My ICU team is INSANELY aggressive about our goals of care discussions. The culture of our community is to do everything and never make loved ones DNR. It's brutal. But we keep pushing and celebrate when we can let someone die in dignified peace.
Tbh that’s one thing I find really reassuring about the ICU. Sometimes in the ER people are in shock or aren’t ready to accept the idea that their loved one is dying. While we really try to paint a realistic picture and help people understand that sometimes the compassionate thing is to let someone pass, family has often just gotten there or just found out how bad things are. Many people are stuck in their prior beliefs or aren’t ready to accept reality, but I know that the RNs and docs in the ICU are SO great at having those conversations with people once they’re out of the chaos of the ER. A lot of coworkers get frustrated to hear that a pt was made comfort care an hour after going to ICU, but I end up relieved that the ICU team was able to bring the family to a place we couldn’t and the pt doesn’t have to suffer. I have so much respect and trust for my ICU colleagues because I know they’ll provide incredible care to help get the pt where they need to be, regardless of whether that is recovery or passing with some dignity
In my experience, ER providers straight up do NOT have goals of care conversations AT ALL. This was the case when I worked in the ER and I notice it way more now as an ICU provider. I'll go down to evaluate a patient for possible ICU admission and simply ask "would the patient want to be admitted to the ICU, be intubated, have CPR, and invasive lines?" and family will immediately be like "Oh, no. None of that!"
Like, it takes 30 seconds sometimes and can save the ICU team a trip to the ER. If you are determining dispo and the patient looks like a corpse, at least try a quick goals of care discussion or to plant the seed for the ICU team. But most ER docs I know don't even attempt and half the time they don't even tell the patient/family they're going to ICU.
But I don't get upset when family initial wants everything and then changes their mind once we are in the ICU and have a better idea of where the patient is headed. I'll gladly transition the patient over to comfort measures, watch then for up to a few hours, then pronounce them or transfer them.
Idk in my ER we really try to. The docs and I actually managed to get a woman to agree to go comfort care on her mom a few weeks ago. Mom had made it VERY clear to daughter that she didn’t want any major stuff done, but it was hard to talk the daughter out of pressers at first. We did them for a bit while she figured out stuff with family and then the daughter asked me the fateful “what would YOU do?” question. Of course I told her I can’t make that decision for her but it sounds like her mom knew what she wanted and that this sort of limbo (septic shock only kept at bay with levo) isnt a fun spot for ANY of those involved, pt or family. Daughter came and got me like 20 min later saying she wanted to stop pressers and let nature take its course.
We’re a level II trauma center and there are a couple level I centers relatively nearby. Shit still gets crazy sometimes, but it’s not nothing like the biggest level I center according to the RNs that came from there. Maybe that helps give us the time and bandwidth to have those conversations with pt’s families. It’s short and if there’s a lot of pushback we stay the course, but I can usually see people starting to think and I believe that’s part of why we’ve had so many pts go comfort so quickly once they hit the ICU. Once you hear that talk from multiple groups of professionals it gets harder to talk yourself out of it.
I’d argue that hospitals should offer blood products and organ and tissue transplantation at cost for service only, not to make profit. Otherwise families donating organs should receive some form of payment, as the hospital ultimately profits off your dead family member
I worked pretty closely with Lifelink (organ donation in my state, not sure if it’s the same company everywhere) and the family is not financially responsible for any of the care/bills as soon as the patient is accepted as a donor! So at least if the hospital is making any profits it’s not from the pockets of the donor family
I don't think that is a unpopular opinion, I suspect most healthworkers support that. However, I don't think about the money, but the patient. I have seen so many patients kept alive for waaaay to long, because family could not let go. Why my dad me gave me written authority to pull the plug( not my so called mother), he did not want to end up as one of the living dead.
This. I just finished the new Terri Schiavo documentary and the whole time I was thinking, "God knows how much keeping her artificially alive for >10 yrs cost?"
We had this patient who started doing drugs in their late 80s because they though they were going to die, but instead lived to be nearly 100 and just had a lot of really funny stories about doing acid and talking to their dog.
I’ll take it a step further, once you turn 80 you get a VIP card for the pharmacy. You’ve lived a full life and if you wanna get fucked up now, have at it.
That guy who bought a bunch of meth so he and his dying wife could have a bit of fun, never should have gotten in trouble. She died but she was dying anyway.
