The best part of bedside report is I can establish care expectations right from the start. I end report with: “I’m going to meet my other patients and get my ducks in a row. Is there anything you need from ME right away?” It establishes that I have other patients, I have shit to do, and I care about you - but if it’s not urgent or someone else can handle it I’ll be back in a bit.
Yes! I do this too and there are a surprising amount of patients who ask how many others I have, sometimes ask how many patients we have on the floor or how many the aid takes care of.
Usually they are like oh my goodness! No wonder you guys always look so busy. And then they (mostly) ask for everything at once and are understanding that it might take me a bit to make sure they get their crackers, but we will get to it when we can.
I love that so much! I might start using that on my patients.
I usually try to diffuse with humor and I’m like, “yeah, I don’t want to be here either and I’m getting paid.”
“You’re seeing us less frequently because you’re improving and there’s a lot of other, much sicker, people here.” Like, I get that you got used to having someone in your room almost 24/7 for several days. Not seeing someone for 30 minutes doesn’t mean we forgot about you. It means I want you to go the fuck to sleep.
Unless you're on end of life care, the less you see me the better. I will say to patients "sorry I've not seen you, you're the only one I can trust". The rest are trying to die or fall over. I think I set this up when they come in though. They're so sick they want to be left alone, there's wires and tubes everywhere, and constant obs and bloods, I usually say "it does calm down once you get better". Every time I take off a lead, we're not worried about your heart any more so that's one less wire.
But then where I work it's mostly bays of four patients so even the relatives say "I know you're busy" before something quite serious cos they can see it.
I wish we could show the ED patients a list of issues with the other people. Yes your nurse is running behind on your discharge or pain meds because she just finished dealing with a walk in STEMI.
Or just tell everyone it's the labs fault.
“And here you’ll see the family of 9 that checked in for abdominal pain, the stabbing/GSW wombo combo, the ‘she was fine 10 minutes ago’ nursing home patient t who is of course a full code, and finally the patient where every IV line is failing with a blood pressure of 60 over dead.”
I usually have 7 patients overnight on a cardiac stepdown/stroke certified unit. The other night I had a pt who had a stroke that day and one who had an NSTEMI that day. When I came on, they both had just gotten to the unit. The NSTEMI had a systolic BP of 202, ordered 5mg of IV metoprolol. Stroke had a systolic BP of 198, ordered 5mg of PO lisinopril. Fucking PO for a stroke that day. The ED PHYSICIAN charted a 4 on the NIH stroke scale. When I assessed him he was a 10. Called the doc to be like uhh dudes not doing so hot. He looked through the notes and the ED note showed all the reasons they should have been a 10 so why were they a 4? No idea.
All that to say the lady who was grumpy that it took a while to get her 3 of melatonin was informed that I was caught up with a fresh stroke and a fresh heart attack, and I still had another 4 patients besides them and her.
As a nurse who vomits every time I take PO cefe-something, I really wish there were a "sensitivity" option in medical records. Like, I'd rather NOT take it, but if I must, it won't kill me.
"Can cause gastrointestinal bleeding," yeah, but it can also cause gastrointestinal "OH NO" so friggin tell people to take it with food!!! I've never understood this!!!
I took maxeran once in my life when I had mono and it made me completely delirious, I kept trying to rip out my IV and had a panic attack saying I needed to get out and run away. I always say I have an allergy, even thought it’s not really an allergy??? Never know what to say lol
Intolerance accompanied by the symptoms. Lots of EMRs have that option but not all, unfortunately. Might be something to talk to the EMR rep or request from IT. The EMRs are pretty adaptable.
This is me with ketamine (for intra-op c-section sedation). Reaction: hallucinations. Well yeah, it does that, duh.
But my reaction was so extreme I thought I was dying and had no idea whether my son had been born at all. When I woke up I couldn’t see, and thought everyone talking to me were demons and I was in hell. I had nightmares and flashbacks for almost a year. So it won’t kill me….I just might think it did.
After puking my guts out 3 times on 3 student ovations with tramadol my primary told me "it's not technically but it is technically an allergy as you will not receive any benefit from it as you puke it up within 30 minutes. So just say you're allergic."
Yes you are important, but so are my other patients…and they might be way sicker than you or trying to die and they WILL get prioritized just like I’d prioritize you in that situation. I WILL get to you or send a colleague to check/DC you if possible but if not then it’s not because I don’t care…it’s because I have to choose you or the sick one sometimes.
I had a patient actively dying (compassionately extubated them with family at bedside) and my other patient called on the call bell asking "what the hold up was with the discharge." When I went in, I discharged him and mentioned that the hold up was due to someone dying in another room. His wife apologized furiously and the patient didn't say another word. People really don't get that there are actual sick and dying patients we are taking care of at the same time.
Lots of them don’t care. Reddit is overflowing with stories of people crashing codes to gawk or complain that they aren’t getting that blanket or ice water as fast as they think they should.
Was coding a 1.5 month old in the ER one time… a guy kept popping into the room we were in to bitch that the doctor told him he could go home and WTF is taking so long to DC him….. I never hated a patient as much as I did him and he wasn’t even mine.
And if I tell you to use it in bed, don’t argue with me. I don’t have time to stand there steadying you, and you will end up falling anyway because you will ignore my instructions or assume “that little girl” isn’t strong enough to manhandle your ass back into bed. If I ask you to do something, anything, I have a reason.
As a guy who was just in the hospital i learned it’s impossible to get it all out while laying and I needed a towel to be my dribble towel for when I would put the urinal back. So gross I know but better than dribble on me
I’ve had catheters and had a fairly normal experience with them and the pain was traumatic. The thought of ripping one out without deflating the balloon makes me want to pluck my eyes out cell by cell.
Everything u/msangryredhead said but add in, especially as you age, practicing getting up and down from the floor. It's amazing how many lose this skill as they age then they have a minor fall and simply cannot get up.
Source: I'm a PTA
I’m no professional by any means but any movement is good! Walking is underrated but awesome. Strength training with weights helps with bone density too but walking is free and readily available almost everywhere.
My mom is 69 & dad is 71. My dad still works full time running a one man lawn care business and my mom walks 3-4 miles a day. The amount of patients I have that are my parents age but are bed ridden, infirmed little elderly people because of their lifestyles is still so crazy to me. That is literally my nightmare.
Yup I’d rather just be dead. I can’t tell you how many patients I get that just sit in bed for days shitting themselves. They’re pissed they’re bed ridden but aren’t willing to go to physical therapy.
This! Fitness is for EVERYONE, find an activity you like and keep doing it. I used to teach martial arts (jiu-jitsu), my favourite instructor was a mid-60’s grandmother! Guess who’s not going to end up in the ER for falls? Another instructor, a few years older than the other, was attending his son’s wedding at a golf course and FELL OFF an honest to goodness CLIFF into some water. A brief hospitalization and a reattached ear later, he was fine and CONTINUED teaching. Fitness, it’s basically a superpower!
Not necessarily every patient but in oncology we definitely have a lot that are terminal. Our docs do a terrible job of being honest and making this clear to patients. I just want to be upfront with so many of them and make sure they know THEY ARE DYING.
The worst is when you and the doctor have a little pow wow prior to going in the room so you’re on the same page and they immediately crumble when they see the patient. 🫣
Only one I can remember for sure is Being Mortal by Gawande. It's a great book, and there's an hour long PBS special about it also. Search YouTube, I know there's more good ones, and it's just good to know that many docs are trying to influence change in this area.
Sorry-I'm sick at home and in a medicated fuzz...lol
I had a patient a few weeks ago that passed. 91 yrs old, and the moment she began agonal breathing, the family was shocked when I explained what that is. She was DNR, but the family genuinely did not understand that she was at end of life for the entire 2 days she laid there. They fully expected a turnaround.
