Jewelsforme

I read through this and it sounds like you were set up to fail, not to succeed. You should not have received more than two patients and ask questions until you are either retired or dead. I don't know why this happened to you but it's definitely not your fault. I hope you can travel or move to a place that has a more supportive orientation program for new nurses. It isn't you.

I had a daughter with a trach. I hope it's ok to post about this. Trach suctioning I could do without breaking sterile tech in my sleep, and did as she was a "wet" trach and sometimes the nurses called out sick. For some training on our MedSurg floor, I bought a big teddy bear and popped a hole in its neck. I put a trach tube in and tied it on. I set up the room for suctioning the teddy bear. Boy, did that help any nurse who felt trepidation suctioning. Remember sterility and being gentle. Get an order for sterile water drops (gtts x 1-3 or whatever loosens up the secretions). The catheter goes in way easier if it's lubed up with sterile water, too. After you are all ready, then instill the gtts to help loosen secretions up. The one issue I had with learning in school and on the floor is that schools and RT will always insist on going in to suction when the patient is inhaling. This is counterproductive. I always notice less stress and optimum suctioning by waiting until the patient takes a deep (or normal) breath (they will have maximum sats), then insert (without covering the suction with your thumb) when their first begin exhalation. This way you are not cutting off their inspiration and they are working "with you" when you do cover the hole with your thumb as they continue exhaling. The secretions will now be flowing outward toward you and the suction catheter. Close off the hole with your thumb and don't go past the feel of the clogged spot. (Deep suctioning not only hurts, but can cause bleeding and scar tissue.) Then when you "hear" and feel the suction has caught the gtts you instilled as well as any secretions, gently spiral the catheter in between your fingers as you exit up and out from the trach. Practice on a teddy bear. Keep doing the procedure on Ted E. Bear patient as well as in your head until you can see when to insert, when to close off the thumb hole, gently spiral when pulling up. Clean the catheter with the sterile water and wait. You may need to suction again or insert a couple more drops if the secretions are sticky. The patient needs help to get this "gunk" out. Very best wishes to you and don't shoot me anyone. I learned this a very hard way on my own baby, thousands of times. It's also why I went into nursing. And if the mom or parent is there, ask him/her if there is a special technique you can use for that specific patient. They will really appreciate your asking and you will learn a lot. I'm so glad you even asked.

Dear working with ptsd -- Please do not give up. You are humble enough to admit your own challenges. Go forward and know the rest of us with challenges or disabilities keep going one foot at a time. Each one of us does the very best possible at all times possible. But no one is perfect. Big hugs to you and everyone who works but feels inferior to the "super nurse" image. We are all super nurses!

Grivet, thank you for your opinion. Proves oh, so much. Hope you feel better soon and I wish you well.

I know Hancock. I even was flown to Honolulu to see an endo. So sad, she just kept asking me if I had diabetes, and had no clue about adrenal insufficiency. I asked her about the axis and she gave the the freaking deer in the headlights look. She told me to follow up if I develop diabetes. I could have died, could still die, and am going on 9 yrs bedbound, without the strength to get up. Every single body function is abnormal now. I could go on, but truly, I do not want to. All I will say is after dozens of "specialists," not one was willing to offer any diagnosis at all. So I'm hanging on by threads, currently on clear liquids, unable to tolerate foods. Every week it's another major physical issue. Thank you for sharing your knowledge on this subject. You are the very first person I ever knew, physician or nurse, who is aware of this plight. Much aloha.

I understand. It is not known because it is rare. With extremely low cortisol, mine was 1.7 at the time, the heart cannot function correctly. I had to do quite a bit of research myself because even physicians would have the deer in the headlight look as I handed them a brief print out from PubMed of other science based sites to show the correlation between cortisol and the heart. But for me, I was having runs of SVT and periods of asystole, documented on the monitor printouts. Perhaps for another patient with very low cortisol, they would have other types of irregular heart rates. I can only relate what happened to me. Treatment was hydrocortisone PO 3 x daily for five years until the adrenal glands began to work again. The steroid replacement therapy was no fun piece of cake. It had its own terrible side effects. But thanks so much for asking. I had no idea until I experienced it. With all my best.

