information available for use regarding this. Good luck and keep your chin up!

Are you working day or night shift.... that alone can throw a wrench into the mix. I too am a runner though I'm only a halfer... When I changed from day to night shift (again) it took me several months to readjust. If you are new to nursing give yourself a few months to adjust to working in the profession. It's different than any other field, and is more physically demanding than most think. The mental demands are high also. Especially if you are trying to learn a new facility as well as beginning a new profession. Try for a shorter workout period at first. Then build back up to your usual runs... This worked for me: Day shift.... I would get up first thing in the mornings on my day off and either go to gym or run (because of scheduling I had to revise schedule to include weekends including sundays). Night Shift.... I would go straight to gym from work. (**** DO NOT GO HOME FIRST**** Just me personally but if I ever go past the front door of my house then I'm done. It's way too easy to find excuses not to go, so I just go straight from work to gym. Kooky I know but it works. ) Throw in a couple of extra days for off days and there you have it. Taking my son to school was the excuse for going in the mornings. I would take him to school and then go straight to gym or run... it helps if you have a partner too. Someone that is waiting on you and expecting you to be there... Hope this helps or at least gives you some ideas... and hang in there it will all come back together again. You are just going through an adjustment period and having to readjust your personal priorities and professional ones. They eventually mix together.

It is!!!!!!!! A nursing home cannot refuse return of a previously accepted resident if he/she has been cleared medically for any condition that would require treatment/care that facility is not capable of providing. They are legally responsible for the patient's care and have received payment for such.

Kudos to you.... for being the nurse we are all supposed to be and thinking of the patient first. And second kudos for standing up for nurses everywhere; LTC, ED, floor nurses, etc.. It drives me insane when another nurse talks down to/about nurses just because they aren't ED nurses. LTC nurses are still nurses their skills are different than ours in the ED but they are still a valuable member of the team. There are good and bad in both environments and where you work is not the deciding factor. Worse still is how anyone (insert EMT) who is not a nurse feels they have the right and/or knowledge base to pass judgement on the competency of a nurse. I was a CNA and LPN before becoming an RN and have also sat for and passed, as well as worked as an EMT-P and there is a distinct difference in the preparation at all levels. Until you are qualified yourself at the same level then you really cannot pass judgement on those that are. As for the LTC patients being brought to the ED, locally we see this often. It is the result of panicking family members with little education on what to expect when time of death finally arrives and many many times the result of nursing staff that send the patients out so not to upset the other residents living at the LTC center. I was told once it is their home too and they don't want someone dying there. This is almost a subculture of thinking that presents itself too frequently. In my state also patients do not have to be AND/DNR to be placed on hospice..... I'm not sure what the thought is there but it happens sometimes.

Just as RN stands for Registered Nurse and is a professional role and title granted with dictional requirements and passing state board of nursing examination, ACNP is not a "cert." is the initials for Acute Care Nurse Practitioner. FNP stands for Family Nurse Practitioner. This is an advanced practice RN with prescriptive privileges and educated the the masters level as a minimum. Many states are now pushing for a doctorate degree to become a nurse practitioner. The role of an ED nurse and that of a nurse practitioner or physician assistant (PA) are vastly different. Some facilities refer to them as mid-levels while others use the term physician extenders, but their roles have nothing to do with generalist nursing or bedside nursing in any specialty area. I believe you need to read/learn more about the roles you are asking questions about.

This works well in most areas of nursing.... EXCEPT the ED and other transient care areas. There is little report to be received on a new patient. If they present via the front door the "report" is simply the triage. In many ED's the triage nurse does not move the patient from the triage area to a patient room a tech or CNA does this and assists the patient in donning a gown and places them on the appropriate monitoring equipment. If the primary nurse is available he/she will assist or complete this and perform initial assessment then. BUT, and it is a big but, the primary nurse is in another patient's room then he/she is not aware or able to assess the patient until they are available. That nurse is still responsible for the patient in question. There is an assumption of care in a timely matter. If the patient is critical/emergent and is brought to room by the triage nurse then someone should assume care on arrival to room. Often times report is as follows..... "Mr. A is 59 yo with chest pain radiating to left arm. started 1 hour ago while raking leaves. he has a cardiac history of HTN and MI x2 with stents and CABG. EKG ordered on on the way to room." That's it.. you go from there. A truly emergent or potential code is not fully triaged before being placed in a room. That is completed once the patient is in the room so that treatment is not delayed, so there is no report. The charge nurse who is monitoring the flow of 2-20 nurses cannot in reality notify each nurse of every patient placed in every room. Each nurse is responsible for managing his/her room assignments and the flow of patients in those rooms. On a completely different note the OP's nurse was on lunch break. This means another nurse assumes care of the patients in those rooms for that time. There should be a report on the patients in progress at that time. As a rule of thumb always document when report is given and who it is given to on each patient. Even when it is just for a 30minute lunch break. The receiving nurse is the nurse responsible for the patient in question and is responsible for completing the paperwork including code sheet and initial assessment.