Doc

Peggy, I agree we need to get past the hopelessness. For this purpose, wouldn't a pin shaped like handcuffs be a more appropriate symbol, since the health system has got us literally handcuffed? Perhaps more expensive, I agree, but very effective, and bound to get people asking what it's all about. It is a very small step, though. How many people actually ask you about the ribbon and how many tell other people about it? My suggestion is announce to the press you are about to launch this "silent campaign" and the more papers/tv channels/radio stations the better. This not only gives it good publicity, it makes it official. Then other hospitals catch on and.... a small campaign becomes a big one. Also, make sure you have a blurb ready on exactly what it is you are launching a campaign about. It's no good saying: "we want better working conditions". Both administration and the public need to know: "We are tired of working 12-16 hour shifts" or "getting payed less than a garbage removalist"...oops hygiene and sanitation engineer (political correctness) I guess what I'm saying is, if you want to empower nurses to do something, do it properly, otherwise pretty soon they will say, "what's the point - it doesn't achieve anything". Show them it does. Your basic idea is good, though. Keep it up!

jt, you are not saying that the lightweight ones aren't worth as much, are you? Seriously though, I think it's going to take a lot more than ribbons to settle a dispute. Not to mention that the hospital administrators can just use it to their advantage by appearing to the public to be on the nurses' side, as yours did.

This has turned out to be a very interesting thread. I was surprised to see the way that psychomotor skills were downplayed. Some health professionals have great people skills and knowledge, but are very mediocre at performing psychomotor skills. In most places I have worked, there is one nurse we called upon to do difficult caths, or to do a venipuncture on someone with difficult veins. I agree that psychomotor skills are not the be all and end all, in the same way that NO one set of skills is the be all and end all. A nurse has to be well rounded, whether an RN or an LPN. The psychomotor skills are just as important. Psychologists are recognising more and more now the validity of physical intelligence. For instance, it is not education alone that makes a neurosurgeon, it is also a degree of psychomotor skill, coordination and aptitude that he/she has to have. In the same way I think it is unfair to say that an RN has more critical thinking skills than an LPN. You can only foster growth of critical thinking skills in a student. You cannot create that aptitude within them. This applies to every realm of nursing competency. It could be argued that a nurse who is very well-rounded in terms of competencies is a bit of a "jack of all trades, master of none". In the same way, a person who has superior people skills but is clumsy in psychomotor skills can be seen as incompetent, as could the reverse (someone with great psychomotor skills but poor people skills). On the other side of the coin, the above three personas can be seen in a positive light. A person who excels in a particular area can be the "specialist" nurse for that area on their floor. Having more of an aptitude in one realm and less in another should not be used in judgement of who makes a more professional nurse. Most nurses are aware of areas they can improve or have less of a capacity in. This awareness is very necessary in professional growth and in seeking assistance in certain things that you have less aptitude for - part of effective teamwork. Having said that, I also have to agree that the LPN and RN programs are quite different. I also know that one state's LPN course is different from another's. Also, in some states LPNs can give medications and draw bloods, and in others they cannot. Because of that none of us are qualified to say "this is the difference in training between LPNs and RNs". I do not know of any study that shows that RNs use more critical thinking, or perform some skills differently to LPNs as a result of the different type of knowledge they have. However, I have spoken to many LPNs and ENs (the Australian/NZ equivalent) who are final year Bachelors students and have stated that the new information they have been taught in the degree has changed the way they practice. This is enough proof for me. However, this doesn't make one a better nurse than the other. That is not the point the other posters like Suzy K have been trying to get across. What they are saying is that RNs have more academic training. With it comes more legal responsibility. The other point is that nursing is still struggling to gain respect as a profession. The Bachelors degree is important in achieving this. Increasingly, nurses are doing postgraduate studies. This is the way of the future. It's a shame that this has eroded into an argument. The points being made were simple (although some were not very well put). I highly doubt anyone here really has a "holier-than-thou" approach. Sometimes in order to hear someone's message, you need to "immunize" yourself from being offended by certain aspects of it, so that you don't miss the main point they are trying to get across.

