Simonesays

I am actually curious: what is the objection to wearing a mask in public? As a general rule, we do things or don't do things all the time that are in the interest of public health and safety. Granted, covid-19 is a novel virus and our understanding of it is evolving. However, if the current evidence supports wearing face masks to prevent transmission, why is it so unacceptable to wear one?

Firstly, CONGRATS on your new baby boy! You are amazing for being pregnant and giving birth during this pandemic. I can't imagine how stressful that must have been. I agree with the other posters that have said to take the extra time with your baby. I was lucky to be able to take extra time when my baby was born and I am so happy that I was able to do that. I got to see many of his first milestones and the bonding time we had together was incredible. To be honest, even if you change to an ambulatory surgery environment, there is no guarantee that you won't be interacting with covid-positive patients. Plus you might not be given the same PPE that you would be given in a higher risk environment. Furthermore, if things continue to worsen in Texas, elective surgeries might be cancelled. I hope that you don't feel guilty for whatever decision you choose to make. It's going to be the right one for you and your family. I hope that you and your family stay safe.

I think that the initial question as to whether or not protests (specifically the protests surrounding the murder of George Floyd) will lead to a spike in corona virus cases is a fairly innocuous-seeming question on the surface. However, it is also a very political question (as evidenced by many of these responses). And maybe it is being asked on the forum now because the number of people attending these protests compared to the number of people attending the lockdown protests is far greater and pose a seemingly greater public health risk. But is it the question arising from these protests that we should be debating? I believe that there is an urgency to protest the racial injustices that we see occurring on a daily basis in this country. We have video of a murder evidencing that this is an issue that can't wait. Unlike the fact that states will reopen, there is no such guarantees that racial inequality will change. I would argue that if it isn't protested now, it will only get worse. In general, I think the consensus from epidemiologists has been that there is a risk that Coronavirus will spread with any sort of large gathering where people are in close proximity to one another. I don't know what type of official response people are hoping for who are upset? There have already been curfews. And the CDC is encouraging protestors to get tested for Covid. Just as the anti-lockdown protestors have been allowed to exercise their first amendment right, so have the BLM protestors.

To be honest, I find it hard to answer this question without acknowledging and discussing the reasons as to why the protests are happening. I think it seems likely that instances of Covid-19 will increase as a result of the protests. However, that is essentially acknowledging that I believe large gatherings of people in close proximity to one another helps spread this disease. Respectfully, in order to have a more meaningful discussion, this can't be a closed question. It needs to be stated why these protests are occurring. The protests are a response to the overt and systemic racial injustices that affect POC on a daily basis. As a nation, we watched the murder of George Floyd, a Black man, by police officers for the alleged crime of using counterfeit money to buy cigarettes. We watched the entire arrest, which he didn't resist. We watched as he repeatedly stated he couldn't breathe. We watched as he called out "mama". We watched as he lay on the ground lifeless and not one of the police officers administered any sort of medical care despite the pleas of bystanders to check on him. We watched all of it. In this instance, the reason as to why people are gathering together and risking spreading Covid-19 matters. It matters because George Floyd's death came after Breonna Taylor's. And Ahmaud Arbery's. And Philando Castile's. And Sandra Bland's. And Tamir Rice's. And many many others. It matters because the disease that we are so fearful of catching and spreading (because it is an absolutely horrible disease) disproportionately has been affecting POC. And why is that? The reasons for these protests matters a whole lot. People (myself included) are knowingly taking a risk gathering together to protest because we feel so strongly that the injustices that are occurring are so horrific that they pose a grave threat to our society.

