bigjay

I worked bedside on an oncolgy/g-med floor for twelve years and didn't realize how tired I was of it until I recently transferred to ER. ER is still technically "bedside" but there's such a variety and different focus it's been a great change for me. Something to consider anyway.

This is how we did it at one facility I was at as a student. The upside is that you're minimizing the amount injected at each site. The downside is the potential for error if someone is not familiar with the system. They may inject the wrong drug, may flush and double dose the pt, etc. I prefer flushing each time as then you know the line is clear. I've worked with palliative pts for over ten years and rarely had any pain issues with this method. If someone is sensitive you just inject the med and the flush very slowly and it's usually tolerable. Localized reactions to drugs ranging from dilaudid to versed are rare in my experience as long as your rotate the site every two to three days.

You have to flush if the port tubing is primed with anything besides the drug you are giving. Otherwise as you said you are not actually giving the drug, simply whatever is in the tubing at the time. I have been in facilities where patients had sc site that were primed with the drugs and would have multiple sites for multiple drugs, eg one for morphine, one for haldol, etc. These sites would always have that specific drug in the tubings so you wouldn't flush after administration. So if you're not doing the above you need to make sure you're flushing afterwards. If others are not doing this this is a HUGE issue since you could potentially double dose the patient if you flush. Your facility should have a policy on this so you should find it and refer your co-workers to it.

I find that being a male nurse you stick out more. People are more likely to remember you and notice you. This can be a positive or a negative depending on the perception. Generally for me I think it's been more of a positive than a negative since I'm generally competant and experienced. I find some of the older docs are a bit friendlier with me than with the younger female nurses but I think part of that is just that they recognise I know what I'm doing.

Please provide this information since the above above is an incredibly offensive generalization.

Very minimal transmission risk since you cleaned his face before hand. MRSA will only colonize in moist environments (rectum, nares, lungs, etc) or the bloodstream. His face (the surface she touched) would only have had remnant organisms which would likely have been removed by the mechanical action of the washing and/or the anti-bacterial action of the soap used. Since he wasn't breathing no new organisms would've been introduced out of the colony within the lungs. The more likely contamination would've been from her touching objects within the environment. Hand-washing would likely have resolved that.

Nursing school definately gives you a pretty wide dating pool if you want to go there. I did and it never became an issue with my classmates. I did tend to date either above or below my year which made things less awkward if things didn't work out. Eventually I met my wife in my last year. Being a nurse doesn't make you any less manly. We deal with things most people couldn't so I wouldn't pay any mind to those who don't get it.

I think you have to take this type of behaviour on a case by case basis. One thing I always look at it why the patient is in hospital and what their future expectations are. If they're going to be going home they need to start working on becoming independant again, feeding, bathing and doing their own care to the maximal extent they can. Often times these patient need to be pushed to do it. I find leaving them with trays, wash clothes, etc tends to yield results when I return. Many nurses that I work with tend to cave in and just do things for patients they are quite capable of doing because it's easier and faster than motivating/forcing them to do it themselves. With patients that are dying (I work on an Oncology/General Medicine ward) I give more leeway even if they are fairly capable. For these patients I don't mind doing some things they could do themselves so that they can conserve their energy for more important things like spending time with family. You still have to draw lines though with some patients. Feeding people who are completely capable is one of my pet peeves.

