IdislikeCODEbrowns

I am a RN who recently donated through Be The Match registry, I have been on the registry for 5yrs and never got a call until this past dec. I was a perfect match for a middle-aged lady suffering from AML in Argentina. The recipients dr wanted peripheral blood stem cells so after a lengthy screening process I started neupogen injections for 5 days, on the day of donation and 4 1/2 hours of being hooked up to the apheresis machine they took a sample of my stem cells and noticed that my CD4 count was not high enough to match the recipients requested dosage. Ultimately I had to be taken to emergent surgery to have the marrow taken directly from my hips as this would positively have enough stem cells as needed for the patient, the courier was waiting for my donation to fly to Argentina so a decision had to be made quickly. The marrow donation was painful but not something I would never do again. So i went through both ways to donate..

What? 48$/hr, that's exactly double my pay per hr, man I need to move to your hospital

Just try to think of the bigger picture, the patient came to the hospital y? What are we currently doing for him? What's the overall plan for this patient (i.e CHF exacerbation plan to continue IV LASIK until can tolerate PO then discharge to skilled nursing) ppl get caught up on the details, which ate important but we can all read progress notes/h&ps, no need to get distracted by their potassium of 3.2 4 days ago

Continuous fluids that should go through a central line are TPN, I can think of others that are intermittent only but need to go in centrally such as +20meq of potassium and certain chemos are best through centrals

If the NGT is set to suction and used for decompression then I would assume it would be more for the patient's comfort/palliation

I have been on the bone marrow registry for many years now and never got a call until this past dec, I happened to be at work on that day and was excited to share the news that I was a 'potential' match for a stranger w/ cancer so I went in to my managers office to share the news and her first response was: "well, just make sure it doesn't interfere w/ your shifts"... Then a couple of weeks later when I learned I was a complete match and had several co-workers injecting me w/ neupogen shots in preparation for the donation (everyone knew what/when I was donating bone marrow), my manager switched my days and scheduled me to work the day of donation and being that everyone knew infusing the manager about what I was doing, I didn't even think twice to check my schedule, long story short my manager put me down as an unscheduled absence and disregarded the fact that I as an RN was out saving a life that day and not at work

MAC-Donalds instead of MIC-Donalds

I graduated from Lonestar Cy-fair in Dec 2011 and already had a job 1mo before graduation at Methodist willowbrook hospital. I already have a bachelor's degree in something else in addition to my ADN

Sorry to offend anyone but my beef w/ this whole issue is that I am seeing more and more pts who pick and choose when they want to be treated like pts and when they want to be 'paying customers who feel its ok to be waited on 24/7, I understand controlling noise level around others, nights or not, but its a slippery slope when people start forgetting what a hospital's are for (to get better) not to have a jug of ice water 3/4 filled w/ ice and the rest water and heaven forbid that there's too much ice... Or what about those pts who insist on staff putting signs on their doors saying 'do not interrupt between 11pm and 7am' really,this is a ******* hospital and you'll probably be the pt who turns around and sues bc your potassium level was 2.5 and had an arrhythmia but was refusing to get labs rechecked at 4am...hospitals aren't hotels bottom line, it's not pleasant and you shouldn't like being there more than your own home

Maybe that 'Big Mouth' nurse you were referring to at the nurses station was trying her best to keep herself awake bc she not only works nights but has 2 small children she must 'watch' during the day when she should be sleeping, and IMO I'd much prefer a laughing nurse than one who's fast asleep at the computer and not able to safely care for her patients, or maybe that 'Big Mouth' was blowing off steam bc she just lost a patient and was trying to handle that stress, nurses are human and just bc they're awake at night when the rest of the world is sleeping doesn't mean they have to play dead so people don't miss out on their beauty sleep, I do agree w/ being respectful of noise levels, you do have to realize its not a hotel and things are moving 24/7, yes even when you're trying to sleep

At my hospital we are not allowed to bring family members if the hospital goes on lockdown for a hurricane. We get to choose whether or not we are on the 'ride out' team (meaning we stay 24/7 at hospital from the moment we start lockdown until the moment we get the all clear, of course we are allowed to sleep in shifts but just have to be in the hospital during the entire storm) or you can choose the 'recovery team' which requires you to work 3 consecutive shifts in a row following the storm. I have never heard of hospitals that allow family members to stay even in dire situations.

My hospital is 'sooo' into this customer service BS, they have given us scripts to follow when doing 'bedside report' we are supposed to have things ready for pts when they come up to our floor from wherever (ER, OBs, etc) like fresh ice water, the towels folded like a fan on the bed, their name on the white board, hot coffee already made, etc. We have cell phones that we give our #'s to the pts and they can call us directly instead of hitting the call light when they want something. We are even in the process of having the pts pick out a colored stone w/ inspirational phrases on it upon their admission so that can be their 'guiding spirit/inspiration' throughout their hospital stay. It has gotten to the point that many of us are more worried about 'pleasing pts' than actually providing medical care. I cannot physically be the pts personal butler while carrying out all their healthcare needs plus babysitting doctors and monitoring techs who do vitals and whatnot. I am only one person and I went to nursing school and sat for boards for a reason, to do nursing tasks to help the patient get healthy, not ensure that their pitcher is full of fresh ice water before change of shift or that the meals come out just the way they want them from food service. I don't need a script to follow to introduce myself to pts, I have common sense and people skills, I do these things anyways, but should I get dinged for forgetting to ask the pt. if they wanted their door open or closed when I leave their room...??? How far will this go?