Well, let the attacks against us roll. I was not in the ER for chronic pain. I was having chest pain and needed a cortisol infusion since the home I'm injection did not stop the arrythmias. I limp because yes, I also have chronic pain. A truck hit me, going down the wrong way and slammed into the front of my little car. Not that the reason will matter much to others. But I live with severe pain, which causes a limp. I could be wrong if you were not responding to me. Then I apologize. But if your response is directed to me, then there you have it. The hospital is 3 miles from me, we have a rather small ER, one I used to go to quite often as a nurse for patient transports up to our floor. When I was a patient there, other than for chest pain, the cardiac bays were empty. Just one example (of many) - A bicyclist came in, walking fine, from England, who was visiting our island for vacation. He said he fell off his bike and just wanted to make sure his wrist was not broken. He was bending it back and forth - I could see because the curtain was not pulled all the way. And his wrist turned out not to be broken. However, I watched as he walked to radiology, walked back to ER, and walked out d/c'd with pain meds and script (yay for him) with his SO to their hotel. But the staff was in with him constantly, offering pain meds, etc. Me? Hot abdomen with bloating and pain with active GI bleed. Hours later, yes, my husband did help me dress and had to go to another hospital, which is hours away, but I rec'd the care and follow up I needed. I could go on, with eye-opening negative care from several hospitals in different states. However I will not because the knee jerk defensive/agitated presumptions are just one of the smaller reasons why I no longer desire to ask for medical care. Chronically very ill people get this kind of attitude and anger directed at them a lot. So on top of feeling ill to the very core of our existence, most of us will avoid seeking medical help at all cost. The indignity is extremely difficult to tolerate while trying to survive numerous system dysfunctions for the rest of one's life. Pain is a whole other different animal. I do wish you well. With much aloha.

I forgot to thank you Anna - for treating each patient as a human, regardless of what we did for a living. I never had the time, nor desire, to dig up any personal info of any patient unless it may help me to care for them. I knew some day I could be any one of them. I just didn't know how soon it would be ♥

In a word, yes. But we value each and every single one of you who do not pass judgment on us, because we are in a very weakened and vulnerable position now and adore those of you who truly care about us. But the ones who show they care, even for the 30 seconds they have to spend with us, are rare indeed. Big hugs.

No, we do not go in "ready to be angry," at least most of us who are chronically ill, unless we are called names like "psych patient" when in fact we are a GI bleed or other REAL physical ailment that needs help. I get mad when I am smiling, quiet, suffering and minding my own business, then someone comes up and says I need a psychiatrist. Then watch the little Portuguese lady come out of me. I try to keep her hidden whenever humanly possible, but some people insist on seeing her. In those rare instances, I introduce them to a part of me that even I don't want to show. Otherwise, I am calm, quiet, or crying quietly when the pain goes over 7 or 8, never demanding attention or help. After several hours of waiting in ERs with no one checking on me, watching far less ill or injured people come in and discharge out, my husband will help me dress, then help me hobble out of there to suffer quietly at home. Believe me, because it's true.

I'll drink to this. You certainly hit this nail smack dab on the head. I used to be a MedSurg and Hospice nurse. I was the nurse that patients asked for by name, even in our hospice community. Man, I thought I would work until I was a little bent over lady with white hair, limping in to care for people far past my retirement age. I absolutely loved being a hands-on, compassionate, caring nurse. That is until one day I could not get out of bed, literally. So this is "chronic fatigue." I already worked with severe low back pain from an MVA as well as body wide pain from fibromyalgia. My endocrine and other body systems were all out of whack. I could not figure out why my right leg was so weak and I kept tripping on it. Then my right arm and hand went weak, then my vision and so on. I had home care off and on and used to joke to my home care nurses and friends that the only body system that is working is my SKIN, the integumentary system. But even that quit working right about 4 years after this nightmare began. When I was last in the hospital for a run of SVT while on a monitor, I was placed on Tele in MedSurg for observation, in the same hospital I worked in, I can tell you that some nurses never touched me, talked to me, performed an assessment, even listened to my lungs or heart - many!!!! One that I used to work with only poked her head around the door to ask me if I was ok, need anything, then disappear for the rest of her 12 hr shift. I felt humiliated, shunned, completely rejected by my own nurse and doctor "friends" there at the same hospital, my previous colleagues. To this day, I have no idea how they filled out the charts without ever assessing me physically. Only one gave me a quick and thorough once-over, a previous friend, another kind soul, as she was DISCHARGING me for home. I never even used my call button because I knew the eyes at the nurse's station would begin to roll LOL!!! Ever since then, I remain feeling ill to the core, every single maddening day, having to spend my life flat to keep my B/P from bottoming and blacking out. There is no freaking cure and this year the IOM has changed the name of chronic fatigue to SEID for short (but for those who do care, it stands for Systemic Exertion Intolerance Disease) and did not even get approved for one measly dollar of funding this year by the good ole' USA government, not one single dollar. It is still a very disrespected illness and therefore, we, the patients, get no respect or dignity. I keep up with as many CMEs and updated videos about medicine and reviewing procedures as my mind can tolerate. I avoid going to doctors and ERs if I can help it, even when I thought I broke a femur during the last fall 2 months ago. My husband bought me used crutches to avoid the searing femoral pain if I placed any weight on it. But I realized it was just probably soft tissue and that once the visible bruising (enormous area) resolved, in time the inner bone pain would get better. It did last week. After years of mistreatment and invalidation from physicians and nurses, this is why I veer away from reaching out for "care" in our medical field. But I will honor and defend our nursing profession as long as I still live, even if it's disabled, on my back or one side, staring at the beautiful birds outside my bedroom. Truly, with aloha, because my heart still feels and empathizes with others who suffer, especially those who are alone ♥