Why would the OP want to go into L+D/OB? Probably for the same reasons any female would, an interest that area of nursing. One's genitalia generally don't determine what field of nursing we're interested in. Will there be challenges? Sure there will be but that's true for any area of nursing. The "no male" challenge will come up surely but that's not unique to L+D by any stretch of the imagination. In my brief experience as a student in L+D and post-partum I never had any patients refuse to be cared for by myself. I had one lady make a comment that it was strange to have a male trying to teach her how the breast feed since I'd never done it. One of my female student colleagues was with me and snickered to which I replied "I have as much experience as you do, just not the equipment!". We all had a bit of a chuckle and moved on. As far as a male L+D nurse being a "drain" on the floor that all depends on how the floor works. I don't see my less experienced female colleagues as a drain when they ask me questions. I don't see my colleagues as a drain when they as me to do difficult IVs or help with a heavier lift. In return they don't see me as a drain when I occasionally have to change my assignment if a female patient doesn't want me doing personal care. If the "no male" situation in L+D comes up so often it creates a too difficult work life for the OP that's something he'll have to deal with as it comes. To dismiss a career choice based on a problem you are assuming is going to be too troublesome to deal with is silly and short-sighted. Those quoting studies of patient preference should probably provide links to them if you're using statistics from them as part of your discussion. To the OP, if this really is your dream job you should definately pursue it. I don't particularly think that question was out of line though since it's likely a situation you will come across. Without haven been there though I could see that the exact manner in which that question was asked could've felt very discriminatory.

Had a gentleman who at 0100 pulled out his pain pump, IV from his port-a-cath, NG tube and foley. Refused to have any put back in, called the doc, doc said it was okay and to leave him until the morning. Everything seems fine until 0600 when a policeman comes walking down the hallway asking if we have this gentleman on the floor. I say yes and he tells me he's at the gas station across the street and refusing to come back with the officers there. I grab a wheelchair and head out to get him. I find him surrounded by 5-6 officers, in the rain, looking pretty miserable (though he had managed to put street clothes on). I asked him if he was ready to go back and he just nodded and hopped into the wheelchair.

I think there's a lot of factors leading to an unhealthy lifestyle in nurses. I also think that as a general population in North America we tend to have an unhealthy lifestyle so that doesn't make nursing stick out by any means. That said I think there are quite a few factors that set nurses at a disadvantage. 1) Most nurses are women. This is not a knock on women by any means but generally women are not as athletic as men. Men tend to be involved in more sports and this is often their social outlet as well as a means of exercise. Women tend not to have this involvement and thus don't have as much of a predisposition to getting exercise through sport. Men also tend to have a great muscles mass than women which increases their metabolism more so than their female counterparts. As well, many nurses as women tend to shoulder more of the at home duties eg child care, laundry, cooking, etc. This leaves less time for exercise and more stress to themselves. I do see this a lot with my female colleagues but I also think this is a comparitively easy thing to fix by making one's partner more involved with these duties (easy to say). I've never quite understood why many of my colleagues insist on shouldering the full load at home when they have a fully capable partner to share it but I hear that they do time and time again (I personally do all the cooking and most of the child care at home since I work weekends only). I think this is often a good starting point for a more healthy lifestyle. 2) Shift Work Shift work makes it more difficult to follow a healthy lifestyle. Twelve hour shifts make eating, sleeping and exercise more difficult. Night shift is even tougher, especially if you have difficulties sleeping during the day. Being unable to take breaks, eat meals, etc at work... well I can't imagine that. I work on a busy Onc/G-Med floor and I take my breaks religously. From what I've heard working conditions in the US are much worse than here in Canada but I could not stand working somewhere where not being able to take breaks was the norm. Sure you may have times where it's impossible to get away but that should be the exception rather than the norm. Again I'm speaking about working conditions in Canada but if that's what it's like EVERYWHERE in the US... yikes. I'd seriously look for better working conditions (I imagine they must exist somewhere), So I can definately see why a lot of nurses can be unhealthy but the reasons aren't much different than the population at large (which is largely unhealthy). It's important to work exercise and good diet in to your life even if it's hard. It may be difficult but it's not impossible.

Try using cold water for your handwashing. That made a big difference for me, especially since as a male I generally don't use lotion on my hands.

