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Bipley

Bipley

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Bipley's Latest Activity

  1. Bipley

    Nurses are overpaid!

    I got one of my ebay gems in the mail today!!!! It's not one of the journals I've been writing about but instead it is some nursing notes on a single patient from 6/16/1889. It doesn't give a dx but it does give ALL nursing notes. I have to admit, I purchased so much stuff over the last few weeks I totally forgot about this one! It does not give a patient name or dx. 6/16/1889 11:30AM Pulse: 120 Temp: 104.4 Notes: Bathed patient in alcohol, gave douche (vaginal) plain boiled water cooled down to the temp 115, gave powdered Quinine. 1:30PM Pulse 120 Temp: 103.8 Notes: Gave milk, pt has had some sleep and has been very quiet. 3:30PM Notes: Gave milk and stimulant (Pinned with safety pin to nursing notes) MD orders (Dr. JJ Moore): Give teas every three hours in a warm glass of water. Give the capsules at the same time. 4:00PM Casules with meals, passed urine, gave milk. 6:00PM Pulse: 120 Temp: 103.8 Gave milk. 7:00PM Gave milk. 9:00PM Gave capsules 12:00AM Gave capsules and milk, gave douche and enema, good results. 1:30AM Gave milk and stimulant. 3:00AM (can't read, pencil writing is too light) 4:00AM Pulse 130 Temp 104.2 Resp 36 Notes: Gave capsules, alcohol bath, skin feels cooler, moist. 4:30AM Pulse 120 5:00AM Rubbed breasts with liniment, drew off about (???) by breast pump, gave milk, fed baby. (Yikes) 6:30AM Pulse 120 Temp: 104.8 Resp 36 Gave quieting powder and stimulant 9:00AM Pulse 120 Temp 104.6 Notes: Gave 4 capsules and milk. Gave stimulant. Pt slept quietly for 1 1/2 hours after douche. Appears better, pulse not too quick, gave 1 quieting powder. 6/17/1889 Nothing until 12AM Pulse 120 Temp 104.6 Notes: Gave 2 capsules medicine, pt has slept for 2 hours. 3AM Gave milk and stimulant, passed urine dark with strong odor. Gave more milk. 4:30AM Pulse 120 Temp 103.6 Notes: Gave milk and Whiskey 8:30AM Gave milk, bathed and rubbed with alcohol, gave two capsules, patient seems much better, no odor to flow, used douche of hot water. 12:30PM Pulse 114 Temp 103.4 Gave milk and Whiskey 3:15PM Notes: Milk and Whiskey 3:30PM Notes: Patient vomited yellow fluid and curdled milk 4:40PM Notes: Gave capsules and vaginal douche 5:30PM Patient has vomited 5 times, greenish yellow fluid, gave Whiskey in water. 15 minutes after milk. Vomited after about 20 minutes. (geez, I wonder why?) Next page is more of the same, each time the patient was given milk and whiskey she would vomit, pulse down to 80, temp 96. Next day she was given more milk and whiskey, breasts pumped with breast pump, baby fed. Patient ended up eating milk toast and champagne. She was given champagne instead of Whiskey and didn't vomit anymore. This patient record is about the size of a check book. One page per day. Nurse had to write quite small to fit it on the page. It doesn't appear that the patient received her "capsules" every three hours as directed unless the nurse just didn't document it. Once her temp stayed at 98.6 or lower for 24 hours she was permitted to nurse her baby without the breast pump. Food increased to broiled steak and tea for lunch and dinner, poached eggs and tea for breakfast. Daily. Pt was weak but able to sleep, keeping Champagne and milk down, feeding her baby, eating well. She no longer needed 24 hour nursing after 6/25/1889. Something else interesting, it never says what the capsules are, just that the nurse should give them q3h. Everything by the doc is written out, no abbreviations but the nurse uses measurement abbreviations only. One other issue, it would appear the same nurse is caring for the patient 24/7, the handwriting is the same person for the full 9 days. Day and night. Wow. I have a cook book from 1886 and it is quite clear, if you don't have enough money for your food purchases then buy plenty of milk before buying meat. Milk is more important. A quart for each adult and a pint for each child daily. With leftover money buy meat. These nursing notes tend to show that was indeed the thinking. Amazing.
  2. Bipley

    How much for your soul? (This is very long.)

