lxpatterson

melena stool is pretty bad, that and fresh clotting blood....maybe it's because those smells are always associated with very stressful situations.

Very sad! I had an injection drug user being treated for recurrent endocarditis that he gave himself...man, you're 35 with a prosthetic valve, don't you get it? He would disappear for half a day and miss a bunch of his ABX drips because of "errands" (which got more and more far fetched) and come back high as a kite.

You use the public bathrooms? I've been indoctrinated by colleagues to use only staff bathroom, which is unisex (but essentially a women's bathroom with a supply of feminine products, face cream, etc).

Male RN here. Didn't realize underwear would cause discomfort. Will remember to wear pants under my gown the next time I'm a patient! Oh, and funny story about gowns. I was in a bicycle accident on my way to work and I didn't have any clothes on me besides the bicycle clothes I was wearing, which was essentially lycra race wear like you see in the Tour de France. You're essentially bare skin under the lycra (in order to pass sweat). The paramedics who picked me up cut these clothes off me because they were pretty much shredded and blood-soaked, leaving me with nothing but a gown and a sheet in the ER for the rest of the day. Every time I got out of the stretcher to have a pee or go for imaging the staff would do a double take because I was bare ass with nothing but gown and socks on.

I started my career in a rural acute care hospital, rotating between inpatient acute medicine and ER. I think it's a great first job because medical staff and senior nurses are usually fairly invested in getting you, a new grad, up to speed. Compared to a city hospital, where the pool of nurses is much larger, the smaller pool of nurses in a rural center requires nurses to be competent in many roles. Therefore, staff will put more into teaching and mentoring because no one wants to be stuck with an incompetent colleague overnight when there will only 3 RNs in the building. But as you pointed out, you probably will not have much sexy stuff like thoracics with multiple chest tubes or central lines with pacemaker wires, etc. In your first year you should probably be more concerned about building basic competency like getting your ACS response and ECG interpretations down, having the ACLS algorithm memorized cold, foleys, NGs, basic ADL care, etc. I think once you are confident in your practice, you will be less concerned about how an teaching hospital ICU might view your resume and more likely to have actual experiences to impress an interviewer.

"Several lessons to be taken away: (1) Don't hand over controlled meds to students, even mature ones whom you trust, (2) Don't carry controlled meds around in your pocket, and (3) Treat your classmates well... you never know when or how they might bail you out or stab you in the kidney." Yeah, don't carry meds around period! I walked around with a syringe of fentanyl all day after a rapid sequence intubation and only found out at the end of the day when the supervisor was trying to reconcile the narc count. Man, did I get (rightfully) chewed out!

I'm glad to be Canadian! I've never had to submit to the indignity of a drug test, nor am I aware of any clinicians at hospitals here being required to do so routinely (unless reported for a specific drug-related issue). I think if I was registered with the Louisiana BON I would advocate for changes in those rules, which seem unusually harsh. Do MDs or PTs have to send in a urine routinely? Do they have their practice and reputation jeopardized over a bit of weed? And honestly, if Louisiana is a place which such an awful drug problem that people have to be constantly tested then I would consider moving to another state.

That's why you always need one female in the headcount. Best ER shift: 1 male RN student, 2 male RN, 1 female MD.

I look at some of the young RNs (1st career, post-BSN, 22 yr old) that started at my current job with me and I think that older grads have maturity and interpersonal finesse that helps avoid a lot of useless BS with patients and staff -you know, the kind that could potentially snowball into a malpractice or disciplinary thing.

I've done enough schooling to realize that you're just a number to the school: you present a prior GPA and a sum of money and they produce grades for you to take on to your next stage in life. By the second month of school I always have my student number memorized because that's really the only number that matters to administration and faculty. Your dick (whether you have one or not) does not figure into the entire equation. Strictly a numbers game.

Someone mentioned that legally, an AMA signed by a competent patient is sufficient protection for your licence. Personally, I would document as well that I discussed death and morbidity with the patient. To me what is interesting is the discussion of moral obligations, beyond wwhat is the minimal legal requirement. Obviously this is a big part of the discussion because most of us are uneasy with the scenario even when the legality of it is clear. The question I ponder is what is the difference between a pt who threatening suicide and the septic pt going AMA home to a certain death. Ultimately, both will die without intervention, but only one is routinely placed on an involuntary hold. Why is that?

That's ridiculous. If we are simply dispensing medications because patients want them then we might as well give them a key to the pyxis and let them help themselves. The reason we don't do that is NOT just because of overdose, it's because like all medications, analgesics have a slew of other unintended effects, many of them unhelpful. In this milleu of "client-centered care" we might hesitate to practice "paternalism", but we are really not benefiting patients if we are not providing them with judgement and guidance. If I have a patient who is a nurse struggling with bone mets, I'm going to give her the full menu of palliation options and she can tell me exactly what she wants and when she wants it. If I have a 16-year old patient with cholecystitis who is chatting with a friend in the room with no diaphoresis or physical signs of stress telling me she has 10/10 pain and wants medication for that, I'm going to inquire further. I wouldn't say this person is drug-seeker, but more likely she isn't communicating her discomfort well and it's to her benefit that I find out what she is really feeling rather than shoving hydromorph in her vein. That's common sense.

Float nursing, if you can find a program that will hire new grads, is a great opportunity. Many of the Toronto area hospitals are putting their new grads through a float program. I declined a float position in the city and chose a rural hospital because it has many of the aspects of float (I do ER, peds, psyc, cardiac/tele, ortho, MS) without having to deal with the interpersonal issues involved with being thrown from unit to unit.

Haha, exactly! I haven't had run ins like that with my medical staff, but that's exactly what I would say to an uppity locum. I stuff order sheets and things like that on a slow night shift as a courtesy, but it's not my job.

Of course you have to figure out what the patient's preferences are, without assuming they are ok with stuff because they are from a certain culture. But once you have established that someone is ok with a family member making decisions for them and having access to their information, it's a matter of documenting it well. It's that documentation that protects you. Secondly, it's mostly people from an older generation that prefers heavy family involvement. And it is very unlikely that an 80 year old Chinese granny with minimal cultural fluency and English competency, uninterested in learning about the intricacies of CHF pathology and treatment, is going to sue you; much more likely it is the scenario where the children of the granny, who may be well-off professionals, are going to sue you if they feel mistreated. I worked in the medicolegal field writing briefs for malpractice and casualty before becoming a nurse. I have never seen a malpractice or privacy case that was the result of cultural misunderstanding (although I'm sure it is a possibility), however I have seen many cases where personal dislike/animosity between patient and clinician, in combination with a minor or even questionable medical error, snowballed into a full blown malpractice case.