The good, the bad, and the ugly

[R!XTER]

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The ugly: family members rescinded a DNR/DNI on an 85yr old with a bowel perf r/t c-diff colitis.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?

[xoemmylouox, ASN, RN]

Leslie I am so sorry. Went through something similar not too long ago. I hope his passing is peaceful.

[sapphire18]

I am so, so sorry to hear about your father, Leslie. You and your family are in my thoughts

I agree, though, that it seems wrong to make him a DNR when he wishes to remain a full code, and is A&O. :/

[itsmejuli]

The Good: I have a job interview for a newly created position that has never been held by an LPN, its only ever been done by RNs.

The Bad: My current employer doesn't know I'm looking for another job. My employer cannot match the benefits of the prospective employer.

The Ugly: I got assigned 2 more buildings to supervise care in. That means another 90 clients and 20 more aids on top of the load I already have.

[LobotRN, BSN, RN]

The sooper dooper good: Able to go part time, and now I AM part time

The bad: I'm now legit cheap enough that I cant/won't hire a cleaning service.

The ugly: Now that I'm home a lot more with the family, I can really see how disgusting we can be. Ewwww.

[CT Pixie, BSN, RN]

Leslie,

I've missed you! But so very sorry to hear about your dad. I agree, with you how can his wishes be pushed aside when he is A&O? Isn't a MPOA only in effect when the person can't make their own decisions?

[onyx33us]

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.

I truly agree with you. But there are some families that have issues (hateful, taking sides or just don't agree) among themselves and that affects their decision making on their sick one. there are also some POA that feels they know better than doctors. Also some are scared to let-go. so there are many issues facing healthcare team..... nice point.

[onyx33us]

The good: one of my patients, who I had last week, looks a million times better. I'm so happy for her.

The bad: another patient is, as one of my coworkers likes to say, on my last nerve. I'll be lucky if I make it to 0700 without saying something I'll regret. Grr.

The ugly: I have to be smiley and kiss butt to annoying patient in the name of good HCAP scores. Normally that's not hard for me, but tonight, it's a struggle.

Remember your piece of paper and bite your tongue. Being a healthcare professional could be very challenging, from listening to confussed resident to kissing butt to dealing with misrable nurses and other nursing staff. LOL be a good nurse, avoid abuse.

[Debilpn23]

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

Hi Leslie

I wanted to let you know I am thinking of you. My thoughts are with you?

[Mommy&RN, BSN, RN]

We had a pt a couple of years ago who needed assistance. I looked like crap. We went ahead and called to code team. When they came in the room, it was said the "the floor does know when to call a code."

They transferred to ICU, he arrested in the elevator. Upon intubation they found a huge bloody mess. He

Died.

He liked at me several times and asked what was going on. I explained to him the he need ICU so they could monitor him closer and provide things we simply could not do on the floor. He looked me straight in the eye and said I don't want to

Go to ICU. I want to stay right here.

[uRNmyway, ASN, RN]

Leslie, my thoughts are with you. I wish you and your family all the strength you will be needing.

Regarding what is going on, I agree with others. I do not think it is right to make him a DNR if he is A&O and doesn't wish to be made one. If anything, emphasis should be placed on helping him cope with his prognosis and accept what is happening to his body, and what WILL happen if they keep having to extend these heroic measures to keep him alive.

It is very difficult for us as healthcare workers when we see patients and families insist on all measures being taken, but the decision should still be made by the person being affected, if they are able to make it, whether it is rational or not.

[TakeTwoAspirin, MSN, RN, APRN]

So sorry Leslie. It's never easy to know the right thing to do, especially not when your own family is involved. Know we are all thinking of you.

[84RN]

.

The ugly: being told by a totally lucid gentleman, "honey, just scratch my balls a little bit."

hahahahahahaha, I literally just snorted my tea. Thanks for the visual.