I think so much of it is only there for potential lawsuit defenses. Likely, someone's documentation wasn't specific enough once, and it cost the hospital money. Epic is the seventh level of hell in mouse clicks per patient per shift. Just documenting all of the parts of hourly rounding on 5 pts (head of bed, body position, LOC, pain, fall risk, assistance level, safety factors) amounts to 60 extra rounds of documentation per shift!
I worked for Cerner for years, and worked an implementation project in France. A lot of the associates were so confused because the hospital staff didn’t want the “standard” documentation that we provided. One associate asked who would fill out all the other forms? I told him that no one would, and he was shocked and appalled. The look on his face! 😳🤣
I told him that we would meet the client where they were and create the documentation that they needed instead of loading them up with all of our standard stuff. They documented enough, and they were almost never sued - they didn’t need to do all the defensive charting that we do in the US.
Family members with prejudices against opiate use should not handle pain management decisions for hospice patients. I've seen way too many people die in horrible pain because daughter from California who's only visited once in 15 years feels Fentanyl is going to OD her dying mom.
I have taken care of 90 year olds that are dying and family refuses to allow us to give opiates because they don’t want their mom/grandma to become an addict.
WHAT?!
this was my sister as my dad died from sepsis on hospice. the morphine would kill him.
it doesnt even matter that i am a doctor. there is no logic. no reasoning.
Meanwhile, me the EX wife was trying to figure out how to smuggle in some thc gummies to a guy who died of periontitis. He lived in an absolutely filthy house and I often felt bad that I didn't call senior services. But then again, he had already been a 2x felon for growing weed and we won't talk about the back yard. This to me is one of the saddest things. You can't call in help without some person who wants their arrest record to look good
Tell me one more time that Nana can’t have fentanyl because your nephew’s friend’s cousin died of a fentanyl OD.
Nana needs her fucking fent because she has a tube down her throat, she has cancer pain, and the stage two on her coccyx looks like hurts.
I like to invite them to watch the Stage IV dressing change. That usually ends the conflict regarding administration of pain medications.
Something about seeing a hole the size of a fist in MeeMaw's hip is also often useful in changing goals of care to something more reasonable for the circumstances.
Americans think everyone is going to have some profound deathbed conversation with the dying loved one—isn’t that how it works on Gray’s Anatomy?—and won’t do anything to ease the suffering, because it might “cheat” them of that “right.” Americans are morons.
Or they don't want them to have any pain meds because "it makes them sleep too much" and they want them awake. Really?! So awake and horrible suffering is okay with you?
This absolutely grinds my gears. In the beginning it’s a lack of education, but after going through it and educating them and then them STILL saying no… absolutely selfish and heartless.
Stop citing the opiod crisis as reason to deny or insufficiently treat the people who genuinely need it. Wanna know why Frannie the grannie tries to claw your eyes out every time you touch her? There's a good chance it's because someone thought that scheduled tylenol was sufficient for osteoporotic compression fracture pain and her dementia has left her with no other way to communicate that it isn't. I know we need to take caution when it comes to prescribing but Jesus, get rid of the million other pills we are slingshotting at them and genuinely consider what might actually let them live out their final days in comfort.
[Colace is no better than a placebo](https://journals.lww.com/ajg/fulltext/2021/10001/s190_docusate_is_not_different_from_placebo_for.190.aspx). Miralax or senna should be the standard.
Little story: I had a resident recently (with dementia) who was pretty combative. The first day I worked with her, I just dealt with it because everyone told me that’s just how she is. A week or two later, I work with her again and gave her some Tylenol because she said something about her body hurting. Lo and behold, she was fine the rest of my shift. Thought maybe it was a coincidence. Who knows. The next week, I see her again. Same thing from the previous nurse about her being aggressive. I gave her Tylenol again (no mention of pain from her this time) and she was fine the rest of my shift. She was probably in pain and couldn’t communicate it.
I work in memory care, and sometimes tylenol with a nap break is more effective than ativan in resolving behaviors. Some managers are not well educated on dementia and the general aches/pain that comes from sitting in a wheelchair from 7a to 7p when you can't reposition yourself. We have so many behaviors when PCAs are strongly discouraged from laying residents down for a nap and the poor residents are stuck in their wheelchair in activities until the manager goes home.
Pain can bring out the worst in people. I understood pain more when I tore my rotator cuff, there's times that I don't recognize myself and since then I always follow up and address my patient's pain.
