Simkah

llg, your wisdom never ceases to amaze me. I think I will lay low and keep my mouth shut. After much careful deliberation, I have decided that this is one battle I choose not to pursue. I will leave it to TPTB to eventually figure out what is going on and sort it out among themselves. "Silence is golden." Thank you again, my friend.

One of my professors in my PhD program is a curmudgeonly statitician. He is an older middle-aged man with an attitude. During his data analysis class, he constantly disparages some of the other instructors, especially the director of the PhD program. This behavior is so unprofessional. I can see an occasional lapse out of frustration or needing to vent in class in front of students. But NOT every. single. class!!! Even worse, he occasionally talks about other students in the program. One student he specifically mentioned by name and talked in detail about some of her struggles with her dissertation, in most negative overtones Not only is this a violation of FERPA, it just makes me very uncomfortable. I would NEVER want to go to him with any problems I encounter in my personal research efforts, because he might talk about me in another class! This whole situation is beginning to really bother me. Any advice on what I should do?

PCMH is a mixture of good and bad. It has some absolutely great units in which you can establish your nursing career, and it also has some units that will burn you out before your first year is finished. Good units (IMHO): cardiac floors. BTW, PCMH has just built a new state of the art cardiac center. Other good floors: postpartum, General Rehabilitation Unit. The nurses on 2 West (peds floor) seem generally satisfied. The newborn nursery is great, but doesn't have a lot of openings. The NICU also seems to be an excellent unit. AVOID the med-surg units at PCMH like the plaque. The pace is chaotic, insanely busy, and most nurses end up working 13+ hrs and they're lucky if they get a break at all (to eat or go to BR). Worst unit in the hospital is the MIU (Medical Intermediate Unit). You will have 4 very complicated patients on vents, multiple drips, isolation, etc., and every other conceivable condition. Any other hospital in the area - these patients would be in an ICU with 1 nurse: 2 patient ratio. BEWARE! Also, on the SIU (Surgical Intermediate Unit), many nurses end up with back injuries. PCMH is considering establishing lift teams, which would really help. There is state-of-the art lifting equipment on the SIU, but many neglect to use it. PCMH was a Magnet Hospital, but wasn't up to standard to renew. They'll try again in 2011. Physicians and administrators wield the real power in this facility and nurses don't have the control over their practice environment that they should. Others make critical decisions concerning nursing, often without consulting the nurses. Ultimately, the bottom line is the bottom line. Nurses on most units are very busy. There is one recent case in which an advanced practice nurse employee was reprimanded and her case turned over to the BON, over a mere dispute with a physician. This has seriously hurt nurse morale at this facility. Greenville is very overgrown, as is entire Pitt County. It lacks the infrastructure to handle the rapid population growth it has been experiencing. Traffic can be insane, and I'm from up North. It can take 45 minutes to cross one side of the city to the other (Friday afternoons and other "busy" times). The crime rate is also high. One young man I know was attacked in his home (armed robbery). He was shot and later died from complications. There are lots of nice restaurants and shops, but I would rather not live in the city. There are nice areas to live outside of the city, such as Washington, Chocowinity, etc. You can also avoid the high city and county tax rates by commuting. This is only one person's perspective. but I hope it helps. Good luck to you. If you do choose to move down here, welcome!

PCMH is a mixture of good and bad. It has some absolutely great units in which you can establish your nursing career, and it also has some units that will burn you out before your first year is finished. Good units (IMHO): cardiac floors. BTW, PCMH has just built a new state of the art cardiac center. Other good floors: postpartum, General Rehabilitation Unit. The nurses on 2 West (peds floor) seem generally satisfied. The newborn nursery is great, but doesn't have a lot of openings. The NICU also seems to be an excellent unit. AVOID the med-surg units at PCMH like the plaque. The pace is chaotic, insanely busy, and most nurses end up working 13+ hrs and they're lucky if they get a break at all (to eat or go to BR). Worst unit in the hospital is the MIU (Medical Intermediate Unit). You will have 4 very complicated patients on vents, multiple drips, isolation, etc., and every other conceivable condition. Any other hospital in the area - these patients would be in an ICU with 1 nurse: 2 patient ratio. BEWARE! Also, on the SIU (Surgical Intermediate Unit), many nurses end up with back injuries. PCMH is considering establishing lift teams, which would really help. There is state-of-the art lifting equipment on the SIU, but many neglect to use it. PCMH was a Magnet Hospital, but wasn't up to standard to renew. They'll try again in 2011. Physicians and administrators wield the real power in this facility and nurses don't have the control over their practice environment that they should. Others make critical decisions concerning nursing, often without consulting the nurses. Ultimately, the bottom line is the bottom line. Nurses on most units are very busy. There is one recent case in which an advanced practice nurse employee was reprimanded and her case turned over to the BON, over a mere dispute with a physician. This has seriously hurt nurse morale at this facility. Greenville is very overgrown, as is entire Pitt County. It lacks the infrastructure to handle the rapid population growth it has been experiencing. Traffic can be insane, and I'm from up North. It can take 45 minutes to cross one side of the city to the other (Friday afternoons and other "busy" times). The crime rate is also high. One young man I know was attacked in his home (armed robbery). He was shot and later died from complications. There are lots of nice restaurants and shops, but I would rather not live in the city. There are nice areas to live outside of the city, such as Washington, Chocowinity, etc. You can also avoid the high city and county tax rates by commuting. This is only one person's perspective. but I hope it helps. Good luck to you. If you do choose to move down here, welcome!

