GregRN

I figure I should graduate with about 70K in loans for CRNA school. YMMV depending on lifestyle, family size, frugality, etc.

Tired, I have to tell you that I really appreciate your posting on this site. You offer a "bigger picture" perspective not always seen when in the trenches and you have a way of reaching your audience with your information in a way that isn't always found in the hospital. Thanks for your participation and insights.

From my own observations I have seen a number of unwritten rules when it comes to nursing practice. Policies and procedures are fine but often times these unwritten rules are more powerful. Here are some I have noticed: 1. Your nose will not itch once all day...until you enter the room of someone on contact precautions. 2. Run around like crazy and you will be labeled unorganized and harried. Move around looking calm, cool and collected and you're labeled lazy and become a target for more work. 3. Never say "oops" in front of a patient. Instead, replace it with the word "there." Same effect for you...and less fear for the patient. 4. The moment you think it's safe to drop ass in your comatose patient's room is the moment their family decides to show up for their first visit in a month. And my favorite personal observation: 5. Never underestimate the healing powers of being over-bedded. Feel free to add some of your own unwritten rules of nursing...

As a group I don't notice one service to be particularly more pompous than another. There are good and bad eggs within each. I do, however, notice a significant difference between private and teaching hospitals. A disproportionate amount of "tude" seems to come from the private vs. the teaching hospital side.

I linked to this thread from the front page of allnurses.com and didn't realize it was the Geriatric section. Not to spoil the mood but when I read the thread title: "Sad Residents, what would you say" I kept thinking it was about Medical Residents...the doctors. I was so confused. Go back and read the responses in the thread from that perspective and it really changes things. Holding their hand, just listening, handing them Kleenex...the whole things seemed odd to me. It wasn't until someone posted something about LTC that I finally figured it out. Sorry. It's been a long week...

The point is the same though. Even if educated that Tylenol will hurt, then the person will take enough to hurt. Tylenol is safe. Trying to kill or hurt yourself is what isn't safe. That's where the focus should be. I'll advocate the spending of money to reach out to those who are hurting and need help in order to reach them before they try to hurt themselves. However, I won't be a fan of spending money on talking about how unsafe Tylenol is. The focus should be on the root issue.

I hate to play the role of Captain Obvious but it's not Tylenol that's unsafe in this story, it's suicide that's unsafe. She didn't mistakenly take half a bottle of Tylenol because she thought it was safe and would be an effective way to treat her whopper of a headache. She took half a bottle of Tylenol to end her life. If you take half a bottle of any medication it's likely going to give you a pretty good head start on meeting that goal. Sorry, but these kinds of arguments drive me nuts in nursing. Are we supposed to now say that Tylenol is unsafe and should be banned? Are we to say that the patient who took the pills had no idea that they would make her sick or even end her life because they were OTC drugs and are perfectly safe? Are we to say that an education campaign on the harmful effects of OD'ing on Tylenol would have prevented this from happening? This is a story about a suicide attempt, not a story about how unsafe Tylenol is. Putting the focus on anything different does not make progress in solving the problem or getting the appropriate help for people. Change the title of the thread to "Suicide...how can we reach people to get them the help they need" and then I'll be on board.

Are you sure?? Source? A blue bracelet, code for DNR, is protected information under HIPAA (not HIPPA...pet peeve) but putting DNR on that same bracelet is protected information? You might want to research that one...

Not to be rude but...so what? What's wrong with patients making their wishes known to the entire world? I would think that's what the patient wants, that if they were to code in such a manner that required intubation or "heroic measures," they would want the world to know to let them go peacefully without the threat of trauma or lengthening their life with no added quality to it. If those were my wishes and my ability to make this decision while of sound mind were all I had left, and my will and legacy depended on it, I would want everyone to know it, regardless of whether they were part of a health care team or not.

