Doey

What I found that works and doesn't require any special equipment but your hands and can be done anywhere, is to apply pressure to both eyes at the same time. I usually do this for about 20 maybe 30 secs. Sometimes not even that long. I do occassionally have to repeat it but it's usually because I haven't held pressure for long enough. Hope that helps.

Wildhoney, check your BON. In my state a RN is required to report anyone who may be, by their behavior etc. practicing under the influence of alcohol or drugs. My facility also has a "fit for duty" policy that describes some of the behavior that must be reported and the smell of alcohol on someone is one of them. It isn't a pleasant thing to do but first and foremost we have a duty to protect our patients. Also, at least in my state, if harm were to come to a patient because of someone's impairment by drugs or alcohol and it was found that others were aware of this, they too are liable. Secondly, the person involved will be given the chance for some help. This could be the "bottom" so to speak and be the turning point for change. Your co-worker definitely has had a hard life from what you have written and probably has experienced things you will never know. But I think you're right when you say we have to be tough sometimes for things to change or we become the enabler. Good luck.

"we drag them down the hall yelling....let this be a lesson to you... " thisnurse, I just read your post in another thread (your incontinent pts), and was cracking up then read this and really lost it. Almost peed my pants! We use the "morgue stretcher" like PRN described also.

Where I work the secretaries take off the orders, putting labs etc into the computer, calling MD's offices for referrals/consults and any notifying any other departments as needed. They write in the meds on the MAR (computerized ones coming soon), and rx's etc in the kardex checking off each order in red. They then sign the order sheet in green with the date, time, their name and title. The primary nurse, not the charge nurse, then checks all the orders, writes in the correct times for medication administration on the MAR and in red signs the order sheet as noted with the date, time and their name. I too agree that whoever signs off the orders is responsible for following through. As for 24hr chart checks, each nurse is responsible for doing their own including the MAR.

I agree with the others. ICU is too expensive and a waste of a bed if medically stable. Where I work any time a pt. is on suicide precautions and is admitted or transferred to a regular floor there must be a sitter provided 24/7 until the pt can be medically cleared to go to psych or has been cleared off suicide precautions. It can't possibly be guaranteed that someone can check the pt q15" when you have other pts to care for. And what can happen in that 15"? A few yrs ago a friend told me about a pt that was on suicide precautions and was to be checked q15". Well someone did check on him, found him to look like he was asleep. Came back 15" later and found he had hung himself. Like debbyed said it only takes a blink of an eye.

Fiesty, Can't add to the terrific things that have already been said here, (very nicely stated Ted), but count me as one who will be buying that issue of Self! We're behind you 100%!!

I read this somewhere awhile ago and when I tell people they think I'm crazy. But then they try it and it works. Using your fingers place pressure on your eyes, both at the same time. Do this for a little bit then release. When I do this I can actualy feel that my body wants to hiccup but it doesn't. Sometimes if I don't do it long enough they are still there so I just do it over again. I'm assuming it has something to do with blocking the impulse from the phrenic nerve. It has never failed to work, easy to do and can be done anywhere because you don't need anything but your hands!

The nurses on this BB do offer support on a professional level as well as a personal one. If anyone writes in with a clinical question re: meds, patient care, physiology, new procedures etc, someone is always out there to offer assistance. I'm not quite sure where you are seeing arrogance. But you have to realize that first and foremost we are human beings. Nursing is our profession. Nursing is not peaceful, it can be competitive and there can be backstabbing. Just like in any other profession. That's because nursing is made up of people, not saints. And people can be competitive and backstabbing. I think sometimes it is felt that because nursing is seen as a caring profession, we care for patients physically and emotionally as well as their families, we help people, we save lives, that we are all like this all the time 24/7. Not so. We are human just like everyone else. Caring and giving constantly, seeing tragedy and suffering constantly plus dealing with the ever present politics involved, expecting nursing to continually give in to everyone else (you know, if no one can do blank blank we'll give it to nursing to do and make it their resposibility) and abuses that nursing suffers from management, patients, families, physicians, alone all wear on you. If something doesn't get done or it doesn't get done correctly or in a timely fashion, it's nursings fault no matter who did it. We are not bottomless pits of caring. When someone gives out continually they need to get something back in order to keep giving and caring. So nurses come to this BB to vent to each other. To fellow nurses who understand exactly what we're talking about. We come here to help "refill" ourselves so we can give. As I said I don't know where you are seeing the arrogance, but then again I haven't read every single post on here and perhaps I interpret some of the postings differently because I am a nurse and I can relate to what is being said. But please don't feel that nurses or nursing feels superior but do realize that we are human and have the same emotions and thoughts as everyone else in the world.

