hybr1d

I must be lucky because I haven't worked with a single nurse who fits into any of these categories! Most have been friendly and helpful. A bit different on the internet though but with almost a million members on this site it's bound to end up that way.

Just an update. Nothing had happened since I was at work 5 days ago with regards to a psych-consult. Patient said she had confided in two other nurses but I saw no notes from doctors or them. Heard some banging from patients room and found her banging her head against the door, sitting on the floor. Called the on-call who said he would write a note and so did (finally someone) but didnt come to see pt. I wrote another extensive note about it. My work really frustrates me sometimes. I'm not a psychiatrist so I won't presume pt has some personality disorder or whatever like that, that's up to the psychiatrist to judge. Even if a pt would be manipulating and is self-harming I have to take it seriously until she has been assessed in my opinion. At least the other doctors will see the on-calls notes and it will be less easy for them to ignore it. I'm doing my best to handle my first case of a pt who is like this so give me a break and serious suggestions and examples of HOW to actually handle it better instead of remarks like "You can still validate a person's feelings without crossing boundaries." Thanks. :-) I'm sure you too can remember how it was before you knew it all!

Thank you dishes (and thank you for the pm!), I needed that. It's sometimes difficult wanting to help but not being able to, or allowed to, make the decisions needed. When I'm back on thursday for my single night I hope something will have changed!

I'm it at the night, no sup or anything. I have a ward by myself and there's no other nurse on the entire floor (used to be one on the other ward but they closed it due to lack of nurses). I know it's very differently organized in my little corner of the world than in US. Had that discussion sometime ago :-) I really hope she will get help tomorrow when the new week starts and the doctors man the same ward for rest of the week since it seems the doctor today didn't do crap

This so much, I have nothing to say about it when the on-call doctor won't do anything. I reported it (and I'm also obliged to) saying this worried me and that she was not in a good mental state. But I got nothing in return, now my back is "free" but the patient still hasn't gotten help. It gets quite lonely as a nurse in the night (I got 18 patients with 1 on-call manning ER plus 3 medical acute wards). I strongly advocate for my patients but can't do much of anything besides giving the best possible care if the doctor decides it. So I sat with the patient half the night because luckily I had a really calm night and most were sleeping soundly, no critical patients, and barely any IV meds to give. So I do not dilly-dally and I thought I was clear that I found this very worrying and serious. Else I wouldn't have two mornings in a row really pressed the issue with the day-time crew.

Yep! I'm totally on board with that. I get frustrated when I don't get that kind of response from the doctor on call and in the weekend and night it's what I have available to contact. The daytime doctors have to take charge of it but it seems they did not. This patient has something like 250 E x3 per day but the p-glucose still rockets above the 30s without the drip. Scary with the patient who tried to commit suicide that way!!

Thanks dishes! I'm not suspicious like the first response, wouldn't have crossed my mind to think this patient would be intentionally sabotaging her link to a somewhat normal like (which is obvious in conversations the patient misses very much and wants nothing more than to come home and feel better). I think this patient has had a rough time for a long time and this time was the time that was simply too much. It would be for anyone. I think I do what you do, I described that I sat down beside the patient, asking about how the drawings are going and how's the family and after eyecontact (which takes a long time to get sometimes) start asking questions of how she's feeling. I did ask some leading questions though when the pt said she didn't dare tell me some things because of how we would react. (Like Have you thought and/or planned to hurt yourself?, if yes I ask In what way?) Not very leading but you get what I mean. I heard back from the daytime nurse when she had some questions and the doctor had refused to deal with the issue because she was only working for the weekend? Eh. Pt had also talked to the daytime nurse and said she knew that I had shared what was going on with her so it's good, it opened up so she could talk to that nurse too about it. :)

Yes it works that way here too. Pt has not been a patient at that clinic but has at some time been a student there and thinks well of the place. I hope the doctors make stuff happen asap. I wish psychiatric issues were taken as seriously as physical ailments, that this patient has held it together this long is a wonder. Its out of my hands and the doctors know about it, but I still wonder how others would handle the confiding.