This has turned out to be a very interesting thread. I was surprised to see the way that psychomotor skills were downplayed. Some health professionals have great people skills and knowledge, but are very mediocre at performing psychomotor skills. In most places I have worked, there is one nurse we called upon to do difficult caths, or to do a venipuncture on someone with difficult veins. I agree that psychomotor skills are not the be all and end all, in the same way that NO one set of skills is the be all and end all. A nurse has to be well rounded, whether an RN or an LPN. The psychomotor skills are just as important. Psychologists are recognising more and more now the validity of physical intelligence. For instance, it is not education alone that makes a neurosurgeon, it is also a degree of psychomotor skill, coordination and aptitude that he/she has to have. In the same way I think it is unfair to say that an RN has more critical thinking skills than an LPN. You can only foster growth of critical thinking skills in a student. You cannot create that aptitude within them. This applies to every realm of nursing competency. It could be argued that a nurse who is very well-rounded in terms of competencies is a bit of a "jack of all trades, master of none". In the same way, a person who has superior people skills but is clumsy in psychomotor skills can be seen as incompetent, as could the reverse (someone with great psychomotor skills but poor people skills). On the other side of the coin, the above three personas can be seen in a positive light. A person who excels in a particular area can be the "specialist" nurse for that area on their floor. Having more of an aptitude in one realm and less in another should not be used in judgement of who makes a more professional nurse. Most nurses are aware of areas they can improve or have less of a capacity in. This awareness is very necessary in professional growth and in seeking assistance in certain things that you have less aptitude for - part of effective teamwork. Having said that, I also have to agree that the LPN and RN programs are quite different. I also know that one state's LPN course is different from another's. Also, in some states LPNs can give medications and draw bloods, and in others they cannot. Because of that none of us are qualified to say "this is the difference in training between LPNs and RNs". I do not know of any study that shows that RNs use more critical thinking, or perform some skills differently to LPNs as a result of the different type of knowledge they have. However, I have spoken to many LPNs and ENs (the Australian/NZ equivalent) who are final year Bachelors students and have stated that the new information they have been taught in the degree has changed the way they practice. This is enough proof for me. However, this doesn't make one a better nurse than the other. That is not the point the other posters like Suzy K have been trying to get across. What they are saying is that RNs have more academic training. With it comes more legal responsibility. The other point is that nursing is still struggling to gain respect as a profession. The Bachelors degree is important in achieving this. Increasingly, nurses are doing postgraduate studies. This is the way of the future. It's a shame that this has eroded into an argument. The points being made were simple (although some were not very well put). I highly doubt anyone here really has a "holier-than-thou" approach. Sometimes in order to hear someone's message, you need to "immunize" yourself from being offended by certain aspects of it, so that you don't miss the main point they are trying to get across.