Beccalyn175, each nurse is very different from one another. However, for those of us who have a heart, compassion and care for each human even after we clock out, that is what a debriefing is for. Do they not have those for you at your facility? It is very helpful to prevent nurses from burning out, carrying guilt, and turning into robots without feelings. If your workplace does not have a debriefing request system, ask about them starting one up. This is beneficial for all nurses, new or old - to help review what led up to an event, what was done correctly, what steps could be done differently (nasal cannulas are not enough during a code situation on any floor), and how can policies or procedures be improved. The house supervisor can also ascertain an update on the patient without releasing the patients' names, ie. "Patient A recently had to be transferred from here to ____ and this is a basic review and update." Nurses can choose to attend or not to attend. There should be no punitive actions taken but rather, a non-accusatory conversation with the goal of lessening any negative feelings or blame, and to ensure the best possible procedures in place if the situation comes up again. I hope this helps and that you can get the debriefing system in place at your facility ♥

When you say you are "one" class away from "being an RN," are you saying you have about 4 credits before you can take your finals, then take the NCLEX? I'm not sure exactly what you mean. Can you help me out? Thank you ♥

Jealousy rears its ugly head. They sound jealous. You just do your best without discussing how good your grades are or that you passed the NCLEX first time etc. You'll get past this and remember a whole lot more practical information to use in critical thinking when you are a graduate nurse, one who gains the confidence of patients and fellow staff alike.

Hi, my last child did not have a suck/swallow. She remained in NICU first 5 months of her life. She initially had gavage feeding of my pumped breast milk thru NG tube. Prior to discharge she had a Peg tube placed. She also had a trach. But I spent every single day in the NICU while I was recovering from emergency and sloppy C-section. I bled for a year and was oh, so weak. But I managed to provide care in the NICU and became such close friends with the team there. That was 23 years ago and we are still friends with her pediatrician. But to this day, I still cannot walk into an NICU without bursting into tears. I do have some serious PTSD from life, but can work in pretty much any other dept. Hope this baby gets to have her mom's breast milk! I LOVE breastfeeding and lactation teaching.

Grinds my gears. Hmmm. We have to work in sometimes a close environment to one another, so I'm positive each of us can do something that grates on others. Yes, the "I am the greatest thing that ever lived and breathed" attitude is very difficult to swallow. The "Yeller" is also another toughie to endure, someone whose "indoor" voice is actually a "Super Bowl" voice {sigh}. But what is the hardest for me to take is the real life, 100% bully psycopathic behavior type anyone. This is not the "I'm having a very bad day, stay out of my way" person. It's the "I'm a Tyrant, have always been, and always will be. If you don't like it, get off my planet" type attitude. The one who refuses to work with anyone or who might play favorites while displaying aggressive action and speech to the select "privileged." They may throw items across the nurses' station, shout and slam items around, hoarding supplies that are in need by everyone, etc. They are condoned by the administration for whatever their reasons. For years, they are known as "Oh, THAT nurse." You don't even have to name them. They are known throughout the hospital or facility for their "Go ahead, make my day" attitude. The kind you wish you could pick up the nearest stick and put his lights out, but that's just fantasy thinking. There's always at least one, everywhere you work. Everywhere. I mean everywhere. It only takes one to disrupt an entire department, make new grads cry, new nurses transfer, and supervisors heave sighs without disciplining or firing the broomstick riders. Ok. Off my soap box now.

