annister

Ok, I understand the topic of this thread has been focused on blame, accountability and the appropriateness of the subsequent disciplinary action that followed. My immediate reaction to the information provided is that it would have been a perfect opportunity for exploring what factors contributed to the series of events that occurred, and what changes could be made to minimize the likelihood that such errors are made in the future. The patient, thankfully, suffered no harm. Multiple actions, involving more than one person, occurred that led to the error. People make honest mistakes and the fact that this particular mistake did not have catastrophic consequences strikes me as a wonderful opportunity to prevent a future occurence that very well could result in serious harm to a patient. Basically, I think that punitive action in scenarios like this are wasted opportunities to address and explore ways to make things like this less likely to occur in this facility. Just my .02$

Where you put it.

I'm pretty sure that's on back order.

Depending on your personality, the positives may look like negatives (and the negatives positives.) So here goes... POSITIVES: * you get to know your patients well and you will be able to pick up on very subtle changes in condition that might otherwise go unnoticed (until they are a serious problem) * IN GENERAL, onco patients are very grateful and appreciative of their docs/nurses * Regular, more reliable work schedule * Extremely specialized and focused practice and skill set (also a negative) * In my experience, oncologists are pleasant to work with and care greatly for their patients * It's a great break from bedpans/call lights/having to take or give report/excessive charting * Physicians tend to rely on and respect your assessments/observations of your patients * There are more, but you get it, I'm sure... NEGATIVES: * I miss the adrenaline rush sometimes (although, I've had quite a few serious chemo reactions/other emergencies to handle with much fewer resources than I had in the hospital setting) * People die--a lot; Many of whom (and their families) you've gotten to know over months or years. It can be hard for one person to experience so many losses * Generally less pay/expensive benefits (if privately owned) * I hate being so much more involved in insurance/dx codes/the financial aspects of healthcare * There always seems to be more bad news than good for patients, and the good news is often short lived * Seeing patients deteriorate over a long period of time, and what some chemo does to people * There are more negatives too, but you get my point... THINGS TO ASK/CLARIFY: * Length and structure of orientation * Usual patient load and patients per nurse/day * If employer will pay for chemo certification/education * Types of treatment provided (just chemo, or blood products/abx/fluids...) * Availability of appropriate equipment and supplies (crash cart/bp cuffs/IV pumps/CVC maintenance and access supplies) I work at a privately owned office in the chemo/infusion suite. I do occasionally miss the acute care setting, but what keep me where I am are the doctors I work with and the patients I care for. If nothing else, it is a constantly rewarding and satisfying job.

It seems to me that if one has the time/physical capacity/mental capacity to get online or call for a reservation for the EMERGENCY room, one may want to consider the possibility that his/her ailment is not an EMERGENCY... I see an EMERGENCY as something warranting a fairly immediate evaluation, not a DOCTORS APPT at 6:30 when I get off of work. The ED schedule should be based on who's situation is most EMERGENT at 6:30 and not who's reservation is for 6:30. It's not a doctor's office and we shouldn't encourage it's use as such. I didn't read the link and I don't work ER so I apologize if im way off base here...

The question of varying dose availabilities is not important from what I read of your situation. You should be asking yourself "why did I give a drug without checking the strength/ml on the vial?" If that sounded "mean", I apologize because my intention was not to make you feel worse. I'll be the first to admit that it's easy to make mistakes in hospital settings, especially as a new nurse on your own. That being said, the problem has nothing to do with how morphine may or may not be packaged. Likely, it is that you are overwhelmed, feeling rushed, nervous (or you should be as a new grad IMO), and still adjusting to your role as a nurse. The best possible advice I can give you is to SLOW DOWN!! It is far more important to be a good nurse than a fast nurse and the two are not mutually inclusive. It is way easier said than done, but it is the solution to the problem. Whenever you are preparing a med, STOP AND THINK, make sure you are clear about the order, make sure you know the amount of the solution needed from the vial that you are using (not based on the concentration written on the MAR) to execute the order, focus only on the task of properly preparing said drug until you have done so, and ALWAYS ALWAYS ALWAYS ask another coworker if you are unsure of ANYTHING you are doing. It's hard to take your time in such a fast-paced and demanding environment, and it sucks to feel like you're too slow, but if you practice safe habits from the beginning, those safe habits will become second nature and speed and efficiency will come with experience. It is awesome that you picked up on a possible (and probably minor) discrepancy that occurred, and I hope that you use it to your advantage in future scenarios. Think smart and you will be a great nurse and your patients will be safely cared for. I think that I've babbled enough, so if you are still reading, good luck in nursing!! BTW, I've never come across a 1mg/ml vial of morphine...

