ArtClassRN

I think this "Who are we to judge?" approach is killing people. It is our responsibility to judge. It is our responsibility to NOT help people kill themselves. The caregivers who refused to make exotic diagnoses, or to place unneeded ports, PEG tubes, fistulas, or to provide unlimited IV Benadryl, or refused to escalate the use of narcotics for chronic pain - those are the ones who looked out for her. The doctors she successfully shopped, the ones who "refused to judge," the ones who provided treatments that made her worse - they helped kill her.

Following following up on this, the person known as Chronically Jaquie died yesterday. While she certainly had chronic illness, I don't think that's what killed her. I think her caregivers helped her kill herself. I don't know if I'm just noticing it more but I'm seeing so many cases were people just aren't being told "No," and it is leading to great harm.

Not very often, but quite a few of them lately in a row with frighteningly common traits.

I ask them why they are refusing or objecting. I consider the patient's goals, the reasons for the objection, and which of their requests I can grant and those I will not. I try to calmly explain what I am going to do or not do in response to their requests In some cases (specifically cases where the patient or my job is in danger) I will call the attending (or security if needed) to come help explain why I will not grant their request. These patients invariably end up firing me and quite easily finding another nurse they can push around at will.

Hello, First, Ehlers-Danlos is a real disease that afflicts people in various ways. However, I have recently noticed a huge upswing in patients being admitted with the EDS hypermobility type. These patients share very specific traits: Chronically ill. Laundry list of diagnoses (or claimed diagnoses) including Lyme Disease, fibromyalgia, mast cell activation disorder, gastroparesis, POTS, dysautonomia, Mold toxicity/sensitivity (but reactions don't occur when they don't wish them - say with friends visiting). Always on medicinal marijuana. They seem to be able to walk perfectly fine, but also have very sporty wheelchairs. They almost always have ports. They are able to eat when they want, and swallow pills when they want, but they have extreme desire for GJ PEG tubes, which they immediately insist all of their medications go through. They are always young, 20's or early 30's and female. They appear healthy looking. And they demand, and get tons of PRN IV benadryl. The first patient I had with these traits got her coveted PEG tube, but was ravenous during her NPO period after surgery. She was disappointed to be told she could not eat until 24 hours after the tube was placed. I went in to start her tube feeding (and tell her she could eat) and when I checked her gastric residual, I pulled out what looked like chocolate shake. She said, "Oh...my tube is telling on me!" I said, "What did you do?" She had drank an entire carton of Kate Farms (they ALWAYS demand Kate Farms) chocolate tube feed. Then she proceeded to order a regular lunch tray and eat the whole thing. With zero nausea or vomiting. But then when tube feeding started at 10ml hour, she complained of "bloating." What the?? Is anyone else seeing an increase in this type of patient? Has EDS hypermobility type become a "desired" diagnosis?

"Dropped pill" means the floor.

There are many ways to advocate for your patient. In this case, consulting with more experienced nurses would have helped you a great deal. Because they might have said, "If the patient is asymptomatic, don't call the MD - because what do you want them to do about it? - You should continue to monitor the patient." Had you done this, the patient's BP would have normalized under your careful guidance and the MD would not be annoyed at you. I think it was a mistake to call the MD in this situation. Sure the MD could and should have been nicer, but that's the way it goes. I would also advise you lose the "poor me" attitude. Good luck!

I think the real problem here is that leadership at your place of employment is a bunch of idiots. That being said, you should not lie to your idiot employer.

Whatever it looks like, it would sure as hell be better than not having any insurance at all.

My Daddy used to day, "Sure, I'll have another drink..." So not much coming from that end. My mommy's policy is that the last check she writes is sure as crap gonna bounce. So that's zero to me and my siblings. My step-mommy, on the other hand, well, her parents sold their house my step-granddaddy had lived in his ENTIRE life - and they cleared about $200. Don't think that is lasting long though. So, looks like I'm working till I drop.

Well, often that's kinda how you get good at it.

Nope.

Yes. I like nursing.

When I was doing my peds rotation, the RN supervisor said, "I worked for a hospital as a maintenance man. I never thought I could be a nurse and deal with poop, pee, and blood. Then I had 2 kids and found out that I could deal with it. I cut the hospital's lawn on a Friday and started as a new grad in the ICU the following Monday."

Do you have any experience (as an assistant) doing direct care for patients in the environments you are applying? Along with demand where you are applying this makes a big difference. I passed the boards on a Tuesday and was offered a position that Friday. I also had a hospital internship and 2+ years experience in Nursing Home, Home health, and hospital as an NA. ac

Never did anything a little narcan didn't take care of.

I can redo it. Every day I can choose a different career. I don't want to, so I don't.

Baby nurses are in orientation or just off orientation. I was a baby nurse when I was 44 years old

Based on the information you gave and your outlook going into the change, you are going to do great!

There is no reason to give a kid 500 mcg of fentanyl.

Ignore it. Don't participate in the parts of the culture you don't like. You'll be fine. In fact I find that nurses that hang on tightly to that "nurses are special" stuff tend to be the most dissatisfied. Because for some, no matter how many accolades they get, it isn't enough.

Study the Chain of Infection.

I have a pretty quick trigger for pushing conflicts like this to management. That's what they get paid for. Many CNAs simply have no respect for RNs and will act as insubordinate as they can. I don't waste my time with them. If management is fine with CNAs behaving as you describe, I'd find another job.

I'm going to guess that there IS a textbook for the course, but you opted to not buy it? If this is the case, go buy the textbook.

No! Change of scenery sorely needed after a few years.