Gypsy Moon

Hi Dinah, There might be a reason why they are acting like that. Here are some ideas on it: they have bad management could be at any level of the chain of command or even across disciplines so that they are acting that way as a result of the environment; could be the person who held the job before you was someone they really liked and bonded with but was fired for unfair reasons and they are unhappy that you are there because their friend is not there; could be they have to compete with each other - again a management quality problem; could be they have seen a lot of people come and go and don't think you will last very long so why bother. I agree with the one who said that the best thing to do is to behave professionally and not worry too much about it. Also, you might consider looking for a different job unless this one has more positive than negative qualities. Consider that may not see any changes in the dynamic and to focus on changing yourself as opposed to trying to change the others. How can you better change yourself in order to get the job done without harming other people in the process?

Mostly roxanol and ativan. Also consider oxygen as a medication and how it might prolong life as opposed to providing comfort. Along those lines, albuterol. How might roxanol help with air hunger? Recently had some haldol prescription given to someone from the doc. Haldol is not a medication that I like. Look at the side effects of haldol compared to ativan. Nausea meds like a phenergan suppository.

In my experience, hospitals have been training people specifically in HIPPA to never peruse charts on patients who are not assigned to us. As you said this happened back in the day of paper charts, perhaps before everyone was constantly getting this shoved down our throats. I have considered what you said and what people have written back to you. In my opinion, there is responsibility on the part of the charge nurse to whom you spoke to guard the patient's chart in the same way that one should not allow one's computer screen to be read by passing visitors or staff. I also don't know how in the world you had the time in your day to not only get a lunch, but to go wandering around the hospital in search of people in other departments. So I am very skeptical that you are a real nurse. I think you are likely making stuff up. A real nurse would have five patients all calling for stuff at the same time and a supervisor walking around behind her telling her what a failure she is. However, if your story is true, that as a nurse you had time to not only have lunch, but to go visit a patient you had on a prior shift, then you should have just said hello and hoped the patient was doing OK and left it at that. The staff in the other unit should not have allowed you access to a chart any more than they should have allowed a family member or a stranger access. So yes, two wrongs don't make a right.

Hi, I've been a nurse for over ten years, mostly working in med/surg. I've had multiple issues with different nursing supervisors and authority figures attacking me. It is difficult for me to deal with the constant quality improvement projects. I find the pace and the work to be overwhelming at times, and am hypervigilant at work, always trying to do a good job. Almost 2 years ago, I discovered that a lot of my problems are a result of chronic PTSD which started in my childhood from my verbally abusive, alcoholic father, and living in a codependent family. I've worked through a lot of it in therapy, done EMDR which is helpful, try not to take things personally, I even got an MSN in leadership hoping to change the environment where it is a positive environment but I haven't yet been able to promote to a leadership role, even as a charge nurse. For the past year, I've been working per diem, part-time and writing a fiction novel. I have been questioning my calling to nursing for almost two years now, don't seem to be cut out for this job. There are a lot of things that I find to be triggers, from the hectic pace to how things are always going wrong - can't find working equipment, meds not in the right place, patients need a bunch of stuff every time I go in the room even though the CNA was just in there, constant programs of improvement adding more and more duties even though we can't get all our breaks in, patients are sick, in pain, needy, constant interruptions on the phone (pager, call light, people just grabbing you in the hallway, etc). I even think that the work depletes my life force somehow, that somehow God is able to use my energy to help people because I am so exhausted by the work. Also, none of my patients have ever coded. I've had some people on end of life care actually pass away. But really only a couple. I continue to retraumatize at work and actually got sent home the other day because I said, look, I'm having a lot of PTSD symptoms today. I woke up at midnight, unable to get back to sleep. The last 2 days have been really hectic. Then when I start my shift, I have a 5 patient assignment, 2 of the IV's are bad, 2 of them are in bad pain, 1 of them running a fever of 39.1C, so in the first hour I'm just putting out fires and will be an hour behind on my regular expected work. Then the charge nurse has to coach me that it doesn't make the patients have confidence when I am spinning in the room like that. Come to find out the licensing body people were on site - probably I am picking up empathically everyone's stress. I find it all to be very dissatisfactory. Does anyone else find themselves having PTSD from the environment? Since my Dad was hard on us, it really affects me because I am always trying so hard to do a good job and it is never good enough. I fail every day. Anyway, I'm almost finished with my novel. I doubt that I'll be able to quit nursing right away from that hobby, but I do feel more called to writing fiction than to nursing for the past two years. It doesn't seem to be any better at work. I find I can manage the PTSD for the most part working part time. But I have to say no a lot to picking up shifts or working back to back shifts, or double shifts. I really have to work very hard to destress between shifts. These nurses who say they love their jobs, I just don't get it. Who are these people and what jobs do they have? Are there med/surg nurses out there who love their jobs and why? Like I said, I don't think I'm in the right field of work. I like when things go smoothly, not at a frantic pace and when I can connect with my patients and when leadership is thankful for the work I do and realistic about expectations. That is not nursing.