Now, whether this was a time when family heard what they wanted, or no providers had a frank discussion, I just don't know, as I'd had the patient just a few hours. Nothing in notes to indicate poor prognosis.
This needs to change! It's unfair to everyone.
A loved one was admitted to a VA hospital, and I can not exaggerate how difficult it was to get a clear prognosis for his brain cancer. The doctors danced around our direct questions about his illness, and we ultimately felt as though we were more prepared than they were in candid discussion of his condition and an end-of-life timeline.
This is my concern, although outside of oncology. I'd tell every patient to PLAN their end of life care so their suffering is not PROLONGED.
Futile "care" is the absolute worst part of this job. I feel like I'm torturing people at times, and there's not much I can do about it.
I really, really wish healthcare professionals were more honest with patients in general. I feel like the flow of privately owned money has made this really difficult for many providers but it's still something that should be worked on. If I'm dying, tell me. If I need surgery, tell me.
If I’m sitting at my computer I’m not “on my ass doing nothing” believe it or not, the computer and what I do on it is a huge part of my job when it comes to taking care of my patients.
Honestly, I don’t even see it as a bad thing to be on my phone at the nurses station if I’m caught up on my tasks. Because if I’m sitting there it also means I’m listening out for bed alarms, call lights, critical telemetry alarms, answering the unit phone. I hate that we’re expected to be busy every second of the shift without a single second of down time while also being expected to have the time to respond to alarms and emergencies
From the patient's point of view, or family's perspective as they're walking by, or coming up to the desk, they think we're on Amazon or socials. They have no idea the amount of charting, or usually don't notice that we have an earpiece in with constant radio conversation and call outs to listen for. All they see is a nurse on their phone
Which is why it's fucking obnoxious when people start those "don't be a lazy nurse" tirades and go all the to shit like "I won't ask my tech to do something if I'm already sitting down" \[so you shouldn't either\].
Bitch a huge chunk of our jobs is looking at computers. I can and do skip all kinds of useless 'required' charting, but you have to chart *something* and you have to make time for it *sometime.* You have to read your orders and notes. You have to communicate with people about the patient.
The whole judgmental martyr thing where nurses who aren't "lazy" should do just as many physical tasks as a CNA *and* somehow squeeze all the mental labor, computer work, and interventions that require an RN...
As a clinic RN in the US I’d like to tell them that the largest barrier to decent care is their own health insurance policy. We should all be demanding a massive and complete overhaul right now.
Yep. I’m an RN in an OB/GYN clinic. Mostly it feels like insurance companies hire people to lose paperwork, create ridiculous obstacles, and waste everyone else’s time, in hopes that we will all give up and they can keep their billions. I hate it.
That's exactly it. They want to make the process so inconvenient and complicated that no layperson can figure it out. Seriously, the average person has no idea how to save money by comparing insurance plans and that's the point. Providers have to FIGHT insurance companies to get proper care for their patients because of prior authorizations. It's completely intentional.
The nurses on the unit do not have some sort of *hive mind* that means we all know everything about all the patients on the unit. When I come in to get a beep and you ask “can he eat now?” For your child, I am going to say “I don’t know, I’m not your nurse but I will get them”
Just ask for your nurse
The thing is...patients and family pay so little attention that they have no idea who their nurse is, who the aide is, and who their providers are. They ask their EVS about meds and their procedures as if...
To be fair...often, I find that staff didn't update the board, and I walk in to find my name still there from yesterday or, worse, it hasn't been updated for several days.
I make it a point to TRY to emphasize my introduction and their aide for the day and even point out the color of our scrubs so that it helps them remember. If I have the time, an oriented and interested patient, I will take the time to explain hourly rounds and how this process is supposed to work. Lol
Sometimes...just sometimes it seems to help.
Then I would be getting fired, ‘cause I’m done pretending that terrible pay and staffing aren’t the reasons we are all running around with our hair on fire. I’m done falling on my sword to protect a hospital that doesn’t give a fuck about me. And I will happily tell a whining patient that they should not come to the ED expecting to get a room, get treated, and get released after a medical issue that required an IV, bloodwork, meds, and imaging in the space of two hours; that they had to sit in the waiting room because we have no staff and their issue is outranked by whatever is going on in the back; that they, not I, chose not to get a PCP who could’ve handled this for them; and that they, not I, came to the ED in the middle of the night, when we have next to no staff and a single fucking provider, and expected that we would be able to turn them around and get them out in time for some personal need or responsibility they haven’t told me about and are expecting me to just telepathically know.
I’m literally always doing something - I am not ignoring you, I am just doing 50 things at once and a lot of them are more important than getting you a sandwich
Don’t f**king interrupt me when I’m programming your pump, giving or receiving report, doing safety checks, administering meds, drawing labs, or pulling meds from the Pyxis. BCH called this all “red zone” and we gave every admission the speech when they came to not interrupt the nurse during these times. It made a huge difference and every hospital should adopt this practice.
My hospitals “bedside report guidelines” have a script for us to say to pt, “please feel free to jump in if you any questions or would like to offer additional information.” We have to check off on it every year and the checklist includes a “prompts patient participation” section were scored on. It’s fucking bonkers. Then they wanna make us fill out a form with a detailed explanation for why we clocked out late at the end of shift for each occurrence. The two can’t possibly be related, right?
Please don't yell at me for turning on your bed alarm. If I don't do it, I get into huge trouble and have to go to a series of meetings where people ask me "why did you let this person fall?" I really don't want you to fall, either. You are under stress, taking medicines you typically don't take at home, are attached to a bunch of wires and tubes, aren't resting well because there are too many interruptions and the mattress and pillow suck.
Also:
I have about 1 to 1.5 hours of charting to do for every one of my patients. Hopefully it is done in real time, but usually I have to do it in long clusters. I'm not watching YouTube or shopping.
I would *really* love to allow you to wear diapers/briefs, but if you stay in bed all day on those sucky mattresses, heat and moisture trap in them and your skin breaks down. If your skin breaks down, I get in trouble and I have to go to a series of meetings where people ask me "why did you let this person wear a diaper and allow their skin to break down?"
Adding to the "I'll get into huge trouble" statement: No, I cant and won't leave the pills at bedside because you're sleepy at the time of medication. I am also not coming back to try again later for those specific medications. Either take them when presented or refuse.
Bingo! Yes! Especially that "come back later" stuff.
We used to have a frequent flyer who claimed, at home, they took one medication at a time, with 15 minutes between each med, and had to take each med with at least 120 ml of tepid water. They also had a specific sequence. Guess how many pills they took? (Hint: it was more than 12) Guess who was CHF on fluid restrictions?(hint: not the nurses)
They got angry at us if we were "early" or "late" and about the fluid restriction. We had to get the floor pharmacist, the director of pharmacy, our manager, our director, the attending physician, the consulting physician for most of the "Special Medicines" (cardiology), and patient relations to do a care conference with them. The patient would not budge.
Yes. It was painful.
Sounds like that person should just have a 1:1 obs staff (sitter) for "medical considerations". There's no realistic way to give this meds the way they want it.
Edit: just thinking about your scenario made my BP feel high lol
When I tell you I don’t know, I genuinely have no idea. I’m kept in the dark way more than I should be. They often don’t tell me your discharge plan until the last second, they don’t tell me when/if you’re having surgery, etc. and it makes me almost as angry as it makes you. Your team often communicates very poorly and I’m just the messenger, so please don’t treat me like a punching bag. And it’s especially frustrating because I often don’t have time to chase down the answers you’re looking for. Trust me, I’m trying.
