LaNorteBellaRN

Kim, I know how you feel in terms of making that difficult decision. If your organization conducts exit interviews (most do, if not, request one) then I would be sure to tell them exactly your reasons for leaving and your disappointment in the lack of response you received. All nurses are not replaceable, and certainly the fact that you are leaving after so many years of service speaks volumes. Good luck.

Certainly you are not saying that all nurses possess correct judgement and they always act appropriately and in the best interest of the patient. I'm a nurse advocate, but I'm a patient advocate first, and I've seen first hand what types of mistakes are made when nurses are not "up to snuff" as you put it. It happens. It's a reality. I agree with the poster who said we have to put our egos aside as medical professionals. That is so true. Physicians are not the only ones who can be cocky and arrogant. I've had handful of colleagues who fit that profile. The system and lines of communication are broken. If hospitals/nurses/physicians were perfect we would not have to have this type of procedure in place. I think the pros definitely outweigh the cons in this situation.

i googled "condition h" and the first thing that came up was a powerpoint presentation that explained the procedure and the need behind it, according to one organization. www.ihi.org/.../2005_11-medsurg/nov_1/implementing_ rapid_response_teams_that_include_patient_family.ppt patient safety initiatives have really taken the spotlight here in canada, and when i worked in fl it had already been in the spotlight for many years. as a nurse, with my experience and in my initial schooling, i have always regarded the patient's or family's perception of their overall condition as very important. i remember in my second year of school i had a psych patient who was going for a broncoscopy and on his way out the door he gripped my hand and glared at me saying "i'm not coming back alive". i had no reason to believe this. he was admitted for mental health issues and was in no distress whatsoever. he never did come back. he coded in the pacu and was unable to be resuscitated. believe your patient, and trust their families when they say to you "something is not right here". i tend to agree that instituting a condition h may lead the way to an overuse of abuse of the procedure. i guess it all depends on how the information is presented to the patient and family upon admission to the hospital. i think it's main objective is to prevent a patient's condition from being 'overlooked' or 'deemed' non critical when in actuality, there is real cause for concern. case and point...the josie king story. sorrell king's story can be found here for anyone who has not heard it http://www.josieking.org/speech.html is there a need for condtion h in our hospitals? when our patient's or their loved ones really feel that there is cause for concern and their pleas for help are either being 1. ignored 2. minimized 3. mishandled etc... what are their options? wait until the worst possible outcome occurs and then say "i told you something wasn't right." by then of course, it's much too late. when i initially heard of this concept, my reaction was very negative. i felt there was no need for it. as nurses, what does it say about us as members of the health care team if there are dedicated personel to swoop in an intervene in moments of crisis? isn't that our roles as nurses to recognize these situations and act upon them? certainly nurses understand that our role extends beyond recognizing and reporting these concerns to the physician. what if the physician doesn't "believe us" or feels we are over reacting? certainly nurses understand that it is our role to be advocates and if the physician doesn't act in a way that is in the best interest of our patient, we must persist..... but then i read what supporters of this initiative had to say. one example is a nurse who lost a neice due to cardiac arrest secondary to a k+ level of 7.6 that went untreated. her sister had insisted that there was something wrong, her daughter's condition was changing. there was much documentation in regards to the physician being notified multiple times of the hyperkalemia. but still there was no intervention. did the nurse do her job? she notified the physician of the labs, repeatedly. does it really matter that she did her job now, today......that little girl is dead. how many times have we been frustrated as nurses to know, really know either based on our assessment or even what we feel in our "gut" that something's wrong. have you ever looked at a patient and just know they're going to code? have you ever been ignored? told "i'm the physician i'll decide what needs to be done....." i think we've all heard that before at some point in our careers. initially i thought that having a condition h was absurd. but the bottom line is that our hospitals and our systems are broken. when it comes to patient safety, we'd like to think we always know best, but we don't. so is there a need for condition h? if it saves just one person's life, and i'm sure it already has....then i'd be inclined to say yes. just my thoughts.