I'm going to admit that I was very ignorant when Covid-19 first became a news story. I also thought that it was being overblown. I likened it to one of the storm warnings that never happens. I was horribly wrong. There are lots of articles written about how comparing Covid-19 to the flu is problematic. There are numerous articles detailing why Covid-19 is different and more challenging to manage. There are first hand accounts from intensivists who have never seen anything like this in their 30-year careers. However, I don't think posting links to these things is going to change the mind of anyone who still thinks the two are alike. I work on a covid unit in NYC. I can imagine that living somewhere less impacted by this disease makes it hard to imagine what it might be like in a hard-hit area. All I will say is that It is truly awful. I'm not going to expand on this because I won't be able to say anything new about this situation that hasn't been better said by someone else. Maybe it's challenging to remember that the numbers associated with this disease are people. And they aren't all elderly people or young people with chronic health conditions who are dying or getting seriously ill (side note: I hate that this is used as a means to minimize the impact of this disease). It could be any of us. I'm sure the economic devastation or social isolation of Covid-19 seems more threatening than the disease itself to people living outside of hotspots. While these things are also awful, they can become so much worse if this disease infiltrates these places. I honestly hope that for these people, coronavirus is the storm warning that isn't as bad as its built up to be. Because it's terrifying to find yourself in a hurricane.

Mine were impacted so I had sedation. I woke up after they were removed and thought I was at work. Apparently, I was trying to get up (half asleep) and do rounds on my (imaginary) patients. I had some minor discomfort after the surgery (4 teeth removed) and only had to take one dose of my Dilaudid (uhh... side note: Dilaudid?!?) I didn't have bruising or much bleeding. However, I was a little grossed-out by flushing the gaping holes where my teeth used to be so that food wouldn't be trapped in them.

You might have experienced "bullying" if you made a post on AN with a title such as, "Fired for a mistake that wasn't my fault" or "I'm brand new and I know more than my preceptor" or "The ICU is so boring for a new grad." Just joking, just joking! We do like to give these kinds of posters a hard time, though.

Yes yes yes! Well said! Another benefit to these types of safe injection sites are that they enable health care professionals to interact with marginalized populations that can be notoriously difficult to reach. Relationships are formed and trust is established. As others have mentioned, other interventions (wound care, social assistance- i.e. housing, infection treatments, etc) can be initiated in facilities that offer a multi-faceted health care approach. I am inclined to believe that people who have a problem with these types of harm reduction interventions believe that drug addiction is a choice people are making, and not a disease. As a comparison, to a certain extent, some forms of diabetes are preventable. However, it doesn't have the same amount of blame and stigma that surrounds drug addiction. When a type 2 diabetic is newly diagnosed, they generally don't get berated for ignoring their elevated H1C levels and failing to adjust their diet and exercise habits. As a general rule, they are simply prescribed medications (along with advice pertaining to diet and lifestyle modifications) that treat their disease. It's harder to be compassionate for someone who we believe has full autonomy of their decisions but continues to engage in bad ones. And I know (I know!) that the substances the drug-addicted population consume are illegal (unless prescribed- and then abused). So my comparison is flawed. But I believe that if we could change the perception of drug addiction, we would have more of an inclination to address it, and we would come up with better methods (and funding) for doing so.

You might be beyond this site (in terms of your EKG skills) but it's kind of fun: Free ECG Simulator! - SkillSTAT

Good lord! Some of this advice seems a little bit unsafe. Please don't walk 15 miles in a snow-storm to get to a job paying you less than minimum wage. That being said, as others mentioned, you could have tried to work with your employer to come up with a solution. It seems like you were only doing the job for the patient hours, however, and you weren't too into it to begin with. If you were already thinking about quitting, your employer saved you from having to make this decision. Focus on school. In terms of a supplementary part-time job, sometimes, the relevant experience isn't always the best experience. If it's money you need, work somewhere that pays you better. And maybe spend some of your time trying to find scholarships or bursaries. There are quite a few out there! As someone else mentioned, though, this is a particularly sensitive topic for nurses. We work in a field where we are highly dependent on the colleagues we work with: to show up on time, to do the job to the best of their abilities, to work together to provide patient care. In some settings, people's lives depend on us. When we have to work short-staffed, or stay late, or come in early, we are not working optimally. We are more tired and stressed, worried that our patients are the ones who are suffering. Weather, illnesses, family stuff: of course these things happen. And in an ideal world staffing would be sufficient to accommodate these things. But, unfortunately, it often isn't. So sometimes (reasonably or not) we get upset at the colleague who calls out in a snow-storm that we have prepared for. Because that means that we have to work that much harder to compensate for their absence. And our jobs are usually already crazy enough as it is. You said you aren't going into nursing. What field are you going into? If you are going to work in a health-care environment, just be mindful of the above.

