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CT stepdown, hospice, psych, ortho

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  1. cb_rn

    What HAVE you said to patients???

    I hate it when families tell you not to give Mom morphine because she doesn't need it. Once we had this patient that just wouldn't leave - literally - every time a d/c order got written the daughter threw a fit until one of the docs would come up with some inane reason to keep her. Including a dermatology eval on a 90 year old for ... a hanging skin tag. The daughter would call in the middle of the night to check on her mom. Ok, fine. So I go through a run down of every burp, fart, and snore that came out of mommy dearest, including the fact that I gave her morphine per the patient's request. Daughter goes bezerk, says she specifically told us not to give her mother that medication and asks how dumb can "we" be at the hospital. My reply? "Miss So-andso, I went to school for several years to earn a license to assess patients. Your mother is ordered morphine on an as needed basis by her physician who went to school for several years to learn how to prescribe medication. She told me her leg was hurting and requested the medication. You don't have the authority to tell me not to give her prescribed medication that she is requesting. She is perfectly capable of making decisions about her healthcare. If you don't want her to have morphine you need to let her get discharged so that you can micromanage her care from home rather than waste your breath with me. Goodnight." Click.
  2. Tread lightly. I respect your need to speak up about the injustice you are seeing. Consider who you confide in, however. You don't know if the person you report her to is her best friend, married to her 3rd cousin, or dating her brother if you know what I mean. Nursing networking is no different than any other network...sometimes bad behavior is overlooked by who you know. I'm glad you recognize her behavior as despicable. Is she taking care of her patients, whether she thinks they are good or bad? I don't mean is she nice, etc, I mean is she meeting their care needs, pain relief, hygiene, etc? If she is treating them within standard, I might be tempted to lay low and let her dig her own grave. If her behavior is as blatant as you say, no doubt someone has already taken notice of it or will soon. The preferable thing would be for a peer or superior of hers to recognize the behavior and report it. Sometimes nursing students can be viewed as being overly zealous in their perception of "abuses" and you risk not being taken seriously. However, If she is denying the "bad" patients appropriate and timely care, you have an obligation to seek out a trusted nursing instructor in your school. Good luck on your decision and please be reassured that, while we all have prejudices and biases, I would say the vast majority of peers do not act in this manner.
  3. cb_rn

    When are ted hose removed/ted hose care?

    Why do teds need to be taken off? Have you ever went to give a bed bath and caught a whiff of a leg thats been in a ted or a compression sleeve for a little too long? Even if it weren't for the other very important issues that other posters have brought up, common sense dictates they have to come off periodically if for no other reason than good hygiene. Imagine wearing nylons non-stop for several days and think about how that might feel.
  4. cb_rn

    Why apologize to doctor when calling?

    So I picked the wrong specialty to illustrate my point. The focus of my point was that no doc should be shocked about getting calls at crap hours. Its not like you wake up one day after you're practicing independently and say "WTH? I have to get calls!?!" Its part of the job. One they were exposed to before making final decisions in picking a specialty. If you have such a problem with taking a call about a legitimate issue at an inopportune time, pick another specialty. Don't expect I'm going to listen to you rant. I'm going to tell you point blank, "Ok I'll document that I called you and received no orders. Thank you for your time." Then I'm going to hang up and talk to my charge nurse to see if we need to pursue another avenue for the patient to get proper care. If you don't call me back after I page you three times, it will be reflected in my notes. Nobody is saying we don't all get testy or snappy. I empathize with having precious sleep interrupted. Maybe a little sarcasm is even slightly justified if you get woken up at 3 am because of a mistake on the part of the nurse. I get that. We are human. However, when I see there is a worried nurse and a group of sympathetic nurses around her clucking their tongues because there is something she's got to call about at 2am and we know she's going to get reamed --- that's a big, huge, hulking red flag. Being "afraid" or "dreading" to call a particular doc because of his/her reputation for being a jerk is a sad testament to that physician. It compromises patient care because of the time spent debating on whether the issue really deserves a call. So be polite. Be proactive. Call only about the issues you must call about. Say you're sorry to wake them just the same way you'd say excuse me, but please don't do it because you are exposing your belly to the alpha dog.
  5. cb_rn

    Best way to lift a sagging breast for apical pulse

    On an awkwardly related note, imagine my surprise when a more seasoned nurse than I used a large amt of tape to "hoist" a very thick panniculum (is that the right word, I call it my mini-version the jelly-roll?!?!) for a sheath pull from the groin. ... luckily the patient was snowed on propofol but it was just kind of awkward to see a roll of adipose tissue suspended mid-air for a couple of hours. I might have felt bad for not asking if it was really appropriate to do this except this was a really stressful pull and it seemed like hemostasis took forever so I'm guessing the patient would have preferred the humiliation of taping to the possibility of losing more blood since it was really difficult to manually displace the extra tissue despite the number of extra hands we had in the room. This is my first time being involved in the sheath pulls so maybe its not as odd as I thought...however, what the heck would we have done if this patient had been alert? Using the clamp was NOT an option and as it was I thought my fingers were going to be permanently contracted.
  6. cb_rn

