steve40

Here is a question for all you LTC nurses. I recently encountered a situation as to where the spouse and power of attorney for health care of a patient was very adamant that she did not what her husband on the medication Depakote. He was prescribed this for mood/aggressive behaviors sometime ago. She stated that she absolutely didn't want him on it. Although I don't agree with her reasoning, after speaking with her I agreed to discontinue the medication. the "catch" is; the uncall MD didn't want to supersede his primary care provider's decision to have him on the medication. His primary care physician was on vacation. The medical director stepped in and said that he conferred with the pharmacy and it was determined that there was no anticipated adverse effects of stopping the medication. SO..again, though he didn't "officially order me to stop it per-say, after speaking again with the POAHC, she confirmed again that she did not want him on it. So I discontinued the medication. I of course I documented the details as such. I guess my question is; was I "legally" in the right for the actions I took? Appreciate any feedback.

Thanks everyone! I really appreciate your feed back and support:)

This patient was not currently on hospice care but both him and the family have been undecided I believe for many months as to admitting him to comfort or hospice care.

I am not sure why this is bothering me so much but maybe other fellow nurses can give me another perspective on the situation. I am a part time night shift nurse and in charge of 2 floors with over 100 patients during my shift. I recently encountered a patient with end-stage COPD which was being monitored for increased falls/pain. I assessed this patient at approximately 12:45 am to find him with low oxygen saturations as low as 59%..granted this was with his nasal canula blowing oxygen into his eyes instead of nares :) I administered the oxygen at 3.5 L/min and shortly there after his oxygen sat increased to low 90's. He was repsonsive and replied " no" when I inquired to as whether or not he was experiencing any pain/discomfort. all other vital signs were stable. Later in the shift at approximately 430 am a CNA requested I come evaluate this patient. I discovered him with a large amount of brownish emesis of like pudding consistency, O2 Sats upper 60's and unresponsive. No repsonse to verbal stimuli, sternal rub etc. I cleared his mouth and oral cavity area as best as I could, raised the head of the bed..increased his O2 slightly...obtained all other vital signs etc. This patient was also a DNR code. I truly felt that this patient was basically dying in front of my eyes. I callled the on call MD and updated him on the situation to which he said it basically came down to the family's wishes...comfort vs. send in to ER for evaluation etc. I notifed a family member almost immediately after contacting the MD and explained the situation and offered either comfort measures or direct transport to the ER. She wasn't sure but called back about 45 mins later indicating she preferred him to be sent to the ER. Well, as it turns out the patient was admitted apparantly with primary diagnosis of pneumonia. abmormal labs. etc. Obviously this could have been as a result of aspiration. I guess my question is...should I have acted differently? Another co-worker, (RN) said; "you have to act for the patient". obviously he was unable to give me his designation at that time. so, was I wrong in not just taking initiative in sending the patient rather than first consulting a family Member and/or the MD...which I did. Just curious to get other nurses opinions on this situation. Thanks, Steve RN

In all honesty, I think that your reason for your not taking break sooner is totally irrelevant to the situation. I think the issue at hand is that this CNA not only acted in a totally inappropriate manor, was insubordinate and very unprofessional. I would strongly question what kind of care she is giving patients if she is capable of this unforgiving behavior to employees. Not to mention the fact that she is answering to you, in all honesty regarding the chain of command. On a personal and professional level I would feel it's in the best interest of both patients and other employees to have her "butt" fired. Your requests where no way out of the realm of delegation and she had absolutely no right to question you.

I don't think I can post not being a premium member but wonder if anyone has any similar experiences or input to my situation. I have been working for a state veterans home for 22 plus years. I was a CNA for 16 and a lpn for 5. I recently became a Rn this past February and had an interview 3 weeks ago and found out I was not offered a position. The "form" letter stated that other candidates offered a "compliment" of skills and experience to fill the positions as nurse clinician 2. The ironic thing about the whole situation is that one of my former class mates was offered a position with no previous experience and also works at the same facility. I basically have a flawless work record...pretty impeccable call in record...and positive annual performance reviews. I feel quite disheartened and would love to tell them where to stick it but have way too many years invested and starting over would seem defeating the purpose given my pay status and seniority at this point. Thanks for listening.

You weren't sure with some of the questions? What is wrong with you....you are suppose to feel like you knew them all!!! Seriously, I can say with much certainty that you most likely passed. Mine also shut off at 75 and I truly felt as if I really knew about maybe...20%. The rest was highly skilled educated guesses:) Good luck!

How about.........I really don't care if you take these pills or not....I am a nurse and am directed to follow the doctor's orders, but if it was me I probably wouldn't take them either because I hate pills.

I read all of this and remember back to my 3rd semester clinical instructor that "made" me feel as if I wasn't cut out for nursing even after I had been in it for 20 plus years. I have recently become a RN and have frequently been questioning if I still want to do it. I know they talk about "reality shock" and all that in nursing school but nothing really seems to prepare us for the real world as we encounter it so to speak. it is unfortunate that we don't get much recognition for what us nurses provide to patients and sometimes it is quite the contrary. I take pride in small things such as a family member thanking me for being so gracious to them and sometimes that is the only real satisfaction we get in the midst of a chaotic profession.

I recently graduated from an ADN program in which the college required a solid 80% in order to pass. This was the standard basicaly through all the nursing classes. the over-all sucess rate for graduates that pass the state boards is somewhere around 97% from this particular college. It is for that reason that I believe the required passing percentage for the nursing program is quite adequate.