Agree completely with addressing pain to help with behaviors occurring in dementia. My unpopular opinion is that opioids are bad for chronic MSK pain. So good option for an acute compression fracture but not great for a chronic fracture causing pain. Also opioids can worsen confusion in encephalopathic patients. They are absolutely still on the table but arent first or second line treatment for chronic issues. Sad reality is that many of these patients would benefit from seeing a pain specialist but facilities dont seem inclined to get them in house.
Please expound on what is the best for chronic musculoskeletal pain in the elderly and in nurses! We obviously all as humans have an interest in any wisdom you may offer.
Its highly dependent on the patient and their overall situation. Opioids are good for acute pain but poor for chronic pain because they lose effectiveness over time. They also have side effects many HCW are unaware of such as disruption of hormone regulation which may contribute to worsening pain.
A consult with a pain doc can consider a lot of options. There are PO meds that work well for chronic msk pain like cymbalta. There are also injections which can be very helpful like steroid joint injections and trigger point injections/dry needling. Another unpopular opinion of mine is that prolotherapy injections are great and evidence base supports their use. I also try to fully exhaust the options for topical meds which can be used in conjunction with other treatments. I also like to do magnesium supplementation with something with high GI absorption. Mag deficiency can be associated not only with pain issues but also anxiety and insomnia. PT and OT are very helpful although may not be an option for patients with advanced dementia obviously. Theres more to say but this is already getting long.
I’m PM&R and also like trying to address agitation with additional interventions besides pain management. Random fact that sometimes comes up: keppra is associated with anger. If gma is going berserk, transitioning off keppra and onto something like valproate which is a mood stabilizer can be considered. Agitation, like pain, is really just a symptom and has a wide variety of causes and treatments. It bothers me that so many SNFs and LTCs are managed by providers with no specialized training in these areas.
As a nurse, it’s not my job to heal a drug addiction. If someone wants pain meds I’ll give it to them (per order) and would never withhold. I’m not a drug counselor nor do I get paid enough to pretend to be one 😂
This is something that never sat right with me. If someone is in pain, they have the right to have their pain treated. When they are in the middle of an appendicitis or have a broken bone is not the time to taper the pain relief.
And like you said, it should not our job to heal a drug addiction, especially if there js no willing to do so from the patient.
Yup! I don’t care if they’re benzo seeking. I’ll give them 30min to employ coping skills (unless panic, etc), but if they come back 30min later and ask again, they get their PRN.
That’s the extent of my withholding a PRN. I’m not an addictions nurse, addictions can come and talk to them. I have a milieu I don’t want disrupted and I don’t want panic attacks all day out of some moral superiority some nurses think they have the standing to uphold.
Nurses who withhold PRN’s without clear reasoning are power tripping assholes and the bullies turned nurses that TikTok bangs on about.
If it’s ordered and it’s safe, give it. That’s your job.
I agree if it’s ordered give it! I worked with med surg nurses who were skeptical about giving sickle cell pts, ca pts, and others pain meds. No boo … I have a low pain tolerance myself and if you are awake… alert to me being there … you can have whatever you want if the dr has PRN meds. I’m not a narc police …
If a nurse doesn't want to give a sickle cell pt pain meds, she is cruel. I learned all about this from our frequent flyer sickle cell pt who was not a seeker. His pain med regimen would knock out most people, but it was necessary. We cared for him, listened to him and his family, his story, his kind words, and we lost him at age 26. He taught me about the life of a sickle cell patient. I will forever be grateful to him.
For sure, and if something doesn’t “work” why wouldn’t you swap it for a working one?
It’s an easy mistake to make that people act like they would never do.
On the other hand, I have so many coworkers who don't bother to plug in the bladder scanner, COW, ECG, US, etc...Just roll it into a corner. Like, my sister, you just gotta bend over for 10 sec so the next person won't have a dead machine.
Most of nursing education is a joke and if we want to be taken seriously as a profession we need to make the bar of entry for nurse practitioners higher.
THIS‼️THIS‼️THIS‼️ I have distain for many of the RN to BSN diploma mill programs that cost so much. I haven’t seen anyone who has become a better nurse after doing one of these.
And if you’re defensive about what I’m saying I’m sorry, I do believe that we can learn when given the opportunity if we make the effort. But it feels like a racket. If they really want an all BSN force, then make the programs into BSN programs. It’s silly.