    Ditto. I'll work a street corner before I work in a hospital as a unit manager again.
  3. Bipley

    ER/Urgent Care and Psych problems

    ER might be able to help. Is it a med change issue? Something the ER/ED doc can actually do? If writing an Rx will help they probably can help you. If I were you I would start with your psych. Call and push the heck out of the receptionist until you can at least speak with your doc on the phone.
  4. Bipley

    How much for your soul? (This is very long.)

    Nobody should tolerate a hostile working environment, nobody. However when it comes to customer service, that's life. Nursing is changing for the good and bad and this is one of the changes. The hospitals that are not making these changes are the hospitals that don't have to, places like county facilities. Where are the patients going to go if they don't spew the words, "Is there anything else I can get for you? I have the time." The hospitals that are making these changes are the ones that are trying to keep the doors open. I was just offered a job yesterday at a hospital I had never heard of before and I've lived in this city for 19 out of the last 20 years. Hospitals are opening up all over the place. There is competition that didn't used to be there. There are lots of things I don't feel are right or fair about being a nurse but sadly, life isn't always right and fair. Patients ARE looking up info on line, they ARE aware of their rights, they ARE aware of what one hospital offers over another. That's how it is. Just because we may not like the customer service motto or attitudes doesn't mean it is going to go away. If we don't like the way our hospital is run and if we cannot change what we don't like then perhaps we need to move on. I'm really not singling you out Fergus, you are one of my favorite people here. I'm referring to ALL of us. This is it, this is nursing, this is what it is all about now. I'm finding it is no longer my cup of tea for a lot of reasons. I love contract work and that is likely what I will continue doing. Not sure I agree with that. While I do believe it certainly feels that way at times it really doesn't mean that. The reality is that we have to compete with hospitals that ARE doing the customer service routine. It's no longer a choice or what we would like to do or have time to do. It's just a reality. And btw, this is NOT the fault of the manager. I don't think there is any job that is on the line more in a hospital setting than a manager and the sucky part is that a manager is never going to win. They are forced to put policies in place that are sheer stupidity and do it in such a manner that nursing can accept. They are essentially told that here, here is what you have to work with, here are your tools, here is the workload now you find a way to make it work. Yet who is blamed when there is no way to make it work and everyone is up in arms? Yeah, that would be the manager. But we aren't just losing a single patient. We are losing LOTS of patients and that is why soooo many hospitals that focus more on patient care are opening up and they are a success. That is why hospitals are specializing in various treatments and procedures. They are trying to find their niche in the system. Transplants... what a horror! Ever work for a hospital setting up a brand stinking new transplant unit? You know those stats they boast of such as a 99% success rate? How do you think they get that 99% success rate? It's an absolute horror sometimes. What we do to some people to force them to live to a very specific calander date so they "fit" with our stats is shocking. But that is what medicine has come down to. We have to specialize in something, our hospital name has to be associated as being the best in "X" area. THAT is where the care we provide suffers. In trying to make a name for ourselves because that is where the focus of the hospital is in. Those special gadgets nobody uses? Since when does a hospital knowingly waste money on supplies and equipment? They don't, they buy that garbage because some idiot doc said they want it. Then when they get it they find out it isn't so great afterall. The MN is being blamed for that too and the NM has no more control over how those dollars are spent than you are. Yet who is blamed?
  5. Bipley

    Your Pet and your schedule...

    And that is exactly what they are too! Our little babies. I have my three pounder and 10 pounder on my lap as I type. I can't move around because it will wake them. LOL
  6. Bipley

    How much for your soul? (This is very long.)