I've got to agree with nurs4kids here. That information is already given in a lot of places to all staff during handover. It is necessary to know what the patients' problems and general history are, whether you can resuscitate them or not and whether they are NBM, etc so that if the nurse looking after a diabetic patient is not in the room and you see the lunch lady handing him the wrong meal, you can stop a potentially dangerous situation. Quite often a nurse or nurses aide does the obs for the whole floor or half a floor. If the obs are out of normal range she needs to know the pt's history so she knows if she needs to report the obs or not. Or during meal breaks when another nurse has to cover for you, they are then responsible for the pt and need to know their history. The nurse in charge also needs to be in the know about every patient on the floor. And there is the code situation, as nurs4kids pointed out. Nottanurse's story about the nurse who looked at the notes of her ex-husband's new partner who was a pt, to find 'ammunition' on her, shows where the line is drawn. We need to know a certain amount of history to do the job and to be able to take on a code, prevent disasters, to responsibly be in charge of the floor, and to cover for someone on a meal break. But that doesn't mean we should pry into the depths of someone's history (especially sexual or psych history, but all medical information could be just as sensitive) for no plausible reason. And to disclose it to your family or friends or in front of others using the pt's name (or room/bed number) is a definite no-no. The example that fergus mentioned about taking a sexual history in front of the mother is also an example of a breach of confidentiality. It is always good policy to assume someone is uncomfortable talking about their sex life in front of someone they know. This also applies to other things besides sexual history - drug/alcohol history is one of the many that springs to mind. The problem is that when you tell the mother that you would like her to leave because you are taking a history, she may say "oh that's ok, she tells me everything". Then when you insist you create a conflict where (no matter how it turns out) the mother feels you have insulted her as a parent and you will loose her respect. The way I say it is: "Can you leave the room now, Mrs Brown, I need to do an assessment." Calling it an assessment mystifies it to some degree, helping you to protect the pt's confidentiality and achieve privacy by better effecting the removal of the parent from the room in a dignified way. As for the original query by the nursing student, I suggest she also differentiate between privacy and confidentiality. Confidentiality generally involves words or information. It is protecting a pt's history, diagnosis, prognosis and other findings from reaching any parties that don't need to know or whom you don't have the pt's consent to disclose the info to. It is acceptable to disclose the info to other members of the team who will be looking after the pt. There are legal guidelines to confidentiality. For instance, confidentiality allows you to disclose the information if it is subpenaed. If the pt tells you they are going to harm themselves or others, you have a legal obligation to report that, which comes before keeping the patient's trust. Privacy is broader than this. If you disclose information under legal obligation you have broken privacy, but not confidentiality. Privacy also includes more than information or words. For instance, drawing the curtain around the pt when exposing their body or when they are in a teary mood, or preventing people from walking into the pt's room unless the pt wants to see them - the pt has a right to be left alone which comes under privacy.

We have a geriatrician here called Dr Death. But he pronounces it deeth. I wonder if that is the real pronunciation or if he felt he had to change it :)

Anyone had a patient with Gardnerella? It smells like rotting fish - I never knew what the word "funky" meant until I got a whiff of that! The discharge coming from the pt's lady parts was yellow-grey. I was dry-retching. Later on that shift another pt had sputum that color and this time I felt my lunch rise up, but luckily didn't puke. I must have a stomach of steel.

Wow I missed a lot in a few days! Wildtime, the internet allows me to keep in touch with what is happening in your country, and I must say there are a few differences. For instance, here the word "thong" means those flip-flaps you wear on your feet, so I had the mental picture of you mud-wrestling, wearing nothing but a single flip-flap!!! I don't really see the relevance of your argument about how selfish people can be in society. You don't need to buy into that mentality. However, in view that people want to meet their own needs first (call it selfishness, Maslow's theory or whatever you like) the public will not look to striking or walking out very well, and the image of nursing is going to suffer even more. I don't like the idea of private facilities setting the standard. For a start that is not the same as nurses empowering themselves to make the change. Secondly, the goal for these organisations will always be cost-cutting. Sure, for a while they may try to attract nurses with good conditions, as many new facilities have done. Don't expect it to last. I was unable to find that article you mentioned on http://massnurses.org, so forgive me, but I fail to see how legislation has to take the power away from nurses, if it is done in the right way. As for Buck's argument that we will not get people to come back to the profession, I think we need to stick with attracting more people to study nursing, as well as to provide the right conditions for them to stick with it until graduation or throughout a full career.

