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totallackofsurprise

totallackofsurprise

ER, Perioperative
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  1. totallackofsurprise

    Help! Had to Quit My Job, Now What?

    Have you considered registry/per diem RN work at a hospital or clinic, or through an healthcare staffing agency? The trend in hospitals now (at least in non-profit community hospitals here) is minimal staffing, expanded with registry/float pool/agency RNs when needed d/t higher census/acuity. You would still be oriented to the hiring hospital/unit, + it's a way to get your foot in the door & prove yourself on the job. I got hired to a couple FT staff RN positions, as a result of initially working at the hospitals on agency contracts. OTOH, if you don't get many registry/float/agency shifts, your bedside skills will stay rusty, longer.
  2. totallackofsurprise

    Tell me this doesn't happen all the time.

    Was the surgery originally supposed to be outpatient surgery, or was your daughter supposed to be kept over night? That would determine what unit she went -- or was supposed to go to -- after she was out of PACU. My boyfriend just had a sigmoidectomy a week and a half ago. They did not change the surgical dressing for almost 24 hours. When I asked why, the ICU nurse explained that the surgical team had left instructions for the wound dressing to be left in place unless it was saturated. Because his wound was stapled with 28 staples, it didn't need changing for almost 24 hours. His first dressing removal/change was done by the surgical resident and team, not the ICU RNs. Perhaps this was supposed to be the case with your daughter? I can't say why your daughter was treated the way she was, but if you (and she) are that concerned, you/she should have talked to the nurse manager on the floor, and possibly paged the surgeon/surgical team to see if the post-surgical care orders matched up with the care she was receiving. Also, you have a perfect right to complain and demand some answers. Most hospitals now are afraid of lawsuits and malpractice -- they will want to know about poor treatment, and they will probably want to know the name of the nurse who cared for your daughter. As for yanking the dressing/packing out -- I have been changing my boyfriend's dressings and I can tell you, it's much more painful for him if I slowly pull tape and dressing off, than if I take it off quickly. Maybe that's what the nurse was trying to do? You need some answers; go get them. Get some satisfaction. Your daughter has a right to get her medical file for that admission and see her chart. If you choose to do so, then you can compare what was ordered with what was done.
  3. totallackofsurprise

    HELP! Newly RN, poor clinical background, where do i start

    If you are a new grad or haven't worked as an RN before, most hospitals will put you on some kind of orientation or precepting. No one gets out of nursing school with good clinical skills -- unless they were a medic in the military before or were previously a phlebotomist or medical assistant. If you get orientation, you will probably receive instruction specific to the institution and unit where you are hired. For example, if you have to draw blood or start IVs, they will make you attend hospital-based classes on drawing blood, proper procedure, order of the draw, etc. Precepting is working with an experienced RN. Usually you will do both -- orientation classes *and* precepting. While you are precepting, tell each of your preceptors (if you have more than one) about your lack of clinical skills. They are used to this. Tell them that you need to observe for a few days before you start trying to draw blood and start IVs. I can't tell you what you will need to know because it depends where you get hired and what you'll be doing. Nursing home care is different from in-patient hospital nursing. ICU nursing is different from med-surg. Wherever you go, you will be oriented and trained. STAY ON ORIENTATION AS LONG AS POSSIBLE. Many units and hospitals will want you to come off orientation early if you show good progress, but you shouldn't do it unless you are very confident. You *need* that time with another experienced nurse, even though at the end of it, she will probably be reading magazines because you are doing all the work because you *can*. There is a big gap between the "book-learning" of nursing school and "real world" nursing. It is tough but it is do-able. Try to get hired at a hospital or facility that orients/precepts new grads for a MINIMUM of 16 weeks. Six months would be better, but let's not reach for the moon.
  4. totallackofsurprise

    Cna bonding too much with me...