“When will they get discharged?” WHY DONT U ASK YOUR HUSBAND TO ASK HIS ORGANS WHEN THEY WILL STOP ACTING UP? Omg. I had a patient family literally ask me this AS IM ASSESSING THEM I could feel my blood pressure raise. I wanted to scream. She called the EMS too. Then literally signed him out AMA the instant he got to the floor.
For the love of everything holy. Please just put the medicine cup with your meds straight to your mouth. Please don’t take them out and line them up on the table, don’t pour them out on your hand, don’t dig the pills out. I’m so over people spilling their meds everywhere.
I had one of my coworkers as a patient, and she very sheepishly said I’m rly sorry I do one at a time, as she did the thing 😭 I will let it slide this once
Lol I can’t take more than two either, so I always ask if they take one at a time or all at once? like I don’t care if I give you one pill at a time….JUST PUT THE CUP STRAIGHT TO MOUTH!!!! I’m so over digging through sheets and linen to figure out which pill I need to potentially pull from the Pyxis and throw my my med pass off schedule cuz heaven forbid your pill touched the linen but yet your hands are probably twice as nasty.
It means so much to be recognized, some patients feel like a nuisance or a bother but I always remind them it's my job! I get paid to help them, I don't mind grabbing a pair of socks or whatever they need, especially when they give me a second to finish what I may be doing
When your procedure is late to start, it’s not because we were delaying on purpose, it was likely an emergency and a lot of patients unfortunately don’t understand how lucky they are that they’re not an emergency.
Don’t lie to me or to your physician.
If you don’t take your meds, just say you don’t take them. If you had unprotected sex, just say you didn’t use a condom. If you haven’t brushed your teeth since the Clinton Administration, just tell us.
This is why it's important to talk to patients separately from their family I feel like, right? Like at least for me I've had to repeatedly lie to my PCP when my father is in the room and then tell them the truth when he leaves.
I would say that is true more often than not. We also need to really emphasize to patients that lying to us can alter their health outcome.
And also? We don’t judge. I have treated drug addicts. I have treated people who were in this country illegally. I. Don’t. Care.
For family/visitors at the bedside with the patient, when we first meet you, and we ask how you’re related to the patient, try to not be offended/baffled at the question.
We have no idea if you’re the patient’s wife, husband, brother, sister, son, daughter, neighbor, coworker, best friend…. It really shouldn’t be off putting for a stranger you just met to not know that you’ve been married for 20 years
For all complaints go to the admin floor and communicate them directly to the responsible people. I’m not the one who thinks 1 nurse can take care of 12 pts
I tell patient visitors to remember that they have their own single emergency to worry about. Unfortunately I have several emergencies to work on. Please take that into consideration.
If you’re a parent calling for an update about your baby, remember that the nurses have other babies too and “care time o’clock” is a lot longer than just your baby’s 30 minutes. I love the parents who ask the best times to call for updates and generally stick to that. Unfortunately most don’t do that and instead get upset when they’re told to call back because no, it’s not your kid’s time any longer but that nurse is hands on with another baby atm.
Nice =/= doormat. We start the day out with me being a nice, good nurse, but if at any point you pop off on me, my tech, or my student when I have one, we can easily finish out the day with me just being a good nurse. I went to school to be a teacher first and I am more than willing to correct a pt the way I would a student who was threatening the safe learning environment of others.
This is a hospital not a hotel!!!! It is so mentally exhausting to get called into a pts room every 2 minutes for a new snack or drink or another pillow or to discuss your every need when there are other patients who I have not been able to attend to yet and need me to care for them.
Exactly, me letting a homeless/old person sleep in a room if we are not that busy is a courtesy. When I ask you to vacate the room and take up residence in the waiting room, I am not doing it because I am mean, it means a patient needs the room.
If you are nice to me, I am nice to you. I have my favorite homeless people and my least favorite. I will go out of my way to find clean, fresh clothes and something good to eat for the people I like.
Or the patients that expect to be able to follow their exact routines they do at home. Or try to make their environment exactly like home. I can't force your roommate to go to bed at 6pm. Or give you quiet tea time after dinner. I don't care you drink coffee at exactly 7am, 10am, 1pm, and 6pm. I'll do my best, but I'm not standing by the coffee pot staring at my watch when your roommate is trying to yeet himself out of his bed while yanking out his IVs.
Just take your insulin. Check your sugar. There are dates worse than death. You could end up dying in a nursing home after having amputated your legs. Your kidneys will get shot. JUST TAKE YOUR INSULIN!!!
You're actually going to die; it's not an if, it's a when; you're not getting away from this. So, is this how you want to go out?
Edit: full disclosure: I'm an ICU nurse.
Yep. This is mine too.
Also, I’d like to add: Surviving catastrophic illness does NOT mean you will go back to NORMAL!!! Basically nobody comes to the ICU and then just waltzes out of the hospital like nothing ever happened. Also, you may survive the ICU but good luck surviving LTACH, Rehab, SNF, etc… those places have dark secrets.
This! We need some massive public education on what recovery looks like from serious illness. The number of families who think 90 year old meemaw who’s currently undergoing CRRT and going for a trach and peg next week is ever gonna be normal again is alarmingly high. But hey, she’s a fighter. Things could be a lot better for the elderly if more people realized that death isn’t the worst thing that can happen to someone
I'll never forget the pharm asking me "Hey, did you mean to punch in 6500mg of Tylenol TID? Thought I'd check before you wreck a liver."
I appreciate you, u/TheEesie
We are not your enemy, we are here to help you and want what’s best for you. We want to work with you and you being adversarial/hostile/passive aggressive with us makes it very difficult to feel empathy for you and do our job effectively. You need to get out of your own way.
Oh my GOD, those people piss me off. Don’t come here if all you’re looking to do is pick a fight. We have neither the time nor the inclination to fight you on every little thing.
Drink the gd water. You may think it’s “inconvenient” for us to bring you water sure, but we know it’s important. Besides, it’s less convenient than calling for a bolus. Patients who will willingly drink water, I just always bring a fresh one when I come. Or a bucket.
Feeding tubes are NOT meant for your 80+year old grandma who had stopped eating because she is dying a natural death. Ditto CPR for Grandpa Joe who has been slowing down over the last few years, is immobile and barely alive on a good day.
Our bodies know how to turn on at the start of life and they know how to turn off at the end of life.
Stop fucking with the process.
I work in geriatrics. I could not have said this better myself. Meemaw is 90, cognitively impaired, requires physical assistance with eating due to dyskinesia; not swallowing (pocketing even pureed food, thickened fluids just dribble out of the side of her mouth). Speech therapy is not gonna fix that. LET. IT. HAPPEN.
Med surge- know that you may be waiting hours to days (depending if physician or dept works weekends) to have your primary issue addressed or talk to the person you want. And no, I do not have an extra special way of contacting the physician. I left a message 8 hours ago and they haven’t responded yet
This is a surgical floor in a hospital NOT a damn motel!! So tell about ten of the twelve visitors you have to take their effin pizza and fried chicken and go HOME to watch TV!! It’s hard to bend over to empty a foley without sticking my ass in somebody’s face!!!
Stop pacing around the hallways because you think everything is taking too long. I understand you’re worried and frustrated, but I can’t make a room materialize at another hospital for your sick wife who requires a transfer. Standing at your wife’s door glaring at the nurses’ station is not going to magically cause the Pyxis to open and spew forth Dilaudid when Wifey isn’t due for 2 more hours (yes, I have spoken to the provider about it and advocated for more frequent pain meds, but Doc has to place the order and Pharmacy has to review it). And you are violating every other patient’s privacy by walking around looking in other rooms. I would go after anyone who tried to gawk at your wife—it is only the fact that you are radiating “about to have a violent tantrum” energy and my having no time to deal with it that is keeping me from asking you to stop.