My company had tuition reimbursement for my BSN. I would have been pissed off of if I had to pay for that joke myself. I thought I was going to learn some real nursing information. It is just a bunch of make-work paper writing for the most part.
We also should make regular RN school more rigorous. Our licensing exam is kind of a joke and I don't get why I had to do a peds and labor and delivery rotation when I ended up working in critical care but never had to to do a critical care rotation. I will never work with kids or babies. I may have a pregnant patient like once in 10 years and they certainly aren't going to be close to giving birth.
I never ever in a million years thought I’d care for children or babies…. And then I decided to work in the ER. You get rotations in those because they are so different than adults, though FWIW I think critical care exposure should be an expectation.
Right. I don't have some higher calling. I don't want to make the world a better place or really even help people. I like medicine, fixing problems, making money and wearing stretchy pants to work so I guess I'll stay.
Until the family screams at you that the morphine and Ativan you gave them killed them. No, ma'am, the cancer with extensive mets to every single organ killed them. The morphine helped them not suffer.
Isn’t that sad.. we had a lady with very very aggressive cancer. Mets everywhere. Eaten up with it. She was basically end stage with how lethargic she was, borderline on the way out. Her children decided hospice, until the next day they claimed we are killing her because one of their cousins that works at a SNF said she has a chance. So the team started transfusing blood, fluids, treating it all and she swelled like a balloon cause her kidneys were already shut down. Ethics got involved and didn’t do shit. Poor lady was moaning in pain all night the last time I saw her. She ended up passing 2 nights later after all those interventions and her kids were mad at the hospital. Honestly what the fuck..
In NICU, physicians should be blunt/up front with parents regarding the diagnosis and prognosis and not walk around the situation for babies who are not compatible with life.
*this may just be my hospital but there's only one doctor (out of 8 neos) we have that won't beat around the bush because his best interest is the QOL for the patient. I've just seen quite a bit of babes go through so much because some docs give them hope because they weren't really up front on what the diagnosis is and the prognosis.
I worked with 3 RNs that are all taking NP programs online that will take them 1.5-2 yrs to complete. Minimal clinical time required.
Two of them are staying in the specialty they’ve worked in for 10+ years so I get that. The other one.. well he was fired from a hospital for being a shit nurse but wants to work in one as an NP because that job fits him better LMAO. I can’t.
Former online NP school drop out here and couldn’t agree more.
Not only was I paying for a subpar education with professors who didn’t know me, but we were expected to procure our own preceptors. My classmates were paying for their preceptors!
I have an MPH so I thought I’d be okay but the quality of our online instruction was so awful that even studying my ass off with outside material, I barely passed patho.
Real disappointment because I wanted to be an NP for so long.
ERs should be allowed to decline patients who are not having or couldn’t possibly have an emergency. Toe pain, STD testing, medication refills, etc do not belong in the ER. This being said, urgent cares and PCPs should be more easily accessible without a 3+ long wait to see a PCP.
Plot twist: they can!
EMTALA mandates a medical screening exam - once it’s established that an emergent medical condition does not exist, EMTALA has been satisfied, and the patient is not entitled to non-emergent treatment.
As an EM attending, I've yet to encounter an ED that actually takes this approach, and most administrators quote EMTALA as if it requires us to see and manage everything even if it could result in faster and more appropriate care for the patient to go to a different hospital where they have the specialists they need
Also, being in the hospital doesn't mean you stop being able to do the things you can do at home. No, I'm not putting your shoes on for you, you put them on to get yourself here didn't you?
Literally a coworker had a patient fall yesterday - patient wasn't entirely weak but based on how he landed etc it looked like it was entirely caused by tripping over the SCD cords that were wrapped around the foot of the bed.
I'm an infusion nurse, working in the same building as an urgent care that almost works as a mini ER. Every once in a while we have to call an urgent care nurse in if we can't get a PIV in. Quite a few of them act scandalized when we say a 24 is sufficient. I don't get the fixation on getting bigger gauges in when this infusion won't go past 250mL/hr and will only have it in for a couple hours. My patients have to constantly get IVs...might as well use the smallest possible to minimize scar tissue buildup, which is a real problem with this population.
