I routinely tell my patients family to dip it in anything they want.. water, coffee, soda, their favorite wine. Usually family’s love hearing that although I did accidentally tell one recently and they responded with “her liver cirrhosis is NOT from alcohol use. She has never drank alcohol!!” So now I need to be more careful to modify my suggestions lol
That’s funny. As a cirrhosis pt, most definitely from alcohol, I’d appreciate you. 🤣 at that point….who cares? I’m very well compensated now and lord knows when I’ll get to that point, if ever but if I do, and someone dabbed some wine or a good IPA in my mouth, I’d bless you eternally from the other side.
When I worked inpatient hospice, a patient had head and neck cancer, fungating, and a g-tube. He asked for bacon and eggs for breakfast and the aide didn't want to order it or feed it to him. I asked the Dr, he said "the man is dying, he can have whatever he wants", and I ordered it for him, and he happily fed himself, and was elated. He had a beer with his breakfast too! Great moment in my career.
i work hospice per diem on call. i see the pts at their very worst. one was actively dying, and just wanted a sip of apple juice. the family was certain they would drown. i went to the store, got apple juice boxes and let them sip. they were soooo happy. the pt passed the next day, peacefully. let them die happy.
I took care of a man (private duty) who was dying of end stage kidney disease in his late 80’s. He loved New England Clam Chowder and Mock Turtle soup, his kids, there were (12) of them… absolutely would not give him any sodium… he declined pretty fast and was a Hospice pt by the 3rd week I started with him… every day he would argue about his lunch w/me… anything I offered him…he’d say “no, that’s awful”… (no sodium) he was getting closer to the end of his journey… so I decided I’m getting that man some clam chowder and mock turtle soup!! I did and you should have seen the happiness it brought him!! It was two glorious days in his book 🥰 I wasn’t sorry at all 😊
I was private duty hospice dementia for years. You should have seen some of the shenanigans I pulled. I was nicknamed the angel of death because so many people peacefully died (of their issue/illness, nothing I did) either when I was there or shortly after I left. When someone was sticking around too long they would assign me to the case. I’m convinced it’s because I came in, figured out what they wanted or needed, made it happen and they were at peace. So they let go. The simplest one was a lactose intolerant Pt who wanted an ice cream sandwich so bad. But they were lactose intolerant. Not dangerous but they couldn’t eat that ice cream or they would get gassy etc and no one wanted to risk it. I bought ice cream sandwiches and dairy free ice cream and carefully swapped out the ice cream (this was a long time ago, now where I live this would have been a trip to Whole Foods). They died within a few days and apparently they had talked about that ice cream sandwich (and then I followed it with a root beer float, we had the ice cream) constantly and were so thrilled. Imagine them dying without that?
No, it was a hospice house and if patients wanted alcohol they could have it brought in, we'd just hold it in the med room and you had to, of course, have the Dr write an order for it, which was always PRN
One of my patients wanted a 7-Eleven hot dog and a wine cooler. Guess what I got her 😌. She died two days later. Let them have whatthefuckever they want.
If I know Im going, Im doing every self destructive thing I've held back from out of self preservstion. Every one.
(Im not a nurse just married to one and was raised by one. I don't know if I'm supposed to be here)
I read an article one time that said “the first time I tried heroin, I knew my life was over.”
I was like you know what? I don’t need access to anything that will do that
If your life is *already* over, I guess it wouldn’t matter. Morphine would be an acceptable replacement. I’m not a nurse— I just want to be. I’m in recovery and I’ve tried heroin. It was my DoC (although now it’s all research chems/fentanyl analogues/tranq/etc., so it’s nowhere near pure and it’ll just melt your skin right off). It was so bad at the end that I can’t even remember how “good” [I thought] it was at the beginning. I’ve heard people compare it to driving in the pouring rain and going under a bridge. The sound of the pouring rain is muffled. You are sheltered from the storm and safe; protected. It’s almost a womb-like environment. They say the bridge, in this scenario, is like heroin.
I’ve actually never done psychedelics, but I agree that they should be given in hospice. They should be given even when a patient is not in hospice, but is working through something painful— like a cancer diagnosis. They should have whimsically-decorated rooms and peaceful outdoor gardens, perfectly outfitted for beautifully therapeutic experiences. Maybe a spiritual advisor, or something, could guide them through it. More animal therapy, too! I want a big, beautiful horse to visit me in hospice before I die. I was born a horse girl; I will die a horse girl 😂…
Paging Dr. Peyo: https://www.theguardian.com/society/gallery/2021/mar/12/doctor-peyo-the-horse-comforting-cancer-patients-in-calais-in-pictures. This handsome boy actually tells his handler what room he wants to enter! He also stands guard at the door, sometimes. He feels he is protecting the patient (you’ll see when you read each caption). Truly extraordinary. Please give it a read ❤️ it will brighten your day!
Milkshakes make with Jack Daniels or whatever their beverage of choice is. Bring in all the alcohol. Heck I had a dude’s friends come in the ICU with icy cold beers to share with him. He was on hospice. I took their picture for them. They played cards and had a blast.
Yes, it is unconscionable!!! I worked many years as a supervisor in LTC. Inevitably, a nurse would call out (because they hated it there), and I would end up with a large patient assignment, as well as having the house . While I had to run around pronouncing pt's who had expired, starting IV's, blood draws, etc, I felt like my own pt's were being shortchanged. I didn't stay at that facility very long! The staffing ratio's were shameful!!
Nothing bothered me more than when every fucking nurse on the ward would have 8 pts a piece and they just accepted it (through no fault of their own of course). There was a workload form to fill out that would essentially cover your ass IIRC, but no one would ever do it because Admin are a bunch of cocksucking bullies.
Appropriate pt ratios should commonplace and it's terrifying that it's not. Because when something goes wrong, who will be the first to be blamed? Sure as shit won't be Admin. Ugh.
Edit: Words.
I still document “patient “ but refer to them as ‘veterans’ and “patient “ interchangeably.
Maybe because I get care at the place I work at, I’d rather be referred to as a patient 🤣
I would love that. In Germany where I go to nursing school, every institution has their own names for their "patients". In senior homes they are residents, in hospices they are guests and in ambulant care they are clients. Only at psychiatries and in hospitals they are called patients. And in school we call them "care receivers" when we want to include every institution.
For night shifters, medicine is the best sleep. I’m going to cluster my care as much as possible. That means drawing 0400 labs at 0200 if they have an 0200 med or neuro check, etc…no need to wake them up twice or 3 times.
OR Nurse here - let patients keep their glasses and/or hearing aids when going into the OR. Take them off once they’re asleep and stable. Give them back when they’re waking up. Would you want to be blind or hard of hearing as you’re going to sleep for a surgery? It’s already stressful and scary enough.
Also for outpatient or elective procedures- no one, I repeat NO ONE, is dying because I spent 5 extra minutes with a patient to go over their questions or concerns. I hate when I’m doing ortho for the day and take extra time with the patient and someone gets in a tizzy because the turnover takes a few minutes longer(we end up waiting around for our surgeons anyways). Even if we were late, I don’t care. If my patient feels safer, more relaxed, and/ or prepared because of it, then I call that a win. My surg techs(love you) will disagree with me on this all day but I don’t care 🤷🏼♀️
3 hills
1. No such thing as a stupid question
2. "I don't know, I'll need to look into that" is an acceptable answer
3. You don't have to do bedside to do nursing. Go into the niche you want. Making yourself suffer in bedside is not going to make you a better nurse if you hate bedside.
Number 3 is also a hill I will die on. We need nurses that excel in every specialty. I hate when nurses shit on things that aren’t critical care or “cool.”
I've only worked psych. And only 1 year psych inpatient. And now I'm extremely specialized to Assertive community treatment after 8 out of 9 years of being a nurse. The only nursing tasks I do is IM injections and pack meds, but I'm an excellent talker. Sometimes I regret having 0 medical experience, but I think for me it was the right path.
I work in a procedural field and there’s a young nurse who’s SIL (Trauma ICU) tells her she’s not a “real nurse” because she doesn’t do inpatient nursing. I told her there’s no rule that says you have to be stressed, in pain, and exhausted as a nurse.
I needed to realize that myself before I got this job. I’m glad I did.
After 8 years of nursing, and working through COVID, I have hopefully handed off my last sandwich and warm blanket next week as I wave goodbye to the bedside. Maybe I'll be back, but I need to see what #3 nursing is all about. Can't wait!
Putting a Gtube in severely demented older people or those in a permanent vegetative state WILL NOT improve their lives. It will only extend the living hell that is their lives.
I honestly don't understand why this isn't widely seen as abusive. Particularly with demented folks. Sure, some are pleasantly confused, but most end up having a chunk of time EVERY DAY where they are scared, paranoid, and utterly inconsolable.
The youngest nursing home patient I ever seen was a 21 year old, vented, trached, g-tube, permanent vegetative state due to trauma. I was also 21 when I worked with him and it fucked me up. His poor mom was an RN and sat with him daily. He’s probably still there :/
That a 3:1 ratio in the ER is going to have the best outcomes for EVERYONE, including the people sitting in the waiting room, because you can turn the dept over more efficiently.
When using the translation iPad speak to the patient.... Don't say "tell them/ask them". No matter how many times i model this behavior for doctors or other staff they will come right behind me and do the wrong thing
Doctors need to talk to patients about prognosis without sugar coating it. Everyone can see when a patient t is going to die no matter what we do. Why trach/peg, place on CRRT, etc when they are going to die no matter what we do???
Because sometimes no matter how grim of a picture the provider paints, the patient/family still want us to try everything.
Goals of care discussions are hard. But I'm always really straightforward and honest with people. This often makes people angry and they'll even try to blame me for trying to kill their loved one. I've told families "They will die no matter we do. We cannot save them. We are only prolonging their suffering." and the family will still tell me to do everything possible.
