rnccf2007

I feel sick when I wake up for work. I feel sick on my drive home. When I get home, I often cry, because I feel that I did not provide adequate care to my patients. The hospital that I work at (a teaching hospital with an excellent reputation) is supposedly commited to "quality patient care." However, I can clearly see that money is the only object and staffing is kept at minimal. Last night, I watched a great nurse with 30+ years break down in uncontrollable sobs. At the end of the shift another nurse asked, "Why is it acceptable for nurses to be abused, what other profession would allow this, it reminds me why there are child labor laws." Three newly hired nurses have quit in the last month. I ask myself, how long I can I work 12-14 hours with one fifteen minute break, if I am lucky. I often have trouble functioning out of work, because I am so stressed and tired. I seriously consider leaving the nursing profession that I love and begin to wonder if hospital nursing is like this everywhere. I would like to hear from other nurses.

Sounds like you have a co-worker from hell that we all have (had) to deal with. Where I come from, eccchymosis simply means bruising. Early in my nursing career (hasn't been too long) I worked with an LPN who sounds like your co-worker. She reviewed and critisized all of my nursing assessments. I am can be silly at times, so I started writing big words for my assessments. No generalized edema for me... "anasarca" , no reddened spots that were not a stage I but "blanchable erythema," etc. She stopped her critisim shortly after. Kind of backfired on me, because now I always document this way. LOL. Thankfully, I don't talk to my patients or co-workers that way. So If you ever get a chance, tell you co-worker..."looks like blanchable erythema to me not a reddened area, etc." Hope you get my point.

I would not have stopped to help, but I would have dialed 911. I used to be trusting, but unfortunately, the world seems to have changed and there are more people feeding off human kindness to commit crimes. I myself, have actually stopped to help people in obvious distress (i.e. an elderly man drops in the intersection in front of my car in the middle of the night, appears to be seizing, and has blood running from his head and ear). That was obvious.

Sounds like in the end the MD needed to put a parameter on this medication. Also how aggressive was the diuresing? 20mg, 40mg, Q6, Q8, Q12? The dose was 40 mg q12. The patient had been given this dose for two days prior and his SBP was trending in the 90s which was WNL for the patient. However, lesson learned. I thank everyone for their comments.

A clothing designer, interior decorator, or writer. Damn, I have misused the creativity offered by being left hand!

Just had to comment on waiving or skipping the first half. Don't do it. You have to recert every 2 years, and protocols change from year to year. I actually enjoy recertification, because you can refresh some skills you may not use on a day to day basis.

You are doing the right thing. A new nurse with the initiative to get ACLS before it is required will be a plus. And...it is not all about getting an edge up. Being open to continual learning is integral to the nursing profession. ACLS certification is not bad. To be honest, the first time that I had to take this course, I freaked. You passed nursing school? LOL, you will pass ACLS. Also, once you register, you will be given an ACLS book, DVD, and other informational materials.

I care! Passing the NCLEX is a big achievement and vey exciting! Congratulations!!!!

I came home and cried feeling like a truly incompetent nurse. I work on a very busy SDU/Tele unit taking overflow from med surg. I had a patient who was being diuresed r/t chronic bladder retention and mild pleural effusion and was prescribed Lasix IV 40 mg q12h for the past 2 days. His BPs were stable with SBP in the mid to low 90s. At 0600, looked at his last VS (0400) and saw a BP of 98/60 (his usual trend) and his HR was 64 on the tele monitor. I did not take his BP and administered the Lasix. At 0650, a nursing assistant told me that the patients BP was 65/45. He took it twice. I went to check on the patient and checked his BP manually. I did not doubt the nursing assistant, but from experience I have seen that machines can be inaccurate. The machine was right. My patients other VS were stable and he was otherwise asymptomatic. Called the doc for a bolus and other orders. To make a long story short, I routinely take VS such as BP and HR before administering BP and cardiac meds, but have never done that for diuretics (even though I realize these meds can decrease BP). Do any of my fellow nurses take a pt's BP before administering diuretics?

To be honest, worked for both. Both are about making money and keeping the rich rich....Actually, my -not for -profit experience was the worst. The not-for profit hospitals (2 prestigious teaching hospitals) were still all about making money---"Get them in---get them out." In the time that I have worked at the last not -for- profit, I had the pleasure of taking care of two high up board members. I never saw so many people hit the floor at 0740, inculding the president, chief medical officer, and chief nursing officer. I was told to treat them "extra special." No getting them "in and out" in this situation. Basically asked to cater to them at the expense of my "common" patients. Asked to solve a management problem because said physician (known to take hours to call back) did not reply fast enough to board members request. I let management handle that and took care of the rest of my patients. They were not happy. If I were a board member, I would not announce who I was. I would sit back and watch how patients are actually treated--"real" patients, "everyday" patients who supply your private jet. This may sound extreme, not.