I think this might be the poem you're looking for: WHEN GOD MADE NURSES When the Lord made Nurses... He was in his sixth day of overtime when an angel appeared and said " You're doing alot of fiddling around on this one." And the Lord said, " Have you read the specs on this order? " " A Nurse has to be able to help an injured person, breathe life into a dying person, give comfort to a family that has lost their only child, and not wrinkle their uniform. They have to be able to lift 3 times their own weight, work 12 to 16 hours straight without missing a detail, and console a grieving mother as they are doing CPR on a baby they know will never breathe again... They have to be in top mental condition at all times, running on too-little sleep, black coffee and half-eaten meals. And they have to have six pairs of hands. " The Angel shook her head slowly and said, " six pairs of hands..no way" "It's not the hands that are causing me the problems," said the Lord, " It's the two pairs of eyes a Nurse has to have." "That's on the standard model?" asked the angel. The Lord nodded. " One pair that does quick glances while making note of any physical changes, and another pair of eyes that can look reassuringly at a bleeding patient and say,"You'll be all right, Ma'am." when they know it isn't so." "Lord," said the angel, touching his sleeve, "rest and work on this tomorrow." " I can't," said the Lord, " I already have a model that can talk to a 250 pound grieving family member whose child has been hit by a drunk driver...who, by the way, is in the next room uninjured..and also be able to feed a family of five on a Nurse's paycheck." The angel circled the model of the Nurse very slowly. "Can it think?" she asked. "You bet," said the Lord," It can tell you the symptoms of 100 illnesses; recite drug calculations in its' sleep; intubate,defibrillate,medicate, and continue CPR nonstop until help arrives...and still keep its' sense of humor. This Nurse also has phenomenal personal control.They can deal with a multi-victim trauma, coax a frightened elderly person to unlock thier door, comfort a murder victim's family, and then read in the daily paper how nurses are insensitive and uncaring and are only doing a job." Finally, the angel bent over and ran her finger across the cheek of the nurse. " There's a leak." she pronounced. "I told you that you were trying to put too much into this model." "That's not a leak," said the Lord, "It's a tear." "What is the tear for?" asked the angel. "It's for bottled-up emotions, for patients they've tried in vain to save, for commitment to that hope that they will make a difference in a person's chance to survive, for life" "You're a genius" said the angel. The Lord looked somber...." I didn't put it there" He said.

Quoted from the morificecript: "Male genitalia are soaped up with wet sudsy cleaning solution and manipulated under bright lights, maybe by his pretty young wife, with male coworkers watching, producing an image which is Mediaographic in the extreme." From a CRNA who was quoted: ".... As to your question. I mostly just have my suppositions to go on. Haven't heard nurses in OR saying much about it, is taboo it seems. I know they get kidded allot when doing the male prep. You know wise cracks from the Drs. and such. The thing I like to watch is when they get into it, their eyes kind of glaze over, you know the look on someone's face when they are having a pleasurable fantasy. I think they talk to each other about it. But I seriously doubt most women go home and talk about it to their husbands, you know how jealous most husbands are. They might make them look for another job.... About half of the women are religious also, so the subject of carnal pleasure is taboo in this situation also. These are my thoughts on the subject and may be totally off base, but I don't think so...... " These two are idiots. And who are these people they quote? Made up fictitious people I think. I don't know about the rest of you, but when I'm caring for a male pt. with the help of a male co-worker I really don't think it makes for a pronographic scenario and neither one of us is getting off on it. If anyones eyes are "glazed over" it's probably due to low blood sugar from not having eaten all day or the nurse is ready to fall over from exhaustion!! Or maybe I'm just repressing my sexual feelings like society wants. You think?