This may be a bit late since your brother is likely recieving his treatment now and hopefully is doing well. I work on an oncology inpatient floor and our palliative docs use methadone very successfully. We typically will use methadone in cases where the pain is either not responding well to typical treatments (morphine, dilaudid, oxycontin, fentanyl) or the patient is having too many side effects due to being on high dose opioids. Methadone is typically very clean in terms of side effects and provides excellent pain control. The down side of methadone is the long half-life. It can accumulate in the system if not properly monitored. It can also cause significant respiratory depression and the rate and severity of this is much more than other commonly used opioids. Our usual protocol is to initially start a patient on only a prn dose of methadone q 4h (dose varying as per their prior pain medication routine). If the patient has pain between the four hour doses we will use dilaudid or morphine q 1h prn. We then track the usage over 2-4 days and start a routine dosage at that point. During the trial period we monitor the patients resps q 3h. If they drop to 8 or lower and the patient is unresponsive we will give sc narcan. If the patient is responsive we typically just wait it out and hold the methadone for 12 hrs or so, using the other BT medication until the methadone clears, then start again at a lower dosage. It's a tricky drug to use but with proper application and monitoring it works extremely well. The trick is to have knowledgable staff and physicians so you don't run into problems. In my five years or so with working with methadone we've only had to narcanize one patient and he came out fine.

I work on an onc/g-med floor and have been here for seven years. I love working in oncology. Cancer is a disease that is debilitating to body, mind and spirit. Working with people who have it is extremely rewarding. Managing the physical symptons, providing emotional support, helping them deal with their illness is challenging and allows me to use all of my skills. I don't know about the unit where you're looking at but on our unit most of the patients are terminal. The ones who recover rarely come to us. We often see people over a course of months or years, each time returning sicker than the last time. It's not always easy and it can be very hard to deal with. You have to be well grounded in your own beliefs about life and death to deal with seeing patients you've spent a good deal of time with leaving this world and helping them through this process. I don't think there's much more rewarding than doing that though.

Hitting the gym is good advice for ALL nurses, not just men. So many of my co-workers have back and shoulder problems (I work on an inpatient ONC/GMED floor so there's lots of lifting and pulling) but very few of them do any sort of exercise or weight lifting. I think it's partly a woman thing and partly a nurse lifestyle thing. Women in general don't tend to have sporting hobbies as much as men and being a shift worker makes it that much harder to get involved in sports, etc since you're often working when they're going on. I get called on for the heavy lifting a lot but I don't mind at all. I'm probably physically as strong as two of my co-workers so it makes sense to use me that way. I use good body mechanics and I'm one of the first to stop an unsafe lift in favour of using the mechanical devices we have. I also start a lot of IVs because I'm quite good at it. I help out with the things I'm good at. The trick is not to let yourself be taken advantage of. I like to help out but some days I find I'm doing more of other peoples work than my own because I don't say no. You need to find a balance and know your own limits and needs. Nursing school was awesome. I had zero problems with classmates or profs in terms of being a male. The only time I can even remember it being an issue was during physical assessment training. Any shirt off assessment I was the model which wasn't a big deal. Dating won't be an issue for you since you're already married.

As a student I was a huge proponent of the pain scale. Now as an RN I don't really find it useful at all. I work in oncology and we deal with a lot of pain issue. Numerical scales are somewhat confusing for a lot of patients. I find mild, moderate and severe pain much easier to work with. As well, the numerical value reported generally isn't likely to change my intervention since it's typically not a ranged dose.

I've never had a problem with a doc yelling at me in person. Over the phone once but that was my own fault. I was new and ended up calling him three times about a coumadin order for a pt he was covering for without having any clue what I was really asking! He and I get along well now and I learned a good lesson about being prepared when calling docs, especially when it's not their patient. It's funny that I've never really seen a doc lose it on a nurse when I've been on the unit. It's definately in part to us having really good docs and nurses. There have been a few occasions though where things have gotten a bit heated and I kind of sidle over and put myself into the docs field of view and make a point of showing I'm paying attention to what's going on. Things usually calm down then. This usually works with patients and family members too. Once the angry person realizes it's not just them and the object of their anger it can make them think twice about escalting it.

Do you put in for OT when your co-workers are late? That would get your supervisor's attention and probably get action on the problem.

I've worked in oncology and palliative care for almost ten years now and it does get easier. You gradually learn to accept that death is simply a part of life and is often an end to pain and suffering... or else you go work in a happier place. Oncology is one of the most demanding areas to work in but it's also one of the most rewarding because of the wide range of physical, emotional and spiritual issues you have to deal with on a daily basis. I love it and wouldn't work anywhere else.

