shhhh

I'm looking around for a change of scenery and I saw an opening available in a speciality clinic associated with the medical center I work at as an ICU nurse. The reason I'm on here asking for some insight from you all is that I've been a patient at this specific clinic for the past couple years and intend to keep going. I really believe my primary specialist there is a leader in his field and I want to benefit from his expertise as a patient. I've been seen by two physicians in this clinic and have interacted with nearly every other staff member during my appointments; everyone is wonderful. But, I could see how odd it would be for them all to see me as a patient for this long, and then have to see me as a co-worker. I feel that this major detail would wreck my chances of being hired there. Do you think being a current patient seeking treatment would be some sort of a conflict of interest that could keep me from being hired?

Wonderful! Thank you!

EXACTLY! I feel like your statement describes the entire situation in a nutshell! I think some people who replied missed a key point that I guess I should have elaborated on: she was perfectly capable of doing it herself (to clarify, she was definitely able to reach), but she wanted me to do it instead. I provided education, stating explicitly what exactly needed to be done. I acknowledged that she might feel uncomfortable if someone else did it, and that she might feel better about it if she did it herself. I had just witnessed her washing her face, applying La Mer cream, and then some makeup. I figured if she was able-bodied enough to do that, then she would probably prefer to do it herself. I always offer set-up assistance for my neuro intact patients who are reasonably independent, because I think it would be odd to not offer it. I figured that she probably wouldn't have wanted that I touch her in such a private area (she definitely didn't want me touching her expensive face cream), and I offered to bring her the supplies so she could do it herself, with plenty of explicit instruction and support. "No, you can just do it." I'm not going to be jerk and say no (and I don't want anyone to get a CAUTI on my watch!), so I did it for her. I've had countless patients apologize to me about having to do things of a sensitive nature for them, but a huge majority of them were too sick, too painful, couldn't reach, or otherwise incapable of doing it on their own. It's no problem to help someone like that. That's why I do this job. However, this time around, I found myself offended because the patient was able to do it herself, but basically insisted that I do it for her. Then, right in the middle of it, say, "Don't you find doing this degrading?" I wanted to say, "Well... only when I have to do this for people who could do it for themselves but prefer to have "the help" do it instead!" :/

I had a well-spoken, educated woman as my patient. She had this pretentious vibe to her, but I found her to be polite. That is, until I explained that cath care needed to be done and the rationale behind having to do it.As I'm performing the cath care, she said, "Don't you find this degrading? I would never do this!" I was offended, of course. It's not like I'm a stripper or something, I'm taking care of people here. How can that truly be degrading to me? And I think I was mostly annoyed, too, because I offered to give her what she needed to do the cath care herself, but she declined. If you're not happy about someone else washing you, you'd do whatever to ensure you could to wash yourself, right? In this instance, I said, "Well, Im used to doing this sort of thing. It's important that you don't get a UTI" because I didn't know what else to say. If/when someone has said something similar to you, what did you say to them? And... What did you REALLY want to say instead? :)

But with that plan, you're assuming that she'll actually read the policy. You know, like she was supposed to BEFORE she "changed" the dressing. Haha.