    When I first began nursing, I was shocked at how little f/u there was for psych patients. Often depending on the person's insurance (or lack thereof), they are supposed to make their own appointments. You can imagine how well that works w/people who don't want to take their meds, or go to counseling, or both. Also, depending on insurance, often the first (& only) f/u appointments psych patients get after discharge from a psych facility is with a psychiatrist so they can continue to get their RX meds. There is a distinct prioritization of meds over counseling by HMOs. It makes sense, but some people need more than that. If she's not interested in talking to a crisis line, she may just not want to really examine what SHE does that contributes to the chaos in her life. The hypersensitivity you point out sounds more to me like borderline personality disorder (BPD). For people with BPD, their close relationships can often be summed up as "I hate you -- don't leave me!" And, unfortunately, there aren't meds specific to borderline personality disorder. It's very difficult to treat. Anyway, just detach as best you can, slowly stop taking her calls over time, and try to change the subject or distract her when she starts revealing all her TMI again. That's about all you can do. Like someone else said, I would not involve management mediation. It is better for you to assert yourself -- and it will be more effective with your co-worker and will give you more confidence, if you do it yourself, rather than having management mediation "do it for you" so to speak. People tend to see others who need to involve an authority figure as "weak" even if it is the appropriate thing to do -- and you do NOT want this person to view you as weak; then she will take even more advantage. Be kind but firm. Be strong! Good luck. P.S. I work in a low-income neighborhood hospital and I have heard from patients that many are being kicked off of disability. Truly *disabled* patients have told me this. Others have said that SSI is rejecting all new applicants. A social worker once told me that if you have held down a job for more than a couple of years, no matter what your mental illness is, you don't qualify for SSI/disability -- you've been too functional for too long. Being functional leaves an electronic/paper trail of income tax and SS contributions. So no matter what a person says (or how they fake mental illness), their work record will speak louder. If your CNA coworker has held down a job for more than a year or two, she's not going to get SSI/disability -- not in this economy. You might want to let her know about this before she really screws up her life. You can say you heard it from an inner city ER RN...
  5. totallackofsurprise

    Cna bonding too much with me...

