Davey Do

I concur with the others. Keep on keeping on, SilverBells. Have I ever stepped down from a role? As an administrator with two different agencies, I was laterally moved out of the door on one, and shown the door with an adieu of "Don't let the screen door hit you in the behind!" Now, I stepped out of a role working in the OR back in '91. I was in orientation and could do nothing to please my mentor. The final straw came when I was first scrub for the first time, with my mentor acting as the second scrub, on a TAH with a doctor referred to as "The Nazi Surgeon". In those days, each surgeon had a file card that listed the instruments and a basic outline of the procedure for a specific surgery. The night before the surgery, I studied that card til I knew it by heart. The surgery was progressing really well, so I struck up a conversation with the surgeon. At its completion, the surgeon said I did a good job and thanked me! I beamed! While cleaning up, my mentor said, "I know (The Nazi Surgeon) said you did a good job, but there were some areas in which you could improve". I resigned the next day and took up a position with another hospital where I had been previously offered a position. Good luck, SilverBells!

Yes. It's once again time for the ever-dreaded mandatory all-day dog & pony show inservice that I would prefer second only to marathon tag-team gum surgery. Four hours involve a boring four hour presentation by a droll self-important hypocritical short man syndrome certified CPI administrator ask-kisser. He reads from the booklet we all have a copy of things like "only an LIP or RN can terminate a restraint", yet does not follow the guidelines. For the whole story, you may want to read this thread: Thank you. Just putting together this thread has helped me to feel better.

I'm currently in the process of processing the events of this past weekend's three 12 hour shifts working in the psych division of Wrongway regional Medical Center. Processing does not always follow a chronological timeline so, like doing art, I tend to start at point a of reference and work from there. Chronologically, I need to digress to about two weeks ago when it was mandated that I attend... A portion of this mandated inservice entailed a CPI training where we learned to deal with acting out psych patients. Wadley, a tech, certified us in CPI for years but he passed away recently and is sorely missed... So now one of the instructors who I don't really know all that well, Clark, teaches CPI. Clark was once a tech, now has the title of art therapist, is a well built man in his early thirties, solemn, and possibly possessing a vertically-challenged syndrome. The book portion of CPI, where we learn and/or review legalities, policy & procedure, etc that was taught by Clark was a real bore. Basically, all Clark did was to read from the handouts in a low monotone. However, the actual physical portion was a real hands-on learning experience. I have taken CPI since the mid '80's and I learned a new thing or two and I let Clark know that I appreciated the tidbits. At the end of the training, I led a round of applause for Clark. Actually, I was relieved to be done with the day, for it truly was... Okay, that's enough of the background information. Sunday night, I was assigned to work the adult women's psych unit. I don't think it was my turn to be pulled, but as I told Mandy the house sup, "The next time it's my turn to be pulled, I want a Get Out of Jail Free card!" After getting shift report at about 1920, I introduced myself to the patients in the day room, and met them each personally. Then, in the company of the LPN, I went looking for the infamous patient, Marie A, who had been responsible for at least six staff injuries. Marie A truly was, the Psych Patient From Hell. I could go on and on and on, but please accept my label. At 1925, the LPN and I found Marie A on the floor, laying face down, between the beds, unresponsive. We couldn't see her breathing, she did not respond to our shake n shout, so we log rolled her to a supine position, as she was wearing a neck brace. The LPN did sternal rubs while I checked for a radial pulse to no avail. I told the LPN to go call a Code Blue and I tilted the patient's head back as best I could and got an sound like a snoring suck of air. Spontaneous respirations were present, I found a pulse, so I yelled, "Make that a Rapid Response!" and I checked her pupils and lightly patted her cheek. Marie A was groggy and slow to respond when the RR team arrived, we assessed her, backboard, gurney, yadda yadda yadd, and she left the unit at 1945 for one of her many trips to ER. At about 2200, I was in the process of admitting and getting med orders for a suicidal patient sent from ER suicidal positive for heroin, amphetamines, and cocaine who was yelling profanities and acting out when she knocked over a WOW. The tech and I assisted her into the locked seclusion room. About that time, Marie A returned from ER via wheelchair. I advised that she return to her room when Clark started some ramma lamma ding dong with her. I got between Marie A and Clark and proclaimed, for safety's sake, she needed to return to her room. In assisting Marie A to her bed, she became threatening and combative. A code Green was called and, with the assistance of Clark, techs, and security guards, Marie was therapeutically held. I recited, in a voice to be heard by everyone from rote memory, my spiel about the reason for the therapeutic hold, the legal process, and the criteria for the restraint to cease. I also said that I was going to contact the doctor for a chemical restraint. I went back to the nurses station and Mandy the house sup, God bless her, had gotten an order from the psychiatrist for Thorazine 50/Ativan 2 IM now. I set up two syringes and returned to the room to find Marie A out of a therapeutic hold. I said, looking at Clark, the staff member who certified me in CPI, and recited, "Only a licensed practitioner can discontinue the restraint process"! Or, "Do as I say and not as I do".

