anonymurse

Right! Support H.R. 4580! We need your help!

RIGHT! Well get behind HR 4580 and give us a hand here! We gotta ditch this 2-year probation!

Apply to the VA. They don't seem to care about how long you've been looking.

There ARE unions for nurses in LA--at the VAMCs in Shreveport, Alexandria, and NO.

Quick reply to OP. Look at it this way. Death is the natural and inevitable end of every life. We can deny that or not. How is being in denial of reality ever good?

And really, it's all about what you can afford.

Sometimes LPN is a great pick. In this locale, high school students can graduate high school as LPNs. Now suppose they need a job just as soon as they graduate, say they're expecting, or they have youunger sibs to feed. They can hire on at the VA and get good health and retirement plans in the bargain.

They say nurses eat their young. Well they don't. Sociopaths do. That's 4 to 5% of the general population. I seem to attract attacks by them. Virginia is what I like to re-label a Right to Get Fired state. That's what happened. How it happened was because I didn't understand how they work. Two outright lying witnesses against one. Then after over a year out of work, I finally got on with the VA. The Federal government carries its unions with it, so I was automatically represented, whether I paid dues or not (I chose to pay, probably more than usual because paying is totally optional, $17 per biweekly pay period). I was attacked again, brought to a meeting and not told the agenda, same method, two outright lying witnesses. Then I remembered my union training. It was a simple single Powerpoint slide about my right to union representation in any meeting where I felt it might lead to disciplinary action or a change in my work conditions. I claimed my rights. They denied them. Now it is they who are sweating. See, what it all boils down to is simple math. As a RN who can't afford even one lawyer, working for a corporation with a giant permanent legal staff that can take a little time to focus on little old me, plus no union representation, I'm going to lose any dispute. But with a union behind me with its own legal staff and a contract that spells out the responsibilities of both parties, things even out enough that the truth can prevail. That's all I ask for. If I do wrong, yeah, fire me, I deserve it. But if a group of people gratuitously attacks me in my workplace when I'm doing a great job and tries to take my livelihood from me for giggles, let 'em burn. Yeah, I did have a chance eyewitness, but I did the other time, too. Same locality. Same situation. Same kinds of people. The union was the only difference. I'm a working stiff with three schoolkids to feed, so I need the little bit of parity my union brings to the table. Beggin' your pardon, my compatriots who favor the theory of a pure free market, but I'm a living example of why theory should reflect the impurity of the real world. Are you not free to select an agent in other areas of life? I recommend you exercise that freedom where it counts most, in your work life.

Not today, nope.

[skipping prodrome clues, defenses, and pre-firing strategies--irrelevant to your situation; maybe I'll add them later.]

Aha, I can't go back to add stuff because 60 minutes has gone by without an edit. OK. Emotional Prep So after all this sinks in, you look over your FB friend list, and like anyone else, you have roughly 400 friends. Ermagerd, you mean to say 16 to 20 of these are just waiting for me to turn my back so they can select the ribs between which to slide the blade? At this point, you're going to want to go heavy denial, but remember--paranoia is an UNreasonable fear. That means there is such a thing as a reasonable fear. And because you've been juked, you have ample reason. It seems the hardest thing to deal with is the feeling of betrayal. You trusted all these people (you may never figure out who did it, but you trusted them all), and now THIS. You want to beat yourself up for not having figured it out. Hey man, in the middle of divorce agonies, I learned my wife had led a double life our whole marriage, a decade and a half. All of a sudden, I had peace. I couldn't very well get 'back' someone I had never known. She was a stranger, and our marriage, a fiction, like a movie. Like any good movie, it had its good times, it had its bad times, but when the movie's over, you don't sit crying in your seat, hoping there's more. You go to the parking lot to find your car and move on. So you may be missing that job, the patients, your good co-workers, but it wasn't as good as you thought it was, and it's gone. I don't know if you can use my way of thinking. Everybody's different. But there is a way for you to achieve closure and heal, and if you want it, you will find it. You have to do it before your head is clear enough to make a plan.

Disclaimer: What follows is my story. Like all stories, it's anecdotal and specific. I'm not an attorney. Nothing I type or have typed is to be construed as legal advice. If you need a lawyer, see one. When you pay a good attorney for your case, you'll get back a whole lot more money than you put in. MY STORY (your mileage WILL vary!) Introduction I'm going to tell my story on the installment plan, adding to this post as I have time. All stories have a beginning. Ours, the victims', always begin the same way. After that, it gets way more specific, but for now, it's easy--for me. I tell you to read two things. That'll give me time to write the rest. Nurses often say "nurses eat their young." This is untrue. The conscienceless, generically termed 'psychopaths' or 'sociopaths,' are 4 to 5% of the general population. It is THEY who eat anyone they can get away with eating, with the tacit, unwitting assistance of the rest. They get their jollies from lying, stealing, cheating, and destroying the careers of those whom they feel have encroached on their natural entitlement--the slightest word of praise from anyone for anything. All you have to do is be smarter, better looking, richer, or--most hated of all--respected for being a truly good and moral being. They have NO empathy, no ability to know how others feel. They are amoral. They consider themselves superior, because while others tie themselves in knots agonizing over matters of conscience, these can strike as quick as thought. If you haven't read the two sources I linked to, do so. The conscienceless are unimaginably different from 'normal,' so much so that it took Martha Stout an entire book to pound this into my head. Check out this fMRI study. Robert Hare's original paper based on EEGs was rejected because the editor thought the evidence MUST have been faked. No, it wasn't. Nursing school didn't teach me this stuff, and I didn't learn until it was too late. Same for you, bro. With advance warning, maybe others will fare better than we.

