-MNC_RN-

Hmmm. Good point. I never thought of that (obviously). I can see how that would be the sticky spot... I definitely don't think I was wrong in trying to retain a good nurse.

Background: - I work in staff development and am the primary educator for two units. One is a specialty care unit, the other is its associated ICU. I am also the lead instructor for our hospital's critical care entry program. Naturally, I keep an eye on my nurses on the specialty care unit and know which ones are good and that I would like to see move into ICU, if they are interested to do so. I have no control over hiring, firing, or any say as to who actually moves into ICU (I teach who the managers hire), but I definitely encourage nurses to move into critical care if they appear interested. (If they're not interested, that's fine... we need good nurses everywhere...) - My wife is in nursing school and is doing her internship at another hospital. - My wife's preceptor is roommate to one of the nurses on my specialty care unit - Preceptor told wife that her roommate is not happy on the specialty care unit and is thinking about leaving. - Wife passes this information on to me. - All of this information peaks my interest, since said roommate/nurse is one I've had my eye on and have thought would do great in ICU. - Very quitely and privately, I pull the nurse aside and mention to her that I've heard rumors that she's thinking about leaving and that before she makes any decisions, I'd like her to consider a move to ICU because I think she would do a great job. She denies the rumors, I tell her I still think she would do a great job in ICU and we go about our business. - My wife calls me today from her internship to tell me that her preceptor is angry AT ME for telling her roommate that I heard that she was thinking about leaving and now my wife wants me to apologize to her preceptor. Now to me, this seems all very high school. My points: - If this information was so confidential, preceptor should not have told wife and wife should not have told me. Or at the very least, someone along the chain should have said something about how confidential it was. Neither of those things happened. - Preceptor is fully aware of my position in staff development and that I work with roommate's unit. She is also fully aware of my position teaching critical care entry. - Both preceptor and roommate are only a year out of school. While they may not realize how tightly knit the nursing community in our city is, they probably realize it now. I know nurses in every hospital around, as do most of my colleagues. Did they truly think that this would not get out if someone else knew? (Maybe they didn't.) - Considering there's a nursing shortage, did they really expect me to not try to hang onto a very good nurse? Especially one I think would do great in critical care? So... Did I act inappropriately? I want good nurses to stick around. I try to convince every one to stay. Heck, I even tried to convince one of my favorite nurses to break off her engagement so that she wouldn't have to move away (only jokingly, of course... well, almost). What should be done? Wife says that I should suck it up and apologize to preceptor, even if I feel I did nothing wrong. I say I honestly did nothing wrong, and that if nothing else, preceptor and roommate have learned that if you want something to remain confidential in the local nursing community, you need to keep it to yourselves. Thoughts?

My questions are: As nurses, do you think there would be any interest in this type of training for you? Yes. Do you have any difficulties or feel frustrated when you communicate with non-native English speakers? Yes. ...which is why there are many nursing researchers working in this arena. That is, researchers who are not "IT, outsourcing, and finance;" researchers who actually have a clue as to what we do and what we deal with. The last thing that nursing and health care need these days is another entrepreneur who thinks that patient care is just business with living product. If you really think it can make the transition from business to nursing, contact a researcher, hospital or univeristy. But you better have a ton of data that say something other than, "It makes money."

Generally speaking, dialysis catheters are used for nothing else. There are always exceptions. My big question would be if he was admitted to your facility and dialysis was DCd, why leave in the line? It's a route for infection and a risk if pulled (obviously). Unless there was a good chance that he or his family would change minds, it should have been taken out even before he hit your doors. [in regards to your original post, you did the right thing.]

Yeah. That one bugs me. There's actually a reason we only take care of one to two patients and it's not because we're lazy. Instead of posting the link, I have copied what I once wrote in another post:

I don't think one can tell after 5 weeks. If you're doing things that are unsafe: problem If you're not doing the work: problem Learning slower: not a problem. The first few weeks of ICU orientation are just getting your feet wet. The next several are for you to start making the connections. About a year after that, you'll start getting proficient. As for the technical, hand-on skills--you probably are clumsy. But you don't get better skills by not doing them. Hands-on skills need to be hands-on. Keep doing that and eventually you'll get better. If your preceptors are still giving you not-ready-for-ICU feedback in another three weeks, then they might be on to something. Suggestions: More shifts, more consistently. Our new ICU nurses work full-time 5 shifts a week. Each shift reinforces what was learned previously. Less than 0.8 and you might not be getting enough shifts to retain information. Also, look at how many hours you've worked, instead of weeks. I have found that the majority of new ICU nurses need about 300 clinical hours before they're ready to be off orientation, another 80 or so independent but with a strong resource, and another 300 or so independent but with a "mentor" to guide them. That's a long time. Even if you're working full-time five shifts per week, you're only a 200 hours total clinical.