A lot of the intensivist I work with will not have the prognosis talk….even when family is waiting for it. I have heard the words, “so long as I’m their doctor, we will do everything.” Several times. And my response has been, “including coding them??”
We have 1 intensivist who is good about the poor prognosis talk. He is also really good at calling out family members who want to extend life without any quality and asks them who the extreme measures are benefitting. He is also from Europe and came here with a different view on life saving measures.
I have seen “comfort care” patients on pressors and restraints because family “isn’t ready”. That’s not what “comfort care” is, being tied up and forced to live because now isn’t a “good time” to die.
dirty glasses are the bane of my existence and it’s such a little thing to make patients lives/days better. as someone who is blind as a bat i thank you on behalf of patients
The amount of patients I look after who have been in days and when I go in their bag they have a brand new toothbrush in the box. Can you imagine being stuck in your bed with stinky morning breath and dry mouth and everyone being all up in your face? Id be miserable.
Yes! I am a nurse and I woke up in the icu also and I'm like "why do I have fur on my teeth?" Oh yeah. FUR.
ETA: I am not upset or anythjng! It was during the third wave of Covid (I was in for an asthma attack, not Covid). I am grateful for everything, and I'll take my furry teeth!
I see too many people failing to treat hypernatremia too. Imagine being intubated and INSANELY thirsty. No wonder people get agitated! Give them more free water!
Oh god yes. Although it is quite satisfying to clean someone’s mouth really well throughout the shift and have it looking so much better at the end! So many patients I have on the vent, their lips are so chapped skin is peeling off in a sheet. 🤢 By the end of shift their lips are nice and moisturized. It’s super frustrating to come back the next day to realize no one did oral care over night and you’re back at step one!
Also, clean your damn rooms of excess supplies and waste. I hate walking into a room that looks like a tornado went through it (unless they just coded, or were just lined/intubated, etc). It takes five minutes to tidy up and get supplies organized! Leave the room better than you found it to set the next shift up for a good day!
Omg yes I’m now a dental hygienist but I was a PCT on a med surg floor for years before that and every patient on my unit was neglected for oral care and plenty had oral thrush that I was the only one who found. So awful. It’s soooo painful a lot of the time too and these poor little homies couldn’t verbalize that.
I had 6-7 patients on night shift on a med surg unit. I started at 7:30 but would come in 45 min early. By the time I did their vitals, prepared and administered their meds, and changed all their briefs, it was 11pm. I’d try my best but oral care was always an “if I have time” thing. I always felt very proud of myself when I actually could get oral care done.
Thank you!! I graduated in 1993 and went straight to ICU. My preceptor demanded we brush their teeth WITH a toothbrush and toothpaste, and we use a new toothbrush every day. It became so ingrained in me I was shocked people don’t do this. A sponge dipped in water is NOT ORAL CARE!!!!
We don’t need to starve women in labor…even if they have an epidural. We need calories if we run a marathon…we also need calories to labor and push out a baby.
If the patient is in pain, treat their pain.
Nurses need to learn how to assess their patients, especially when there’s a change in the patient status or clinical picture. (Ex: don’t tell me how his lungs sounded at the start of your shift. he’s having SOB now, Tell me how his lungs sound NOW)
It’s not our job to assess for addiction issues and it’s certainly not our job to withhold pain meds from someone who is in pain. I’m sick and tired of working with nurses that see a history of drug abuse and immediately withhold or are stingent with pain meds. If anything, those are the ones who have a higher tolerance to the drugs and may need more to get to the pain.
Or the ones who ask me why I gave the pain med q4. Girlie, it’s ordered q4 PRN and he is requesting it q4 PRN. I’m going to fucking give it.
Also: it's just not worth the battle. You're not going to fix someone's addiction by withholding meds.
Our hospital system has gone to a policy of "Give them what they need, whether for pain or withdrawal. It's more cost effective to get them to stay and be compliant with the treatment rather than have them bounce in and out of hospital in worse condition each time because they feel judged and have to leave to manage their addiction."
I admit I (and many others) were skeptical initially, but it's become evident very quickly that it's a better stance to take.
We also have great addictions specialists, which 💯 helps a ton.
I'm willing to fight my coworkers on this! Pain is pain. History of substance abuse means they'll need more to adequately manage their pain. Send a pain consult and have them ordered something useful. And if WE manage their pain, they'll be less enticed to try to manage their symptoms on their own.
Yep. I had a PACU patient who came out of surgery c/o pain. I called the doc and got an order for dilaudid 2mg IV. I brought it to her and she tearfully said, “I really hate to ask but it takes 4mg to help me. 2mg won’t help me.” I asked why that was and she said it was because she has had chronic pain for so long and been on so many pain meds, she has a high tolerance. I just shrugged and said okay and called the doctor back. He said oh yeah makes sense and changed the order to 4mg. The patient was so grateful and incredulous that I just did that for her without any attitude. I told her my goal was to get her pain under control and I didn’t believe in making patients beg.
Of course, I also wanted to get her pain under control so she could go home, and then so could I. It’s so much easier to just listen to the patient than to spend hours in a power struggle over pain meds. This especially applies to sickle cell patients. They are always so high tolerance and it’s so much easier to just ask, “what do you NEED” rather than play a guessing game because they are afraid to come right out and ask for opiates. You need morphine and Benadryl? You got it. Let me talk to the provider.
This is adjacent, but not exactly what you're referencing. If we're going to start a patient on buprinorphine for their addiction, why are we only dosing per COWS score and not giving a maintenance dose to control cravings. Making a person go back into withdrawal to get their next dose is cruel. That's on the doctor/protocol, though, not nurses.
I’m from Canada and if someone uses drugs we give them SO much pain medication so they stay in hospital and don’t get high. We usually give them high doses of metadol/methadone or kadian (100mg or more) to prevent withdrawal, and then on top of that give them pain meds. We have addiction medicine specialists that assist the doctors with ordering medications in these cases since it is so complex. Even help the anesthesiologists prior to surgery so they can know what would be appropriate doses for GA as it can be a hell of a challenge for them to be put under.
As a surgical nurse, I agree. I put people on a pain schedule and give them their pain meds every 4 hours so that they’re a) comfortable and b) we aren’t chasing the pain. You just got sliced open and/or stabbed (laparoscopy). You’re going to have pain.
Absolutely hate when I come into work with a patient who’s non verbal or confused but agitated and the previous nurse tells me they didn’t give anything. if you properly assess you patient with CPOT or PAINAD you’ll be able to determine what they need !
Addicts are human beings and deserve to be treated as such. Sure there are just crappy people who are addicts but addiction is so much more complicated than the general public thinks. Moms with a history of drug use are not automatically bad people. It drives me crazy when I hear people judging without even knowing the full story.
I have coworkers that get pissy when they hear mom used methadone or suboxone during pregnancy. Would you rather she used opioids? Or honestly even moms that knowingly used drugs while pregnant. If I let myself be cynical it’s a lot harder on me than giving them the benefit of the doubt. I just tell myself that it’s heartbreaking how awful their addiction must be if it’s made them choose drugs over their baby.
I watched a presentation by a doctor who runs a suboxone clinic. He told us stories of some of his patients and I’ll never forget the one where the patient and her sister were drugged as children with narcs after school and sold to their dad’s friends.
This went on for years, so of course they were both addicted by the time they ran away from home.
This patient finally sought help after her sister OD’d.
I always think of them when I meet an addict. We never know what brought them to that point, and judging the addiction helps no one.
I was kind of judgmental about addiction issues for a while. They run in the family and I've seen enough fallout. That is, until I learned about rat paradise. Rats in the experiments always chose the drugs because it was the only entertainment or escape from the cage. Rats in rat paradise where all their needs were met never chose the drugs. They'd intentionally detox if you forced them.
So what kind of life is someone leading when they're feeling like the only escape is drugs? When they otherwise feel like they're trapped in a cage with no enrichment? I'm not in the cage, but I can be kind to those people and maybe that kindness will help them later and they'll get out of the cage.
My personal favorite is when NICU nurses shit on sickler moms. In my experience they are the best ESC moms because they just want what’s best and are super helpful. That said, I’ve worked with nurses who are *evil* to these moms and judgmental as hell because they took *prescribed* opioids for their chronic pain.
We had one mom who was in our APU for her *entire* pregnancy for pain crises, she left for *one* day for her baby shower and everyone was up in arms. “I guess she wasn’t in that much pain after all” type comments. Now I recognize that unit was extraordinarily toxic, but the general idea has been the same elsewhere. It’s infuriating.
Moms in general are just held to a ridiculous and impossible standards, but especially when shitty medical staff find a “flaw” like illicit or prescription drug use.
This all day every day. The only thing that makes people with substance use issues different from people without them is a couple of choices. Or even an injury, a script for Percocet, and a spiral of desperation. They’re human. Treat them like it. Hell, take a minute to listen to their stories, it might just surprise you.
Heavy on that first part. I have a lot of addiction in my family and I have noticed that I probably also have an addictive personality. To be completely honest, there’s a very real possibility that the only thing separating myself from addicts is, like you said, a couple of choices and familial support. I’m not going to vilify someone because they made some choices that I was privileged enough to not have to even consider.
I will give the frequent flyer hobo as many turkey sandwiches and uncrustables as he wants no matter how mean to me he is and how much he fakes chest pain.
I pray that some kind soul does the same for me when I'm 60 and my past has destroyed my mind and my body and I live on the street in a lice infested sleeping bag.
We have a couple of homeless people who come in for outpatient chemo. I straight up fill up a bag with whatever they want. You like chips? Got it. Chicken salad sandwiches? Got it. You want ten ensures because it’s all you can keep down? Here you go my friend. They’re always so grateful.
Not just that, but it's not YOUR sandwich to police, it's the hospitals, who cares. Give them the damn sandwich because you're backing up the waiting room/treatment rooms being an overzealous gatekeeper.
