ChristaRN

In reference to the previous post that you are referring to, I just wanted to point out that back in nursing school I was taught that the decision to give or not give a cardiac/blood pressure med SHOULD be based on your own assessment of vitals JUST PRIOR to the med being administered. Of course, I do trust my techs, thankfully haven't been given a reason not to, it's just a practice I've always been taught and continue to this day. I think it's a smart practice for me - I just always imagine that if vitals are obtained during 2000 rounds and I have a med to give at 2100, alot could change in an hour and the few seconds it takes to obtain a set immediately before have more than once changed whether I would or would not give a med, had I relied on the previous set of vitals alone.

Thank you, Thank You, THANK YOU! I have to say the posts you were referring to actually kind of hurt, I try my best to provide great care for my patients and relieve as much pain and anxiety in my patient's as possible. It stings to basically be accused of child abuse when in reality we are the ones trying to put so many abused children back together if you will. Thanks again for your support! :heartbeat

I love the idea of a Psychiatric Medical Surgical type unit and while they do exist in small numbers it's unfortunately unrealistic to hope for such combination units in all nursing specialties so I don't think we'll be seeing any psych-OB, psych-rehab, psych-oncology etc. It would be great if we had more nurses who are experienced both in the medical aspects of patient illness as well as psychiatric aspects. I think alot of medical minded nurses are uncomfortable with acute psychiatric issues and I understand that. For a non psych nurse I think treating mental illness is quite a challenge. We can't measure mental illness and target a certain number and aim for that as we can with BPs and glucose levels. We can give medications but that's not always really treating the problem. We can be unsure how to communicate with a patient who is acutely psychiatrically ill. I don't think those nurses who are uncomfortable with psychiatric care are talking about a patient whose psych illness is currently well controlled; they aren't trying to cast all patients with mental illness off to an island so they can be avoided. I liken it to placing a patient with an acute cardiac problem on an oncology floor - those onco nurses likely would not be comfortable because it's an acute problem which they are not familliar with caring for. I see acute psych problems in the same way. It is NOT a good idea to keep a psychiatric diagnosis from your treating physician as that disease process or any medications that one may be on to treat it are important pieces of information and can effect current medical treatment or even easily explain a problem that the patient is currently having. I sincerely hope the previous poster will keep in mind that while there may be few colleagues of ours who unfortunately may still stigmatize mental illness most will not allow that to effect the care they give and may actually be able to give BETTER care based on that knowledge. We need to advocate for ourselves in all nursing disciplines to ensure that we get adequate training in all aspects of care that would should be expected to provide and some psychiatric training is certainly something that we and our patients would benefit from us recieving. Perhaps offering a shift of shadowing in a psychiatric unit would do a world of good!

She went to rehab for several weeks after leaving the hospital and then eventually went home with her dad and sister. I assume she's doing well because we haven't seen her since!

:saint:I posted this story in another type of thread a while back. I think of this a little more as a story of undying love rather than a ghost story but I do think it fits here. Last year, I cared for a 3 year old child who had been in a MVA with her mother and older sister. Unfortunately, mom died in the accident. The older sister broke an arm and was admitted to the Peds unit for a night or two with an ORIF. The 3 year old had multiple injuries including two broken femurs, a broken arm and more that I can't remember off the top of my head. She was initially in the PICU so never got to be with her sister after the accident. I cared for this little girl when she was transferred to Peds. Now she was almost always alone. She had not yet seen her sister and her father I assume was busy with funeral arrangements etc. This child had not even been informed of her mother's death. She was a very stoic child, would never cry despite being in obvious pain I'm sure. She never showed ANY expression of emotion, wouldn't talk to ANY of the staff, wouldn't eat or drink even when we brought her some of her favorite foods. She just broke my heart. I would park my chair and portable computer in front of her room at night when things would settle down just in case I did hear her cry or anything. One night I heard her quiet voice starting to talk, in obvious conversation. She was saying "Mommy, I'm coming too now? Mommy, why can't I go too? ". I got such chills! I walked into the room and that little baby was wide awake, holding her arms out as if in a hug and focusing her eyes on a spot in front of her face. I am SURE that her mother was in there at that moment, being with her baby just as she would have in life. I cried the whole drive home that morning, thinking of the terrified child being comforted by her literal angel of a mother. I just wonder, with her undeniably seeing her mom there in the room that night, did she then know that mommy was gone from this earth?