We dealt with something similar in our Trauma-neuro ICU. In our case it was decided by joint committee (physicians and nurses) to have specially trained charge RNs irrigate ventriculostomies toward the patient (we have always been able to flush them toward the drain), and administer intraventricular medications (antibiotics). Both of these were previously MD-only procedures. After much investigation we discovered that AACN and AANN both discuss the need for nurses to be specially trained and validated to do these types of procedures; we found no legal contraindication in our state's NPA. In the end, we started an education and training plan along with validation which includes return demonstration. The education plan included specifics to look for during pre- and post-procedure assessment, and our neurosurgeons were more than willing to oblige and list everything they would want to be called about. While the staff was very nervous at first, they are much more comfortable with it now. We don't do it that much... maybe once or twice a month; we have annual validation of competency to keep the nurses current.

My first experience? I couldn't stop laughing. Seriously. I was an NA in my first job orienting to an oncology floor. My first day there, a nurse, knowing I was new, asked if I would like to help her with some post-mortem care. I did... and couldn't stop laughing. Part of it was nervousness--it was my first experience with death in that way. Part of it was excitement--I was actually doing something that mattered and I was on my way to nursing school and being a nurse! Family had long since gone; the nurse I was working with looked at me funny, though. My first time seeing someone die was entirely different and definitely did not have me laughing. I was still a nursing assistant and was helping out in a code doing compressions. She was a little old lady--80-somthing, I imagine--and she didn't make it. Not even close. It was then that I realized that the woman dying didn't bother me. She was dead and ain't nothin' I coulda done. What bothered me then, and always will, is how much the family gets hurt by death. I will never forget the image of her husband standing at the end of the hall weeping. Families get to me. I remember one young man a couple of years ago in my ICU who commited suicide. He went on to be an organ donor. The night before he was brought down to OR, his mom came in and noticed that the nurse (I was charge at the time) was about to do some cares. She talked to the nurse and asked permission "to give my baby a bath one last time..." That was hard. Hell, I tear up even now just typing it. It's never a weakness to cry when a patient dies, or when a family or patient cries. If your emotions interfere with your ability to do the job, that's a problem, but emotion in general will not hinder you. Finally, don't "block" death. That will only get you into trouble (unless you want to be an alcoholic). It's the natural conclusion to life. Sad, yes. Sometimes tragic. As I have written in past posts: Everyone dies sometime. The only differences are how soon and how well. We try to prevent too soon, and we try to make every death as good as it can be. That's all we can do. Really.

Some random thoughts of mine on the matter: 1. Nurses don't constantly deal with death. I've been in the field for 11 years and, from what I can remember, I've only had 8 of my patients die. And that's working in critical care and trauma. I've certainly dealt with other dying and dead patients (certainly many more than 6), but having your personal patients die will not be common. 2. For me, families are by far the hardest part. The actual death of a patient doesn't bother me. For them, it's over. Whatever your belief system, they are no longer in pain, no longer have fear, no longer have suffering. For the families, though, it's just begining. A family's grief kills me each time. You know what, though? I know how to deal with that... emotion, anger, saddness, loss. They're all emotions we've dealt with in the past. Now, if you're not an empathetic person, that could be a barrier, but most of the time all that's needed is your presence, tissue, and you nodding your head. Maybe the occasional, "She must have been a beautiful person to have impacted you this way..." It's still not fun or easy, but it's not the worst you'll deal with either. 3. Everyone dies sometime. The only differences are how soon and how well. We try to prevent too soon, and make it the best death it can be. That's all we can do... the rest is out of our hands. Know that and it can take a lot of the fear out.

