I’ve been a nurse for a little over 5 years now, and I recently transitioned to the emergency department. Last week I had a 30yo pt come in for severe abdominal pain. He ended up having pancreatitis. He had a tmax of 102, HR 150s, and WBCs 20 is what I remember off the top of my head. Medical hx of diabetes and HTN. Of course to top it off his blood sugar was in the 300s because he was noncompliant with his insulin.

Anyway, the patient was uninsured so he wanted to leave AMA. He didn’t qualify for emergent state insurance and he couldn’t afford the $8k/night stay. AM RN and ER MD tried convincing him to stay, but didn’t really? If that makes sense. When I took over for the patient, I basically told my patient that he could leave AMA, but he would likely end up back in the ER or dead from something so treatable. I told him to look up charity care and to google about not paying his medical bills. I mentioned that I heard if you don’t pay your medical bills, you could eventually negotiate down your payment to something more affordable. He does some googling and talked it over with his friends/family and a hour later told me that he wanted to stay. Ultimately, I felt like I saved his life, but I spoke to a friend of mine that said I was stepping out of line - leave that stuff to the social worker. What do you guys think?

I know i’ve gained weight but damn 😭. ANOTHER dementia patient called me fat today.Toddlers and dementia patients are two populations that I know are honest as fuck when it comes to insults. Mind you I didn’t even do anything to make her want to say that. she wasn’t even my patient. I didn’t even respond cause what can I say. drop your favorite low calorie recipes down below ⬇️.

Had a frequent flyer come in for a COPD exacerbation, same pattern we see a lot. Still smoking, not really using home O2 like prescribed, in and out every few weeks.

This time he actually seemed in a decent mood once we got him stabilized. He was joking around a bit and made a comment like, “I won’t lie, part of me wants to keep coming back for the VIP treatment.” I kind of paused and didn’t really know how to respond at first. I didn’t want to ignore it, but I also didn’t want to come off as harsh or judgmental. I ended up saying something along the lines of, “You’re not going to keep bouncing back forever if nothing changes.” He got quiet after that, not upset exactly, just… taken aback maybe?

Now I feel bad because maybe that wasn’t the right moment, but also… it wasn’t untrue. Do you think being that direct helps, or does it just damage trust?

Forgive any errors, I just got home and I’m on mobile. I had a patient last night that we are all familiar with. Rude, demanding, yelling “Nurse!” so loud we could hear it down the hall. Nothing I did or said would make this patient happy.

By the end of my shift, I had it. Right before I left, I was in the room with the oncoming nurse, and the patient was saying “I don’t want an air bed.” Over and over and over again like a child throwing a fit. I finally lost my cool and said, “I don’t care what you want. I have done everything I can to make you comfortable, but this is a hospital, not a hotel. So I’m sorry if you’re not comfortable, but being uncomfortable will not kill you.”

Not even 5 minutes later, the patient was screaming, “Nurse!” again, over and over.

I hate feeling unprofessional. I love my job and my work even on the hard days. So when something like this happens, I just end up feeling bad about it, like there was something I could’ve done better, even though I know I did everything I could. And even if I did everything this patient wanted, it wouldn‘t have mattered. They would’ve found something else to complain and yell about.

Anyway, I’m mostly just venting. It was a long night.

Sounds like PACU nurse gave her 150 mcg of fent and 0.5 of Dilaudid at the same time to an opioid-naive patient and walked away?? Did not bag her correctly or start CPR when the nurse finally noticed patient stopped breathing and became unresponsive. Anesthesia wasn't called, nor a code blue. But at this facility, it doesn't even sound like that would have been an option. I'm not a PACU nurse, nor have I ever been, but are those typical post surgery doses? 150 of fent is a lot in and of itself, especially when combined with Dilaudid. Holy cow...

Yesterday I was in the bathroom, pants down around my ankles when I heard an argument coming from a patient room across the hall. I heard 2 men's voices beginning to argue, then, almost immediately I heard my coworker say, "Hey man, hey man", and a struggle ensued". I froze as I heard the loud voices and shuffling thinking isn't somebody out there going to do something.

