suanna

The patient has no significant health history but is a DNR status? Dosn't his family love him, or is thier a BIG will? Anyone discuss with the patient the fact that if he codes we are just gonna watch him die even though ther may be an eaqsily treatable problem that we can manade.? I'm not sure I get this post.

It's been a LONG time since I was a new grad, but what I advise the staff I'm precepting is that the day is way too big to focus on. Ask yourself "what do I need to get done in the next 30 min?" If you get those done, you can focus on secondary tasks or get ahead on your next 30 minutes. I'm not saying you don't ever look at the big picture, or you are going to come up to some 30 min bites that are going to be way too much to handle.

The same lawyers that help with SSDI also handle these supplemental employer offered STD programs. Often the requirements to get paid from these plans are as restrictive as federal SSDI. On top of that, if you do end up qualifying for SSDI, the 3rd party insurance you have been paying premiums for wants their money back out of your SSDI award-you know the one that the lawyer gets a chunk of for getting what you have been paying the government to provide all your life. Only pay 50-60% of your gross- guess what, they want it ALL that back even if you need your SSDI award to pay bills the 3rd party insurance wasn't enough to cover. Don't get me wrong- I still sign up for it, but it is designed to be only slightly better than nothing.

That is part of the problem- it is frequently easier to just do it ourselves than to try to get the staff that could and should be doing some of these tasks to take responsibility for their assignment. Unfortunately, after you have "just done it yourself" a dozen times today, the staff that should have been "doing it" assume you are going to pick up those tasks unless their is no other option, then they will "do you a favor" and pitch in for a while. I don't think they are going to do your med rounds when you get behind, or do a new admit patient history. I don't think they will be calling the doctor to get the orders written last shift clarified, but it is perfectly OK for you to pick up their work whenever its convenient for them.

We pay into social security for our entire working life. We work a job with one of the highest incidents of back/spine injury in the working world. We then end up with a choice when we have the back/knees of a 80y/o at 60- apply for disability or cripple ourselves trying to get a few more mos out of a body that is worn out. After 30 years in the floor doing pt care- I don't think I can learn to do QI or Case Management or some other accomodating position. Most of the time just sitting at a desk fopr 4 hours is enough to send me ODing on Motrin and Benadryl and heading for bed. You are 23y/o with no work history and a proclivity for clubbing on the weekends till you black out because you self medicate with alcohol and pot to treat your social anxiety disorder...Blech! 60 y/o nurse that has to have the NA tie her shoes because she can't get down that far- yep, you deserve a break today- and for the rest of your life.

We've known this for 20+ years. "Body Mechanics" are just a way for the hospital or Workmans Comp administrator to twist the injury to make it seem like it was the nurses fault. I have been counseled about improper use of body mechanics when lifting. You see employee health because you don't want to further injure an already strained back. Instead of a couple of days off and an encouragement to FU with your PCP if the pain dosen't improve- you get a nasty note threatening your job since you obviously violated company policy and hurt yourself lifting a patient. " It obviously wouldn't have happened if you had used proper "Body Mechanics"!!!

I want the shift supervisor to call me up every hour and ask if I would "Please record the VS from my patients is it wouldn't be too much trouble". Maybe pharmacy can call me whenever a med is due and tell me "how much they appriciate it if I would pass the ordered meds on my patients". I am so tired of being told I have to be all sugar and spice to the non-licenced support staff because apparently they are doing me a great favor by doing any work at all, and I should be thankful they don't write me up for disrupting thier day with all that noisy patient care I'm doing. I'm not saying I want to be nasty and rude to the NAs and techs I work with, I'm just tired of the attitude that I should be grateful for any scap of work they manage to put out. It seems they are the worker of last resort- if all the nurses are frantic, and no one has had a break but the NA, and somone may die if something isn't done- then maybe, if I ask real nice, they will get up and help out for a few minutes- but the want an extra break, and to clock out earily without loss of pay, and they don't have to do any of thier regular assigned duties because they answered one call light, or helped keep an eye on a confused patient for 10 minutes until I could get back to the bedside. When I was a NA I worked my hiney off because I recognized I wasn't in charge. I was there to "assist" the "nurse" like the title says. I worked with a good group of nurses who didn't dump on me if they could help it, but it they were watching the Tele monitors and chatting about thier weekend, they were using thier training to monitor and assess the patients. If I was sitting at the desk and chatting about my weekend, I was wasting time. I didn't have the education and licence to sit at the desk and plan my patients needs for the next few hours. I don't think you did or said anything wrong, and I ran the world, you could fire the NA for being "insubordinate" and "disrespectful". These are the words I keep hearing thrown at nursng staff when they try to make a suggestion to better meet the needs of the patients.

