exp626

I look at it this way: when I'm a bedside nurse, I work for the patient. When I'm a charge nurse, I work for my coworkers...my job is to help them take care of their patients. Obviously I have other duties as a charge nurse, but patient care and safety have to come first. I work with with a couple other charge nurses who don't share that philosophy. It is a harder day when I work with a charge nurse who doesn't help as much, so I try to lead by example. Ideally, we'd all work in an environment where this role is rotated, which helps our leadership remember what it's like to be a bedside nurse! No matter what, I never complain or say anything (except in a safe place like AN!), as I don't want to start a war. Some charge nurses or team leaders are favored or friends with management, and you have no idea until it's too late!

The other day I was taking care of a patient admitted for rectal bleeding. He had a history of chronic pain and took an opiate and a separate dose of Tylenol. I called the doctor for orders for his home pain meds, and she said he can't have the Tylenol because of the bleeding. When I was reporting off to the next shift, the oncoming nurse echoed that. I have no knowledge of this and can't find any contraindication or precautions in that setting. Can someone explain this to me? Thanks!

If they have a pacemaker or preexisting left bundle branch block the EKG won't reveal anything. Several years ago a cardiologist admonished me for ordering an EKG on a pt with a pacer, saying he wouldn't sign that order.

I work on a cardiac unit, so we don't have rapid response for CP. My manager gets annoyed when we call a rapid response for anything though, which I think is an unsupportive and unsafe culture. He doesn't say much, but he'll take it out on them by never offering to develop them professionally (relief charge duties and the like). I can see how it would be taxing on the RRT to be called for every patient with CP, but what else can you do? I wouldn't want to be the nurse who doesn't follow protocol and my pt has an MI. Do you have a charge nurse or remote tele nurse you can enlist? Maybe they can help decide if you should call the RRT. The medical floors in my hospital will call the remote tele nurse or the intervention nurse. Otherwise I'd continue to call the RRT as instructed, and if they're unhappy you can (politely!) remind them that you're not cardiac trained and there's a policy for them to evaluate CP. You could also discuss this with your manager and see if you can get some education in evaluating CP...maybe it could be unit-wide education. (Giving Ntg as part of a protocol can be dangerous, for example if the patient has aortic stenosis or are on sildenafil or tadalafil it can bottom out their blood pressure, so you'll most likely never see that happen.)

My Dad passed away from failure to thrive. I was so happy that I didn't have to talk Mom into declining the feeding tube when offered. It was hard for us all, but I think it would have been much more difficult to prolong his life with a feeding tube. My thoughts are with you, I hope she finds peace soon.

...What Earthmama said. But to give you hope, let me share this: I diverted. I was able to keep my job, thank goodness. Now I've completed a contract with IPN, and I'm working in a new and wonderful job. When I interviewed, without going into details I shared that I've completed a contract with IPN. I told her because I work in a small medical community and I didn't want her to find out from someone else. She was fine with it and I presume this earned me some level of respect. I didn't grovel and made my journey a selling point. Since you haven't practiced for a bit, you may wish to take a nurse refresher course. But keep filling out those applications, something will come along! Best of luck to you!!!

Congratulations! I believe that if we're going to disclose our story, it's important to share what we've learned and how we've changed as a result. I'm so happy for you!

Surrendering your license is a drastic move you may come to regret. I would imagine getting it back will be more difficult than keeping it, and you're making the decision based on assumptions. Why don't you cooperate and find out what happens as it transpires. You need to cooperate with the powers that be...be proactive and go to them before they come looking for you. Maybe you can pay the attorney on credit?

COC stands for "chain of custody". It's a form that you may have to take to the lab when you test. I've completed a 5-year monitoring program and never once had to use one. I know someone who went to Hawaii while she was being monitored, and it was no problem. They have testing sites, and she had no problems. (I don't think she was selected to test while she was there.)

Don't forget, each step of this journey is your choice. And congratulations on reaching this next step! Best wishes

I assume you refer to political leanings, as I don't know what else it would be! If so, it's probably more related to your location than anything else. I'm a liberal, but I live in a very red district and most of the nurses I work with are very conservative. It's not fun to be in the minority, is it?! I've figured out that getting along with my coworkers is more important than espousing my views to them, so I just don't engage. I respect our opposing views and pretty much keep politics out of our discussions. If I'm around a discussion I disagree with, sometimes I'll stick around and just listen, as I learn even from people I disagree with, and I like to hear other people's opinions. If I'm not learning anything, I just excuse myself.

All the stuff people already said, and Don't complain about or judge your patients...and don't complain about spending money on indigent or non-compliant patients. Don't sit on your discharges all day to avoid getting new patients. Your coworkers and charge nurses will be on to you. Don't whine/complain/get ugly every time you get a new patient. (I work with someone who does these things, and it can make for a very long day.)

I'd go to Asheville NC. Close to the Appalachian Trail and demographically they're my people...liberal hippie-types. I live in a very conservative "red" area. That, and it's not too far from my family, so visits wouldn't be too hard.

There's a saying, "Home is where your family is". Those ties are important.

My stethoscope is always either in my pocket or my bag, I don't like to wear it around my neck. No one borrows my stethoscope. No one. I don't care if it offends anyone, having my scope in someone else's ears is so gross I may as well give it to them.