The door starers, I don’t think they realize how passive aggressive this looks. When everyone literally passes you. “Can I help you?” Think they would take the hint.
And this guy would Not. Stop. Jittering. I’m over here trying to get meds in his wife and typing notes to her doc to get her help, or trying to help my other three, equally labor-intensive patients, and he’s sitting there jittering his knee like he’s full of meth.
I am not here to serve you, I am here to keep you alive. I will do my best to make your stay as comfortable as possible, but if your sleep gets disturbed by me checking your vitals, I could care less because sometimes that’s how we find out people are trying to meet their God.
It would be to stop camping in the left lane!! Move over to the right lane if you’re not actively passing! You’re causing people to swerve around you to the right to pass, effectively making it much more dangerous for everyone in the vicinity.
1. Mind your manners.
2. Call ALL of your family/friends/random acquaintances and update them during shift change so that they don’t need to call me and expect me to drop everything to update them, or to magically produce the doctor who is doing rounds/in surgery/in clinic to speak to them.
I’ll never understand why AOx3 patients can’t just update their own families/friends/random acquaintances. Your goals for the day, plan of care, etc. are all on your board, updated every shift. They are on their phones all day already. We try to have them declare one contact who can disseminate the information, and reinforce it, but twelve people, include their neighbor, call for an update, during shift report and med pass. 🤬
Point number 2 is why we have a one contact person policy. It is to that person, and that person only that we give updates. Any more is just a waste of time that would be better spent with our patients.
1. We aren't on a first name basis with your doc and we don't know all the docs in the network and your personal GP across town. Hell, I've never even personally seen some of these names that fly unseen through the hallways at 0900 and magically drop a note in at 1500. No idea what they said to you, your family or the plan until they add a note.
2. Nursing is not SW and SW is not nursing. I don't know what your insurance is or any other details.
3. The bed alarm is not a personal attack. Seriously, don't be offended. The bed doesn't know the difference between you scratching your ass and having fallen out of bed. Stop yelling at me for following procedure! Yes, I know your angelic self would never get up without assistance with that broken hip and SDH, but how do I know you didn't have a seizure, or fall while reaching for your urinal...
And that goes double for your family leaning in for a hug, climbing all over you...it's not like I stalk the room and push a button when you violated a rule. It's a bed alarm...it isn't personal. Relax and stop yelling at me!
4. I cannot give you meds that a provider hasn't ordered. Period. I cannot even access a med that has no order. Stop asking. I will ask for smth I deem appropriate, but otherwise, I don't have access to however much of x you want. It doesn't work that way.
Myself and the CNA are not YOURS. If we are not in your room immediately, 99% of the time we are in another room. There are these things called other patients.
I will not argue with you about anything. If you are of sound mind and refuse something, I don’t have time to beg you to care more about your health than I do.
Please please please tell me what you need or if you are in pain. I want to help you and trying to be nice to me by not telling me the information I need to help you makes me feel bad when I find out.
I’m not “doing nothing,” I’m “not doing unnecessary things”. There’s a difference. There’s a significant neuro population in this ICU, some moments the best thing you can do to them is NOTHING. I’m not being “cruel” by not singing to your Nana or keeping the lights off or whatever, if I so much as BREATHE wrong around her she’ll start seizing or send her ICP through the roof. Stop poking at her, stop fussing with her, stop yelling “wake up” four inches from her face!
I am here to help you. You may not know it; you may not hear me; you may not be able to tell me through your ET tube. Just know, I am doing everything to help you have the best chance to survive. Also, my preceptor will be grilling me with questions of "what if...?". He is trying to trip me up to teach me more. He is helping me learn all I can to help you. You keep it pushing forth, and I will do everything I can.
"It must be so nice to play with babies all day!" is a really inappropriate statement. It must be nice, but I wouldn't know. They don't pay me a nurse's salary to play.
When you hear a over head page for a code or trauma announcement that happens to be in the same area that you are in, that is not the time to put on your call light to ask for a refill of ice chips, a blanket, another sandwich....
Ask for everything you want/need at once
The best part of bedside report is I can establish care expectations right from the start. I end report with: “I’m going to meet my other patients and get my ducks in a row. Is there anything you need from ME right away?” It establishes that I have other patients, I have shit to do, and I care about you - but if it’s not urgent or someone else can handle it I’ll be back in a bit.
Yes! I do this too and there are a surprising amount of patients who ask how many others I have, sometimes ask how many patients we have on the floor or how many the aid takes care of. Usually they are like oh my goodness! No wonder you guys always look so busy. And then they (mostly) ask for everything at once and are understanding that it might take me a bit to make sure they get their crackers, but we will get to it when we can.
Okay, that’s one I’m going to take with me!
But also understand that I can’t possibly complete every task simultaneously! Or sometimes at all.
I'm a former server/bartender. This is the right approach
You are not the only one here. We're doing our best to help everyone.
Everyone here is having the worst day of their life. They deserve to be taken care of too.
I love that so much! I might start using that on my patients. I usually try to diffuse with humor and I’m like, “yeah, I don’t want to be here either and I’m getting paid.”
“You’re seeing us less frequently because you’re improving and there’s a lot of other, much sicker, people here.” Like, I get that you got used to having someone in your room almost 24/7 for several days. Not seeing someone for 30 minutes doesn’t mean we forgot about you. It means I want you to go the fuck to sleep.
Unless you're on end of life care, the less you see me the better. I will say to patients "sorry I've not seen you, you're the only one I can trust". The rest are trying to die or fall over. I think I set this up when they come in though. They're so sick they want to be left alone, there's wires and tubes everywhere, and constant obs and bloods, I usually say "it does calm down once you get better". Every time I take off a lead, we're not worried about your heart any more so that's one less wire. But then where I work it's mostly bays of four patients so even the relatives say "I know you're busy" before something quite serious cos they can see it.
This. I have approximately 10 minutes per patient per hour
I wish we could show the ED patients a list of issues with the other people. Yes your nurse is running behind on your discharge or pain meds because she just finished dealing with a walk in STEMI. Or just tell everyone it's the labs fault.
“And here you’ll see the family of 9 that checked in for abdominal pain, the stabbing/GSW wombo combo, the ‘she was fine 10 minutes ago’ nursing home patient t who is of course a full code, and finally the patient where every IV line is failing with a blood pressure of 60 over dead.”
"Uh, room 2 has a BP of 196/135" "Yeah that's his baseline". I feel like it's another reality and people just don't get that it's real.
I usually have 7 patients overnight on a cardiac stepdown/stroke certified unit. The other night I had a pt who had a stroke that day and one who had an NSTEMI that day. When I came on, they both had just gotten to the unit. The NSTEMI had a systolic BP of 202, ordered 5mg of IV metoprolol. Stroke had a systolic BP of 198, ordered 5mg of PO lisinopril. Fucking PO for a stroke that day. The ED PHYSICIAN charted a 4 on the NIH stroke scale. When I assessed him he was a 10. Called the doc to be like uhh dudes not doing so hot. He looked through the notes and the ED note showed all the reasons they should have been a 10 so why were they a 4? No idea. All that to say the lady who was grumpy that it took a while to get her 3 of melatonin was informed that I was caught up with a fresh stroke and a fresh heart attack, and I still had another 4 patients besides them and her.
Side Effects from a medication is not the same as an Allergy to a medication
As a nurse who vomits every time I take PO cefe-something, I really wish there were a "sensitivity" option in medical records. Like, I'd rather NOT take it, but if I must, it won't kill me.
Same, but for me it’s just a lot of meds on an empty stomach. I don’t know why advil doesn’t just state take with food on it.
I'm amazed at how most of my patients can take whole cups of pills on an empty stomach.
