What made your jaw drop

[DextersDisciple]

Pt had moderate sedation and was brought to recovery drowsy but arousable. PCA started but no other drugs administered by nursing. Pt begins snoring and becomes completely unaroausable. Friend at bedside asked how frequently the pt was pressing PCA button. Friend was indeed pressing the button for the patient q6mins.

Pt received over 7mg Dilaudid and had to be reversed.

What's something that made your jaw drop?

[Horseshoe, BSN, RN]

I'm Swedish :)

Some friends of ours were vacationing in Sweden, and their son was hit by a car. They said the Swedish medical system was the best they had ever experienced. Their daughter just got her MD here in the US and has matched for her residency in my city. She says she was inspired by the Swedish medical care her brother received!

[DextersDisciple, BSN, RN]

Some friends of ours were vacationing in Sweden, and their son was hit by a car. They said the Swedish medical system was the best they had ever experienced. Their daughter just got her MD here in the US and has matched for her residency in my city. She says she was inspired by the Swedish medical care her brother received!

I heard they allow up to a year maternity leave. Macawake can you weigh in??

[City-Girl]

Whenever I'm setting up a PCA for a patient, I always explain that PCA stands for patient controlled analgesia and if the patient is awake enough to push the button, they are safe to get the dose and the patient alone is the only one who should be pushing the button. The pumps have pre-set safety standards that can be changed to lower dose, but never higher.

[macawake, MSN]

I heard they allow up to a year maternity leave. Macawake can you weigh in??

It's a bit complicated, but I'll try to explain how the system works. Yes, we do have very generous paid parental leave. It's 480 days paid leave (=15 months), but the law says that you have a right to stay at home for 18 months with each child. So either you get paid for all of the 15 months or if you choose to stay at home for the full 18 months, it will be at a slightly lower pay level. (You basically stretch the 15 months pay to last for 18). After the 18 months are up you have a right to return to your old job/position.

Out of the 480 paid days, 90 days are exclusive to the mother and 90 days are only for the use of the father. It's a "use them or lose them" type of thing. If one of the parents chooses not to use the 90 days that are exclusive to them, they lose the pay for that time. They don't lose the time though. The parent who stays at home with the child still has a right to be home for the full 18 months. They'll just get paid less.

The mother also has a right to stop working seven weeks prior to the expected delivery (with pay). Earlier of course, with sick pay, if a doctor says it's medically necessary. After the child's birth both parents have a right to stay at home for ten work days (two weeks) together. The remaining 480 paid days of parental leave is taken by one parent at a time.

The most recent statistics I could find are from 2013 and then 75% of paid parental leave was used by mothers and 25% was used by fathers. The percentage of paternal leave has increased somewhat since then, by I don't have the exact figures.

You also have right to have shorter workdays until your youngest child turns eight. You can choose to work 80% of fulltime = six-hours days. That however isn't paid, but an employer can't discriminate against you when it comes to promotions etc. if you choose to utilize this option.

If your child is sick (short-term cold/flu etc. or longer periods for more serious conditions), you can also stay at home to care for them. In this scenario you receive your full pay. Not from the employer, but from one of the social safety programs.

Some friends of ours were vacationing in Sweden, and their son was hit by a car. They said the Swedish medical system was the best they had ever experienced. Their daughter just got her MD here in the US and has matched for her residency in my city. She says she was inspired by the Swedish medical care her brother received!

What crummy luck to be hit by a car when vacationing. I hope the son made a full recovery!

I'm happy to hear that the care he received inspired the daughter to go into the medical field :) I am actually quite proud of our healthcare. Like virtually all Swedes, I fully support the idea that healthcare is a human right and that it should be available to all citizens at an affordable cost.

Healthcare here is different from the U.S. Most facilities and hospitals aren't as nicely decorated as the U.S. hospitals I've been in. If you visit a hospital here that was built in for example the 1950s, it shows The equipment is state of the art and the staff are highly trained, but no one really feels it's a priority to make the facilities look like "hotels". The decor is very basic, they slap on a fresh coat of paint when needed, but that's about it.

[psu_213, BSN, RN]

Jaw dropping moment: Pt had a fistula placed for dialysis earlier in the day, but now was back on the unit. The nephrologist (who was a real jerk to begin with), comes out of the room and says to me (I'm not the patients nurse), "he has an arterial bleed at that site. You should probably go in there." The nephrologist then walks away from the room and off the unit like nothing was happening. I walk in and the pt is spurting blood from his arm. Pt ended up being OK. Still can't believe how obnoxious (arrogant, etc.) that doctor was.

