EponaRN

If you live in fear that you may be written up when you've done nothing wrong, you will only start to become bitter and someone will suffer. If it isn't your spouse, family, patients, it will be you. Utimately you should go for your dream job because you want to! You shouldn't not do something because of rumors. Perhaps your manager would give you glowing recommendations? It sounds like you have a stellar record on the job...

Unless they are suicidal or homicidal you don't have a legal basis to keep them under a treatment director's hold which is what you would need and in order to start that the patient has to request an AMA discharge first. Otherwise our docs would let the detoxers leave if they want the drugs that bad, if they aren't there to get clean you are wasting your time.

If it "might" have been drug withdrawal, what kind? Unless alcohol or benzo withdrawal it isn't a medical emergency and you don't really have to keep them. Then you get into competency and capacity issues for ability to accept and agree to treatment, are they really alert/oriented x4 if they are withdrawaling? Also DKA can look and smell like intoxication.

There is not enough information here to make an informed decision on a message board. Kind of a "had to be there moment" it seems. How old is this patient is the first thing I'd ask, what is their reason for admission, why do they have a foley, IV, O2, yet they are A&Ox4? What options were tried besides a sitter? Where any pharmacological interventions tried? If not, why not? Was any attempt made to ask the patient what they would "bargain" for treatment? I.e. music, laptop, any distraction techniques at all? What is their medical history to begin with, is there dementia? Is he sundowning? Is this akithesia? In the Psych facility I work in on the Child/Adolescent unit I work on we have gone a month without Seclusions or Restraints with increased acuity and a full house so it can be done! The art of nursing has to meet the science is all...

To answer a few questions this is a Psych hosp only axis one is depression and SI w plan r/o Ptsd. Med doc started hctz 12.5 qam but no further testing ordered at this point. I put her on strict I & O with RN to assess hat contents. If bp doesn't respond well I am going to request either tx to children hospital or imaging of kidneys pancreas and aldosterone/ cortisol levels. She was on cal count too for no appetite so phyochromocytoma could be poss however does that explain low creat and high albumin? I will keep you guys posted. thanks!

As far as cuff size we tried multiple machines and stuck with manual just to be sure it wasn't a human error or machine error, in fact we had three different people take it about an hour apart just to be sure. She denied pain and I suppose stress could raise your BP to that degree but the labs coupled with the strange BP for a normal weight female is what has me stumped. Thanks for answering

Welcome to the club! Enjoy it now!

sorry I should clarify, she's denying strange urine color, I hadn't been able to observe it.

I work in an acute inpatient Mental Health hospital and last night I was on the Adolescent Unit and this case caught my and the Charge RN's eyes. 14 year old African American female, sickle cell trait, normal weight, normal ECG, low MCH &MCV, high plat, BP 150/100 but seesawing to 139/90 at times usually hovering around 150/100, Pulse between 90-115, low creat at 0.62, high albumin at 5, normal I&O, denying flank pain, back pain, strange urine color, no peripheral edema, no congestion, isolative, quiet, flat affect, focused on her blood pressure, but history of depression and SI. Fam history high for hypertension and she confirms diet high in salt and fat at home although it had been 48 hours since her last meal there. She seems asymptomatic as far as her subjective disclosure is concerned but I can't get over it. I notified the Medical on call and he will see her today but as with many cases in Psych hospitals, if no symptoms, no problem. I'm terrified this girl will stroke out on me or go into kidney failure from a partial or full on crisis (known to happen with trait even) and we weren't proactive enough. I expressed assertively how concerned I was about her and that it just didn't feel right and I was needing to go with my gut that this kid should not have persistent blood pressures with diastolic that ******* high. Her electrolytes were all normal and WBC and RBC counts normal. I'm stumped any ideas?

I am not trying to take an "anti-Walker" stance or tax stance on anything. I am talking about the real threat of cutting large swaths of funding to hospital systems that get MOST if not all of their funding from the very source getting cut and what that will do to patient safety, even if in the short term. You do not have to be for or against Walker to see the potential, possibly unintended effect, of patient harm and/or death.

Not sure I gave the impression I cared about the administration making money, I thought I was talking about patient safety and the real possibility of it being threatened by too much too soon cuts to funding. You kind of just made the point I've been making all thread.

Your opinions on taxes aside, care to answer my question on patient safety being potentially impacted by cutting an exorbitant amount of Medicaid in rural and urban areas of my State that will have to figure out how to manage with the less money (they already get paid half or so what a treatment is worth, also had to create a hospital "tax" on all hospitals to get extra money for those Medicaid hospitals) which will result in Nursing cuts because that is the biggest expense (it's basic Economics not commenting on the morality of it) and since anything can happen, 12:1 was maybe a high number but what about 8:1 on a Med/Surg floor when you were used to 6, daily, there would be a lot of adjustment and lot of error would there not?

Yes but your system has been in place for how long? This is radical change that is happening in this State not incrementally but immediately once the new budget starts in June. While we can probably get there, there will be a lot of I fear, death and error in the meantime as the scramble begins to figure the system that will work out.

he was the county executive that oversaw the complex and the behavioral health department before becoming governor.

