TygRNoef

Would you be willing to keep that patient in a LTC facility to wait and see if that's the case? Not many of them carry themselves to the bathroom. I've seen more than one infected wound that had no noticeable odor. The OP probably didn't report them to the ED RN either, but in this case, with the information provided, I still think it's pretty clear that sending the patient to the ED was the best course of action.

It seems you've hit on the problem, and missed the problem all at the same time. Since you can't see where the racism originated, you assume it must not be racism, yet the reason you can't see where the racism originated is because it originated before birth. Generally speaking, minorities get lower quality prenatal care, lower quality medical care at birth, lower quality preschool education, lower quality grade school education, and lower quality secondary school education. Then, when searching for a job, they have to work against overt, and covert racism, and while hospitals likely won't engage in overt racism, covert racism certainly DOES exist. Once they finally DO get a job, they then have to deal with both overt, and covert racism to move ahead in that job, and in that regard, hospitals ARE guilty. The unit I'm employed on has a single Fillipino nurse, and 3 white male nurses, every other nurse on the unit is a white female, I hear derogatory comments about the Fillipino nurse all the time when people think no one else is listening, if you think that doesn't translate to missed opportunities for her, you're only kidding yourself. She's easily in the top 10%, as far as quality, of nurses I've ever met, yet her career is going nowhere, and it's not because she wants it to go nowhere. Everywhere I've looked, the further you go up the ladder the higher the proportion of white male nurses, and the lower the proportion of all other nurses, with black and hispanic females suffering the largest losses. While individual preferences explain individuals not moving up the ladder, it does not explain the steady loss in proportion all the way up the ladder. This coming from a white male nurse in an urban hospital that serves a community that's nearly 40% hispanic. If you think not having hispanic nurses has no effect on quality of care in a hispanic community, you're also just kidding yourself. Many of our patients speak very little English on a unit where no one speaks Spanish, and have cultural needs that no one understands.

It depends on you. Sputum used to make me gag far more than feces. Working in cardiac, and LTC before this, I've seen FAR more feces than sputum, and now sputum doesn't bother me at all, but feces still makes me gag. Now I actually enjoy suctioning, because you see immediate benefits.

I find myself in the same boat. I don't know everything, and I know that no one else does either. All of us will, at one time or another, miss the obvious, and make mistakes. Some of us more than others of us. As a new nurse, I missed a lot of things, and made a lot of mistakes. Some of my colleagues were understanding, some were not. Today, when I see others make a mistake, I try to see myself in their position before I pass judgement. What were they seeing when faced with the situation? What were they thinking when faced with the situation? What pressures were they under when faced with the situation. Could I have done better? How much better could I have done? Would I have done better? Did they do the best they could with what they had? Sometimes, even I forget myself and need to be told I'm being a jerk. In just the last week I yelled at an ED RN that was sending me a critical patient, but all she could tell me in report was that the patient had an elevated BNP and an elevated Troponin, information that I already knew, because as soon as the patient's name appeared as admitted on our unit, I looked up their labs and X-rays. When I got the patient he was in rapid A-fib with Cardizem and heparin running, information I couldn't know because our hospital doesn't have the ED notes on the same system as the rest of the hospital. I shouldn't have yelled at her, it did no one any good. I was that jerk.

I've been steaming about this a bit, and I'd like to address another couple of points you made. Why don't you have enough information? What information are you missing? The OP stated, in the opening post that the patient had a temp of 101.5 that spiked to 103 AFTER being administered Tylenol. The OP also said that the MD asked to check the wound packing. What is your suggestion for a patient with a fever that doesn't respond to Tylenol and a possible source of infection? X-rays and blood tests in the AM? Sepsis IS an emergent situation. Again, the symptoms of sepsis are: Fever above 101.3 F (38.5 C) or below 95 F (35 C) Heart rate higher than 90 beats a minute Respiratory rate higher than 20 breaths a minute Probable or confirmed infection. The OP did not mention the HR or RR, but based on the information provided, sepsis is a pretty obvious possibility. Go back and read everything written here, post 65 is the post that I quoted you claiming you earlier said the glucose wasn't a big deal, which you NEVER claimed until post 65.

Let me fill you in on another reality of my job. I no longer work in LTC, I clawed my way out of that field, because it IS pure hell for an RN that actually cares. I now work in cardiac critical care, and while I still get yelled at by MDs, I now have 5 patients to deal with on most days, I CAN now argue with the MD without worrying about whether or not my other 179 are still breathing. I don't know what staffing is like in your particular ED, but in ours, the ratio is 1 RN to 5 patients in most of the pods, and 1 RN to 2 patients in the trauma pod. It IS my choice, and I'd say it's a damned good choice. I NEVER once sent a patient to the ED that didn't get admitted, so I'd say I have a right to feel like I've never used an ED as a dumping ground. When I make that choice not to argue with the MD who asks that the patient be sent out, I do it knowing I have to get back to the business of keeping the remaining 179 patients in the facility from being sent to you as well. I also never ONCE blamed ED RNs for resenting that they often ARE a dumping ground for overworked LTC RNs, what I said is that blaming the LTC RN is the wrong strategy, it won't make them less overworked, and they can't make themselves less overworked. It may not result in better care for that ONE patient, in some cases, but it nearly always results in better care for all patients involved. Sending you that ONE patient that is exhibiting signs of possibly going bad allows the LTC RN to take care of the rest of the LTC patients more effectively and keeping them in the facility.