Hi Lesliee, I agree with the other posters. She needs to be told that how she's behaving is having a detrimental effect on the unit and won't be tolerated. It's easy to get hot under the collar when talking to someone about things that really upset us but whether you have a private meeting with her or with upper management don't let your emotions rule. Speak firmly and bring up specific things that she has done, the behavior that upsets you and why. Not general statements like "all the power has gone to your head" etc. It's easier for everyone to deal with specifics. I agree with wildtime, you need to have a private meeting with her. She's only been in this position a week and I don't know what kind of person she was as a floor nurse, but she may not realize how she's coming off. Some people get into a management position and think they have to change their behavior to "go along" with the postion or imitate others that have managed them in the past. They haven't found their own style yet. So I would go with this approach to be fair to her as a newbie in this position. But she needs feedback to know that this style is not effective. Good luck and let us know how things turn out.

I have a Littman also which I absolutely love. Most of the time it's around my neck, I too feel naked without it!! Plus I don't want it "walking away". I had it for about 10yrs. when I sent it out to be cleaned/sterilized and had the tubing and ear pieces replaced. I was told at the time the same thing that buck said about wearing it around your neck and the oils from your skin causing the tubing to crack over time. They told me to apply something like Armoral on the tubing every so often to help with this. I also now wear a stethoscope cover. There are two secretaries I work with that make them. Different patterns for different times of the year. Those help. Also, watch out where you keep your stethoscope when not in use. Extreme temperature changes decrease the life of the tubing too.

I don't work OB but at the hospital where I work the two entrances to the unit are always locked. The supervisors and the nurse manager have the key. Everyone else has to be "buzzed" in. Babies wear a warning bracelet also as do all dads. There is an outside (corridor) window to the nursery and for the most part the blinds are usually kept shut. On the bassinettes there is no mention of the sex of the infant. I think it's only last name. If any unexpected situation should arise as the one you described the staff is instructed to call a "code baby" to make all hospital personnel aware that a possible infant abduction is taking place. If I'm not mistaken, at this point all entrances to the hospital are locked and of course security responds. But the rest of the employees know to keep a watch out for suspicious people during this time. I agree that the expense of putting locks on the doors and securing the unit will be cheaper than the bad publicity as well as a lawsuit and the heartache the parents would have to endure if an infant were harmed or abducted.

Nicely stated bigjay

Nicely stated bigjay

e-nurse Congratulations and good luck to you!!

Kewlnurse, thank-you thank-you thank-you! This has been a pet peeve for me for some time now. I don't know what it is with surgeons and demerol. Do they think it's some kind of miracle drug? There is certaintly a vast array of pharmacologic and non-pharmacologic methods of pain control, all of which are superior to demerol. I absolutely hate using it. No sooner than it's given and the 80yo fresh hip or belly is climbing oob and hallucinating and still not getting adequate pain control. Then the med is d/c'd and of course nothing else is ordered because "we have to let it get out of their system". Other meds are ordered to cover the behavior, ativan or haldol, but again inadequate pain control. When an alternative to demerol is suggested, like morphine etc. the answer seems to always be that the doc doesn't want to decrease their respirations. Nurses are continually being updated on issues re: pain control, proper medicating for ETOH withdrawal etc, but who updates the docs? We have mandatory inservices on these issues and others but it seems like no one tells the docs. To be fair some do take suggestions when they are offered and I guess after 20 nurses throughout the hospital are giving the same spiel they take the hint. But how many patients have to suffer needlessly in the mean time. So this is not just issue in your area. I think it's probably widespread.

Kewlnurse, thank-you thank-you thank-you! This has been a pet peeve for me for some time now. I don't know what it is with surgeons and demerol. Do they think it's some kind of miracle drug? There is certaintly a vast array of pharmacologic and non-pharmacologic methods of pain control, all of which are superior to demerol. I absolutely hate using it. No sooner than it's given and the 80yo fresh hip or belly is climbing oob and hallucinating and still not getting adequate pain control. Then the med is d/c'd and of course nothing else is ordered because "we have to let it get out of their system". Other meds are ordered to cover the behavior, ativan or haldol, but again inadequate pain control. When an alternative to demerol is suggested, like morphine etc. the answer seems to always be that the doc doesn't want to decrease their respirations. Nurses are continually being updated on issues re: pain control, proper medicating for ETOH withdrawal etc, but who updates the docs? We have mandatory inservices on these issues and others but it seems like no one tells the docs. To be fair some do take suggestions when they are offered and I guess after 20 nurses throughout the hospital are giving the same spiel they take the hint. But how many patients have to suffer needlessly in the mean time. So this is not just issue in your area. I think it's probably widespread.

