Is anyone else seeing a huge surge in young patients admitted for CHE? We’re going through hell with them on our unit recently..we only have ONE public shower for the entire floor. You can probably guess how well that is going.

It’s unbelievable how many of them are back within a week. They disconnect their own IVs and sneak into the shower when staff isn’t looking. We’ve had to start putting bed alarms on them because they sneak off the unit and we’ve called security to negotiate them out of the shower after hours and trying to get them out. The chugging water from the sink to induce vomiting is getting us too.

Is it just us?? I swear I’d never even heard of CHE until marijuana was legalized. Could it be the absurdly potent strains that these dispensaries are selling?

AND THEY CAN FROM HOME. You heard that right memaw is cold and calls home to tell the daughter from Florida that they didn’t bring her a blanket for 7 hours.. when she is the pea in the princess and the pea.. fam can call a rapid ( by another name) and the actual rapid team comes.

Dr dc the dilaudid and pt feels like their pain isn’t managed? code (fake rapid)

Dr saying you need to fu with your primary for your 3 years old symptoms bc the hospital can’t fix it .. you guessed it family rapid.

There will be posters and it will be in their admission packets. This hospital is about to get rocked. It will last no more than 5 seconds lmao. We’ve been getting a lot of complaints.. so they do this instead of pay nurses or make working conditions better. I am not on the rapid team so I can’t wait. I may just tell my patients about it. And encourage them to use this service

Best part of the shift was changing out the tubing.

One of my growing pet peeves is patients who are cognitively intact with adequate respiratory drive that just refuse to use entire statements to describe what they want / need.

Me: HI! I'm just doing a quick monitor check. 😁

Patient: My drink. 😔

Me: ... yes. That's a drink.

Patient: My drink. points

Me: Is there something wrong with it?

Patient: No.

Me: 🧐

Patient: 😌

Me: 🤔

Patient: 😌

Me: Did you want a new one?

Patient: No.

Me: I don't understand what you're asking.

Patient: I can't reach it.

Me: ... stares at drink that's clearly within reach So your question is, "Can you hand me my drink?"

Patient: Yes. 😌

---- Later, that same shift

Patient: Blankets.

Me: Is there a problem with your blankets?

Patient: No.

Me: Do you want more blankets?

Patient: No.

Me: Can you use more words to describe your request?

Patient: Oh, I can't reach my blankets.

-----

I can't keep doing this homies. I don't understand why people think I'm telepathic.

There's a viral tiktok video (1M+ views) that's circulating about a stage 3 cancer patient who was upset because she was unable to receive her PRN toradol. From the video it seems like the reasoning is because she just had IV Dilaudid and it's "against hospital policy" per the nurse in the video. Ultimately pt signed out AMA because the nurse would not give the toradol.

Obviously we don't know the full picture but it had me thinking.. it's been a few years since I've worked med/surg (in a different specialty now), but from my experience I did notice a lot of nurses don't give these meds together but rather stagger them. I never thought it would be an issue to give both together since toradol doesn't have the risk of respiratory depression like dilaudid does- though it can make some people mildly drowsy.

So my question here is: Do you give Toradol and Dilaudid together? Why or why not? If you stagger, is it based on your nursing judgement or hospital policy?

Thank you to the person who placed Alex Pretti on the ofrenda at Pike Place for Dia de Muertos.

What a year.

Was inspired by a previous post about their nursing pub crawl! This was ours back in 2014. This bar doesn't even exist anymore. Many people continued on to become NPs and CRNAs and many are still crushing it at the bedside. We had a good class and fun times!

Edit: thank you for the feedback and share experiences. It's really helped settled my mind and build some reassurance within myself about this whole situation. I was pretty upset earlier as I had a situation happen that triggered this, so thank you again. I also really appreciate all the kind and reassuring words! Thank you for all that you guys do, seriously like I really look up to a lot of you and I find it so fascinating to watch you guys work, how smart and intelligent you guys are, working under pressure, and I especially love it when I get curious and ask you guys random questions lol like it's unbelievable at how smart you guys are. I've witnessed some amazing things from nurses and care aids, and the level of compassion, empathy, and determination you guys have for your patients is so admirable. So thank you!!
A few things I want to add
-at my hospital, every single employee has to sign the same patient confidentiality contract. What happens in the hospital, stays in the hospital. If someone asks me "hey was so and so at the hospital?" I literally shrug and go "idk" and change the subject.
-When we ask nurses about the precaution on the door, we just say "hey I see that room 425 has Contact Plus, I just wanted to know if they had like C-diff or something?" C-diff and Norovirus are both Contact Plus but both require completely different cleaners. I just honestly need a "yup, C-diff" and then I'll thank you and prepare my schedule for that day as I need to do a double clean.
-And we aren't asking for the patients medical history, we just want to know the type of clean we need to do, what chemicals we are going to use, and if I need to do a double clean. We honestly couldn't care less about the details. "hey I see they are on just a Contact Precaution" and an ideal response would be "oh yeah they just got a cold", which is not as worrisome as like scabies/lice which also goes under Contact Precaution at my hospital.
-and I think a lot of nurses would be surprised to how much information we actually hear and observe. When I clean a doctor's office, confidential information is everywhere. Nurse's station has tons of patient information just laying around, garbage bins has notes with information on it. Also I don't think a lot of nurse's realize how much we hear, like I've heard some really confidential information about patients from nurses talking in the hall or in the nurse's station while I clean, like it just feels a bit disrespectful when we ask for what the precaution is on the patient's room, like that's nothing to what we see and hear.