[LovingLife123]

Lol. I'm still confused by the PCA. All of ours are a lockout if 10 minutes. So, to me, the fact someone could push it every 6 minutes and get a delivery is crazy. Most of ours are morphine but we also do dilaudid. And I think it's .2 q10 with a 4mg/4 hour lockout.

I've had numerous jaw dropping moments. Some within the past week. I won't mention for fear of being recognized on here.

[mmc51264, BSN, MSN, RN]

the settings. With the new changes, we no longer have 4 hour limits/lockouts, we have one hour limits. We very rarely use them anymore (ortho unit), pts get long lasting blocks, regional nerve blocks, ketamine if opioid tolerant. HUGE education to families that if we catch anyone pushing the button, the PCA goes away immediately. Have never had any serious issues with this.

[gracie65]

I don't have any good PCA "jaw drop" stories, but I do have an end-of-life one. Had a pt. who was admitted with respiratory distress and it became apparent shortly thereafter that they wouldn't last much longer. Pt. was now on continuous BiPap wear and their spouse and children had been constantly at the beside for almost 48 hours. The doctor pulled the family outside the room and explained that the end was probably near and since the pt. was still listed as a "full code," did they want to change that option. Without missing a beat, the daughter spoke up and said, "Well, we don't want to do anything to empty Dad's wallet....just keep it on the cheap." Both the doctor and nurse were in stunned silence. Pt. was put on comfort cares with husband by their side. That dauther disappeared and didn't even show up for her Mom's last hours.

[orangeroom]

Wasn't the original question 'What's something that made your jaw drop?'

Well, working in labor and delivery, many things don't even phase me. I tend to spend lots of time in the pt's room. You learn a lot that way. After a while, apparently I become invisible to pt's family members. The older laboring pt stated something snarky to her husband. He responds back with "We didn't have to be here. You had choices. You could've swallowed." OMG! It was so hard for me to keep a straight face and not react! He was not physically appealing at all! Blarg!

[dec2007]

Any friend/family member/Joe Shmoe from off the street who got caught pressing PCA button on my patient would be kicked out of the hospital. We have a ginormous obscenely-colored sign on our PCAs that state no one is to press button for patient.

2 mg/hr seems like a pretty high dose.

We have those huge, brightly colored signs also, but apparently a lot of people either can't read them, or think they are the exception and the sign is only meant for other people. We used to have a sign outside the ICU that said " Please call before entering." The pizza delivery guy was the only one who ever followed that instruction.

[oneof5]

I am going to tell you why we use so many narcotics, particularly Dilaudid. HCAP scores. The biggest downturn in scores is "pain isn't adequately controlled" Adequately to patients means "NO PAIN". So since reimbursements depends on scores and surveys, then if you aren't bringing out the big guns on pain control then you aren't getting paid. Thanks Joint Commission for making pain a vital sign. Patients will tell you that their pain is a 10, right before they respiratory arrest. I have worked PACU for 15 years! Patients aren't educated enough on what to expect from pain after a surgery. If doctors tell patients that they are going to have pain after surgery, if it is an elected surgery, they won't have it. We are a give me society and a no pain society. I will tell you this, the new laws that they have enacted in Tennessee about narcotic dispensing should be a crack down on all this pill mill crap. If you ask for a 2nd pain pill prescription after the original supply given after surgery, then you have to enroll in a pain clinic contract. All patients getting more than a 3 day supply of narcotics have to sign a contract with the facility that they are aware of the side affects and potential problems and that they don't have multiple narcotic prescriptions already. The doctors can look in a data base prior to giving a narcotic prescription to see if the patient has had a recent prescription. If they have, hopefully they won't give another. It is a big problem and everyone suffers. Boy do I have a book of stories that would cover this topic.

[DextersDisciple, BSN, RN]

Wasn't the original question 'What's something that made your jaw drop?'

Well, working in labor and delivery, many things don't even phase me. I tend to spend lots of time in the pt's room. You learn a lot that way. After a while, apparently I become invisible to pt's family members. The older laboring pt stated something snarky to her husband. He responds back with "We didn't have to be here. You had choices. You could've swallowed." OMG! It was so hard for me to keep a straight face and not react! He was not physically appealing at all! Blarg!

Yes! The point of this post is to write something that made your jaw drop- not debate PCA doses! And your story really did make my jaw drop í ½í¸­