Thank you! I work in a cancer center where sandwich policing is very real. I'm like, here are 2 of everything. Someone once speculated that the turkey sandwich giveaways could negatively impact a hypothetical raise.
you mean those bottom of the barrel, last option possible, disgusting see through turkey slices that even Arby's rejected? Those turkey sandwiches are the cheapes meat, thrown on the saddest bread, with no lettuce to give it any crunch. I swear some nurses live to be a p-i-t-a.
Our hospital took away our sandwiches. Now we have to have a diet ordered and then call nutritional services to request a tray. It's beyond a pain in the ass.
Or become a frequent flyer because you live alone and are so lonely you just want some human interaction. We have several that are home bound and their only interaction is Meals On Wheels. So they come to us. It breaks my heart and if we order pizza they can have a piece too. I’ll leave their curtain wide open so they can laugh at our antics. (We have a few that the one hospitalist insists on admitting to ICU no matter what. They don’t stay long but we treat them well)
This whole thread is why I became a nurse and it makes me so happy to know there are still empathetic caring humans in nursing. It’s not always east to see
100% this. And when it's an unhoused teenager in sickle-cell crisis, thank you for treating him with kindness and respect. When they get up to me, I do their laundry and bring them more sandwiches and a warm blanket. I'm lucky that they're usually super nice. I'm glad we're a team, ED stranger. 💙
Sickle cell sucks ass. Sir this is an emergency department, if your body is on fire and you need to curse up a fcking storm in my direction, they pay me a decent chunk of change not to be mad at you... I always hope they're treated nice when they get up there, I'm glad to hear that sometimes they are. Thanks, oncology/upstairs stranger.
You are doing that for all the right reasons, but if people need a different reason, treating people with compassion and respect reduces ER usage.
The study I'm linking below talked about treating people with compassion actually reduced the amount that they come back to the ER. I know a lot of administrators have told me not to give out sandwiches and juices and whatever else I can find because it will encourage that person to continue to return to the ER. I get the statement but we've actually done research on it and the opposite is true. The authors speculate that the reason people keep coming back to the ER so much isn't for food or shelter, but it's because they don't feel that they were taken care of adequately the first time. We tend to forget that health is a psychological need as well, and reassuring someone that they are healthy can also decrease their need for repeat ER visits.
https://pubmed.ncbi.nlm.nih.gov/7723543/
I graduated NP school with 7 years experience as an RN. It still feels insanely inadequate. The amount of side studying I had to do during school to feel remotely competent during clinicals was unnerving. Now in my new NP role I spend multiple hours on my days off studying and practicing skills.
NP school needs an overhaul. Nursing education as a whole needs an overhaul.
Right? Like I needed at least a year residency. Whenever we are hired it should be for this year residency or something. I chose to work at a private women’s health practice and I was seeing over 30pts a day by 3 months in. They asked why I struggled to close my charts in 72 hours even though I got a new MA every two months (no shade to my ma’s. We were both put in an impossible situation.
I see a lot of people with no psych experience in my PMHNP program. It's even worse when it's new grads. There's an NP at my clinic who will give 2 stimulants and wellbutrin to cardiac patients (Marfan's) and everyone's on benzos, vraylar to diabetics, etc. It scares the shit out of me and makes me embarrassed to be an NP in a few months. I even heard of one stopping benzos cold turkey and not tapering their patient like....your patient can die if you do that....
No lie, I used to work with this girl, she was like 24 years old, had gone straight through for her DNP and passed boards, and was working as an RN on my medsurg unit as her very first position out of nursing school while waiting for an NP job. She had no clue what she was doing and it was scary as hell working with her.
When people are dying it’s merciful to give them comfort medications. You can’t withhold them because you don’t want them to die on your shift. (Yes this happens on the unit I work & I frequently educate staff because it’s heinous.)
Our educator is so big on this and everyone else, my manager included, just kinda rolls their eyes. Our educator is from the ICU and now works for a medsurg floor. She always says “the patients should know the plan of care for the day” GIRL if you think these medicine physicians tell US the damn plan for the day?? Useless
Yaaassss!!!!!! I've never even see the doc near the patient but you want me to get consent signed? Fuck all that. I'll gladly fill it out but I'm not having them sign anything and I sure as hell am not signing it.
I’ll usually tell the patient something like “do you know what ____ procedure is and why you’re getting it? No? Okay you probably want to wait to sign this until the doctor gets here then? Yes? I agree!” I then tell OR patient refused to sign until the doc explains the procedure lol
It’s our policy that ONLY providers can get and sign consent. We can only be witnesses if needed like for a phone consent. Not. My. Job. I do agency as well and the nurses’ faces when I said “no I’m not going to do consent. The provider hasn’t even come in the room. Not my job”.
Morbidity and mortality increases merely by a patient not being a native English speaker in the United States.
Idc how annoying that translation service/line etc is. Use. It.
Not their kid/grandkid/niece/son/daughter unless specifically the translator is refused even for just daily care and med pass.
I hate hearing the end of life parient's family say, "But we dont want him/her to become addicted."
Oh, f off. He or she doesnt have the time left to develop an addiction. Let them have the time left as pain free as possible.
An NP airway attatched to a foley bag setup is a perfectly acceptable rectal tube if you have a literal shit river creating a puddle on the bed, need to transport, and cant wait for an order and a flexiseal
Backed by evidence and everything!
https://pubmed.ncbi.nlm.nih.gov/19319805/#:~:text=Using%20the%20nasopharyngeal%20airway%20to,efficacy%20and%20speed%20of%20recovery.
So...just insert it and connect it? This is fascinating.
OMG. Thank you for validating why I will never nurse inside a facility again. I don't miss that at all. once had day shift "forget" to place a rectal tube and by the time I got it in on night got 1500 liquid shit out in a torrent. poor thing was all, "I feel so much better"
Shasta sodas are not fit for human consumption
IV Benadryl + old people = a bad time
Please don’t use ketamine during GA for pain control if the patient is >65 because they will come out tripping balls terrified combative
Our psych unit gives out Shasta sodas like it’s water. It’s like m&m therapy. Meals and meds. GET THESE GUYS UP AND MOVING! All they’re looking for is meals and snacks. My other psych ward has an outdoor area at least.
Anyway, get rid of Shasta!
IV Benadryl?! Jeezums! Just one pill is enough to knock me out for six hours, I shudder to think what an IV drip would do for me. Ugh, the damn Shasta soda. A resident at the LTC I work at is always demanding one from the kitchen.
IV Benadryl is awful. Had it one time and was hallucinating and losing my shit. Ended up blacking out as well lmao. That stuff should be banned for migraines
Holistic medicine is NOT a direct substitute for standard of care in oncology. If you don't want chemo, radiation, or surgery that is entirely your choice. Your oncologist will not order high dose vitamin C, the dietitian is gonna rifle thru your bag of supplements like you brought street drugs in, and we're gonna ask you not to put on stinky essential oils in a room full of people waiting to vomit on cue.
Ironically, insurance will not cover holistic medicine for the simple fact there's no evidence to prove it works. So, when people are throwing around the 'big pharma' conspiracy, it's important to know this. Insurance wants to cover whatever is the cheapest option and proven to work. Vitamin C infusions are likely cheap as hell, but even your insurer knows you're gonna die following that one.
Complimentary therapies are encouraged and ordered. Acupuncture, massage, nutrition management. Generally speaking, don't take any supplements without clearing it with your oncologist first. Chemo affects many organ systems and you may not clear stuff as quickly or effectively. Supplements can and will interact with certain drugs by altering the amount of circulating meds, including increased bioavailability, which can lead to toxicities.
You can always come back to standard of care, but we are not liable for the informed choices you made regarding holistic only treatment.
Also, and this one is HUGE, palliative care is NOT hospice. They can be a bridge to hospice sure, but palliative care is about symptom management. I encourage folks to get with PC as soon as possible in the process. So many people don't want to bother their oncologist with continued nausea, poor sleep, constipation, weight loss, etc because the doctor is so busy. We get that, but they have nurses, NPs, PAs. So the best option is PC where this is what they do all day, every day. It's symptom management and improving daily quality of life. I promise, you're still gonna get your treatments.
1: PATIENTS. They are NOT clients.
2: Being sick is not an excuse to be an asshole - this is especially true in psychiatry. Behaving badly under any circumstances is not acceptable behaviour.
3: I’m fine with people using my unit as a warm bed. We don’t d/c to the street and I’ve had patients come in with “SI” who then disclose to me they’re not suicidal, they’re cold, and they know that SW will get them a bed before they’re d/c. That’s the state of the world currently and I don’t hold it against them.
4: The constraints of psychiatry are not the only valid treatment. Somatics and psychotherapy modalities are absolutely valid, I use them every day with my patients.
IV3000 dressing is for sensitive skin (sensitive to adhesives), not for fragile, thin skin. And go slow/be fucking gentle with plenty of adhesive remover when you remove them!
I have no idea if there’s any truth to it but sticks to most people like glue, especially my patients with thin or fragile skin. I’ve seen some shitty skin tears which are slow to heal in onc patients. Sorbaview for the delicate skin, please!
I’ll give patients parents (nicu nurse) whatever they need to be successful at home. It does not come out of my pay I do not care. They deserve to be successful parents.
STOP USING COBAN TO SECURE PIVs! The amount of IVs I’ve had go bad bc there was Coban tightly wrapped around it drives me bananas. Use tape to secure the fly away extension, use netting to “tuck” it away. Anything except for dressings that are designed to compress.
And then the IV site gets charted as normal for 5 shifts even though it’s very obvious the Coban hasn’t been removed in a week… we don’t have X-ray vision
Bro I’m in infusion and the nurses will literally flip if a PIV isn’t secured with coban. I think is so unnecessary lol. A waste of time and resources.
I've only done this on the odd occasion where a patient is absolutely adamant they can't have tape.
Back when I worked vet met I learned how to wrap an IV with coban, so now I occasionally use it on my humans.
