Mr. Murse

I'm not sure if you read the original post or most of the other responses on the thread, but we all agree that briefly going in to your patient's rooms together after report is a good and necessary thing. Verify patient well-being, check IV drips, check wounds or drains, establish immediate needs, etc. This all makes a lot of sense. Giving a FULL bedside report, on the other hand, does not. It's a waste of time and completely unnecessary.

Yeah I've walked into patients lying on the floor and other crazy things before too. Which is why I'm 100% on board with going in the room together at shift change, but I feel like it should be after report instead of before. That way the oncoming nurse has a good idea of what's going on with the patient so they can immediately go assess drains or mentation or whatever else is most pressing for that particular patient without wasting time on unimportant things.

I'm wondering if anyone else thinks the incessant push by unit managers to do a "bedside report" is ridiculous (I assume the facilities I work at are not the only ones doing it). Don't get me wrong, I fully support the idea that both the nurses coming and going should visit each patient together before one leaves, but it's the push to actually do the full report at bedside that's just a good intention gone wrong. On many floors and ICUs the manager intentionally makes a round during shift change to nag and enforce this petty and unnecessary policy. I understand the intended purpose, I really do, but inevitably bedside reports become unnecessarily long as the patient and family want to chime in about their great uncle who had really bad hemorrhoids or their friend whose cat just had kittens. Even if you manage to keep it on track, bedside report is a waste of everyone's time in my opinion. Just let the nurses report in the hall or at the desk, then round through every room to visualize the patients, then move on with the day. I know I'm venting, but surely I'm not the only one annoyed by this?

?Never said that it did, my friend. I also work at a hospital, where "1-2mg Morphine q5min PRN shortness of breath" is completely up to the nurse's discretion and it most certainly could hasten death with certain patients. You are in a different setting using different forms of the drug. As I said multiple times.......subjective. I'm not disagreeing with you or accusing you, and I'm not even sure why this discussion has taken any kind of argumentative tone. My only point in chiming in at all was to point out that the issue is not as clean cut and simple as some of the post (including the OP) seemed to imply. I'm sure you do your job well, and please believe I'm not accusing you and I understand quite well how it is "supposed" to work.

I was responding specifically to pmabraham, and I'm not sure how my tone or words could be interpreted as accusatory or throwing shade, but if they came across that way to you or anyone else then I apologize. I'm 100% in favor of a patient dying with comfort and dignity. It's just very subjective and situationally specific with few clear cut lines. Even objective criteria like respiratory rate is still very subject to the patient's over all clinical picture.

First of all, I'm not accusing anyone of euthanasia. I'm saying there is a thin line between "making someone comfortable" and accelerating their death, and it is most certainly not clear cut or precise. I assume that I don't even have to tell you this, but everyone's response and tolerance to pretty much any kind of medication can be drastically different......especially pain meds. I've given enough pain medication to some non-comfort care patients that I'm quite certain would have killed many other people, because that's what they needed to control their pain and that's what their body could handle for whatever reason. So just because you gave a ton of Morphine to one patient, that doesn't mean that exact same amount would not have killed another. It is not at all a false belief that Morphine can kill people, or at the very least accelerate their death. I've seen people get Narcan for too much Morphine, and they quite possibly would have died without it. Again, I'm not accusing anyone of anything. At all. I'm just saying there is a lot of gray area and subjectivity when it comes to this topic.

You have a valid point, but where's the line that separates "helping" a person with the process of dying and euthanasia? It's vague at best.

It may be a little inaccurately broad to say "Morphine will not hasten death". In the hospital setting when a patient transitions to Comfort Care it is not uncommon to see orders like "Morphine 1-2mg IV push q5min PRN shortness of breath" or something similar. Then it is up to the nurse's judgement how far to push that, because that dose is certainly enough to cause respiratory depression and "hasten death", especially for a fragile elderly person. Comfort care involves some of the tougher decisions nurses have to make, I think, because none of us want the patient to suffer, but where is the line between hastening death and simply easing suffering? I have certainly seen nurses caring for comfort care patients that I questioned their decision of how much pain medication to give......too much and too little. But maybe the author was referring exclusively to home hospice settings and the like.