Maybe we need some vents from the health care workers' point of view to slam back into the public's point of view. First of all, do you really think we want to work short? Most nurses that I know love to work 12+ hour shifts with a 5 minute break, if luck permits. You probably know what a "lunch break" means. And, afterall, we are the ones making the big bucks to keep staffing at a minimum. How would you like it if I came to your place of employment and harassed you all day, telling you how to do your job as a graphic artist (which I have no education, training, or clue about)? How would you like to drive home after work in tears; because you do not feel that you did your best, while in the back of your mind you truly know that this was mostly due to circumstances beyond your control. And don't give me any BS that this can be handled by collective communication with administration...been there done it. Also, no BS about joining the ANA, I am a member of the ANA and ONA. And what patient/family member complained the other day about my lack of care? A: on the call light every 5 minutes to complain about heating/air conditioning in addition to the development of every new sypmtom known to man and God (for the second visit in 2 weeks), B: the patient that was suffering major anxiety over a test that she was about to undergo. I sat on her bed and held her while she cried in my arms and gave her the courage to undergo the test. Sorry patient A, the heating and air conditioning was not my priority, but I am sure that your complaints will be what makes me a "lazy" nurse.

I think it does pertain to where you work. Not too many years ago, some hospitals in my area (inner city) asked employees to cover up their visible arm tattoos with long sleeves. I never worried about this because my tattoo is on my shoulder. They never stated the policy for those who had tats on their wrist or hands. Several years later, I was shocked (r/t previous experience) when I started working at a prestigious suburban hospital that is connected to a major teaching hospital where some health care workers have visible tattoos, which they are not required to cover up. Not sure of exact policy. I believe (hope) that this due to the acceptance of tattoos as art and individual expression, not the qualifications of the person hired. However, when going to a job interview I would not openly display any tatoos (as much as possible). Not just tattoos, for example, when going to a job interview, I wear less makeup---part of the interview process, yet I wear make-up the way I usually wear it once I have a job. Part of the interview process. Don't get me wrong---if I showed up as a goth princess my first day of the job, they may question their decision--LOL

So sorry for your loss. The death of a loved one is very hard, as you know. Before I became a nurse, I remember the great care that was given to my father by the nurses when he was dying of cancer. I think that is why I eventually became a nurse. Strangely, some of my most rewarding experiences in nursing have been helping patients die with dignity and comfort, as well as guiding and comforting their family members. Thank you and God bless you.

Good advice. At both of the hospitals that I have worked at, if a health care worker was exposed or suspected to be exposed they were sent straight to the ED. I wonder what the physician would have said if it was him/her, children, wife, mother, etc. who may have been exposed. "PROBABLY ISN'T INFECTED" isn't good enough!!! Not sure about the prophylactic ATB. However, know a ID nurse who was started on a prophylactic ATB after possible exposure (can't remember what for). I also worked with a nurse who was squirted in the eyes by body fluids from a patient who had AIDS, Hep B & C, and herpes. Needless to say, she went straight to the ED and had to be continuously tested. She was devastated. I was definitely scared for her. Unfortunately, as health care workers we know the risks that are involved. BUT. we are there for each other. Give her support and/or prayer! It will help.

LOL, I can definitely relate to this. I read this post after I submitted my comment. When I worked for the muni court, the "prisoners" in their orange jumb suits and handcuffs were usually more pleasant that the general public. In fact, they were basically nicer. The key is to treat all peole with common respect. I even met one man in a store two years later who thanked me for this. I have found no difference in the patients that I have worked with who are "prisoners."

As far as I am concerned, this practice is legal, because this is a matter of public record. You can go to the local court system to look up this information, and much of this information is also available on-line through courts that have available Web sites to look up a person's criminal or traffic record. Before working in health care, I worked at a muni court. That being said, is this ethical or moral? As nurses, we have all come across situations that are considered "legal." However, what is legal often crosses a fine line between what can be considered ethical or moral. Does the nurse have a reason to look up this person's record? For example, feels that the patient my be a threat to his/her safety? I have taken care of patients who have been handcuffed at the bedside with a police guard. Then, I may want to know their criminal history. However, this is usually supplied on admission. Otherwise, I do not see a reason to do this other than being nosy or having nothing better to do (i.e. taking care of the patient). I have also worked with nurses who looked up criminal and traffic records of family members for no reason. For me, it is a need to know basis, just the same as HIPPA. Unfortunately, their are no laws concerning this, because it is public record. Just my opinion.

