RaeRae1997

I've seen patient's with HR 100 on monitor, but having bigemny PVC's. When I palpated radial pulse I only got 50 because they were not perfusing the PVC's.

Hope you can find something better.

I think if you have one of those vanity type RN plates your just asking for someone to suddenly cut in front of you so you can cover their, "Owe my neck hurts" when you bump their rear. Lots of people think nurses are loaded.

I worked nights for many years I totally agree with this comment, except Melatonin worked best for me. I guess everybody's body reacts different to meds. I also tried to work all my nights in a row to keep a certain schedule for as many days in a row as possible. GOOD LUCK. Also know those who have been around a long time and work day shift now, LOOOOOVE you for working nights so we don't have to.

You thought fast and acted fast. Way to go! You also learned an important lesson that most nurses don't know till it happens. Everybody in the hospital or having a procedure is a fall risk (some obviously more than others). Just keep it in the back of your mind and you'll always be ready in the future. I'm sure a lot of my patient's think I'm a worrier cause I always make pt. sit up on side of bed for 5 minutes before getting up. Once they stand I make them stand for a few minutes beside the bed, that way if they start to get dizzy or faint I can push them back toward the bed. I also use gait belts, so I can keep a good hold on them and control any fall without hurting myself or them. Yes, I'm a worrier but I always liked that boy scout motto about being prepared. I've found the times bad things have occurred I didn't follow that "be prepared" motto and ended up getting burned. I also try to ask my patient's who are allowed oob if I can help them to the BR frequently, that way hopefully I can prevent a sudden immediate urge to get there fast. By the way I fell out one time at the dentist, I wish someone would have been fast on their feet like you were, cause I ended up with a big knot on the head and horrible headache.

AACN.

Most places have a written policy on that matter. Look for yours and follow it. I would think yes this would be a HIPPA issue without written or verbal permission.

Take care of yourself first. Get well. It seems very inappropriate for her to even ask you this.

This makes me so sad. I don't work with children, to hear about one being traumatized like that rips my heart. I've only taken care of one deaf person and never had to think of this issue because we didn't use restraints. I'll be aware to never put an IV in a deaf person's hand, I'd just never really had thought about it d/t not taking care of many deaf patient's. Thank you for sharing this so we can all be more aware in these instances. I feel so sorry for the child and family. If it were my kid I'd be fighting mad.

We put all our vent patient's on peptic ulcer meds to decrease incidence of VAP.

I made a decision somewhat like yours. I was going to my local community college working on a 2 year AS degree while I was on the waiting list for ADN program, which at the time took forever. So by the semester I was to graduate with my AS degree, they accepted me for the fall semester in ADN program. I had a nice boyfriend at the time I had been dating for a year. I also had applied to several BSN programs d/t taking so long to get into ADN program. I had got accepted to BSN program, 4 hours away from where I currently lived. I had to decide, do I want to stay here, do 2 year ADN program or move 4 hours away and do 2 1/2 years and have a BSN when I'm done. I really didn't consider the guy I was dating at the time. I just went for the BSN. I figured we'd keep seeing each other on weekends or whenever we could. He didn't see it that way. He said he didn't want to see me again. I was broken hearted at the time but soon figured out if he was really important to me I would have made that decision based on his needs as well. All ended good because I met and married my husband of 16 years and got the BSN from the school that was 4 hours away. All I'm really trying to say is what is your fiance saying about this? Also put your mind in the future, say your lying in your death bed. When your looking back over your life what do you envision would be your most important memories and let that guide you. I wish you the best. Even if your dream of being an RN is delayed a little you could still obtain that goal.

I'm glad to hear your there for your team members and advocate a safe environment. Now that your one of the most experienced staff everyone will look to you for guidance and it sounds like they have a great resource. Just be careful with considering family members assistants, if something went wrong and they got injured, your workplace would have a huge risk management disaster. They are not trained CNA's, RN's, or LPN's nor are they employee's and that would probably be a lawyers first but not only thing he or she would come up with.

