sarbo1010

Of course, when any adverse event happens it seems to be human nature to find someone to pin it on. Hence documentation is the only thing that will save your butt. Several years ago I had a patient that had been on the floor for >24 hours when she became my patient. In for AMI- but she also had AMS - I immediately called the cardiologist, pulmonologist and Internal medicine about this and was blown off by all 3 and the IM doc told me he knew about her mental status - don't bother him again. By around 10 am she started to deteriorate and I called a stroke alert. Turns out she had a large bleed that was missed in ED, and by all her docs. My nurse manager says to me - "This is probably going to bite you in the but" I just looked at her and told her I started calling docs the minute I got the patient, I documented as I went along - no late documentation and said "fine, I'll take all 3 docs down with me" . That was the last I heard of that crap. that being said they then went after the stroke nurse who then at a later date resigned that position and went back to ICU. You have to document, document, document. And whenever I call a doc and they ask that lovely question "what do you want me to do"...... I just let them know that this is information they need to have and I have now transferred liability of this situation to them. Do what you feel is appropriate. It usually wakes them up a bit.

you are correct about trusting the pharmacy and I did catch an error in a pharmacy draw of chemo about 25 years ago. a physician gave some chemo to a few patients through the omaya reservoir and 2 of them had adverse reactions. I pulled the syringe with the remaining medication out of the discard bucket ( a big no no) and return it to pharmacy in order to find out just how much of this medication the patient had received. They did a recheck and at that time discovered that they had used the wrong dilution and so the patient got 10s of time more medication than they should have, an antidote was administered but it did no good. So yup, nursing and being a patient is fraught with trusting others not to screw up. I still wouldn't like giving meds that another nurse drew up, that being said what is the policy there - is there one that will protect you if she screws up?

We had this same problem in Florida when lobbying the Florida legislature about safe staffing ratios about 10 years ago. The legislators simply told us that since our governing body the Florida Nurses association and ANA do not support safe staffing why should they. We never even made it to a bill.

I know you are heartbroken right now, but this will probably lead to better things. It sounds like your manager did not communicate with human resources and I would accept that the reason you didn't get hired is because they have filled all positions. Sucks, but probably true. With that in mind, you tell the next job there are no available positions that you are interested in at the hospital that you currently work, that - whatever the job is that you are applying for is your passion and you are seeking a position in the field you have chosen. I have been "forced" out of a position that I thought I really wanted in similar situation and in retrospect it was absolutely the best thing for my future. It sounds like you are very focused and proactive, you will do great. Now go out there and grab the world by the ass.

Okay, so looks like you did the right thing, but it's not the only right thing. #1 yes her b/p was on the low side, but is that where she lives? Did it drop lower after a dose. This lady is not narcotic naive, so chances of actually doing her in with drugs is unlikely. You are not going to change her. After 32 years of these kinds of patients, I choose the path of least resistance. Giving a patient meds every hour would just tick me off because with 6 patients I usually just don't have time. Thats when I call the doc and tell him I am not a human pca pump and this patient either needs a pca or pain management. But as long as the VS of the patient are at their baseline, I load them up. I don't have time to argue with management, patients, or doctors - just the reality of the situation we are faced with since payment is based on keeping these people happy. Had a patient last week who set the timer on her cell phone so she could have her pain meds on time and she would call me on the phone. She was happy, I am happy.

Yeah, it is a requirement, but I think that they just pay a fine, lots of hospitals are still on paper. I travel nurse off and on and paper for me is non negotiable. Surprised to find a large hospital in New York City was still on paper and there are 2 hospitals in Tampa Florida, still on paper. That being said, some of the smallest hospitals i have ever worked at - Zephyrhills Florida- was using cerner back in the 90's. Ya just never know.

Being raised in the paper charting era, I used to lament and glorify the old days of paper charting. I did an EMR conversion last year and OMG paper charting SUCKS. I will never accept a job that is doing paper charting. Just too time consuming trying to figure out what is going on. How the Hell did we ever do that? Kuddos for you if you are going to give it a go. For this old chick, paper is in my past. hope all goes well for you

Yes, the diploma nurses were hands down the best nurses I ever worked with. And a masters trained nurse - the worst. I think she just never practiced actual bedside nursing until she finished her masters. I relieved her one day to find that she got behind on her ivpbs and so was running all of them about 5 at the same time through same iv site without any regard for compatibility or fluid overload. smh.

Amen, and I worked hard for my BSN, I want it on my badge, along with that PCCN that I continue to slave over to keep. It also keeps me current on topics i probably wouldn't normally seek out. This is again a problem with nurses, we need to encourage each other.

1. How about entering a confused patients room to find them using their cigarette lighter to read something, because patients where allowed to smoke back then. 2. The annual education component where the fire department came and a patient's bed with a dummy in it was set on fire so we could practice putting a fire out with a bath blanket. Good time

Run like hell before a fresh batch of patients hit the ED and they change their minds.

Yeah, this does remind me of the time I had a patient with radiation pnuemonitis and sats in the low 80's. He needed steriods and antibiotics but I couldn't get the fellow on call to do anything. On my third call to him he stated "do not call me again with this patient". I promptly wrote that as an order. In the morning the attending wanted to know why this patient is not on .....steroids and ABX. My administrator wanted me to change the order also on the fellows request, stating that's not what he meant. I told her if he would like to call me and discuss the incident I would consider it. I heard nothing more, but never heard an order like that out of him again. And i did not change that order.

thanks for sharing, gonna have to look into this "tile" thing

Often a doc will borrow a stethoscope they find laying around, carry it to another floor, realize it's not theirs and just drop it there. So I would start by sending a flyer out to the other floors. I hope you have some identifier on it - that will help in locating it. Good luck. I had one stethoscope for 20 years before it grew legs and walked off. Think the bright purple helped with retention.

omg, just reading this thing lets me know I must drive the hsp crazy. I love the floors that are noisy, too quiet makes me nuts. Clutter - I can walk through it, around it, and under it. I love chaos and can toon out any and most noises. My short contract in ED let me know that may actually be a perfect fit, if there was ever uncontrolled chaos, lots of noice and a mess - that's the ticket.