I'll find your first post, oh, here it is. Hmmm, I see NOWHERE where you said anything even resembling, "I definitely agreed that one if not both of her patients should go to ER." Your implication was clear, you capitalized "non-emergent," and related a story of another patient with a fever who was simply given Tylenol, despite the fact that the OP's statement pointed to another cause for the fever, which you so obviously missed. I also see no mention of "Glucose would have been nice but as STATED, not necessary." The word "glucose" doesn't even appear.So, I am sorry that YOU can not read what YOU have clearly written, you made a mistake, then kept down the path of said mistake, and now you're trying to dig your way out by claiming you never made the mistake. Then you go on to say, Well, allow me to inform your opinion a bit more, I've worked in LTC, and I can assure you, when you call that MD at 2am, once he tells you to send the patient out, he hangs up on you. Sure, you can call him back, but that will result in your getting screamed at, and your having to argue with him to be able to "clarify and explain what you think." When I worked night shift in LTC, I was responsible for the direct care of 60 patients of my own, plus I was supervising LPNs that covered another 120 patients. You don't have the time to argue with an MD about that one patient, especially knowing the MD is also overworked, at my facility, we were one of 5 that our MD covered, the smallest of the 5 (with 180 total patients at our facility). I get that LTC staffing is not your problem, but blaming the LTC RN won't fix the problem, if you're tired of being the dumping ground, contact your legislators, impress upon THEM the problem, because telling the LTC RN that you "know" they can do something they actually can't do won't fix a damned thing.

My NCLEX had apothecary questions on it, but I was supplied with a calculator.

I've been called to come in while on vacation more than once. . .

In your OP, when you said, my first thought was SEPSIS. Reading this entire thread, I was wondering why nobody thought of this. Instead, people like VICEDRN are berating you because you wouldn't take your 2 year old child in for a fever of 101.5. I agree, I wouldn't bring my 2 year old in for a fever of 101.5 either, but your patient had a fever of 103, and a wound bad enough to require packing (a source of possible infection). I'm thinking VICEDRN and the RN you called report to need to review their skills a bit. The symptoms of sepsis are: Fever above 101.3 F (38.5 C) or below 95 F (35 C), Heart rate higher than 90 beats a minute, Respiratory rate higher than 20 breaths a minute, Probable or confirmed infection. You didn't mention your patient's PR or RR, but everything else you mentioned pointed to sepsis. . . My advice to you, blow off that ED RN, he/she was probably either having a bad day, or is a bad RN. You did what was right, and as much as ED RNs seem to like to think they're gods, they make mistakes too. I can't tell you how many times I have received a dialysis patient from the ED who is in acute CHF because the RN didn't inform the ordering MD of the patient's history when the MD ordered 4L of fluid run in wide open for possible dehydration due to a head cold or diarrhea.

No, there's nothing you could have done different. If anyone bore any blame on this man's death, it wasn't you, if he did, in fact die. I'm just struck by something in your description of his case. Sats in the 60s at night? I imagine he had a DNI order, and a no Bi-PAP order. That was a man in need of serious breath support. The problem is, that offering that breath support would only be a bridge to treat his symptoms while you treat the underlying disease, CHF. Depending on the stage of CHF he was in, even breath support could have beeen futile.

It seems like your mother is one of the many that think we just hand out pills and clean poo. I remember a discussion I had, regarding the damage cocaine does to your heart, with someone once, where I informed them that I had knowledge in the subject at hand because I am a nurse on a cardiac critical care unit, he argued that cocaine isn't damaging to your health. He responded by telling me that changing sheets and cleaning bed pans doesn't imply medical knowledge. I know most people know that nurses do more than that, but there are a fair percentage of people, including patients, that give me a great deal of push back when it comes to the education portion of my job, because I'm just a nurse.

1 RN to 3 patients? On a Med-Surg floor? Honestly, if I could have a ration like that, I'd be fine with no aide at all. I work in Cardiac PCU and our ratio is usually around 1:5 with 1 PCA for 30 patients. It's not safe, and close calls are common. Management knows, and regularly just tells us, "everyone survived." They have, so far, but close calls are pretty common.

Are they charging you for the event, or are you just speaking of the money you will spend to be able to attend? I wouldn't go if they were charging for the event. I have never attended one, but I know a lot of people that have. Most didn't get hired, but a couple did get hired. Some of those that didn't get hired at the event got hired by some of the managers they met a few months, or weeks later. I wouldn't say it's a waste of time, but weigh the pros and cons, it's not like you're going to go and get handed a job. Is it worth your time for a chance at a job?

I use Medscape almost exclusively. I never subscribed to their e-mail lists, and only sign on when I care to get some CEUs. I've done a few that were intended for just physicians, and, as long as you're properly registered, it converts the credits to give you CEUs, or at least it did on the couple I've done. If you do the one's intended for physicians, be ready, they are a lot more in depth than the nursing ones.