Congratulations on your position as nurse manager, SilverBells! I sense you will do a good job, knowing the facility and reaching out for ways to be a good manager. The director of a unit on which I worked had to confront me on not fulfilling my a responsibility. None of the nurses liked performing this non-patient care responsibility and avoided it whenever possible. The director said something to me along the lines of, "My job isn't any more important than your job, we just have different responsibilities. One of my responsibilities is to make sure you do your job. And, hey- you don't have to like it, you only have to do it!" I could get behind that- I didn't have to like it, I only had to do it! Another bit of wisdom I learned from this director was to always put principles before personalities. Personalities can be be in flux whereas principles are carved in concrete. If we adhere to sound principles, we can always deal with fluxing personalities. Good luck and the very best to you, SilverBells!

One of the great things about being an old, arrogant, crabby nurse with a reputation for quality patient care is that I can say just about anything to anybody since I possess pretty good communication skills, Daisy. I often say to peers and coworkers, "You can tell administration, 'Dave said...' and I will stand behind you and my words". I was joking with Jason Hiney RN once about me getting fired and Jason said, "Dave, you'd have to kill somebody in order to get fired from here!" Ranger Rodd RN said to me, after an inservice, "I'd say what you say in inservices if I knew I was going to leave this job!" "LIve to never be ashamed if anything you do or say is published around the world- even if what is published is not true" -Richard Bach

Exactly, Hoosir_RN. My belief is that the perpetrator has boundary issues and has never been been herded into the pen of appropriate behavior. They are allowed to roam free and unencumbered. Clark is a good example of this.

Thank you for your submission, JKL. It was a worthy read. I've taken a portion of your post to utilize as an example of playing chess, thinking several moves ahead. I had considered this counting thing as a possible retort administration might use and have devised a couple of comebacks: First, the concern is not about me being petty- it's about inappropriate behavior on the part of Clark which fits the definition of, among other discourtesies, harassment. My so-called "pettiness" is a red herring. Next, the whole CPI training, like many other inservices, are mere formalities. They are not actual educational processes by which we are given information and tested to assure our knowledge of that information. We are given the answers to the tests at the time they are taken. Actual listening and assimilation of the information is not a necessity when the accepted process is a worn and well known method. I have more ammunition to argue similar points, but suffice it to say I feel prepared for just about any opposing premise.

This caused me to laugh out loud: And I am truly sorry for your discomforts, @TriciaJ. When I read this, I thought , "She hit the nail on the head!" I'm going to be pouring over these posts for some time to come, but I wanted to say something about TriciaJ's before I took a break.