Too, not to. Hate autocorrect.

Spikey9001, PM me and I'll pick up on it when I get home. Can't figure out how to PM off this phone, and anyway there's to much info to Swype at you. I just have a few Qs to see how closely your situation lines up with mine, looks super close, and yes, you can totally recover from the blow. Things have never been so good for me.

I think the AHA rhythm strip class is like $50. At that price, it's worth a shot. However, I think it's way more important to work as a NA if you've never done it. Your NAs can make or break you, and working as one will teach you to be a considerate co-worker.

Easy, Go to usajobs.gov and lay for a VA gig, heck, move if ya gotta, and if it turns out to be LTC, no worries--first, a RN with a BSN is a RN with a BSN so far as the VA is concerned, so you'll be paid the same as someone starting out in ICU, and second, the work load is gonna be reasonable, and it'll be the best-funded LTC you'll ever work in.

An old NP told me the MOST important thing is to know your place on the continuum of order to chaos. If you're orderly, you'll hate the ER, and if you're chaotic, you'll hate working in a shot clinic. She said just get to know yourself and take any job that puts you in your comfort zone, because exact specialty of preference doesn't matter nearly as much as being able to survive. I want to add that the work culture of the places you will consider is super important. I was in an ER waiting room once and the level of fear there was so high there were 3 RNs standing at the desk blaming each other for something. That hospital was paying a nice sign-on bonus when I was applying but no thanks! Choose carefully. As Frank Zappa sang "Do ya love it, do ya hate it? There it is, the way ya made it."

Ask your wound care nurse. Local documentation conventions rule. And as everyone's been saying, make darned sure the cause was pressure before staging it.

Depends on her subjective take on how solid those 'signs' were.

It's not plagiarism because we're paid to chart. That means the words belong to the hospital that paid for them. And if someone else cuts and pastes my words because it describes a situation that's unchanged to a "T," then that belongs to the hospital, too, and in addition, that person saved our employer money.

It's real simple. A hospital system has a permanent legal staff that can work nurses over one at a time. Nurses generally don't make enough to afford even one lawyer. But unions have legal teams to defend individual nurses. Now that's worth it right there for me, the respect that comes with having equal legal firepower. Equality, what's it worth to you? If you're a VA nurse, you belong to either of 2 unions depending on whether you're a LPN or RN. There's a no-strike clause in the contract, which I entirely support. When you hire on, you're automatically a member--and you don't have to pay dues unless you feel like it. Musicians call it 'playing for the tip jar.' They have an incentive to do their best by you. And if you live in a 'right to get fired' state, the VA is even more attractive because the Federal government carries its unions wherever it goes, so it's a tiny island of mutual respect in a sea of arrogant 'see ya later, sucka' attitudes. I can't speak for nurses in other unions elsewhere. I have no idea how they're making out. All I know is I'm super happy. If I'm called in and I have even the vaguest suspicion the meeting may result in disciplinary action, I'm entitled to have a union rep there, and the union's contract with the VA takes precedence over regulations. Haven't you ever felt uneasy when being called in? I'll never have that feeling again. Yeah, considering my personal experiences, I prefer to be a respected equal rather than a powerless peon, and I'm never going back.

I saw an agency ad that said not to bother applying if you haven't been working within a year. Another one said you had to have had 2000 hours within the past two years. Sort of the same. If that's a death sentence, it would be worth not being that picky the closer that deadline approaches.

Not arguing with anyone else's ideas, just describing me and my buds and our policies. Figured I'd mention them to present alternate POVs and stimulate more conversation. I use an IV pump (by policy). I use the transfusion set made specifically for the IV pump. Policy limit is 125 ml/H. Rationale is that the pump works by "massaging" the fluid downstream. Over 150 ml/H and the pump starts to crush RBCs, increasing risk of hemolytic reaction and rhabdo. I give no fluids at all during transfusion except PRBCs (policy). Besides the bag of PRBCs, there is a bag of NS attached to the transfusion set that is there to prime and flush the set, but just a tiny bit, and not concurrently given. Fluid overload can come fast. I don't want it to come any faster than it does. It was hard for me to understand just how fast until my patient went from asymptomatic to horribly dyspneic (flash pulmonary edema) in 5 minutes running PRBCs at 125 ml/H, and we had to call a rapid response. I assess before transfusion, and not just breath sounds, BNP, vss, whether they feel even slightly SOB, etc. Whatever's in the chart and in report, I get a fresh transfusion history from them and family with details of adverse reactions. I ask if they ever have swelling, get SOB, were ever told they have or might have CHF, or have renal issues. And I ask if they have ever been treated with Lasix. If it even vaguely smells like they're prone to fluid overload, I call that history in along with my request for a PRN order for IV Lasix between multiple units, maybe even with one unit if they've been on fluids. Sometimes the cardio will say to just give it, or to give a higher than normal dose. And then, of course, I give pt ed about adverse reactions and what to report, and repeat with each set of vss. Just my two cents.