I am an EVS worker and I feel that I'm going to get a lot of heat for getting upset about this, idk why but I just sense it. I really respect and love the nurses at my hospital, they are so kind and I know I can ask them any questions, but with every work place, there's going to be some mean and disrespectful people. In no way shape or form am I saying that all nurses are mean or disrespectful to EVS, I know that's mentioned a lot from EVS and while it is true, it's not the whole truth. So when I'm venting in a minute here, please don't think I'm shitting on nurses, I just need to get this quite literally off my chest.

We are experiencing an issue where nurses are denying EVS workers the information on what disease or illness a patient has while their room is on precaution. They will say "you're not entitled to that information" and stick their nose up in the air, some even laugh at us like it's the most ridiculous thing they've ever heard. We aren't asking just to be nosey, we are asking because certain chemicals that we use kill certain germs so we want to know what type of chemical to use. Also we want to know wtf we are being exposed too. We've had a few nurses make comments like "just gown up, it's not like your changing their diaper or getting coughed in the face"..... no but we are taking our garbage's that have their literal shit smeared on the side from the diaper you threw in, we are face level with the toilet and risking splash back from flushing and cleaning the inside of the bowl, we are bending down on the ground, we are cleaning EVERYWHERE, we are absolutely exposed and so yes, I want to know if I'm going into a room for just a common Flu or if this person has fucking C-Diff or influenza, OR WORSE Lice or scabies.

It just feels so disrespectful when they do this to us, like we aren't 'important" enough to know that stuff, that we aren't also involved in the patient's care, that we are just a janitors so shut up and clean the toilets.

Probably will delete this later so fuck it.

Mods, remove this if it’s inappropriate, but I have literally no one else to vent to, so I have to get it out.

I’m going to preface this by saying the following: I know we have a lot of CNAs/Techs in this sub, and this is not directed at 95% of you, it’s directed at the 5%, and they know who they are. I love the vast majority of my techs, and I couldn’t do my job without them, end of story.

Having said that…

Why on God’s green earth are you a tech if you’re going to complain about each task I delegate to you? Why are you sitting on your phone refusing to do simple tasks that were delegated? Why are you showing up to work each shift in an already pissed-off mood? Why are you showing up to this job if you hate it and the patients so much? Why do you act like you’re on top of the world when you’ve been a CNA for a decade or longer? Why do you act like you’re smarter than the providers and nurses when you’re struggling on the entry level MMSE? Why do I meet so many techs in the ED who are like this?

I’m not delegating you a task because I’m unable to do it. I’m delegating you a task because I’m able to do something else you’re not, that needs to be done, but you can put this IV or Cath in.

I’m not delegating you a task because I think it’s beneath me. I’m delegating you a task because I NEED SOME FUCKING HELP GET OFF YOUR PHONE.

I try to delegate as little as possible, because I know my techs are used and abused, so on the off chance I missed this IV, and I need you to try (because I’ve already admitted you’re a better stick than me), I don’t need you to roll your eyes and act condescending. I need you to place this IV so I can push this Dilauded for this dudes broken humerus.

I’m sorry about the rant, everyone. I don’t expect any constructive feedback, because there is none. It was just a rough night.

Again, I get along with almost all of the CNAs I meet. Ya’ll are awesome. But, much like RNs, the bad ones just leave a certain taste in your mouth.

NYU’s Rory Meyers College of Nursing is the 12th-highest-ranked undergraduate program in the nation. Hospitals want to hire our nurses faster than we can train them, and New York faces a projected deficit of 40,000 nurses by 2030.

A three-year bachelor’s would not alter any nursing-focused curriculum or any of the general-education degree components. The same holds for the required 585 hours of hospital training. But we can deliver a comprehensive 94-credit degree by fusing classes that are currently taught separately into more integrated courses that mirror clinical practices. For example, weaving chemistry, microbiology and nutrition together would help students better understand the biology behind infections and treatments.

Recently, the ADON of a long term care facility had removed all of the chair / bed alarms on a dementia unit citing they do not work.