    You sound like a kind person who has gotten unintentionally involved with this person due to her lack of boundaries and your need to get along. I understand allowing a co-worker some liberties because it's just you and she stuck together at night, and if you don't work together well, things won't work at all. You also sound like you've done a bit of amateur psychological analysis of her. But you're a nursing student, not a psychologist or LCSW. Put aside your ideas of what's wrong with her and concentrate on what needs to be done. The basic problem is she is troubled mentally -- how, we really don't know, and a psych nurse, LCSW, psychologist or psychiatrist are really the only qualified people to judge exactly what is wrong. The only reason you need to know or make an educated guess what her diagnosis is, is in order to extricate yourself. How you react could possibly cause a specific type of reaction on her part. Based on her behavior, she sounds very needy -- needy of attention (telling people she was hospitalized), and needy of a friend. She also sounds like she has poor boundaries -- there are many professionals with mental illnesses their co-workers would be surprised to learn about because they don't go around telling people they're mentally ill or were hospitalized. (I will leave it for another thread to discuss the ways in which mental illness could be de-stigmatized if such professionals DID surprise their co-workers or others in their personal lives by revealing that they have a mental illness.) She also sounds like a "drama queen" -- a non-professional term but an accurate one. She might be histrionic, as you say, but there are so many other things it could be. I knew a bipolar who was *constantly* starting drama because she lived off it. First your problem is the way that she has pushed into your life -- and the way that you have allowed it. It sounds like you let it happen initially because you were trying to be kind and you were also very practical: you have to work with her, so maintaining a good working relationship is important, and avoiding friction is also important. Second, she has accepted the invasion into your personal life as the status quo, and pulling yourself back (or pushing her boundaries back) is going to upset that status quo for her. Your knowledge that re-setting the boundaries more appropriately is healthier for both of you will not change the fact that she will undoubtedly perceive your withdrawal negatively. Third, you still need to maintain a good professional (if possible) working relationship, in order that both of you can get your work done on the shift where you depend on each other. So, first of all -- you need to be honest with her. Don't make "You" statements; make "I" statements. You have to tell her how you feel, but without red-flagged words that can distract a dramatic person from the point. The less you make it about her, and the more you make it about you, the better her reaction will probably be. From what you've said, you sound uncomfortable with the way things are. So tell her that. Say, "Jane [whatever her name is], *I* am very uncomfortable with the way you're always telling me your personal problems and telling me very private things. *I* don't know what to say when you tell me such things, and *I* am not the right person to talk to if you need help. If *I* were in your shoes, I would try to find a counselor or clergy person to talk to -- someone who is qualified to give you advice and make suggestions. *I* might also try a support group, such as Families Anonymous or Emotions Anonymous [or AA or NA or whatever else might be needed in her case]." You also sound like you're worried. So tell her that. "Jane, *I* am worried that you reveal too much personal information to people here at work. It could have negative consequences for you. *I* am afraid what people will say about you behind your back because people always gossip in work places, that's just the way work is. If *I* were in your position, I would keep many of the things you tell people to myself, because *I* would worry how they would use that information." You also sound like you feel burdened. So tell her that. "Jane, *I* feel helpless when you tell me all the rough things you're going through, because I know that I can't really help you, but *I* can't un-hear it once I know it. *I* am having a hard time listening to all of this stuff from you because it is upsetting to *me* to have to hear it and know I can't do anything about it or help you. *I* would appreciate your discretion on these matters because *I* feel it's too much information. *I* would appreciate it if you would give me a break." Believe me, I have been where you are, and I've had to have such difficult conversations. Some people, you can't sympathize with them, because then they will just pour more misery out; you can't advise them, because they have a million "Yes, but" reasons why they can't do what you're advising; and you can't solve their problems for them (unless you can demonstrate that they're a danger to themself and/or others, and have them appropriately committed). And, I myself suffer from major depression, atypical, so I also understand the perspective of a truly mentally ill person. I have been on medication for 20 years to manage my depression, and I've been able to hold down jobs without informing everyone I work with that I'm 'mentally ill'. A couple decades of meds and a decade or so of counseling has let me get very good now at stepping back from my "feeling state" to a "thinking state" and examining whether my judgment or behavior is rational, and try to modify or adjust my judgment or behavior. But many (if not most) people with mental illness, especially younger mentally ill people (I'm in my 40s) can't do that very well, because it takes *living* with your disorder and *trying* to function -- and treatment -- to develop these skills. And that can take years. (In my case, it took my 20s.) I can recognize when I'm not thinking