estrogen

46 y.o. IV drug user infected with botulism. Spent cca. a month at our facility, on a vent, completely paralyzed including his face, with 0 muscle tone. I'll admit that it took me a couple of days to realize that he is not in a coma, but all in there, with a completely clear mind. Over the course of a couple weeks, he started getting a little better, started moving his right hand slightly and signal thumbs up, thumbs down as a means of communication and eventually with a lot of help he started writing on a note pad. I was excited, because unfortunately, we don't commonly see people getting better / overcomming their condition at out facility. I had high hopes and I honestly thaught, (it seems like most of the other nurses did too) that he will pull out of it. Over the last few nights, he complained to me about being constipated and asked me to do a digital to get the poop out several times. He complained about pain and the feeling of fullness in his rectal area and an upset stomach (no vomit, no residual). His stool was pretty soft and formed. He had spontaneous BM's regularly, he just wasn't getting all of it out, so I did not suspect and impaction. One time he wrote on his pad "I'm suffering". I asked him if it's due to his rectal discomfort and he signed yes... I did another digital, gave him his scheduled methadone and ativan that he asked for and when I asked him, he stated relief. The next day, I learned that he coded sometimes during the day, had a cardiac arrest, was resuscitated and sent to the hospital. The next day they called us that he died. Maybe I didn't recognize the severity of his suffering, because he didn't have the usual means to express it. Maybe if I would have kown and sent him to the hospital, he would still be alive? Or maybe I was mistaken and he never had a chance. He was a nice guy, just a year older than my husband. As far as I know, he was pretty much alone. He must have suffered a lot during the course of his disease. I wish I knew what's going to happen. I would have sat with him through the night, I would have held his hand, said more kind things.

...And that's exactly what I'm planning on doing. I have a quite consuming life outside of the facility. Thanks!!

...Not quite yet, but keep having your fingers crossed for me :wink2: Thanks!

I thought I owe you guys an update... I just spoke to our DNS yesterday to hear what's new. According to her, out of the seven nurses that were on night shift, two are moving to evenings and two are looking (or allready have) new jobs. Which leaves me and two other nurses, which is the amount we need. "It seems to be working out nicely", the DNS said...haha. Isn't that kind of telling of what the strategy was? Let's slam them with the news and then wait it out and see who bails and who prevails. But I guess that on the management level of a company it's the thing to do and one would get rewarded for a great move... Afterall it makes them look much nicer than if they had to fire people, right? ...Still can't help it though and as a common floor nurse, it leaves a bitter taste in my mouth either way. But that's the nature of the game, I guess... Afterall we have to be managed and as I allready said, better this way then by handing out pink slips... So, now that we're down to the "final three", the battle for the schedule begins. The DNS again handed the resposibility over to us nurses: "If you guys can't come up with something, It'll be simplest for me to implement a 4 on 2 off rotating schedule for everyone." Well, in my opinion, 4 on 2 off on NOC shift sucks. all the other nurses seem to agree with me, however everyone is incredibly passive, shrugs their shoulders and doesn't try to come up with anything. so I sat down and figured out a set (non-rotating) schedule, that accomodates the other two nurses wish to work full time and my wish to actually work less than full time with as little need for day care for my kids as possible. I presented it to the DNS and she said "Oh, yeah! That would work. Thanks for doing the work!" I presented it to my co-workers and they again shrug their shoulders and said something to the effect of "yeah, sure...whatever... as long as I get my 40 hours." So now, we have to have a meeting about it with the DNS to see if everyone officially agrees with my proposal so that the DNS can officially implement it. Again, she for now refuses to set a date for this meeting herself. "It's up to you guys, i'll come in any time of day and night." My colleagues, yet again are shrugging their shoulders.... I'm tired. I hate this. I honestly hate to be the one who pulls and pushes everyone else along, yet somehow I find myself in that position a lot. At work AND at home. (I'm sure there is some kind of a Freudian explanation for that.) I kind of feel like I've done my share, I'm not goint to be organizing a meeting now too. Somebody else can do that... Hey, I have a new name for this way of management: Let's call it The SURVIVOR method or The BIG BROTHER method! Can you tell I'm a big reality TV fan? :chuckle Man I'd make a great manager! Unfortunately I would probably hate every minute of it and with my other traits like sensitivity, tendency to take things personally, anxiety, fear of the unknown and strong need for structure and predictability I would probably also go crazy in a very short amount of time.

