The good, the bad, and the ugly

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So much has been going on at work lately, I just wanted to start this thread for us to share one or two lines on each to reflect recent events at work. I'll start:

The good: the last two shifts I worked have been so much better than the way its been lately in terms of volume and acuity. Here's hoping it continues.

The bad: I had a near miss with a med error that really shook me up. A reminder to be even more hyper vigilant and I'm so so thankful it was a miss.

The ugly: family members rescinded a DNR/DNI on an 85yr old with a bowel perf r/t c-diff colitis. Pt was taken to OR with approximately zero chance of survival. How is this even allowed?

i can only assume TX.RN.Shannon has never herd the "definition of a gentlman", and now i need to go get a rag to clean up the drink of coffee i took as i read the ugly" part : )

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Specializes in Emergency/Cath Lab.

Good: Asked to start training to be a charge nurse

Bad: SSDD walking through the doors.

Ugly: Seeing the utter failings of parents and the impact it has on kids.

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Specializes in Emergency Room, Trauma ICU.

Good: sticking a 12 day old with a 24g on the first try!! (Esp cause they were born at 36 weeks!)

Bad: more and more ETOH pts who come in.

The ugly: being puke hugged by a ETOH on suicide watch who also has HIV. Had to get a fresh scrub top :(

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The effin' awesome: Starting my own business and doing >$150K the first year with one great client

The bad: That client loses a lot of work, and no longer needs me as much...and I have wasted two years doing no marketing so then my income dropped to ... $35K and I have to spend two years playing catch-up getting more clients

The ugly: That client is 8 months overdue on a big invoice on my last case with them and will not return my calls :(

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i can only assume TX.RN.Shannon has never herd the "definition of a gentlman", and now i need to go get a rag to clean up the drink of coffee i took as i read the ugly" part : )

Actually, I have "herd" what a gentleman is. I used the word here with just a wee bit of sarcasm.

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Specializes in Critical Care, Education.

Sorry - don't mean to threadjack BUT

PLEASE don't hesitate to involve your ethics committee in cases of 'futile care'. Granted, I work for a faith-based organization and our facility-based committees may be stronger than most, but they never hesitate to get involved when a clinician asks them for help. Group membership includes physicians, so they don't have any qualms about having 'critical conversations' with other docs. Just because a (misguided, deluded, inappropriately motivated, etc.) family wants a treatment/intervention does not mean that the doc has to do it.

As a bedside (ICU) nurse, I have actually refused to participate in an futile resuscitation - thought I was gonna get fired because of my conscientious objection, but didn't. Wasn't my assigned patient, but I knew enough about the situation to make an informed choice. Afterward, the doc (ED, code leader) & dept. manager said they respected my choice - but wished I had told them in advance of my feelings. Note: my refusal did not stop the code because there were plenty of others available to work it.

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Specializes in Med-Surg.
The effin' awesome: Starting my own business and doing >$150K the first year with one great client

The bad: That client loses a lot of work, and no longer needs me as much...and I have wasted two years doing no marketing so then my income dropped to ... $35K and I have to spend two years playing catch-up getting more clients

The ugly: That client is 8 months overdue on a big invoice on my last case with them and will not return my calls :(

Wow, really sorry to hear about that GrnTea...Wish you luck finding more clients and getting in touch with the defaulter!

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Oh, I have other clients. I'm just not willing to write off that big an outstanding invoice. Thanks, though! :)

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I'm sorry, but there comes a time when the doctor needs to step up, grow a pair, and spell it out to the families real nice and simple! The families need someone to tell them "no" so that they can feel less guilt about not trying everything possible I know, but there really comes a time when we are just torturing these folks.

Sorry - don't mean to threadjack BUT

PLEASE don't hesitate to involve your ethics committee in cases of 'futile care'. Granted, I work for a faith-based organization and our facility-based committees may be stronger than most, but they never hesitate to get involved when a clinician asks them for help. Group membership includes physicians, so they don't have any qualms about having 'critical conversations' with other docs. Just because a (misguided, deluded, inappropriately motivated, etc.) family wants a treatment/intervention does not mean that the doc has to do it.

As a bedside (ICU) nurse, I have actually refused to participate in an futile resuscitation - thought I was gonna get fired because of my conscientious objection, but didn't. Wasn't my assigned patient, but I knew enough about the situation to make an informed choice. Afterward, the doc (ED, code leader) & dept. manager said they respected my choice - but wished I had told them in advance of my feelings. Note: my refusal did not stop the code because there were plenty of others available to work it.

what a timely thread.

although this is a personal situation for me, it still pertains to nursing and its ethical standards...or its lack.

the good: my father is officially a dnr.

the bad: he does not know, as his wife is the mpoa and she has not told him.

the ugly: dad wants to fight it all - he is PETRIFIED to die.

he has 1 kidney with approx 10% function, and cannot be consistently dialysized (sp) because his bp plummets.

in the icu, he has had 3 cardiac arrests in 2 wks - rescusitated ea time.

on a vent with a new trach (can't wean him off); new fdg tube; and a zillion lines.

also newly dx'd with liver ca with mets to spine.

just turned 82.

i agree with the dnr.

still, and as a nurse, how can his wishes be dishonored when he remains completely alert and oriented?

his wife agreed to dnr after much pressure from pulmonologist and oncologist.

they both maintain he must not be processing all this info (about his health).

is that their way of suggesting he's incompetent?

thanks for letting me share the g, b, and u.

leslie

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Specializes in Sleep medicine,Floor nursing, OR, Trauma.

Oh my heart. Leslie, I am so sorry to hear of what you, your dad and your family are going through. As one who is in the midst of the ICU/intubation battle with my own dad, I understand the turmoil. It's not much, merely the words of a stranger on the internet, but you have my sympathies and my support. I'm always here to lend an ear and a virtual hug PRN.Kindest regards,~~CP~~

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Oh my heart. Leslie, I am so sorry to hear of what you, your dad and your family are going through. As one who is in the midst of the ICU/intubation battle with my own dad, I understand the turmoil. It's not much, merely the words of a stranger on the internet, but you have my sympathies and my support. I'm always here to lend an ear and a virtual hug PRN.Kindest regards,~~CP~~

as i am here for you as well, cp.

and thank you, most sincerely.

leslie

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I know I'm a little off topic but here it goes:

The good: I'm getting married next month!

The bad: I failed nursing school this past semester!

The ugly: I'm unemployed at the present, but I'm job hunting!! No luck yet!! When I get hired again, I'll be back with an update!!!

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