First born, no alcoholism, male, son of a nurse. Who knows, if you crunch the numbers enough, maybe the social worker is right. Like the statistic that a disproportionate number of medical/nursing personnel are left-handed.

In many cases you're exactly right. And in many cases, that's the point. Verbalizing what we already do--verbalizing a theory--organizes a skill/task/thinking so that it can be repeated and analyzed in a methodical manner. Consider Shoe Tying Theory. We all tie our shoes. We've all done it since we were kids. You can do it with your eyes closed, right? Great. Explain how you do it step by step. Did you do it clearly enough? Or did you forget to assess how tight the laces were pulled in the first step? If you didn't explain how to pull them tight enough, perhaps shoes will fall off; if you didn't explain about how to keep them loose enough, they're uncomfortable. Do you make two loops and entwine them, or one loop wrapping the loose end around? One way is more labor intense than the other--what if you're trying to save time? How about double-knotting? It may improve safety by keeping the shoes tied, or it may create embarassement if your mother insists on taking your shoes off before you rush into the bathroom. Consider velcro shoes--an alternative theory? We do nursing theory all the time unconsciously, but verbalizing it allows us to analyze and make changes or improvements; it also allows us to teach it consistently. Just because the nursing process is a no-brainer to you, doesn't mean that it is to everyone. (Trust me ... I have had new grads that really don't understand it.) Actually, no. Patient autonomy is a reletively new development. Time was that doc knew best regardless of your thoughts or feelings. There was a time when it was assumed that all people wanted to live forever regardless. Also correct. Sciences don't exist in vaccums. Einstein's theory of relativity borrows plenty from chemistry and mathematics, not just physics. That fact doesn't make it any less of a physics theory. Infection control borrows plenty from medicine and microbiology. That doesn't make nursing's influence any less important, or less necessary to study. Also, just because we've been doing something for a long time doesn't mean that we still shouldn't study it. That line of thinking will get you a task-oriented job... monkeys can do tasks. Nurses are educated to think and think critically; to learn that, you have to learn the ins and outs of how and why we think the way we do.

Bingo. No, nurses at the bedside don't sit around chatting theory. They do, however, use P&Ps to guide their care. Theory and research lead to change and improvement in practice. Without theory, we would still be... - Painting besores with molasas - Reusing needles - Not washing hands - Not listening to hearts and lungs - Not caring about a patient's autonomy - Putting pain control at the bottom of our important list From a staff development perspective, it's theory (Benner's Novice to Expert) that actually gets you an orientation. Back in the day, you were thrown out and expected to fly. Be grateful for that one. I would challenge anyone to--rather than groaning and rolling eyes when learning about theory--actually think through a theory and see how it impacts your practice. In fact, try it here: post a theory and see how many of us come back with why it actually matters.

I would say yes, with some cautions. I used to work with a woman--a nurse--who was a patient educator and she was blind. Not partially, or "almost", but blind. She had a guide dog who was well known around the hospital, had one of those cool braille computer keyboards, and everything. She was a great patient educator. She went blind from macular degeneration, so she wan't blind through nursing school. That's where it might be hard. You have to see for nursing school, I would think. I'm trying to think of how they could adapt for you and I don't know if it's wholly possible. Parts can be adapted, certainly, but I don't know about all. Edited to add: The best folks to answer your question would be the schools. If you can get through school, there are lots of fields of nursing that you could work in... patient ed, phone nursing, research, maybe school nursing. Probably not IV team, though.

I don't lie about it... really doesn't matter anyway. The docs that I see pesonally I all work with anyway. I find it helps, since we can cut to the chase about all sorts of stuff. I've never been in a situation that I was unfamiliar with or needed lay information, so I can't comment on that. It actually helped once when my wife was seeing the doctor for some really unusal edema issues she was having. She wasn't getting anywhere with the docs she was seeing because, of course, when she would see them, the edema wasn't so bad. I went with her one day and started to describe what I had seen in what I thought was very basic language ("Yeah... she's been having this 4+ pitting edema throughout the day...") and his ears perked right up.

Sounds pretty typical. In fact, my wife's undergrad grading scale (non-nursing...music, actually) was 92%+ was an A. It's becoming more and more common in colleges/universities, period.