James 1:27 says "Pure religion and undefiled before God and the Father is this, To visit the fatherless and widows in their affliction, and to keep himself unspotted from the world." You'll notice this is a pretty good overall description of nursing. What exactly is religion? The apostle John says "God is love," so it would appear here that religion is the action of disinterested love, disinterested meaning impartial--without being 'spotted' by a personal interest, without considering that there might be anything to gain from your patient or her family--and this is reflected in good boundary setting, which maintains a nurse's ability to think and act straight (that is to say, in the patient's best interest). What I see here is that James considers religion to be the action of disciplined love, a fair description of good nursing. So just from your own personal standpoint, you can feel comfortable that you can do those things James said and not deliver any less care than someone who claims a formal religion. ===== Now someone raised the subject of reassurance. You can do that as a non-member of the patient's religion. You can use their own knowledge and experiences to guide them to a recollection of the certainty they felt at some religiously significant moment in their lives, and that remembrance will surely comfort them. Before I was a nurse, I visited a Christian friend in the hospital. He just learned he was dying, in fact he was going to die very soon. He was worried about not going to heaven (this is different from worrying about going to hell). If heaven could be earned, this man would have had the penthouse, the way he spent his whole life taking care of others and never addressing his own dreams. But he was in distress and worried. And I did what anyone can do. I ran the checklist with him, and here it is: Romans 10:8 "But what saith it? The word is nigh thee, even in thy mouth, and in thy heart: that is, the word of faith, which we preach; 9 That if thou shalt confess with thy mouth the Lord Jesus," Now here I asked him, "OK, did you take Jesus to be your lord, or your spiritual boss, in front of others?" And he said "Yes." "and shalt believe in thine heart that God hath raised him from the dead," I asked him, "And do you believe in your heart that God raised him from the dead?" And he said "Yes." So I said "OK, let's see what it says:" "thou shalt be saved. 10 For with the heart man believeth unto righteousness; and with the mouth confession is made unto salvation." I said, "Well you did those two things, and right there the Bible says you're saved. OK?" And he said "OK." And he was OK. See there? You don't have to be Christian to say those things. Another thing I learned from an ER guy is that you don't have to be Catholic to administer last rites. Seems anyone at all can do that, and if you can't get a priest there in time, at least you can ask one over the phone how to do it on the spot. He had to go and I didn't get a chance to learn the details, but it's a useful thing to tuck away in the back of your head. But now I'm going to tell you that if your facility has a chaplain on call, you get her over there pronto, because if the hospital hired an expert, then you let the expert do her thing. It's not exactly out of your scope of practice, but it's not exactly in your scope of practice, either, and if you have a credentialed resource, it would be good nursing judgment to refer that aspect of the case to her. I don't mean to say some nurses aren't experts in their religion or even others, I'm just saying that the field of pastoral care is a mine field, and the chaplains have maps that say where the mines are buried and I for one don't.

One thing that's a common procedural error is paying attention to the HR number on the monitor. At our place, that's the HR of a sliding 6-second window. But when a MD asks for a HR, he's asking for BPM (beats per minute), and that's the standard, measuring HR over a 60-second period. Now if you will look for the HR graph in the pt's details, you will see the HR for a sliding 60-second window. Yeah, your tech just called you in a panic because he saw 160 for a moment on the screen, but look at the true HR--might be 110, 90, 130, whatever. So rule #1 is: don't panic. And don't tell the MD the pt's in the 160s if you want appropriate orders. If there's any way to measure BP too and have it sent to the screen, do it, especially in the first hour of initiation. Second, when you catch a new pt from the ER, always check the med admin record. Always. Sometimes you'll find they've been given a beta blocker just before they came up, and here you have a stat order for a cardizem push and drip. Again, check the HR over 60 seconds. Not too bad, say 130 or less? Wait a while to assess the effect of that beta blocker on HR/BP, especially if they're naive to cardiac meds. But really it's not a good practice to give a pt a PO beta blocker, then put them on a cardizem push/drip. Google it. If their HR is high enough to begin with, start with the cardizem and hold the blocker. Cardizem has a short half-life compared to PO beta blockers, which might hang in there 12 hours with no way to reverse the effect. Third, communicate with the MD. Compare notes. Suggest. Negotiate. Don't guess. When they wrote the orders, they didn't have as much information as you now do. Help 'em out. Sometimes, even if they aren't willing to forgo the drip, they'll d/c the push and let you start at a lower rate. And, um--we ARE talking about afib and svt, and not sinus tach, right? Saw that twice last week, cardizem drip/push for mild sinus tach. We got 'em d/c'd.