Stephia87RN

I feel like the way that I explained it everyone thinks the SLP just to me and calmly asked me the questions. She actually shouted them at me even after I answered her in a normal tone.

I got into a disagreement with the SLP that was assigned to my patient and I need some advice and feedback so I know how to move forward. Patient was an adult that fell out of a tree and face planted on concrete. Bilateral skull fractures and extensive TBI. Patient came to us from the ICU with restraints due to patient behavior. Pt was restless and agitated, moving around in bed to the point of throwing herself over the side rails and slamming her head into the side rails. We place seizure pads on the bed to protect her head. She was also pulling at her lines. The RN's before my shift were giving .5mg dilaudid, 1mg Ativan, and 2 mg of haldol approximately every four hours to keep the Pt calm and from thrashing in bed and pulling at lines. She received the last dose at 0338 and I resumed care at 0730. Patient would be calm for 5-10 mins at a time and restless/agitate the rest of the time. SLP walked up to me at the nurse's station and asked "why are we giving her dialaudid, haldol, and Ativan all at the same time. I explained the reasoning and SLP says we are over medicating the Patient. She followed the question asking why the patient needed the PICC and the Foley if she was pulling on it. Very annoyed and upset, I replied with "I don't know, I'm not a Dr." And left it at that. Now I understand I could have handled that part better, but I was offended that she would question my judgement. SLP went to the provider and told him that nursing was over medicating the patient and told the provider that the patient dos not need the lines anymore and that they should be removed. Provider agreed and discontinued the lines and the meds. That night all meds had to be added back on by the night hospitalist because they couldn't keep the patient in bed and the patient ended up in 5 point restraints. The next day, the patient was restless and thrashing around all morning so I decided to give the haldol. The SLP happened to be in the room when I was giving it. She asked me why we were giving the medication and the patient happened to be calm for that 5-6 mins. I told her I was giving it because it was ordered. SLP went to the provider and accused me of unnecessarily sedating the patient and that the patient was not a harm to herself and didn't need the medication. The provider accused me and things got ugly. Needless to say, I removed myself from the patient's care team. I have to sit down with the SLP and her manager in two days because she made a formal complaint of my behavior. I feel she overstepped her boundaries and outside her scope of practice. I also believe she damaged my relationship with the provider and his ability to trust my judgment in the future. What can I do? What should I do? I'm lost and upset and beyond frustrated. Any advice would be helpful. Thank you!!

We have the same thing here on our Neuro floor. It gets depressing when we have the same behavioral patient for one to two months because they have no where to go. The difference for us though is we have great charge nurses and a great manager. They really push gen med patients to the gen med floors and rotate staff on the more difficult patients.

I started on a Neuro unit as a new grad and loved it! We're a nationally certified stoke center so that's the majority of our patients. They can be difficult because many stoke patients have impaired mobility, but having a patient come in completely down on one side and then a week later being able to walk again is one of the most rewarding parts of my job. We do get some difficult TBI patients, but you learn how to care for them with time. Good luck!

Try placing a towel between the legs of the patient do nothing sprays out of the bed pan in the front. Keep the towel in place until the bedpan is removed or you can use the towel to grab onto the bedpan as she is turning so it doesn't spill.

The smell of the preservatives used in the specimens always made me kinda nauseous. My teacher told me to take Vicks vapor rub and put in on the outside of my nose as well as in the nostril. Once I wasn't dealing with the unpleasant odor, I could focus on dissection. It also comes in handy when you're a nurse doing wound care, c-diff clean up, ext. I carry a small jar of it in my scrub pocket.

Thank you so much for everyone's response. Your info is much appreciated!

Would it be safe to say then that shadowing is something that we would see on the original surgical dressing when the patient gets to our medsurg floor post op and drainage would be the expansion of the shadowing as the incision continues to drain?

Will someone please explain to me the difference between drainage present or shadowing present on a surgical dressing? My facility offers both descriptions to choose from for charting and I couldn't find anything helpful on Google. Thanks so much!

I work on the Neuro floor at my hospital. Part of our seizure precautions are having the oxygen set up and ready to go (mask or NC attached) and the suction set up and ready to go including suction kits and Yaunkers. Check 02 and suction would mean to make sure everything is ready to go and all working in case the patient has a seizure. If the patient has a tracheostomy or is vented, it means to check the 02 saturation and suction the trachea as needed to maintain the set O2 sat. Parameters. At least that's how it works at our hospital!

It's only abandonment if your a licensed individual such as LPN or RN. I wouldn't worry too much about it. You can tell your future job interviews that your doctor ordered you to stop working due to health concerns while pregnant.

Nursing is a high stress job. My suggestion to you would be to invest in a CNA class and try working as one for about a year. This should give you a better idea if you'll be able to handle the stress of the medical world. Best of luck to you!

Thanks for the explanation! I get it now 😀 For the longest time, I tried to rationalize this in my brain.

I was in the same situation. I interviewed for my dream job out of school, but was passed over. A few weeks later I accepted an RN position at another hospital in town. Fast forward to two months later, when I was just about done with orientation, another position opened up and I was offered my dream job which I accepted immediately. The best thing to do is handle it as professionally as you can. As soon as you have a green light from the new job's HR, put in your notice. Try to give a months notice if you can, but they may not want to keep you orienting as a nurse since you plan on leaving. So wait to give a start date to your new job until you talk with your old one. I know I felt bad for leaving a floor that put so much time and training into me, but it comes down to whatever is going to make you the happiest. You don't want to regret taking the opportunity just because you want to be nice. In my case, the old hospital boss was very upset and didn't even let me finish my shift that day. But at least I was professional and tried to give my one month notice. Good luck at the new job! I'm a month into my new one and I couldn't be happier with my decision.

It's really important to gain a full understanding of each organ system before you start the nursing program. In the program, most of the teaching is by organ system so having that strong foundation will ensure you won't be lost in your nursing classes. I would email your teacher and explain how you're feeling. She can hopefully suggest some additional reading or maybe a tutor that can help you feel more on level with everyone else. Keep your head down and keep moving forward. It'll be over before you know it :)