I so agree. If it can happen, it will. (eventually)

:ancong!:

I agree. Plus you would be putting your BS degree to good use. But anyway you can get your foot in the door and it works with your schedule is a good thing. Sending you good luck wishes.:tinkbll:

Sounds like your a hard worker. That's always a valuable asset. I think whatever you can do to get and keep your foot in the door and prove what a resource you are will increase your value to the company and chances of getting the RN position you want in the future.

That Md was so wrong. I bet they won't mess with you anymore though cause they now know you won't put up with that kind of behavior.

I went to an all day pain management class that helped me with issues like this, it really gave me better understanding. Distraction is a method of pain management, maybe while someone is talking with her it helps a little or maybe she doesn't want people to know until they ask because she is afraid they will end their visit if she complains without being asked. I also wonder if some patient's have been trained to act out because in the past they just told nurse or Md they hurt but were stoic about the pain and subsequently got nothing. I used to be afraid to give someone who had been on pain meds a long time what seemed like a huge dose. I was afraid I'd be the last person to give a dose of med and the patient would die. Someone in the pain management class stated, "would you rather be the last person to give a person medicine to decrease their pain or the person who made them suffer till they died because you were afraid to give that dose". Some point will come where there will be a last dose. I think I've probably been played plenty of times because of this philosophy I adopted but so be it, if it's ordered and they say they hurt and want something I give it. Sticky situation, glad I work in a hospital not hospice, sounds like there are loads of factors your dealing with there that I can't even comprehend from my perspective.

Looks like your nurse manager is trying to stay on budget. It seems like it would be across the board throughout the hospital. I know at my hospital there are some floors you can go work extra to get OT but there generally giving it because it's not the best floors to work on, but even this has decreased over the past few years. Occasionally we get OT if our census is up but we have to have some kind of justification. I think the economy thus our ability to make extra money is going to get worse before it gets better. It sucks not getting a raise our hospital experienced this for the first time last year. I work at a really large hospital that pays way better than any others nearby so if I decided to be ticked enough to leave I'd be making less anyway. I just deal with it and try to remember the positives outweigh the negatives where I work.

I think med errors need to be written up not as a form of punishment, but because the hospital risk management teams really need to evaluate trends. It's good to see if a certain type of error is made frequently and figure out why. If you made the error, 100 other nurses may have made the same error and may not have even realized it. We need to change our whole mentality about reporting errors. Look at it as a way to improve care, and learn from mistakes so that we don't repeat them. I'm in no way saying would should tolerate those who make repeated intentional errors because of laziness or lack of concern. I know I personally have learned from lots of unintentional errors I made due to lack of knowledge or because the way an order was written, etc. I know not all hospitals are embracing this concept, and I remember in nursing school to be written up was absolutely horrible. In the past 3 years my hospital has established a safety coach committee. We meet once a month with staff from risk management. People on the safety coach committee are people who work on the floors. We try to encourage people to report errors and look at errors from a different perspective. Errors usually are not made just because of one factor, there are usually lots of contributing factors and we have been able to look back at these errors then implement ways to prevent it from happening in the future. The way your supervisor dealt with it makes me believe you probably work in one of those places that doesn't look at reporting errors as a way to learn, not punish and I'm sorry about that. One day when your in charge and someone ask should I write this up I'm sure you'll deal with it so much better than your current supervisors because of your experience.

It's your license, you worked hard to get it. Find out what your written chain of command is at your workplace and follow it, because lawyers will be looking at that. You are your patient's advocate. Follow the chain of command if you must. I understand if your new and want to run something by the charge nurse but if she gives you advice that makes no sense to you, ask in a nice way what her reasoning process on the subject is so that you can learn. By the way, just because it's late is not a reason, just an excuse. Make sure your giving all the details, and assessment changes your seeing happen. When you call the Md, have your facts together and a plan for what needs to be done. We use SBAR at our hospital to give report. That means give the situation, background, assessment, and your recommendation. Also have your request ready, your more likely to get whatever you want if you ask for it directly. So what if the doctor is irritated, it's not your job to keep him happy. It's your job to keep his patient's safe and improving. When I first started I worked at a small private hospital and actually had Md tell us, "don't call me I'm going home to sleep". At first I was naive and in awe by Md degree and experience and my lack thereof. After I saw and experienced a few things happen like your relating I started looking a things differently. Just because I don't have Md behind may name it does not mean my decision or thought process is faulty. I'm the one there who sees what is going on, Md's are going to hear about it if I feel like they need to no matter what anyone else thinks. My response to don't call me became,"would you rather me just wait till they code then call you after the fact?" After 3 years there I went to a large teaching hospital. We are encouraged to ask, advocate and assert. It's not being rude or disrespectful, it's just a matter of always doing what's best for your patient. Being assertive is something that will be learned real fast after you've been burned like this a few time. Have confidence in yourself and your skills, you were on the right track but just missed a connection.