Oh, I just remembered something I think I should add. If you've already been doing this, wonderful, but if someone else is reading this and is being harassed, I wanted to stress the point to you that you should document everything! Like, seriously, bring a notepad and write down anything that can make your case if you have to go to your manager or HR! At my previous job right before I took my current job, our unit secretary started nursing school, and a few months after that, she got too big for her britches, developed a rude, holier-than-thou attitude, and started condescendingly "suggesting" to very experienced nurses (like, they've been nurses 15+ years) how to do their job. Yeah, I'm not kidding. I left before it got too bad, but my friends on the unit kept me in the loop because they wanted me to go to HR with them to report everything I had to deal with before I left. My friends filed a hostile work environment claim. The secretary found out about their claim and immediately filed a sexual harassment claim against them. Why? Well, in her mind, if they were filing a claim against her and trying to get her fired, it was most likely because they didn't like her because she was gay. Her behavior had nothing to do with her being gay. No, they didn't like her because she was a crazy, mean b*tch! Anyway, her claim fell through because she didn't have any documentation that anyone was sexually harassing her (which makes sense, because no one was harassing her!). Unfortunately, my friends who had good reason to report her lousy behavior never thought to write every rude thing down that she did or said, and since they had nothing in writing, the unit secretary was allowed to come back and work after stretch of administrative leave. My friend told me it made for a very awkward work environment until the secretary transferred to another unit some months later. HR told the unit that they could see right through the secretary and felt something was off about her, and she definitely would have definitely been fired if someone wrote down dates, times, who said what, who did what, etc. But from a legality standpoint, no one in that situation had a real leg to stand on because it was basically all heresay. Backing up your claims with everything in writing definitely gives you more clout to the powers that be. If you don't, it seems to really keep their hands tied and they cannot give the appropriate punishment. Okay, off my soapbox!

I really hope your meeting stops this goon's acts right now. I can understand how co-workers get comfortable with each other and they crack off a rude joke every now and then, but most people tend to really stop in their tracks and start behaving themselves if anyone says, "Whoa, that was a little much. Knock it off." Because this guy was told to stop and keeps doing it? No excuse for that, no matter how dim you may be. I suspect he's a lunatic. I will say that you get brownie points for going directly to him first and telling him to stop privately. You can definitely use that to your advantage. Good luck to you!

A nurse I once worked with was upset one day because payroll found out she erroneously got a wage increase. She had known that she got the raise and wasn't supposed to, but she kept quiet. Someone in payroll eventually found out about the mistake. They figured out how much they had overpaid her over time, then they took the money back in installments over a few months. She was expecting us to feel bad for her, but she got no sympathy because all of us she was telling this to were like, "Hey, if you knew you got an increase you weren't supposed to get and did nothing about making it right, you were being a tad dishonest there!" You can always look in your union contract to read about nursing pay raises if your hospital has a nurse's union. Usually, it's very explicitly written in union contracts. Since payroll hasn't notified you of any mistake after so long, it's probably not a mistake at all and it's an increase you're entitled to. A $2.00 raise after six months (presumably after you made it through your six-month probation) doesn't seen that out of the ordinary. If there's no nurse's union, or if just knowing for sure would make you feel better, I'd address it with someone. But it sounds like you have nothing to worry about. Good luck!

Just last weekend, I extubated my brain dead patient. As you would expect, prior to extubation, he had no purposeful movement, no localizing, not posturing, etc. A few minutes after extubation, as his sats were dropping and he stopped breathing, it appeared to me that his entire body just tensed up severely. It looked like neuro-storming in slow motion (to me, at least). I really wasn't expecting him to actually move at all, but what I saw didn't really shock me either. I surmised that his body was experiencing profound air hunger and the movement was the consequence of that. I pushed 10 mg of morphine, and he went asystole about two minutes later. Withdrawing care from a patient is never a walk in the park for me, and I felt very gloomy the rest of the evening. Reading the OP's original question, I thought that perhaps what I experienced was similar. Does anyone agree with me?

Pretty darn interesting... I'll present this to my unit's nurse educators and see if we can get a dialogue going on what is ACTUALLY best practice!

Just letting you know that we use CHG wipes in our ICU's. We use them when inserting lines, on blood culture draws (AND on the blood culture bottles), and lab draws. We just don't really use them when pushing IV meds; we use alcohol wipes instead. I really don't know why you are being told to not to use them; it really is best practice.

