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.

Lab work is standard at the ER. As well as ecg. So I'm certain they did it. As I said not heard of that alcohol protocol though and I'm certain the doctor did not give such instructors to the nurse. Yeah, acronyms can be a bit confusing for the swede here. We got our swedish versions :-) thanks for explaining. How many different levels of care do you have where you work/patient load per nurse on the different units? Curious about that, sounds like we have quite different system here. Surgery/ortho/oncology/medical units all have this heavy load.

Would you mind spelling out for me the names and meanings of the different levels of care in english? I understand the day to day speak well but not so accustomed to the different health care related words and acronyms, would be much grateful for it! What's PRN or FT? q1h? I guess it's something x 1 hour. During the day our unit is split in 3 groups so 6 pt per 1 nurse and tech. But it's difficult then too, I was actually more stressed during daytime than on the night shift. I think at our icu or cardiac icu (what's the acronym/correct name for that in English?) they are 2 pt per nurse+tech both day and night. If I get a patient in withdrawal I should then assess and re-asses using ciwa? Tried to find a translation or valid similar protocol in Swedish but haven't. I did find ciwa mentioned in a guideline report. I will definitely take a more aggressive stance towards the resident, having learned from this event and your knowledge. I would be distraught if a patient of mine died like this and it could've been prevented. I think this might, and rightly so, become a Lex Maria, that is that this event by law must be reported to the government and the clinic will be scrutinised.

Yep. It's heavy. Why we are so often upset when they send us patients who are basically in need of ICU-type care. I mean I can't possibly or safely deliver that kind of care. I mean besides all the bedpans and diapers I also need to squeeze in the i.v. treatments and administration. I know other wards have maybe 24 patients but then it's 2 techs, not sure which would be least stressful. What kind of staffing do you have night time?

Yeah. I'm sure it could've been. I'm certain they did check electrolytes (at the very least these) before sending pt to the ward. The resident who was on call has always to me seemed good at her job, if just a slight bit arrogant, but surely must've ordered those. There was 1 person in the room when the patient crashed but not sure what happened just before. I feel a bit more certain of what I'm gonna do if I'm put in this situation myself as a nurse, thanks to you all :-) it will surely happen at some point. Especially the part of what kind of patient load per nurse would be most safe. Couldn't possibly handle someone like this safely while also caring for 17 others. I bet we all have our horrible residents stories! I know one who turned and walked away during a cardiac arrest cause "it isn't my patient" (but was only doctor on the ward at the time). Warms my heart to hear you percieve me that way, I try my very very best to be just that!

Thanks! Gonna save that one. Yeah, it's enough if one patient gets really ill at night and then I can't manage much else but that, I have 18 patients total to care for. Us nurses aren't really allowed to leave our wards at night even if to help eachother out but we sometimes have to. Realise everytime sometime new happens how much there is left to learn.

Alright, back from a little nap :-) I don't think we have these protocols, not us nurses anyway. I've never heard of them. I have read the swedish guidelines regarding delirium tremens before since I'm a sponge regarding information but yeah, this is the first patient I've heard of at the ward who's been in this state. I work at a small countryside hospital but the regions main hospital has better suited wards (psych detox wards) for this and I believe that's where they end up normally. I'm sure they do have that kind of guidelines there. If an intox comes to the hospital generally they are supposed to be monitored @ ICU since we don't have the manpower at night to give that kind of acute care for any lenghty time on the medical wards. I'm learning a lot from what you write so I'm all ears here. I know the patient was given oxazepam per os, which is considered secondary choice to diazepam. I don't know what dose oxazepam but it should've been 25 mg tablets x4 + 10 mg as needed until patient is sleeping according to guidelines for alcohol withdrawal but I highly doubt pt was given that high dosages, I'll see in the narcotics journals when I'm back from my vacation. Guidelines for delirium tremens here is diazepam rectally or in drip or propofol sedation. I wish I knew more but I didn't dare go read the journal though I wanted to so I could set my mind at ease, the regulations are tight for a reason. I really really wonder what went wrong. The doctor hadn't come up to see the pt but must've known of the situation, when she finally came pt was already in asystole. Just have this feeling this could've been avoided. I mean oxazepam per os instead of diazepam rectally or iv when someone is seeing cats, 40 degree fever and is going totally wild? I really hope my colleague wont end up in the line of fire in the aftermath.

I don't know. Didn't look in the journal since it wasn't my pt.

What are those short for? For me mg = milligram and k=kalium (swedish potassium).

You learned from this and as the others have said the patient is alive. Some colleagues do come off that way but try to shrug it off, I bet they have made mistakes or misses themselves, we all do at some point. You've talked to the doctors and done your best. Try to see what you've done right too, I'm sure it's most things.

Hi! I work night time at a medical ward and lately have received a lot of intox patients. My colleague who tonight was working on the opposite ward (we are 1 nurse plus 1 tech per ward) received an alcoholic who'd been on a binge. I asked about delirium earlier during the night to check what was going on and they did have quite a lot to do with the patient who was agitated but they didn't mention it. Forward four hours and they call me to see if tech on my ward could help out, after 20 minutes alarm goes off and patient is in cardiac arrest. I run to help and get the impression patient had had a 40 degree Celsius fever, hallucinations, agitation, cramps and basically all symptoms of DT. Suddenly asystole so no defibrillation went off. It left a sad feeling in my gut, how quickly have you seen delirium tremens develop? Was quite a young person. I have personally never seen DT. The ER doctor must've noticed something off but still put patient on the ward instead of ICU, shouldn't it be treated in ICU generally? My colleague must've given the doctor feedback during the night of condition. Week before had unclear intox who also arrested but lived. Doesn't feel very good to receive patients who are this ill and can survive with ICU care. Anna