Solve A Neurologic Mystery

Solve this neurologic mystery:

RS is a 70 year old, lady who lives independently in a first floor apartment in the city. She has no close relatives but has neighbors who know her very well and check in on her from time to time. She hires a cleaning lady that does her house cleaning and laundry every week. Her nearest relative is a niece who lives in the same state but is 8 hours away by car. Her medical history includes anxiety disorder, hypertension, hyperlipidemia, COPD, and mild kidney insufficiency. She has a 40 pack/year history of smoking. Read More

What Is The Deal With All The Highly Educated & Professionals Becoming RNs?

So I pretty much always have nursing students with me. I have senior BSN students who are doing a critical care class (six 12 hours shifts), ADN students from 2 different programs doing their preceptorships (eight 12 hour shifts), ABSN students doing clinical (six 12 hour shifts), and direct entry MSN students who shadow me for a shift. In addition I come into contact with a variety of other students who are being taught by my RN co-workers. My hospital also has a "student nurse technician" program where they hire nursing students to do CNA type work. So I regularly talk to 5-10 nursing students a week and nearly always have a student with me each shift.

What I am so shocked about is the level of education of these students who are in nursing school. I can't even remember the last time I had a ADN student who didn't already have a bachelors degree with me. Of course the MSN and ABSN students already have bachelors degrees, but what is surprising to me is that so many are already professionals in others areas. I had a student who already has a bachelors and masters in architecture and worked for a well known local firm, I have had lawyers, police officers, scads of teachers, and a few engineers among others. Even a guy who is an MD in Russia. Read More

Make sure the reference you provide is expecting a call.

When providing references please make sure they are ready to talk about you. It looks really bad when their first response is, "Who?" You may also want to make sure that your references are available, not out of town or otherwise unreachable. Share your tips... Read More

Acute vs. Primary Care NP? Can't decide

I'm interested in going back to school to get my Master's. But I can't get started because I can't decide on a program! I know one thing for certain: I'm interested in endocrinology/diabetes management.

I enjoy the fast-paced acute care setting so I've considered Acute Care NP/CNS. Newly diagnosed diabetes, ICU admissions, DKA, HHS, endocrine disorders, etc. Awesome! I would love to do consults and education. But I feel like I'm already developing HTN & GERD from being stressed out...

Then I think I would love to have time/freedom to build long-lasting relationships with patients and families, to address psycho-social issues surrounding chronic illness diagnoses. That leads me to FNP programs. But I'm afraid I'd get bored/frustrated in an outpatient clinic...lack of autonomy/time/resources/support...

What have been your experiences as Acute Care NPs/CNS's? As Primary Care NP's? What have been some of the rewarding and frustrating aspects of your job? Do you prefer inpatient or outpatient? Do you have a job that allows you to work in both settings? Peds or adults? Read More

Antagonizing patients--just a vent

I have been in psych now about 7months. I am very disturbed at some of the behaviors exhibited by experienced nursing. Why do some nurses antagonize these patients. Patients are there for a reason, is it really necessary to be sarcastic and use foul language with these patients? Could this behavior happen or even be tolerated on any other type of unit?? Why is this okay for psych patients? I can't stand it. One of the off-going nurses got in the patients face demanding that he go to his room. The patient back talked, but really he is very psychotic. He went to the doorway and stood in the doorway. That wasn't good enough for the nurse. The nurse got right up in his face, I mean nose to nose, and screamed you better get in that room right now, I'm not playing with you... it was just so unnecessary and demeaning to the patient. The nurses posturing was also scary... ughgh... its just sickening sometimes... very un-therapeutic and sad Read More

DNP....Is it worth it for me??

I have recently been accepted into the Arizona State University Adult DNP program. I am having the toughest time deciding if it is the right move for me to make.