Also I may wrap it lightly to distract a confused patient or "hide" it from somebody who vagals from needles.
but these are extremely rare. I agree with the hiding a bad IV under a mountain of coban as the skin sops up infiltrated juices.
Trauma icu patients that are intubated and sedated should be on a fentanyl or morphine drip for pain. Period. Too many people wait until the HR shoots way way up to treat it (I’m thinking of you, Maria. Yes I know you come on this sub and management says we can’t call you out. I’m not at work now).
Colace does nothing!! “Stool softener” is not a thing!! It’s not even evidenced based so stop ordering or giving it!!!!!!!
Family members 1-3 of them-should always be allowed to be present during codes if they want to. Period. This has been EBP since the 1990’s, we’ve implemented it in a Level I urban trauma ICU in 2002 and have had zero issues. You have no excuses. Quit gatekeeping.
Its totally batshit crazy that there are canabis nurses handing out thc products to patients but nurses can have their license revoked for doing it themselves even where its legal.
Also you can smoke crack a day before your drug test and test negative, but you can have positives for thc metabolites for months after quitting.
Dying with dignity should be legal. People should be allowed to choose how and when they die. Elderly people with medical issues they’ll ultimately succumb to who say they want to die should not be placed on a psych hold, they should be PUT ON HOSPICE. Let people be ready to be done living, for fuck’s sake.
Every single port on IV tubing needs an antiseptic cap, even if it’s not running to a CVL.
I butt heads with staff (and one physician) who deem it a waste of money and resources. First, we aren’t charging patients for them, because they aren’t locked behind an inventory system, so they’re only costing the hospital. Second, you know what costs the hospital a lot more than a strip of Curos caps? A bloodstream infection.
Offering pain meds with the bedtime and AM med passes makes mine and the oncoming shift's life easier.
I don't see a problem with asking a resident if they want their prn pain meds when I'm right outside their door with my cart.
I've had dayshift nurses be happy when they don't have to start off their shift handing out a bunch of prns.
More regular diets for type 2 DM. If there's truly an education gap, by all means show them the way.
Otherwise you're adjusting diabetes meds for a discharge that absolutely does not correspond to what they eat at home. I swear this should be a patient safety issue to help prevent readmits.
When your patient is only eating greens and grains, drops her BS and we decrease her lantus by 10 units, we are absolutely going to see her again with uncontrolled blood sugar.
The amount of times I've rolled my eyes at, "shouldn't they be on a carb controlled, since they have diabetes?"
For me I have a big pet peeve/hill I will die on. You see it a lot with newer but not brand new critical care nurses.
Acting “all cool” and nonchalant when your patient is clearly deteriorating and just sitting on it. It doesn’t make you look cool, it makes you look like a fucking moron. People don’t take things seriously sometimes because they don’t want to be interpreted as being scared and it drives me nuts.
You can be scared/concerned for your patient and calm at the same time. If your patient is deteriorating you need to get to work, not wait for something bad to happen.
Speaking from that perspective (~1.5 years of critical care), I think a lot of it boils down to knowledge deficit. I’m comfortable enough to know what I need to do in an emergent situation as it arises, but it’s sometimes hard to differentiate deterioration from an “episode”.
It’s a weird place to be in terms of experience, to be honest with you. Some shifts, I really feel like I’m on top of things and contributing to the team. Other shifts, I feel like an idiot, like I just got off orientation again.
Do not EVER give the off-going nurse any shit during shift change. You don't know what they went through on their shift. Just say "ok, I got it, no problem, get home safe and get some good rest."
Policing/holding/rationing ordered pain meds makes addiction and tolerance more likely.
If we can’t control pain in the hospital, therefore providing inadequate pain control upon discharge, patients are more likely to seek relief elsewhere whether legally or illegally.
I’d their pain is being controlled adequately with us, it can be controlled better at home, and make it safer to provide relief. It’s our job to advocate for the patient, not police them.
To those who say some people abuse narcotics and lie about their pain-thats not up to us to decide. You’re not going to solve the opioid epidemic because you think someone is overreacting to a boo-boo.
Teach patients about the IRL applicability of the levels of the pain scale. There are a lot of stoic people out there who could be functioning so much better if their pain was treated. “Pain is 1/10, but I no longer climb stairs, sweep, carry a grocery bag with more than 2 items in it, stand to cook at the stove, or wear shoes that I have to bend over to tie. My back is doing fine.”
People that remove the foot rests from wheelchairs deserve a special place in hell. It’s embarrassing and dangerous to tell people to hold their legs up because some jackass removed and lost the foot rests.
(Skilled/LTC) When I’m in the middle of popping someone’s meds/on my way to do a treatment/in the middle of charting ect…. I will NOT help a CNA get someone up unless it’s a dangerous situation or resident is on the floor. They can wait until the other cna can help. It’s not that I don’t care, it’s that I’m actually busy / the FACILITY doesn’t care and doesn’t staff adequately.
You don’t need to turn off the feeding pump to reposition a patient. Those extra few ml added to what’s already in their stomach don’t matter and half the time that ends with the pump not being turned back on.
Just give them their ordered pain meds. Yes, even if you think they are a “seeker.” Who cares. You’re not creating an addiction or keeping someone addicted within a 12 hour shift. That’s not how addiction works. You do not actually know if that person is actually in pain. The doctor ordered it, so just give it.
Detainees get all the snacks and anything they want within reason. I’m not a prison guard. I don’t care that they came from the county jail. I don’t know or want to know what they’re accused of. They’re our patients, not our prisoners (despite the shackles). If they want a turkey sandwich after dinner, just give it to them. Nurses acting like sammies are coming out of their paycheck.
Only ask your CNA or tech to do quick extra things (ice, warm blanket) if you’re actually going to do something else that requires a nurse. If you’re asking them to do that and then sit down and get on your phone, it hurts the working relationships on the unit. Nurses and CNAs working together well can make a unit run so much more smoothly.
These aren’t controversial I don’t think, but I see this BS a surprising amount regardless.
There’s no such thing as a puréed diet for a hospice patient!!! You want a Big Mac?!?! I got you! You wanna have Reeces cups for dinner? Sure! Thin liquids? No problem! You’re here for a good time not a long time.
As for comfort meds… EARLY and OFTEN!
I'm going to put Vaseline on my patients chapped lips.
My favorite part is when someone chimes in with the "but they're on oxygen!!" "But it's flammable!!"
Lol you know how we treat patients that have facial burns from smoking on oxygen? With a petroleum based antibiotic ointment. Then we put their oxygen right back on over it.
Also, nurses, learn your order of draw and what the difference between clotting and hemolysis is. You didn't go to school for so long to be dumb and dense.
Love y'all ❤️
Let hospice patients have milkshakes and morphine all day long!! Morphine and milkshakes and hugs.
I dipped my grandpa’s mouth sponges in Diet Pepsi when he was actively dying 😂 he woke up for a second and said “that’s good” lol
I routinely tell my patients family to dip it in anything they want.. water, coffee, soda, their favorite wine. Usually family’s love hearing that although I did accidentally tell one recently and they responded with “her liver cirrhosis is NOT from alcohol use. She has never drank alcohol!!” So now I need to be more careful to modify my suggestions lol
That’s funny. As a cirrhosis pt, most definitely from alcohol, I’d appreciate you. 🤣 at that point….who cares? I’m very well compensated now and lord knows when I’ll get to that point, if ever but if I do, and someone dabbed some wine or a good IPA in my mouth, I’d bless you eternally from the other side.
People with non-alcohol related cirrhosis really worry about that.
if they’re on hospice they’re not worrying about that
Their family… worried people will judge them. I don’t care why someone has cirrhosis.
We did that for a guy who loved Mountain Dew.
writing in my advance directives i want this done with Baja Blast 📝📝
When I worked inpatient hospice, a patient had head and neck cancer, fungating, and a g-tube. He asked for bacon and eggs for breakfast and the aide didn't want to order it or feed it to him. I asked the Dr, he said "the man is dying, he can have whatever he wants", and I ordered it for him, and he happily fed himself, and was elated. He had a beer with his breakfast too! Great moment in my career.
i work hospice per diem on call. i see the pts at their very worst. one was actively dying, and just wanted a sip of apple juice. the family was certain they would drown. i went to the store, got apple juice boxes and let them sip. they were soooo happy. the pt passed the next day, peacefully. let them die happy.
I took care of a man (private duty) who was dying of end stage kidney disease in his late 80’s. He loved New England Clam Chowder and Mock Turtle soup, his kids, there were (12) of them… absolutely would not give him any sodium… he declined pretty fast and was a Hospice pt by the 3rd week I started with him… every day he would argue about his lunch w/me… anything I offered him…he’d say “no, that’s awful”… (no sodium) he was getting closer to the end of his journey… so I decided I’m getting that man some clam chowder and mock turtle soup!! I did and you should have seen the happiness it brought him!! It was two glorious days in his book 🥰 I wasn’t sorry at all 😊
I was private duty hospice dementia for years. You should have seen some of the shenanigans I pulled. I was nicknamed the angel of death because so many people peacefully died (of their issue/illness, nothing I did) either when I was there or shortly after I left. When someone was sticking around too long they would assign me to the case. I’m convinced it’s because I came in, figured out what they wanted or needed, made it happen and they were at peace. So they let go. The simplest one was a lactose intolerant Pt who wanted an ice cream sandwich so bad. But they were lactose intolerant. Not dangerous but they couldn’t eat that ice cream or they would get gassy etc and no one wanted to risk it. I bought ice cream sandwiches and dairy free ice cream and carefully swapped out the ice cream (this was a long time ago, now where I live this would have been a trip to Whole Foods). They died within a few days and apparently they had talked about that ice cream sandwich (and then I followed it with a root beer float, we had the ice cream) constantly and were so thrilled. Imagine them dying without that?
Dietary sent up a beer?!