Your hospital almost certainly has an ethics committee. They can help apply ethical perspectives to sorting through issues like a different doctor, second opinions, transferring to another hospital to provide care, etc. If your husband is worried about certain parts of the patient's chart up and disappearing then the more eyes you have looking at the patient, the better off she will be. Requesting ethics consults are absolutely within the scope of practice for RN's and can be done by any RN at any time. One more thing to add: one of the nice things about being a traveler is that you don't have to tread as lightly when it comes to political stuff like this. As a full time RN one has to maneuver some political waters carefully when calling for an ethics consult. Sometimes the docs feel like an ethics consult was called because they were doing something unethical, were doing something wrong, or weren't doing enough, etc. The ongoing relationship can be hurt after this. However, some ethics consult requests are done confidentially, as is the case here. At the same time, a traveler has the ability to rattle some cages without as much worry of relationship strain or retribution from others on the health care team since their assignment is much shorter and ongoing relationships are not a concern. lostdruid, am I correct that your husband works in a non-teaching hospital?

The worst gift I ever received was the one never given. It was my birthday, and while I have never made a big deal of it I always appreciate when people say, "Happy Birthday." Where I work there were a number of people celebrating birthdays this particular month. Cards were passed around at various times to sign and write a little note. Different people brought in a cake, a dessert, something on that person's birthday in an attempt to make it a good day for them. My birthday came and went without so much as a mention of it. All those cards that were passed around to sign apparently weren't meant for me. No card, no cake, no dessert, no mention. All of my family is in another state. I did receive a call from my parents and my younger sister wishing me a happy day, which of course I missed. I called them back but they didn't answer. My older sister and her husband didn't even call to wish me well. I usually spend my birthday with my sweetie, but this birthday no sweetie was to be had so I kind of kept to myself. I was starting to wonder if maybe the private, quiet, walled-off way I carry on through life was starting to catch up with me, if people thought that I just didn't care about certain things. I decided to get out of the house for a bit. The best gift I ever received came next. I went to the gym that night with a lot on my mind. I was replaying all these events in my head, thinking about all my personal mistakes I've made in my recent past and how I needed to quit shutting myself off all the time and should start opening up more. I thought about how I didn't even know how to do this, where to start. This was heavy stuff. I handed my gym membership card to the trainer who scanned it in the computer. He handed it back to me with the usual, "Have a good workout." I just nodded 'thanks' and sheepishly put my head down and started walking toward the locker room, back to the thoughts that were consuming me. After a few seconds I hear someone say, in a surprised voice, "Oh, and happy birthday." It was the person who had just scanned my card. A total stranger. It was the only live voice I heard wish me a happy birthday that day. I pretended not to hear him and just kept my head down while walking away. It didn't cost him much, and probably seems kind of silly to some people that something so simple could mean so much from someone you don't even know. It was a great gift and was very much appreciated. Thank you.

I've seen some very passionate people, for whom nursing is their calling, do some very mind-numbingly, stupid things and compromise safety with patients. At the same time I've seen some money-grubbing bastards provide care in such a way that their patients are blown away by the attention they've received and frequently get nice comments from them. Point being, so long as the standard of care is met and/or exceeded, I really don't care the reasons someone chooses nursing. My care doesn't suddenly become better because I receive less money. If so, I'll really suck when I'm a CRNA. But if you insist on being paid less then what you're worth for the sake of being noble, you are more than welcome to come work for me some day.

Agreed. The way I've gotten around this is to bring it to the attention of the patient. Should a patient not meet the computerized form's assessment of a social work consult, for example, but I feel they need one, the conversation might go like this: "Mr. Smith, I want to make you aware of the many programs and services available here at the V.A. that will make this transition much easier for you." I then go on to explain what they are, how they will be helpful, how they don't have to be a lifestyle change but only something to get them through this phase, etc. I then ask the patient the question, "Would you find this helpful and want to find out what services are available?" Then, when submitting the consult, I'll write, "PATIENT REQUESTS information about xyz..." Regardless of if they fit the computerized assessment's criteria of needing the consult or not, if a patient requests it, they must follow through. Sneaky? Yep. Does the patient benefit? Definitely.

Well, I guess if an earle can be a leslie, then an Emmanuel can be an Emmanuella.

Please don't wish that on me...