I want to thank everyone for their replies and words of encouragement. I think the worst part about all of this was the Charge Nurse's words - If you were him, would you want to live? These were the last words this dear gentleman heard as his soul was departing this earth. Just a few minutes before, we had been joking with the patient - now he was dying, surrounded by strangers. Failure to rescue - or failure to resuscitate someone who is a full code - is a serious offense with my state's BON. The tragic thing is that the patient could have easily been resuscitated at the point the Charge Nurse arrived on the scene. His pulse was still very strong and regular, and positive pressure ventilation with an ambu bag and oxygen, along with IV lasix (for flash pulmonary edema), should have been sufficient. Had she been reported, the Charge Nurse would have certainly lost her license. Who's to make the judgment as to the quality of a person's life? Sure he was elderly, sure he had mild dementia and some major functional limitations due to his amputations, but who are we to say that his life is not worth living? In that instance, the Charge Nurse became his judge, jury, and executioner. So sad that this happened under the watch of healthcare workers - his life had been entrusted to us. This was my first encounter with this Charge Nurse - not a very good first impression. Later encounters just reinforced this very negative first impression. She was a very unpleasant person, so burnt out in nursing that she was crispy on the edges. Years later, when I had groups of students on this unit (as a nursing instructor), she was very nasty to the students. In fact, there was a battery incident involving this nurse, in which she slapped a student on the hand (not my clinical group, thank goodness). I found out later that this particular facility has a "good ole' gal" system in place, in which some of the older, more favored nurses can get away with murder (literally), and others are written up and thrown to the wolves for the most minor offenses. Anyway, enough of my thoughts on this matter. Time to leave it all in the past. Thank you for your comments. Writing about this has been painful, but it has also helped me reach some form of closure.

I was a relatively new and inexperienced nurse and was orienting to the hospital on a chaotic medical-surgical unit. The orientation began by following the nursing assistant(s) for a shift and participating in basic patient care tasks. This was to promote better team playing among the members of the nursing care staff and empathy for the nursing assistant role. As I was functioning in the role of a nursing assistant and did not have much experience with this particular floor (it was my first day at this new job), I was a bit vulnerable. The nursing assistants were not given much of a patient report. I did not have time to look over the patients' charts or Kardexes, but just hurried from room to room as I followed the nursing assistant to help her with the many patient care tasks on this busy medical-surgical floor. One of our patient assignments was an elderly gentleman with dementia who was also a double-amputee. As we were turning him to the side, to give him his bed bath and to clean up bowel incontinence, he suddenly began gasping and his breathing became erratic. It was obvious that he was going into respiratory arrest. We repositioned him with his head up high in the bed, tried to stimulate him to get him to breathe, placed oxygen on him, and called for help. When the charge nurse arrived shortly afterward, she made these caustic remarks: "Don't revive him. Take the oxygen off. Let him go. He's a DNR (do-not-resuscitate). If you were him, would you want to live?" Since I believed the charge nurse had accurate knowledge of all the patients' code status on the floor, I obeyed her orders without question. I was not the patient's primary nurse and did not have accurate knowledge of his code status. He could have easily been resuscitated at that point with an Ambu bag, oxygen, and some furosemide IV. But tragically, he progressed from respiratory arrest to full cardiac arrest and then died as we looked on helplessly. The whole situation was very surreal, like a bad dream. About 15 minutes later, it was discovered that the patient was indeed a full code and should have been resuscitated! The patient's primary nurse (who afterward appeared on the scene) was very upset with the Charge Nurse for allowing her patient to die. I was a bit suspicious all along because this client was not wearing the required "DNR" armband. But many patients on this disorganized floor did not have on the proper code status bracelets. After the shift was finished, I went home in a state of shock. I immediately telephoned the nurse manager for this floor (who had been off that day) and also the Director of Nursing (DON) to inform them what had transpired. I also dutifully wrote up everything that had occurred in a facility incident report. I point blank asked the DON if I should report this "failure-to-rescue" error and patient death to the state Board of Nursing (BON). She emphatically said, "No - we will take care of it." I also e-mailed one of the staff at the BON and asked her in the e-mail about a detailed "hypothetical" patient-care situation and if this should be reported directly to them. The BON official replied that following the "Chain of Command" in my "hypothetical occurrence" at the hospital was sufficient for them, but I could always directly report the occurrence to the Board if so desired. So I did not report the incident to the Board. It turned out that the incident was "swept under the rug." I was devastated. The Charge Nurse was severely counseled but not fired. She retained her license and continued to practice on the floor. Nothing was ever reported to the Board. The patient's family was not informed of the true circumstances surrounding their loved one's death. I found out that this incident had been "kept quiet" to avoid bad publicity in the community. No doubt they also wanted to avert a huge lawsuit and big money payout by the hospital. It was about eight months later that I became fully aware of the facility's inaction. I decided at this point to let it go. I knew "whistleblowers" in nursing often suffer severe repercussions and the case was now very "cold." I knew if I reported this incident to the Board, I would not be supported in my allegations and the charges would probably be turned on me. In fact, I possibly could lose my license as a result! Since my state is an "at will" employment state, I probably would be fired, then branded as a troublemaker and would not be able to find employment anywhere in the area. So I chose to remain silent. I still feel twinges of guilt that I had taken the "coward's way" out. But this seemed like the most pragmatic and reasonable thing to do at the time. Of course, hindsight is always 20-20 and this happened a long time ago. I have experienced much personal growth since then and now possess business-world savvy as well as nursing expertise. If faced with a similar circumstance, I would demand proof of the patient's DNR status. Otherwise, I would immediately initiate the resuscitation ("Code Blue") process. I now know to directly and in a timely manner report such occurrences to the BON. Hospital administrators often choose to cover up healthcare errors and cannot be trusted to disclose these events to the proper authorities. I would describe my decision-making process at the time as what I had been taught in nursing school - the "follow the Chain of Command" philosophy. I sought out the proper authorities at the hospital. I followed their advice and filled out the facility incident report. I trusted them to do the ethical and right thing. It turned out that they did not do so. I was not expecting this.

