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Here.I.Stand BSN, RN

SICU, trauma, neuro
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Here.I.Stand has 16 years experience as a BSN, RN and specializes in SICU, trauma, neuro.

Here.I.Stand's Latest Activity

  1. That sounds dangerous... the pt’s BP is normal BECAUSE they are on whatever BP med. Plus diuretics are frequently (usually?) not for BP but to avoid a CHF exacerbation... or a beta blocker can be used post MI or as an anti-arrhythmic. I’ve known some physicians to be quite tolerant of a low BP because the benefit of the med outweighs the risk of a soft BP. Besides the resident lives on these drugs. A regular dose isn’t going to randomly tank someone’s BP when they’ve been on it months to years. If in doubt they really should be calling to clarify
  2. Here.I.Stand

    Transition to bedside shift reporting

    If your staff is giving pushback, it is your responsibility to listen to what the objections are and have a concrete plan that you will support for mitigating those objections. Mine would be: shift overlap is 30 MINUTES. It’s not 45 because pt has requests or because you have assignment changes or because donning/doffing PPE takes extra time. If it is impossible to give/receive report on the assignment the charge nurse makes in 30 MINUTES.... it won’t happen. End of discussion. Your manager’s pet initiative is not my schedule’s problem. I imagine in a med/surg setting it would be very challenging to get it done in 30 minutes; you would at the very least have to have the same ratios budgeted for days and nights so one nurse is communicating with one nurse. Tall order I know... but shift overlap is 30 MINUTES. They must be supported in ways to budget time per patient. So 5 patients is roughly 5 minutes per patient—the nurses MUST be supported in keeping that to 5 minutes. That might affect pt satisfaction scores that their nurses spend no longer than 5 minutes in bedside report per pt and don’t get a full bathroom trip and PRN meds during report — doesn’t matter! Shift overlap is 30 MINUTES. If you try it and it doesn’t work FOR YOUR STAFF, you might need to find your Ernest Shackleton leadership backbone and push against the “hard place.” Your staff is your highest priority after pt care.
  3. Here.I.Stand

    Inappropriate documentation?

    I took the OP’s use of the word “BLANK” was to avoid putting the real info on a forum. Not that she put blank spaces or whatever into the legal document. She said she made the note after speaking to someone in the hospital about what had happened post transfer.
  4. Here.I.Stand

    Radonda Vaught Fatal Error Case Timeline

    Exactly. Even if it was a typical routine human error “med error” that resulted in harm, I don’t compare that to the homicide of Mrs. Murphey... Not sure if you’re aware of the death of Kim Hiatt (you’re in Australia if I’m not mistaken?) but she made a calculation error with some calcium ?gluconate which resulted in the overdose and death of a baby in the PICU. She wasn’t criminally prosecuted but was fired, and was so distraught she committed suicide. Based on what I know of that case, I don’t think I would have indicted her. It was an arithmetic/algebra mistake in an urgent situation, and the baby’s little body was compromised to begin with. (I believe she had some CHD things and sick enough to be in a PICU.). She immediately realized what happened and reported her mistake, and clearly felt tremendous personal responsibility. RV bypassed multiple safety checks including 1st semester nursing school “five rights.” She didn’t miscalculate the dose of an ordered medication; she gave a med which can never EVER be given without mechanical ventilation. No matter how physically healthy a person is, there are exactly zero people who can tolerate a paralyzed diaphragm. Then she left that patient unmonitored. Had she stayed after what she believed was pushing Versed, she would have seen that she was desatting and could have started bagging immediately, and could have saved that poor woman. I’ll say it again, she was reckless which caused Mrs Murphey’s death... reckless homicide is criminal; why should she NOT be charged criminally? She doesn’t get to commit reckless homicide and face no charges, if anyone else would face charges. If anything as an RN I think she should be held to a higher standard... but definitely not a LOWER standard because well she’s a nurse and nurses are human and who hasn’t made a med error and who orders Versed for a scan anyway and hospitals will always throw the nurse under the bus and this could set a scary precedent and oh the humanity........
  5. Here.I.Stand