Well I'll be the contrasting voice in the comments here and say that I actually really have enjoyed nursing (I'm almost 11 years in). I've done med/surg, ICU, charge, travel nursing, and currently doing primarily PICC team/vascular access and float, and have found enjoyment in all of them. Nursing has provided me with so much growth emotionally, intellectually, and not to mention financially. It's a fascinating place to study people, and if you really look closely then the chance to meaningfully help people is constantly there........as long as you're not expecting thanks or praise. ha. Sure, there are some huge flaws with the field and things that bother me incessantly, but looking back over my decade in nursing I can say without a doubt that nursing has given me more than it has taken from me. If I were you, I would first try exploring another facility or two before completely bailing on hospital/bedside nursing altogether. The culture at a facility can make ALL the difference in the a nurse's experience in the field. I currently float to 3 different hospitals in my area and they're very different from eachother even though they're all in the same network. It's not just the unit you're on either necessarily because usually the culture permeates the whole hospital. Maybe a different culture would change your perspective on it. It's also not unlikely that bedside nursing may just not be your thing. In which case maybe look into nursing outside the hospital, or branches of nursing that are more office oriented. Or keep working towards being an NP as you mentioned because their jobs are definitely not the same as ours. Anyway, good luck. It's interesting how drastically different of an experience one nurse can have from another. I hope you find a place that feels right.

The $100 (ish) I pay every year for malpractice insurance is well worth my peace of mind. What I've been told (and seems to be verified by the post above who had been sued, and by the Radonda Vaught situation) is that the hospital will defend you.......up to the point that you broke protocol or actually did anything wrong, which is quite likely if you're already being sued. Then you will be hung out to dry and tossed under the bus. In other words, if you've done everything perfectly and someone took you to court unjustly, hospital lawyers will defend you. But if you've actually done anything wrong (honest mistake or not), then you're on your own. It seems a bit silly to suggest lawyers are going to go after you BECAUSE you have malpractice insurance. That doesn't even make sense.

There's never been a literal nursing shortage. It's a misnomer. There are plenty of RNs out there to fill every needed nursing roll, and there are plenty of nurslings rolling out of school every semester all across the country. The problem is that there's simply not enough nurses willing to work for the pay and work conditions that are being offered. Which is why travel nurses and contract nurses are dominating staffing in so many hospitals right now.

Honestly, if you're still training, it sounds like you're developing some bad habits early on that are going to catch up to you sooner or later. Habitually carrying unwasted controlled meds around in your pockets until you conveniently get around to it? It's just a bad situation waiting to happen.......

I don't say this to worsen your anxiety.......but this won't be the last mistake you ever make. In fact if you're human like most of us, it will be one of many. All you can do is learn from them and move forward using it to make you a better and more vigilant nurse. Be grateful it was a relatively minor mistake and let it make you better and stronger and more confident, not beat you down. On another note, grades don't necessarily correlate to real life scenarios. Often times the top of the class students have a lot of trouble applying their book knowledge to the real world, and students that score lower in the classroom turn out to be great in real life scenarios. It's just the difference in how our minds work. Not saying you're not good at the bedside, because it sounds like you're doing well, just saying memorizing information and taking tests well doesn't really mean much when you're in the real world applying the information you've memorized. Don't be too hard on yourself.

I've brought this topic up on its own thread before, but I'm wondering why you think heparin needs to be held to draw a PTT? obviously if you're drawing from a different lumen of the same PICC (or CVC, etc) as the heparin gtt then you would pause it briefly so you're not literally drawing up heparin out of the in flow, but what is the rationale behind pausing a heparin drip for X amount of time to draw a PTT? I have yet to hear any rationale for this common nursing practice, and have been told by various docs and pharmacists that it's unnecessary. Given the short half life of heparin you're actually getting an inaccurate therapeutic PTT if you're pausing for 10-15 min before drawing, as is common practice.

I work in the ICUs of 2 major hospitals in my area, and on the vascular access teams of 3, so I've had a pretty good view of the covid situation for the past couple of years around here. So here's my honest, non-biased-as-possible view. Ever since the Delta surge (which was the first surge since widespread vaccine availability) there has been a glaring and undeniable difference between our non-vaxxed and vaxxed covid patients. During Delta, the vast majority (I'd estimate around 75% or so) of our covid ICU patients were unvaxxed. The handful of vaxxed patients who were critically ill almost always had a major comorbidity (think chemo or transplant patients), while the unvaxxed had the "usual" comorbidities that increased your risk of having severe covid (obesity, diabetes, hypertension, etc). The vaxxed patients that did end up in the ICU without a major comorbidity generally had a much better course and often recovered without much issue. We still have unvaxxed patients who are "recovered" from covid but still hospitalized due to the damage it did (people on ecmo waiting for lung transplant, etc). To answer your question more directly, yes, we have seen vaccinated covid patients die from covid but they almost always had a major underlying issue severely impairing their immune system. There has been the rare exception of an otherwise average-health, vaccinated patient dying from it, but it was certainly the exception and not the rule. There has been a very clear trend of unvaxxed patients having a markedly more difficult disease course and higher mortality. Then again, if you're a skeptic and/or a denier then no amount of data or anecdotal evidence will convince you.