    What in the world gives you the idea that I said nothing? Or that any of us said nothing? What do you have to back this up? I would pitch fits, create graphs and charts, demonstrate nursing error corrolates with being short staffed, I did every bloody thing in my power to get more staff. It's more than unfair of you to assume otherwise. Attitudes like this are a big reason why a person who has a genuine insterest in making a unit better finally gives up, puts their foot down, and screams... ENOUGH! You don't like it? Don't let the door hit you on the way out. And the more you slither up the food chain of authority in a hospital the more budgets are crammed down your throat. There ARE only so many dollars to spend. We may need $1.50 for every $1.00 we get to do the job properly but the bottom line is that we have a very expensive hospital to run. The pay and benefits you receive make up the majority portion of hospital costs. Your cost to the hospital is NOT just your salary. It's the taxes that are matched, the benefits that the hospital pays the majority of, the additional taxes the hospital has, the times you call out sick and need to be replaced, the Worker's Comp premiums, and the list goes on and on. Employees are the biggest expense to a hospital. When I was in management employee costs accounted for 75% of hospital dollars. Not sure what it is now. When people began demanding that the customer is always right. We have been forced into a situation where if we don't serve the customer the way they expect to be served, they go somewhere where they do get what they want. That's just a reality of life and you and I won't be changing that in the near future. If you want to push all the patients to your fellow hospital, likely you will. But that means you will be out of a job and eventually you will go to a hospital where you give the patients what they demand if you want patients to care for. Nursing is the first in line when it comes to patients. A patient does not return to a hospital because of their doctor, they return because of their nursing. They can get great care, and a super outcome to their overall condition but if they were not treated as they feel they should by nursing they WILL and DO go hospital shopping. Customer service is a part of your job. Period. I can't continue with this post. I'm getting too angry. Look, you can blame your manager for the sky falling in. But until we all look at this problem and ACT on it instead of WHINING about it, nothing will change. I wouldn't be a manager again for all the money in the world. When you become a manager you really find out who your friends are and who they are not.
  7. Bipley

    How much for your soul? (This is very long.)

    Don't paint us all with such a wide paintbrush, not all are like that. I went into management because I was foolish enough to actually believe I could make a difference. I *did* make a difference in a LTC setting but to try to be positive, do the RIGHT thing, actually do my job in a hospital setting, I don't think it can be done in many hospitals. I was also foolish enough to believe that part of my job as a manager was to defend the nurses when they screwed up too. Yeah, try that once for yourself. Defend a nurse that just made a stupid, yet human error. We all know it happens to all of us, when the nurse feels like a piece of pooh is it appropriate to stand there and scold her like a little child? No, it isn't. The way she feels about her own human error is punishment enough, that error will likely keep her from making a similar mistake. But when you refuse to fire someone for a human error that we have ALL done it suddenly becomes an issue of... well, you didn't do the same for me! You play favorites, Bipley! There is a world of difference between a med error vs. coming into work so hungover you can't perform your job well. One is an honest mistake and the other is a total disrespect for your profession, patients, and coworkers. You know, there are two sides to this coin. It's easy to point fingers at the manager/DON, it's quite a different story when the blame is put where it should be place. That would be all of us. Being a manager is like having a severe case of food poisoning, you are attacked at both ends. In a hospital setting you are attacked by nursing and attacked by those above you. Either way it is a no-win situation and I think most who go into management do so believing they can actually make a difference. When you experience your 10th to 12th episode of management food poisoning you finally give in and say enough. Then survival kicks in. You put your foot down, you tell them how it is going to be, and if they don't like it they can move on. I used to be soooo angry, I would keep my nurses up to date on what I was trying to do. My long term goals, how I was trying to do it. It was never fast enough for them or good enough. *I* was blamed for every bloody decision by hospital Admin. If they didn't get enough of a cost of living raise (merit raises aside) *I* was personally to blame. WTF? What say-so do I have in cost of living raises? Hospital costs? And speaking of hospital costs be honest here... how many have slipped something in your pockets and taken it home? A course of PO abx's? TEDS? Saline? Read these very threads. There was a nurse on another thread (regarding support stockings) that admits she just takes hers from the supply room. Any clue how much this happens? Used to be that we couldn't keep Augmentin in the Pyxis. I'd go to give it and the Pyxis would say there were 40 and there were actually none. Not even enough for ONE dose for the patient who is actually paying for it. We finally had to increase our narc spaces in the Pyxis and put the drugs that were stolen in narc spaces to keep a closer eye on them. What about wasting supplies? We ALL have a hand in hospital cost, some have more of a hand than others. That's all. Then there is the good buddy system. When I was a staff nurse "X" was my friend. But she took advantage of our friendship and thought she could get by with calling in sick every Monday or Friday. Just how much of a merit increase should she get? You tell me, how much of a merit increase should she get? You are short staffed? Yeah, so am I! I have a full time job doing what I do but when my "friends" call in sick, who is there to replace them? Yeah, that would be me. Don't talk to me about being short staffed, I'm busting my tail to try and help and then I stay another 4+ hours daily to try to make a dent in my own work. Then while I am covering for my "friends" while they are calling out for the 10th time of the year all I hear is whining and complaining. The hospital is terrible, I need a raise, I have too much work, too many patients. Yeah, so do I. I've asked for help, I've asked for more staff, I've asked, demanded, and insisted on more staff for better patient care. Let me tell you what goes on in the meetings for managers, we are told this is how it is and it isn't likely to change. Tell your nurses this is all the budget will accomodate. Ohhhh, so you are a manager too! Do you think I am getting $20K annual raises merely for being a manager? I likely make about a dollar or two an hour more than you for 50% more work and hours. I want to know what your manager has to do with this. How is this his/her fault? That IS who you are blaming so you tell me how this is your managers fault. I don't think you realize it, but you just proved my point beautifully. Yes, that is correct. That is the idea behind computerized charting. Again, may I assume you are blaming your manager for computerized charting? We are told what to do, our job is to pass on the information to you in a way that doesn't seem like the end of the world. We can get into a screaming match and I can tell you to suck it up because this is how we will ALL be doing it or I can try to present it in the most positive way I can. Do you really think I am any happier about these issues than you are? Com'on, you are not being fair here. I never did that as a manager, perhaps that is why I worked such long hours. If your hospital is putting people in your critical care units that are not qualified, why are YOU still working for THAT hospital? It's a two way street.
  8. Bipley