Ha, ha, ha. I see this was posted seven years ago and I wonder if you are still a nurse. I have been a nurse for almost 10 years in med/surg. We have some positive things about our job. But it is usually a very hard job. I cope by working an non- benefited position on a part-time basis. But then again, I can afford to with all of the experience I bring to the table and my education level, my pay is generous. This morning I was saying to myself, "Don't worry, you will be fine. If they put you on call or don't. If people are mean to you. If the patients are crazy. If they give you six patients and everything is understaffed." I am pretty good at my job now and take my lunch and my breaks. I try not to take anything personally. I try not to care too much. I recognize that my environment creates stress and trauma to myself and everyone around me and to cut everyone a little bit of slack. I always try my best to be completely professional no matter what BS is being flung in my direction and no matter by whom. I just keep trying to do the impossible and live up to impossible expectations in an impossible environment with impossible situations. I fail every day. I had trauma therapy for a year to achieve this attitude and I would not hesitate to go back to a PTSD specialist if I found myself not coping. But I can not work full time, I am a healer, a giver, and my life force is drained leaving me exhausted every day. God himself holds me up.

I have been a med/surg nurse for 10 years. I must say that your nurse to patient ratio sounds really bad if you are in a hospital. I don't work full time anymore because I can't tolerate the pace and stress of nursing. Even with four patients, sometimes the load can be very demanding physically and mentally with no room for error. I took a job as a per diem worker where I don't get benefits. Often they ask me to work more than I would like - which is about 20 hours (honestly I would rather be in a different department but they are so desperate for med/surg nurses because people don't want to do it). We work 8 hour shifts. The people who work 4 shifts per week are getting benefits. I have clearly stated numerous times that I won't work 4 shifts a week because I took the job to work part time and people who work 4 shifts are getting benefits. I might consider at some point offering to go to a variable position with 4 shifts a week where I could earn benefits but for now, I just say no to more than 3 shifts in med/surg. So I do think that you are in a bad situation but it is not within your control to hire/fire or change the med/surg world. It has been like this for at least the last 10 years that I have been a nurse. I sound like I hate my job and sometimes I do hate it. But it is mostly the pace and stress. I do my very best when I am at work, giving 100% of what I have. It often takes me days to recover physically and mentally. It just isn't worth it for me to kill myself so I have to limit my hours and stick to it. I have developed an "I don't care anymore," and an "it's somebody else's problem" attitude. I also have PTSD and am seeing a therapist for EMDR treatments. The med/surg nursing environment of high stress is not really a good fit for me. But, as I said, I give 100% and they are desperate for people willing to work med/surg so it is real easy to get and keep a job. Not so easy to advance or get that specialty experience.

I was discussing this with fellow nurses and the unit secretary today about a patient in the hospital who wanted to leave but was so confused she was only oriented to herself, lives alone, and had no ride. It is our responsibility as professionals to provide care and respecting a right to refuse treatment, the patient must have capacity. I believe that to re-approach and also as you have described, but as you point out that sometimes even combative patients must have cares. Ultimately we and the facility are liable for neglect, in my mind, if the patient does not have capacity and we fail to protect and provide care from them. This is not the same as a person of sound mind refusing a treatment or a blood draw or a new IV or a person of sound mind going home AMA. If the patient is alert and oriented X 4 then they have capacity to refuse treatments. Otherwise, the nurse has a responsibility to find a way to provide humane, respectful and legal care. I have not found in my experience that all patients have a right to refuse everything at any time and this lets us off the hook then if we chart it and notify the doctor. The doctor will call me on it every time and we will find a plan to help the patients get the help they need to overcome their acute confusion as well as in long term dementia patients.