straight or when I'm using poor judgment, perhaps because of a situation (recent loss) or a change in state (PMS mood swing). But many mentally ill people can not do that because they simply don't have the experience and/or have not had quality treatment over a long enough period of time to learn how to do this. And some just aren't motivated. I wanted to graduate from college; I wanted a career; and when that ended (lay-off), I wanted to make a career change (to nursing) and, once again, graduate from school and have a career. I am not the most mentally healthy person in the world, nor probably the most mentally healthy RN, but I am functional and patient care under me never suffers because I am committed to my work. (And also because -- due to recent sickness and loss of my parents and a step-parent -- I have been in patients' or family members' shoes, so I know what it is like for loved ones to be hospitalized, and I try to care for patients and their families the way mine were -- or the way I wish mine had been.) Some people, however, are too caught up in their own problems to be motivated to try to be functional and productive, and they don't have the years invested in realizing that it is healthier for them to try to be functional and productive; they want the "easy way out" and to not have to try, sometimes because they just want to be lazy, and other times because they truly believe they're incapable. (And, for some seriously mentally ill people, they truly *are* incapable of being functional and productive.) I'm not sure which it is in your CNA co-workers' case, but your statement that she has indicated she would like to use the mental illness to have to work less or work less hard means she may be one of those types of mentally ill people. The problem for people like your CNA co-worker is that, if you told them they were mentally ill, they probably wouldn't believe it. Obviously she's going around saying she was hospitalized, so she has probably been diagnosed (if that is even true -- the hospitalization). But it sounds like she has a total lack of self-reflection and no ability to analyze her own behavior. So a lay-person (you) diagnosing her mental illness and telling her what's wrong with her just won't work. If she's trying to shirk work as you think she might be, she will both want a mental illness diagnosis but will also maintain within her own mind the belief that she's not mentally ill, she's just misunderstood, or she's "special" or whatever. If she was actually hospitalized for a mental illness, I would suspect she has been RXed meds and either never took them or took them for a while and stopped (that's the #1 reason why psych patients wind up in ERs -- they stop taking their meds). Understand that some mental illnesses (like many chronic illnesses) are hard to treat because the medications have unpleasant side effects and patients tend to become non-adherent. Also, for bipolar and schizophrenic patients -- and some anxiety-panic disordered patients -- being in the mentally ill state (psychosis, for example, or mania) feels "good* physically. They don't need to sleep, they have energy, they think rapidly, their senses are very keen, and their possible hypervigilance feels like a positive quality. (For many, this will all eventually spiral up into being overwhelmed with racing thoughts, inability to focus or concentrate, visual and auditory stimuli, forced speech, inability to complete tasks, unproductive agitation, paranoia and/or delusions, and an otherwise total breakdown in ability to function in the world and with other people -- but the ride up to that peak can take some time.) Taking appropriate medication (antipsychotics, antianxiety meds, etc.) *dulls* all of those seemingly positive physiological qualities. Personally, I've always thought that if you have to have a mental illness due to heredity and/or environment, depression is the best mental illness to have -- because you WANT TO TAKE YOUR MEDS, because they make you feel *better*: the fog lifts, you have more energy, you can focus and think more clearly. This is not the case for schizophrenics who take antipsychotics, or bipolars who take antipsychotics, or some anxiety/panic disordered folks who take anti-anxiety meds. Most of those meds slow people down, and some of them have unpleasant side effects like weight gain, muscle tics/tardive dyskinesia, decreased libido, anorgasmia, erectile dysfunction. Also, for any of these diagnoses (schizophrenia, bipolar, anxiety/panic disorder), it is not uncommon for suspicious, paranoid, or highly anxious thought patterns to make them afraid to take their meds, either because they are delusional and think the meds will allow others to control them (schizophrenia, bipolar) or because they are afraid the meds will dull their thinking/behavior or are harmful and/or have harmful side effects (anxiety/panic). So, yet more reasons why people with these diagnoses are hard to treat and have difficulty adhering to treatment and medication regimens. The point is, whatever your CNA co-worker's diagnosis is, you don't know. So you don't know if she's getting treated or not. If she was recently discharged, she was probably RXed meds; but if her behavior hasn't changed much, she may not be taking them as directed or at all, for the above-mentioned reasons. This makes it all the more imperative that your statements be about *you*, not her, to minimize her negativity and potentially hostile reaction (depending what her disorder is, she might think you're "with them" or that you've "turned against her" or that you "just don't get it" or aren't up to "her speed" or whatever). If you appear to take on the inability to cope -- i.e. the mental/emotional weakness within the dynamic you two have established -- it will inevitably change the dynamic, because she is used to you being the "stable" one, and she is also completely unable to consider the point of view of anyone but herself (what she needs, what she needs to talk about, what