On our pediatric ward, parents are not required to stay, but are strongly encouraged to do so. "Family-Centered Care" is the official policy of our Children's Hospital. However, there are many tragic instances in which the biological parent is NOT allowed to visit unsupervised. Our policy states the following concerning parents:

Several years ago, two of my female coworkers had the Roux-en-Y gastric bypass surgery. This is the procedure in which the stomach is reduced to the size of an egg and the duodenum and part of the jejunum is bypassed, creating malabsorption. They were both morbidly obese and had tried numerous diets, but to no avail. One was relatively young - in the low 30's, and the other in her mid-50's. The younger woman fared marvelously and lost over 100 pounds in a little over a year. I believe her weight finally stabilized around 150 pounds. She did suffer one complication - a gastric ulcer which formed shortly after the surgery, with significant abdominal cramping. With a simple oral anti-ulcer medication prescription, this condition was completely alleviated and she healed without any further problems. The older co-worker had a more harrowing road to recovery. In addition to the morbid obesity, she suffered from multiple comorbid conditions (such as HTN, Type II DM, atrial fibrillation) and was taking numerous medications, which significantly complicated her recovery. At one point, the coumadin dosage that she was accustomed to taking before the surgery caused her INR to skyrocket to 11 and she was hospitalized to prevent hemorrhage. She had several other equally frightening episodes that resulted in hospitalization as well, but she survived. She also had bouts of explosive diarrhea and sometimes had a fecal smell. I have been out of touch with these two for almost two years, but people who have seen the older woman report she has lost a LOT of weight - over 100 pounds - but "is pale and looks really unhealthy."

I did something very similar during my first year of nursing and felt HORRIBLE about it! In my case, I had copied down the wrong day from the schedule (either that or the schedule was changed after I copied down the days, can't remember which). Someone called from work and I QUICKLY made it in! Things like this happen. Quit being so hard on yourself :)

That "uneasy feeling" is your conscience. Abortion is the actual taking of human life. The pay is lucrative for a reason, because it is very difficult to find staff who will participate in performing this procedure. Don't do it.

As long as the potent neurotoxin thimerisol is present in the influenza vaccine, I will refuse this immunization year after year after year (and I work in direct patient care). There are so many contaminants in our environment to which we are exposed daily on an inadvertant basis, why subject oneself to such a potent toxin willingly? I liken this to taking vitamins with food coloring or artificial sweetener additives - an oxymoron. http://www.fda.gov/cber/vaccine/thimfaq.htm http://articles.mercola.com/sites/articles/archive/2007/08/14/mercury-contamination-is-destroying-public-health-and-spawning-an-autism-epidemic.aspx http://v.mercola.com/blogs/public_blog/Children-With-Autism-Get-Their-Day-in-Court-20994.aspx

At our last pinning ceremony, one of our graduating students wore a white mini dress, no slip, with an orange thong showing brightly through! Give me a little tradition anyday.

I totally agree. Some serious privacy issues involved here.