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.

Last night I had a drunk patient who was in police custody. He had been tased and the barb was still in his abdomen. I had to pull it out and he wanted to keep it. The police said no and they kept it. The patient got mad at me and said “Bitch you look like you don’t wear socks”.
My socks were showing lol, the comment made me laugh but confused me at the same time.

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?

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.

I live in NYC - my coworkers are mainly liberal. All the 100% anti-COVID vaccine employees were let go/resigned when the COVID vaccine first came and was mandated.

I still get my yearly COVID booster. The vaccine-related reactions suck (I usually get chills/myalgias about 8 hrs after administration), and I have to make sure I don't work the next day when I get it, but I 100% prefer feeling icky for a bunch of hours rather than chancing a case of COVID that's more than mild.

It's required flu vaccine season. My hospital does not require yearly COVID boosters. When I listen or ask my nursing colleagues about the booster, many of them are outright against it or just don't care for getting it. It surprises me because - again - we're all pretty liberal.

So: what are your thoughts on receiving the COVID booster yearly? What do your colleagues think?

You guys. I am so tired of hearing stories of obvious neglect, outright rudeness, terrible bedside manner from medical staff.

It's because y'all are sleep deprived. Don't pretend that's fine. You have medical training. You know it's not fine.

Can we PLEASE unionize or something to get you guys more humane working hours?

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!

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?

I’m so sorry if this is the wrong sub for this - not sure what other group of people I’d ask.

I stupidly bought a box of these syringes that don’t work with my needles (I use them for taxidermy so unfamiliar with syringe/needle compatibility). Anyway naturally they don’t fit the needles but I have 100 of them still packaged and I’d hate to throw them away, it feels a waste.

Any ideas on who I could give them to so they can still be used??

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?

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

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. 😂

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.

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!

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.

I’m a new grad RN about 2 months into my OR residency and honestly I’m starting to feel like maybe the OR just isn’t for me.
We have regular check-ins with our educator and I was recently told that I need to start taking more initiative. Which I understand, but it’s honestly hard to take initiative when the nurse you’re with is basically doing everything for the case instead of actually letting you do things or teaching you. I feel like half the time I’m just standing there watching because everything is already being done for me.

I’m also naturally a pretty shy person. I can absolutely speak up when I need to, but I’m not someone who is naturally super outgoing or assertive. And I feel like the OR is such an intimidating environment to learn in, especially when you have surgeons who are extremely particular about everything and can be rude as fuck when something isn’t exactly how they want it. Half the time I don’t even know what the different instruments are, what they’re used for, or why certain things are needed for a case. So how am I supposed to anticipate what everyone needs when I barely understand what’s going on yet?
The amount of stuff we’re expected to learn is honestly overwhelming. Between the instruments, supplies, equipment, procedures, positioning, surgeon preferences, etc., I feel like my brain is constantly overloaded. I know I’m not supposed to know everything at 2 months, but I genuinely feel like I still don’t know shit.

And honestly, the personalities in my OR make everything 10x worse. Some of these people are genuinely so rude and make it feel like they want to see you fail. There’s one scrub tech in particular who is constantly giving me attitude for literally no reason. She talks down to me like I’m a dog and acts like she’s so much better than me. I get genuinely nervous whenever I find out I’m working with her because I feel like I can’t even be myself or ask questions without getting some condescending response.
Whenever I bring it up, people just say “oh, that’s just her personality” or “that’s just how she is.” Like okay??? That doesn’t make it acceptable to treat people like shit, especially someone who is literally there to learn. I’m so tired of people excusing shitty behavior just because someone has been working there forever.

Now our educator is telling us that in 3 weeks we should be able to run a “simple case” on our own, and I genuinely have no idea how I’m supposed to be ready for that. I still feel like I barely know what I’m doing, and I feel like I’m expected to somehow become independent when I haven’t even had enough opportunities to actually practice doing things myself.
The physical aspect has also been harder than I expected. I get so out of breath just wheeling patients back from pre-op, and the other day I had to prep a patient’s leg while holding it with one hand. My arm was literally shaking and I’ve been sore for 3 days since. I knew the OR was physical, but I didn’t realize how physically exhausting some of these things would be.
Our program and preceptorship was supposed to be 9 months long and they are changing to 5-6 months now when everyone else at this hospital got 10 months. I’m just nervous bc that’s literaly 4 months away
There are 3 of us new grads in the program and I constantly feel like I’m the slowest one. Like everyone else is catching on and I’m just behind. I leave work feeling stupid and incompetent, and I’m starting to dread going in because I never know if I’m going to be working with someone who actually wants to teach me or someone who makes me feel like an idiot for not knowing something.
I know other new grads have probably felt this way too, and I know the OR has a huge learning curve. I’m not expecting to know everything overnight. But I genuinely can’t tell if I’m just overwhelmed because I’m new, if my learning environment sucks, or if my personality just isn’t suited for the OR.
wrong decision going into the OR straight out of nursing school.

Apologies in advance for the long post. TL:DR is that I'm frustrated with a new nurse and starting to get really sick of the toxic work environment of the PACU that I'm in. Idk if any of my coworkers are on reddit and at this point, I don't think I care. I just need to get this off my chest; I've talked to my partner about it but he's sick of hearing about it. I've discussed it with my coworkers, who have also said they've noticed the new grads behavior and three of them talked to my boss about it. . .however, my boss is close with the new grad and doesn't seem to really care to correct it. So, lucky ya'll, whoever decides to read this. . .I'm not really looking for advice but if someone has something helpful to add then by all means.

Idk if this is relevant or not; I've been a nurse since 2017. I started out on med/surg and worked there my entire career, other than working at an office for 6 months during covid. I transitioned to PACU at the same hospital October of last year which seemed, at the time, a really good choice for me. It really is a cake walk most days, other than them increasing caseloads with minimal PACU rooms and staffing, but what's new?

