RNed

Is your manager also a good leader ? I have a good manager, however I do not believe she is a good leader. I distinguish management and leadership with different characteristics. Today, I believe it to be difficult to be both in our current health management style. What would be the characteristics and behaviors of a good leader is supressed by the style of management demanded by the higher ups. Money as the major decision maker is the message sent to middle management and this stymies leadership behaviors. I identify more leadership people in private business than corporate or organized business. I believe this is a result of corporate buisness saying, " we want you to manage our people, it is we who will lead." I say I have a good manager. I do not fault her for not being a great leader. She must abide by the messages giving to her and that is, " do not lead, manage."

I am not sure we need a policy regarding euthanasia. This question poses the idea that we can assist someone who determines their quality of life is not ideal or tolerable and after this evaluation take acts that terminate life. I question whether we need to have a euthanasia debate. I believe the problem lies much earilier in the equation. People seem to die fine without our help and despite our help ! The real question is, " should we intervine with massive support to postpone a death event.' The fact that we can - does not mean, we should. I may be out-of-line here, but I don't necessarily believe withdrawing ventilator support is euthanasia. The cause of death is underlying lung disease. This person was not born with a ventilator and the fact that a ventilator is not available or choses not to be available is not the cause of death. Many people have died because service was not available or the technology had not been developed. Never-thel-less their cause of death was not do to lack of intervention, but do to underlying disease. In summary, do we need euthanasia or do we need stronger laws regarding patient rights and choices in how much medical care is utilized? Absolutely, we need to continue education of society in the application of medical interventions. Society needs to have a full understanding of what we can do and can not do. The questions regarding euthanasia becomes mute, if we do not apply the full weight of medical intervention. In short, euthanasia is closing the barn door after the horses are gone. We need to ask these types of questions long before we call for the ventilators, tube feedings and pacemakers. Its not magic or mystical to keep someone alive, but to have them think, interact, respond and smile that is magic !!!

Nursing and marriage is like mixing apples and oranges. Being a nurse places no more hardship on a marriage then other professions. I have heard it said, "that you get married when you don't know each other and get divorced when you do!" Some spend to little time in understanding who they are marrying. To often I hear nurses referring to work as a cause of divorce in the false belief that being a nurse was the problem. Marriages do not work when the two in the marriage can't, don't or won't continue the hard work it takes to make it work. Being a nurse does not bestow additional burdens over and above anyone else. It takes two to get married and two to get divorced. My long hours and I'm always tired caused my divorce. He or she didn't understand what it is like to be a nurse. You and your spouse bare the responsibility of divorce and it didn't have a darn thing to do with being a nurse. Nursing and divorce do not belong in the same conversation. One has no relationship to the other except when one tries to justify the act and project the cause.

I don't quite understand. This seems to be a problem of reporting between the sender and receiver. Not much more than that. Some get very detailed reports and others give scant reports. I take the report given to me and then followup with a patient's chart review and assessment. A good report makes things easier to some extent, never-the-less, I confirm what is said in report by chart review, etc. A poor report is just that a poor report. I still need to followup, so there is little change. I give report based on what occurred during my shift and any additional stuff, I THINK IS HELPFUL !. Questions, I answer if known and say, I don't know if not known. If it is important to them they can look it up. I say, "Vital signs Stable, Normal, or OK " if you want to know their MAP, go look it up !! However, I remember most abnormal values. This event sounds more like a personality conflict, rather than harrassement or poor nursing skills. Remember, it is only the "special" nurses that can properly assess the nursing care given while they are at home and asleep. I haven't actually met any of them, but I have ran into a few wannabe's.

Wait one week, if a better fight doesn't surface and overshadow this one, wait one more week. If at that time all is going well, then you know this is the only issue you need to confront and once resolved you will have a nice place to work. Or you can take Brett's advice. LOL

Get a good anatomy book and study the underlying structures of the wrist. Practice feeling and visualizing those structures on your husband, boyfriend or girlfriend's wrist with the book turned correct for orientation. This is one of those things, I do not suggest you do by yourself because you need to reverse that visualization when you attempt the "stick" on the patient. So study it in the correct orientation as though you were actually doing it. Prior to sticking the patient attempt to feel and visualize their underlying structures in your head. Enter the needle at an approximate 80 or 90 degree angle. Advance the needle slowly thereafter. Remember not to place to much pressure on the artery from above as this can occlude the artery and might hinder blood return. Specially on the low b/p patients. At times, I have used my palpation finger to sorta "pin" the artery between my finger and the bone therefore securing the artery prior to sticking. Do easy patients first and then move to the swollen, edemous, low b/p, difficult sticks. Chart Allen's test and note distal warmth and color prior and after the stick. Practice and good luck.

