pricklypear

It isn't required at my clinic. Our crash cart doesn't even have ACLS meds on it.

babykitty - you work in a dialysis clinic that allows you to cannulate and perform dialysis through a native vein? I wouldn't think any of the major dialysis providers would have a policy like that.

A. the tech shouldn't have done anything except turn the pt to her side to allow her to vomit without your instruction. B. look up your policy on BFR with catheters. I'm pretty sure it's 350-400. There's really no need to increase the BFR beyond the current rate to give a bolus. C. 500cc?? You should show your tech the policy on standard treatment for hypotensive episodes as well. Good Luck

My experience has been either 6 or 8 hours, usually in sets of 3. I've never had them ordered every 3.

NT suctioning definitely requires skill! Performing it incorrectly or unnecessarily can cause considerable harm and distress to your patient. Please read up on the technique or ask your facility's respiratory department to help you.

Give yourself some time. If you have some good monitor techs, learn from them - they've seen everything!

Hey! What's wrong with the "Mellow Drifter?" When I worked resource pool, I always tried to be that. Maybe you're misinterpreting the "she will make you feel like she doesn't care what you saying" part. You DO have all the characters down to a T, though!!

Geez, calm down...no need to get yourself so worked up and defensive. If you feel like you need to wear a mask because you can't deal with odors, be my guest. I still think it's unprofessional, and while it may or may not further embarass patients, it has the potential to do so. Wearing a mask to see a MRSA patient. Only if the MRSA is in the sputum, or is likely to become air borne in droplet form. And isn't that a totally different situation?

Sorry, Mochabean, I just totally disagree. I've seen and smelled some really, really bad stuff - and never seen a team of health care providers wear masks because of any "intolerable" smell. As Fuzzywuzzy pointed out, masks do very little to eliminate odor, anyway. A dab of metholatum on the upper lip works better. If you can't stand the heat, get out of the kitchen. Do you really think someone is going to complain that they felt embarassed that you were wearing a mask? I'm pretty sure your patients just suffered in silence, just another humiliation to endure. I used to know a new grad in ICU who expected that she would be wearing a mask whenever something unpleasant assulted her nose. This was immediately nixed not only by the other staff but our manager, as well. It's unprofessional and inappropriate. It non-verbally communicates to the patient, "You're disgusting." Does it really sound ridiculous? How about: It you don't like kids, don't be a teacher... If you don't like blood and guts don't be a paramedic... If you don't like money, don't be a banker... If you don't like animals, don't have pets... Get my point?

I have never worn a mask because of odor. I have never made a patient feel bad because of something they have absolutely no control over. Yeah, stuff stinks. And there are even worse things than C-Diff. Like I said, if you "need" a mask, you belong in a different profession altogether. You just deal with it with a straight face, in a professional manner, and move on.

Maybe you should find another line of work if you can't deal with the smells of health care. Believe me, there are much worse smells and sights than a soaked diaper.

Kind of an unnecessary comment. Have you ever worked in an outpatient HD unit? If you had, you would understand the frustration of having an incontinent patient in a RECLINER who probably cannot stand or be repositioned without several people, poop everywhere, no privacy curtains or nice little bath buckets with hot soapy water. Alarms, turnaround, patients wanting this and that, docs on the phone, BPs in the toilet all around the room. It's not really that HD units are "poorly" staffed, we are just not staffed for that kind of treatment on a regular basis. Having someone be incontinent on the ED gurney with supplies and help convienently nearby is a different story.

I'd add in office/clinic nursing, possibly dialysis, school nursing, home health, case management... Most nursing jobs do involve "direct" patient care, in other words, "having contact with patients." But"bedside nursing" really refers to hospital/staff nursing, LTC, nursing home type of jobs. As for new grads? Dialysis sometimes hires new grads, home health sometimes, too. Although I would recommend getting some "bedside" experience in your pocket. It's not always pleasant, but it does offer tons of learning experiences in procedures, disease process, time management and people skills. These will serve you well and broaden your horizons in the future.

I'm not sure how a short note with a few tasks is improper delegating. I receive written orders all day from doctors, I can't just not do them because I feel that I was treated unfairly. It doesn't matter, anyway. Please understand that the point is: the patients' needs were not met because the tasks were not performed as instructed by the RN (yes, instructed), and the CNA displayed wholly inappropriate and unprofessional behavior.