Well, this Dog & Pony Show was anything but boring, primarily due to a disagreement between me and the CPI instructor, Clark. The next three paragraphs are excerpts from my own personal documentation: As we were discussing page 15 which states, "the RN is responsible for patient care" and "RNs have the authority to initiate and stop the restraint" Clark said, "Anybody can initiate or stop a restraint". I spoke up and said, "I disagree". I stated that only an RN can terminate a restraint, that there is a process, and the RN makes the final decision, for which I received argument. Clark brought up theoretical cases, stating "What if...what if...?" and "some nurses will leave a patient in restraints even after they've calmed down". I replied that I was "not speaking of opinions, perspectives, generalities or other nurses". I stated, "When I'm the RN on the unit, and I am in charge, no patient will be released from restraints until I deem so". ...For years at past CPI trainings, a question has always been asked, "Who can initiate a restraint?" with the answer being "Anybody." The question that has always followed was "But who terminates the restraint?" The answer has always been "Only the RN." There's a lot more to this documentation, but I wanted to give you the gist of it. During the discourse with Clark, I also made a request. These next two paragraphs are excerpts from more documentation: I had to request that the CPI instructor Clark refrain from "flagrant profanity". Clark used obscene words like "p****d, a**, b*******', f***" a total of about 18 times before I finally voiced my request. Clark's argument was that he was merely repeating what a patient had said. This was untrue, in that his presentation was sprinkled with profanities, as I kept track on the pages of handouts. Also, Clark was not entering verbatim words used by a patient on legal documentation, he was merely repeating profanities as an example of patient behaviors. Clark could have been more appropriate by using euphemisms, or the first letter of the profanity. We all know what "F this! F that! F! F!" means without having to hear the actual obscenity. I'm considering using the documentation as communication to administration. I may just keep it for my own records. Any input from allnurses members will be appreciated. To end on a positive note, my supervisor, RoofElmo, during the inservice gave me recognition for my recent interventions and subsequent documentation. RoofElmo was referring to an adult male psych patient who medically decompensated last Friday. She also mentioned that the CNO praised me. I told my medical nurse wife Belinda that the situation would be one with which she routinely deals. But when a psych nurse medically makes a good call, they're a Rock Star Nurse! Or, in this case, a burned out 70's DJ Nurse!

I try to live by a code where I don't want to have to have external validation in order to feel as though I am a good nurse. However, when external validation is given, it feels good. In the past few months, I've identified symptoms on two patients, who are in their 50's, and got orders from the NP for labs. Both were transferred from geriatric psych to medical. One was experiencing a little GI distress and it was found that their lithium level was critical. The other was experiencing malaise, was on lactulose, and was found to have a high ammonia level. Often times, psych patients are labelled "somatic" and are written off due to their psych diagnosis. But sometimes, if it quacks and walks like a duck, it is a duck. I was running the copier the other day and happened to see my name on a form that was pinned to the bulletin board above it. I thought, "Oh jeez! What have I done wrong now?" The form, dated last November, recognized me for the above interventions. On another note, I received a call early one morning from my supervisor regarding incontinent patients found to in need of hygienic measures when day shift made their initial rounds. A nurse extern had been working the floor the midnight before and was believed to have not done his job. The supervisor requested that I round with the nurse extern to assure the patients' hygienic needs were met. I was caught off guard and taken by surprise at this allegation, but followed the supervisor's request. The nurse extern in question has proven to me to be a very good caregiver and was upset when I informed him. He said that he had checked on all the incontinent patients and/or provided care to them at the end of the shift. I immediately sent an email to my supervisor singing the praises of this nurse extern. I ended the email with a belief that I would not hesitate for this nurse extern to be in charge of taking care of me or one of my loved ones. I gave a copy of the email to the grateful nurse extern. I received a timely reply from my supervisor thanking me for following her request and for the support of the nurse extern. My supervisor noted that there may have been mitigating circumstances involved and that the nurse extern was only one of four staff members working that particular night. It felt good to to be able to support a conscientious, hard-working co worker deserving of recognition and to also have my opinion respected by my supervisor. I just wanted to share some of that good stuff with you all. There's more, but I don't want to get too big for my britches.

