Silverlight2010

1. Patients with ongoing issues, i.e have been having problems with chronic pain, joint problems, GI issues.....not necessarily the reason they were admitted, but it is still a problem. When the doctor is in to see them on AM rounds, they consistently fail to mention their concerns. (I always ask if they told this stuff to the doctor, always hear "well, no") Somehow they expect me to magically fix all these problems at 11pm. So much easier and faster to get orders when the doctor and his team hear it first hand. 2. Ineffective coping and denial I can understand. The over the top, aggressive, shoot the messenger behaviour gets tiring. Just because your buddies smoke more, drink more, do more drugs than you doesn't mean your healthcare providers are morons and don't know what they are talking about. You are the one that almost died. Make the most of your second chance or don't. Your choice. Welcome to life isn't fair 101. 3. The ones that "move in" and then proceed to complain about everything but do their best to avoid getting discharged home.

Give gifts, no. Exchange of contact information, no. Errands or favors...we take that on a case by case basis. Who is asking? What is the favor/errand? Why is the patient unable to do this themselves? Patient have any ulterior motives? Are any staff members put in a compromising position due to the request? Some examples come to mind: Patient A wants to order in takeout just for themselves and their nurse "who understands me, not like the other ones..." No thanks. (Attempt at staff splitting and manipulation anyone?) Patient B, on strict bedrest and no visitors expected for some time. Bored beyond belief, anxious about upcoming tests. Patient asks if anyone going downstairs would be willing to take his $2 and get him the daily paper. There is almost always someone willing to do something along those lines. The exchange of cash is witnessed by a second staff member and the change returned with a receipt. We feel we can be professional and still go the extra mile where and when it's appropriate.

The dumbest thing I've ever heard was "we can't give this patient ondansetran because he's not a cancer patient" We use it for our heart patients when gravol and maxeran just don't cut it.

I work in a critical care unit that stocks 22, 20, and 18s on our supply cart. We do have 16s and 14s on our crash cart but I've never seen them used. I use several criteria in my selection. I look at the size and condition of veins (and arms). What do I think I can reasonably get? What are they in for and what do I anticipate them requiring as far as IVs are concerned. I usually go middle of the road with a 20, smaller with a 22 if they have difficult veins, and try for an 18 if they have been or may be a code.

We still use syringes and draw from vials of insulin. Do you have individual pens for each patient?

The problem with this is that what it takes for the patient to be satisfied and what is good nursing care (or is even practical) are frequently two different things. I work on a unit that often receives high praise from patients (not clients or customers). If a complaint like this had come in it would not have made it far. For me the real problem here is not that a patient was unhappy that their nurse couldn't waste valuable time hanging around but that due to this frivolous complaint another patient went hungry.

A complaint that you did a great job but just didn't spend enough time in her room afterwards? This is a complaint worthy of wasting anyones time? Maybe the patient needs a gentle reality check along with the patient advocate and manager who thought this was worthy of a meeting.

The nurses on one unit back when I was a student would confiscate the alcohol and lock it up, making sure to document how much was in the bottle. Can't have a patient that is drinking in their rooms. Not safe to administer many medications if the patient has been drinking (not to mention heavily). Increased fall risk if they drink? Absolutely! Did they give it back at discharge? Probably, but I was long gone by then. If the alcohol is so important that they insist on keeping it, then they are free to leave. At some point we are all responsible for our choices.

I'm a little curious and am wondering what is your specialty or area of employment? Your only three posts all contain the theme "if you can't handle the families then find a different profession". A lot of families are truly scared and stressed but manage to behave in an acceptable manner. That doesn't excuse some of the outrageous behaviour nurses face at work every day from patients and/or families. I'm all for going the extra mile to help patients and families deal with what is going on but a little empathy for the nurse (or CNA) that was kicked, had a meal tray thrown at them, or was called vulgar names might be nice.

I'm just wondering if someone could fill me in on who pays for the drinks, sandwiches, guest trays and so on. Is this a "cost of buisness" or does the patient end up paying for this on his or her bill. I can't imagine insurance companies footing the bill for these things.

If I had a nickel for every patient that didn't ring to report chest pain (or other "I need to know about this" type symptoms...). My favorite is the patient that reports chest pain long after the fact to the cardiologist during rounds but never let the nurses know about this pain. Fortunately the MDs are familiar with this type of stuff and we never find ourselves in trouble over it. We do give the heads up to the oncoming nurse though to keep an eye out for this stuff. I'm wondering who calls a rapid response on a patient and doesn't send someone to find their nurse. (let alone call a rapid response for what turns out to be indigestion?)

There is a pharmacist here that does flu clinics and I've seen him do IM injections.