I think all of us here would use some common sense and NOT post stories about male, underage patients that reflect poorly on us as the nursing professionals who care for them. Whatever a creepy pedophile wanted to hear about, I really doubt we would comply and give them any of the indecent stories that they desire. Sadly, someone like that probably knows where they can obtain abhorrent things like that online. Since I have a younger teenaged brother, male cousins ranging in age, and am married to a former Marine (who was raised in a house full of boys and no sisters), I can without any doubt state that the "gross" mentioned in the OP had more to do with BOOGERS than anything else. So to lighten the mood, here's a list of things that landed all of these fellows I'm related to in the ER, some with the possibility of an overnight stay in the hospital (cue "Jackass" theme song): 1) Inserting keys into an electrical outlet (toddler was just fine! It just dimmed all the lights in the Coast Guard Base for a few seconds) 2) Rollerskating down slide. 3) "Sledding" down stairs in a laundry basket. 4) Sliding down a slide on river rafting sandaled- feet. 5) Thinking Dimetapp has a yummy grape candy flavor, and drinking four bottles of it. 6) Deciding riding a razor scooter down a steep, grassy incline while wearing a backpack full of high school textbooks is a great idea. 7) Thinking jumping on a bed is enjoyable (they all did this, and our family has pictures of all of them with all their black eyes- none of us girls did this!). 8) Beans up nose. 9 Button up nose. 10) Bean in ear. 11) Bug in ear. 12) Accidentally swallowing Crash Test Dummies action figures heads (see: http://en.wikipedia.org/wiki/The_Incredible_Crash_Dummies) 13) Pretended that the porch was a "tightrope", attempted to "walk the tightrope" and then promptly fell off and broke arm. 14) "Homemade fireworks" 15) Offensive warfare with wiffle bats. Near misses I should include that could have resulted in injury if it wasn't for an adult stopping them: 1) Offensive warfare with claw hammers. 2) Jumping off top bunk of bunk bed holding a plastic grocery shopping bag "parachute" 3) Jumping from roof, onto trampoline, with intent of jumping on trampoline, then off trampoline, then flying through the air and landing in swimming pool. And last, but not least: 4) Feeding the very hungry arabian stallion a carrot "like a mommy bird does a baby bird". Despite what you might assume (people who are childless/was never a young boy/never grew up with young male relatives), we were not raised by terrible parents; us girls in the family NEVER got hurt and all of us are still alive to this day. I think it's just a boy thing. Now, I don't think anyone of them did anything weird, funny, or gross while in the hospital because mom was so mad at them for landing themselves in the hospital, all they did was lay there in fear and do exactly what they were told! :)

For me, it's confrontational family members or patients who get right in my face, point fingers, and yell at me over things I cannot (actually, NO ONE, for that matter) can control. I think an adult yelling at a professional who's doing their job to help just shows a lot of immaturity and weakness in that person, and I can't help but think those type of people are really close to physically assaulting whomever they're unleashing their rage onto. And the threat of getting physically assaulted is what really scares me. Sometimes they do swing, but it's just the ones who are, without a doubt, actually mentally ill. I've been lucky everytime so far; I'm just good at ducking and running!

Thanks, everybody! All your comments really contribute. To clarify, DH documented something along the lines of, "Hospitalist paged a second time per Code Team/ED doctor's request. Hospitalist called unit approximately 5 minutes later, stating over phone to this nurse, 'I'll be there in 20 minutes. I left the hospital to get a cup of coffee.' Message relayed immediately to ED doctor." And with regards to what xtxrn mentioned above, I suspect my husband's charge told him to document it in the patient's chart because there's probably very few nurses at this hospital who really trust that an incident report will actually be filed. I think it's easier to "lose" an incident report that incriminates a doctor than it would be to "lose" a piece of a patient's chart.