I'm sorry that you feel attacked. That was not my intention.

This might come as a surprise to you, Gompers, but I also do not discuss religion with anyone, especially not it the workplace. I don't approve of any employees (or anyone actually) imposing their religious views on anyone else, and eventhough I concider myself privately a spiritual person, I am not particularly religious. I perceive spirituality and religion as something very private and individual. I may go to church every once in a great while and I have great respect for all religions.(...and that's as far as I will go with describing my own spirituality.) However this gentleman happens to be very religious. Religion is if not the most important then definitely one of the most important themes in his life. As far as my ethical dilemma, I am not really questioning the appropriateness of the gift of a Bible. If he was all about fishing, I would be looking into buying him a book about fishing. If he was into horticulture... you know what I mean... Also, if he was, say Muslim, I would look into buying him a Koran. The same goes for the book vs. "book on tape" issue that someone brought up. If he likes to read, why would I decide, that it's more appropriate for him to listen to a tape? (Eventhough I'm not denying that he may enjoythat also?) What I am unsure about, and am trying to find an answer to, is the appropriateness of any gift to a patient such as mine in general. See, I'm asking myself, what if he starts to think of me as a friend? What if I become "important" to him? ....Then, one day, what if I go to another job an he never sees me again? Could I actually possibly hurt him with my gift? Sometimes, humanity requires courage. and I don't know if I posess such courage.

Thank you Miranda! I've been reading your posts for a while and I admire your intelligence end eloquence. What an inspiration!

Thanks for your input and your suggestions....but... A).... I never said I'm religious. B) As I stated earlier, the man really likes to READ. Why do you assume that a book on tape would be a better idea? And why inspirational stories? I'm just curious how you arrived at this particular conclusion...

Oooops! Is this one time likely to get me in trouble? :chair:

When I was in nrsing school I got to watch a foot amputation once. Aside of the fact that it was tragic, very gross... and very cool A fem-pop bypas was even cooler... How they opened the whole leg up around the bone, as if they were opening a book... Very cool! I love surgery!

Yup... Agree!

Thanks for the great insight. I appreciate that!

Once, I crushed a Dilaudid pill for a pt. Then I realized I took it out of the wrong bingo card, that belonged to another patient. It was on night shift, everyone was busy and there wasn't another nurse around to be a witness. After all the Dilaudid was already out of the card and crushed, so even if I called another nurse to witness the waste, she/he wouldn't have been able to say, what it is that I'm wasting. So I dumped the powder into the sharps myself and I wrote it into the narc log as Dilaudid - one taken and wasted and signed it by myself. Was that a mistake? Did I set myself up for trouble?

Thanks so much for the support, CrunchRN and everyone else! I did talk to the DNS briefly. ...As far as reassurance goes, she did tell me, that she'd "most likely" go by seniority, if we cannot come to a concensus amonghst ourselves nad she also said, "I really don't want to lose you, since you've shown some falexibility and dependablility"...whatever she ment by that, how seriously she ment it... I given the previous events, that you mentioned earlier, I have a certain degree of mistrust. After all, as had been said before, for the most part, we are probably just numbers to the management... In regards to the employment situation in this area. I don't think that I'd have a problem finding another job. The question is, how dependable would the next job turn out to be? It might turn out to be even worse... You can't really tell before you've worked there. And I really like this job. I like the facility, my patients, the people I work with and - a BIG plus - it is five minutes from my house. So it's not that I couldn't find another job, if I had to. It's that I don't want to...

No. If the NOC shift runs from 11 to 7, istead from 7 to 7, that eliminates the heavy 2000 med pass, that required the three nurses on the floor. The rest of the night in my opinion is manageable with two nurses. I see the management's point there.

I actually found the wording of the article quite respectful and truthful except of the phrase "lower skilled" as the writers were setting themselves up for a misunderstanding... They could have found a better phrase, but it is evident what they ment. Say Carpentry is also not McDonald's and requires a significant amount of complicated knowledge and skill. I don't have a problem my profession being grouped into the same category. Basically, what they ment was probably "skilled jobs requiring less than a Master's Degree or Doctorate".

