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jane82

jane82

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  1. I posted this tread to get advice for what happen, how much fault of it was my own, and insight for what I could do differently. The only thing that upset me was the person who said forget about looking for a hospital job. That is like saying I am a horrible nurse and I should just stick to where I am or quit. I appreciate the post that had constructive criticism, support, and/or advice on what they would do so I may do things differently next time. I know I set myself up for nasty comments, but that doesn't mean I have to take them lying down and accept them.
  2. I didn't think to update this thread topic since no one comment on it so far. I don't think it was iodine from the surgery since he had showered a two times since the surgery. At our facility patients get a schedule to showers and he had been showered twice that I know of. However, I’m not entirely sure how long iodine take to wash off, so it could have been stained still. He had not been lying on that side at all due to the pain and the skin anteriorly to the staples was the only area hard and dimpled. I reminded the patient that he has a right to request and refused treatment ultimately and he later requested labs to be done. Turns out he has cellulites and he is now taking antibiotics for it. Thanks for your response I’ll remember that next time if I come across something like this again.
  3. Hahah I have no idea what happened there...no I'm not mad about that, major typo there …lol...I always give two weeks notice, even when I had crappy high school temp jobs...even though this facility sucks I know I might need them as a reference...I just don't feel it is safe there and I don't feel supported by the management. Thanks ...I wish you luck in your career also! :)
  4. I know you don't need an order for suction I was answering Gardenfan’s question from a previous post. I learned that in nursing school, I unfortunately didn't think of implementing it until it was too late ...that is the dilemma here….I forgot... I didn't put it together…I looked at her vitals and saw they where WNL after increasing o2 and the HOB and I didn't take time to think twice about the whole picture. I know I will never do that again, and I will just now pray for her soul and her family. After leaving that morning I went to my church and let a candle for her, her family and one for me to me a better nurse. I can't help but feel like I was inferior and I failed her. Maybe she wouldn’t have lived even if I suctioned her, maybe she would have still died, and at least if I did I would know I did all I could with what the facility had. I just don’t understand why none of the other more experienced nurses who took care of her the two days she was there and the oncoming nurse who has been nursing for 20 years didn’t think of suctioning her either… I guess we all failed her. I plan now after reading these posts recommending an in-service for trach care during and post trach removal. I guess now I can only try to pick up and be better each day. I don’t feel persecuted at all on here. I just wanted to answer questions and clarify the situation, so I can get advice and insight for what actually happened. I only felt hurt by one person on here, but not persecuted.
  5. No, they don't have an EAP. I never got a call back before the code. Which is not unusual, they seemed more annoyed when you go to them with problems. There is one pretty good doctor there, but he doesn’t have that many patients under his care. This was the first trach I have seen there. I had one during clinical, during my Med surg 2 rotation over a year ago. I forgot though... I did ask another nurse that night who has been there for five years who also was one of my preceptors about trach care for a healing trach. He said he has only had one. I should have at least asked him to at least look at her since he is one of the very few who helps others, but I didn't think of it. He was on another unit and I only saw him in passing, if I told him what I told the nurse on my unit I'm sure he would have tried to help.
  6. Thank you sugarcoma I really enjoyed reading this. I hope to get to the point you speak of where you can look at someone and just know when they are about to "crump". I know I should have done more but in the moment I thought I did well. I looked at her vitals instead of taking time and considering how the patient is reacting. I pray that this was God's plan as trite or as cold as that might sound. I recently heard that this doctor won't deal with patients unless you really press him and the on-call doctor is a joke. He acts like you are the biggest a-hole for calling him in the middle of the night (that is if he even calls you back). I hear other nurses complaining and taking to management about the staffing, lack of supply, and resourcing issues. It's hard to know who you can go to because like you said "many nurses seem to love out-nursing their peers". This is a privately owned facility that revenues about 12millliion annually for building that holds approx 180 beds, so I don’t think they are hard up for funding (maybe I’m wrong but it seems like they are doing more than fine). The place looks really nice, but they are putting the money in the wrong areas for improvement. I know I will find problems like this everywhere, but I know almost any hospital is better than this. When I was still precepting a fellow nurse who is very good said "welcome to hell!”… I know I should have ran then, but I was too naive. I was just hopeful and excited to start my new career. I know I need a new environment, so I can take time to breathe and think critically (I have never taken a break on midnights, and I try not to drink too much because I know peeing takes time out of my shift, and if I eat it’s a protein bar as I chart). I will end saying that I agree with what you and the other nurse said… sub-acute rehab is Hell!