I think most hospitals are doing what they can to cut cost and stay in business. We're living in some tough financial times right now, their are lots of people who don't have jobs. It's an employers market (lucky them). If PRN staff get paid less than you do at time and 1/2 it makes financial sense to maximize their hours and cut as much OT as possible. It also make sense to maximize their hours because at most places PRN people don't get benefits, so if you have tons of PRN people hospitals decrease the amount spent on benefits, which is huge. It really sucks loosing OT if you counted on it to pay the bills. I've always just counted on my base rate at 36 hours per week to pay bills, if I make any extra OT it gets spent on the nice little things in life like vacation.

Really great question, your trying to think of what's best for the patient so that's always good. I think everything needs to be individualized. It's important to find out what the patient and family wishes to be done, taking into account skin integrity risk or known issues. Use the braden score to guide you with the last part. If you took care of someone a week and noticed that every time you checked their bed they were dry till 4 am, wouldn't just make more sense at that point to just do a visual check and move on until 4 am. Since you know there is a set pattern of wetting at that hour. I also think it's a good idea before bed to offer to assist folks with any bathroom needs. I work in ICU, we don't have a choice, people are woke up frequently due to multiple needs. However in any setting I know it's important for people to get rest. You function a lot better, heal better and enjoy life more with adequate sleep. We try to do our care in lumps, when the NA goes in to do 2 hour turn, measure urine, check chucks and do mouth care on vent patients, I go in, do assessment and give meds. That way we can minimize our disruptions to sleep. I worked nights for 11 years, it sucks to wake people up, but if people can't move on their own it's important that they are turned and check for wetness q2. Q2 seems like a lot of waking up but it's better than getting a horrible infected bed sore. I hate being woke up myself but it's just one of those necessary evils. Good luck. Know what would be the coolest idea. It would be great if they had pads or diapers resonably priced that would wick moisture away and put off a bright glow sort of like glow lights when wet. Oh yea, moisture barrier is my best friend. Everybody makes fun of me and tells me I keep the moisture barrier ointment companies in business.

i don't disagree that their are lot's of nurses in drug monitoring programs, have suspended licenses, and/or have lost their license. i've even worked with one who ended up in a drug monitoring program (and that's a whole other interesting story there). i just think we are a society of give me one more chance to get it right even though i messed up in a real bad way. personally i'm sick of this whole, "i deserve one more chance" mantra. how many one more chances are there? i probably feel this way cause over the years i have had to work with nurses who are lazy, dishonest and just don't care. yet they keep getting one more chance. others have to work harder to pick up their slack. if we want the world as a whole to hold nursing in high regard, respect us, give us a hand in shaping the future of healthcare, we have to prove ourselves worthy of the honor and only accept the best of the best into nursing schools and our work places. we need to set high standards. in healthcare you don't always have one more chance. sometimes there is just one opportunity to get it right, if you don't get it right someone dies. in reference to the rn who "sacrificed" you to the physician, i assume what ever this person said about you was a lie and that's why it irritates you. it seems like this would be an argument to get rid of people who are dishonest before they have a chance to get rn placed behind their name. yes, all our s*** stinks. i agree with this too. i'm not saying i've never made mistakes. i'm 100% sure i'll make more. the difference is there are unintentional and intentional mistakes. dishonesty is a very intentional mistake that should not be tolerated. if we would refuse tolerate it in nursing schools their might be less nurses out there putting blemishes on the title of rn and lpn.

All it means is your normal. Almost everyone of the really good nurses I work with recount having had these same kinds of feelings.