But the thing that I like about the mandatory modules online is that they can be taken in digestible bites instead of a cram everything down your throat all at once, JKL. And I don't have to deal with yawn-producing peers or presentors! There's always someone who wants to belabor a point, tell a story, or just profusely pontificate with which we have to deal.

This caused me to laugh out loud! And thank you for sharing with me your own professional Trials of Hercules, Katie. Mine pale in comparison. If your pain is a ten, mine is only about a four.

Your empathy is overwhelming, Daisy, for I feel as you truly feel my pain. In order to feel as though I have some control, I'm wearing what Belinda would call my favorite grunge outfit: Faded black Hard Rock T-shirt, black jeans, and worn-out tennis shoes. I won't be the most stylish belle at the ball.

Just a little retold story as to why I chose Jonny Fever as my Avatar: I worked with a couple of nurses who referred to themselves as Rock Star nurses. I asked one of them, "If you're a Rock Star nurse, what does that make me?" She replied,"Some old burned out 70's DJ like Dr. Johnny Fever!" Hence. On every other website, I use my Davey Do's cartoon character's face as my avatar. Somehow it seems more fitting to keep Dr. Fever here on allnurses. Thanks again for all the welcome backs!

Again, I'm sorry for your predicament bit it is what it is, nurse_lime. Red flags and fireworks should have been going off. A couple of years ago, I came onto the geriatric psych unit to find (someone's) name on the patient list and immediately contacted the House Sup to work another unit. He gave me grief, but I stood my ground and told him I felt uncomfortable, and if push came to shove, I would refuse to work. I got my way and refused to discuss (someone) with any other staff member. In 1979, while I was going through the EMT program, 15 years before HIPAA, confidentiality was drilled into our heads. I won't even discuss some patients at all with my wonderful medical nurse wife who I trust with my life.

HIPAA is overkill protecting patients' confidentiality. Any contact outside of the realms of the professional relationship is a violation. In other words, HIPAA believes that if you say the word "murder", you've committed a murder. (Disclaimer: My subjective perspective.)

Yeah. Sorry about the situation, nurse_lime, but as you said , "I know I was Unprofessional and crossed a boundary but in my defense it was an old family member and my heart was in a good place. But then again I never should’ve contacted her regardless." As soon as I've found out a family member, ex or not, is a patient, I distance myself and do nothing to jeopardize confidentiality. Sorry & good luck to you, nurse_lime.

I bought my first Mad Magazine in May 1970 (for 35 cents at the hormonally pubescent age of 13) and it changed my life. I felt as though I had come home and these people spoke my language; the language of spoof humor. As Mad Magazine had comics of "(Various Things) We'd Like To See", I give you "Nursing Ads I'd Like To See":

From the quoted portion of the deposition, it was as if the liability insurance had found me guilty of the charges without further investigation. Luckily, the jury ruled in favor of me and the plaintiffs received no compensation from the suit waged against me. A judge dropped criminal charges, so all's well that ends well.

Makes ya kinda wonder, eh CSUSM?

There have been a lot of past threads on this subject, CSUSM. Try putting "liability insurance" into the search option and you'll get a lot of hits.

I admire the fact that you're doing some gathering of data in your problem-solving process, vanilla_brownie. I echo the advice of others: give nursing a real chance before you make this major life decision. In life, everything we choose to do, the roads we take, and the people who we have relationships with, have their assets and liabilities. The decision is up to us on whether we want to deal with the liabilities in order to experience the assets. Good luck and the best to you, vanilla_brownie!

I am a member of a website that specializes in comics that has similarities to allnurses, in that it has forums and a similar color scheme. I submitted a comic in my own series, where I travel the website with my dog having adventures with other characters on the website, that was nursing related. I changed the name of this particular character's name to CPR Mouse and put it in a hospital gown and bed.