At my hospital nurses are assigned empty rooms all the time...I work med-surg and pt. ratio is typically 1-4, our pt. assignment goes by acuity/location (room #) and skills/talents of each nurse. We do rounding with administration 1-2 per shift to update status on each pt. and where they are in terms of needs/discharge planning so our CN's have an 'idea' of what to expect staffing-wise for the oncoming shift. Our pt's are initally admitted/transferred to our floor by our Administrative Coordinator who oversees the 'new' patient and what they may need and which room on each of our med-surg floors they anticipate bringing them to. Our AC makes placements based on many diff things but it usually tends to work out pretty well. Of course there are times when a pt.'s status may change drastically throughout the shift making them more 'acute' than others and some of us may have a 'heavier' group once in a while, but as a floor when are usually pretty good about working as a team and pitching in to help others out. The only thing being assigned an 'empty' room on our floor means, is a new admission, that is a guarrantee, so while it may be good for a little bit, it just means that you have the opportunity to get that pt. w/ a bag full of new 'tricks' haha.

One of our respiratory techs at my hospital was telling me a story the other day about a trach pt. who was AAOx3 and during a suctioning session, the pt. coughed (which is usally to be expected) but this particular guy had a tendency to have copious amounts of secretions that were let loose during suctioning and in many instances, these secretions had a history of becoming airborne, in any light, the pt. purposely aimed at the RT while she was pulling back the suction catheter and in close proximity to the pt. and a huge glob of gunk flew out and landed on the RT's face/eyes...the kicker to the story is that this was an HIV-positive pt.!!!

I am still pretty new myself but one thing I learned last night was to be very cautious when holding onto a med (especially a narcotic) when it should be wasted at the time you drew it up and figured out you weren't going to give it d/t pt. condition, long story short, pt. complained of pain last night, still a fairly new transfer from our Observation unit, before I went to go give the 2mg of Morphine I checked her BP to make sure all was OK before giving her the narc, well BP was 87/59, needless to say I nixed the morphine plan and went into the med room to find someone to waste it w/ me, when a couple older nurses advised me to just hang onto it in case she needed it later when BP went up, so I did. Fast forward 5hrs when I remembered the morphine and had been through a 2hr rapid response w/ this pt. for hypotension not too long after I checked her low BP when she complained of pain. The pt. was transferred to CVICU and started on dopamine drip (no one was too familiar w/ this pt. and we didnt know that her BP was not going to return to normal anytime soon for us)....anyways, waste meds right away b/c I had to go all the way back down to CVICU and plead w/ the nurses there to waste w/ me (vial had long been thrown away so all I had was a full un-marked syringe of 2mg of morphine diluted w/ NS so they had to take my word for it, that it was indeed what I claimed it was in the syringe)...

I am just kind of curious...do you know how exactly this patient contracted this disease?

To give you all an update: the patient died at shift change a day after she was transferred to our floor, I was pleased to learn that the night nurse on the Sat. night shift gave the meds as prescribed. There are so many misconceptions about hospice and even though our floor is the 'go to' floor for contract hospice patients, they are few and far between, b/c as many of you all know, a good percentage of patients/families wait until the last minute or never even enroll in hospice services, so when they come to our floor it's usually b/c they were in ICU and family decided to withdraw care, etc. I would love to pilot a hospice education program on my floor and this would be a perfect example of a common misunderstanding in these types of situations. Needless to say, this sweet lady died a peaceful death so that is all that matters in this instance, however, I would like to put forth more education so more outcomes like this can happen on our floor. Thanks for your advice :)

I was prescribed Adderral for the same issues when I got my job almost 6mo ago. I had to take a urine drug test as a part of routine screening and was forewarned that I would most likely test positive for amphetamines. I was not surprised when I got the call from the Medical director or something like that who was informing me of the results. All I had to do was go to the pharmacy where I have been filling my Rx and print out a copy of my account history to show the 'legality' of my Rx for Adderral, etc. The pharmacist signed it and faxed it to this person who called me and that person contacted my hospital that was to be my future employer w/ the results and everything was OK. The employee health nurse who collected my urine had said that she has had several applicants in this same situation so they were used to dealing w/ this issue. No worries, as long as you have a legit Rx for this prescribed med, then when amphetamines show up in your system you have proof as to why.

So I work on a med-surg floor with specilization in oncology and are the floor for our contract hospice patients. I picked up an extra day shift this past weekend and at 1745 I get report from our IMU for a patient who is a DNR, comfort care only, possible hospice referral in the AM...she had originally had breast CA with the onset of massive infection and was in multi-organ system failure. The family had, had her extubated over a week before this decision to put her on hospice and she had actually been coded down in vascular surgery the night before when she went in for emergency placement of a dialysis catheter to try to treat renal failure. Anyways, per family's request, she was to be given 2mg Morphine q2hr, alternated w/ 1mg Ativan q2hr, so every hour she would be getting one or the other. I had no problem w/ this b/c I knew she was actively dying, so why not let her be most comfortable, after all, the painful cancer tumors were still present, the fact that she can't 'verbally' express her pain is the only factor missing. The family was refusing vital sign checks on our routine schedule as they didnt want to know what exactly was happening. When I gave report to the night nurse she seemed very uncomfortable with the med schedule that was prescribed for her. When I told her that we were not hastening the patient's death, she quite frankly said, "Yes we are." I am a little upset at her reaction mainly d/t the fact that there is so much mis-information out there about pain control at the end of life and I am concerned that maybe this may have prevented her from providing the meds on the before-stated schedule throughout the night, resulting in great patient/family suffering. I called to check on the patient around 11pm that night and my CN said she was still w/ us but after that I haven't heard any updates. Anyways, what I guess I wanted to clarify was if by 'agreeing' to this med schedule for this hospice pt., was I being 'Nurse Kevorkian'? Last vitals before transferring to our floor was BP 100's systolic and O2 sats in the upper 60's; pt. was unresponsive and agonal breathing when I received her. Any thoughts?