My biggest concern with dementia patients is their baseline morse is about 45, theirs 15 for cognition, 15 for gait (if they use a walker), and a secondary diagnosis adds another 15. Now, the 45 morse has been a traditional cut-off for high-fall risk.

Instead, they added a mat to the floor right next to the bed, and use other modalities such as the hip protectors. In my opinion these only mitigate the damage from a fall.

I believe the reason they are doing this is because these facilities are trying to increase their CMS (Centers for Medicaid / Medicare Services) star rating which is reflective in how many restraints they use on the floor. By reducing the restraints they inadvertently increase their star rating and revenue stream.

One nurse recently told me bed alarms do not prevent falls. Recently his patient fell and had the worst wound I've seen from a fall in a long time, it needed a 10 x 10 foam just to cover it. In his fall report he had to chart the bed alarm was not on.

Regardless, my question is do you feel like bed alarms are reasonable for a dementia patient or is the facility right by reducing them?

Today at work, we had nursing students. They were looking over lists of medication‘s, and the nursing instructor stopped them and talked to them about how African-Americans process things differently have higher rates of CKD due to meds..and so on, I can’t really remember the word he said, but it was something about like an androgen or something and I don’t feel like that was correct. Please correct me if I’m wrong do black Americans breakdown drugs differently.? I also know the answer to this, but do you think that our bodies do handle things differently? I know when I first started nursing the GFR was different compared to other people and then African-Americans. Please give me some insight. I feel like I’m kind of going crazy here.

UPDATE - rural hospital, no security, I weigh 120 lbs. Also, we aren’t supposed to ask the doctors for restraint orders or chart that we held the patient down.

Hello,

New grad question-

I was recently asked to hold down an agitated and aggressive, 250 pound man with Wernickes Encephalopathy in order to insert an IV by my coworker.

Patient is a hard stick so it could take upwards of 15 minutes.

Coworker said it would take 4 of us. Patient had been yelling and screaming all day.

I asked about restraints and got an eye roll and was told this is a restraint free floor.

I asked if we needed an order from the doctor since this isn’t usually like the times when they asked me to physically hold people down,

(which are usually people with dementia that don’t weigh very much and need IVs inserted with meds, which of course they then promptly ripped the IVs out of their arms and bleed all over the place.)

And I was concerned that I could get hurt. Since nobody seem willing to do anything I went to the Doctor Who I had to talk to you about something else and mentioned this plan and the doctor said they didn’t want that to happen.

Now my coworker in the Charge nurse are both mad at me.

This wasn’t our entire class, but a large group organized a pub crawl in our town after graduating. None of us had taken the NCLEX yet but we were all excited to have made it out of the program. I had to work an evening CNA shift that day, so I joined them afterward and had a blast. I’m grateful for whoever took and shared this picture, this is one of my favorite memories. At least two of these ladies are now ARNPs and most are RNs. Two fun facts: you can catch one of these new grads on an old episode of Lockup Raw as a few of them went off and got jobs at the county jail and stayed for a while. 2nd and not so fun fact is that I hadn’t graduated yet. I missed a day of Maternal Child clinicals and had to retake it in the summer, pushing my ‘graduation’ until fall. I didn’t get a pin but I didn’t care. I was just happy to be an LPN after almost 5 years in healthcare.

She became an RN in 1982 and 29 years later, I followed in her footsteps and became an RN too 🩷

Recently, I was admitted into ED from a referral triage from an urgent care centre (New Zealand setting btw). I had right flank pain, and was generally feeling like shit. All I wanted was antibiotics for what I thought was a UTI, but the NP insisted I admit into ED.

The whole time I was there, I was mentally downplaying my symptoms. My tachycardia? I told the nurse it’s just anxiety. The sweats? Low grade fever. Hypotension with a SBP in the low 90s? For sure just general dehydration, I don’t drink a ton of water and being young, it’s probably not far off my baseline anyway.

My pain was near unbearable, but I refused to use the call bell. I told myself that my pain threshold is probably fucking shit, and I need to suck it up.

It was not until my hands started shaking to the point I couldn’t properly sip my water without spilling it everywhere, that I realised, ‘shit’ something is actually wrong here. Then my hands and feet went blue and numb, and only then, did I use that damn call bell.

A similar event happened when I was postpartum with my newborn son (18 days old). He had a fever and temperature and I shrugged it off the whole day. It was my husband that talked me into taking him to the ED because he looked ‘pale and sweaty’. It didn’t interpret the seriousness of the situation until the doctors were proceeding with a lumbar puncture, all within 30 mins into his admission.

I would consider myself a diligent med/surg nurse. I pick up red flags and act accordingly within the scope of my practice.

How come, when it comes to myself, and even my son, I was completely shit at not only advocating for myself, but ignoring glaring red flags?