    Radonda Vaught Fatal Error Case Timeline

    There are med errors and there is reckless homicide.
  6. Here.I.Stand

    How to handle patient’s threats

    Exactly... I don’t know this pt’s story but unless this is a new and minor thing (say, rolled his ankle when he got up to ambulated) I would offer the non-pharm things as an adjunct — not as an alternative. Especially if the pain is unrelieved after several shifts of PO pain meds... if that’s the case, is ice and elevation alone REALLY going to be effective? Unlikely. Sometimes people really do just know what works for them... I’d rather give a “seeker” the benefit of the doubt than torture someone who truly needs pain relief. It’s not passing the buck to involve the provider — you don’t have prescriptive authority. If the pt wants to leave AMA that’s his right. As long as he’s made aware of the risks he’s running by leaving, he has that right. A few years ago a patient left AMA just after receiving tPA; she was given it at an outside facility and transferred to us. When she found out that no the ICU can’t accommodate her smoke breaks she flatly refused... this was after talking to both the resident and attending neurologist, and the nursing supervisor. She made a potentially really bad choice and I hope she did OK after leaving, but competent people have autonomy and are free to make bad decisions. As far as being respectful, I keep my tone and words neutral and not judgmental. Let him know that per policy here’s the form I have to go over with them, risks of leaving and things to watch out for/please seek attention for. So say it’s an infection he’s needing IV antibiotics for.... sorry I don’t remember this pt’s story (read your post a couple days ago) but infection is ringing bells. There’s a difference in respect if you say “this is a bad decision and your infection is just going to get worse” and “the risk of leaving now is this infection won’t be adequately treated; you should call your PCP for a/b/c sx — or go to the ED for x/y/z sx. Do you have any questions about that?” Again just neutral, factual wording and tone.
  7. Here.I.Stand

    Radonda Vaught Fatal Error Case Timeline

    That’s very true... you make very valid points there. I’m guessing Mrs Murphey would get swifter justice too had the reporting all been more timely and thorough
  8. Here.I.Stand

    Radonda Vaught Fatal Error Case Timeline

    The C-suite occupants didn’t kill Charlene Murphey..... their actions or consequences or lack thereof isn’t anything I would waste energy on.
  9. Here.I.Stand

    Guns at the Bedside

    WOULD he? the first rule that we are taught in any lifesaving situation is make sure the scene is secure. I wouldn’t think the law can fault hospital personnel for ensuring their own safety. I don’t know your boyfriend from Adam... and I am pro-gun-rights (AND RESPONSIBILITIES).... but I wouldn’t feel safe around someone who feels the need to bring a gun into the hospital. If you need treatment that badly, you honor the rules of the hospital. Besides the constitution doesn’t override individuals’ property rights. A hospital is well within its rights to say “Wrongway Regional bans guns on the premises” — just like I can refuse to allow a houseguest to bring a gun into my home.
  10. Here.I.Stand

    I hate my job

    I hope you notified law enforcement of your assault... if not I would. Hugs
  11. Here.I.Stand

    Farewell Esme - In Loving Memory

    I’ve been wondering about her, and my heart is hurting with this loss... but happy for her that she’s no longer in pain. Thank you for letting us know and sharing her beautiful obituary (and beautiful face!)
  12. Here.I.Stand

    Hazard Pay

    None where I work
  13. Here.I.Stand

    Is Assessing Gag Reflex Still a Thing?

    I’ve never worked ED but don’t see anything wrong with what you did... if the pt wasn’t protecting his airway and needed to be tubed, 1) I wouldn’t be immediately concerned about that one piece of info, and 2) his gag reflex would be eliminated with the pre-tube paralytic anyway. In the ICU we do q2 hr oral care/subglottic suctioning... the vast majority of patients are going to gag with that so I don’t necessarily go out of my way to check it. If the pt has a severe brain injury and in particular if we’re anticipating brain death, I might be more intentional about checking for cough/gag. That way I can notify the team sooner rather than later—or be able to let them know that we’re not yet ready for brain death testing. That seems obvious, but on one or two occasions the neurosurg resident came in, seemingly ready to start getting things lined up and I was able to let them know “hold your horses... he still has a cough/gag.”
  14. Here.I.Stand

    Turning a morbidly obese patient

    Nope. A bariatric bed can structurally handle more weight, and it’s wider to accommodate the extra width of the patient.... it does NOTHING to alleviate gravity. The pt’s skin is experiencing all of the same pressure as it was prior to the new bed and needs to be repositioned q2 hrs
  15. Here.I.Stand

    I put the blinders on and am regretting it

    Workplace violence is absolutely not an expectation, part of the job, what we signed up for.... none of that. Is it a possibility — sure. In my setting though (adult ICU), attempts to assault staff will buy that patient a set of 4-point restraints. It is perfectly reasonable, when interviewing for jobs, to ask how specifically this issue is addressed in the facility. It is also reasonable that if you WERE to be assaulted on the job, that you plan to take the same action as you would if you’re assaulted anywhere else. If you would report an assault by an intimate partner? If you were to report a random act of violence? You should also report assault by a patient. ACTIONS define assault.... perpetrators do not.
  16. Here.I.Stand

    Pay rate for per diem position too low?

    8-9 years ago I was making $44/hr for per diem in LTAC. Day shift... can’t remember what the night differential was. It was extremely difficult work... at the time I didn’t even think $44/hr was worth it

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