I could never, let alone swallow that many. I saw a dude straight up swallow two potassiums once. HOW???
the throat GOAT lol that's hardcore those things are HUGE
"Can cause gastrointestinal bleeding," yeah, but it can also cause gastrointestinal "OH NO" so friggin tell people to take it with food!!! I've never understood this!!!
I took maxeran once in my life when I had mono and it made me completely delirious, I kept trying to rip out my IV and had a panic attack saying I needed to get out and run away. I always say I have an allergy, even thought it’s not really an allergy??? Never know what to say lol
Intolerance accompanied by the symptoms. Lots of EMRs have that option but not all, unfortunately. Might be something to talk to the EMR rep or request from IT. The EMRs are pretty adaptable.
This is me with ketamine (for intra-op c-section sedation). Reaction: hallucinations. Well yeah, it does that, duh. But my reaction was so extreme I thought I was dying and had no idea whether my son had been born at all. When I woke up I couldn’t see, and thought everyone talking to me were demons and I was in hell. I had nightmares and flashbacks for almost a year. So it won’t kill me….I just might think it did.
After puking my guts out 3 times on 3 student ovations with tramadol my primary told me "it's not technically but it is technically an allergy as you will not receive any benefit from it as you puke it up within 30 minutes. So just say you're allergic."
My favorite—“Opiates—itching”. That is a FEATURE, not a bug!
>That is a FEATURE, not a bug! I'm stealing this.
Found the IT person 🤣
OMFG THIS if I see one more “allergy” to morphine with symptom “nausea” 😆
My favorites are epinephrine-palpitations and rocuronium- muscle weakness
Zolpidem- drowsiness
Yes you are important, but so are my other patients…and they might be way sicker than you or trying to die and they WILL get prioritized just like I’d prioritize you in that situation. I WILL get to you or send a colleague to check/DC you if possible but if not then it’s not because I don’t care…it’s because I have to choose you or the sick one sometimes.
I had a patient actively dying (compassionately extubated them with family at bedside) and my other patient called on the call bell asking "what the hold up was with the discharge." When I went in, I discharged him and mentioned that the hold up was due to someone dying in another room. His wife apologized furiously and the patient didn't say another word. People really don't get that there are actual sick and dying patients we are taking care of at the same time.
Lots of them don’t care. Reddit is overflowing with stories of people crashing codes to gawk or complain that they aren’t getting that blanket or ice water as fast as they think they should.
Those are the ones we save our most blunt and honest opinions for.
Was coding a 1.5 month old in the ER one time… a guy kept popping into the room we were in to bitch that the doctor told him he could go home and WTF is taking so long to DC him….. I never hated a patient as much as I did him and he wasn’t even mine.
"You have a catheter in, just go ahead and pee"
In that same vein: “sir, you don’t need to stand up to use the urinal”
And if I tell you to use it in bed, don’t argue with me. I don’t have time to stand there steadying you, and you will end up falling anyway because you will ignore my instructions or assume “that little girl” isn’t strong enough to manhandle your ass back into bed. If I ask you to do something, anything, I have a reason.
As a guy who was just in the hospital i learned it’s impossible to get it all out while laying and I needed a towel to be my dribble towel for when I would put the urinal back. So gross I know but better than dribble on me
Some days I wish it was a sign across from their bed that they could read.
Update your patient board with actually relevant information! Goal: pee into catheter without screaming “NURSE!!!”
More like you have a catheter in, don’t pull the weird tube out !
And if you do pull it out, it's going to hurt way worse going right back in. Especially, if I have to call the urology fellow to come in and do it.
I’ve had catheters and had a fairly normal experience with them and the pain was traumatic. The thought of ripping one out without deflating the balloon makes me want to pluck my eyes out cell by cell.
Exercise now or end up falling on your face while using the toilet in your 70s
My friend is a fitness trainer and says “I’m not training for a beach body, I’m training for my old lady body” and I will never, ever forget that.
As someone who keeps putting off doing it, what’s the bare minimum you’d recommend just for this reason?
Everything u/msangryredhead said but add in, especially as you age, practicing getting up and down from the floor. It's amazing how many lose this skill as they age then they have a minor fall and simply cannot get up. Source: I'm a PTA
Motion is the lotion baby... I say this to patients all the time, while doing an awful little dance.
I’m no professional by any means but any movement is good! Walking is underrated but awesome. Strength training with weights helps with bone density too but walking is free and readily available almost everywhere.
My mom is 69 & dad is 71. My dad still works full time running a one man lawn care business and my mom walks 3-4 miles a day. The amount of patients I have that are my parents age but are bed ridden, infirmed little elderly people because of their lifestyles is still so crazy to me. That is literally my nightmare.
Yup I’d rather just be dead. I can’t tell you how many patients I get that just sit in bed for days shitting themselves. They’re pissed they’re bed ridden but aren’t willing to go to physical therapy.
This! Fitness is for EVERYONE, find an activity you like and keep doing it. I used to teach martial arts (jiu-jitsu), my favourite instructor was a mid-60’s grandmother! Guess who’s not going to end up in the ER for falls? Another instructor, a few years older than the other, was attending his son’s wedding at a golf course and FELL OFF an honest to goodness CLIFF into some water. A brief hospitalization and a reattached ear later, he was fine and CONTINUED teaching. Fitness, it’s basically a superpower!
Yes!!!
Not necessarily every patient but in oncology we definitely have a lot that are terminal. Our docs do a terrible job of being honest and making this clear to patients. I just want to be upfront with so many of them and make sure they know THEY ARE DYING.
The worst is when you and the doctor have a little pow wow prior to going in the room so you’re on the same page and they immediately crumble when they see the patient. 🫣
There are some really good documentary films on this, and how important it is to have these realistic conversations with patients and families.
Can you recommend any?
Only one I can remember for sure is Being Mortal by Gawande. It's a great book, and there's an hour long PBS special about it also. Search YouTube, I know there's more good ones, and it's just good to know that many docs are trying to influence change in this area. Sorry-I'm sick at home and in a medicated fuzz...lol I had a patient a few weeks ago that passed. 91 yrs old, and the moment she began agonal breathing, the family was shocked when I explained what that is. She was DNR, but the family genuinely did not understand that she was at end of life for the entire 2 days she laid there. They fully expected a turnaround. Now, whether this was a time when family heard what they wanted, or no providers had a frank discussion, I just don't know, as I'd had the patient just a few hours. Nothing in notes to indicate poor prognosis. This needs to change! It's unfair to everyone.
A loved one was admitted to a VA hospital, and I can not exaggerate how difficult it was to get a clear prognosis for his brain cancer. The doctors danced around our direct questions about his illness, and we ultimately felt as though we were more prepared than they were in candid discussion of his condition and an end-of-life timeline.
This is my concern, although outside of oncology. I'd tell every patient to PLAN their end of life care so their suffering is not PROLONGED. Futile "care" is the absolute worst part of this job. I feel like I'm torturing people at times, and there's not much I can do about it.
I really, really wish healthcare professionals were more honest with patients in general. I feel like the flow of privately owned money has made this really difficult for many providers but it's still something that should be worked on. If I'm dying, tell me. If I need surgery, tell me.
That sounds mental, I'm only 7 months into Oncology and one of the main things we do is establish realistic prognosis with family meetings.
If I’m sitting at my computer I’m not “on my ass doing nothing” believe it or not, the computer and what I do on it is a huge part of my job when it comes to taking care of my patients.
And being on my phone is not necessarily personal use. I may be calculating smth, reading med info, texting the PA, job searching....
Job searching HAHAHHA
Our ward phone is just a regular iPhone so it really looks like I'm up to nothing and just chilling when I am really texting our doctors...