1. Put the patch between shoulder blades. Invest $34 for a box of 100 Tegaderm (sheesh to your facility for not doing this already). Still disappearing? 2. Get one member of administration to implement 'fake' this room is now under video observation for illegal drug activity. No longer disappearing? Was an employee. Still disappearing? Keep video monitoring notice in place, and 3. Implement security cameras, cheap on EBay, store to chip and playback on day of patch disappearance. You will catch the thief. Not a violation of HIPAA if protection of patient from abuse. This is abuse if it is happening.

Watching paper charting convert to computer charts over the last decade or so has brought some real pros but also very real cons. For example, the current hospital has implemented a system that went online over the course of about 3 years, with the lab being the very last dept to get on board. Some of the pros are simply basic: We know the patient's basic information already when they present for care. We have some of their current meds, allergies and physicians listed, as well as family / emergency contacts, AMDs and health hx. But here are some of the serious cons I am seeing: Not every department has access to the same patient's information (huge glitch). Example is dietary allergies. Patient is allergic to shellfish and up comes shrimp cocktail (leading to "WAIT, don't eat that" and swiping it from the tray, call kitchen and find out this allergy is not showing up there). This info is in all (I hope) depts but doesn't show up in the kitchen. It was an original allergy, input during first patient admit. How does this information not get entered simultaneously across all depts? No one has been able to explain this part to me. Here's another one. Patient comes in who is alone, poor historian or some form of mental disability, unable to offer important new information, whether it is new address, new physician, different insurance, new allergies or change in meds. This throws a huge monkeywrench into the admitting nurse's day as she tries to do all the contacting last known family or contact to find any and all new information. This could have been performed by the new physician having access to a system to update the hospital's information for the patient. This happens more frequently as the population ages and families may not maintain close contact with the elderly who might still be living on their own. How do we address this situation? Thank you for inputting your experiences that could resolve these types of issues.

Whoa, the "G" word. No need to explain. I was raised in the military, married military and received "care" in military hospitals. We have a dear family member who was placed in a state hospital in the early 60s which has since been shut down due to all the nightmarish reports on patient mistreatment. I used to volunteer at local VA hospital in mid 70s. If they are so dysfunctional with their own vets, you might understand why you would have a better chance working at WalMart or McDonald's who would accommodate your disabilities rather than a government medical facility. Perhaps you could go into home care, telephone triage, or telephone case management for insurance companies or civilian hospitals. It's a BIG world out there and based on just my own life experience, I would get as far away from a government run anything. But that is a decision only you can arrive at on your own. Sending hugs.

You did the right thing. Never mess around with an asthmatic. They can turn so fast and so bad on you that you may not get to 911 or the ER, praying you can get an ET tube down if you happen to even have one with an order and are skilled/proficient at that procedure. Once the airway collapses, getting a support down the airway may not be possible. I really move fast on asthma patients. Take good care.

I hope you have a strong lactation services dept/lactation specialist where you all work. They will set him straight no matter how large and empty his ego tends to be.

Are we making serious positive headway utilizing I.T./Computer Charting in patient care, or are we also creating more or larger problems using these electronic charting systems? 1) Name at least three positive outcomes you see utilizing electronic charting. 2. Name at least three negative outcomes, challenges, or even problems to the using of electronic charting. 3. If you could change just one of the processes or portions of processes of your current online I.T. charting, a) what would it be, b) why would you change it, c) with the hopes for which outcome after the change is implemented? Thank you for your participation.

Anything can happen, although we hope not. With the very best laid plans and with our eyes literally on the patient, there will be moments our eyes cannot be on the patient. And if we take a break perhaps the next person may not check as frequently as ordered or required. Patients are very intelligent and know when the best time is to attempt. If your dept is normally chaotic during change of shift, the patients will quickly observe that and plan. Fortunately this has not ever happened where I worked, when I worked. Perhaps more bodies could be performing observation while report is going on, even if those bodies are supervisors, secretaries, and floats from other depts. Eyes are eyes and patients have the right to get through the worst time of their lives with the safest place we can provide for them. However, if someone is intent on dying, along the lines of "as long as there is a will, there will be a way." We must do all we can to remove those "ways" until the patient is stabilized with the correct meds and therapies. Best wishes to you because this would be a heart breaking situation for all involved.

If you work at a very good institution, they will find a way to accommodate your limitations. I've worked with an RN in a very busy MedSurg who only had one hand and no prosthetic on the other arm. I've worked with a blind nurse confined to a wheel chair, guided by a seeing eye dog in the hospital and she did most of the discharge instructions and answered questions based on her years of experience and knowledge of hospital policy and procedure. I wish you the very best and you find the position that best fits your capabilities and desires!

Congratulations. You must be floating. I know I was elated. Enjoy the journey!