Rvanurse2012

Sometimes I have found that people just are not the best communicators and generally interact in a aggressive manner just because this is who they are as a person it's not personal. Other times some people just don't care and will be aggressive and interact inappropriate even with intervention and redirection. -Dustin

This patient isn't frightened , he can no longer control any other aspect of his life so you attempts to control us by under minding and directing his own care despite redirection and education attempts. he is very capable of calling for help as we have equipped him with a call light that works. I did not post this blog to have my nursing care judged on bias opinions that don't know all the details. This is sad health care has become a nick pick throw the professional under the bus and assume they are neglecting the patients. Pointing fingers at folks instead of backing our colleagues. We don't have doctors we have a doctor that practices at our facility only. As far as suggestions in tx I have being a CCRN made my suggestions and they have been shot down. -Dustin

Oh and I must of forgot to mention I'm a nurse not a doctor ... And I'm amused you really had to ask why I'm giving neb treatments to a patient ? I mean I'm not lazy but why would I create extra work by giving medications not ordered to random patients .... not only is that a medication error .. It's over stepping a nurses scope of practice I don't prescribe I administer and carry out orders from a provider. -Dustin

Auto correct how -Dustin

You have a unrealistic view of a long term care environment you have 17 patients and 8 hours to complete ordered care. You tell me hoe many test calls you do lol -Dustin

What nurse do you know that goes down the hall administering neb medications just to random patients without orders ? Obviously a md order has been written to do so and further more I didn't post to be judged in English and how I refer to my patient in an informal environment . -Dustin

Of course I have already checked for infection that was first intervention done -Dustin

Ty I am glad I'm not only one that his experienced this I thought for sure I was possibly being over dramatic but now I see this is a lot of Pysch nursing -Dustin

If he is a partial code that's one thing it should state what can and can not be done

I also feel like the with the trach patient its a controlling behavior because he tries to tell me how long to hold it down in his trachea how to suction wants you to beat on his chest ( cheats pt ) to the point I tell him I can not hit any harder do to the fear of causing a bruise then when you are suctioning him it's almost like he is enjoying it making a gag like gesture , eyes rolling back In his head. Weird I know but then I'm almost scared to say something because I do to want managemr or the doctor to think I'm that nurse that is lazy because I am not I'm concerned I'm literally tearing the lining of his trachea due to over suctioning ... The trach patient and the cath pt almost fight for attention ringing there call lights in sequence one behind the other asking for something simple to get you in room the. Requesting you to close door then asking for there prospective routine nursing tx. almost as it is secretive or there ashamed of it because they know there being obsessed

The cath pt maybe the first time and after no it's 100 ml max the guy is in his mid 20's

Oh forgot to add this In a 8 hour shift ... And the cath pt .. it's not even but an hour later he wants you to cath him again and then you don't get but maybe 100 ml max. Then the pt complains about urgency says frequency etc and in thinking let me run a cath down me 10 times a day and see how many infections I get It's almost uncomfortable because I know that there is no way there is a need for that many caths and suctioning especially when you get not only 100ml if that and then with trach pt you get scant amount of sputum clear at that and clear lung fields X5 pre and post suction

So I recently switched jobs , and I went from acute care ( critical care and step down units) to long term care but not your usual nursing home patients , these are Pts with mental and physical disabilities and considered young adults -ages 18-50 being oldest. The majority have CP and a few traumatic brain injuries. I have two patients that require prn nurse intervention one being str8 cath as needed per his request and one that has a trach. Requiring suctioning. Let's address first dude ... He will request that you straight cath him numerous times a shift despite timing between last cath times. Request we'll over what I think you would need to cath someone who is not able to urinate without nursing intervention ... Is there a limit to this the order states as needed within no limits and I have asked staff and they say they just do it when ever and how many ever times he request... Now here's the trach dudes story .... He request suctioning numerous times a shift. He request prior to neb tx , then after and then will request again in between the last neb and then again prior to ha neb and after and then again .. Each suctioning you hardly get anything but a scant amount of clear secretions , he wants you to hold the suction catheter down until he nods to pull it out. Is there a limit to this and how can I approach the fact that this seems to me as a behavior problem almost a stimulation type thing because he is a quad that doesn't feel anything from shoulders down. Any suggestions ???