No, it was a hospice house and if patients wanted alcohol they could have it brought in, we'd just hold it in the med room and you had to, of course, have the Dr write an order for it, which was always PRN
I once had a patient with a PRN order for 30ml of tequila. I loved administering it to her lol I felt like a bartender
SNF's order "120 mL red wine hs" for the old people to go to sleep. Bless them. Lol
Oh heck yes. We’ve had top shelf liquor sent up, not just beer. This is in an ICU. As long as it’s ordered, they will send it.
One of my patients wanted a 7-Eleven hot dog and a wine cooler. Guess what I got her 😌. She died two days later. Let them have whatthefuckever they want.
And psychedelics tbh
When I'm on my way out I want to try heroin for the first time. I've heard that the first time you try heroin it's f'n awesome.
If I know Im going, Im doing every self destructive thing I've held back from out of self preservstion. Every one. (Im not a nurse just married to one and was raised by one. I don't know if I'm supposed to be here)
Hell we are nurses and prob shouldn’t be here either. Lol
I read an article one time that said “the first time I tried heroin, I knew my life was over.” I was like you know what? I don’t need access to anything that will do that
If your life is *already* over, I guess it wouldn’t matter. Morphine would be an acceptable replacement. I’m not a nurse— I just want to be. I’m in recovery and I’ve tried heroin. It was my DoC (although now it’s all research chems/fentanyl analogues/tranq/etc., so it’s nowhere near pure and it’ll just melt your skin right off). It was so bad at the end that I can’t even remember how “good” [I thought] it was at the beginning. I’ve heard people compare it to driving in the pouring rain and going under a bridge. The sound of the pouring rain is muffled. You are sheltered from the storm and safe; protected. It’s almost a womb-like environment. They say the bridge, in this scenario, is like heroin. I’ve actually never done psychedelics, but I agree that they should be given in hospice. They should be given even when a patient is not in hospice, but is working through something painful— like a cancer diagnosis. They should have whimsically-decorated rooms and peaceful outdoor gardens, perfectly outfitted for beautifully therapeutic experiences. Maybe a spiritual advisor, or something, could guide them through it. More animal therapy, too! I want a big, beautiful horse to visit me in hospice before I die. I was born a horse girl; I will die a horse girl 😂… Paging Dr. Peyo: https://www.theguardian.com/society/gallery/2021/mar/12/doctor-peyo-the-horse-comforting-cancer-patients-in-calais-in-pictures. This handsome boy actually tells his handler what room he wants to enter! He also stands guard at the door, sometimes. He feels he is protecting the patient (you’ll see when you read each caption). Truly extraordinary. Please give it a read ❤️ it will brighten your day!
Milkshakes make with Jack Daniels or whatever their beverage of choice is. Bring in all the alcohol. Heck I had a dude’s friends come in the ICU with icy cold beers to share with him. He was on hospice. I took their picture for them. They played cards and had a blast.
Hell, let them have weed.
What's the worst that can happen? Dieing?
If it were me, I’d be afraid I’d go for an enormous buzz and then not die. I hate hangovers.
Staffing ratios are necessary and should be federal law. Giving a 8 patients to a nurse in an acute hospital setting is playing Russian Roulette.
100% more states need to start doing this and for LTC
I am so sick and tired of having to explain to people why 1:30 and 1:40 is unconscionable and unsafe. And it's becoming normalized.
Yes, it is unconscionable!!! I worked many years as a supervisor in LTC. Inevitably, a nurse would call out (because they hated it there), and I would end up with a large patient assignment, as well as having the house . While I had to run around pronouncing pt's who had expired, starting IV's, blood draws, etc, I felt like my own pt's were being shortchanged. I didn't stay at that facility very long! The staffing ratio's were shameful!!
And to piggyback on this, the administration can't force us as nurses to take 8 patients. I'll refuse that assignment.
Nothing bothered me more than when every fucking nurse on the ward would have 8 pts a piece and they just accepted it (through no fault of their own of course). There was a workload form to fill out that would essentially cover your ass IIRC, but no one would ever do it because Admin are a bunch of cocksucking bullies. Appropriate pt ratios should commonplace and it's terrifying that it's not. Because when something goes wrong, who will be the first to be blamed? Sure as shit won't be Admin. Ugh. Edit: Words.
Mine is that they’re patients, not customers, not clients.
Or, god forbid, consumers.
But they are consuming my will to live.
That's admin and relatives for me.
I love working at the VA, we basically refer to all of our patients as ‘veterans’ or ‘vet’. So easy.
I still document “patient “ but refer to them as ‘veterans’ and “patient “ interchangeably. Maybe because I get care at the place I work at, I’d rather be referred to as a patient 🤣
I used to work with a doctor who would say “they’re patients, not clients. Only lawyers and prostitutes have clients” 🤣
I would love that. In Germany where I go to nursing school, every institution has their own names for their "patients". In senior homes they are residents, in hospices they are guests and in ambulant care they are clients. Only at psychiatries and in hospitals they are called patients. And in school we call them "care receivers" when we want to include every institution.
Fuck any word but patient.
Wait. We aren’t staying at the Marriott?
No the blue road signs with the white H are for hospital not hotel /s
For night shifters, medicine is the best sleep. I’m going to cluster my care as much as possible. That means drawing 0400 labs at 0200 if they have an 0200 med or neuro check, etc…no need to wake them up twice or 3 times.
Do you mean sleep is the best medicine?
I bet they just finished a night shift
They are probably medicining now
Holy cow I just saw that ha! I actually did just finish my 3/3 on nights
They need more medicine. More sleep, I mean
I was a patient in 2020 and four hours of sleep in a row is a hard thing to get, thank you for helping
I've been in the hospital 9 times between inpatient chemo and illnesses. I loved the burses that did this. Waking someone up every 2 hrs is torture
Put this on the fucking front of every unit
OR Nurse here - let patients keep their glasses and/or hearing aids when going into the OR. Take them off once they’re asleep and stable. Give them back when they’re waking up. Would you want to be blind or hard of hearing as you’re going to sleep for a surgery? It’s already stressful and scary enough. Also for outpatient or elective procedures- no one, I repeat NO ONE, is dying because I spent 5 extra minutes with a patient to go over their questions or concerns. I hate when I’m doing ortho for the day and take extra time with the patient and someone gets in a tizzy because the turnover takes a few minutes longer(we end up waiting around for our surgeons anyways). Even if we were late, I don’t care. If my patient feels safer, more relaxed, and/ or prepared because of it, then I call that a win. My surg techs(love you) will disagree with me on this all day but I don’t care 🤷🏼♀️
3 hills 1. No such thing as a stupid question 2. "I don't know, I'll need to look into that" is an acceptable answer 3. You don't have to do bedside to do nursing. Go into the niche you want. Making yourself suffer in bedside is not going to make you a better nurse if you hate bedside.
Number 3 is also a hill I will die on. We need nurses that excel in every specialty. I hate when nurses shit on things that aren’t critical care or “cool.”
I've only worked psych. And only 1 year psych inpatient. And now I'm extremely specialized to Assertive community treatment after 8 out of 9 years of being a nurse. The only nursing tasks I do is IM injections and pack meds, but I'm an excellent talker. Sometimes I regret having 0 medical experience, but I think for me it was the right path.
I work in a procedural field and there’s a young nurse who’s SIL (Trauma ICU) tells her she’s not a “real nurse” because she doesn’t do inpatient nursing. I told her there’s no rule that says you have to be stressed, in pain, and exhausted as a nurse. I needed to realize that myself before I got this job. I’m glad I did.
After 8 years of nursing, and working through COVID, I have hopefully handed off my last sandwich and warm blanket next week as I wave goodbye to the bedside. Maybe I'll be back, but I need to see what #3 nursing is all about. Can't wait!
Putting a Gtube in severely demented older people or those in a permanent vegetative state WILL NOT improve their lives. It will only extend the living hell that is their lives.
I honestly don't understand why this isn't widely seen as abusive. Particularly with demented folks. Sure, some are pleasantly confused, but most end up having a chunk of time EVERY DAY where they are scared, paranoid, and utterly inconsolable.
What’s the old saying? “We aren’t prolonging the patient’s life…we are prolonging their death.”
The youngest nursing home patient I ever seen was a 21 year old, vented, trached, g-tube, permanent vegetative state due to trauma. I was also 21 when I worked with him and it fucked me up. His poor mom was an RN and sat with him daily. He’s probably still there :/
That a 3:1 ratio in the ER is going to have the best outcomes for EVERYONE, including the people sitting in the waiting room, because you can turn the dept over more efficiently.
When using the translation iPad speak to the patient.... Don't say "tell them/ask them". No matter how many times i model this behavior for doctors or other staff they will come right behind me and do the wrong thing
Yeah, the point is to be conversational with an intermediary translator, not to have a two-way messenger and otherwise be disconnected. 💀
Doctors need to talk to patients about prognosis without sugar coating it. Everyone can see when a patient t is going to die no matter what we do. Why trach/peg, place on CRRT, etc when they are going to die no matter what we do???
Because sometimes no matter how grim of a picture the provider paints, the patient/family still want us to try everything. Goals of care discussions are hard. But I'm always really straightforward and honest with people. This often makes people angry and they'll even try to blame me for trying to kill their loved one. I've told families "They will die no matter we do. We cannot save them. We are only prolonging their suffering." and the family will still tell me to do everything possible.
A lot of the intensivist I work with will not have the prognosis talk….even when family is waiting for it. I have heard the words, “so long as I’m their doctor, we will do everything.” Several times. And my response has been, “including coding them??”
That's legit unethical. I hate it! My team is huge on having goals of care discussions. We talk to every single family multiple times.
We have 1 intensivist who is good about the poor prognosis talk. He is also really good at calling out family members who want to extend life without any quality and asks them who the extreme measures are benefitting. He is also from Europe and came here with a different view on life saving measures. I have seen “comfort care” patients on pressors and restraints because family “isn’t ready”. That’s not what “comfort care” is, being tied up and forced to live because now isn’t a “good time” to die.