Part of the problem is the system is finding more and better ways of sabotaging us. Before CPOE you saw or spoke to the physician so you knew when there were likely to be order changes- most of the time you were part of the decision-making process in changing the medications. Now docs review labs, notes, and VS on the train home and enter new orders from their laptop without ever talking to a bedside caregiver. We used to stock most IV fluids on the floor, and meds were delivered once or twice a day. Now, even on a med-surg floor, pharmacy is delivering a dozen times a day- How do they expect us to keep up with the patient care if we aren't included in the planning of care and kept updated on the changes. Add pt's home meds into the mix- heaven knows you can never be sure if the med list the patient or family gave you is current of accurate. You fill out the med history to the best of your abilities and the Hospitalist, who has never seen the patient, takes 10nsecounds to check off OK to any meds that look pretty close. Next think you know you find tour patient is on 3-4 different beta blockers because the pt's med list, the admitting service, and the consulting service all wrote for different meds or doses without reviewing or evaluating the patients current meds. 3 phone calls to each service and pharmacy about the discrepancies and you finally havae a med list that makes sence- but you are 3hours behind on all this patients meds, and those of all the rest of your team. Now you find out the same thing has happened to 3 or your other 4 patients, and if you spend the next 3 hours getting the med sheets straightened out you will end up passing none of your meds- WHAT DO YOU DO? When you get done with that, don't forget, you have 2 complex dressing changes, a pre-op checklist to complete and a dozen labs to review and call back to 2 or 3 different services each. Sometimes I think it would be better to just put all the pills in a bowl and let patients and families stop by the desk and pick out their favorite combination for colors and shapes.

Who in the world told you this? An employer may have a policy of not allowing staff to work if they test positive for one substance or another, but the BON (at least in my state) only prohibits working while "impaired". It is up to the nurses judgement if he/she has taken a sufficient quantity of narcotic (or any other medication) to be "impaired". There is a difference in using an illegal drug that is known to impair judgement, using a legal mood altering substance while responsible for patients, and using a legaly prescribed medication that in its side effects, includes the potential for impaired judgement. Consider the fact that benadryl makes most people sleepy, but if you know how you react to it, and feel comfortable with your ability to tolerate it, there is no reason why you cannot take an antihistamine to deal with your seasonal allergies. Recreational use of pot while practicing nursing...I cannot find a reasonable argument that would allow this, even in states where it is legal, but to put legitimately prescribed analgesics in this same catagory is unfair and unrealistic. In most states alcohol is legal, but no one would argue a couple of "Jagerbombs" before you take report would be OK. Pot is much more appropriately compaired to alcohol than narcotics. For most people it isn't prescribed, and there is very little chance you could be such a little bit stoned that you professional judgment wouldn't be impaired.

I'm sure this is a facillity specific question. I doubt you will find a "splinter" clause in any states scope of practice/ nurse practice act. I think this is why I would be driven NUTS by camp nursing. If you do anything more challenging than what you could expect from a cub scout and you are at risk for all sorts of litigation. No thanks.

I've been a nurse for 30 years, I'm good at my job, and almost always get through each shift with little difficulty. I enjoy my unit and my peers. I worked one position for 20+ years, and have been in a new one for just over 5 years now. I have nightmares about my job almost every sleep, and always have. If it isn't nightmares about my job, it's about "Nursing School"- that was a LONG time ago. I'd love to dream about my kids, my grandchildren, my wife, my vacation, but no luck. My question: do most of you have nightmares about your work on a regular basis, or am I a bit "touched in the head"?

I have never in my career had a physician or peer give a hoot about heart sounds. It's nice to be able to say "this patient has a loud pan-systolic murmur that I didn't hear eariler in my shift", but realisticaly, if the patient isn't showing signs of clinical compromise, no one is going to care about thier heart sounds, If they are showing clinical compromise, the medical staff is going to assess by echo, labs, cath, X-ray, EKG, tele rhythm strips, stress test; all with or without anomalous heart sounds.... What you think you hear at thier chest is treated as a bit of quirky trivia.

In a word- yep. If I could do my job without being the one responsible for ensuring the resident medical staff wrote appropriate orders, the pharmacy sent and timed the right meds, housekeeping properly cleaned the isolation room before the next patient is admitted. I am sick of entering orders for the attending docs since they are "too busy"' to learn and use electronic order entry (but assumedly I am not too busy to enter thier orders for them), holding the hands of every "senior" resident medical staff aho haven't taken the time to learn thier ACLS but are in charge of the code blues. All these things are OK, if I have time after doing my direct patient care, but more often than not, my patients get less-and-less nursing care as I'm forced to take over other tasks. Nursing is the "patient care coordinator" and "patient advocate"- which means we are stuck with making sure everyones job is done before we can get to ours.

On the "computer med admin systems" issue; These things are only as helpful as the data they are fed. In todays in-patient world, patients are unstable or they wouldn't be in the hospital. That results in fairly frequent changes in meds and schedules. If the data isn't entered properly to set the patient up to get the expected med, then the patient can go DAYS of WEEKS on the wrong meds before someone notices it. I've seen patients get the wrong med for 2 weeks and people just kept wondering why he was not getting any better and why in the world the doc ordered that med schedule. I've found the errors to be many times more frequent and much more difficult to check and correct with computer med documentation.