Both my wife and I are nurses. My personally is laid back and things will work out. My wifes is type AA working on a heart attack at 45. We had difficulties in marriage and children. She felt very guilty about the kids and the lack of parents at home as much as she thought we should be. A bit worrisome for her than I. We measured the kids and found both to be well adjusted, good grades and good social behaviors. All appear well with the children. I said these kids are not broke, we do not need to fix them. We measured where we lived and what we did. We both liked our jobs and the area. We measured our marriage and goals. Now, that was in need of repair. We didn't see enough of each other and when we did at least one of us us to tired to be a participant or the phone was ringing with another problem at work. Vacation seemed to be the only time we were able to detach ourselves from the day to day routine and they were far and few between. The point I am trying to make is - find which piece of life needs correction and fix it only. Not to sound to stereo-typcial, but my wife and the others nurses I worked with seemed to focus on the children and their guilt of "mom" working. However, when we and some "highly paid professionals" looked at our situation it was not the children that needed to be fixed. It was their parents. Another post speaks of a speech therapist and states, "she is not happy". It refers to the fact she only sees her children after 6 pm and on some weekends. The question, " are the children doing well and if so shouldn't she be happy with and for her children. Working moms are not bad moms, if that was the case, working fathers would be bad fathers. No secrets on how we fixed our problems. Define what works and what doesn't work. Fix only those things not working ! Use your nursing skills, define the problem, develop a plan, assess the plan and if needed change the plan.

Not sure if I can jump on the bandwagon and say nursing is a fanastic job in the current atmosphere. However, one point which could be supported is that there is a shortage and job availability is almost anywhere one chooses to live. This could be a selling point to the young who are not sure where they will end up. High Tech work is great (I guess) unless you choose to live in our rural communities. The biggest selling point is that no matter where you live there will be a healthcare facility somewhere close and it most likely will need nurses.

One of the things the nursing shortage has developed is latitude for travel nurses. In essence they can stipulate certain parameters regarding work, days off, units worked, area worked, etc. Management has an option of not contracting with an individual who's working conditions do not fulfill the requirement. This is why it is so improtant that management define the needs and contract to those needs. If the travel nurse has the superior position, she/he can decide to work somewhere else. If management has a superior postion they can choose not to contract. It is supply and demand.

In short, remember the Gi tract, esophagus, stomach, duodenum, jejunum, ileum and then colon. PEG tube= percutaneous endoscopic gastric tube. Placed in the stomach, primarily for tube feedings. J-Tube = Jejunem tube, placed in the jejunum, primarily for tube feedings. Why the difference? Some patients are at higher risk for aspirations and J-tubes lessen that risk do to placement of tube feedings farther down the GE tract. In addition, sometimes they may want extended healing time or resting of the doudenum or stomach do to surgery, disease, etc. and opt for a J-tube. In general they are somewhat the same. Depending on port configuration, you may have medication ports, etc. Typically you check for residual content Q 4 hours. I flush the port with 5 - 10 cc water after medications to confirm something didn't get stuck and that all medications entered the bowel. Check with your policy and procedure manual. Absolutely, check the chart and confirm you are dealing with gastric tubes, there are many more tubes that exit the abdomen, T-tubes, fistulas, drainage tubes, etc. which do not enter the gut and are for output only ! There is more to it than that, hope this refreshes your memory.

"It always amazes me that people get upset with those who use the term that has ALWAYS been the name for the work those individuals do.... instead of being upset with the individuals who are being disrespctful & crossing another RN's strike line in the first place. "Replacement staff" is sugar-coating it to make it more acceptable. It is NOT acceptable. It never has been. " I did not say or imply that crossing a picket line is acceptable. What I wish to convey is the need for "new" thinking within our ranks. I find it just as offensive to be labeled as having a "union mentality" implying less "mental capacity" than those who are not unionized. I certainly do not think my or your mental capacity is less becasue we belong to a union and support a union agenda. Nor, do I believe those who cross a "picket line" do so with the sole intent to harm the union or our fellow nurses. Although surely they do undermined the power and unity of the picket line they cross. Our adversary remains the same. Those power brokers who deny satisfactory working environments and adequate pay. I only suggest "new thinking" might indeed bring new solutions. Over the past 10 years we have failed to provide great improvements in our labor movement. We can not continue to blame "strike breakers, replacement workers or as you wish to call "scabs" as the cause for this failure. That is an excuse our "unions" and "membership" exercise to often. Our's is the failure to development a leadership capable of uniting all nurses with a clear and concise message and then following up with a clear and concise agenda. We will never organise all nurses as long as we continue to divide and call our fellow nurses names. I believe that to be true and that is all that I said. "The anger nurses feel against them has nothing to do with "the union" leaders." The anger nurses feel has everything to do the the "union leaders". "SCAB" is soley, terminolgy of union rhetoric, promoted by unions and for union purposes. It serves no purpose for nurses to call other nurses "SCABS". We may not walk in the same footsteps, however, we are on the same path.