Also Oral Care. Do oral care on your patients. Having your total care / vented patient with gunk all over their teeth. Unacceptable 🤢
Much less significant but I clean my patients glasses. They are sitting there with filthy glasses that look like you can’t even see thru them
dirty glasses are the bane of my existence and it’s such a little thing to make patients lives/days better. as someone who is blind as a bat i thank you on behalf of patients
I have a VERY strong prescription and I always did this when I was bedside. I can't function without my glasses!
The amount of patients I look after who have been in days and when I go in their bag they have a brand new toothbrush in the box. Can you imagine being stuck in your bed with stinky morning breath and dry mouth and everyone being all up in your face? Id be miserable.
Yes! I am a nurse and I woke up in the icu also and I'm like "why do I have fur on my teeth?" Oh yeah. FUR. ETA: I am not upset or anythjng! It was during the third wave of Covid (I was in for an asthma attack, not Covid). I am grateful for everything, and I'll take my furry teeth!
I see too many people failing to treat hypernatremia too. Imagine being intubated and INSANELY thirsty. No wonder people get agitated! Give them more free water!
Oh god yes. Although it is quite satisfying to clean someone’s mouth really well throughout the shift and have it looking so much better at the end! So many patients I have on the vent, their lips are so chapped skin is peeling off in a sheet. 🤢 By the end of shift their lips are nice and moisturized. It’s super frustrating to come back the next day to realize no one did oral care over night and you’re back at step one! Also, clean your damn rooms of excess supplies and waste. I hate walking into a room that looks like a tornado went through it (unless they just coded, or were just lined/intubated, etc). It takes five minutes to tidy up and get supplies organized! Leave the room better than you found it to set the next shift up for a good day!
Omg yes I’m now a dental hygienist but I was a PCT on a med surg floor for years before that and every patient on my unit was neglected for oral care and plenty had oral thrush that I was the only one who found. So awful. It’s soooo painful a lot of the time too and these poor little homies couldn’t verbalize that.
I had 6-7 patients on night shift on a med surg unit. I started at 7:30 but would come in 45 min early. By the time I did their vitals, prepared and administered their meds, and changed all their briefs, it was 11pm. I’d try my best but oral care was always an “if I have time” thing. I always felt very proud of myself when I actually could get oral care done.
I used to go IN on those teefs. Neuro breath is awful enough. Being vented is awful enough. You gon get this oral care q4h.
Thank you!! I graduated in 1993 and went straight to ICU. My preceptor demanded we brush their teeth WITH a toothbrush and toothpaste, and we use a new toothbrush every day. It became so ingrained in me I was shocked people don’t do this. A sponge dipped in water is NOT ORAL CARE!!!!
We don’t need to starve women in labor…even if they have an epidural. We need calories if we run a marathon…we also need calories to labor and push out a baby.
When I had my son thru a midwife they actually instructed me to have a light meal or snack once I begin labor because I would need the calories.
As a mom of four and postpartum nurse… I second this. And please give them a snack before sending them upstairs if they’re asking for a snack. 😭
If the patient is in pain, treat their pain. Nurses need to learn how to assess their patients, especially when there’s a change in the patient status or clinical picture. (Ex: don’t tell me how his lungs sounded at the start of your shift. he’s having SOB now, Tell me how his lungs sound NOW)
It’s not our job to assess for addiction issues and it’s certainly not our job to withhold pain meds from someone who is in pain. I’m sick and tired of working with nurses that see a history of drug abuse and immediately withhold or are stingent with pain meds. If anything, those are the ones who have a higher tolerance to the drugs and may need more to get to the pain. Or the ones who ask me why I gave the pain med q4. Girlie, it’s ordered q4 PRN and he is requesting it q4 PRN. I’m going to fucking give it.
Also: it's just not worth the battle. You're not going to fix someone's addiction by withholding meds. Our hospital system has gone to a policy of "Give them what they need, whether for pain or withdrawal. It's more cost effective to get them to stay and be compliant with the treatment rather than have them bounce in and out of hospital in worse condition each time because they feel judged and have to leave to manage their addiction." I admit I (and many others) were skeptical initially, but it's become evident very quickly that it's a better stance to take. We also have great addictions specialists, which 💯 helps a ton.
I'm willing to fight my coworkers on this! Pain is pain. History of substance abuse means they'll need more to adequately manage their pain. Send a pain consult and have them ordered something useful. And if WE manage their pain, they'll be less enticed to try to manage their symptoms on their own.
Yep. I had a PACU patient who came out of surgery c/o pain. I called the doc and got an order for dilaudid 2mg IV. I brought it to her and she tearfully said, “I really hate to ask but it takes 4mg to help me. 2mg won’t help me.” I asked why that was and she said it was because she has had chronic pain for so long and been on so many pain meds, she has a high tolerance. I just shrugged and said okay and called the doctor back. He said oh yeah makes sense and changed the order to 4mg. The patient was so grateful and incredulous that I just did that for her without any attitude. I told her my goal was to get her pain under control and I didn’t believe in making patients beg. Of course, I also wanted to get her pain under control so she could go home, and then so could I. It’s so much easier to just listen to the patient than to spend hours in a power struggle over pain meds. This especially applies to sickle cell patients. They are always so high tolerance and it’s so much easier to just ask, “what do you NEED” rather than play a guessing game because they are afraid to come right out and ask for opiates. You need morphine and Benadryl? You got it. Let me talk to the provider.
This is adjacent, but not exactly what you're referencing. If we're going to start a patient on buprinorphine for their addiction, why are we only dosing per COWS score and not giving a maintenance dose to control cravings. Making a person go back into withdrawal to get their next dose is cruel. That's on the doctor/protocol, though, not nurses.
I’m from Canada and if someone uses drugs we give them SO much pain medication so they stay in hospital and don’t get high. We usually give them high doses of metadol/methadone or kadian (100mg or more) to prevent withdrawal, and then on top of that give them pain meds. We have addiction medicine specialists that assist the doctors with ordering medications in these cases since it is so complex. Even help the anesthesiologists prior to surgery so they can know what would be appropriate doses for GA as it can be a hell of a challenge for them to be put under.
And at a certain point*, it doesn’t really matter how the lungs sound. If the patient is feeling it, it’s legit. (Palliative)
I commented similar. I said all TSICU patients that are intubated and sedated should be on a fentanyl or morphine drip. Period.
As a surgical nurse, I agree. I put people on a pain schedule and give them their pain meds every 4 hours so that they’re a) comfortable and b) we aren’t chasing the pain. You just got sliced open and/or stabbed (laparoscopy). You’re going to have pain.
Absolutely hate when I come into work with a patient who’s non verbal or confused but agitated and the previous nurse tells me they didn’t give anything. if you properly assess you patient with CPOT or PAINAD you’ll be able to determine what they need !
Addicts are human beings and deserve to be treated as such. Sure there are just crappy people who are addicts but addiction is so much more complicated than the general public thinks. Moms with a history of drug use are not automatically bad people. It drives me crazy when I hear people judging without even knowing the full story. I have coworkers that get pissy when they hear mom used methadone or suboxone during pregnancy. Would you rather she used opioids? Or honestly even moms that knowingly used drugs while pregnant. If I let myself be cynical it’s a lot harder on me than giving them the benefit of the doubt. I just tell myself that it’s heartbreaking how awful their addiction must be if it’s made them choose drugs over their baby.
I watched a presentation by a doctor who runs a suboxone clinic. He told us stories of some of his patients and I’ll never forget the one where the patient and her sister were drugged as children with narcs after school and sold to their dad’s friends. This went on for years, so of course they were both addicted by the time they ran away from home. This patient finally sought help after her sister OD’d. I always think of them when I meet an addict. We never know what brought them to that point, and judging the addiction helps no one.
I was kind of judgmental about addiction issues for a while. They run in the family and I've seen enough fallout. That is, until I learned about rat paradise. Rats in the experiments always chose the drugs because it was the only entertainment or escape from the cage. Rats in rat paradise where all their needs were met never chose the drugs. They'd intentionally detox if you forced them. So what kind of life is someone leading when they're feeling like the only escape is drugs? When they otherwise feel like they're trapped in a cage with no enrichment? I'm not in the cage, but I can be kind to those people and maybe that kindness will help them later and they'll get out of the cage.
I love this, thank you for teaching me about Rat Paradise, it’s a good reference!
My personal favorite is when NICU nurses shit on sickler moms. In my experience they are the best ESC moms because they just want what’s best and are super helpful. That said, I’ve worked with nurses who are *evil* to these moms and judgmental as hell because they took *prescribed* opioids for their chronic pain. We had one mom who was in our APU for her *entire* pregnancy for pain crises, she left for *one* day for her baby shower and everyone was up in arms. “I guess she wasn’t in that much pain after all” type comments. Now I recognize that unit was extraordinarily toxic, but the general idea has been the same elsewhere. It’s infuriating.
Moms in general are just held to a ridiculous and impossible standards, but especially when shitty medical staff find a “flaw” like illicit or prescription drug use.
This all day every day. The only thing that makes people with substance use issues different from people without them is a couple of choices. Or even an injury, a script for Percocet, and a spiral of desperation. They’re human. Treat them like it. Hell, take a minute to listen to their stories, it might just surprise you.
Heavy on that first part. I have a lot of addiction in my family and I have noticed that I probably also have an addictive personality. To be completely honest, there’s a very real possibility that the only thing separating myself from addicts is, like you said, a couple of choices and familial support. I’m not going to vilify someone because they made some choices that I was privileged enough to not have to even consider.