Let me tell you a little about myself. I have been a nurse for 2 years. I started out working as a new grad on tele/post open heart floor. After a year and a half I have transferred to resource and float all over the hospital between med-surg/ tele/ ICU resource person/ Stress lab….and I love not knowing where I am going to be from day to day. When I originally applied to the DNP program I really didn't think that I would get accepted based on only being a nurse for 2 years but I figured I would try anyways. Well here I am accepted for Fall 2013 and still trying to weigh the Pro's and Con's to make the right decision... Read More

Drawing the Line: Shutting Down Verbal Abuse

According to the ANA, a whopping 48% of nurses reported experiences involving strong verbal abuse (ANA, 2001). The impact of workplace bullying is often insipidus. Like a cancer, it grows slowly, silently, and has devastating effects.

Low staff morale, increased absenteeism, attrition of staff and the deterioration of quality patient care are some of the results of bullying (Hughes 2008).

To combat bullying, you must adopt a "zero tolerance" mindset. No one, no matter who they are or what their relationship is to you, has the right to be disrespectful to you. Helpful guidelines... Read More...

ARDS: Should we be prone to prone?

The buzz in critical care circles these days is the recent publication of the results of the PROSEVA Study Group in the New England Journal of Medicine. This European study begs to answer the question long-debated by critical care professionals over the years - is there a benefit to prone positioning in Acute Respiratory Distress Syndrome (ARDS)? Prior to the release of the PROSEVA results, trials that tested this hypothesis have failed to show a beneficial effect on patient outcomes. Read More

When family refuses IV pain meds for cancer pt...?

What do you do when a pt's spouse refuses to allow you to administer IV pain medications as ordered? Pt has end stage cancer w/ brain mets. DNR. Confused most of the time. Has not been deemed incompetent, has no power of attorney. Says "no" when you ask her if she's in pain, all the while she's yelling out that she's in pain. Spouse tries to console her if he's in the room, but is often gone... But has an unpredictable schedule.

Spouse said he doesn't want pt "knocked out" & she "isn't herself" after she's had IV pain meds. (Like rolling around in pain IS her??) He will allow PO Percocet 10, but pt has swallowing difficulties r/t confusion. Spouse has been educated many times by many different nurses regarding pain associated w/ pt's type of cancer.

Talked to the doctor during rounds, but he offered no guidance and the spouse wasn't present. Went to the charge nurse who said to talk to the nurse manager who said to address it with the social worker who said to contact the oncologist (again) who said that if the pt can't swallow then "she'll just have to hurt." Seriously??!!??

What would you do?? It feels ABUSIVE to allow her to be in such awful pain for so long, but the spouse will cause a HUGE scene if he thought the pt had received IV pain meds. What are my options to protect my pt & keep her at least reasonably comfortable?? Read More!

Nursing Hostility and Other Nonsense

In my short career as a nurse I've seen some terrible behavior among nurses, and I'd like to share my take on things.

I've only been a year for two years, and working as a nurse for 13 but in that short amount of time, I've seen an astounding amount of hostility between my coworkers and directed at me in the two facilities I worked at. It made me sad, it burned me out and it made me feel like I was working in a mine field.

As a fellow nurse, I respect you. We ALL had to work our tails off to get through the hell that was nursing school, study feverishly for the NCLEX exams, then scramble desperately... Read More

How does anyone do double shifts? I'm tired after 40 hours

I just started a new job about a month ago, so I know I'm still getting into the swing of things, but I feel kind of silly for what's going on. I get 6-8 hours of sleep on work nights, I eat alright and do my best to manage my stress, but I feel dead to the world after my 4 shifts in a row (4 on, 2 off, 4 on, 1 off) that I have ended up taking a 2-3 hour nap shortly getting home after every string so far. I feel useless on my day off unless there's stuff I urgently have to do (laundry be damned!) so how is it that people pick up extra shifts and routinely do doubles? I know that some people have to do it for financial reasons but what I want to know is HOW? Is there some sort of magical trick that I'm missing? Read More

Rate Your Pain

The control of pain could be one of the most subjective and complex assessments that a nurse has to complete. JHACO has put the patient's right to have their pain controlled on the forefront of nursing assessments. What is a nurse to do with all that subjective information? Read More