My husband is a nurse who works at a different hospital than I do, and he been there a few years. We're just biding our time until he can find a job at a different place. The stories he tells me about what he has to put up with makes my hair curl. I would love to tell you a few nightmares that stick out in my head just to feel better from venting about them, but I really wish for advice or perceptions from any experienced nurses and anyone in nursing administration on this one incident that recently occured. A patient (not my husband's) unfortunately coded early in the AM on NOC shift and this patient did not survive. This was a major shock to everyone involved; this patient, even though in their 60's, was rock stable, and was awaiting to go to surgery to have a lap chole. The protocol at his facility is that the ED physician comes to the unit to run the code, but the hospitalist (who's the patient's PCP during night shift) needs to be present to help recount patient's history, work through H's and T's, etc. The hospitalist on shift is notorious for being sub-par (writing the most ridiculous orders, taking forever to call back when paged, etc.) and did not arrive when paged for this code. This was no surprise to my husband, because he overheard this particular doctor say once, "Oh, it's silly for me to go to my patient's codes, because the ED docs always run the codes anyway." The ED doc asked my husband to page them again. He did, and when they called back, the hospitalist said to my husband, "I'll be there in 20 minutes (!!!)... mumble...mumble." He said, "I didn't hear what you said." And after some more coaxing, they finally said, "I said, 'I'll be there in 20 minutes (again... can you believe that crap!?). I left the hospital to get a cup of coffee." My husband relayed that to the ED doc and, of course, the ED doc went nuts. Apparently, leaving the hospital while on duty is typical for this particular hospitalist, but this ED doc only had heard rumors until now. He wanted the whole incident written up, and rightly so, because from what my husband understood, there was no way anyone could have foreseen this patient dying. The charge nurse (who was this patient's nurse) encouraged my husband to document the phone conversation in the patient's chart, and as a result, all of the hospitalists are mad at him now for documenting it. His nurse manager has just given him a warning, and I think this is just another incident that's going to make him look harder for a job elsewhere. I'm just baffled and I don't know what to tell him. I work at a large university hospital, and I usually have to kick doctors out of codes for just being in the way and gawking, so being told about there being not enough doctors at a code is foreign to me! My biggest question is this: Do you think it was wrong for my husband to document the phone conversation? I feel like all objective data should be documented, and that this doctor has been playing with fire for a while now and should pay the price for their negligence. Even if their presence probably wouldn't improve the outcome, I still feel that they should have been there. I also feel that since the hospitalists are employed by the hospital, they should NOT leave the hospital for any reason whatsoever, and certainly should notify another MD to sign out to them if they absolutely have to. I can understand how it can be viewed at "tattling" by the hospitalist team, as well, but hearing about this "'good ol' boy mentality" among the hospitalist team ticks me off. What do you think of this situation? What's protocol at your hospital? Thanks everyone!

Your story reminds me of one I heard: A doctor who worked with my mom would borrow a stethoscope every time he'd round in the hospital, then leave, forgetting it was around his neck. He'd get into his car and just throw it in the back seat with the dozen other stethoscopes he had picked up. Every month or so, his wife would collect them and bring them all in with homemade cookies and say, "Sorry my husband's a nitwit.":lol2: Anyway, I still have the Littmann that my parents bought for me when I started nursing school almost ten years ago. I think what's helped me keep it this long is having one of those ID tags you said you were going to get, and then attaching a small keychain watch onto that ID tag. I HATE wearing watches (feels annoying, and I think watches are germ magnets), so I got a small, neat-looking keychain watch with sweeping second hand so I can do cardiac assessments conveniently. People have noticed it and given me compliments. I think it makes my stethoscope more conspicuous looking. When I've laid somewhere and then ask if anyone has seen it, someone usually knows where it is because they remember seeing the shiny little watch attached to it.