CKMB is still used along with Troponin I. They both rise about 5-7hrs after MI but the troponin remains elevated much longer, 8 days or so. Troponin is cardiac specific. There have been studies done in pts. who received cardioversion, defibrillation or falls who presented with elevated CKs but troponin remained negative. Also troponin is being looked at as a possible predictor of prognosis or of future cardiac events. Some pts. presenting with unstable angina with negative CKMB and EKG findings and a slightly eleveated troponin have been found on echocardiographic testing to have some wall motion abnormalities indicating myocardial damage. There have been instances of false positive troponins but improvement in lab techniques have decreased this. There is also the thinking that perhaps these so called false positive results are really indicative of subclinical myocardial damage. Troponin is also useful in determining if infarction has occurred prior to hospitalization in pts. who have experienced atypical or non-specific symptoms and then days later present to the ED with c/p etc. and have CKMB within the normal range but elevated troponin, probably indicating they infarcted at the time of their original symptoms.

This thread seems to have alot in common with another one, "Nursing is Pathetic" (SUBQ, have you read that one? It's long but I think you'll find it interesting) Anyway I don't know why there are so many who are in conflict with what SUBQ is saying. He clearly states in his first post that "ladies I don't mean to sound sexist--it's that I have to make my point" He also says "not all women in nursing are like this" He is acknowledging that what he's saying may sound sexist but is explaining his point. It doesn't mean he is sexist. In one of my posts on the aforementioned thread I had given my opinion on how we as women (in general) are socialized to be caregivers and to take whatever is thrown at us at THE EXPENSE OF OURSELVES. And we may not want to admit it but (at the risk of sounding sexist) we are raised differently and socialized to handle problems differently then men. Behavior that is seen as being assertive and acceptable in men (and supported), is seen as aggressive and bitchy in women. Our society (including ourselves) has difficulty in accepting the same behavior in women and men. Another point, when any group of people feel that they cannot go higher up and voice their complaints because they are not listened to or their concerned are pooh-poohed or they are condescended to they lash out laterally, to each other. Now having said all that, I have had experiences similar to SUBQ. We probably all have. My co-workers and I were trying to support the day staff in their endeavor to get more help. Our administration comes around on all three shifts every so many months to see how things are going and give us the opportunity to voice our concerns. On one of these occassions we gave examples of why the day staff needs more help. We also stated the same at our administrative meetings (held every three months). When administration came to the floor to speak with day staff, instead of telling them the things they were bitching to us about, they said things were fine and there were no problems!! Why for heavens sakes didn't they say anything!! It's easier to ***** because it takes too much courage to speak up?? At one time there was alot of complaining on my shift but myself and another nurse couldn't get everyone together to go to administration. We finally got so sick of the whole thing we went to one of our meetings (we were the only two there of course), and laid it out on the line. I can't believe myself what came out of my mouth but at that point I didn't care if I got fired. It didn't happen all at once but changes did happen. Also administration did come in early to ask how things were going and if were they getting any better. Now, not every single problem was solved at the time and I can't say that things are hunky-dory right now (this incident was a few years ago) but it's just another example of how people ***** but when it comes down to it few ever say anything when it matters. I also have asked them why they don't go off the floor to take their breaks instead of wolfing down something in the report room. The answer, because it would leave the floor too short and their co-workers would get stuck with the brunt. I said, that's when you call someone, nurse manager,supervisor,clinical coordinator, somone, and say hey so and so is on their break and I'm here alone I need some help. You're not screwing your partner if you both do the same thing and act together. Sooner or later they'll get sick of having to fill in. But they know no one will actually do that, so we ENABLE the system to keep on as is by our behavior. As far as SUBQ quitting his job, he was leaving a situation that he felt was unsafe for his patients as well as for himself. He wasn't abandoning his co-workers. I'm sure he would stick up for, support, and help his co-workers when needed but he was hired to care for his PATIENTS not his co-workers. His first responsibility is to them (his patients) and then to himself. If he felt he was not able to give adequate care and there was no resolution in sight and he felt he was compromising himself, then it is his perogative to leave the situation. This is definitely off the original posting of this thread and I'm sorry, but I just felt I had to respond. And nursedude where are you?!?!