My reason for concern is the mismanagement of the Milwaukee County Mental Health Complex under Scott Walker that went seriously understaffed, CNAs were cut leaving RNs to have to pick up extra shifts and overtime. This got so bad one patient in particular repeatedly sexually assaulted other patients and even impregnated one of them. It wasn't until after this, despite repeated requests for better conditions and a locked ward that Scott Walker seemed to comply, but his ambitions were already set on Governor so the mess is still being handled and not settled. My 12:1 ratio was pure speculation I will give you that, however a cut to the budgets of hospitals, especially in rural and the Milwaukee area that do not have private insurance as a fallback since most of their patients have Medicaid, are going to have an extremely hard time adjusting. As I said, I understand the need for cutting budgets and slimming things down but a whole host of problems can occur if you cut the wrong things by too much. Cut family planning, you have more unwanted children and a greater burden on society. Cut mental health services and you have the mentally ill in prisons. Use a scalpel not a hacksaw. http://milwaukeecountyfirst.com/?p=854 http://www.ahrq.gov/research/nursestaffing/nursestaff.htm Let me just set the record and say I hope it doesn't become a disaster, for the patients' sake. But there is a very real possibility that it will.

Really because my url even says nursing-patient-issues? Obviously that is a fight I will gladly take on, however I am wanting to discuss the potential harm that can happen to nurses and patients alike if reduced funding, which will reduce nursing staff (biggest cost to hospital systems it is an obvious move), and the same amount of patients will be in the hospitals with the same needs or worse because they only come to ER during catastrophe instead of when things are easily treatable. This is a new problem that will most assuredly spread across the United States as debts are reduced, as they should be I'm not questioning that. But if you do too much too soon, you will completely turn over the apple cart.

I'm for a national and higher sales taxes, or consumption taxes, as it would be since those who are in the top 1% don't receive an income they don't pay taxes on their wealth (which is why Dems want estate tax), they are called a leisure class for a reason, they don't work. They may pay taxes on investments but usually are able to easily offset this with loopholes. But that aside, if we farm out nursing to ancillary staff what will be left of nursing in 15-20 years? Not saying it's a bad idea just wondering what you feel the role of a nurse will be at that juncture.

This is not an idea I've heard of yet and if you could ensure that hospitals and pharmaceutical companies were honest in their pricing, then I'd be for it. I am a small business Capitalist, as it may be a surprise to those that have probably pegged me a flaming Liberal. I believe in competition and it's effect to drive down price and increase quality. The only thing more effective than your vote at the ballot is your wallet.

Sigh, I didn't bring up taxes, I also kept repeatedly saying "this isn't about taxes" so once again "this isn't about taxes" This is why I brought it up on the Patient Safety thread. Funny how my non-Nurse Economist husband can understand how I am not arguing Economics here as far as taxes go but the cause and effect of cutting funding to an already overburdened system. Is it speculation? To some degree but it isn't an unfair analysis.

whoa knee jerk reaction, i was trying to find out your frame of reference not insult you.

Quick question, what is the max number of patients you have had to care for?

Please cite this because according to those who actually study Economics, small business and new businesses create jobs. You are willing to pay more taxes then? It will happen eventually, cannot kick the can of crumbling infrastructure, failing schools, and now potentially terrible health care down the road forever. Also, please look up Marginal Utility and learn that law of Economics. It hurts a middle class worker of $50K to pay 2% more of his income far more than someone making $500K. The top 25 Corporations in the U.S. took subsidies and paid no taxes. http://www.forbes.com/2010/04/01/ge-exxon-walmart-business-washington-corporate-taxes.html http://money.cnn.com/2010/12/03/news/economy/employers_doing_more_with_less/index.htm They are not creating jobs despite sitting on $1.6 trillion in wealth. Please step out of your ideological box and realize I am not trying to argue Economics with you and taxes, I am trying to bring up the very real threat of patient safety. Also Wisconsin Medicaid existed before 2006, it just took the name of Badgercare around that time.

It is only "free" to people who are below the federal poverty line, many people pay into the system premiums because they cannot afford insurance in the marketplace. Many farmers rely on this and even some nurses who work 2 part time jobs who do not give benefits. If he was so concerned with money, he would truly share the sacrifice and not give away more tax breaks to the Corporations. This isn't about whether or not I think we need to fix our fiscal house, this is about patient safety, my license, and my freedom. We can go to jail for negligence a there is no law mandating ratios, our malpractice insurance could go sky high as well. Think outside of the box of "taxes" please.

Here's the thing, you can make cuts but the drastic cuts that were made were not thought through. Also, why then give away tax breaks to Corporations? I find it ironic that one cannot step outside of the political points on this and see this is not shared sacrifice, this is sacrifice of the middle class. Our entitlement programs in this State are not in the red, they were raided to "balance" the budget. Many people pay into Badgercare with premiums because they cannot afford the insurance through their workplace. Many farmers rely on this as one farmer put it "I work 100 hours a week in the fields, and my wife at Wal-Mart, this will put a complete hardship on our family as we cannot afford marketplace insurance" This isn't about left vs. right. Sure we need to get our fiscal house in order but if you are okay with working in a non-mandated ratio state where your hospitals are flooded with uninsured patients then please come to Wisconsin! We ALL know uninsured patients come in when they are catastrophically ill so try taking care of 12 of those! This isn't about taxes, it is about patient safety!

Should have said high patient to nurse ratio, oopsies