good day everyone - happy 4th :) i had a question i wanted to put out there for opinions. do any of the organizations you work for have a "condition h" procedure in place. for those of you who are unfamiliar with it (i was until very recently) i've pasted information below with the source link. if your hospital does have this procedure, how has it worked? is it effective? what are your opinions in general, even if your hospital does not have this in place. i look forward to the discussion. thanks :) https://www.patientsafetygroup.org/uploads/projects/162/wallsigndraft2.doc the story. josie king was an 18 month little girl who died because of hospital errors in one of the best hospitals in our country. through the creation of a patient safety program, the king family's hope is to help prevent this from ever happening to another patient. the josie king call "condition h" has been created here at upmc shadyside out of our desire to provide our patients and families an avenue to call for immediate help when they feel it is needed. josie's mother, sorrel king, has worked with upmc shadyside to design condition h. we are dedicated to making the hospital the safest place possible for patient care to happen. condition h -- what does the h stand for? help -- "condition help" patients and families can call for help by initiating a "rapid response team". a rapid response team is made up of designated members of the hospital's healthcare team, including at least a doctor and nurse, who come to the patient's bedside in an emergency and manage the situation, much like an ambulance team does in the community. the reasons for the condition h can be: a report from a family member or visitor to a healthcare provider (i.e. nurses, physicians) of a serious noted change in the patient's condition that is not being addressed an emergency situation where a noted change in the patient's condition is not being recognized by the caregiver or does not receive the attention deemed appropriate by the family. if after speaking with a member of the healthcare team, confusion or conflict of what needs to be done for the patient is evident. who will respond to a condition h? an internal medicine physician or nurse practitioner, the administrative nursing coordinator/supervisor. a floor nurse, and a patient relations coordinator, when in house. we hope that you never need to call a condition h; however, this valuable resource for patients and families is another way that upmc shadyside hospital is partnering with patients and families to provide the highest quality and safestcare possible.

Now I know why there are so many nurses in the profession who have unsafe practices --- because there are so many colleagues/students/'newbies" who feel they have NO RIGHT to question. So they continue on with their incorrect or unsafe practices and then TEACH others the same....so you have this generation of nurses who were always taught the incorrect way because no one ever questions. I may sound a bit extreme here, but it makes sense doesn't it? I agree, there is indeed a way to ask someone a question without sounding disrespectful or demeaning, but as nurses, nursing students, intern, doctors or whoever, we have an obligation to the PATIENT to ensure that things are being done correctly and most importantly, safely! How are students supposed to learn if asking questions inconveniences or 'angers' their preceptors? If I were a student nurse or someone considering entering the nursing profession I would be appalled at some of the responses in this thread. (I apologize if I am repeating something someone else has said, quite frankly I stopped reading the responses after 3 pages, it was too disheartening). Whether someone has been a nurse for 34 years or 34 days, mistakes can be made. No one ever knows everything, and we as nurses should always be learning. I think it's a step backward for the profession to hold such attitudes about questioning a colleague or a verteran nurse etc.... I've been a registered nurse for 11 years. I've practiced in the United States and Canada. It's been my personal experience that when someone becomes angry or overly defensive after being asked a question (physician, nurse, manager, administrator etc) it's probably because they realize they were wrong OR didn't know the answer. It's much easier to say "I've been a nurse XX amount of years and I won't have some student questioning my practice...." than to just say "You know I'm not sure, but I'll find out." What's the big deal? Even if it is some arrogant wanna be hot shot student who thinks they know it all and is trying to show up the nurse....... just answer the question, and move one........... like any professional should. It's not hard to see where the saying comes from........"nurses eat their young". We shouldn't.