    Becoming a nurse as an Air Force wife

    Marine wife here. I've never had a problem obtaining a job when we move but that is because I have a BSN. I've been told many times the BSN was the key in me getting the position over another interviewer. If you are not doing a BSN off the bat, immediately get into a RN to BSN program and finish it post haste. Also, I'd go directly to a hospital to get experience, in the most intensive position you can find. Try for an ICU or CCU or at the very least telemetry and get in at least a year of quality experience. The more specialized units are the ones that tend to have openings for experienced nurses around the country. Also, when you interview, try not to emphasize that you are a military wife. I have found that there is a certain amt of prejudice in hiring us because we tend to pick up and move every 2 to 3 years. Not saying you should lie about it, but keep it on the DL if you want to be taken seriously as a candidate. In that same spirit, try to keep each job you get for the entire length of time that you are stationed in that area - your case looks much more convincing to an employer if you have 2-3 years in each position you've held rather than a string of 1 year stints in various places. Keep up with your certifications and become a fantastic interviewer. Apply for your nursing license in the various states AS SOON AS YOU KNOW WHERE YOU ARE GOING. Some states (cough GA cough) take forever to give you a license. Be aware you may have to drive, my current commute is about 40 miles from the base but its only 3 days a week. Expect to have to work nights as you will always be the new kid on the block with your move schedule and, as such, you will probably be the low man on the totem pole for prime shifts. Finally, collect excellent references from employers. Do not burn your bridges and make sure you give ample notice prior to leaving each job. Hope this helps, from a nurse that's been there, done that.
  7. cb_rn

    I got a ethical question

    I'm sorry, what? You have to debate that you its possible respect patient autonomy without following their wishes? check out this link http://plato.stanford.edu/entries/autonomy-moral/#BasDis Can I suggest very gently that you edit and proofread with a heavy hand and perhaps have a studious friend read it for clarity? I had to read your posts several times to make sense of what you were saying due to various inconsistencies in your writing style and missed words. When constructing position papers, those kind of errors can really detract from your points, no matter how solid they may be.
  8. cb_rn

    Why apologize to doctor when calling?

    Nothing wrong with saying sorry to wake you. Being polite is always in style. I just get ****** when we have to sit around and hem and haw about whether we really have to call the doc in the middle of the night because we know certain docs are gonna be jerks. It really compromises patient care when we tiptoe around certain docs and hate to "bother" them. this doesn't just extend to middle of the night calls. My thoughts -- if you didn't want to take calls about patients, become a medical examiner. I do apologize for needing to wake someone because its no fun, I don't accept bad behavior from anyone, no matter what credentials are behind their name.
  9. cb_rn

    Stop! I don't want someone like you touching me!

    Just had a situation where patient refused a dialysis cath because the doctor was from a foreign country. The patient also refused virtually all care from any non-caucasian nurses on a floor where very few of us are caucasian. It was a very unpleasant situation.
  10. cb_rn

    Getting hit on at work?

    I find your response a little bit flippant. I started working mental health at age 18, stayed there almost 8 years. Yes, I got hit on. Most everyone did. However, the fact that they were psychiatric patients or that we were unusually attractive staff (kidding ) had little to do with it. Its not just pretty nurses that get hit on. Sometimes patients think they develop romantic feelings for their caregivers due to the fact that we show care and compassion. Often its not even a real "pass", its an older gentleman trying to deny his illness by pinching the young nurse on the fanny or in psych it could be a patient trying to get attention by saying something outlandish and inappropriate. Patients often perceive themselves as being in powerless positions and making suggestive comments is one way they try to tilt the power balance more to their side. Don't make the mistake of thinking any wolf whistle, suggestive comment, or come on is all about the unadulterated animal sex appeal of the recipient. Understanding the probable motivation of the come on helps to dictate the response that will help stop the situation. Often if it is genuine interest, a gentle let down by the nurse is appropriate and often solves the situation. If it is due to the patient's self image, addressing those issues can help identify other outlets to help the patient deal with self image. A persistent family member could just be trying to deal with the stress of having a sick loved one. If its a cry for attention, state its inappropriate and then ignore. If its about the power balance, provide nursing interventions to help the patient feel more like he or she is the driver in her care. Dismissing all come ons as simple responses to sex appeal is a mistake and a missed opportunity for a nurse to identify possible issues and need for interventions with a patient. It doesn't matter who you get hit on by, sociopath or man down the street (who may be a sociopath, you never know).
  11. cb_rn

    Picking RN jobs

    Hows the job market there? If its tight, I would snap up the actual offer. You can switch to a position of your choice after you get some experience. A new grad program, especially on a specialty floor is INVALUABLE. Literature supports a strong orientation for new grads efficacy in providing patient safety and new grad satisfaction. If you must wait, I'd request 72 hours to consider the offer and no more.
  12. cb_rn

    Need advice about job situation

    Sorry that happened. This is probably of no consolation to you but it is often difficult to transition into a nursing position when a unit is used to you in a more supportive type role. If the job market weren't so tight, my advice would be to never work on the unit you worked on as anything other than a nurse. Hope you can find a position in your hospital.
  13. cb_rn

    CA RN needs to move out of state

    Pick carefully which states you want new licenses in (most bang for buck will be a compact state) because the whole license thing is a giant money siphon. Every one you apply for will end up setting you back at least $100 by the time you pay for transcripts, background checks, etc, etc
  14. cb_rn

    The CA New Grad Crisis?

    the hospital may not be paying for benefits per se but they are reimbursing the agency hand over foot to pay for that experienced traveler's benefits, housing, and salary.
  15. cb_rn

    Telemetry Monitoring

    I worked at a large hospital with a big open heart program that was like this. We had a view of the central monitoring screen in every room up toward the ceiling that you could look up at and view everyone's rhythm. It was darn inconvenient but you got used to looking for your patients' boxes while you were in the room with others and recognizing the blue alert highlights when something funky was going on. If you don't have a view of the central screens in each room, I'd start campaigning with management to either install them or hire a monitor tech.