is going on in *her* life). By stating your uncomfortableness, your worry, your feelings of being burdened or knowing too much info, you flip it around (we hope) and force her to consider how *her* actions make *you* feel (if not how they affect her). But remember, this person probably has a limited ability to look at how her own behavior and impaired judgment are affecting her own life. So there is probably nothing you can do *for* her -- and probably all you can do is protect yourself and establish and maintain healthy, firm boundaries. Stop taking her calls. Don't "cold turkey" on her calls, but start taking only 1 out of every 2 calls. If she asks why you didn't pick up or didn't call her back for the 1 out of 2 you don't take, just say you were "busy", you were "out" or you had a headache or other ailment and were laying down or sleeping. Then, days or weeks later (depending on how she takes it and how fast you think she can accept your emotional "weakness"), take only 1 out of 3 of her calls. Then only 1 out of 4 of her calls. And, while at work, throughout this time of taking fewer and fewer of her calls, continue to use "I statements" (I'm uncomfortable, I'm emotionally exhausted, I'm worried, I feel helpless, I can't do anything, etc.) to maintain and firm up your boundaries. Whenever she starts to go into her usual behaviors and too-intimate revealing of personal information, you need to speak up and use "I statements" to re-iterate that you can't "cope" with her TMI. If she persists, you must get up and do something different -- say you have to go to the bathroom, you're going to the vending machines, you left a patient on a commode, you see a patient call light, whatever -- just reinforce that you can't (and won't) continue to listen to her drama by excusing yourself. Hope this helps. Remember, while you may have begun to listen and to accept her too-intimate confidences out of kindness and practicality (of needing to get along), it is kinder in the long run to let her know that her behavior is off-putting and socially unpleasant. In therapy with some behaviorally disturbed or autism spectrum disordered kids, sometimes therapists put 'healthy' (or healthiER) kids with the behavioral problem kids, because it is through the social relationships, the healthy kids' maintenance of boundaries and appropriate behavior, and through the modeling of social behavior, that the disturbed kids learn to modify their own behavior. (Assuming they're not too disturbed -- which, if they are, and they're dangerous to other kids, they don't get put with others, anyway.) You can be that healthy person with appropriate behavior, modeling normal social behavior, and helping her see (probably on an unconscious level) that something with her behavior with others is "not right." Because she is already an adult, she may have a limited ability to learn, but unless she is *really* in a mental health crisis (i.e. psychotic, delusional, in the middle of a panic attack), she will pick up on your overt cues if not your subtle cues. And by using "I statements" and making it about yourself, you kind of force her to consider *others'* feelings, which it sounds like she is too wrapped up in her own dysfunction and drama to do. She may not survive this transition. From what you've said, she sounds quite overwhelmed. (Did she hospitalize herself, or did someone else hospitalize her?) She may act out. She may wind up hospitalized again. She may also be crafting a "mental illness/disability" pattern of behavior, so that she can work less and not get fired under ADA rules. (This may be part of why she has openly told some people she was hospitalized for a mental illness). Try not to be contemptuous. Most people who want to work less *do* have some kind of emotional or mental problems. I mean, we ALL would like to work less and earn more, but healthy people realize that's not the way the world works. Healthy people also realize that we would lose some self-respect, dignity, and/or pride if we did actually get paid or get government assistance to NOT do that which we are perfectly capable of doing. And most healthy people enjoy getting out of the house and being productive. Of course, in the case of nursing, many of us hate the stress involved, so it's a fine line... but it's relatively safe to say that most people in nursing, or who remain in nursing of any kind, get a sense of fulfillment from helping others. And helping others also helps us forget about our own problems and gain some perspective on how 'bad' we think our lives are. (There but for the grace of God/Gaia/Allah/Krishna/The Great Spirit/Buddha go I...) Go slow, but go as fast as you can. It is better for both of you in the long run. And, being hospitalized is not the end of the world for this woman if it happens again. Sometimes it allows a person to get their disorder under control, because they're not doing it by themselves in their own (unstructured) life -- they are in a supportive environment with structure helping them to self-regulate and stay on their meds. (Of course, this depends heavily on the facility and your insurance... sadly.) Good luck. You will need it. And, try to learn from this! Remember how this person made you feel initially -- most likely, you had some kind of gut reaction about her oddness or too-quick sharing of intimate info -- and think about that gut instinct you had. Use that gut instinct in the future to be more selective in how personal you get with co-workers. When you get that "funny feeling" about someone, maintain your distance, detachment, and always use "I statements." In general it's best to use "I statements" with ALL people. It clarifies communication and is direct and honest. (Unless, of course, you're lying -- but in this case, you're not lying -- you really are uncomfortable and stressed by this relationship with this CNA co-worker, the things she chooses to share, and the way she frequently contacts you at home.) Hope this helps.
  6. totallackofsurprise