Thank you for your input and the well wishes :) I delivered lady partslly the first time. It was very traumatic (mostly for baby, given her injury) and NOT the delivery experience I had imagined, however, as you said EFW is something that cannot be "accurately" measured, even with ultrasounds, therefore SD is somewhat unpredictable as well. Besides I know MANY women who have given birth lady partslly to babies much larger than 9lbs4oz :) My main concern is for this baby. 5-8% of all Brachial Plexus injuries, especially palsies do not resolve and there is permanent deficit. Of course, my preference is not to have a section, it's major surgery, the recovery time is longer and the risk of infection etc. However, this internal debate I have with myself where the other side is telling me KNOWING what my last delivery was like, knowing I have predisposing factors to SD going in (lge baby, past hx etc) am I willing to risk the baby's well being in order for my own desire to have a lady partsl birth????!!??? The answer is no. I certainly respect this physician. His reputation is great, and the simple fact that he presented the option of a c-section to me but would not let me decide then and there tells me he wants me to make an informed decision that is not rushed and involved both my husband and me. I was just curious, based on the experience of others (especially nurses :) ) if I were to go into labour at 36 or 37 weeks if most OBs would still proceed with the planned section or present the option of lady partsl delivery given the gestational age, and HOPEFULLY smaller baby size. Thanks again for your input. I have an appt this a.m. and will be asking some questions.

I'm G 2 P1 with an EDD of Sept 28, 2005. My first daughter was born at 41 weeks. She was 9#4oz and 21.5 inches. Labour was long, and she was a shoulder that resulted in a brachial plexus palsy, which thankfully fully resolved by the time she was 5 months old. My OB has suggested a scheduled c-section at 38 weeks given my history. I'm agreeable to that, as I know it is the only way to avoid 100% a repeat of last time. I mean they could induce at 38 weeks, baby could be smaller and still get stuck right? So my question is this......if I should go into labour on my own say before 38 weeks, what is the likelihood that he will still section me? I have an appt with him tomorrow and will ask this, but just wanted some opinions. Thanks.

Thanks!! I had the same reaction when I heard who he was but I think they are accustomed to that as he quickly stated "this is not pertaining to you". Which does make breathing alot easier. I was on shift the day of the event in question so that is why I was called. It was not bad at all. Thanks again.

Has anyone ever been contacted by the College of Nurses of Ontario Investigations and hearings department. I was not long ago. I am not named in this investigation, but was on duty in the department on the shift in question and they would like to ask me a few questions. Has anyone gone through this before? What is the usual procedure? Is there anyone who can share their experience? I don't know if I will be able to be of any help to them, but I would like to be prepared since I have never gone through this before. Thanks.

I worked in a small community hospital ED for 5 years and then bacame the department manager. I always had the opionion that you do, department managers should have the skills and knowledge to be able to perform in their respective units. When I started as manager, I thought the fact that I knew the department so well would be advantageous because I knew the process, policies, staff AND how to function effectively if needed. I soon realized that being a seasoned member of that department for so many years did only one thing for me...... created hostility from the staff because I knew how to "work in the department" and would sometimes not come in to replace sick calls or come in and work as staff when it was busy. Their expectation was that since I was the manager and used to be a staff nurse that I come in if sick calls could not be replaced. The reality of the situation was that I was not an ER staff nurse, I was the department manager and that position brings forth a whole different load of accountability and responsibility. I suddenly was responsible for every nurse and tech in the dept, I had to make sure their competencies and certifications were up to date. I had to review charts to make sure charges were not being missed because of my administrative responsibilities and financial accountability to the corporation. Just to name a few. I think the emphasis should be that the manager knows how the department functions, not knows how to function in the department. I know that you said that their job was important too, but you should really think about just how important it is. I don't think one job is more valuable than the other, just different. Managers take a bad wrap alot of the times when in reality, most staff nurses will admit they wouldn't want to do the job themselves. Now all that being said, I know there are horrible managers out there. It is a shame when your doctors don't know who your deparment manager is. I don't even begin to understand how that can happen. But for those of us out there who take pride in our profession and career choices as administrative nurses and not bedside nurses, it sometimes gets frustrating to hear about all the downfalls managers have. But we do exist. Those managers who aren't in the dark ages when it comes to nursing. We can still work along side the front line staff and keep our heads above water. We still keep our ACLS, PALS, NRP, TNCC and ENPC up to date. We're actually still nurses, we're just wearing a different cap :)

