Eastern RN

BAM!!!!

No weighted blanket for me. I decided to do nights only instead of the days, nights, days, nights and repeat circus. I had done only nights for a few years previously as we had a dog who was IDDM, and my hubby worked away - so I could manage her glucs, insulin and meals better. Then did straight nights a few years later- pretty much until I retired. I found it easier to just stay in the night shift mode even on days off. Granted by this time our son was away at University, and hubby still worked away a lot. So it was quite easy. I always was a night owl anyway - even on days off. The issue right now is that since I retired, I want to be like “normal” people and sleep at night and be up during the day. I’m getting there slowly!

He has Large ketones in his urine, Blood glucose 390 (he usually runs low,never seen him above 180) And generally knows whats going on with his own body, He's vomiting, kussmaul respirations, fruity breathe, weakness, blurred vision, sleepiness the whole nine yards. WONDERFUL assessment and you did exactly what you should have. You will run across a large amount of health care providers from different backgrounds, education, specialties etc in your career. Continue to do what you do, stand your ground and make sure your patient gets the proper and best care possible!

I feel for you girl. One lie - led to another, and as well you involved a co-worker. I graduated from nursing school in 1982. I have made med errors. Thankfully none of them had adverse effects on the patient. I can't recall the errors now, but I know I reported them to the nurse in charge promptly, and completed an incident report. I think I was directed to meet with the DON for one of the errors, but otherwise, no fall out. Listen. We are all human. And I think you got bad advice from the senior nurse you consulted. As for the family being angry - that's something you can't control. And - you have no idea of the family dynamics associated with the gentleman and the patient. You are a fairly new nurse. I have no doubt this incident will be one you learn so much from. Come clean with all of it - deal with it - move on. Best of luck to you! As for getting a PRN order from the Doc to cover the medication - that's not proper practice for the nurse, or the Doc.

I loved bedside nursing, but time restraints, shortage of staff and many other issues, made it impossible to perform bedside nursing the way I felt it should be done. Like in the "good old days". On night rounds you gave a backrub, spent an extra few minutes with a patient who was struggling, took the time to really have a chat with a patient who seemed to need it. Although I have spent the last 17 years in ER - prior to that, I did a lot of bedside nursing on the floors. The few times I have done some overtime on a patient floor in the recent past - it was getting in and getting out of patients rooms. Rarely did I enter a room unless I was summoned, or a med was due, or a drain check - you get the idea. Not very satisfying! So in my opinion, a lifelong option - yes, I do know some RN's who do it - but not this chick!

Yep - worked with a bully for many years. Both in the same unit, and on different units. Our facility is around 100 beds. She and I had words one night. I walked away because I would have slugged her. I called my manager to come down (it was on nights), and deal with her. The words were over supplies. I needed something from their stock room. I was in ER, she in CCU. The exact words from the manager were "If you think I am getting mixed up in the middle of a **** show between you and *******, forget it - no way." No one on the facility has ever had the gall to deal with her, and it's like everything, you let something go on long enough without taking care of it, and it becomes the norm. And that is what has happened. So, although I am no longer at that facility - 35 yrs was enough, before I finished - my tactic to deal with her was one of avoidance. As an aside - NPs - at least in my experience are not immune from bullying either. I have been on the sidelines and witnessed it.

"Do you see that in fact you are in a situation where you are thinking about "making him mad". It is predatory, abusive, and all the other verbs that go with abuse. Seek out your local women's abuse group. A counselor there can talk at length with you about a plan, and steps to assist you going forward. And hopefully get you to realize that predators who stalk victims have a very specific agenda, and you need to see this to prevent yourself from getting further caught up in this situation, but going forward. He is grooming you, you are his specific target, and this is very, very dangerous. Protect yourself. No matter how much you love your job, getting caught up in all this is soul sucking, and not worth your sanity or most importantly, your safety." GREAT reply and post. The local women's abuse group will help Shelby get the ball rolling and give support and direction. Not sure where Shelby works - there must be an EFAP - employee/family assistance plan - with a contact person. Speak to someone who can help you NOW Shelby. Start documenting. Take measures to keep yourself safe. No job is worth any kind of disability - be it psychological or physical - and certainly not worth your life either. As well - if you get this predator gone and taken care of - he won't be able to do this to other people.Would you want him doing this to your best friend? your Mom? your sister? Get started NOW. Do it for you and do it because it's the right thing to do for everyone!

Yesssssss! I graduated Nursing School in 1982 and was taught this! I guess it's time to re-think.

Absolutely = hands down - "O2 Stat" - where the heck did that come from - SOMEONE wasn't listening carefully in class. I have heard it from RN's, LPN's, PCA's - you name it.

I stand in front of the patient, at a distance that is comfortable for us both - (as long as my physical safety is not compromised), raise one of my hands to the level of my head, palm facing patient, hand flat, and say " I am not going to engage in this disussion (or continue with this assessment, or perform this procedure - whatever fits) unless it can be done in a manner that is respectful to both of us. Please come and find me, or another RN, when you feel this can happen. In the meantime, if you feel more unwell, or become distressed, please notify us or get someone to do it for you." All said quite politely. Then I walk away. I have found this approach blows many patients away - the last thing they expect is a response of this sort. If the patient is escalating his/her behaviour - they are obviously looking to engage and push things further. For the most part - this has worked very well for me. Side note - I work in ER. Many years ago we had an ambulatory teenage patient arrive c/o shortness of breath, dizziness, tingling in hands, anxiety, trembling - the nurse who assessed him felt he was having a panic attack and hyperventilating - which proved to be correct. She got him to recline on a stretcher in a treatment room and tried to talk him through regulating his breathing. He just would not acknowledge what she was saying and refused to co-operate. The patient was quite stable - so she tried another approach. She got a paper bag - rolled back the top edges a bit, and placed it over his mouth and nose - all the while telling him what she was going to do and the rationale for it. We do have non-rebreathers and such - but the paper bag was handier. Anyhow - the patient ripped the bag off - ripped it into pieces and refused anything she offered. I was in the room with her. Her next approach - she looked at the patient and in a non-threatening tome said " I'm trying to help you. You are obviously not willing to play the game. When you are, please ring your call bell and let me know." I will NEVER forget it because it was very out of character for that particular nurse to say anything along those lines. The patient had a friend who was going to stay with him so we knew we would be notified if the patient's condition changed. In any case - it was only a few minutes later when the patient rang his call bell, the paper bag went on and symptoms eased off within minutes. Another life saved!!!