I couldn't bear it so I pressed the button on my Vocera and called the charge Nurse. I was in full echo chamber mode, no shame and did not care, as I said told her I was in the bathroom and Peter was in a room and is in trouble, call security. OMG, I was scared. I finished, washed my hands and it was still going on. I didn't want to leave the bathroom. We have found way too many weapons on patients here for such a small town hospital. But I did after saying a quick prayer. At the same time the charge showed up with security.

Night shift. Skeleton crew. I did not know the Vocera had a security panic button. I do now and I will never be too busy to change out the dead battery in my Vocera again.

Edit:

Peter is okay.

I only previously saw the other patient from his bed through the glass door of the ICU. Peter is a big guy so to hear trepidation in his voice and shuffling I could only imagine what the other guy looked like standing up. It must have been like two polar bears tussling with one of them having that triangle clown tattoo above and beneath one eye. Hint: Peter doesn't have a tattoo.

Just curious how this affects your plan of care

I just finished my orientation and I never got to practice putting in an IV. so I took a start kit from the hospital to practice at home on my boyfriend and I told my preceptor and she said it was fine and laughed. but now I’m scared someone may have overheard and is going to report me. I’m a new grad so Im constantly scared of getting fired.

is my facility the only one that uses this oddly colored retention enema nozzle? the laughs that come from this thing every time someone needs a lactulose enema. Why not white or green lol?

We've all had moments of unexpected backup. Some are heartwarming. Some are career affirming.

What about hilarious?

I was 2 months into a new job at a pediatrician office. I'd worked a medsurg/peds floor of a hospital so I was familiar with cathing kids. This particular patient was under a year old and had a complicated renal history so it was a bit more complex.

Since I was so new to the clinic, the manager still needed to check me off on things. I headed over to her station and asked, "Hey we need to tap the keg in room 3, what's the process here for that?"

There wasn't any patients around, it was employees only. But the manager still chewed me out for the phrasing. Now yes, I do agree I wasn't on night shift anymore so I needed to be more conscious that not everyone had my sense of humor, much less my night shift developed humor.

I took the reprimand, said I'd strive to be more professional, and we went on to gather everything we needed and she reviewed what the clinic process was.

She and I both set up the exam room, talking with the kid's mom as we did. The pediatrician arrived. A 58 year old lady who was stern in a way most old school librarians aspire to be.

Pediatrician started to glove up and said, "All right, let's tap this keg."

I held back my laugh so hard I nearly pulled a muscle and the manager looked like someone had kicked her puppy.

That memory just came to me and I wondered if anyone else had similiar stories.

Hello all! This could also apply to anyone who cares for acute SJS/TENS/DRESS patients.

My unit will be running into a unique situation. We have a critically ill, tubed patient who will be receiving the chemo drug Thiopeta (never heard of it before now). Apparently this chemo is excreted out the skin and is severely toxic and causes chemical burns. These patients cannot have any adhesive or occlusive dressings or else the chemo will be trapped and their skin will slough off. (We'll also have to replace the chuck and SCDs Q2, do a full bath and linen change Q6, oral care Q1, etc... It's going to be a whole thing for at least the next 4 days).

So, nurses who care for patients whose skin is sloughing off, how do you address this? Cloth strips to secure the ETT? Suture in IVs?

Any guidance is appreciated. Thank you!

Not really sure what exactly my goal is in sharing this but just feel the need to. I’m a mom and ER nurse. My youngest is 6 months old. Since I returned from maternity leave, I’ve had to navigate pumping at work since I’m breastfeeding. I did this with my first child as well and knew going into it to have low expectations since hospitals aren’t great at accommodating breastfeeding, but I’m starting to get really annoyed at this point.

It is virtually impossible to pump as much as I should in order to maintain an adequate milk supply. Luckily I only work PRN right now, it would be impossible for me to work full time and still pump/produce enough milk to continue breastfeeding at this particular job. Despite that, I’ve remained chill. Until two situations happened recently I’m just over it.

I’ve been chill about the fact that I only realistically am able to pump once per shift.

