Penguinurse

If you're saying that you started the heparin infusion through the port that you had not already flushed, it shouldn't be too much of a problem, as long as it was patent. And if it wasn't, sooner or later, the IV pump would alarm and alert the staff of the problem. The heparin solution you use to flush the ports should be much more dilute than the solution you're infusing for the treatment of the PE.

God bless you for being so incredibly compassionate! This poor woman is so lucky that you're looking out for her, and letting her know it's okay to still want to feel like a woman even though the outer trappings are gone! Does your facility have access to psychologists/therapists? Maybe a connection there to a relationship or "sex" therapist who can make recommendations? I bet their firewalls would allow much more of the type of content needed to get the info. :chuckle

-Technology is always a good thing. So sure, I'll go ahead and schedule that bilateral knee replacement for my 85 year old mom who weighs 300 pounds and has such severe emphysema that she can't walk more than 10 feet without crippling dyspnea! -The Doctor is the boss of nurses. If I didn't like the way that nurse looked at me last night when I refused to perform my incentive spirometry, I'll just tell my doc during his 5 minute visit with me, and he'll fix her wagon! -Nurses have the ability to be in 4 places at once. So there's never a good reason for me to have to wait more than 2 minutes for anything, ever. :chuckle

I completely agree with Grimmy's post. In my experience, MD's who are consistently rude/mean are simply acting out their own power trips, and the worst thing to do is to act intimidated or scared. That's exactly the reaction they want, and it simply encourages them. If you remain professional, polite, and calm, and respond to their irrational/unreasonable questions, demands, and comments with simple logic, they'll learn that you are immune to the crap they try to pull and will generally knock it off when dealing with you. It's hard, especially when you're new and docs seem like total authority figures, but remember this - without you, docs would be helpless. Who gives them the majority of the info. they need to make decisions? Who does the great majority of assessment for patients? Nurses. Don't let 'em make you feel insignificant or like a servant. And if it gets really bad, definitely report the behavior to your boss, in writing, with a request to inform you of the follow-up action taken. You should never, ever have to take abuse from anyone you work with.

My most frustrating experiences have been at ALF's...they are designed to assist basically well people, and the caregivers are generally not trained to care for the ill. Tons, tons, tons of education, frequent visits, and yet more education have helped me cope. And in my state, Nevada, a really ill person can stay in an ALF or group home if the facility submits a waiver to the state to the effect that hospice (or another outside agency) will assume management of the patient's care. This doesn't mean it's always appropriate; I would much rather move my hospice pts. to LTC than try to manage them in ALF's. However, many of the patients have lived in the ALF for a long time, it's their home, and they (understandably) don't want to leave.

I agree - there's no place like a medsurg. unit, including tele or oncology, to cement the basic skills you'll need for any specialty area you decide to go for down the road. Get your basics down, then you can build on them when you go to hospice nursing.

I think we're getting better at using our voices - it helps that the national nursing shortage is (finally!) getting press! But we need to become as good at advocating for ourselves as we are at advocating for our patients...my experience is that we will sacrifice ourselves too readily. Our time off, so that we can fill in on the short shifts. Our family relationships, from working too much and taking so long to "wind down" after a 16 hour shift. Our backs, feet, and cardiovascular systems, from lifting, running, and stressing too much! Let's take care of ourselves, so that we can take care of our patients! :icon_hug:

I work as a hospice field manager, and deal with a few assisted living facilities that use med techs. As an RN, I can tell you it's truly frustrating to have nonlicensed staff giving meds to my terminal patients! I have one ALF that won't allow our patients to receive Roxanol (liquid morphine) unless their local pharmacy draws up individual syringes of the med. This means that instead of a bottle with an eye dropper for dosing, the techs have about a hundred individual syringes, each with 0.25ml of morphine in them! When I ordered a regular bottle of Roxanol from our mail-order pharmacy, you'd have thought I'd tried to kill someone - apparently, at this ALF, the med techs can't count liquid meds. The facility RN told me that in the past, the techs had been off count by bottles - yes, BOTTLES, not ml's - of Roxanol. :uhoh21:

A question for those who support reinserting the feeding tube (and this is an honest question, not an attack :): If there were incontrovertable proof, such as a living will or videotaped statement, that this patient wouldn't want to be sustained artificially, would you still support her parents fight to keep her on the feeding? I ask because I'd like clarification about your reasons for supporting the feeding...is it a general issue, meaning that you believe no one should ever be removed from a tube feeding, or an individual issue, because there is no such proof that this patient ever said she wouldn't want to live this way? If a lot of people around the country believe that no one should ever come off a tube feeding, that's scary to me...does that mean we are obligated to use any/all technology available in every situation? Case in point: when I was in the OR, one of our ortho surgeons did a bipolar hip replacement on a woman who was 104 yrs. old, end-stage dementia, GT, unable to communicate with the world, contracted into a fetal position. She'd been dropped during a transfer. :stone Thanks to all who post rational, polite entries...we don't have to agree, but let's all respect.

Hi all, I've been in Las Vegas for about a year and a half, and am wondering if there are any organizations/informal groups for nurses to meet up and hang out. Also, any good conventions or meetings held here? (I'm running low on free post-it pads and pens :chuckle ).

Mercyteapot - that reference to Congress was simply to point out that we, as Americans, are woefully underprepared to think about (much less plan for) our eventually deaths. Hopefully this whole mess will accomplish at least one good thing, and that's to make folks more aware of the need to make their wishes known before something incapacitating happens to them.

I've read lots and lots of posts from people who suspect Mr. Schiavo of really horrible things - does anyone have any documented proof of any abuses, past or present? "I suspect" or "I heard" or "it seems like" are not enough when making serious accusations. And despite any real or perceived personality "flaws," he's not a criminal unless tried and convicted. Back to the basics - no matter what you think about the spouse or parents - the real issues as I see them are: 1. The right to die in the current age of life-prolonging technology, and 2. Who makes decisions for you when you can't make them for yourself? Your spouse? Parents? CONGRESS?? :uhoh21:

What's everybody thinking about the potential impact of the Florida case on our jobs? Stopping a tube feeding is fairly routine for hospice; do you think the new national attention will change that in any way? I hope that if nothing else it raises awareness of the importance of having living wills or DPOA's in place before the need for them arises.

I did 6 years med/surg and tele before going to the OR, which saved my sanity. :) After a few years of not dealing with awake patients, I'm over my burnout and in hospice, but if I hadn't gone to the OR I wouldn't be in nursing today.

Hope this still helps, since it's been a few weeks since you posted, but I think a really hot topic (which I recently had a bad experience with) is palliative sedation. It's the process of sedating patients to control symptoms, sometimes for days or weeks at a time. Lots and lots of discussion on the net, and lots of ethical debate. Good luck with your paper!