Well there are some other questions that come to my mind when I read your post. How long had the child been vomiting? To what degree was this child dehydrated? Indicators such as sunken eyes, dry mucous membranes and last void would be indicative of that. I worked in the ER for many years. We saw kids all the time with GI bugs, vomiting and very often would give them phenergan supps to alleviate the symptoms. Not all children who are vomiting need a full work up, IV and admission, however, a thorough assessment has to be done to come to that decision. The pediatric dosing for a child with vomiting is 0.25-1 mg/kg with a max of 25mg PO/PR/IM. The biggest thing with Phenergan is that it has a sedating effect. So if the child was on any other medication that caused CNS depression or was lethargic to begin with this could pose respiratory depression issues. If the dosing was accurate based on the child's accurate weight (you said under two years old, how much under two?) And the accurate amount was indeed given, and the child was not on any other meds that are contraindicated or was not allergic, I would be more inclined to think that there was an underlying reason for the child's death. I wouldn't think the Epi is an issue at all since I assume they only gave that onces the childed coded. More things I would ask are: Was the child lethargic? Fever? Did the child arrest in the ER? Past medical history etc... I have never had any problems with phenergan in pediatric patients. My heart goes out to your friend. How devastating it must be to lose a child. Robin

I do agree with what you are saying. I know the "realities" of nursing all too well. I worked ER for most of my career, the place where the doors never close and we can never say "We're Full!!!" There's always room at the Inn when you work in the ED. But I also know that most of the rewards I have felt in my nursing career are from those genuine hugs, smiles and tears with "thank yous" that my patients or their families have said over the years, or maybe the joke that a patient told me that cracked me up and the fact that they made me laugh made their day. Sounds corny right? I've come to learn that sometimes the patients don't care if they get their meds at exactly 0800, but they darn sure do appreciate the fact that you washed their dentures for them. Organization and learning to prioritize is essential to surviving in nursing, but learning what's important to the patient and keeping their "entire" well being in perspective sometimes makes all the difference to them. And that's who it's all about isn't it? I suppose I should just be happy that she survived her MI, pulmonary edema (twice) two rounds on the BiPap, quadruple bypass and a pacemaker insertion due to 3rd degree HB, and I am, I'm eternally greatful for the nurses and doctors who have worked so hard where my grandmother is concerned. But I personally think it's more unbelievable that no on has had time in three weeks to wash her hair, than if someone actually did take the time to do it. I don't know, is that unreasonable?

I remember about 6 years ago, it was an abnormally slow day in the ER where I worked. This gentleman was brought in by EMS, more for a social situation, although he did have some medical issues as well. I remember him being so disheveled, unkempt, his beard was nearing ZZ Top proportions, and not because he wanted it that way. He just seemed so 'sad'. He kept apologizing for his appearance, "I am usually so clean shaven but I haven't been well lately." I let him talk as I listened because it seemed to help him relax. When I was done his EKG, and drawing his blood I asked him if he'd like me to help him wash up at the sink and I would give him a shave. He said no at first, "You're too busy, I couldn't ask you"....but he hadn't asked and I was not busy at all. So that's what we did, and I remember his smile and actual tears in his eyes. "Thank you so much, you don't know how much better I feel just being cleaned up a bit." I was reminded of this today as my Grandmother cried on the phone when I called her in a hospital three and a half hours away, where she has been for a month recovering from bypass surgery. Three weeks. Her hair has not been washed in three weeks. The last time it was washed was three weeks ago when I travelled to see her and I washed it for her. Everyday the nurses go in and get her up to a chair, wash her, change her bed and put her back. And in three weeks no one has had the time to wash her hair. "I know I'd feel so much better if I could just manage to wash my own hair, I feel aweful" is what she told me today. I've been a nurse for almost 10 years. I know, and I can appreciate the compromises nurses have been forced to make because of cutbacks, lay offs, shortages and overcrowding. And patient care has suffered directly because of it. But I also know that surely to heaven, there must have been 15 minutes in the last three weeks that someone, ANYONE could have spared to wash my grandmother's hair. I'll be leaving right after work tomorrow to drive 180 miles each way so I can wash my Gram's hair and see her spirits lifted just a bit.

i have no idea if this is the reason why, but the first thing that came to mind when i read your question was the fact that there are crnas - certified registered nurse anesthetists. so perhaps that is why people differentiate now. or maybe there's a whole other reason i'm completely unaware of :chuckle that's my guess though.