First of all, I want to congratulate you on your accomplishments. I have recently become a RN after years of hard work and I commend you for what you have done. I can certainly empathize with your situation as I was in a similar one many years back. I did disclose the information to one employer and they over-looked it. I think that given your circumstances and being as reputable as you are, any employer worth considering would understand your situation. Good luck!

Actually, If she is using "safe" and propper technique, it's not totally unheard of to practice on another human being. Of course, as with my training we generally did that type of thing using sterile water for the injection rather than any type of medication of course, and typically it was under the supervision of an instructor. I will say however, as a nurse I make a lousy patient and would be very reluctant to let someone practice on myself either.

that is a horrible experience to have to endure. I think that speaking with one of your instructors is an option in addition to trying to find some kind of inner peace/strengh in knowing that your friend would support you in whatever you decide to do.

I just wanted to say; from what you describe it sounds almost idenctical to my NCLEX exam......shut off at 75......and I passed! I know we seem to dwell on what we feel we don't know rather than give ourselves credit for what we do know. GOOD luck!

there is some very good advice here regarding strategies for taking the NCLEX. in addition, think of the NCLEX as the " Ivory tower of nursing" you always have all the staff and all the equipment you need. Think of pain as psycho-social and often times not a first priorty. Of course, the good old ABC's of nursing. Always think of patient safety first particularly in situations where mental health issues are at hand and the patient is at risk to harm him/herself or others. Don't ask "why" questions. Try to avoid asking questions that only require a yes or no answer rather than open ended giving the patient opportunity to elaborate if they feel comfortable. Watch for information stating that the patient's condition suddenly declined, particuarly their level of consciousness. That is always a red flag that something acute and life threatening could be going on. As previously stated in a post, dont just automatically assume you are going to call the doctor unless it is obvious that implimenting a nursing intervention will not provide the best outcome for the patient. Also try not to read into questions. Such as; you received a lab report that a patient's Potassium level was 7.0. Unless it states you have an order in place to administer medication to amend the situation then obviously you would need to contact the physician to get an order.

WOW.......it seems clear that you have a valid reason to feel the way you do. I think maybe a good part of what I am feeling is aprehension over actually practicing as a Rn after becoming quite comfortable in the role I am currently in.

I was just wondering if anyone has experienced feelings of uncertainty regarding nursing after working so hard for years to become a RN? I have actually been in the nursing field for over 25 years......done the "scenic route" of nursing as I call it. I was a nursing assistant for 20 years, a medication assistant for a year and a LPN for 5. Now, recently after striving hard to become a RN I am starting to question if I even want to do it anymore? has anyone else had feelings similar to this?

I agree with you. I do believe that instructors are available for a purpose, regardless of which type of teaching strategy they use. I trust that they have the experience and knowledge required to guide students in becoming successful as future RN's.

I just wanted to add; I had a 3rd semester clinical instructor for the ADN program that literally had me shaking in my boots. She would ask me drug interactions, side affects, half-lifes.blah blah blah...and if you didn't respond with in 15 seconds she would say "BUZZ....your time is up....go look that up and don't come back to me until you know the answer......." that was exactly what I would do, and when I approached her I was prepared to recite what she was looking for just like a text book stated. I went through one week in particular where I felt I was doomed to fail the course. As ironic as it seems, she gave me a perfect evaluation and low and behold, several months later, I am now a RN.

I just wanted to add; I had a 3rd semester clinical instructor for the ADN program that literally had me shaking in my boots. She would ask me drug interactions, side affects, half-lifes.blah blah blah...and if you didn't respond with in 15 seconds she would say "BUZZ....your time is up....go look that up and don't comE

I took the NCLEX and it shut off at 75 questions and the board of nursing sent me a letter saying I got everyone of the questions right. JUST KIDDING...seriously.....it is awful....but it's what we make it out to be. I also agree that we impose such high standards on ourselves as that is what nursing school is geared at. I think that some of the best advice is to enforce the fact that if you made it through nursing school you do have what it takes to be a good nurse whether you pass the NCLEX the first time or it takes you a few more tries:)

I have worked at a veterans Home for 22 years. I have to say that at times it can be anything but calm LOL. They do try to structure them more towards a "home-like" atmosphere, that I will agree on. As far as hourly pay, many state facilities are actually several steps above hospital wages. You have to keep in mind however, that such as where I work, there may be as many as 50 or more residents (per floor) to be responsible for. Probably what seperates them most predominantly is the fact that many of the residents in a long term skilled nursing facility are chronicaly ill. That is not to say that their condition's can't become suddenly acute however. My best advice would be not to base your decission on the expectation that the environment will be calm:)

Over the course of my nursing career I have experienced numerous patient deaths. It always seems there is some circumstance revolving around one that you always remember. Several months back, a terminally ill patient whom had been suffering from leukemia for a number of years began declining in health rapidly. One night around supper time, he became very anxious and indicated that he had to get ready because they were coming to get him at 6pm. Several minutes later when checking on his status again he had passed away at nearly 6pm on the dot.

God Bless your Dad. And thank you for the reminder that there is a real human and emotion behind the machine and sometimes mechanical actions of nursing.

Stress in nursing? NO........I have been in the nursing field for 25 years and lately at work I feel like I am going to have a heart attack, stroke, and nervous breakdown all at the same time:) I have found the confiding in a nurse or "mentor" you feel you trust or look up to is good way to vent our feelings and get feed back on how they deal with similar situations.