Call me crazy, but I think it's all a matter of money. We have had issues (on and off) getting IV: B12 Magnesium Decadron Leucovorin Cisplatin 5-FU and most recently, Taxol (probably THE most frequently given drug where I work) It's not only an unfortunate obstacle in successfully treating our patients, but a safety concern as the original orders are constantly changing to accommodate these shortages and other drugs are being substituted. I wish I knew a solution to the issue, but I don't.

Look! It's a bird...it's a plane....oh, wait, it's just a high horse...

"sure, I can run your chemo in wide open so you can get to your important appointment...I didn't realize your appointment involved a ride to the ER via EMS. How silly of me. "

Take any and every opportunity that presents itself (and seek new ones) to perform skills that you have "learned." If you practice as a student, you have one less worry when you start your first nursing job. Bite the bullet and DO IT!

My immediate reaction is this... NCLEX is based completely on the "perfect world" version of nursing. Is it possible that your experience as an LPN is causing you to answer the questions in the mindset of the "real world" scenario? Seems like I would have to retrain my brain if I ever had to take the NCLEX again after actually working as a nurse. ...just a thought.

When my Baker Act patient (accidental OD) asked why He couldn't have the wall clock in his room, I said "they are afraid you'll be in here killing time" before thinking. I thought the sitter was going to fall out of his chair. Patient thought it pretty damn funny. I always thought that was a dumb thing to remove, considering that between the O2 tubing, IV tubing, Electrical sockets, etc. would be far more enticing equipment in the interest of causing bodily harm than an 8 inch wall clock.

The only thing stopping me from ripping off your arm ( which is very firmly gripping by boob at the moment) and using it to knock the silly grin off of your face, is the fact that I have one hand Kinking off your NG, and the other trying to pour your residual into the syringe. I have elbows, however, and this won't take much longer. You aren't being cute.

I'm not sure about the rules with HIPPA, but the boundaries set by HIPAA may have been overstepped. Sorry, I had a rough night shift...

I've come to accept the reality that not everyone (well, anyone) can be perfect like me. Don't bother trying, it just makes you look silly.

It's not insulting. If it were, nurses would be insulted by everyone but other nurses. And from what I've seen, many nurses can't seem to get along with each other. I notice some people can turn anything into an insult. I just turn everything into a joke. It's way more fun to laugh my orifice off than to feel insulted. Unless I slip up and laugh about the wrong thing in front of the wrong person...

I can remember being obsessed with this fear that I had of death and dying for most of my childhood and teenage years. I dwelled on all of the potential (negative) possibilities that my imagination presented. Fear, of anything, is a terrible state to live in. (worse than Florida maybe). I can say with absolute certainty that being a nurse has drastically improved my outlook on death. I have worked only in oncology since becoming a nurse and I honestly have no idea how many of the patients I have cared for have passed away, quite a few right before my eyes. I no longer see death as "the ultimate worst thing that could happen.". I think of it as complete freedom from any of the troubles, worry, pain or sorrow that one is burdened with while alive. I truly believe that the only negative impact death has is on the living and I no longer feel the need to consider how my own death could negatively affect me....Do I sound bat**** crazy at this point? I am sorry for your loss(es) and I hope you can feel a sense of relief and peace in the concept of death one day, instead of anxiety and fear. Sorry for being so long winded....it's a bad habit I can't seem to break.

I could give you a textbook sized list of BS justifications for why your facility is right or wrong, but who would I be kidding anyway? I'd be lying if I told you I wouldn't be just as angry in the same situation. Finish your degree, get outta there, and give someplace else the benefit of your knowledge and skill. Best wishes to you!