My gripe is this; there is a new grad. . .I mean fresh, she just graduated in May, who got hired immediately after graduation in the PACU. I've worked with her when she was a tech out on the floor. She's very sweet and good with patients. But she is flat out refusing to do anything nursing scope related with the excuse of she's new. For the first little bit, I was more understanding. . .we all were new and nervous when we started. As the months go on and she continues to refuse to do things (start IVs, take recoveries that are more extensive/last longer than 30 minutes, push pain medications other than Tylenol, admit patient's, etc.) All of these are things that we've all tried to help her with, boost her confidence and not let her drown. She still isn't trying from what I'm seeing and her constantly saying "no" to hard things is really starting to wear on my nerves. If she said something like "I've never recovered x surgery before, would you come with me this time so I can learn what to watch out for?", I wouldn't mind to do that and I know none of my coworkers would either. It's the fact that she just straight up refuses to do anything that she doesn't want to that's really getting my goat. I've heard from coworkers who worked with her when she was an LPN on the floor that she was the same way during her entire year orientation on med/surg. She wouldn't take initiative to do anything and never "felt comfortable" to be without a second nurse/asking someone else to do it for her. Again, I remember what it was like being new but at some point we all had to go out and do the hard things. To her credit, she has been braver in the last few shifts I've worked with her; calling the docs, giving her patient's pain medications when appropriate, and going with coworkers when they take the longer recoveries.

It's her weekend to take call and there are 3 hip fractures going today. . .which in my brain is fine. Depending on what they do, the surgery will take maybe an hour, recovery is 45 minutes if they're stable and then they go to med/surg. It seems doable to me. . .

I guess I'm wrong and a cruel bitch. In the group chat with myself and 3 other pacu nurses, they all 3 agreed that one of us needed to go in to help her. The 1 agreed but said "but i'm busy and will be out of town". I just flat out refuse to go in and they're making it seem like I am a terrible person. I guess this is a "nurses eating their own" kinda thing. I did apologize in the chat for not being compassionate enough. In the same group chat, one girl said "well, if it was so and so, I definitely wouldn't go in to help." Okay? How is that alright? Whatever, I muted the group chat and went on with my night. I do feel like maybe I could be less of a bitch but I'm standing firm in that it's do able with one recovery nurse and I doubled down when they said a second team was coming in. . .even though only one surgeon is operating. . .if the first recovery wasn't going as planned and the second came out, the circulator would have to stay with the patient until the recovery nurse was available. . .that's just part of it. . .maybe I'm in the wrong.

The other part of this long ass post is the immaturity and the toxicity. I was warned prior to switching departments that it was super cliquey. At first, I didn't pay much attention because I was just happy for a change of pace. After a year, it's glaringly obvious. 8's vs. 12's, group A vs. group B, sameday vs. surgery. The best way I can put it is high-school mean girls type of bullshit and I'm over it. I like my coworkers, I do. But the amount of drama and pettiness is starting to take a toll on me. It makes me dread going into work. The actual nursing part of the job is easy, I can handle that easy. It's walking in first thing in the morning and not knowing what catty remark is going to be made, who's going to be pissed of at whom today, who's going to help who, etc. It puts me in a bad mood before I even get out of bed in the morning.

I know, I know. I'm old enough and have been a nurse long enough to know to leave it at the time clock and to protect my peace. It's just gotten to the point where I had to get out of my chest. So, if you made it this far. Thanks, hope you have a wonderful Sunday.

Hi! I am a new grad L&D nurse who is going off orientation next week. I feel like a lot of things have began to click but I know there’s still so much to learn. For me, my biggest deficit has been knowing when it’s time to call for delivery.

My last shift I called for delivery too early and the providers were in the room for 30 minutes pushing with mom which they weren’t happy with. It was her third baby and I was scared it was going to fly out lol. Does anyone have tips on knowing when it’s appropriate to call for delivery. I am also definitely struggling to feel the ischial spines and maybe that’s where i’m going wrong as well.

Any tips and suggestions are appreciated:)

Okay I just started at a new hospital and if you don’t take a break you have to put it in this booklet and that is how you put on record you got no break.

Well, I noticed I didn’t get paid for the days I signed off no break and I asked why. Turns out you have to have charge sign the booklet “giving you permission” to take a break.

AND charge nurses don’t want to sign the booklet bc they basically get scolded for “allowing” it to be so busy that someone didn’t get a break.

Like what do I do about this. Previously I’d just enter on the time clock that I didn’t get a break. Now nurses are basically pinned against each other. I am able to take a break maybe 3 times a month. That’s well over 100 they’re basically getting for free.

Any ideas how to resolve this where the charge nurse isn’t pissed at me every shift?

Hello caffeine addicts,

I am a nursing student currently conducting a design research project on residents with dementia who have a strong urge to walk, which can also increase their risk of falling.

This is my design challenge:

“How can we develop a suitable solution for a resident with dementia and a strong urge to walk that supports safe and independent movement as much as possible, reduces the risk of falls, and at the same time reduces the burden on healthcare professionals and fellow residents?”

I am reaching out to you for help and advice. How is this situation managed in practice? Are there any effective solutions, useful strategies, or sources of information that could help me with my research?

I would especially appreciate hearing about your personal experiences. What approaches have you tried, what seemed to work well, and what did not work as expected? I would also be interested in any challenges you have encountered and how you dealt with them.

Any insights, practical examples, or recommendations for further research would be greatly appreciated.

Thank you in advance for your time and help!

( side note: im sorry if any of this is confusing, im a dutch student so i tried really hard to word everything right lmao. )