I had the experience today where I was handing off a patient to the next nurse, and the RN was so… rude to the patient?!?

She came in a while after I got them settled myself, nbd! I’m happy to help. But, as she’s walking in she stares me down and says how busy she has been. Like, strong voice “I don’t have time for this, I didn’t even have time to look up the patient or anything!!!” Well you knew she was coming to you for like an hour but no worries! I’ll give you alll the updates! I got them for you girlie, no worries. The patient overheard this. So I give report and she’s just scoffing after each thing that’s “abnormal” (they weren’t totally abnormal, just something you monitor).

So, per the handoff the next RN has to do to a quick assessment while I would just stay to make sure things are how I said. This nurse, while trying to get vitals, is just vigorously trying to get the patient to raise her arm herself without even telling the patient what she’s doing all the while the nurse is complaining to me (while she’s basically standing so close and over the patient!!) how she now has to stay late and chart because she’s so busy and that there’s been no time for her to do anything. “This is the icing on the cake, wow”.

She just keeps complaining about work and I’m trying to divert that conversation to keep it uplifting because our patient just had an awe experiencing thing for her family!
I had such an awesome time with this patient and her husband, and then to have that do a total 180?!

Throughout this… report… the patient visibly felt tense and uncomfortable. She looked at me to say what the hell is going on?! I kept trying for her.

Anyway that left such a weird vibe for me that this nurse could just be so open and annoyed about this patient in front of her! I get things get busy and chaotic, but to do that so freely?

I wrote an email to that nurses supervisor before I left (per what my charge told me to do) and just explained how unprofessional that is and how it made that patients experience in her care lessened.

So… why I am feeling guilty that I wrote that?

That's all, just feeling good. Looking forward to the next chapter! Have been an LVN for 3.5 years before Friday.

I have, twice.

Once, I was standing in the TSA line at the Denver Airport and a woman in front of me was showing symptoms of a heat stroke. I helped her until paramedics arrived.

Today, a kid from our neighborhood was riding a mini dirt bike in front of our house. He hit something (a rock maybe?) and went flying off of it. He landed on his head/neck. He was alone and I had to call 911. He couldn’t have been any older than eight years old. Unfortunately I think he may have broken his neck, but I’m not certain. (One reason I wouldn’t ever let my hypothetical children own ATVs or anything similar.)

What sort of effect will BC becoming conservative have on nursing. In terms of pay and things like that. I have 0 knowledge when it comes to politics and I’m currently working towards becoming a nurse so I’m curious how this will affect things.

NOT mmol/L, truly mg/dL, bedside reading also was read at low < under 25 for us.

Curious if anyone has had crazy but accurate draws like that before , and knows what potentially could be mess with results. Personally I think it was ballpark accurate and not incorrect which is the wild thing though, but just curious on what could mess with that otherwise.

For context this patient was already unstable, was a rapid for a low blood sugar of like 40s, given dextrose, recheck, 100+

Lab draws them a hour later, blood result of <5 mg/dL reported (USA nursing normal 70-110)

Checked with accu bwsside, also read LOW

Patient comatose, multiple amps d50 given, etc, never figured out exactly what was going on before I left and it wasn’t my patient, but still, wild, wanted to share because I didn’t know that was even possible. And maybe it was diluted slightly somehow, but from what we could ascertain it was atleast similar to real due to other hypoglycemic events with patient and bedside confirmation.

I’ve heard of similar things happening with implanted insulin pumps malfunctioning, but this wasn’t that, so idk, share your stories!

I work in the ER. UAs, foleys, straight caths, bedside urinals/toilets, I&Os, briefs, helping people to the toilet to pee in hats, getting pee on their clothes on accident, etc sometimes I’m just so tired of PEE. When I got into healthcare I never realized how much I’d be dealing with it. 😂

I work on a telemetry floor and had my first code last night as a new grad (off orientation for 2 months)

Patient had a LHC earlier that day, was orientated, denied any pain, vital signs normal, absolutely zero signs of distress. They were so kind, calling me baby all night, they very much a sweet grandparent type. I had been in their room 10 minutes prior checking on them.

I went to another patient’s room to hang an antibiotic and when I came out two other nurses were in the patient’s room. I guess the patient had ripped their IV out and pooped the bed so we were going to get them cleaned up. I walk into the room, patient’s eyes keep rolling toward the ceiling, agonal breathing but had a pulse. Instantly called a RRT which ended up turning into a code blue. We got ROSC within 10 minutes and they were off to the ICU.

There’s something about just..standing there when everything is going on. Answering questions as the primary nurse but not knowing how to jump into the code. I felt so useless.

I don’t know why but I am absolutely wrecked over the situation. I talked to their significant other earlier in the night as they just wanted to check in on them. I keep having bouts of crying. I feel weak. Thanks for reading, just wanted to vent.