Why is noone responding??? I'm sitting here anxiously waiting for a suggenstion or comment from someone. Is it really that unbearingly long? I'm so sorry... I shortened it a little. (I know, not enough.) I'd appreciate anything, as I'm getting so stressed and anxious, working myself up over this, that I'm ready to howl at the moon or something... PUHLEEEEEEZ!

Please, please, bare with me. This is a horribly long rant. but I would really appreciate your opinion. A year ago there were staffing cuts in the hospital that I worked at at the time. I survived the lay off, but it were the two nastiest, most stressfull months in my life sofar. Eventhough I did not get layed off, I ended up leaving that hospital a few months later, because the working atmosphere there never really recovered and was more than grimm... Everyone there seemed tense, stressed and cranky all the time. Not a nice place to go to work every day, really... Anyway, now I've worked in a SNIF for over three months and I enjoy this job very much. A few days ago we were informed by our DNS that there will be cut backs. we will go down from three nurses on night shift to two and there will be a change from 12 hour shifts to 8 hour shifts. she gave us the option to come up with a schedule by ourselves by a certain deadline or she will implement a rotating four on, two off shedule. Yeah, it looks like, there will be lay offs again. It seems to be following me around like the plegue... I'm scared. Since I'm currently working there only two days a week, I'm scared that I will get left out somehow and that I will be pushed out by more pro-active people. It might sound funny now, but eventhough I've only been there for three months, there have been so many changes lately, that on my shift I am the second most senior person. However this is not a unionized work place. The DNS told me, that she'll go by seniority, in case she needs to let someone go, but in reality, she can do anything she wants. And she's been known to change her mind in the past... I really don't want to leave, I don't want to get etched out. This morning I called the DNS to get updated on what's going on over there, since I'm not back till next thursday and I'm so affraid to miss out on something and consequently get walked all over by the other nurses that are there daily and - I can imagine in such a situation - kissing up to the DNS. She wasn't available, so I talked to the staff coordinator. She didn't really want to say much, she only told me, that there is a deadline for the night shift staff to come up with a schedule and that this one nurse who's only been there for about three weeks by the way, but is very ...you know... "active and involved" in this (hmmmm, wonder why:uhoh3: ) is working on creating a schedule. When I asked her again, if it'll go by seniority, she didn't confirm it. She said that it is really up to the DNS. I told her, that I don't want to bohter the DNS with lots of phone calls regarding this issue, but that I don't want to miss out on any information or meetings and to please call me, if there is any news. I also told her that I would like to emphasize, that I really like to working in this facility and that I definitely don't want to leave. I also told her that eventhough there are schedule patterns that I am not particularly fond off, for the sake of stayng, I am willing to adjust to whatever is necessary, as much as I can. she said that she'll be sure to relay it to the DNS, but who knows? Maybe they really don't give a damn... I want to be pro active and do what I can to protect my status there, but I also don't want to be the one, who calls the supervisors every five minutes and is up their you know what all the time... Oh I'm so anxious now. These things really upset me. I'm affraid that if I don't stand up for myslef I will loose out. It's a pride issue as well as an issue of not wanting to lose this particular job. I'm really sorry that this is so long and sort of ranting, but I'm so nervous. Can anyone give me some advice? Any personal experiences? Any feedback? Am I doing too much or too little to protect my own status in the company? Arrrrrgh, how I hate job politics!!!

I really really appreciate everyone's thaughts on this, the pros and the cons. All of them, without exception are valid. I would like to point our one thing though. In this case me wanting to give this gentleman a gift is not just because I desire to be kind, or for me to feel good, or to in other ways satisfy my urges for charity. (Eventhough there wouldn't be nothing wrong with that either.) This man has noone. He is and has been for years completely incapacitated. We, the health care workers are the only people he EVER comes in contact with. This man, as I found out from his chart, has zero own resources. He cannot ask someone to go and buy him a book, or a video or audio tape. He can't ask someone to go buy him a new shirt, or even something good to eat (well, he doesn't eat, but if he did...) He is completely dependent on what others, provide for him, which, as you can imagine, are basicaly only the bare necessities - shelter, food, medical care. Not that there isn't anything to be said for occupational therapy, but really, how much diversion can they provide for him after years of staying in the same facility? So to me this isn't (wouldn't be) about catering to any of my needs, like the desire to give someone a present, because I like them. To me this is a rather practical, more then somehow a spiritual issue. To me it would be catering to his basic need for sensory stimulation, to me it would be essentially... well, nursing.