I work a modified full-time line where I do 60 hours per pay period and get paid for 80. I give up my shift premiums and my sick time is calculated differently, using my banked stats rather than the usual method (not an issue for me as I'm rarely sick). I have twin 3 years olds and another baby on the way in July. It's been awesome to be home with the kids during the week (wife is a public health nurse, Mon-Fri) and not have to worry about all the headaches of finding and co-ordinating child-care. The downside is missing out on weekend activites but at this point in my life with a young family that's barely even an issue. I also don't need a ton of sleep so if there is something going on in an evening when I'm working days I'll go to it and push through the next day without too much problems. The work is easier on the weekends because there's fewer people involved. You can pretty much do your own thing. It's quieter and there are so many less bodies around it just makes things much calmer. I love it and I'll continue on it until my next child is in full-time school.

C-diff is pretty much endemic is hospitals. Anti-biotic therapy tends to decimate the body's normal flora which leaves it open to invasion by opportunistic organisms like C-diff. Without doing a lit search I can't be sure but I think Vanco leaves one especially vulnerable to it. Proper handwashing for staff, patients and families is the most effective way of preventing these types of infections but in a hospital setting where c-diff spores are all over the place, it's hard to completely prevent it.

My wife and I have been doing latin and ballroom dance for a year or so now. We got into it through a friend of ours who we met through our baby group who is a dance teacher. We do waltz, tango, foxtrot, swing, merengue, cha-cha, salsa, samba and rhumba. Usually we head out to dance parties once a month or so to keep things up. We'll have to stop shortly though since both my wife and our teacher are three months pregnant so we'll be having a bit of a break.

I've been at about a half-dozen codes in the nine years I've worked at my hospital. Four of those years were in palliative care so no codes there. I work on an oncology/G-med floor now. We usually get DNRs on pts before they code. The one memorable time I did compressions was on a 34 year old woman on Christmas Day. She came in with pancreatitis Dx from ER at 6:00 pm on my day shift. Unbeknownst to me (and not really communicated in report) she had a host of previous medical problems and was in really bad shape. We were unable to get a BP, critically high blood sugar, intractable pain that didn't respond to anything we gave her. The MD on call was familiar with her from previous admits and said "This is how she always presents, she looks worse than she is". We also didn't have any vacant ICU/CCU beds. After 45 minutes of watching and working we still didn't have a BP and her sugar was still critically high, pain still out of control. At one point she asked me "Am I going to die" to which I of course said no. The RT was in to draw an ABG and asked me if this lady was normally unresponsive. I took one look at her at that point and called the code. She was still breathing with pulse at that point but we don't have a pre-code team so our procedure is to call to get everyone there to try to head it off. Unfortunately she did code and I did compressions on her for an hour. Thirty minutes in someone was going to spell me but we then realized there was no board under her! I had to keep going since at that point it would've been tricky to slide one in and no-one else was likely to keep a good rhythm without it. The code was unsuccessfull. Very sad, especially when at one point her ex-husband came into the room trailing her six year old asking "What the hell is going on!". It was heart breaking, especially on Christmas day.

I usually respond with "Last time I checked" while glancing down at my crotch area...

I really think this is excellent advice for ALL nurses who do frontline patient care, male and female. In my experience very few of my colleagues do much in the way of regular excercise, much less core strength building exercises, and I think this is a major factor in injury causation / prevention. I find I get a lot of older nurses telling me "You can get away with that now but down the road...". While I agree you should never over-do lifts I also usually like to remind them that I'm a completely different person than most of them. My body is quite used to being bent, torqued and twisted with pressure applied since I've done judo for many, many years. I find as long as I keep up my exercise level and weights I never have back pain even when I do lots of lifts and transfers. Good body positioning is also key. Always keep your back in a straight line and you'll greatly reduce your chance of injury, this is something I'm always very concious of when I approach a heavier lift/transfer.