As others have said, you didn't do anything wrong. Yes- you could have kept the doc in the loop a bit more by letting him know his colleague would take care of the script for discharge but since you thought they were working together, and were communicating about these things, this likely would not have occurred to you. This is part of being new and figuring out the inner-workings of your hospital. I also have been yelled at a few times by MDs. One was over the phone and I will take some of the responsibility for it (a long story but essentially I was pestering the doc- in the name of pt advocacy- and didn't realize he was in the middle of a surgery). However, that was also a systems problem and there should have been someone covering his service while he was undertaking an 8+ hour surgery. Another memorable incident was with an attending who felt I should not have called an RRT for a patient with new onset uncontrolled afib and desaturation (with cyanosis!). The MD was on the floor at the time (I had alerted him to my assessment findings prior to calling the RRT) and he tore a strip off of me in front of everyone (i.e. Do you know who I am, I can manage this episode, etc). I calmly explained to him that an RRT was a nursing resource (true) and that as a newer RN I wanted the support of experienced staff with critical care backgrounds who could help me care for the patient (true). I wasn't questioning any of his orders but he seemed to take my initiative as an indication of this. I later found out that a nurse had recently called a code on a patient he was attempting to manage on the floor (I was on a med-surg, not critical care floor at this time) and he seemed to be deeply insecure about this. His outrage at me didn't change the fact that I felt I made the right call for my patient at that time. And if I was in the same situation now, I would do it again. Remind yourself that this episode had more to do with the MD than it did with you. Yelling at a coworker is not acceptable behaviour and should not be tolerated. Don't be afraid to stand up for yourself. As others have said, find a way to deal with this behaviour that works for you and your personality. Unfortunately, we work in stressful environments and chances are it will happen to you again at some point in your career. It's a human response to be upset that you were yelled at and I felt the same way in both episodes I mentioned. However, don't let this interaction shake your confidence in your capacity as a nurse.

I don't disagree with the premise that nursing staffing ratios are unsafe in many institutions within the US. A united voice begets power and can effect positive change (go unions!). However, the OP didn't phrase his concerns in this manner. Instead, he made inflammatory comments about an entire gender. He failed to recognize the way his own privilege and experiences as a male differ from that of his female colleagues and how these differences might shape our actions. And furthermore, he didn't offer any helpful suggestions as to how we as nurses can amass together and use our power to wield positive change. His divisive comments seem to serve no purpose other than to offer him a chance to make a sexist and insulting rant. (Hmm... who else does this sound like?) If the OP is dissatisfied with his working conditions and wants to improve them, he should start by doing his homework. He should look into how states like California were able to create mandated nurse to patient ratios and build upon that idea. He should talk to his colleagues and listen to what they have to say. Chances are, some of them already have some ideas in relation to this topic.

Wow!! I wish I could like this post more than once. This is such a thoughtful, well-written, and helpful post. I couldn't say it better and I couldn't agree more.

So sorry for you loss. That's terrible that they lost his DNR papers. A big yikes! My thoughts are with you and your family.

I'm so sorry for your loss. I can't imagine how hard that must have been for you and your family. It takes a lot of courage to be able to be present for a loved one as they are passing away and it sounds like you guys gave him a beautiful last couple of days. I teared up reading your post. Hugs to you and your family.