I agree with everyone and then some, but I did want to mention that the nurses you work with would be raked over the coals if they worked with my current nursing crew, and how things are being run at your hospital are NOT acceptable in the least. I was a CNA for about a year at a small hospital before I got my RN license. It was very apparent that some nurses felt that there was "nurse work", and then there was "tech work". Everything unappealing, of course, was "tech work". I've had nurses there leave their patient's rooms pretending they didn't notice the smells of dirty briefs! It was typical for a nurse to pass a med, then walk out of the room to tell the CNA, "Hey, patient so-and-so needs to use the commode", then sit down and play Bejeweled on a computer in the nurse's station. I've moved on to a larger university hospital as a nurse, and every unit here promotes teamwork. On the floors, the nurses and CNA's work together to keep people clean. In the ICU, the nurses don't have CNA's, but if a fecal explosion is too much to take, it's okay to ask another nurse for help. I think it's worth mentioning that it's normal to be disgusted by cleaning up patients when first starting out, and it WILL get easier to handle over time. I think most of your complaints are probably really about your lousy co-workers than the nursing tasks itself. I think if you worked someplace where the teamwork is great and everyone (CNA and RN staff) takes their turn dealing with unpleasantness, then you'd probably be much happier. But most importantly: If you do decide to continue school and become a nurse, PLEASE remember how miserable you feel being the one doing the grunt work now, and don't stop basic nursing care after you're a nurse. Delegating everything gross to the CNA's will not get you any respect, especially if you get a job someplace like where I work. If you turn into one of the lazy nurses who made your CNA job awful, you're paying all that misery you feel forward, and in the end, you won't any better than THOSE nurses are.

I'm with everyone else! Someone on this site posted a HORROR story in which they were verbally offered a job by a hiring manager, so they comfortable enough to give two weeks notice at their current job. When this person called the new place asking about a start date, the new place had no idea who they were. Turns out, the hiring manager that "hired" this person didn't communicate ANY OF IT to upper management or HR before they just up and quit and walked out! I think about that story every once in a while and it p****s me off that someone (who seems like such a nice person here online) got jerked around like that. But it was valuable for me to learn because looking back, I NEVER got a written offer for ANY of my jobs and I think I was just really lucky there was never any trouble for me. I'll be requesting everything in writing in the future now!

My dad's a superintendent at a prison and has been for years. We're amused at how similar our jobs are sometimes (dealing with patients/inmates, the politics of the facility, preferential treatment of some, etc.). He's found himself doing "triage" (like, for example, an inmate asking him if he would call in the nurse from home at 1am for a hemorrhoid. Um... No.) and how I've used what he's taught me about pressure points to subdue violent patients long enough for security to help me restrain them. The list goes on. I think if I had to choose, I'd deal with patients and have the support of security, rather than dealing with the dregs of humanity in a prision and BEING the security. Being in corrections can turn you into a jaded, cynical jerk with burnout, but so can working as a nurse. It all depends on what kind of CO/RN you want to be. I don't know if my dad's situation is any bit similar to yours, but my dad's a public employee, therefore he's been depending on PERS for a big chunk of his retirement. Even though he's been a DOC employee for many years and considered a high man on the totem pole, he does have that nagging worry that voters will eventually vote to gut his retirement account, even if he is a "tier one" account holder. I know that co-workers of his who have been employed less time than he has have already had their retirement accounts messed with. I think the retirement aspect might be more fruitful for a nurse than a correctional officer, because nurses have chances to work for private companies as opposed to state facilities. That might make nursing more appealing. The trouble is, there's been a glut of new grad RN's since 2008, who have been fed lines about the "nursing shortage". There's a lot of skepticism on this website regarding the nursing shortage; many unemployed nurses on here will tell you that there isn't a nursing shortage at all anymore (thanks, recession!). There's many new grad RN's who come on here and voice their frustration with not being able to be hired as it's cheaper for facilities to hire an experienced RN (who's probably going back to work because their spouse got laid off) than it is to train a new grad for over 8 weeks to do the same job. I guess I don't really have an easy answer for you. I'm really unsure that the grass would really be greener for you if you went to nursing school because it might be very difficult for you to get a job when you get out of school, but I can understand your burnout with your current job.

My first thought was, "Jeez! What a lousy night!" My second thought was, "Was there a full moon last night??"

The exact same thing has happened to me countless times. I've had many Spanish-speaking patients in their 30's or 40's who have an okay grasp of the English language, but they have children who speak both Spanish and English very well. As soon as the kid comes in, they just let the kid translate. I never thought it was odd because I understand that it's kinda exhausting trying to communicate in language that's not your first. These people already feel miserable and tired from whatever brought them into the hospital, and then they're being inundated with all this health information that they may not really be too knowledgeable about. I'm sure she was speaking broken English with you because she thought it was convenient for you. I'm sure when her daughter arrived she took advantage of her kid being bilingual and gave herself a break. And like OrangeTree said, she probably thought by doing this, she was giving YOU a break, too.