I don't know how much Peds experience you have but in MY years in peds and PICU they are NOT always easier to care for. Many of my patients are adult size teens who either are severe MRCP that create messes as big as any adult or could be a teen on a vent for any reason that is unable to participate in their own care. The worst two "code browns" I have experienced in my nearly 7 years as a nurse have come from teens. Don't generalize Peds as easy! For the OP, just realize that what you describe as the behavior you see from nurses you work with is NOT acceptable and not what you should aspire to be. I work on a unit which does not use techs/nursing assistants and the RNs are it for patient care. If you can't accept that you are (or should be) expected to be VERY involved in physical patient care, even the tedious things, then you have some thinking to do. Decide either that you WANT to be a nurse and are willing to provide that care for your patients or trudge through school and some experience until you can get a no direct patient care job. If neither of those options sound good for you then you may need to consider another line of work. I wish you the best!

Since we're no longer in flu season I realize that my comment may be a bit late. I personally have no problem with the flu vaccine being required for me to work. I also realize that some people have to be exempt, especially for severe allergies, not just "it makes me sick". My hospital last flu season made the flu shot mandatory and in the case of people who refused for WHATEVER reason, they had to wear a mask AT ALL TIMES while in the hospital, not just while in a patient room. For those of you who object to the vaccine, regardless of the reason, how would you feel about being required to wear a mask for months every time you worked? Just curious as to some responses.

First off, please don't attempt to be a nurse manager without a MINIMUM of 5 years (10 is better) as a bedside nurse. No nurse has ANY business trying to be another nurse's boss without having been in their shoes for a significant amount of time. Secondly, sure, there are some nurses who don't have the best attitude but I would rather the crabby old nurse who knows her stuff over the customer service puppet with the sunshine personality who couldn't resuscitate their way out of a paper bag. Sorry, but the whole customer service thing is a joke. We are nurses, not servants and that's what the whole customer service movement wants, for us to be servants. Please, go into nursing for the desire to care for patients, not the desire to get away from the bedside ASAP while telling people how to do the job YOU don't want to do. I firmly believe that ALL managers should have to keep their clinical feet wet.

Good point. I hadn't thought about that side of the coin; my only response to your post is that, if she was a professional, good supervisor she should have come to the OP and said something along the lines of "I recieved a phone call from xyz hospital regarding obtaining a reference for you as a potential employee. I wanted to let you know that I feel that you are a valuable employee to our company and am open to any feedback you might have as to why you felt the need to seek another position. Since you are a valuable employee, I sincerely hope that you are considering our company for continued employment once you complete your nursing program".

I personally LOVE whoever it is who is sitting with my confused/suicidal patient (in my hospital sometimes a NA, sometimes a dedicated "sitter") They are helping me be able to get all the rest of my work done which I wouldn't be able to do if I was sitting with that patient all the time. Sitters are very valuable to nurses, they are our eyes and ears when we can't be with the patient and on more than one occasion I have had a patient who felt comfortable enough with their sitter to really open up (such as a teenager who had OD'd on a medication, at first insisted it was an accident but admitted to the SITTER after hours that he was indeed trying to kill himself). If it weren't for that sitter, would he have felt comfortable enough to open up? Would that teen have gotten the help he needed if it weren't for the sitter who made him comfortable enough to open up? I'm sorry that you've had some bad experiences - most of us love you and people who do your job. When you're a nurse, I'm sure you'll be the kind of nurse who will respect all of her coworkers and they will respect you too!

I think there's no real answer to the question of whether or not having a visitor in bed is ok, certainly no answer that covers all situations. With teens, I think I tend to be more strict and 'suggest' that the boyfriend/girlfriend is welcome to move the sleep chair next to the bed. Only rarely would I allow a teen's partner to stay over night. With adults, I think it's all about them being respectful. I think it's probably not the best idea when the patient has a roommate because I'm not sure that the desire of one patient to be physically as close as possible to their significant other should be more important then the other patient's desire to not be uncomfortable sitting just feet away from the snugglers, especially if they are going further then just sitting with an arm around eachother. As for sex, I'm sorry - I am not a prude at all but it does NOT belong in a hospital period. I would probably have a heart attack if I walked into a room to care for a patient and they (or in my case as a PICU nurse, likely their parents) we engaged in a sexual act. Customer satisfaction should only require us nurses to deal with so much and I think having to work our jobs around when our patients are having sex is just a little too much haha!