Hi GemGirl, Here's some web sites of college rankings etc. that might help you; www.usnews.com/usnews/edu/beyond/bcheal.htm http://collegeapps.about.com/education/collegeapps/blus.htm www.utexas.edu/world/univ/alpha/ http://collegeapps.about.com/education/collegeapps/msubcrank.htm Good luck!

I work with two nursing supervisors who both went through the Regent's program. One went in as an ADN and the other went in as an LPN. They both liked it very much as it fit in with their schedules at the time and they both would do it over again. One of them is considering enrolling in the CIS program. You've probably been to the site already, but if you haven't check it out. www.regentscollege.edu If you want more info. about it e-mail me at [email protected] and I'll speak with them about it. Good luck!

Absolutely not. First off this goes against my facility's policy. Second, even if I knew this patient and knew what kind of pain they were probably having, I would go to them to assess them in case this was a new pain. Then I would inform the nurse assigned to this pt. of my assessment and would ask if he/she would like me to medicate the pt. This is the ideal but as mentioned before this isn't always possible. If that's the case, I would check in pxys to see when the last pain med was taken out for this pt. and the nurse's notes as well as MAR. Of course I would ask the pt. also if they were alert and oriented. But I would always check with the pts primary nurse. I can always assess the pt. when I get there with the pain med and change my course of action if it is a new pain, at that time.

I think that all the things mentioned in the above posts are valid for why we as nurses miss illnesses/injuries in ourselves. Yes we are nurses and do well with assessing others. But first and foremost we are human beings just like everyone else, and like everyone else denial and rationalization are real for us too. Couple this with our knowledge and it's easy to ascribe our symptoms to something less serious. And of course our co-workers always know before we do. Also we probably tend to ignore symptoms as we carry on with our daily lives taking care of our homes and families and coming to work (wouldn't want to call out sick and deal with the repercussions of that!), and taking care of our sick patients. And Laura, re: your son, I know exactly what your're talking about. For me it was with my mother. She had severe aortic stenosis and was experiencing a lot of chest pain, fatigue etc. Had a CABG 10 years earlier and needed another one along with AVR. Post-op she wasn't doing well (my first clue should've been when the surgeon told me that he was unable to put in a balloon pump). She was of course vented and on countless number of drips. Anyway, on her second day post-op she needed to go back to the OR to have blood removed from around her rt. ventricle. I spoke with the surgeon (who was filling in for the original surgeon) and he said that he was basically "cleaning house" but he hoped that this would help to improve her condition. Now, I work in critical care and deal with vented pts. all the time. Another clue might have been that my mother was vented, on 100% O2, PEEP of 15 and had a SpO2 of 80 and was blue!! Duh, did I get the picture?? Not to mention that when they did an esophageal echo they suctioned out almost a liter of pink frothy sputum. Give fluids to increase BP and perfuse kidneys, then give Lasix to get it out of her lungs. I knew all this going into the second surgery, and as I have told others, the nurse part of me would peek through and see all this but almost immediately the "daughter" part would kick in and think "Well let's give it a try it may help". Thinking back on it now I realize that if I had been her nurse I would've known and been saying this woman is not going to make it. There would have been no question in my mind. But in this situation the daughter part was the more important one and "she" was the one that was "out". (sounds kind of like multiple personalities!). This is why whenever I'm dealing with a patient or family memeber who is a nurse/doctor etc. I treat them just as I would anyone else and explain things from square one. Because at that point they are not nurse/doctor, they are the patient or family memeber emotionally involved and that's the point of view they will most likely be coming from. I did realize that my mother wasn't go to make it but the daughter wasn't ready to see that. So when the nurse told me she had died in the OR I wasn't totally shocked. I knew, and knew that I had known all along. So don't beat yourself up over any of these things. There are a lot of mechanisms in play here. That's why EVERYONE needs a nurse.

In the hospital I work in L/D nurses are not required to be ACLS certified at this time. We just went through a joint commision survey and as far as I know nothing has been said about it. If something were to occur, an RN from critical care would be called to the unit to assist.