It does in my hospital. Probably not just in isolation rooms, either. Funny, I can never seem to get a room cleaned when it's desperately needed, yet I had a patient recently who went for dialysis and came back to a completely empty room! They even threw away her get well cards...that was fun to be in the middle of...but I guess that's a whole other discussion. Yes, it is sickening to see how much is wasted in hospitals, especially when admin seems to be pinching pennies on the things we actually need--like employees.

We have a lot of HDY and PDY patients. We don't get much more of a warning than "we're on our way down the hall" when they take pts. to ADU. We recently started using an SBAR sheet and the ADU nurse fills it out and faxes it to us when HDY is complete. Problem is, these sheets get selectively filled out and depending on who does it, half may be left blank. Also, it seems that they fax the SBAR and transport the pt. simultaneously (and sometimes just dump them in the room without warning. I hate our current system, but I would be very worried about a situation with NO post HDY communication. I have seen, more than once, pts. return from dialysis in much poorer condition than they left in. It's so hard on many pts. bodies, and some people are just "worn out" after treatment, but communication between nurses helps me figure out if a pt. is just "worn out", or something is seriously wrong. I honestly think it should require a bedside handoff. I hope this helps.

Why can you only ask for........one........thing..........at..........a...........time..........?????? When I say "Is there anything else I can do for you right now?":) You say "Nausea Medicine.":rolleyes: I say "Sure, let me get it. Is there ANYTHING ELSE I you'd like me to bring you when I get your Phenergan?":o You say "Nope.":rolleyes: Three minutes later, I'm back with your Phenergan and you say "Can I get something for pain?":rolleyes: I say "Sure, give me just a minute and I'll bring your pain meds. ANYTHING ELSE WHILE I'M GETTING THAT?":o You say "Nope." Just a minute later, I say "OK, here's your Dilaudid. Call me if you need ANYTHING, otherwise I'll be back to check on your pain level in 30....yadda yadda.":) You say "Can I have a Sprite.":idea: :eek:And so it continues from sprite.......to another blanket.........to more ice..........to a sleeping pill (to which I say how about two?)...........Good Lord people, I'm lucky enough to have both arms just give me a damn list and let's get this done already!

I am not quite as hardcore one way or the other as some here, and I do feel for anyone dealing with addiction. Hell, I'm smoking a cigarette at this very moment. Addiction, to anything, sucks. I'll admit, I was quite a wild child and am lucky to have survived some of the things I've done, and without having suffered the legal consequences of them. I kind of feel like the family dog that managed to swipe the steak off of the dinner table without getting caught. I was honest enough with myself, however, to acknowledge that the only way to get out of that lifestyle was to stay away from that lifestyle...permanently. So, with all of that irrelevant BS out of the way, Ill get to my point... What would you say to a recover"ed"/"ing" alcoholic if she/he told you they were looking for a job bartending or at a liquor store? I'd probably ask.....uh, why?? How about the "rehabilitated" pedophile whose second chance includes teaching your kid's 4th grade gym class? It's cool, he's all better now... Or the stage mom whose daughter is recovering from an eating disorder telling you she can't wait for her to get back into beauty pageants. And then there's the nurse who went through rehab for narcotic addiction, who is psyched about getting back to work--at a facility that practically has a vending machine filled with narcotics in every hallway. It sounds dramatic (and sarcastic, sorry it's a huge character flaw of mine), but they're all ultimately the same thought process. So why is one more outrageous than the other? I'm probably already going to get flamed for being insensitive, so I'll go ahead and add that in many of these scenarios, the person in recovery is not the only one affected by his/her choice to re-enter an environment that constantly dangles their biggest temptation before them every day. So, while I empathize with those who suffer from addiction, I am more inclined to consider the wellbeing of those who are inevitably affected by someone else's bad decisions.

All I can say about this post is that I wholeheartedly disagree.

Is that geographically possible?

I say more or less (mostly more) true here in FL. I'll add that, sometimes, in order to send one of my pts. to the icu, they have to have coded and been intubated. And it is not for a lack of patient advocation on the floor nurses' part.