I didn't read all pages of the post but in my experience PIV lines will not always give blood return even if they are patent. I didn't read all the research either, but my thoughts on this are that the valves in the vein are often contributing factors with PIV lines. The valves can create issues with placing the line and can sometimes be in the way. One can "float" the catheter through a valve, or push through, it feels like to me and then if the line is directly "up against" or just past a valve this could cause a problem with blood return. Sometimes these sites are "positional" and moving the catheter a few mm in or out will result in better flow. The other issue that I am aware of from PIV catheters is that often the vein might appear to be large but the lumen of the vein is small. This is especially seen in smokers, in my experience, or people with peripheral vascular disease. So that when one is starting the PIV the chosen catheter may not be especially good fit for the vein because it was chosen based upon the appearance of the vein but the lumen of the vein is smaller than one thought. These sites can be a challenge as well and I sometimes think about what possible long term complications can occur with these types of patients when they require hospitalization and have these tiny veins. If an IV flushes well or has infusing fluids I really don't understand what the problem would be to infuse the medication even without blood return. Not every patient has ideal veins and not every catheter is not hampered by valves or properly sized. Sometimes even a 24 gauge catheter is too large for some patient's veins but they still need the medication and somehow we make it work. Is this best practice? No, best practice might mean in this situation a perfect vein with a perfect catheter size. This is an excellent Evidence Based Practice question and if one were curious, one might go to the journals and see what information is available. In the real world it is realistic to not require blood return, in my experience.

I am burned out on med surg nights also and have been since about the three year mark but still keep ending up with managers who want to put me in that slot. I did go back and recently earned a Masters in Nursing Leadership online from GCU and this helped me to get through another year and a half of med surg and kept me more engaged and interested. But now I want to use it and be a manager in med surg and make a great working and patient care environment. I got fired for trying to give suggestions to my supervisor at work who has only an associates in nursing and has no interest in even allowing me to do charge nurse. It is ridiculous how petty and competitive nurses are and I am not all about sabotaging other people. If anything, I will help you out and help you reach your goals. Anyway, Then I had a recent possible job I applied to the ER and the supervisor hijacked my application and made it be for med/surg nights. After eight years as a nurse and having a MSN the last thing I want is med/surg nights. I went to part time before I got fired and I think that is about all I can tolerate. Of course they declined my availability as only part time so maybe I will lose my unemployment. But the thought of full time med/surg nights where I am unable to earn a promotion or go forward and learn a specialty is extremely depressing. So the only thing I could think to do to get out of it was say, hey, I can do it but only part time. So that is my advice - try to go part -time or take some classes to keep yourself mentally stimulated outside of work. Or look for a job in a specialty field of nursing.

Well, I met with my supervisors and they said that it is definitely within my scope to read them if I have the training. They said I could go to the EKG class in January. My one supervisor is an EMT and a nurse (he has an associates in nursing) and he said he is responsible to read them all the time. So at least in Wyoming the nurses can read the EKGs according to the supervisor and the new doctor. But I agree with the above comment that I always have radiology sign off on the reports before using lines unless another doctor looks at them and OKs it. I guess if they start asking me to read xrays next then I will have to comment about it.

I am a med/surg tele nurse and can interpret telemetry rhythms. When it comes to EKG's I have always had the docs sign off on them. If I chose to learn to interpret EKG's then I would feel confident in my skills. The other day a new doctor asked me on the phone to interpret one and I said it was outside my scope. He said I should take a class because it is within my scope. I agree with the other comments that if you study it and use it then you can possibly interpret them but I am not really sure what the state board of nurses would say in your state. That is why I was searching on this question in the first place. If you are an APN working in cardiology for a cardiologist I would be confident in your skills in most cases but in your shoes I would be looking at frequent learning opportunities. The last time I studied for a tele test I tried the beginning course at the ECG Academy which is an online rhythms opportunity. The class has straightforward and also obscure presentations and if I were to get serious about EKG interpretation I would be following on their chalkboard where they post the problems and do continuing education.

How strange, rocephin usually is given over an hour for IV injection. What a bizarre practice for giving IV ceftriaxone. Not just the air injection but the bolus of it.

Hi, I was thinking about this today. The D& C may have been the source of the air embolism and not the IV line. See the article by Stephanie Gordy & Susan Rowel, Vascular Air Embolism. Doi: 10.4103/2229-5151.109428 Oh also check Wikipedia on air embolism, it clearly states that the uterus can be a source of air embolism. It seems like the nurses agree that some bubbles in an IV line are harmless.

But all of those things being equal, increasing an assignment 50% gives the HOSPITAL 2-3% profit and is that WHY the supervisor chooses to email staff how bad patient satisfaction is and then increase the work load? Just curious about that rumored bonus.

Oh dear toomuchbaloney, So crazy but one sweet, young supervisor laughed that patients come to the hospital to see the nurses. Rather they come to see the doctors. It is difficult to explain I guess l