  7. Thanks, I think I may look into something like that because I feel scared now every time I work now. I have actually planned on getting my BSN even before going through the ADN program. I did it this way to save on cost and to start working sooner.In hindsight I think I should have just gone the BSN route, even though my school has a good reputation it seems like all hospitals are going the BSN route. I'm I am enrolled in a RN to BSN program to start this January.
  8. Want to thank you all for the support, encouragement, and most of all advice. It truly means the world to me right now. I feel the need to clarify a few details though based on your questions and comments. The patient did not have an order for suction. In report I was told it was an old trach site that was healing. She was getting 4L of o2 via nasal cannula. I didn't even know it was an open trach until I took the dressing off and changed it. Like I mentioned before I changed it due to the drainage. The opening was very small and it did look open but not like I have seen before (it was very small). When the EMT's arrived they intubated her through the trach and there was a lot of blood from them doing that, so it was partially healed. There was no collar or anything like that, just her skin and a dressing covering it. The lungs did sound congested and I logged for the doctor to take a chest x-ray and evaluate the old trach site. I didn't call the on-call doctor because I took a full set vitals twice and I checked her via pulse ox more time that I remember. I later talked to the admitting nurse about her and what happened and she said the trach was taken out 5 days before I had her (not sure how true that is). I was tempted to ask why she didn't get an order for suction or a suction machine at the bedside after knowing that, but I was afraid to admit my own guilt in the oversight. I do plan on still continue nursing and I will learn from this and all your advice and input. I just thought I should quit until I find a better hospital or facility. I have been applying at hospitals ever since I passed my NCLEX, but I think if I don't work I'll have more time to look for work and less of a chance at a event like this one. My insurance just kicked in so maybe I'll quit after I get a few therapy sessions in. I still don't know what I am going to do but I will defiantly renew my liability insurance that I had in nursing school for now. If anyone has a good company they would recommend I would love to research them. One thing that did bring up my spirits (other than these post) was a patient that was just readmitted that I sent out three weeks ago. Turns out my assessments where right and she had a pleural effusion and had 1500ml total removed via thoracentesis. She looked so good and thanked me for my help that night. There was an order for a bladder scan qshift also since she had a foley in the hospital that was just removed. She had 680ml from the scan so I straight cath. her. When I did that I noticed it was malodorous, dark and cloudy. The dip stick showed protein, ketones, leukocytes, and a high amount of blood. I will have to see what is going on when the lab comes back, but this was a good moral booster). I have one more question in case anyone is still following this or cares to answer. I had a patient last night who had a hip replacement with staples. He was a 50ish year old male with a history of diabetes and hypertension. When I was assessing the area I noticed the area surrounding the incision site just next to it looked like orange peel skin. I thought orange peel skin only had to do with breast cancer, but it really like it. The skin was more yellow than orange though. This entire leg was swollen, both pulses where present, cap refill was less than 3seconds. A previous nurse logged for a Doppler, it was done this morning and was negative for a DVT. He also had a low grad fever of 100.2. He was taken Norco regularly about every 4-5 hours so I think the acetaminophen in that may have been keeping a higher fever at bay. He said everyone including the doctor said his site looks fine and no S&S of infections. He also said it has looked like this for a while. I know he must be having a infection going on, probably cellulites, but I would like more info about the "orange peel skin" if anyone knows if it occurs in a soft tissue infection and what it may indicate, because the doctor looked at it again and said it was fine (the patient said the doctor looked at it again as long as it take to say his name lol). If it is nothing like the doctor said I'll let it go, but I just feel like it may be infected. I really want to thank everyone again for the support and input! I will try my best to learn, be better, and move on from this.
