Pam RN

Actually, I do make my opinions known and my husband always talks to me and wants to know what I think. He says he's so happy that I'm around and suppportive. But, with other family members I have to be careful because they don't want my opinion so I weigh my comments carefully because in the end it's not my decision and she's not my mother. I'm sure others have been in the same position being a healthcare provider and being on the outside. Tricky.

Thank you all for your very good replys. Yes, she did have hepatorenal syndrome and was hospitalized for two weeks a month or so prior to her transplant. So, yes that makes sense about the dialysis now post op. I have to get my brain back in ICU mode. Hoozdo, congratulations on your transplant and thank you for your insight. Boy, you sailed through the hospitalization part. I have heard through others that had family members transplanted that the road is hard and long for even the most youngest and healthy persons. I am surprised they went ahead and transplanted her quite frankly. She was rejected for the list but went in to appeal and they took her. This is a very aggressive program so she is not unusual apparently. But, since I'm an inlaw and not part of the direct info from doctors and not consulted on my opinion I'm not sure if they re-evaluated her psych-wise and if she was on anti-depressants. I know the nurses were on the transplant floor were very direct with her and had to do the "tough love" thing but I don't know if the doctors considered that information or if they even read the nursing notes. Gee, what a surprise. We'll see if the brochial lavage helped with pneumonia and if the dialysis helped with the edema and kidney function and getting urine of better quality. Fultzymom I'm glad to hear your dad did so well so he must have been motivated. Everyone has been positive but my MIL is a negative person and does not have much faith in anything. She does things mostly out of duty and guilt so I hope she didn't go through this to satisfy her family members. I hope she did it because she wanted to for herself and for her life.

Hi, first time here since I'm in the OR and usually post there. I have some questions about post-transplant in elderly patients. My MIL had a liver transplant a week ago Monday at the age of 75. She has autoimmune hepatitis and two days before her transplant nearly died but had a central line inserted and dialysis cath inserted and had a round of dialysis. Now post op she is in the ICU, reintubated for pneumonia. She had progressed as expected for her age and condition preop. Was extubated I think, on post op day 4 or 5, eating full liquids, doing poorly on her incentive spriometer, edema in all her extremities, making urine. From info through the family, the doctors will be doing a bronch with lavage to clear out the secretions. She had dialysis yesterday and a liver biopsy. Her Bili was in the 7's and is now down in the 6's. I have no experience with transplants what-so-ever. What can you gather from this? What are your expert opinions and I want you to be brutally honest. I really don't see her doing well with this. She certainly has the will to live but preop she refused to do what was ordered for her like PT, working on her IS and trying to gain strength. She was lectured by the medical staff (docs, RN's, etc) to comply with the treatments or she would have a long road ahead.

I have the Coaguchek machine by Roche. I had a Mitral Valve Replacement 18 years ago this May and have been using the machine for about 8 years. After 10 years of needle sticks my veins were getting pretty scarred and as someone mentioned getting to a lab is not always convenient, especially when out of town. My cardiologist is in another city 90 miles from where I live so when I had my blood drawn at the hospital I worked at or at a hospital near my house it's a hassle because my doc is not on staff. The company recently recalled the strips a few months ago and the FDA won't be approving new ones until April so back I went to the lab and I hate it. The machine could be improved due to size and the amount of strips used to run the controls but it really is so much better than going to the lab. There are guidelines such as if my INR is greater than 5 or 6 I do have to have a venous draw to double check the value. Also, being a nurse, the Coumadin Clinic gave me some additional instructions to follow that they wouldn't give the average patient such as holding my dose if my INR is higher than 4.7. I check my level on the day they tell me to and then call in my result and then they call me with my instructions. It's that simple. They also told me that the patients who are able to understand how to use the machine and perform a fingerstick on themselves and get the drop of blood on the strip correctly. If the nurses at the office feel the patient can't perform this then they would not approve home use for them. The home machine is not appropriate for every patient but I am so glad it's available as an option.