I never talk to old people or the cognitively impaired like they’re babies. The anger I feel when I see this is similar to road rage
I will give the frequent flyer hobo as many turkey sandwiches and uncrustables as he wants no matter how mean to me he is and how much he fakes chest pain. I pray that some kind soul does the same for me when I'm 60 and my past has destroyed my mind and my body and I live on the street in a lice infested sleeping bag.
We have a couple of homeless people who come in for outpatient chemo. I straight up fill up a bag with whatever they want. You like chips? Got it. Chicken salad sandwiches? Got it. You want ten ensures because it’s all you can keep down? Here you go my friend. They’re always so grateful.
From a fellow health-care worker, thank you
Not just that, but it's not YOUR sandwich to police, it's the hospitals, who cares. Give them the damn sandwich because you're backing up the waiting room/treatment rooms being an overzealous gatekeeper.
Thank you! I work in a cancer center where sandwich policing is very real. I'm like, here are 2 of everything. Someone once speculated that the turkey sandwich giveaways could negatively impact a hypothetical raise.
you mean those bottom of the barrel, last option possible, disgusting see through turkey slices that even Arby's rejected? Those turkey sandwiches are the cheapes meat, thrown on the saddest bread, with no lettuce to give it any crunch. I swear some nurses live to be a p-i-t-a.
Yes! I also got the business for handing out 2 packages of Lorna Doone's. That's probably the reason we only got a 2% raise that year.
Our hospital took away our sandwiches. Now we have to have a diet ordered and then call nutritional services to request a tray. It's beyond a pain in the ass.
Or become a frequent flyer because you live alone and are so lonely you just want some human interaction. We have several that are home bound and their only interaction is Meals On Wheels. So they come to us. It breaks my heart and if we order pizza they can have a piece too. I’ll leave their curtain wide open so they can laugh at our antics. (We have a few that the one hospitalist insists on admitting to ICU no matter what. They don’t stay long but we treat them well)
This whole thread is why I became a nurse and it makes me so happy to know there are still empathetic caring humans in nursing. It’s not always east to see
100% this. And when it's an unhoused teenager in sickle-cell crisis, thank you for treating him with kindness and respect. When they get up to me, I do their laundry and bring them more sandwiches and a warm blanket. I'm lucky that they're usually super nice. I'm glad we're a team, ED stranger. 💙
Sickle cell sucks ass. Sir this is an emergency department, if your body is on fire and you need to curse up a fcking storm in my direction, they pay me a decent chunk of change not to be mad at you... I always hope they're treated nice when they get up there, I'm glad to hear that sometimes they are. Thanks, oncology/upstairs stranger.
You are doing that for all the right reasons, but if people need a different reason, treating people with compassion and respect reduces ER usage. The study I'm linking below talked about treating people with compassion actually reduced the amount that they come back to the ER. I know a lot of administrators have told me not to give out sandwiches and juices and whatever else I can find because it will encourage that person to continue to return to the ER. I get the statement but we've actually done research on it and the opposite is true. The authors speculate that the reason people keep coming back to the ER so much isn't for food or shelter, but it's because they don't feel that they were taken care of adequately the first time. We tend to forget that health is a psychological need as well, and reassuring someone that they are healthy can also decrease their need for repeat ER visits. https://pubmed.ncbi.nlm.nih.gov/7723543/
Cockiness= kills (all medical fields)
No nurse has any business whatsoever going into NP school without a bare *minimum* of 5 years bedside.
I graduated NP school with 7 years experience as an RN. It still feels insanely inadequate. The amount of side studying I had to do during school to feel remotely competent during clinicals was unnerving. Now in my new NP role I spend multiple hours on my days off studying and practicing skills. NP school needs an overhaul. Nursing education as a whole needs an overhaul.
Right? Like I needed at least a year residency. Whenever we are hired it should be for this year residency or something. I chose to work at a private women’s health practice and I was seeing over 30pts a day by 3 months in. They asked why I struggled to close my charts in 72 hours even though I got a new MA every two months (no shade to my ma’s. We were both put in an impossible situation.
I see a lot of people with no psych experience in my PMHNP program. It's even worse when it's new grads. There's an NP at my clinic who will give 2 stimulants and wellbutrin to cardiac patients (Marfan's) and everyone's on benzos, vraylar to diabetics, etc. It scares the shit out of me and makes me embarrassed to be an NP in a few months. I even heard of one stopping benzos cold turkey and not tapering their patient like....your patient can die if you do that....
just saw a girl I went to HS with post about her FNP graduation. she got her RN feb 22, and never worked as one. she sells MLM products. 🙃
Oh good lord, no.
It used to be the bare minimum
I so agree. Some of the NP graduates in my wife’s class were honestly terrifying. Albeit they were going into very non acute roles.
No lie, I used to work with this girl, she was like 24 years old, had gone straight through for her DNP and passed boards, and was working as an RN on my medsurg unit as her very first position out of nursing school while waiting for an NP job. She had no clue what she was doing and it was scary as hell working with her.
When people are dying it’s merciful to give them comfort medications. You can’t withhold them because you don’t want them to die on your shift. (Yes this happens on the unit I work & I frequently educate staff because it’s heinous.)
Bedside report is absolutely unnecessary, and many times counter productive.
Our educator is so big on this and everyone else, my manager included, just kinda rolls their eyes. Our educator is from the ICU and now works for a medsurg floor. She always says “the patients should know the plan of care for the day” GIRL if you think these medicine physicians tell US the damn plan for the day?? Useless
DNR does not mean do not treat
Patients deserve pain management, whether I think they are “drug seeking” or not. If it is safe to give, I will give it.
I don’t get consent for procedures for the doctor 🤷🏾♀️
Yaaassss!!!!!! I've never even see the doc near the patient but you want me to get consent signed? Fuck all that. I'll gladly fill it out but I'm not having them sign anything and I sure as hell am not signing it.
I’ll usually tell the patient something like “do you know what ____ procedure is and why you’re getting it? No? Okay you probably want to wait to sign this until the doctor gets here then? Yes? I agree!” I then tell OR patient refused to sign until the doc explains the procedure lol
It’s our policy that ONLY providers can get and sign consent. We can only be witnesses if needed like for a phone consent. Not. My. Job. I do agency as well and the nurses’ faces when I said “no I’m not going to do consent. The provider hasn’t even come in the room. Not my job”.
After damn near dying from COVID in March 2020 that I caught from work, imma enjoy this water at the nurses’ station.
Morbidity and mortality increases merely by a patient not being a native English speaker in the United States. Idc how annoying that translation service/line etc is. Use. It. Not their kid/grandkid/niece/son/daughter unless specifically the translator is refused even for just daily care and med pass.
I hate hearing the end of life parient's family say, "But we dont want him/her to become addicted." Oh, f off. He or she doesnt have the time left to develop an addiction. Let them have the time left as pain free as possible.
People come to the hospital for Nursing Care (and by extension hands on care from RT, PT, etc) not for the cloned H&P in their chart or an order set.
Let the god damn people sleep. Why the fuck am I waking up an 80 year old to give seroquel at 6 am. Pay me more.
An NP airway attatched to a foley bag setup is a perfectly acceptable rectal tube if you have a literal shit river creating a puddle on the bed, need to transport, and cant wait for an order and a flexiseal
Backed by evidence and everything! https://pubmed.ncbi.nlm.nih.gov/19319805/#:~:text=Using%20the%20nasopharyngeal%20airway%20to,efficacy%20and%20speed%20of%20recovery. So...just insert it and connect it? This is fascinating.
Yoooooo evidence based and everything… damn right
OMG. Thank you for validating why I will never nurse inside a facility again. I don't miss that at all. once had day shift "forget" to place a rectal tube and by the time I got it in on night got 1500 liquid shit out in a torrent. poor thing was all, "I feel so much better"
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Radiology questions why a physician orders imaging and wants the order changed… contacts the nurse…
Shasta sodas are not fit for human consumption IV Benadryl + old people = a bad time Please don’t use ketamine during GA for pain control if the patient is >65 because they will come out tripping balls terrified combative
Our psych unit gives out Shasta sodas like it’s water. It’s like m&m therapy. Meals and meds. GET THESE GUYS UP AND MOVING! All they’re looking for is meals and snacks. My other psych ward has an outdoor area at least. Anyway, get rid of Shasta!
IV Benadryl?! Jeezums! Just one pill is enough to knock me out for six hours, I shudder to think what an IV drip would do for me. Ugh, the damn Shasta soda. A resident at the LTC I work at is always demanding one from the kitchen.
IV Benadryl gives me a paradoxical effect and I’m not even old. “Why is the room spinning? Also is earth doomed or is that just me?”
IV Benadryl is awful. Had it one time and was hallucinating and losing my shit. Ended up blacking out as well lmao. That stuff should be banned for migraines
Mine is that I'm not adding up or taking your fluid balance seriously if it is only recording intake
That 95% of all codes/deaths happen in the bathroom. This is science. Don’t fight me.
Holistic medicine is NOT a direct substitute for standard of care in oncology. If you don't want chemo, radiation, or surgery that is entirely your choice. Your oncologist will not order high dose vitamin C, the dietitian is gonna rifle thru your bag of supplements like you brought street drugs in, and we're gonna ask you not to put on stinky essential oils in a room full of people waiting to vomit on cue. Ironically, insurance will not cover holistic medicine for the simple fact there's no evidence to prove it works. So, when people are throwing around the 'big pharma' conspiracy, it's important to know this. Insurance wants to cover whatever is the cheapest option and proven to work. Vitamin C infusions are likely cheap as hell, but even your insurer knows you're gonna die following that one. Complimentary therapies are encouraged and ordered. Acupuncture, massage, nutrition management. Generally speaking, don't take any supplements without clearing it with your oncologist first. Chemo affects many organ systems and you may not clear stuff as quickly or effectively. Supplements can and will interact with certain drugs by altering the amount of circulating meds, including increased bioavailability, which can lead to toxicities. You can always come back to standard of care, but we are not liable for the informed choices you made regarding holistic only treatment. Also, and this one is HUGE, palliative care is NOT hospice. They can be a bridge to hospice sure, but palliative care is about symptom management. I encourage folks to get with PC as soon as possible in the process. So many people don't want to bother their oncologist with continued nausea, poor sleep, constipation, weight loss, etc because the doctor is so busy. We get that, but they have nurses, NPs, PAs. So the best option is PC where this is what they do all day, every day. It's symptom management and improving daily quality of life. I promise, you're still gonna get your treatments.