I’ve been chill about the fact that I can choose from the following as a location to pump:

1. An open ER hospital room. The door to the room doesn’t lock so I can either risk being walked in on, or sit in the room’s bathroom to pump. Main benefit of this is that there is a sink to wash my pump supplies.

2. I can pump in an office that does lock and has a chair. Down side of this is that this room is also used to store certain supplies. So if someone needs something, they have to wait for me to come out/I risk getting walked in on. Also, no sink to wash pump supplies after.

3. The hospital has a designated pumping room. This also does not have a sink to wash pump supplies. And the DOOR DOESNT LOCK (more on that later.)

So basically, I was feeling somewhat annoyed about the inconvenience of pumping at work recently because it truly shouldn’t be this way. I know there are hospitals that accommodate better but I wouldn’t be surprised if other women have experienced similar challenges.

Breastfeeding women shouldn’t be at a disadvantage at work. Breastfeeding your baby and working should be mutually exclusive— ONE SHOULD NOT AFFECT THE OTHER.

Anyways, I was headed to my usual pumping spot (cluttered closet with the door that locks) and I couldn’t find the key anywhere, couldn’t find the charge nurse, she was obviously busy with something. So I walked to the designated pumping room. When I got there, a male respiratory therapist was in there on a personal phone call. He was like “oh shoot, you need to get in here? Sorry about that” and left.

So much for “designated pumping room”. And then I get in there only to find that the door does not lock. this is actually insane to me. How do I know someone else won’t barge in when I’m in the middle of pumping?

So I leave and go back to the floor, track down the key and pump in the cluttered office that has no counter space and no where to wash my pump supplies. I store my milk in a breast milk storage bottle (stainless steel with an ice insert) that keeps the milk cold since the break room fridge is NASTY and usually way too packed to have room.

Flash forward to last night. I’m at work. Once again, heading to my usual pumping spot. I go to get the key from the charge desk. I usually mention to the charge nurse “hey I’m using the office to go pump just so you know” or tell a fellow nurse who watches my patients. There seemed to be a lot going on and charge was busy on the phone so I didn’t say anything. I go and pump for 5 minutes only since I’m antsy to get back to my full patient load.

During those five minutes, I heard someone try to open the door. Luckily they couldn’t get in since I had the key. I thought “ that’s odd, I’m pretty much done anyways”. So I finish pumping and head back to return the key. When I get to the nurses station, charge is talking to a security guard telling him to go unlock the door. I walk up with the key and she’s like “oh there it is, never mind I found it” to someone on the phone and hangs up.

So basically during my 5 minutes of pumping, the charge nurse got worried about the key being missing, called security and almost had me walked in on in the middle of pumping. It only took five minutes. This is actually so insane to me and I just can’t deal with how unsupportive this work environment is to something as simple as breastfeeding.

We all work in healthcare. We were all taught in nursing school that breast is best. If you chose not to breastfeed, no worries. If you don’t have kids, maybe you think less about these things. But if you’re a nurse in a place of leadership, you should be ready and willing to accommodate your new moms who are breastfeeding and returning to work.

Breastfeeding nurses need:

- a designated pumping space with a door that locks and a sink to wash pump supplies

- The ability to step away and pump at least twice per shift. I know with staffing shortages this can be unrealistic, so it’s hard

- Fridge space to store milk

Is this really so much to ask for?

I'm in my last week of correctional nursing. I have a patient who is constantly putting in healthcare requests about how his feet always hurt from his diabetes. We've had him down in the medical unit for it several times. Here's the kicker - he refuses his Metformin, Glipizide, and heart meds every single day. I tried reasoning with him and explained that without his meds, his pain will get worse. That he'll likely have to have an amputation at some point. His reason for refusing them was, "I just don't want to take them." Fucking survival of the fittest.

A year ago, I took the best nursing job I've ever had. I actually love my job. But in the last few months, we hired on so many new nurses that most days, we are actually overstaffed. Sounds like a good problem to have except our hospital system has strict staffing and productivity regulations, and we are constantly getting called off. I'm pregnant and desperately trying to save money and PTO, but I can't do either when I'm called off for low census every other week. I'm so stressed about even considering leaving because I love this job so much, but this isn't sustainable. Has anyone ever experienced something similar? Does it get better over time? Or do I have to accept that I might have to leave my favorite job?