And THIS just made me physically ill. My mom (way back when she was a CNA) used to work with another CNA who was given preferential treatment; the woman had an ankle that was sore frequently, was very overweight, and was hopelessly depressed because she was single and didn't want to be. All of this added up to a very slow-moving, apathetic worker who forced my mom to pick up her slack. The nurses felt sorry for this CNA and told my mom that she should just get over it. My mom grew resentful of having to work harder when she worked with this particular CNA. But your story is SO MUCH WORSE. Did this woman know how much of an idiot she was??

Oh my gosh, you NEED to report that!

I did make it clear that I was under the assumption that the OP probably couldn't restrain the patients in the LTC where he/she works. I explained that in my particular specialty and hospital, it's generally an appropriate measure to subdue someone acting violent. I'm unsure how extensive Poi Dog's nursing experience is and if he/she worked in any other specialties apart from LTC, but I just wanted to share with the OP that not ALL facilities are like his/hers and the grass may been greener on the other side. It's really lousy that nurses in some LTC environements not only experience a lack of support from management when this abusive behavior occurs, but they can even be blamed for it occuring. I don't see this changing any time soon. I can't fathom a "happy ending" happening any time soon for Poi Dog and stated that maybe he/she should persue another specialty or facility that's more supportive.

I'm really sorry about what you went through. I've been punched, kicked and slapped. It really makes you feel violated, in a way. The worst for me was when a guy hawked up a huge loogie on my scrubs (after calling me some choice awful names) only because I asked him to slide from the stretcher to his bed and he didn't want to (I found out later that he was incredibly misogynistic and would only barely tolerate the male nurses). What happened to him? Well, after he ran all around the unit in just a T-shirt, dragging his foley around on the floor, being disruptive and attempting to assault anyone within his reach, security finally showed up, tackled him and SLAMMED him down onto the floor. I don't believe security was going overboard either. They needed to slam him to get him to realize that trying to attack nurses in the hallway wasn't going to work out in his favor. I work ED/TICU and we get lots of drunks and drug addicts, along with our demented old folks who also might be violent. We even get sober guys who are just big jerks. Regardless of their diagnosis, anyone who swings after their first warning is restrained. Maybe some Geodon or Haldol IM if they're really flipping. Our rationale is that if they're THAT much of a b-hole to want to swing at you while they're sober, then they're dangerous and should be restrained for the safety of everyone else. If they're so altered/mentally ill that they want to hit you, then not only is that a safety risk to the staff, it could be a safety risk to themselves and we need to "first do no harm". I work with a very "tell-it-like-it-is" trauma surgeon who's an admiral in the Navy. He's intimidating and doesn't take any guff from anyone. We had this one guy, COMPLETELY SOBER and seemed to be appropriate until he was told by me that no, he must lay down in the bed and be still, and NO, he couldn't take his collar off (unstable C1 fx). A few expletives and some mean name-calling from him, an attempt to climb out of bed and swing at my face, a tackle by me and few more nurses, then a call from security to help us put him in 4 point restraints, he's back in the bed. The doctor comes in and sees this guy and guy starts whining, "Look what they did to me! What about my civil rights!?" The surgeon just says, "If you're going to act like an animal, we're going to hog-tie you like one." The patient was pretty quiet and fairly reasonable after that. Restraining residents is probably NOT an option at your facility, but it works for us. But to answer your question, that behavior is NOT acceptable at all where I work. I think the ED environment can be so chaotic that we have to take control any way we can. It's unfortunate that we have people in our society who force us to go to such great lengths to preserve safety for everyone. In your situation, I agree with KalipsoRed. I think she will continue to act this way, and dealing with that every time you go to work will cause you to grow resentful. I would look for another job if I were you.