"As you already said, it would be stupid to invest so much in a career and find out you cannot do it." Your quote. Seriously - if you are truly having the negative thoughts and feelings about becoming a nurse - DON'T!!!! It's expensive, physically and mentally demanding, and even if it was always your dream to be a nurse and you love everything about it - it's a tough job. As a 33yr veteran - I feel very lucky to have chosen a career that I love to this day, although it has become increasingly difficult to be the nurse I want to be as the years go by. And you know - it's silly things that make the job difficult - not the patients themselves usually. Hospital politics, bullying, short staffing, demanding schedules, mandated overtime, increased workload, lack of appreciation and on and on. You just can't escape it - at least in a hospital environment anyway. Think carefully and choose your career wisely - because unless you plan to change careers on a frequent basis - you will be working at your chosen career for a while - maybe a lifetime! Good luck to you.

Awesome story MrPopeye! Thanks for sharing. I kind of stumbled into nursing. But - after 33yrs - I can say I can't imagine ever having done anything else with my life. Old fashioned nursing school - 3 yr RN Diploma program - lived in residence etc etc. I was going to be a medical lab technologist - until I realized that Chemistry was a huge part of the curriculum. I passed Chem in high school - but just barely. My BFF was going into nursing - so I said why not? Wouldn't change a thing. I do feel for the young ones coming into the profession these days. It certainly is not the "atmosphere" at work that it once was. I graduated in 1982 - just putting in my time now until I retire. Still love nursing - but there is nothing easy about it. Good luck to you MrPopeye! PS - so sorry for your loss - I lost my Dad Jan 13th of last yr - it was sudden and unexpected - he was well one moment and gone in 10 seconds. Massive PE. Probably had an occult malignancy going on somewhere that he and we weren't aware of. He died in Florida (my parents have been wintering there for over 25yrs, permanent home is in Ontario), in his lazyboy - coffee in hand, watching the morning news, Mom in the chair next to him. He was 80 - but a very well and active 80. He was my rock - I am still struggling to find a "new normal". But I am very grateful Dad passed the way he did - he couldn't have planned it any better. Sorry for going on a bit.

I read this just now and hope you have now know that you did not fail the patient. Her family did. It seems one family member did not respect her mother's wishes, and once she was resuscitated and procedures to "save her" had been started, the remaining family members could not get it together enough to recognize that this was NOT what their Mother wanted and make the decision to have her made a DNR - and have their Mother placed in a Hospice or at least a palliative care environment where her wishes for end of life care would be respected and carried out. I see this ALL the time. In our province of approx 500,000 people - the 2011 census had the # of people that were age 65 and over just shy of 100,000. That's 20% of our population. How many of these people have advance care directives? From what I have seen over the years - VERY FEW. And - as the poster said - it only takes one family member to challenge that - and BAM - the ball starts rolling..... downhill. To be fair - if someone presents in ER or the EMS arrive at a scene and there is no family present and it's not immediately known that the patient does not wish any advanced life support measures - well - in most cases we are going to try to save that person. Unless of course they are cold and blue, or they are obviously already dead or near dead. And who makes that decision - depends on the EMS, depends on the physician. We try to do what is ethical. BUT - I cannot tell you how many times in my 32 yrs of nursing that I have heard a doctor have a discussion with a patients family about a DNR - and put it something like this - "If your Mom's heart stops or she stops breathing do you want us to do everything we can to save her?" For real - if the doctor is having that discussion with the family - generally it means the **** is about to hit the fan so to speak. People who are not in the medical profession have no idea what that "everything" is. So many times over the years I wished someone had produced a video that shows exactly what goes on in a code, shows exactly what happens when people are placed on ventilators and remain there for extended periods of time - and basically just rot in the bed. Just pop in a CD for people to see - the good, the bad and the ugly - all of it. I would imagine families would make some different choices for their loved ones. I'm not saying that no physicians I work with explain and present the "DNR" issue properly. I have seen the issue of making a patient a "DNR" explained to many, many families in a clear, easy to understand manner - and families have been able to make informed decisions that they are comfortable with. Another thing that irks me - patient comes in who has had the DNR discussion with family at some point already. The family they live nearest to. The patients wish is to be DNR. BUT - there are other family members as well who do not live close by - and are unable to get there quickly. So then it's "Well, Mom said she didn't want to be on life support - but I can't decide that on my own - I have to wait until - my brother - or whoever the rest of the family is - gets here. So lets put her on the breathing machine for now until the rest of the family gets here and then we can make a decision" . I have heard this more times than I care to remember. And anyone who had read my rant this far knows what happens when the rest of the family does get there. No one wants to be the bad guy and be to one to suggest that life support be discontinued. Every now and then it does happen. But rarely. Poor old Mom usually stays on the vent and slowly deteriorates - sometimes quietly, sometimes dramatically - and I would expect not without discomfort. Which does not leave us nurses with a warm fuzzy feeling. There may just be something to having a DNR tattooed on your left chest. It can probably be done quite elegantly. Anyhow - peace out - my rant for this month is done. I hope.