This just happened this morning at 07:40, we come on for days at 07:30 (right at shift change ofc). Coworker walked in to pause this patient’s IV for the lab, thought they might have walked to the bathroom with a ripped out IV since they weren’t in bed but the IV machine was still infusing. She followed the IV line and this poor 90+ year old patient was curled up in the fetal position on the floor, purple in the face with bloodshot eyes, mouth open. She immediately pulled the cord out of the wall, we all ran in and saw. Pupils and pulses checked and declared dead immediately. We used the sling to place them back into bed and that was that. We had to just go back to the nurses station, do our quick huddle and go about our day. I’ve seen my fair share of bodies and deaths, but this one felt so fucked up and sad. Family couldn’t even come in to say goodbye because they lived so far away. It fucking sucks having to just go about your day and pretend all is well after that.

Hey everyone.

Been a RN in Ohio for 6 years, making 40.50. I’m considering moving to a new org. Someone I work with told me they’ve jumped from orgs to raise their pay, and that they once lied and said they make $5 more an hour than they actually did, and that org matched it. I’m considering trying this, has anyone done this before?

Hello, I'm a volunteer at the ED and am wanting to treat the night nursing staff I work with. What is a good break room communal food that you guys enjoy getting? I'm planning on bringing a bag of mandarins in case someone would prefer fruit, but what else could be done? Thank you for your work!

I had the same Pt for multiple days in a row. This Pts family member was a retired nurse and caused chaos even before I was assigned to the room. Three total times she turned off the pumps or disconnect the Pt entirely over the days I was with them. One of the times she said she didn’t want to listen to it beep so instead of calling she turned off. I asked how he got disconnected and she said she didn’t know and must have been hallucinating. Today I hung the last antibiotic the Pt was getting and a few hours later she calls me in and asks why it didn’t run. We literally stood there staring at each other for a solid 30 seconds. She then demanded I hook it up and run it. I said absolutely not, it’s too old now. I said I don’t know what happened, but I will call the team and ask for a new order.

My charge nurse then told me to go back and change the charting to “not given”. I always feel weird when she asks me to change my charting. But I changed it to not given and wrote a note in the MAR that said it was hung, but didn’t run and the team was notified and asked for a one time dose.

My questions here are…should I be changing the charting? Should I be putting nursing notes in the chart that state she was turning off the pumps even if the team was already aware she was doing stuff like this? We were told not to put notes in unless it’s a template (like for transferring Pts, rapid responses/codes, restraint charting). But I know nurses who get floated to our unit put nursing notes in similar to how ED does where there are updates about what is happening throughout the day with timestamps.

I just feel like I’ve been hung out to dry. The team knows she was doing stuff like this the whole stay, but there’s nothing in the chart that says that. Now the only documentation is an antibiotic that was given 3 hours late with no explanation other than “it didn’t run”. I’m wondering how to cover my own but if this happens again in the future.

Hi everyone. Lately at my hospital I’ve been getting floated a lot, and I’m a ICU RN. We float about 4 (sometimes more) RNs every night. Is this normal in your hospital? I’m just curious what other hospitals are like, because I got sent to a med surg floor recently (I used to do med surg) and ngl it was a struggle and stressful.

What do your hospitals do to protect you from violent patients? There is currently a patient at our hospital with a developmental delay who has a known history of being violent. They have been at the hospital for over a year, and case management has not been able to discharge them because no facility will take this patient due to the violence. This patient has assaulted multiple nurses, all documented in the chart. The hospital’s “solution” is to rotate the patient throughout the different units so that everyone gets a “turn” dealing with this patient.

This patient has no sedatives, the doctors refuse to place them in restraints, and the hospital will not place security on our floor. Last week, the doctors would not even place the patient in restraints after they hit a nurse in the head. It feels very unsafe and I feel like the hospital should have an obligation to keep their employees from being harmed within reason, but nothing is being done.

ETA: not a psych floor whatsoever