A coworker and I both had patients like that about a week or so back. Rapid-fire questions and "requests" but wouldn't let you finish a sentance. Somehow expected us to be mindreaders in the process as well. A lot of "I want" and "go get me" but would cut you off before three words were out. I just remained polite, charted on their actions, statements, and my responses/ plan of care. You can't please everyone, just keep your cool and remain professional. You did fine.

Isolation and non-isolation patients rooming together to save on sitter costs? Wonder how long that will last after the first lawsuit by an outraged family/ SDM if the non-isolation patient becomes infected. Housekeeping duties? When do they think the nurses will have time for that with all the other cuts? Sheesh.

Where I work the consulting doctors, or occasionally their residents will come and see the patient in person. I'm unsure what they would want to know that could be determined over the phone unless it's to arrange something specifically prior to their visit or check on other tests that the patient might be off the unit for and therefore be unavailable. A neurologist might want to know about any current treatments that could affect his tests and give me a time to stop sedation prior to a neurological assessment. You could always try a general "Hello Doctor (fill in the name here), how can I help you" or "what would you like to know?"

I've cried at work and I came home today fighting not to cry. Had a situation at work that pushed me so far out of my comfort zone that I'd need binoculars to find it again. My patient was still alive at the end of the day but for a few scarey minutes I didn't think that would be the case

That's really inappropriate. A sick day is a sick day and hounding you both over it is beyond unaccaptable.

What kind of insulin would she be on that testing her sugar twice per week is sufficient?

No option either for those of us who work rotations that include both day and night shifts

Where I work it's always been at nursing discretion. We just chart reasons for doing so. Might be a different story if the K+ was critically low and the patient was symptomatic. Even then I would try to come up with something that would allow me to run the infusion at the prescribed rate but still prevent discomfort. Most of our patient are fluid restricted so running a primary line isn't always an option. Fortunately our potassium replacement is usually given PO either with Slow K or liquid KCL.

^^ In agreement here. Steep learning curve and you never really stop learning. I had a big learning curve this morning and just try to take it all in and become a better nurse.

I'm kind of shocked to be honest. I've worked as a sitter and never had problems getting help from the other staff, including the nurses. I'm an RN now but if I have a patient with a sitter and they get out of control I'm in to help and then depending on the situation, on the phone to the doctor to get orders for either restraints or medication. To have the patient sustain injury without trying our best to intervene is unaccaptable but it's equally unacceptable to stand by why any staff member is abused by a patient (intentionally or otherwise). We have a code in our facility that we call when someone become too much to handle.

Wow. Giving the med is the right thing unless the patient isn't tolerating it or the order has changed.

I'd give it. Vanco is generally once a day. I'd just note in my chart that the patient was away from the floor at time med was due and make further note of when it was administered. Alternatives could include starting the infusion before departure and the patient goes to the appointment with the infusion running, set to switch to a mainline infusion at say 10-20 cc/h when the vanco was finished. I'd have done this if the vanco was a 1 time dose intended as a prophylactic prior to a procedure, knowing the RN in the procedure room would manage the infusion (and would expect to see it running). Also have to add as long as they are tolerating it well. For 2.5 hours late I likely wouldn't reschedule a UID med, but if it were many hours late I'd check to see if the MD wants the schedule changed but would probably still give it. They are on it for a reason. Just think about the number of antibiotic resistant organisms we have because of incorrect use of antibiotics. My quick mental check list for giving late or held meds Is the order still current? (not changed, discontinued or put on "hold" by the MD on rounds) What is the med and what is it for? How many times per day are we giving it? How late is it and how close is it to the next scheduled dose? (think onset of action, peak times, duration) Is the patient condition appropriate for this med? For example a patient fasting pre-procedure has the morning metformin held. They come back, it's lunch time and their next scheduled metformin is due in about 4 hours or so. I'm about half way between scheduled dose times. In this case I don't give it. If the patient has insulin coverage orders, even better. I can cover a high accu until we get their diabetic meds on track. I wouldn't take it to the nursing chair. This happens unfortunately in nursing practice and meds are not given in the acceptable time frame for many legitimate reasons. In this case, "patient not available". Great topic for a nursing post-conference if your group does that. Just chalk it up to another experience that will build your nursing judgement skills.

Try not to worry about it. Easier said then done but I read what you've posted and get the picture of a patient that can ambulate to some extent and was probably otherwise progressing through recovery as expected until his daughter came and felt he needed to be treated as an invalid. It's really not you, it's them and the unrealistic expectation by some that nurses are now personal slaves subject to maintaining customer satisfaction in order to keep their jobs. I really feel that this "buisness model" does patients and health care providers a disservice.