Hala, I am not sure what kind of setting you work in. Every ward will have a different routine. I assume you already know how to prioritise tasks (ie which do you do first, the shower or the dressing?) but are having difficulty with the planning. If it is the other way around let me know. To plan my day I write down times on a piece of paper. Then next to the times I write which special tasks I need to carry out such as medications and tests. I find that I can always remember if there's a few things to be done at 10am but don't know exactly what, so I find this useful. Your ward/unit should also have a routine in their procedure manual or elsewhere. Ask your manager. The ward routine will help you as they are a good guide as to how to stay on top of everything during your shift. ------------------ http://www.GreatNurse.com/

Just a couple of thoughts: if we take the approach "this is the way things are going to be from now on and if not, we quit", we will lose the public's support. School teachers have been down this path many times. I am not anti-striking or anti-lobbying by any means - this approach has had success, but very limited success. Secondly, what is the problem with effecting change through legislation? As some of the other posters here and in other topics have pointed out, it is us who are accountable when some disaster happens, and as the conditions in so many facilities are at such an abismal standard, a disaster is literally waiting to happen! Legislation is what defines our minimum pay, and it is legislation that defines the minimum nurse-patient ratios, maximum hours a nurse is allowed to work, and other conditions. Put simply, legislation sets a state or national standard for conditions that affect patient safety and nurses conditions. Then if your employer disregards that legislation they are committing an offence, and if you find yourself in a malpractice suit or being reported to your registration board or the health complaints commission, you have a concrete defence that your patient ended up in whatever situation because your employer did not follow the legislation which is written in black and white, and your licence, dignity, reputation and life savings remain intact. Doc ------------------ http://www.GreatNurse.com/

Oh yeah I just remembered the pt at neurosurgery, who had an abcess in her skull. They actually tried grafting the bone segment back on, but she ended up getting meningitis, and the site kept getting reinfected, and they had to debride. She wasn't helping things out by picking the scab all the time. Eventually there was almost nothing left to debride and her brain had herniated through the hole in her skull (gives the word "conehead" a whole new meaning!), and because there was no skin you could SEE it! Everyone kept trying to reinforce the importance of infection control measures and told her not to touch the wound. "This is your BRAIN!" we would say. By this time small bits of her brain came off with the debridement. One registrar was of the opinion that she was just too far gone (neurologically) to understand how she contributed to her state. The neurosurgeon said he thought she understood, but he knew she had broken parole and this was her way of staying out of prison. I don't think I could be that desperate in her situation. Doc ------------------ http://www.GreatNurse.com/

Thanks for the feedback. I agree that we would benefit from challenging the systems that put obstacles in our way. However, any call to change is usually met by resistance. In a culture where nurses already put each other down quite a lot, this resistance is huge. It doesn't matter to most that this change might benefit us all as a profession, it is the threat of change in an already stressful environment that makes nurses react in such a way! That, and also that we have been conditioned to respond in that way. I think we need to work on ourselves first: set an example for others on how to react to new ideas, and other stressful situations. Work on our communication so we find the most effective way to elicit change from others without getting hammered by negative reactions. How to keep check of our feelings so WE don't just snap if someone pushes our buttons. Finally, how to relax, wind down and be calm in a tense situation. For this to happen we need to keep check of our feelings, unload through debriefing, look after ourselves on and off the shift to make sure we cope on a functional, rational and calm level. Once we have achieved this, we can start communicating in a constructive way with colleagues about issues that are getting in the way of safe and effective care, or that are counterproductive in some other way. When our colleagues come to some understanding and consensus about these issues, we can gather support from each other for some of the bigger issues on an organisational or state level. Infighting and young-gobbling always involves some sort of power struggle. It is only when we empower ourselves and others around us that we can combat it. I call on you all to speak up about what YOU do to achieve these things: 1) Debriefing 2) Unwinding or relaxing at home 3) Dealing with tension at work 4) Communicating a call for change 5) Empowering yourself and others around you Take care, Doc ------------------ http://www.GreatNurse.com/