    Slugged in the chest by med-surg patient

    So you understand the details of a real policemen vs. a wannabe type more than most. I can't imagine anyone asking a real police officer to go to work without a gun. If he is needed to protect others, he should be permitted to do as he has been trained. We aren't talking the wannabe's here but the real deal! To ask him to put his life at risk with nothing to defend himself is beyond stupid and sounds EXACTLY like a hospital! Geez..... I don't blame him in the least for refusing to work hospitals. Hospital admin can be amazingly stupid. How much liability would there be if your husband was harmed because the hospital refused to allow him to protect himself?
  9. Bipley

    Was I wrong or was the order wrong?

    What brought this to light? Did someone question the order or how you handled it?
  10. Bipley

    Vet tech calling herself RN

    I think you might be assuming that is the case everywhere and that's just not true. I see ads all the time for schools offering vet tech/asst. programs, 9 months and you are out the door working your new career. I've lived in five states and none of them required 2 years. My old vet clinic didn't have trained techs, they were trained on the job. No school, none. That is just not an RN.
  11. Bipley

    Vet tech calling herself RN

    I don't have a problem with moderation and I never did. That's what I'm trying to tell you. I have nothing to PM you about, I asked a question, you answered, I understand, and that's all. Nothing more.
  12. Bipley

    Sore feet! And what's a "corn" anyway?

    One thought is to try Crocs brand. The way the shoes fit is to NOT touch the sides of your feet. If they fit properly the only part of the shoe that should touch your foot is the bottom. There should be a bit of air between the sides/top of your foot and the shoe.
  13. Bipley

    Vet tech calling herself RN

    I never claimed to have a dispute with moderation. I asked for an education. I didn't realize I needed to keep that hush hush.
  14. Bipley

    Slugged in the chest by med-surg patient

    I wonder why we don't push for better protection in a hospital. Seriously, why don't we get the same thing the VAs get? How come we pay taxes so others can have protection but we can't? Life is changing and hospitals are changing. We take care of a whole different group than we did just 25 years ago. We have mega drug and gang wars, ever been to an ER when a gang banger is shot? What is security to do? I know I've seen them pony up to the opportunity to fix that problem. They dial 911! Yeah, I can do that for myself. I'm not saying that all security folks are weenie types, there are some really good ones out there. But their lack of training and lack of legal power certainly does limit what they can do. They've cut our budgets, they've cut our supplies, they've cut our staff, they've increased our workloads, ... now they have room in their budgets for REAL policemen working at hospitals. Even if they had them near the ER that would be cool. If s/he was an ER policeman yet we could call with a creepy patient or visitors on the floors that are on the edge of doing harm... wouldn't that be cool? Just think about it, we find ourselves in a very dangerous position and we call security. Do you want the 90# wannabe protecting your back side or a REAL policeman? I know, we can all dream the impossible dream... However, I'm interested to know why we aren't all pushing for something a little better? No, make that a LOT better!
  15. Bipley

    Vet tech calling herself RN

    BlueEyes... I believe I need an education here. I'm reading the posts and I'm not seeing what you refer to.
  16. Bipley

    Slugged in the chest by med-surg patient

    I may be wrong but I believe we all have one, but you can only see your own. You can't see mine but I can. If you are at 0%, you haven't done anything wrong.