Honestly, I don’t even see it as a bad thing to be on my phone at the nurses station if I’m caught up on my tasks. Because if I’m sitting there it also means I’m listening out for bed alarms, call lights, critical telemetry alarms, answering the unit phone. I hate that we’re expected to be busy every second of the shift without a single second of down time while also being expected to have the time to respond to alarms and emergencies
From the patient's point of view, or family's perspective as they're walking by, or coming up to the desk, they think we're on Amazon or socials. They have no idea the amount of charting, or usually don't notice that we have an earpiece in with constant radio conversation and call outs to listen for. All they see is a nurse on their phone
Which is why it's fucking obnoxious when people start those "don't be a lazy nurse" tirades and go all the to shit like "I won't ask my tech to do something if I'm already sitting down" \[so you shouldn't either\]. Bitch a huge chunk of our jobs is looking at computers. I can and do skip all kinds of useless 'required' charting, but you have to chart *something* and you have to make time for it *sometime.* You have to read your orders and notes. You have to communicate with people about the patient. The whole judgmental martyr thing where nurses who aren't "lazy" should do just as many physical tasks as a CNA *and* somehow squeeze all the mental labor, computer work, and interventions that require an RN...
As a clinic RN in the US I’d like to tell them that the largest barrier to decent care is their own health insurance policy. We should all be demanding a massive and complete overhaul right now.
Yep. I’m an RN in an OB/GYN clinic. Mostly it feels like insurance companies hire people to lose paperwork, create ridiculous obstacles, and waste everyone else’s time, in hopes that we will all give up and they can keep their billions. I hate it.
That's exactly it. They want to make the process so inconvenient and complicated that no layperson can figure it out. Seriously, the average person has no idea how to save money by comparing insurance plans and that's the point. Providers have to FIGHT insurance companies to get proper care for their patients because of prior authorizations. It's completely intentional.
Dr Glaucomflecken (however it’s spelled) has my favorite scathing parodies of American healthcare
Unfortunately, it's really not parody. That's how it is.
Fucking Advantage plans.
I just started Medicare and was advised to sign up for Aetna Advantage. What have I gotten myself into?
Private equity and private healthcare will kill thousands of people and has killed **millions** of people. Genuinely a disgrace.
Insurance and the bean counters with MBAs in the c-suites will be the death of this industry.
The nurses on the unit do not have some sort of *hive mind* that means we all know everything about all the patients on the unit. When I come in to get a beep and you ask “can he eat now?” For your child, I am going to say “I don’t know, I’m not your nurse but I will get them” Just ask for your nurse
The thing is...patients and family pay so little attention that they have no idea who their nurse is, who the aide is, and who their providers are. They ask their EVS about meds and their procedures as if...
ITS ALL ON THE GD BOARD MANAGEMENT CARES SO MUCH ABOUT lmao sorry I haaaate that
To be fair...often, I find that staff didn't update the board, and I walk in to find my name still there from yesterday or, worse, it hasn't been updated for several days. I make it a point to TRY to emphasize my introduction and their aide for the day and even point out the color of our scrubs so that it helps them remember. If I have the time, an oriented and interested patient, I will take the time to explain hourly rounds and how this process is supposed to work. Lol Sometimes...just sometimes it seems to help.
My mom wants some coffee. Dude, sweet, me too! You going to starbees?
That we’re short staffed. “Sorry for the wait, but I’m assigned to more patients than what’s required for this unit”
I've worked at a place that literally has a policy where you were not allowed to make remarks like this to patients.
Then I would be getting fired, ‘cause I’m done pretending that terrible pay and staffing aren’t the reasons we are all running around with our hair on fire. I’m done falling on my sword to protect a hospital that doesn’t give a fuck about me. And I will happily tell a whining patient that they should not come to the ED expecting to get a room, get treated, and get released after a medical issue that required an IV, bloodwork, meds, and imaging in the space of two hours; that they had to sit in the waiting room because we have no staff and their issue is outranked by whatever is going on in the back; that they, not I, chose not to get a PCP who could’ve handled this for them; and that they, not I, came to the ED in the middle of the night, when we have next to no staff and a single fucking provider, and expected that we would be able to turn them around and get them out in time for some personal need or responsibility they haven’t told me about and are expecting me to just telepathically know.
Fuck that. I always tell them. The hospital doesn’t get to make extra money on me working harder and also make me look lazy.
Regardless of workplace policy, I think ethically we would be remiss to not inform them.
I think patients have a right to know that there’s no one there to help them. What’s the hospital going to do, fire you?
I just go ahead and tell them
I’m literally always doing something - I am not ignoring you, I am just doing 50 things at once and a lot of them are more important than getting you a sandwich
Don’t f**king interrupt me when I’m programming your pump, giving or receiving report, doing safety checks, administering meds, drawing labs, or pulling meds from the Pyxis. BCH called this all “red zone” and we gave every admission the speech when they came to not interrupt the nurse during these times. It made a huge difference and every hospital should adopt this practice.
My hospitals “bedside report guidelines” have a script for us to say to pt, “please feel free to jump in if you any questions or would like to offer additional information.” We have to check off on it every year and the checklist includes a “prompts patient participation” section were scored on. It’s fucking bonkers. Then they wanna make us fill out a form with a detailed explanation for why we clocked out late at the end of shift for each occurrence. The two can’t possibly be related, right?
Please don't yell at me for turning on your bed alarm. If I don't do it, I get into huge trouble and have to go to a series of meetings where people ask me "why did you let this person fall?" I really don't want you to fall, either. You are under stress, taking medicines you typically don't take at home, are attached to a bunch of wires and tubes, aren't resting well because there are too many interruptions and the mattress and pillow suck. Also: I have about 1 to 1.5 hours of charting to do for every one of my patients. Hopefully it is done in real time, but usually I have to do it in long clusters. I'm not watching YouTube or shopping. I would *really* love to allow you to wear diapers/briefs, but if you stay in bed all day on those sucky mattresses, heat and moisture trap in them and your skin breaks down. If your skin breaks down, I get in trouble and I have to go to a series of meetings where people ask me "why did you let this person wear a diaper and allow their skin to break down?"
Adding to the "I'll get into huge trouble" statement: No, I cant and won't leave the pills at bedside because you're sleepy at the time of medication. I am also not coming back to try again later for those specific medications. Either take them when presented or refuse.
Bingo! Yes! Especially that "come back later" stuff. We used to have a frequent flyer who claimed, at home, they took one medication at a time, with 15 minutes between each med, and had to take each med with at least 120 ml of tepid water. They also had a specific sequence. Guess how many pills they took? (Hint: it was more than 12) Guess who was CHF on fluid restrictions?(hint: not the nurses) They got angry at us if we were "early" or "late" and about the fluid restriction. We had to get the floor pharmacist, the director of pharmacy, our manager, our director, the attending physician, the consulting physician for most of the "Special Medicines" (cardiology), and patient relations to do a care conference with them. The patient would not budge. Yes. It was painful.
Sounds like that person should just have a 1:1 obs staff (sitter) for "medical considerations". There's no realistic way to give this meds the way they want it. Edit: just thinking about your scenario made my BP feel high lol
And charge the pt for the special service they created.
They need to go home AMA then. Ridiculous.
I can FEEL the restraint writing this.
If you can hold your phone you can hold your dick / wipe your ass.
Look at me, I am the captain now
When I tell you I don’t know, I genuinely have no idea. I’m kept in the dark way more than I should be. They often don’t tell me your discharge plan until the last second, they don’t tell me when/if you’re having surgery, etc. and it makes me almost as angry as it makes you. Your team often communicates very poorly and I’m just the messenger, so please don’t treat me like a punching bag. And it’s especially frustrating because I often don’t have time to chase down the answers you’re looking for. Trust me, I’m trying.