No, that didn't sound mean. You're absolutely right. I'll just let her talk her way into trouble if she seems to know it all. I'm trying to give her our way of doing things, give her hints and shortcuts and the like and if she doesn't care to listen then it's up to the supervisor to deal with. If it continues I'll take my concerns to the boss.

I work in a small OR and they just hired a couple of nurses that are on orientation. One woman is having diffuculty catching on to the fast pace and just catching on in general. Even doctors comment on her sometimes questionable performance. The other one is too new to make that assessment, yet. But, the issue with her is that she just keeps talking and talking. The couple of times I had her in my room and I was explaining how we did things like a prep or whatever I couldn't get a word in edgewise. I would start to explain something or better yet, answer her question and she would cut me off with her own experience at her other job or relay a story and just blablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablablalba....................... I couldn't even interupt her or try to talk more loudly over her because she was like brick wall in her own talking world. I've been thinking of possible things that I could say and approaches I could take but I'd like to know if any of you have had this issue and would love to hear any suggestions that I might try. The first woman who is not catching on also has an annoying habit of criticizing everything we do and how we do it. I felt like I was being accused of bad nursing and also heard complaints from other staff members of the same issue and they expressed similar feelings. One day I was just so sick of hearing it that in frustrated moment of fairly well contained rage I just threw up my hands and said "Take it to Carol if you have problem with it." Then she complained that I was rude to her. But, she was told in her meeting "Boy, if you made Pam mad than you must have done something really bad because she never gets mad." So, any suggestions on precepting know-it-all nurses would be appreciated.

I found out it would be north of Boston near Danvers. My hubby said people in the company live all over--Boston, Salem, New Hampshire. I work in the Operating Room, which hospitals would you recommend? I work in a day surgery center in downtown Chicago now with different surgeries like podiatry, ortho, lots of plastics. Which area of Boston would you recommend?

My husband was just offered a promotion which would require a relocation from Chicago to outside of Boston. What's it like out there besides the seafood? How's the job outlook? What's the housing market like out there? Go Cubbies!

How do you deal with the internal cancer of a gossip/backstabber? I have a woman at work, not an RN, who makes this destructive behavior her life. She's near retirement age, very competent at her job, knowledgeable but spreads her black-cloud of negativity to everyone she touches. She talks about everyone, acts buddy-buddy with someone new each week and then backstabs the others. She will, out of the blue during a surgical case, start blabbing on about someone to engage the doctor to get on his good side and make herself look good. She points out everyones mistakes and makes sure it gets spread around to everyone in the place. A few others egg her on and when they are together it's not pleasant. She's very sneaky about it, always making sure she comes out smelling like a rose and everyone else is at fault. It's eerliy quiet as no one mentions her behavior or complains about it. Are they afraid of her or are they professional and choose not to join her in the gossip game. I find it very stressful to work with her and have put her in her place at a few choice times, but like a cockroach she keeps coming back. The boss doesn't say anything about her. I made my feelings known to the boss but I'm not sure if anyone else has ever said anything. What's the best way to deal with this dysfuntional person?

That just chaps my a%% that there is no respect for the patient, the surgical process or the job we need to do. Why do we need to threaten them to ensure our safety processes get done? Everything has to turn into an argument. But who's the first to complain? We know, the one's who tried to prevent us from doing the job in the first place.

I need to vent and get some opinions about coworker hostility. I'm in a free-standing surgicenter that a friend recruited me. I've been there for almost and year and at times it's great and other times I go home wanting to shed some tears. Gee, that's everywhere you must be saying but I know the source of the frustration is some negative, unhappy people spreading their misery on all of us. I've never seen some of the most miserable, hostile, passive-agressive, back-biting people in my life. Most of them are scrub techs in the waning years of their careers in surgery and I guess it must be the grave yard where they plan to retire from. Our RN staff in the OR is low and the boss hasn't made a move to fill a vacant position. They use scrub techs in circulating roles at times and that leaves me feeling uncomfortable being the overseer of their work, which I have verbalized to the supervisor on numerous occasions. One tech in particular is the instigator of a majority of the gossip and negativity that goes around and is very crafty at getting the doctors on her side. When she's not working the place is very different. Low key, people just go about their own business. It's tough to deal with her and I've only heard one person make mention of my above complaints to me. So, then that makes me feel paranoid that I'm "just being sensitive." What's the working environment like at your place? Do you feel the RN's get respect? Do the scrub techs rule the roost? I used to work in a hospital OR with a mostly RN staff and did not have the same treatment or uneasy feelings I do at this place.