  9. I want to thank you all for the support, encouragement, and most of all advice. It truly means the world to me right now. I feel the need to clarify a detail though based on your questions and comments. The patient did not have an order for suction. I do plan on still continue nursing and I will learn from this and all your advice and input. I just thought I should quit until I find a better hospital or facility. I have been applying at hospitals ever since I passed my NCLEX, but I think if I don't work, I'll have more time to look for work and less of a chance at a event like this one. My insurance just kicked in so maybe I’ll quit after I get a few therapy sessions in. I still don't know what I am going to do but I will defiantly renew my liability insurance that I had in nursing school for now. If anyone has a good company they would recommend I would love to research them. I really want to thank everyone again for the support and input! I will try my best to learn, be better, and move on from this.
  10. @doppelganger The acuity level on this unit actually very high and many patients get dumped at this facility that are not ready for rehab and we send them back out quite frequently. There is a LTC unit in the facility also. This was not on the LTC unit this was on the rehab sub acute care unit. I and other staff have spoken up about the ratio with but management doesn’t care. When I was first hired they said it was a patient max of 14. A turn out that only applies to day shift. I did offer the patient nectar thick liquids and they were provided to her. The HOB was elevated 30 degree to start with, if you read my post you would see I only elevated it higher. I never saw the family I am only stating what other staff members told me. Believe me I am not trying to justify anything here. My heart truly breaks for what happened and unless you have been in my shoes you have no idea what I do for these patients. I know I have helped some maybe a lot. I have patient thank me for my care I give them because many people there ignore call lights and treat them poorly. I wish I was better that night and this is something I will have to try and live with. Before this happened I thought seriously about quitting. I wanted to stick it out and I don't want a lap in my employment but I know it is my license on the line. You can't tell me that your critical thinking skills will be sharp when you are caring for 28-40 acutely ill patients per night with a staff that has a low moral for helping others. I will not forget about looking for a hospital job and you saying that is really just hurtful. I know none of you know me but during all of my clinical rotations I had nothing but praise from my clinical instructors on my critical thinking skills and my interaction with patients. I am just too overwhelmed with what I am assigned to do and after these posts I know now that I should defiantly quit.
  11. thank you everyone for your input and thoughts... I really do believe if I didn't have such a high patient load I would have thought about her condition more critically. I try my best daily do give good patient care but when I do decent care I fall behind and I get questioned by the DON's on why I am over. I say decent care because I know I am not doing all I know I can. I have always wanted to be in healthcare since I was little, but I am so discouraged where I am at now. We have an on call doctor and the regular doctors do not show up until around 9am on average and some patients have been there for weeks before they even see a doctor. I have called the on call doctor before and he always has an attitude like "why are you calling me with this?" I had to tell him one night that we need to send a patient out for respiratory distress so I know my assessment skills are not horrible. That patient was gone for a month before she came back, so I know it was serious. I know the other nurses missed things also and if there was a suction machine in there I would have put it together even as busy as I was. I just wish I was the one who could have thought to get a suction machine. Maybe that wouldn't have saved her but at least I could rest easy knowing that I did all I could. I am currently looking for a hospital to work at because LTC facilities are not worried about the nurse patient ratio whatsoever. I know a lot of hospitals nurse to patient ratios are high but I think I could handle 5-7 patients better than 28-40 patients.
  12. I am a new nurse working in a sub acute rehab facility/LTC. I am typically assigned to care for 28 to 40 patients on midnights. I have been trying to get into a hospital but not having prior experiance or a BSN forced me to accept this job for experience. I have been concerned from the being with patient safety and the patient load I have. Awhile back I had a patient whom I was not familiar with. She had a trach site, on O2, with continuous tube feed, and a mental illness condition. Later the CNA said she told her she was having difficulty breathing. So I checked her spo2 I raised the HOB from 30 to 45 degrees and increased her o2 and the sp02 increased. I notified the doctor on call. When I later entered the room I noticed the patient looked really pale and asked if she was ok, the nurse replied "no she isn't, get a suction machine". I was in a panic, I thought "should I have suctioned her ?!?" I ran out to the find someone who knew where suction machine one and was told that there was one on the crash chart so I grabbed the crash chart and ran toward the room. When I came closer to the room someone said it was a code and to announce it on the overhead. I feel like I did not do all I could for her and I have been crying almost daily because of it. I even started smoking again after quitting 6 years ago. I can't sleep without sleeping pills and I see her pale face in my head over and over. I would love some honest opinions from more seasoned nurses on this event because I feel so horrible about what happened.
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