(((((((JB2007))))))) I'm sorry. Sometimes I wish I had gone into archeology. I have felt like I was banging my head against a wall for most of the 9 years I've been nursing.

Saude - Please don't be so hostile and defensive. The thread has nothing to do with time management. That could be a new thread that you could start since you feel so passionately about the subject. If you feel you're being "attacked" you can report as a TOS violation - cause we don't usually attack people around here. And I'm not sure where your "performance ratings" came into play anywhere in this thread.

Yep, the joys of working nights and being totally screwed up in the sleep department. I never had anything THAT dramatic () happen, but I did wake up totally confused many times - thinking I had overslept because it was dark, thinking it was morning instead of late afternoon and vice versa. I feel like a new person working days.

No, the point is that the CNA behaved inappropriately. And that the OP did nothing to bring it on herself by "being too busy to take a pee break." I take exception to the tone of the bolded portion of you post. Of course it matters to me that the OP "not finding a way to take a break caused her to become ill." I've been there myself, so have many others. Patients actually come first. When there are things to take care of, crises to deal with, eating a cracker doesn't score high on the priority list. I'm glad that you apparently have not run up against this kind shift in you career as a nurse. Can I have a job where you work?

I`m glad you guys did well in your inspection! It just baffles me that these state surveyors don`t know even what they are looking at. That`s like me going into a machine shop and making up rules on the fly. I was hoping when I got away from hospital nursing that I was getting away from the bull**** of that kind of mindless regulation. I guess not.

OMG. Where do they FIND these people? Do they even really know what they`re talking about???

Did I miss something? Since when does it matter WHY the OP left the floor for a few minutes on a break? The POINT is that she left instructions for the CNA to perform a couple very simple tasks well within her job description. And, not only did the CNA not perform the tasks which were legally delegated to her by an RN, but she was verbally threatening and disrespectful. This would be the equivalent of me telling my boss (or ANY of my co-workers, for that matter) that I am not her "n-word" and I`ll do WHAT I want WHEN I feel like it. This woman needs to go work in a junk yard, not a health care facility. It was completely inappropriate. It`s easy in hindsight to say "Oh, I would have said this or that." It doesn`t matter what you should have said or done. Just realize that you did NOTHING wrong, but she did. My advice is to arrange a meeting with your supervisor and this (I don`t think I can use the term I would like). Don`t say "I felt sick" " I hadn`t had a break" - because that isn`t relevant. Just state that you requested in writing that the CNA perform certain duties, and she failed to do them. And that she was disrespectful of you not only by what she said to you, but by the way she discussed the incident with other employees. Or, you could talk directly to this "person" and tell her that you expect her to perform her job, and you expect to be treated with the respect you deserve. If she cannot do this, you will have no choice but to file a complaint. Or, you can go directly to your supervisor and talk it over with her\him.

I guess I'm just so disheartened because I've seen such disregard for individual wishes. I've seen such disregard for the need for pain relief. Or, I should say, patients with extensive burns/trauma just might need very large amounts of pain medication instead of the "usual dosage." I've heard too many times, "That is a larger than average amount of medication, I'm not comfortable ordering that." BTW, the video of this man speaking at a university was VERY moving. http://www.uwtv.org/programs/displayevent.aspx?rID=3619&fID=567

The downside is, that once narcotics are introduced, "incompetency" can be claimed.

When I worked ICU, we had a patient who basically had a dead body but a living brain who constantly asked (he mouthed words since he was vented) to be allowed to die. This was a previously very robust and healthy man who suffered a sudden, traumatic injury. He was deemed "incompetent" by his "saviors" and his agony was dragged out for several months. It was horrible to have to care for him- his suffering was obvious, but there was nothing you could do. Several nurses refused to be assigned to him for ethical reasons. The ethics committee was involved, but sided with everyone except the patient. I think it paid more to keep him alive - he had good insurance. This will continue to happen until people make their wishes known BEFORE something happens, and families stand up and fight for what they know their loved-one wants. I wish some of these doctors could live for just 24 hours with the agony that some people are forced to endure. Outcomes might be different. It's just pretty scary.

That's ridiculous. There will always be times when you may need to get a manual. When I took my state certification (in AZ) many years ago, manual BPs were one of the skills you were expected to know.