Interesting read! The premise of your article isn't inflammatory. And yet lots of people seem to be responding as if you are saying something egregious. We are in the middle of a documented opioid crises. Traditional approaches to NPOA have not been working and it is time to do something different. These are well-documented points. I have to conclude that it's your phrasing (masculine/paternalistic and feminine/maternalistic) that's been rubbing people the wrong way. Admittedly, I'm not sure if I love it myself. Although interesting in theory, I think it draws attention away from your actual thesis (which seems to be a holistic model of compassionate care, something that most people could probably support). Instead, the focus turns towards stereotypical gender roles and how we might fit in as male and female HCPs within a binary system (maybe why some of the responses have been defensive?). Anyways, I really enjoyed reading your article and hearing your perspective about this topic. Although not an academic article, the New Yorker published a pretty interesting piece recently about the opioid crisis. If you haven't already, it's well worth a read! And thanks for taking the time to write out such a well-researched piece.

Ugh. This makes me so mad! Wishing you good luck with your job hunt. Or a giant surprise severance package

Hmm. I think you do make some good points. Especially in your second post. But I have to disagree about this one. It is definitely true that universal health care has its problems (i.e. wait times, sustainability in the context of an aging and sick population). However, it does promote equitable access to health care by removing the barrier of financial burden. i.e. If I don't have to pay to receive medical care, I am probably going to be more inclined to seek it- and seek it early, than if I don't. For someone with money, medical fees are not going to be a barrier to seeking care. However, for others (i.e. the working poor- even those with insurance) copays and deductibles are barriers to health care. Do you think someone working at a minimum wage job supporting a family is likely to get that suspicious mole checked if they have to pay to do so? For some people it is a choice between rent, food, and health care. Furthermore, I would argue that we don't all get to go to the same hospitals. This depends on whether or not I have insurance, and how good my insurance is. Anyways, I don't mean to derail this thread and turn it into a universal health care coverage debate. That is another topic for another day. As an aside: I was quite sick when I was little and lived in a country with universal health care coverage. Now that I live in the US, I keep thinking back to that time and what would have happened if my family had lived here. I think of the financial burden my illness would cost us and how that would have changed the trajectory of all of our lives. I realize the privilege I have at being able to work as a nurse in the US. I love being privy to technology in health care and the culture of safety I see everyday at my job. However, I probably will never stop hoping for universal coverage so that patients can enjoy these things without having to worry about how much it will cost them and their families.

Ohh. This is fun! Bring on the wand! - universal health care (including dental, vision, mental health care, medications) - focus on health promotion (i.e. access to affordable nutrition, education related to various facets of health, affordable housing, extended paid maternity/paternity leave, etc etc etc) - expansion of harm reduction strategies (i.e. safe drug injection sites) - a cap on the profit pharmaceutical industries can make from medications - better access to PCPs for patients - mandatory biannual medication reviews for patients who are taking more than 3 medications routinely by their PCPs in conjunction with a pharmacist (to help prevent interactions, wean off medications when possible, etc) - improved nurse to patient ratios - functioning equipment (and enough of it to go around) - free CEs for medical staff - improved long-term care for our elderly - I'm pretty happy with my salary/vacation but would like to see my underpaid colleagues get what they deserve (especially EMTs!) - Oh! I almost forgot one of the most important ones: bye bye Press Ganey! Cards, thank-you notes- these can be written in lieu of the survey.

Hahaha. Eww! My poor patients! Yep- there are actually really nice shower facilities.

