0.adamantite

I had no idea about this program. We will be done paying my student loans in a few months. I work at one of only a handful (less than 5 total) of facilities that provide mental health services in my state and I work in a urban hospital that serves a very disadvantaged population. I'm sure I could have qualified. I wish there was more information about this program available to people. Good luck to all of you that apply. Student loans are a huge burden and anything helps!

LOL. Sadly they are the hospital supplied graham crackers. The 2 crackers in the blue packet everyone is talking about. I hadn't considered the peanut butter, but I might now .... Shame on me

Yes, please take away some of my responsibility. I want to be able to take a meal break and not cram 4 graham crackers in at the nurse's station so I don't faint.

The subclavian line has a larger amount of heparin instilled into it (I think at my facility it is 5,000 units). This must be drawn out before use or else the patient gets a bolus of heparin. We are not allowed to touch the subclavian and I wouldn't want to anyway.

Sorry if I offended someone. I was making an observation based on some things I saw in my nursing practice and was trying to be non-judgmental and understand if there was a reason for this behavior. I see now that this is not a cultural behavior. I was hoping it was not my approach, I do my best to treat all of my patients with respect and caring. However, I will re evaluate my approach from now on to make sure that it is not something that I am doing to cause these reactions. Thank you for your feedback!

"You need to speak respectfully to me." Has worked surprisingly well for me. The has startled a few patients in the their tracks and then they try to back pedal. I had one lady say, "I guess you're right about that." Then if they comply I do my best to resolve their issue in a reasonable manner. If they don't comply, I leave.

Okay, so on the topic of hospital shootings. We just had training on this. They told us that hospital shootings are usually targeted at one individual. Such as a patient / family member angry at a specific doctor for something that happened. Patients and visitors are usually not targeted. Anyone in scrubs could be a target, however. We were told to do these things: 1 - Flee if at all possible. 2 - Hide. There are many rooms that are only accessible by key card. We also had patient beds and large furniture to barricade doors with. Shooters are usually moving quickly and do not stop to enter a blocked or locked door. 3 - Fight, ONLY as a last resort. Charge at the attacker and use any make shift weapon available, such as a chair or IV pole. As for other non-lethal methods, we were told that a strong stance and a loud "NO!" as well as yelling for help, and keeping yourself between the person and the exit is important. We have Restraint Personal Requested (RVR) called for any out of control patient, family member, or visitor. We were taught some self defense techniques, such as getting out of a person's grasp. However, we were explicitly told not to harm anyone on purpose. I have had to yell "NO!" at a few patients who were physically combative, and that immediately startled them into stopping so that I could remove myself. I have also had to call a RVR on a set of family members. I have told people "You need to lower your voice, and speak respectfully," and this has worked surprisingly well. I see no need for guns in the workplace.

Yes, this is the behavior I am describing. I hope it's not my approach that is eliciting this response. I speak respectfully and always use "sir" or "ma'am." It is with the younger crowd. Now that you mention it, I can think of other cultures that I have seen this (white American). But I've had 3 black American patients this week that have displayed this behavior so I thought it was perhaps a cultural response.

If you are someone that says "I wouldn't want you as my nurse," I don't want you as my patient. You sound difficult to work with. It will be a relief to dump you onto another nurse ... muhahaha. No longer my problem!

I am not an American but from a European culture. I have cared for all kinds of patients and I have no problem with doing this. I have a question I have noticed about a trend I have noticed in some black American patients, but not in other patients I've cared for. (Please note I am not talking about patients from Africa, the Carribean, etc) When I speak to patients of this culture, I have noticed a percentage of them will ignore me. This has happened many times, enough for me to take notice. For example, I will ask the patient "Are you having pain right now?" or "Are you feeling sick to your stomach?" In a clear tone. The patient will be awake, alert, but will lay on the bed with their eyes closed and not respond. I will ask again, and again they will not respond. Many times, worried that they have gone unresponsive, I will nudge them and say "Are you awake? Are you okay?" And get a look of annoyance from them. I'm wondering if this is a cultural thing for some black Americans. As a European, who was routinely berated for not responding promptly to people around me, I find this behavior to be perplexing and a bit irritating, as it will go on like this through the interview (with the patient repeatedly not responding to pertinent questions). I know in some cultures, stoic-ness is valued, and I wonder if a history of oppression / discrimination has made some individuals feel that no matter what, their voice will not be heard, so they instead remain silent. I also understand that patients respond differently to pain and other ailments, with some shutting down and others showing their discomfort loudly. In an atmosphere of today where diversity is a sensitive issue, I'm hoping I didn't offend anyone and hoping that someone can help me understand this behavior so that I can work more effectively with all of my patients.

The floor was chaotic and I was running around myself busy with a patient who had just vomited a large amount of blood and a critical hemoglobin came back (I think 5.3 or 4.7, can't remember). I was rushing to grab some supplies when I saw a patient had an emergency light on (this was back when we had code buttons in the room). It wasn't my patient but no one else was around, needless to say I responded immediately to this "emergency." I dropped everything and ran to the doorway, it was a patient on Contact Precautions. The family had brought food and a woman was standing there with her arms crossed. She demanded that I heat up her mothers food. I told her because the room was on isolation we couldn't use the community microwave to do that. I told her that I had an emergency and would be back later once I had handled it, I shut off the emergency light, and ran off to my vomiting patient with her saying "Is my mother supposed to eat her food COLD?!" God forbid....................... Edited to say that most days I would gladly address the issue, but the whole unit was in the toilet that day and I was scrambling to keep my own patients safe and deal with an active, new onset upper GI bleed. At the time cold food was the last of my worries. I'll never forget the rudeness and outrage of cold food lady!!

I have made med errors before that have no affected the patient in any way, thankfully. I have had 1 patient who transferred from a different area where there was a major med error that happened with them, but I can't go into details. It was due to the previous RN not using the bedside barcode scanner and involved a high risk IV medication. The patient survived but it could have been extremely bad. Sometimes I think that with the stress and workload we have these errors could happen to anyone, and it terrifies me. The thought of harming or killing one of my patients is a subject of many nightmares. There by the grace of god that I slow down, triple check, and keep my patients safe.

Yes, I will tell the family that the patient is confused and agitated, but in a polite / discreet way. I will explain that we are doing the best we can for the patient.

For AAOx3 patients - I ask the patient why they are refusing and try to rectify the problem, reassure them, or provide education. For example if they are afraid to move due to pain I will set up a plan with them to administer pain medication prior to the movement, explain why moving around is important. I will say "Dr. Smith likes his patients to move" (patients seem to respect their doctors more than nurses sometimes). If the patient still refuses I will reaffirm their right to refuse but explain the consequences - "You will be at increase risk of blood clots, pneumonia, etc." I will then involve the charge RN and depending on the urgency of the situation I will notify the MD of the patient's refusal. Then I will document everything that I tried. For confused patients - It depends, patient may need restraints or chemical sedation in order to provide safe care. For example confused patient won't swallow pills / spits them at me. Swinging fists at me when I get close to change their wet pad. I probably can't force them to swallow a pill but I can get an order for IV Haldol to see if it will calm the patient enough to allow cares, and then escalate from there.

Same story here. Short staffed constantly, beds overflowing with patients. Very ill patients, too. We can barely keep up, some nights most area hospitals are full and we are sending patients to the next city!