I did contact the doctor on call at night but yeah didnt get much from it. So I properly informed my colleagues so they could work on it on the day. Not worried about my job, I live in Sweden and I think the laws are very different from other countries, I am very safe in that aspect. But I am of course still much concerned for my patients.

I did alert the doctor on call already the first time she told about it plus spoke to my 5 colleagues for advice in the morning. The doctor didnt say much more than "if XX want no contact with psych then XX has to take responsibility and not self-harm". The nurse in charge the first day hadnt even brought it up at rounds which I dont get, was overly clear this needs to be looked at. I told pt that I can not not tell about this due to the severity of it and I think it came across. I like to think I have done my best but I am sure I could have done something different too. I am a bit naive as a person but yes manipulation aspect of it did cross my mind and I will think of it more. There is no chance of the patient getting home care, its been looked at, neither is treatment at psych, they dont take patient as ill as this. But they can sometimes have staff on our ward watching their patients getting medical care. Re the pumps it became an abscess around it this time so they had to get it. Last time the pump broke and it got infected after they had opened up trying to fix it. They are putting in a new one in a month. They had a psych consult over some weeks ago and the patient got really upset about it and wouldnt see the doctor. Pt was talking about maybe accepting psych care from the other hospital where she had had a better experience and I told the day time staff too. At the end of our conversation was ok about me telling the day time nurse about everything too. What did you mean why pt has a bed with a bedpost? My English failing me. We have the same beds across the hospital and same as psych. Maybe i sad it badly, I mean the edge of the bed. I think thats called a bed post? If not please correct me!

Hello my follow nurses! I am wondering how you would handle this situation: Patient in its 20s. Has severe type 1 diabetes with resistance to sc insulin. Taket 250 E doses with not much effect. Has lost 2 pumps due to infection. Is now since 1 month stuck at my ward with continious glucose/insulin drip, can go from 12 to 30 in p-glucose in 2 hours without. Is very private and does not say much. Has however warmed up to me and we have talked quite much. Has evident suicide ideation, wont verbally say it but nods when asked. Also has suicidal plans. Self-harmed by banging head against bed post. Did not want me to tell anyone due to being afraid of psych, has not had a good experience with them. I told the day nurse about it yesterday. Tonight pt actually called for me when the anxiety got too much which is huge for being this patient, did not self-harm since our last conversation. Patient obviously needs help. Agreed to me telling day time nurse who in turn could speak to the doctor but did not want to talk to them personally which i said would be difficult cause they need to assess. Patient wished I would work more, feels no contact with the other nurses but yeah I am off now for 10 days. Well I am slightly groggy now but how would you handle a patient who confides in you like this? I am concerned and wish I could do more. I did strongly encourage the pt to be honest if it gets too much and that the only way to avoid psych at this point is to accept treatment.

It varies from patient to patient. If the patient has all cognitive functions intact I try to reason with them and make a deal like alright we wont do it now but how about 5 o clock? It usually works. If they get violent or verbally abusive I dont bother, my safety comes first. Sometimes I call their next of kin and ask them to talk to them. The ones with dementia are trickier, they will most likely percieve whatever I do as a violation if they dont want it done so sometimes I give them some oxazepam and come back later. First I send in another tech since it might just be a person thing though. When it is something that HAS to be done we are 2-3 people and do it with force which feels horrible, every time. A difficult subject for sure!

Hi colleagues! I had a patient with a bloody cough a while back. She coughed me in the face. I asked about TBC-testing the patient, which hadnt been done, and they came back positive. I asked my boss about it and told her about my exposure but didnt get any reaction from her, but she is quite blasé no matter the subject. Should I ask for testing for myself or not?

I got a few tattoos and piercings. Piercings in the face and ears. Bosses react more than patients. They cant fire me for it since the swedish guidelines state that there isnt a correlation between that and infections in patients.

I'm writing from Sweden so it's most likely a bit different here. We clean the rooms, if time allows, but only beds and such, housekeeping does the floors and bathrooms.