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!

AMEN to this post! This happens at least several times a week. Me: (Puts in 1900 labs) 1900 comes, and the phlebotomist is blowing up my phone. Phlebotomist: Do you need those labs done on room 8 at 1900? Me: Yes. (in my head: OMG, why did you have to ask, I didn't enter those for farts and giggles). My patient will have an x-ray ordered and the x-ray tech will call and ask me all sorts of questions that I would have no idea of knowing unless I was the MD's mind reader. I.e. "Do the doctor want it in this view or this view, what kind of contrast, blah blah blah. Do we really need in STAT?" I grind my teeth and have to page the doctor, but I know they can check with the doctor themselves. One time I asked why they didn't just page the MD themselves, and the guy was stammering on the phone "Well ... uh ... it's just easier if you do it."

Nurse here with future husband in law enforcement.

Thanks for the support, everyone. I am saving up for something specific and am almost done, so the OT should end in a few weeks. The patient was admitted with a GI complaint and had been having complications (multiple abcesses), and had an extended length of stay. I think the family members had been googling things and presented a lot of scenarios/diagnoses that the hospitalist found unlikely. He stated to me that he thought he could handle the case and that a GI specialist didn't need to get involved. I remember him specifically yelling at me "Since when do we let family dictate plan of care?!" at one point. I doubt he would have come back to speak to the family, as he was driving in his car when answering the phone. I know our hospitalists are so busy that swinging back around to see a patient for the second time is often a hardship. I think I ended up telling the family the doctor's decision and encouraged them to speak to him in the morning if they had further concerns. I guess I'm not sure of their rights in this situation. I know patients and families always have a right to a second opinion, right?

Today I had a mini meltdown at work. I had a patient who was quiet ill and the earlier in the day, the family had requested a specialist consult. The nurse previous to me had checked with the hospitalist, who denied the family's request. The family had left at that time, and I'm not sure if this doctor's decision was communicated with them or not. However, when I came on shift, they returned and filled the room. When I entered, they started asking questions and I answered as best I could. Then they asked when the specialist was coming. When I explained to them it wasn't ordered, they became irate & demanded to get one involved. I admit I was a bit intimidated by their attitude and numbers, so I caved. The hospitalist had left for the day but was still on call. When I paged him to ask him about the specialist as well as a few other questions the family had, he returned by call and ripped me apart for asking him about the specialist yet again when we he had already said no. He hung up on me and I felt the tears coming. I excused myself to the restroom, took a few deep breaths, and did my best to return to work and talk with the family. The hospitalist called back to apologize for his reaction an to address some of the other questions, and that almost restarted the flow of tears again. I think I've been working too much OT lately. Does anyone else cry when frustrated or being berated? I want to be able to handle these situations with grace and not dissolve into a blubbering mess.

We have a feeding tube declogging protocol. Otherwise I would have tried harder to get in touch the MD. The call centers I talk to have the MD's cell phone number and if they do not answer their pager in 30-40 minutes you can call back and they will patch you through to the MD's direct line. All they need to do is put in an order to replace the tube.

I have a CZ ring but nobody knows the difference. I can get it replaced whenever I want for free at the jeweler so it looks brand new. We were able to afford a much more expensive setting ($4k) with the centerstone .5 carat CZ (which was free). Eventually my partner will replace it with a real diamond, or maybe not. On topic, I think wearing rings at work is gross. There is no way to clean the germs from all those nooks and crannies. I also think that the alcohol hand foam can eventually damage the metal. Although all of my jewerely is insured, I fear loosing it or damaging it or loosing a stone at work. So therefore, I save myself the trouble and leave my rings safe at home. Or I've heard of wearing them on a chain around your check, however I have been strangled by my shirt collar at work by a patient and wouldn't fancy wearing a necklace for that same reason.

46k down from 80k+ in a little less than 3 years. Our combined income (me & partner) is 70k. We pay roughly $1200 a month towards the loans, but our minimums are about $350.

As a PCA - I used to work at a nursing home with the same group of residents. I would dream about doing a toileting round on them, taking each one to the bathroom in my sleep, in the same exhausting pattern I had been doing for years. I would never wake up refreshed! As an RN - I have recurrent nightmares about forgetting I had a patient on my assignment. I'll get to end of shift report and then the horror dawns on me that I forgot about the patient in room "7" all shift - never assessed them, checked on them, or gave them meds, even though they were assigned to me. I have nightmares about missing entire med passes (i.e. I suddenly realize it's 1030 and haven't done my AM med pass). I had a dream I got a new job in LTC and they assigned me 120 patients, and it was 3:30pm and I was still trying to get through my 8am meds! And then those times you wake up in the middle of the night, and in a foggy haze try to get up and "check that IV pump in room 8." I have talked nursing jargon in my sleep and confused my significant other.

Something just happened. You may never know. I've had this happen once or twice. These deaths are very devastating and unfortunate. It could be that she threw a massive clot. There may be an autopsy depending on the medical examiner's protocol or family wishes. Just so you are aware, a bowel obstruction is not a benign diagnosis. A family member of mine died of one last year after their bowel perforated while in the hospital. Depending on symptoms and clinical presentation patients can need emergent surgery to save their life. Fluid balance & electrolytes are important. Also a good abdominal assessment and watching for changes in pain. Keeping a close eye on those pesky NG's. I am always wary around patients with an obstruction, let's just say I have seen them go terribly wrong and not just with my family member.

I would totally do this!