This is pretty much all that exists to date that I know of in terms of empirical evidence for herbal remedies: 1. Armstrong NC, Ernst E. The treatment of eczema with Chinese herbs: a systematic review of randomized clinical trials. Br J Clin Pharmacol 1999;48:262-264. 2. Budeiri D, Li Wan Po A, Dornan JC. Is evening primrose oil of value in the treatment of premenstrual syndrome? Control Clin Trials 1996;17:60-68. 3. Diehm. C. The role of oedema protective drugs in the treatment of chronic venous insufficiency: a review of evidence based on placebo-controlled clinical trials with regard to efficacy and tolerance. Phlebology 1996;11:23-29. 4. Ernst E. St. John's Wort, an anti-depressant? A systematic, criteria-based review. Phytomed 1995;2:67-71. 5. Ernst E. Ginkgo biloba in der Behandlung der Claudicatio intermittens. Forttschr Med 1996;8:85-88. 6. Ernst E, Rand JI, Barnes J, Stevinson C. Adverse effects profile of the herbal antidepressant St. John's Wort (Hypericum perforatum L). Eur J Clin Pharmacol 1998;54:589-594. 7. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials. J Urol 1998;159:433-436. 8. Ernst E. The efficacy of Phytodolor ® for the treatment of musculoskeletal pain - a systematic review of randomized clinical trials. Nat Med J 1999;2:14-17. 9. Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clin Otolaryngol 1999;24:164-167. 10. Ernst E, Pittler M1-1. Ginkgo biloba for Dementia. A systematic review of double-blind, placebo-controlled trials. Clin Drug Invest 1999;17:301-308. 11. Hopfenmüller W. Nachweis der therapEuropean Uniontischen Wirksamkeit eines Ginkgo biloba-Spezialextraktes Meta-Analyse von 11 klinischen Studien mit Patienten mit Himleistungsstörungen im Alter. Arzneimittelforschung /Drug Res 1994;44:1005-1013. 12. Kiene H. Klinische Studien zur Misteltherapie karzinomatöser Erkrankungen. Therapeutikon 1989;6:347-353. 13. Kleijnen J, Knipschild P, ter Riet G. Garlic, onions and cardiovascular risk factors. A review of the evidence from human experiments with emphasis on commercially available preparations. Br J Clin Pharmacol 1989;28:535-544. 14. Kleijnen J. Controlled clinical trials in humans on the effects of garlic supplements. In: Kleijnen J (ed). Food supplements and their efficacy. Maastricht: Riftsuniversiteit Limburg, 1991:73-82. 15. Kleijnen J, ter Riet G, Knipschild P. Evening primrose oil. In: Kleijnen J (ed). Food supplements and their efficacy. Maastricht: Rijksuniversiteit Limburg, 1991;51-61. 16. Kleijnen J, Knipschild P. Ginkgo biloba for cerebral insufficiency. Br J Clin Pharmacol 1992;34:352-358. 17. Kleijiien J, Knipschild P. Mistletoe treatment for cancer. Review of controlled trials in humans. Phytomed 1994;1:255-260. 18. Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for the prevention and treatment of the common cold. The Cochrane Library 1999;1:1-14. 19. Melchart D, Linde K, Worku F, Bauer R, Wagner H. Immunomodulation with Echinacea - a systematic review of controlled clinical trials. Phytomed 1994;1:245-254. 20. Morse PF, Horrobin DF, Manku MS, Stewart JCM, Allen R, Littlewood S, et al. Meta-analysis of placebo-controlled studies of the efficacy of Epogam in the treatment of atopic eczema. Relationship between plasma essential fatty acid changes and resonenses. Br J Dermatol 1989;121:75-90. 21. Neil HAW, Silagy CA, Lancaster T, Hodgeman J, Vos K, Moore JW, Jones L, Cahill J, Fowler GH. Garlic powder in the treatment of moderate hyperlipidaemia: a controlled trial and meta-analysis. J Roy Coll Phys London 1996;30:329-334. 22. Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive function in Aliheimer disease. Arch Neurol 1998;55:1409-1415. 23. Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and meta-analysis. Am J Gastroenterol 1998;93:1131-1135. 24. Pittler MH, Emst E. Horse-Chestnut seed extract for chronic venous insufficiency. Arch Dermatol 1998;134:1356-1360. 25. Pittler MH, Ernst E. Artemether for severe malaria: a meta-analysis of randomised clinical trials. Clin Infect Dis 1999;28:597-601. 26. Stevinson C, Ernst E. Safety of Hypericum in Patients with Depression. CNS Drugs 1999;11:125-32. 27. Schneider B. Ginkgo biloba extract in peripheral arterial diseases. Meta-analysis of controlled clinical studies. Arzneimittelforschung 199;242:428-436. 28. Silagy C, Neil A. Garlic as a lipid lowering agent - a meta-analysis. J Roy Coll Phys 1994;28:39-45. 29. Vogler BK, Pittler MH, Ernst E. Feverfew as a preventive treatment for migraine: a systematic review. Cephalalgia 1998;18:704-708. 30. Warshafsky S, Kamer RS, Sivak SL. Effect of garlic on total serum cholesterol. Ann Intern Med 1993;119:599-605. 31. Weib G, Kallischnigg G. Gingko-biloba-Extrakt. Meta-Analyse von Studien zur therapeutischen Wirksamkeit bei Hirnleistungsstörungen bzw. peripherer arterieller Verschlubkrankheit. Muench Med Wschr 1991;10:138-142. 32. Weihmayr T, Ernst E. Die therapeutische Wirksamkeit von Crataegus. Fortschr Med 1996;114:5-7. 33. Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia. JAMA 1998;280(18):1604-1609. There are some books out there, but as well as being outdated they do not offer much in terms of empirical evidence. HerbMed is an excellent database with lots of useful information on herbs, with some evidence provided for a few of the herbs. The adverse effects, contraindications and interactions of the herbs are also available on the site. The address is http://www.herbmed.org/ In addition you might like to try http://www.science.uts.edu.au/health/tcm/History_TCM/herbal.htm for some info on Chinese Herbal Medicine. If aromatherapy interests you, check out the post I made on that subject at https://allnurses.com/bb/Forum17/HTML/000020.html Doc ------------------ http://www.GreatNurse.com/