We have a "non-punitive" "No-Fault" med error policy. It is designed to encourage nurses to report med erors instead if covering them up. It does seem to have worked- our incidence of reporting went up a noticable amount after the policy went into effect. You can still get in some trouble- if it is determined you were so far out of expected policy that you may be clinicaly unsafe- you can get remedial med admin counceling- but that is if, say, you crush a P.O. med and inject it into a IV line- Your problem isn't med administration, it is you may not have enough common sense to work as a nurse.

Without knowing the details it's difficult to respond, but as a general rule: nurses are to accept abusive belittling behavior with a smile and never make a comment back to a patient even if they are completely oriented and are just being a jerk to the nurse because they can. We are, after all, there to take all the abuse a patient wants to throw at us- 'cus they are sick people and we are supposed to be full of compassion. I'm not sure I agree with this policy but it is the way most people see our jobs. If the patient isn't playing with a full deck, I can see being a bit upset that the nurse got into a sparring match with an unarmed opponent. Me, just because someone is old, and has some health problems that require assistance in the home, dosen't give him the right to treat a care provider with anything but respect and courtesy. If it happened to me, I would have been tempted to tell him he was being innapropriate and I wasn't going to tollerate it. Sometimes a nurse just gets tired of being the doormat.

I'm OK with the name the way it is. I don't want it spread around that Nurses are willing to work for no pay, in terrible working conditions, with little or no equipment. That may become the policy for hospitals in the future.

My L&D instructor was quite up front when she said " I don't think men should be Nurses, I don't want them in my class or my clinical rotation, but since the university insists you guys (two of us) have to complete this , lets just make the best of it." I have felt more loved before, but it was nice to have some in-your-face honesty, even if it was a sexist rant and a gross abuse of authority- I'm sure other instructors felt the same, they were just too politicaly correct to say it. I serious when I say I appriciated this instructor more than some others. At least we knew where we stood.

I've had the same issue. I've had to get my patients boyfriend off her PICC line while they were in foreplay, and she wanted her Q2H Dilaudid injected before they got to "the good part". At least we have private rooms, but with some of our patients, we could charge a premium for a "semi" just for entertainment value.

This has been an issue in nursing forever. If a cashier at Walmart is called every name in the book in front of the customers and co-workers, I'm betting the manager isn't long in that job, but if a doctor dresses down a nurse at the bedside/in the nurses station, at most he/she is encouraged to please tone it back by his department head. More often than not, the facility takes the doctors side. As for patients, they can spit on us, punch us, bite us, threaten us, and (at least at me facility) we are instructed to call security- not a law enforcement agency- and the patient is transferred to a different floor, new nurse, and given the kid gloves treatment so as not to "re-escalate" the situation. Assaults that would result in an arrest if directed against a gas-station attendant, when directed at a nurse will get you a private room and a new caregiver (more to your taste), at most hospitals I've worked for. In theory, pressing criminal charges could be a violation of HIPPA and a nurses broken nose is an infringement on the patients rights. ANA has been working on this issue for years, but in my 30yrs in nursing, the only answer I've seen is we need to learn to duck.

There are pulse Ox probes designed for the forehead- they come with a cute terrycloth head-band and are placed around the temple area. Manufacturer does not attest to accuracy of finger probes used anywhere but the finger. If you have staff that continue to insist on this placement, see if your units can order some forehead probes. It would be interesting to see it using the probes designed for forehead monitoring, do your fellow nurses see better or worse O2 saturations. When a finger probe is used on the forehead, and then changed to a probe designed for the head, are the results better, worse, or the same? Even if your boss only orders a couple dozen head probes, it will be a learning experience for the nurses using the finger probes in the wrong place.

I've posted this before but here it is again: Invert your needle. They teach inserting the needle tip down bevel up. When you do this the tip of the needle enters the vein beefore anything else. It then scoops/wicks blood back into the catheter giving you a false flash. If you invert the bevel, go in at an acute angle to pierce the skin, but flatten out quickly aiming the bevel as if it were a paper punch flat to the vein, the needle enters the vein not tip first, but along the entire lumen of the needle. You don't get a flash until the whole lumen of the needle is in the vein and you can advance the catheter easily. Yep, it hurts a very little bit more-but you only have to stick once. Also NEVER use a tourniquet when starting an IV. Use a manual BP cuff and deflate it to about 20-30 mmHg below systole. That way the vein dosn't blow out like an over-inflated innertube when it gets pricked with the needle.

We were given the opportunity to donate our time, or money, or to participate is some other fundraising efforts for other worthwhile charities in our area. Nurses give so little throughout the year it was nice to actually do some good for people in the in the area. In that way, during Nurses Week, we could offset some of our guilt about being such an enormous drain on our health care systems resources.