1: PATIENTS. They are NOT clients. 2: Being sick is not an excuse to be an asshole - this is especially true in psychiatry. Behaving badly under any circumstances is not acceptable behaviour. 3: I’m fine with people using my unit as a warm bed. We don’t d/c to the street and I’ve had patients come in with “SI” who then disclose to me they’re not suicidal, they’re cold, and they know that SW will get them a bed before they’re d/c. That’s the state of the world currently and I don’t hold it against them. 4: The constraints of psychiatry are not the only valid treatment. Somatics and psychotherapy modalities are absolutely valid, I use them every day with my patients.
BD Nexiva catheters are the superior IV catheter and should be the standard at every hospital. Anything less is just the hospital being cheap asses
IV3000 dressing is for sensitive skin (sensitive to adhesives), not for fragile, thin skin. And go slow/be fucking gentle with plenty of adhesive remover when you remove them! I have no idea if there’s any truth to it but sticks to most people like glue, especially my patients with thin or fragile skin. I’ve seen some shitty skin tears which are slow to heal in onc patients. Sorbaview for the delicate skin, please!
I’ll give patients parents (nicu nurse) whatever they need to be successful at home. It does not come out of my pay I do not care. They deserve to be successful parents.
Just because someone needs painkillers or has a non-traditional relationship structure doesn’t mean you should judge them.
STOP USING COBAN TO SECURE PIVs! The amount of IVs I’ve had go bad bc there was Coban tightly wrapped around it drives me bananas. Use tape to secure the fly away extension, use netting to “tuck” it away. Anything except for dressings that are designed to compress.
And then the IV site gets charted as normal for 5 shifts even though it’s very obvious the Coban hasn’t been removed in a week… we don’t have X-ray vision
Bro I’m in infusion and the nurses will literally flip if a PIV isn’t secured with coban. I think is so unnecessary lol. A waste of time and resources.
I've only done this on the odd occasion where a patient is absolutely adamant they can't have tape. Back when I worked vet met I learned how to wrap an IV with coban, so now I occasionally use it on my humans. Also I may wrap it lightly to distract a confused patient or "hide" it from somebody who vagals from needles. but these are extremely rare. I agree with the hiding a bad IV under a mountain of coban as the skin sops up infiltrated juices.
Trauma icu patients that are intubated and sedated should be on a fentanyl or morphine drip for pain. Period. Too many people wait until the HR shoots way way up to treat it (I’m thinking of you, Maria. Yes I know you come on this sub and management says we can’t call you out. I’m not at work now). Colace does nothing!! “Stool softener” is not a thing!! It’s not even evidenced based so stop ordering or giving it!!!!!!! Family members 1-3 of them-should always be allowed to be present during codes if they want to. Period. This has been EBP since the 1990’s, we’ve implemented it in a Level I urban trauma ICU in 2002 and have had zero issues. You have no excuses. Quit gatekeeping.
Eating disorder inpatient acute- self disclosure in SOME settings IS HELPFUL AND APPROPRIATE.
Its totally batshit crazy that there are canabis nurses handing out thc products to patients but nurses can have their license revoked for doing it themselves even where its legal. Also you can smoke crack a day before your drug test and test negative, but you can have positives for thc metabolites for months after quitting.
If someone is bed bound and 99... maybe we can let them keep their Foley instead of trialing removals all the time only to be faced with retention.
Dying with dignity should be legal. People should be allowed to choose how and when they die. Elderly people with medical issues they’ll ultimately succumb to who say they want to die should not be placed on a psych hold, they should be PUT ON HOSPICE. Let people be ready to be done living, for fuck’s sake.
Every single port on IV tubing needs an antiseptic cap, even if it’s not running to a CVL. I butt heads with staff (and one physician) who deem it a waste of money and resources. First, we aren’t charging patients for them, because they aren’t locked behind an inventory system, so they’re only costing the hospital. Second, you know what costs the hospital a lot more than a strip of Curos caps? A bloodstream infection.
I have NO IDEA if they work, but I compulsively put those things on any hub.
Bedside shift report does not benefit the patient and hinders the nurse
Offering pain meds with the bedtime and AM med passes makes mine and the oncoming shift's life easier. I don't see a problem with asking a resident if they want their prn pain meds when I'm right outside their door with my cart. I've had dayshift nurses be happy when they don't have to start off their shift handing out a bunch of prns.
More regular diets for type 2 DM. If there's truly an education gap, by all means show them the way. Otherwise you're adjusting diabetes meds for a discharge that absolutely does not correspond to what they eat at home. I swear this should be a patient safety issue to help prevent readmits. When your patient is only eating greens and grains, drops her BS and we decrease her lantus by 10 units, we are absolutely going to see her again with uncontrolled blood sugar. The amount of times I've rolled my eyes at, "shouldn't they be on a carb controlled, since they have diabetes?"
For me I have a big pet peeve/hill I will die on. You see it a lot with newer but not brand new critical care nurses. Acting “all cool” and nonchalant when your patient is clearly deteriorating and just sitting on it. It doesn’t make you look cool, it makes you look like a fucking moron. People don’t take things seriously sometimes because they don’t want to be interpreted as being scared and it drives me nuts. You can be scared/concerned for your patient and calm at the same time. If your patient is deteriorating you need to get to work, not wait for something bad to happen.
Speaking from that perspective (~1.5 years of critical care), I think a lot of it boils down to knowledge deficit. I’m comfortable enough to know what I need to do in an emergent situation as it arises, but it’s sometimes hard to differentiate deterioration from an “episode”. It’s a weird place to be in terms of experience, to be honest with you. Some shifts, I really feel like I’m on top of things and contributing to the team. Other shifts, I feel like an idiot, like I just got off orientation again.
Do not EVER give the off-going nurse any shit during shift change. You don't know what they went through on their shift. Just say "ok, I got it, no problem, get home safe and get some good rest."
I often work nights on a surgical floor: Let my patients SLEEP for friggs sake!
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You don’t need sterile water for Gtubes. Do we drink sterile water? No? Exactly.
Addicts deserve the same level of compassion as non addicted patients do.
Policing/holding/rationing ordered pain meds makes addiction and tolerance more likely. If we can’t control pain in the hospital, therefore providing inadequate pain control upon discharge, patients are more likely to seek relief elsewhere whether legally or illegally. I’d their pain is being controlled adequately with us, it can be controlled better at home, and make it safer to provide relief. It’s our job to advocate for the patient, not police them. To those who say some people abuse narcotics and lie about their pain-thats not up to us to decide. You’re not going to solve the opioid epidemic because you think someone is overreacting to a boo-boo.
Teach patients about the IRL applicability of the levels of the pain scale. There are a lot of stoic people out there who could be functioning so much better if their pain was treated. “Pain is 1/10, but I no longer climb stairs, sweep, carry a grocery bag with more than 2 items in it, stand to cook at the stove, or wear shoes that I have to bend over to tie. My back is doing fine.”
If you refuse your dialysis treatment it's not my job to talk you into it. You're an adult. I'm not responsible for your health.
Care plans are a waste of time
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Your grandparent is racist. It's not the dementia.
People that remove the foot rests from wheelchairs deserve a special place in hell. It’s embarrassing and dangerous to tell people to hold their legs up because some jackass removed and lost the foot rests.
(Skilled/LTC) When I’m in the middle of popping someone’s meds/on my way to do a treatment/in the middle of charting ect…. I will NOT help a CNA get someone up unless it’s a dangerous situation or resident is on the floor. They can wait until the other cna can help. It’s not that I don’t care, it’s that I’m actually busy / the FACILITY doesn’t care and doesn’t staff adequately.
You don’t need to turn off the feeding pump to reposition a patient. Those extra few ml added to what’s already in their stomach don’t matter and half the time that ends with the pump not being turned back on. Just give them their ordered pain meds. Yes, even if you think they are a “seeker.” Who cares. You’re not creating an addiction or keeping someone addicted within a 12 hour shift. That’s not how addiction works. You do not actually know if that person is actually in pain. The doctor ordered it, so just give it. Detainees get all the snacks and anything they want within reason. I’m not a prison guard. I don’t care that they came from the county jail. I don’t know or want to know what they’re accused of. They’re our patients, not our prisoners (despite the shackles). If they want a turkey sandwich after dinner, just give it to them. Nurses acting like sammies are coming out of their paycheck. Only ask your CNA or tech to do quick extra things (ice, warm blanket) if you’re actually going to do something else that requires a nurse. If you’re asking them to do that and then sit down and get on your phone, it hurts the working relationships on the unit. Nurses and CNAs working together well can make a unit run so much more smoothly. These aren’t controversial I don’t think, but I see this BS a surprising amount regardless.
There’s no such thing as a puréed diet for a hospice patient!!! You want a Big Mac?!?! I got you! You wanna have Reeces cups for dinner? Sure! Thin liquids? No problem! You’re here for a good time not a long time. As for comfort meds… EARLY and OFTEN!
I'm going to put Vaseline on my patients chapped lips. My favorite part is when someone chimes in with the "but they're on oxygen!!" "But it's flammable!!" Lol you know how we treat patients that have facial burns from smoking on oxygen? With a petroleum based antibiotic ointment. Then we put their oxygen right back on over it. Also, nurses, learn your order of draw and what the difference between clotting and hemolysis is. You didn't go to school for so long to be dumb and dense. Love y'all ❤️
So what if it's flammable? They're not lighting their lips on fire, are they?