Okay, here's a few good ones. One time at the gastroenterology ward a resident was trying to assess what was causing a mysterious GI pain for the last 24 hours. The patient was kind of vague about it, and none of the history seemed to match anything. The resident decided to do a PR, put on gloves and went in. In next to no time he pulled out a vibrator that was still buzzing, and remarked: "isn't that a great advertisement for Eveready!" Another patient had an x-ray and they found a mouse skeleton in his rectum. In the ER there was this woman who dropped her husband off, saying he was bleeding. On her way out the triage nurse noticed she threw something in the bin. It turned out to be his member. Luckily they were able to sew it back on. When I worked in the psych unit I got used to seeing some pretty strange behaviour, but no-one is exempt from being surprised from time to time. There was one patient who pulled out both his eyes and ate them - the voices told him to do it. The doctor used to affectionately refer to him as "socket head". I thought nurses were the twisted ones!!! One of the psych nurses who was like a veteran - had been there 30 years - told me there were two people that used to get their rocks off by putting their members in the wringers on the washing machines and rolling the wringers up and down. OOOOOOOW! I personally can handle sputum, urine from catheterised patients, vomit, eyeballs, cauterized flesh, maggots and all that sort of stuff but I can't stand the sound of bones being sawed or the stench of malaena. Most people haven't seen true malaena. I once had to clean up an elderly guy who was swimming in malaena - the real black stuff. The only thing that smells worse is a cadaver that has been left for a few days. ------------------ http://www.GreatNurse.com/

I strongly agree with the fragrances - not just bronchospasm but migraines and skin rashes too! As for the nails, there are a few of us that play classical guitar and as a result we have slightly long nails on one hand. We don't use acrylics or clip-ons and we don't paint our nails. We take extra care in handwashing to get that soap in under the nails. I have NEVER had difficulty donning gloves or had a nail penetrate the glove. I don't file the nails on my right hand to a sharp angle and they are not really that long. Do you think it's really an infection risk? [This message has been edited by bshort (edited March 14, 2001).]