The whole "which specialty is harder" topic is something I really, really dislike and am sick of. Through my almost 7 years of nursing I have worked Med-surg, Peds and PICU full time (and of course floated here and there like most of us have to). I consider my current job in PICU to perhaps be the most technically challenging for me (vents, CVPs, Alines, ICP monitors etc) but Lord have I heard how easy my job is from some others (our monitors tell us everything, we only have one to two patients so how hard could that be etc). I personally think that no one regardless of how many specialties they have worked can give the definitive answer to the question of which specialty is harder or more important because it IS so subjective and honestly ridiculous to argue over. I am going to use this time to give some kudos to some of my nursing colleagues and show some appreciation for their specialties: ER nurses - I really appreciate how you never get more then maybe a few minutes notice from an ambulance call of what is coming into the door (if you even get that). I appreciate the stress of having to balence patients of various acuity (newly intubated, psych, kids, crazy demanding patients and family etc) and trying to get people moved as fast as you can so you can be hammered again in a second. Med-surg - I've been there and I think you don't get enough credit! I have worked on M/S units evenings and nights with 8-12 patients and the challenges of getting their 900 meds out on time, full physical assessments, charting, incontinent care (no CNAs arent that plentiful to the point where these nurses don't have to change massive code browns too), admits, discharges, postops, AMAs, needy patients and families who you don't have the luxury of shipping off to another floor..... oh yeah, and the random death/code blues/patients who go down the tubes while the rest of the unit doesn't stop. Not easy at all! ICUs (adult, kids, neonatal etc) - Any of your patients could decompensate at any minute, care is complete and heavy in many situations, family stress is at a high, drips, monitors, vents, codes, almost codes, admits, transfers in or out, and sometimes everything seems like it should be the priority. Tele/Step-down - I really feel for you here because as people are getting sicker and ICU beds are taken up so many of your patients really should be in ICU and you don't get to just have one or 2 Psych - Wow, I give credit to you guys! You're trying to treat things that you can't see or measure like a blood pressure or a blood sugar and you never know when a patient is going to go off. And from my times floating to behavioral health I know your ratios are ridiculous many times! Peds - How many times have we been told that kids are "easier"? Never mind that just as adult are getting sicker so are kids; there are many 14 year old 100 lb plus MRCP kids, trach and G tube dependant, total care. Oh and the chemo that many peds nurses give on top of caring for a child like the above, the 2 year old who won't let you get an assessment done, the teenager being difficult, the parents being more difficult... oh and of course kids go down the tubes way more quickly then most adults! L&D - As much as many of your cases end up great, when things go bad they go really bad and most other nurses would have no clue what to do with your types of emergencies (a good friend who is an ED nurse once told me that an obstetrical emergency is the one type of emergency that she feels most helpless in). I realize I didn't touch on most specialties - I'd be here all night, and this post is already too long. If you made it through reading the whole thing thank you! To the others I didn't mention (OR, PACU, Pre-op, School, Home Health, Hospice, Rehab, office/clinic, long term care) you guys are as important as any other nurse and your job is just as vital to the health care system we all work in. Remember, if it wasn't for the ED nurses we'd all get our patients dropped off in a second's notice and unstable and if it wasn't for the rest of us the ED nurses wouldn't have somewhere to ship everyone off to once they're done with them. I appreciate all my fellow nurses!

Lets fast forward to when/if you become a nurse - you have a little old lady with signs/symptoms of CHF, doc is notified and wants no changes to therapy. You decide a little Lasix wouldn't hurt and go ahead and give some Lasix. Patient experiences an allergic reaction to the med that you gave without a license to practice medicine. You WILL lose your license, no Good Samaritan law protects someone PRACTICING OUTSIDE THEIR SCOPE.

Please don't mess with oxygen! If this man had a history of COPD turning the oxygen all the way up could put him in a life threatening state. In nursing school you will learn that oxygen is a medication and you must be extremely careful with when and how you administer it.

As a STNA you are not yet able to do the thorough assessment that is required to know whether or not a breathing treatment is necessary. Obviously not being there to see the patient myself I can't provide an accurate assessment either but what I can say is the following: (1) As a STNA you are very much over stepping your bounds by ADMINISTERING MEDICATION as you did. (2) As an STNA you are not able to perform critical assessment. Not all situations where a patient can't breathe will require or be improved with a nebulizer. Also, especially taking into consideration the patient's baseline or possibly history of lung disease, 92% very well may be perfectly adequate for the patient. It's also quite possible that the source of breathing difficulty may not be respiratory at all (i.e cardiac, anxiety related etc). I cannot comment on the nurse's action or lack of action since I wasn't there to see how it all carried out but my advice to you: in no position, as an STNA now or a nurse later should you EVER be comfortable over stepping your bounds. You may be very good at your job but you are not a nurse, doc, or RRT so making a decision to administer a med (as you did, which was essentially practicing medicine without a license) is not in your scope of practice. You could really put yourself in hot water some day if practicing above your scope is something you do regularly and a bad outcome is noted. Also remember that if you make a serious mistake and harm a patient that the nurse who is overseeing you may likely be disciplined as well as yourself. If the nurse refused to assess the patient after a couple mentions of your concerns and the patient seems in obvious distress and you feel you have to, go to a supervisor. Best of luck to you, just remember where your job ends!