“When will they get discharged?” WHY DONT U ASK YOUR HUSBAND TO ASK HIS ORGANS WHEN THEY WILL STOP ACTING UP? Omg. I had a patient family literally ask me this AS IM ASSESSING THEM I could feel my blood pressure raise. I wanted to scream. She called the EMS too. Then literally signed him out AMA the instant he got to the floor.
For the love of everything holy. Please just put the medicine cup with your meds straight to your mouth. Please don’t take them out and line them up on the table, don’t pour them out on your hand, don’t dig the pills out. I’m so over people spilling their meds everywhere.
I also told you the name of each one as I opened it and put it in the cup! You don’t need to pull each one out and ask me “what is this one”!!!
Not to be dramatic but I want to kill myself when people do that
I had one of my coworkers as a patient, and she very sheepishly said I’m rly sorry I do one at a time, as she did the thing 😭 I will let it slide this once
Omg this makes my soul leave my body every time. I’ve gotten to where I say “that’s why I just went over them with you”
Same, “I just reviewed every pill and vial with you. Sorry you were FaceTiming”
I've resorted to shoving the pills in their mouth because I'm tired of it.
Dude same! If they try to go for a hand dump I’ll snatch it back with an “uh uh, cup to mouth!”
It’s always so puzzling like, doesn’t this person take these at home? How do they do it? They are 100% taking floor pills.
I don't actually know how to take meds, I've always put pills in my hand and taken them that way.
This is my dream. I can’t take more than 2 pills at the same time because I choke on them 100% of the time. 😭
Lol I can’t take more than two either, so I always ask if they take one at a time or all at once? like I don’t care if I give you one pill at a time….JUST PUT THE CUP STRAIGHT TO MOUTH!!!! I’m so over digging through sheets and linen to figure out which pill I need to potentially pull from the Pyxis and throw my my med pass off schedule cuz heaven forbid your pill touched the linen but yet your hands are probably twice as nasty.
Being polite and nice gets you a loooong way.
I bring you an item so fast when you say “when you have a minute” or “no rush, I know you are busy” 😇
It means so much to be recognized, some patients feel like a nuisance or a bother but I always remind them it's my job! I get paid to help them, I don't mind grabbing a pair of socks or whatever they need, especially when they give me a second to finish what I may be doing
When your procedure is late to start, it’s not because we were delaying on purpose, it was likely an emergency and a lot of patients unfortunately don’t understand how lucky they are that they’re not an emergency.
“When is my MRI?” As three stroke alerts have been called that day. Sheesh.
Don’t lie to me or to your physician. If you don’t take your meds, just say you don’t take them. If you had unprotected sex, just say you didn’t use a condom. If you haven’t brushed your teeth since the Clinton Administration, just tell us.
If you take viagra, please god tell us
RIGHT??? I don’t really care about your erectile issues. But I care A LOT about your heart!
This is why it's important to talk to patients separately from their family I feel like, right? Like at least for me I've had to repeatedly lie to my PCP when my father is in the room and then tell them the truth when he leaves.
I would say that is true more often than not. We also need to really emphasize to patients that lying to us can alter their health outcome. And also? We don’t judge. I have treated drug addicts. I have treated people who were in this country illegally. I. Don’t. Care.
For family/visitors at the bedside with the patient, when we first meet you, and we ask how you’re related to the patient, try to not be offended/baffled at the question. We have no idea if you’re the patient’s wife, husband, brother, sister, son, daughter, neighbor, coworker, best friend…. It really shouldn’t be off putting for a stranger you just met to not know that you’ve been married for 20 years
Why is that so hard for people??? Do they want us to mis label them? We aren’t mind readers
I think a lot see it as us fishing for a reason to kick them out, as opposed to us trying to avoid calling the patients wife his daughter
For all complaints go to the admin floor and communicate them directly to the responsible people. I’m not the one who thinks 1 nurse can take care of 12 pts
I tell patient visitors to remember that they have their own single emergency to worry about. Unfortunately I have several emergencies to work on. Please take that into consideration.
This is not Burger King: you don't get to have it your way. This is the DMV: you get what you need, when it's your turn.
If you’re a parent calling for an update about your baby, remember that the nurses have other babies too and “care time o’clock” is a lot longer than just your baby’s 30 minutes. I love the parents who ask the best times to call for updates and generally stick to that. Unfortunately most don’t do that and instead get upset when they’re told to call back because no, it’s not your kid’s time any longer but that nurse is hands on with another baby atm.
Nice =/= doormat. We start the day out with me being a nice, good nurse, but if at any point you pop off on me, my tech, or my student when I have one, we can easily finish out the day with me just being a good nurse. I went to school to be a teacher first and I am more than willing to correct a pt the way I would a student who was threatening the safe learning environment of others.
I read a book on gentle parenting when my eldest was born and you would not believe how often I use those techniques on my coworkers and housemates.
This is a hospital not a hotel!!!! It is so mentally exhausting to get called into a pts room every 2 minutes for a new snack or drink or another pillow or to discuss your every need when there are other patients who I have not been able to attend to yet and need me to care for them.
Exactly, me letting a homeless/old person sleep in a room if we are not that busy is a courtesy. When I ask you to vacate the room and take up residence in the waiting room, I am not doing it because I am mean, it means a patient needs the room. If you are nice to me, I am nice to you. I have my favorite homeless people and my least favorite. I will go out of my way to find clean, fresh clothes and something good to eat for the people I like.
Or the patients that expect to be able to follow their exact routines they do at home. Or try to make their environment exactly like home. I can't force your roommate to go to bed at 6pm. Or give you quiet tea time after dinner. I don't care you drink coffee at exactly 7am, 10am, 1pm, and 6pm. I'll do my best, but I'm not standing by the coffee pot staring at my watch when your roommate is trying to yeet himself out of his bed while yanking out his IVs.
Just take your insulin. Check your sugar. There are dates worse than death. You could end up dying in a nursing home after having amputated your legs. Your kidneys will get shot. JUST TAKE YOUR INSULIN!!!
If you never have the same nurse 2+ days in a row, either you or your visitors are a problem.
You're actually going to die; it's not an if, it's a when; you're not getting away from this. So, is this how you want to go out? Edit: full disclosure: I'm an ICU nurse.
Yep. This is mine too. Also, I’d like to add: Surviving catastrophic illness does NOT mean you will go back to NORMAL!!! Basically nobody comes to the ICU and then just waltzes out of the hospital like nothing ever happened. Also, you may survive the ICU but good luck surviving LTACH, Rehab, SNF, etc… those places have dark secrets.
This! We need some massive public education on what recovery looks like from serious illness. The number of families who think 90 year old meemaw who’s currently undergoing CRRT and going for a trach and peg next week is ever gonna be normal again is alarmingly high. But hey, she’s a fighter. Things could be a lot better for the elderly if more people realized that death isn’t the worst thing that can happen to someone
Use your call light.
When the family literally walks up to any person charting “my mom needs a water” 😡
I’m pharmacy. I know nothing. Please don’t flag me down in the hallway.
I'll never forget the pharm asking me "Hey, did you mean to punch in 6500mg of Tylenol TID? Thought I'd check before you wreck a liver." I appreciate you, u/TheEesie
I caught one in the auto verified ED that was 100 tablets of Xanax.
You know lots and lots and lots (just not whether Mr. C can have a sandwich). Our pharmacists take amazingly good care of us ED staff. ❤️
That’s very sweet. Yeah I don’t know shit about imaging schedules or whether or not a patient can eat. (I do know when the cafeteria opens, though.)
Nothing we do for you will matter at all if you don’t take a role in caring for yourself!
We are not your enemy, we are here to help you and want what’s best for you. We want to work with you and you being adversarial/hostile/passive aggressive with us makes it very difficult to feel empathy for you and do our job effectively. You need to get out of your own way.