    Feel like such a failure..

    Hi JBudd. In my academic career, starting from a very young age, I despised math. I hated it from the 3rd grade onward. I would not understand it in school. I would come home, and my mother would help me with my homework. The techniques she used were old fashioned, but simpler and worked for me. I would get the right answers. I would go back to school, and the teacher would mark my answers wrong even though my answers were CORRECT, just because I didn't use the proper "technique" to arrive at the right answer. So you can imagine how intimidated I was by medication math! I was terrified. Fortunately, the instructor was a great math teacher. He explained that med math is not really "math" (where math = algebra, geometry, calculus, etc.). He explained that med math is ARITHMETIC. You only need to know how to add, subtract, multiply, and divide. That was a relief! I knew I could do ARITHMETIC. I knew I could add/subtract/multiple/divide. And the technique we learned was dimensional analysis. This is a fantastic technique. It takes all the guesswork out. To be absolutely certain your answer is correct, all you need is a calculator! If you have further questions, I can explain in more detail... but previous posters did, so hopefully that made sense.
  7. totallackofsurprise

    Tattoos

    One of the agency RNs that comes to our ER has a full-sleeve tattoo (it's *really* cool) and no one has ever said anything to him, as far as I know. One of the FT staff RNs also has visible upper arm tattoos; he doesn't cover it up with a long-sleeve T-shirt, so it's visible and sticks out from his scrubs. One of our former FT RNs had a couple smaller fore-arm tats, which he didn't cover up, and I never heard anyone say anything to him. He still comes to work registry occasionally. Then again they all worked nights, so management is unlikely to stroll through unexpectedly on that shift... Also we are an inner city ER that gets a lot of action -- so we're definitely not one of the hospitals that's trying to please and placate a largely white, affluent, elderly patient population who dislike tattoos and view them negatively. I don't know what the super-nice, ultra-professional teaching hospitals require... I'm trying to get a job at one of them, but I haven't yet... However, having brought both my mom and stepdad to appointments and visited them in the hospital a lot, and both of them were at (two different) well-respected, highly regarded teaching hospitals, I never saw any RN at either hospital showing a tattoo. So it probably depends where you're working, what kind of facility, where's it located, etc. In the case of our inner city ER -- staff turnover is high, we always have agency nurses on every shift, most of the regular FT RNs are actually registry... so we're probably one of those hospitals that's in the "beggars can't be choosers" situation...
  8. totallackofsurprise

    Male Nurse, Female issues?

    Dude, just do what their husbands/boyfriends do... let it go in one ear and out the other. They probably won't notice... Sigh. I wish I worked on a predominantly male unit... and I'm not a male nurse. I came to nursing as a second career after working in nearly all-male environments (IT) for over 12 years. It was a huge culture shock for me... not an enjoyable one. Believe it or not, some of us women nurses can't stand other women nurses. And I don't mean that in a catty way, I mean that in a "why on earth do they say/do the things they do??" kind of way. I was so miserable my first year out of nursing school, largely because of the cliquish, catty, gossipy, mean behavior of other female nurses. But god forbid I try to bring up an article I recently read in a nursing journal; that turned into me being a "know-it-all". When we hired more male nurses I was SO GLAD. Somewhere (maybe allnurses?) I read that male nurses are like the graphite rods in nuclear reactors: they prevent a total meltdown. I never let them know they got to me (the catty beyatchy nurses) but I was SO RELIEVED when they hired a bunch of men. I remember one shift that was terribly hectic (hot summer night, inner city ER, lots of ETOH/ODs/shooting/stabbing/battery) but went so smoothly... at the end of it, I was so relaxed compared to my usual shifts, in a good mood, joking around and friendly even though I was dog-tired, and I was wondering, what was so different about this shift? Then I realized while I was driving home... oh, yeah -- 6 nurses on shift (not counting Triage), but only one female: me. And for what it's worth, I have several male friends who tell me I'm totally different from other women -- in a good way, they say. My bf says the same thing. Whatever it is, I am not cut from that same cloth. The whole hair/bf/gossip thing is not me; I can't relate to it at all.
  9. totallackofsurprise

    Men in Nursing Historical Timeline

    SO GLAD to see this on here. Probably no one but male nurses is reading it, which is too bad... I HATE the exclusive emphasis on Florence Nightingale, like she was the only person from the dawn of time, to ever start organized caregiving! Florence Nightingale is NOT why I went into nursing. As a nurse and as a woman, I think the emphasis on her holds the profession back.
  10. totallackofsurprise

    Benefits of being a male nurse vs Female nurse

    In an inner city hospital, you're slightly less likely to get attacked by a patient. Then again, as a male, you're regarded as a challenge by some combative ETOH patients, whereas a woman they wouldn't challenge... so I guess that evens it out.
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