There are a number of issues to consider prior to joining a union. Priority one, is the leadership of the union effective. Without good leadership and an active membership the union most likely will not do a good job of representation. With good leadership and an active membership you can accomplish almost anything. I am not anti-union. However, I do not blindly serve anyone without having measured those who are identified as leaders. This includes unions. I have a general rule, any nursing union leadership which refers to replacement nurses, more commonly known as those nurses who cross a picket line, as "SCABS" more likely than not represents the UNION first and NURSES second. Until nursing unions understand they represent nurses first and drop the rhetoric of calling our fellow nurses "SCABS", we will continue to have non-support from a large portion of our fellow professionals. When we call our peers a derogatory name, we give the right for all to call each of us names. It only serves to demostrate we are common labor and should be dealt with as common labor. Villianizing the replacement worker (calling them "scabs") is a union tactic to serve union purposes, it serves no purpose for nursing. The union needs an escape goat and the adminstration needs to have the forces divided. The more the union fights amoung itself the better it serves adminstration. Adminstration loves to hear that one "loud-mouth" nurse complain about "SCABS" rather then the real health issues. Why does it always seem the media focuses on the "SCAB" yelling and quietly mentions the issues. And for you union members which would find this offensive. I am one of you and a past union representive. Give respect and we may receive respect. Maybe next year they will not cross our picket line !!

I think in most CCU/ICU settings, IABP patients are 1:1 , unless proven over time to be stable. However, I note that adminstration has inferred a possible charge of insubordination. This bothers me. When adminstration attempts to imply or infer threats it represents the difficulties occurring in staffing and the means inwhich they (adminstration) is attempting to solve problems. Of coorifice, they can charge any employee with insubordination. The question is, are they willing to follow thru for this case! If they got their way the first time,I suspect adminstration will continue to manipulate the staff by these means. I recommend the nurses get together and education themselves in labor practice and nursing regulations in their particular state. Threats or implied threats work when we are uninformed about our rights,laws and responsibilities. We put our patients, ourselves and our hospital at risk. We serve our adminstrators well to correct their mis--interpetations. We keep ourselves out of trouble and therefore by default the hospital out of trouble. It is best to call there bluff (tactfully), when you have all the facts. Insubordination is vague in scope and practice. You stated this assignment was unsafe in your staff, bedside view. It was her obligation to prove to you or the state labor and nursing board this in fact was a safe nursing assignment and that your refusal to accept was do to other reasons. First, she needed to prove your assessment was false and hers was true. Hard to do if you are management and not a bedside nurse. Second, she needed to identify a reason outside of patient safety why you would refuse this assignment. Again, unless you have documented disciple actions in your personal file a difficult task. The nursing board most likely would ask, what alternatives were discussed regarding the assignment? what were the resources available if either patient became unstable during shift? what is the experience level of the nurses on staff that night and the nurse in question? of the nursing supervisor? what was staffing? etc.? what is hospital policy? Most hospitals would not charge a nurse with insubordination without one darn good case. Also remember insubordination is labor and not neccessarily a nursing board issue. No threat of losing your license, unless you took the assignment. They, the hospital, risk the loss of face with the remaining staff and possible countersuit by the accused nurse. I pose this because,once someone accepts the assignment a precedent has been set and it makes it difficult for the next nurse. I may be wrong here, so feel free to correct me. Just a thought !

Great Idea !!! on that insurance and retirement concept. Where is the ANA and our local state associations on this? I somewhat think the employer supplying insurance and retirement lessens our individual responsiblities and accountability. In addition, it becomes a barginning chip used in negotiations. This divides the nurses within an association and lessens the unity. Some want more money, heck with the insurance and retirement, others demand better insurance and retirement. Thus we remain divided and our message is mixed. Not sure the hospitals and health systems would give either up. It would cause the nurses to be more united and that's not good. Also, the retirement accounts have a dual purpose for the health system. Increasing their finacial picture and worth on paper. the insurance would cause difficulty by reducing the insurance pool in purchasing employee insurance. This would cause the adminstration to pay more for their insurance. I doubt they would support "that" concept. Great idea, count me in ! Where's an insurance agent when you need one??

I have been reviewing this bulletin board over the past 7 days. Quite interesting and stimulating. Thank you. I have a question to ask any interested in responding. I have worked in healthcare many years, x-ray tech from 1972 - 1987 and RN from 1983 -1994. My nursing experience has typically been Operating Room than Critical Care i.e. open heart recovery, IABP, LVAD, Vents, etc. However, I had an opportunity to pursue other vetures and spend time with the kids. My hiatus has been 7 years. Currently, the children are going to college and I have decided to return to Nursing. I have reviewed an RN refresher coorifice and it appears to be basic nursing. My previous RN working peers have not supported my taking a refresher coorifice (to basic) and suggest that a modified orientation would be sufficient for my return. One friend is a nurse educator and says 4 week orientation would problably bring me up to speed fairly quickly and I could progress from there. Question 1. Has anyone taken the RN refresher coorifice and if so, does it represent as a basic nursing refresher? Question 2. For those of you that have taken a hiatus from nursing and returned, how fast did your skills and your comfort level return?