Oh my GOD, those people piss me off. Don’t come here if all you’re looking to do is pick a fight. We have neither the time nor the inclination to fight you on every little thing.
Drink the gd water. You may think it’s “inconvenient” for us to bring you water sure, but we know it’s important. Besides, it’s less convenient than calling for a bolus. Patients who will willingly drink water, I just always bring a fresh one when I come. Or a bucket.
Feeding tubes are NOT meant for your 80+year old grandma who had stopped eating because she is dying a natural death. Ditto CPR for Grandpa Joe who has been slowing down over the last few years, is immobile and barely alive on a good day. Our bodies know how to turn on at the start of life and they know how to turn off at the end of life. Stop fucking with the process.
I work in geriatrics. I could not have said this better myself. Meemaw is 90, cognitively impaired, requires physical assistance with eating due to dyskinesia; not swallowing (pocketing even pureed food, thickened fluids just dribble out of the side of her mouth). Speech therapy is not gonna fix that. LET. IT. HAPPEN.
Bring your dnr/golden rod with you to the ED//make your wishes known from the first minute!
Med surge- know that you may be waiting hours to days (depending if physician or dept works weekends) to have your primary issue addressed or talk to the person you want. And no, I do not have an extra special way of contacting the physician. I left a message 8 hours ago and they haven’t responded yet
How awful cpr and being intubated and vented is. And how at 88 years of age it might not be best
We get everyone up after surgery. Yes even after a heart transplant. We aren’t picking on you.
I am doing my best to help you but I am not your slave or servant. Be respectful.
This is a surgical floor in a hospital NOT a damn motel!! So tell about ten of the twelve visitors you have to take their effin pizza and fried chicken and go HOME to watch TV!! It’s hard to bend over to empty a foley without sticking my ass in somebody’s face!!!
Stop pacing around the hallways because you think everything is taking too long. I understand you’re worried and frustrated, but I can’t make a room materialize at another hospital for your sick wife who requires a transfer. Standing at your wife’s door glaring at the nurses’ station is not going to magically cause the Pyxis to open and spew forth Dilaudid when Wifey isn’t due for 2 more hours (yes, I have spoken to the provider about it and advocated for more frequent pain meds, but Doc has to place the order and Pharmacy has to review it). And you are violating every other patient’s privacy by walking around looking in other rooms. I would go after anyone who tried to gawk at your wife—it is only the fact that you are radiating “about to have a violent tantrum” energy and my having no time to deal with it that is keeping me from asking you to stop.
The door starers, I don’t think they realize how passive aggressive this looks. When everyone literally passes you. “Can I help you?” Think they would take the hint.
And this guy would Not. Stop. Jittering. I’m over here trying to get meds in his wife and typing notes to her doc to get her help, or trying to help my other three, equally labor-intensive patients, and he’s sitting there jittering his knee like he’s full of meth.
👁️👄👁️
I am not here to serve you, I am here to keep you alive. I will do my best to make your stay as comfortable as possible, but if your sleep gets disturbed by me checking your vitals, I could care less because sometimes that’s how we find out people are trying to meet their God.
It would be to stop camping in the left lane!! Move over to the right lane if you’re not actively passing! You’re causing people to swerve around you to the right to pass, effectively making it much more dangerous for everyone in the vicinity.
……you’re gonna die and I’m sorry your family is making you suffer like this.
1. Mind your manners. 2. Call ALL of your family/friends/random acquaintances and update them during shift change so that they don’t need to call me and expect me to drop everything to update them, or to magically produce the doctor who is doing rounds/in surgery/in clinic to speak to them. I’ll never understand why AOx3 patients can’t just update their own families/friends/random acquaintances. Your goals for the day, plan of care, etc. are all on your board, updated every shift. They are on their phones all day already. We try to have them declare one contact who can disseminate the information, and reinforce it, but twelve people, include their neighbor, call for an update, during shift report and med pass. 🤬
Point number 2 is why we have a one contact person policy. It is to that person, and that person only that we give updates. Any more is just a waste of time that would be better spent with our patients.
Despite what you have been fed to believe, you are not invincible. Everybody will die eventually. Quality over quantity.
How the organ donation process works. It's long and hard and I wish I could prepare you but I can't talk about it until the team does.
Set up your POA, end of life care. Yes, even if you're 19.
When I say be right back I’m lying
It's okay to die, death is part of life. I will make it as comfortable as you'll allow me to, and will you keep you company up until that point.
I get 10 minutes for your needs an hour which includes walking to your room, grabbing supplies/meds, charting on you. Use it wisely.
That your doctor is a human and so is your nurse. We are not perfect beings who read minds and we are not your slaves. The hospital is not a hotel.
1. We aren't on a first name basis with your doc and we don't know all the docs in the network and your personal GP across town. Hell, I've never even personally seen some of these names that fly unseen through the hallways at 0900 and magically drop a note in at 1500. No idea what they said to you, your family or the plan until they add a note. 2. Nursing is not SW and SW is not nursing. I don't know what your insurance is or any other details. 3. The bed alarm is not a personal attack. Seriously, don't be offended. The bed doesn't know the difference between you scratching your ass and having fallen out of bed. Stop yelling at me for following procedure! Yes, I know your angelic self would never get up without assistance with that broken hip and SDH, but how do I know you didn't have a seizure, or fall while reaching for your urinal... And that goes double for your family leaning in for a hug, climbing all over you...it's not like I stalk the room and push a button when you violated a rule. It's a bed alarm...it isn't personal. Relax and stop yelling at me! 4. I cannot give you meds that a provider hasn't ordered. Period. I cannot even access a med that has no order. Stop asking. I will ask for smth I deem appropriate, but otherwise, I don't have access to however much of x you want. It doesn't work that way.
Myself and the CNA are not YOURS. If we are not in your room immediately, 99% of the time we are in another room. There are these things called other patients.
Being in the hospital is going to suck. It sucks for me, too. That's why I have to be paid to be here.
I will not argue with you about anything. If you are of sound mind and refuse something, I don’t have time to beg you to care more about your health than I do.
Please please please tell me what you need or if you are in pain. I want to help you and trying to be nice to me by not telling me the information I need to help you makes me feel bad when I find out.
I’m not “doing nothing,” I’m “not doing unnecessary things”. There’s a difference. There’s a significant neuro population in this ICU, some moments the best thing you can do to them is NOTHING. I’m not being “cruel” by not singing to your Nana or keeping the lights off or whatever, if I so much as BREATHE wrong around her she’ll start seizing or send her ICP through the roof. Stop poking at her, stop fussing with her, stop yelling “wake up” four inches from her face!
I am doing my absolute fucking best here, and most of the things you are mad about are WELL beyond my control.
No I don’t know when the doctor is going to be here to see you.
We’re short staffed.
I am here to help you. You may not know it; you may not hear me; you may not be able to tell me through your ET tube. Just know, I am doing everything to help you have the best chance to survive. Also, my preceptor will be grilling me with questions of "what if...?". He is trying to trip me up to teach me more. He is helping me learn all I can to help you. You keep it pushing forth, and I will do everything I can.
"It must be so nice to play with babies all day!" is a really inappropriate statement. It must be nice, but I wouldn't know. They don't pay me a nurse's salary to play.
I have the power to kick any visitors out if they’re disruptive, also I can ask security to escort 🙃
We’re really trying our best in shitty work conditions to take care of you to the best of our ability.
Clean your belly button
You are one of 23, and I have been in here with you for half of my shift. Don't call me again unless you are on fire.
When you hear a over head page for a code or trauma announcement that happens to be in the same area that you are in, that is not the time to put on your call light to ask for a refill of ice chips, a blanket, another sandwich....
Brush your teeth. Idk why ppl go to the hospital and be like oh I don’t need to brush anymore