Shelly: No advice that I can give to you that others haven't. I feel that you were grievously wronged. I will say a prayer for you. Trust in God. And not to be vindictive, but remember what comes around goes around. Patti

you can make a (big) difference in the lives of alzheimer's/dementia patients. one of my greatest joys was working with this patient population as a nursing assistant. it was both challenging and rewarding. as an acute care nurse, i see an increase in this patient population r/t the aging of america. therefore, all nurses need to be educated on issues r/t this patient population. two great resources are the alzheimer's foundation of america and the alzheimer's association. i am working on an advanced degree and would like to eventually become a nurse researcher with a focus on alzheimer's. below is part of a discussion i wrote while pursuing my bsn. hope this shows you how you can make a difference: i realized that the greatest challenge in caring for this population is communication and effective management of behavioral issues. knowing what behaviors are characteristic of dementia patients is not enough to effectively manage these issues. a clear understanding of the causes of specific behaviors can enhance assessment and application of effective dementia care techniques. effective verbal communication is also important, however; non-verbal communication becomes essential as thinking and language skills progressively decline. despite education on care of the patient with dementia, health care workers may sometimes forget that the patient has a past with their own unique experiences. the patient may have memories which we assume are nonexistent due to their cognitive impairment. according to mauk and barnes (2009), when working with cognitively impaired patients, "it is important that the caregiver not lose sight of the client's perspective" and the patient may "find comfort in some behavior such as carrying a doll" (p. 520). we may assume that the patient's thoughts are "not grounded in reality" (mauk & barnes, 2009, p. 520). i remember mary, a resident with late stage alzheimer's disease, whom i took care of when working as a nursing assistant. the staff was aware of her history based on information obtained from her family. we dressed her in purple, because that was her favorite color to wear. we gave her a baby doll, also dressed in purple, because she loved children but was unable to bear them. she wandered up and down the hallways in her wheelchair mumbling incoherently, her voice barely a whisper. her baby doll was always in her lap and its face was covered with pink kisses because of the lipstick she loved to wear. one day; while taking care of her, i commented on how, only she, could get away with wearing pink lipstick with a purple outfit. she gestured for me to come closer. i bent down to her; she pulled me close, kissed my cheek and whispered in my ear. what she said was not incoherent. i thought my ears were playing tricks on me, and i had to ask, "mary, what did you say?" she whispered in my ear again, "i appreciate the great care that everyone has given me here." i thanked her and stood back up feeling a sense of wonder, while touching the pink lipstick kiss that i knew was on my cheek. i never heard mary speak again. perhaps the "great care" that we had given mary was beyond the obvious. we had also validated her as a person."

Wow, good question for someone with diabetic neuropathy who wants to style their own hair. To suggest going to the salon may be unrealistic for many people r/t the high cost. Also, many people are non-compliant because they feel that they have no control over their own health care. Suggestion (not sure if I am right). Most people don't burn their hands or fingers when usining a curling iron. Could the patient wear gloves such as Isotoners or curl their hair while looking directly into the mirror and notice the position of their hands on the curling iron. while not touching the "hot spots"/

I have always run Zosyn over 30 minutes according to pharmacy at both places I have worked.

Can I work for this hospital? She got a partial scholarship? What do the give to good nurses? Probably a kick in the a.

Let me get this straight, we have a future nurse who not only cheats but is abusive. No wonder why nursing will never be truly considered a profession.

I do not think that you are a poor or stupid nurse. You want to learn! That is the sign of a great nurse! We can't know everything. I am a tele and critical care nurse. The best place to find this information is not on any Web site, because this information can be confusing and unreliable. I looked some of them up! There are some Web sources where you can find practice problems. However, your best resources, before you visit any of these sites, is to visit a book store and find ecg books that will give you information on how to interpret apical and ventricular rates, complexes, arrythmias and management, and practice problems. Some books I would recommend: ECG Interpretation: A 2-in-1 Reference for Nurses (Lippincott Williams & Wilkins) ECG Success: Exercises in ECG Interpretation (Shirley A. Jones, FA Davis) ECG Workout: Exercises in Arrhythmia Interpretation (Jane Huff, Lippincott Williams & Wilkins)

I tend to agree with you to a point... But, what if she passes the NCLEX---and many incompetent nurses have. What will happen to her patients? How can she cheat during a code? Nursing boils down to more than a test! Just remember that an incompetent nurse can ruin many peoples lives. How, as a nurse, can I not worry about an incompetent nurse and just say let God handle the situation?