"You need to write faster!" exclaimed the doctor. I was keeping a record during a Discogram and she, the doctor was reading numbers and information to me and shouted at me in a snotty tone of voice, twice, that I need to write faster. Well, I guess I'm just too slow for this job then. Call me what ever you want but I guess I can't keep up anymore. I can't multi-task, I write too slow, I can't get the patients to the room fast enough. Maybe I need to go back and do long cases in the hospital rather than short quick cases in the surgicenter. I feel like I can't keep up and now I've been shouted at for it. :angryfire

Funny you should mention this. I've been working in a surgicenter for a short time and feel the same way you do. A few of the techs have a real attitude towards the RN's and one bad day a went off on two of them after tiring of their comments. The instigater of most of it looked at me in complete shock and told me she wouldn't have said anything if she knew if bothered me so much. Where I work our supervisor is a tech and is good at the job, respects everyone and gives us nurses our due. I think the company that owns the centers is making a habit of hiring techs for managerial roles because "they're cheaper" as one person put it. That then, disturbs me. I feel that some techs really think our job is a piece of cake and if one is good at their job they can make it look easy. But, as we all know there are so many responsibilites that the techs are void of so then it gives them a sense of confidence without the consequenses. I used to work at a hospital that employed a mostly RN staff which gave us opportunities to scrub and participate in both roles. I didn't feel demeaned there and didn't feel like I had to watch my back because a knife was going to be plunged in it out of jelousy. The person that said it creates a hostile work environment is so right. Although my current position works for me at the moment (hours, case load, ease of travel) I still will be open to any position that should come my way if it is in a more supportive and professional environment.

I'm working in a free-standing surgicenter and I feel like the quick turnovers are at times unsafe or more conducive to making mistakes. For instance I got a call tonight from my supervisor asking me about a specimen that was sent out on a patient last Friday. She was a local gyne case which ran over into another doctors time who does epidural pain injections. I didn't have some insurance paperwork to send with the specimen because the doc had the chart and we needed to quickly turn the room over and start the pain doctors six cases. After the six cases were done I ran and got my paperwork and had the secretary at the desk call for a pick up for the specimen all the while I was at the desk and saw she made the call. Even later I noticed the bag with the specimen was gone. There was some question about the specimen and she was inquiring if I had sent it. I didn't log it in the spcecimen book because frankly I forgot. I assured my supervisor that I did not leave the specimen in a corner and had the courier pick it up. I'm slightly paranoid now wondering if something got messed up. I just feel like all these fast turnovers don't let me have a chance to think things through and make sure all my t's are crossed and i's are dotted. Did I get my out times? Did I leave any blanks? Did I really see that the consent was signed? For such a responsible job and our license on the line I think it's such a crap shoot if we remember to do what we have to do. Thoughts?

I started at a surgicenter a couple of months ago and I'm getting used to the way things are done there like the really quick turnovers and some of the cases I've not done before like epidural pain injections and eyes. I like it but it seems like no matter how hard I try I can't seem to have smooth turnovers in those really quick cases like the pain room. Either the patients IV bag is bone dry when I'm ready to take them or I take the patient back and their is some issue or the doc still needs to talk to them. The communication is horrible and I feel that people will let you sink and take the fall rather than working as a team for a smooth outcome. Any tips on how to cover my backside? There is no facilitator in the preop/PACU combo unit to oversee the turnovers and it seems haphazard. Any ideas on what to do about that as well?