Even though you have mixed feelings about the job offer, congrats! You're doing something right in the application process. I'm not 100% sure (and someone feel free to correct me) but when I look at how these ratings are based (i.e. CLABSI, CAUTI) I wonder if they take into account the populations these hospitals are caring for? Do they control for illness/injury severity, comorbidities etc? The hospital I worked at previously scored more poorly than some of the smaller regional hospitals. However, we were also a referral centre and took care of the sickest patients in our area who were more susceptible to these infections. Not to excuse a poor rating, or diminish the components that cause a hospital to rate poorly, but it is maybe something to look into a bit further if this rating matters to you. As others have said, 2 years might be a long time to sign a contract for. I would consider whether you have to stay on this unit the entire time (or if you could transfer), if the hospital is a teaching hospital, nurse turnover rates on the unit, how long your training will be etc. Keep in mind, you can always interview for this position but keep looking at other opportunities. As someone else mentioned, it's also probably not a bad idea to have a lawyer look over the contract if you have any concerns. Good luck with your job hunt!

I bike to and from work. It's a 30 minute commute each way (give or take) and pretty flat. It saves me from having to take the train (which is generally very crowded) and allows me to decompress. I can honestly say this has been a game changer. I could never muster the energy to go for a run before or after a shift so combining my commute with my workout has been the perfect solution for me.

I think you've actually answered your own question. ICU is a very challenging environment where a focus on critical thinking (rather than a preoccupation with skills) is essential to positive patient outcomes. As a new grad, you're likely going to spend more time and attention on your skills than a more experienced RN. You are also honing your critical thinking. This is expected. However, the critically ill patient population is fragile and can't necessarily withstand the learning curve that comes with being a new grad. You should congratulate yourself for being self aware and acknowledging your own limitations. You are prioritizing the safety of your patients and that should be commended. Your manager probably recognizes your potential and is guiding you towards a unit that, at this point in your career, is likely to be a better fit. Let us know how everything goes! Good luck to you!

In Canada, almost everyone pays for health care. It is a shared expense that is paid on a sliding scale. Those who have more pay more. Some employers cover this expense, but not all. And some people who fall below a certain income level/certain populations don't have to pay at all (similar to Medicare/Medicaid). So, in essence, universal coverage doesn't necessitate "free" health care. Canadians pay for their health care. And without various insurance providers controlling prices and coverage, it is cheaper. I firmly believe that access to health care and medicine is a human right. I don't think that when a person is sick or injured they should have to worry about whether or not they can afford treatment. In effect, this belief implies that those people coming from positions of financial privilege or jobs with health insurance are more entitled to health and wellness than those who are impoverished or out of work. In the US, I pay for my insurance here even though I may never have to use it. I pay for my insurance because if I get sick or injured, I don't want to go into financial ruin paying medical expenses. From an insurers point of view, it's the healthy people who offset the costs of those who are sick. This is the same model that is used in Canada. But it is applied at a much larger level and thus creates a system where more people can be covered for a fraction of the price. Everyone shares the expense. Before you attempt to make a judgment about a health care system, you should really be more informed about it. And, hopefully, once you are engaged in it you can see its benefits. If you try and regard health care less as a service and more as a means to achieving a stable and productive society, you might be able to appreciate it better. Also, your argument about taxes doesn't make sense. You don't want to pay taxes that will be used towards health care but you are willing to pay taxes that are used to prevent/treat fires??

I enjoyed reading your comments in this thread. I am also originally from a socialist country with a universal health care system. When you live and work in this type of setting, it is easy to take for granted the safety net that exists and forget about the personal costs incurred to get healthcare in the US. I don't think that people here (in general) sue because they want their feelings acknowledged or to feel "happ[ier]." Although maybe this is an underlying factor. Primarily I think people here sue for the financial reimbursement. Even though I have great health insurance, a medical mistake could potentially cost me and my family thousands of dollars in medical fees. I wouldn't want to personally have to pay these fees if it was the result of an error (or several errors). And I am definitely not a litigious person. This is obviously a very sad case and I feel bad for both the mother (and the rest of her family). I also feel bad for the nurse. Like others have said there were possibly other concomitant factors (under-staffing, over-emphasis on patient satisfaction scores, etc.) that would be interesting to hear about. Hopefully, though, this mother gets some peace after this lawsuit is over.