The books on tape are a great idea. Someone asked how he reads if he's a quad. He has a kind of a "book stand" that goes on his bed side table. He asks us to pull the bedside table over his bed and to put the head of his bed up. Then he just asks someone to turn the page as we go in and out of his room. He only has a couple books of psalms and some other lithurgicals scripts that he reads over and over.

Sending it through the mail is a good idea. I'm currently not a church member.

I have this one pt. who I really like very much. He is an about 80 y.o. quad on a vent and has been in the facility for years. His mind is so sharp and he so hungry for company, conversation and any kind of information, yet he has no one to visit him. He likes to read and he is very religious. Would it be inappropriate for me to buy him, say a really nice bible? I remember something being said in nursing school about receiving or giving gifts to/from pt's is inappropriate.... What do you think?

We're a sub accute skilled unit with approx 50 beds for patients on vents. so far we've been staffed with 3 nurses, 3 CNA's and 3 RTs on both 12 hour shifts. Now our management decided to implement some drastic changes (to save money, of course). Instead of 12 hour shifts they want to change to 8 hour shifts and on NOC shift, they want to go down to two nurses instead of three. The DNS told us, that for her it will be simplest to split the assignmet between three nurses, and rotate the schedule 4 on, 2 off, but that if we are able to come up with a different schedule, (say one nurse takes 4 days on, the other takes the opposite 3 days every week) she is more than willing to go with that. I personally am working only two twelves a week. I have little kids and a working husband and therefore I am not particularly interested in working four or five nigts a week. Three would be allright with me. I'm not quite sure though what my other co-workers will want to do. To me personally, the four on, two off rotating schedule seems extremely inconveniet and uncomfortable. ... I mean, you can't really plan your life around it, if your work and rest days are allways changing. And especially on night shift, if you only have two days off in a row, you don't really get a decent rest, because the first day off you're sleep deprived and miserable... What are your experiences with scheduling on NOC shift? What works for you? What doesn't work?

We're a sub accute skilled unit with approx 50 beds for patients on vents. so far we've been staffed with 3 nurses, 3 CNA's and 3 RTs on both 12 hour shifts. Now our management decided to implement some drastic changes (to save money, of course). Instead of 12 hour shifts they want to change to 8 hour shifts and on NOC shift, they want to go down to two nurses instead of three. The DNS told us, that for her it will be simplest to split the assignmet between three nurses, and rotate the schedule 4 on, 2 off, but that if we are able to come up with a different schedule, (say one nurse takes 4 days on, the other takes the opposite 3 days every week) she is more than willing to go with that. I personally am working only two twelves a week. I have little kids and a working husband and therefore I am not particularly interested in working four or five nigts a week. Three would be allright with me. I'm not quite sure though what my other co-workers will want to do. To me personally, the four on, two off rotating schedule seems extremely inconveniet and uncomfortable. ... I mean, you can't really plan your life around it, if your work and rest days are allways changing. And especially on night shift, if you only have two days off in a row, you don't really get a decent rest, because the first day off you're sleep deprived and miserable... What are your experiences with scheduling on NOC shift? What works for you? What doesn't work?

When I worked med-surg I made up my special grid there too. Here, I.ve been using the roster we're provided and mostly it's worked fine. But yeah, maybe I could play around with it and make it a little more detailed. But on the other hand, I don't really want to cater to this nurse-princess either. This is LTC, the people don't change that much from one day to the next. Overall, I tend to take pride in giving a intelligent report that is pertinent to the pt's changes in condition. If the pt. is running an infection, I'll say so. Which abx they are on, often multiple of them, I'll admit, I don't allways know each of them of the top of my head. There is an allert sheet, that has all the abx and the incidents listed. Each nurse is obligated to check it and update it for changes during her shift, so why repeat it during report (unless there is some accute situation developing)?