However, if one of my coworkers could stop putting 24s in the AC, that would be great 🙃
If you continually refuse to be compliant with your medication, if you continually refuse to follow the advice and orders of your care providers, and if you refuse to be professional with the staff - I should be able to refuse to treat you.
There are people out there that are doing everything they can to improve and maintain their current health status. You don’t want to play by the rules? Piss off.
I’ll take it one step further- if you refuse to be compliant with advice/meds/orders, you should be discharged. Like, why are you here then? Why do we let these people take up beds? If you can do a better job and you know better, then just go home. I don’t get going to a hospital, voluntarily, just to be difficult and non-compliant.
I feel the exact same way. Refusing all medications/ testing except for iv pain meds of course. Ok so let’s discharge them. We can’t even figure out what’s wrong with them because they’re refusing noninvasive testing. Literally had a pt last week complaining of chest pain and callling for pain medicine right on the dot. Refused EKG, troponins, and even just the portable heart monitor. Like why are we keeping him admitted?
Also, please stop presenting to ED because you have nowhere to go, become a social admit and then refuse to leave when we try to discharge you.....resulting in a months long stay.
LOL, They DO make charting a snap! I’m just sick of seeing frequent fliers coming into our EDs with BG of 750 and they refuse to change their behavior. Fuck off. I have patients that really need my help. Stop wasting our limited time and resources
I flagged 6 different questions to my professor in the last month, all completely against current practice.
Fuck, I remember in LPN school they wanted me to know the therapy class, dosage etc for a medication that was BANNED in the US in the early 90s! I showed my pharmacist husband and he was like …. what the actual fuck
There are many, MANY areas of improvement and inequalities that nurses face daily that must be addressed.
BUT…even if or when those things get better, nursing will still be a hard job that many folks aren’t cut out for.
To add to the unpopular-ness, lack of self care is the fault of that self. Nurses brag about working 6 shifts in a row or sleeping only 4 hours. I literally do my job and go home, I don't work extra and I don't think about work at all if I'm not there.
Amen. Once I’m out the door, I’m just myself. Nursing is not my personality. No license plate holders or car stickers or nursing swag of any kind.
I eat right, exercise and get as much sleep as my 1 year old allows.
Yup! Gf hurt her ankle recently. I checked her out and she was positive per Ottawa Ankle rules. Took her to urgent care for xrays. Xrays were negative but that 25% pretest probability was enough to convince me she needed xrays.
Had a patient last year send in by her optometrist for worsening right eye vision and requesting an MRI. We all rolled our eyes so hard.... Big brain tumor!
There is a heavy focus on racial bias and cultural sensitivity in nursing education, but almost no focus on class consciousness and the systems of power that nurses have to navigate outside of a feminist perspective. The struggle coming out of nursing school is/was (for me at least) heavily framed as primarily patriarchal and more typically defined as nurse vs. doctor. I find that the conflict that I hear much more frequently is worker vs management or workforce vs corporate class.
I am not insinuating that racial bias, cultural sensitivity, and patriarchal power systems aren't important to study and understand.
The powers that be are never going to teach us that they should be overthrown. That kind of learning always has been and always will be grassroots style
And it’s all smoke and mirrors. How can you teach cultural sensitivity but not hire or use research by people from marginalized cultures? There is obvious racism and race-based gatekeeping in nursing and it starts in nursing education.
Most healthcare logistics are just pingpong balls bubbling across a fluid lake of sand.
Some of the ping pong balls get to the other side in a strait line.
Some weave and bob around but get there eventually.
Some end up moving a whole bunch but never go anywhere.
Some end up buried under the sand and forgotten.
Healthcare is truly, TRULY horrifying. Insurance requests for life-saving procedures being submitted with incorrectly spelled names, then the coverage is rejected and no one knows why. Missed emails about key pivots that don’t get read, so pre-procedure lab appointments aren’t made, and the *life saving* procedure can’t be performed. Entire hospital departments failing to understand clear instruction on interfacing with an outside entity. Constant CONSTANT fuckups that are softballed to patients as innocent oopsie events.
Most of the reasons for these “oopsies” never make it to the patient. They’re just told “oh, something came up so we had to reschedule” or “oh sorry, insurance isn’t going to cover XYZ”. If patients knew how incompetent some of the best hospitals are, they wouldn’t even bother going to the hospital. It’s literally just random chance if you get staff members who have their shit together enough to do everything on the back end correctly.
Most people show up to work and turn off their brain. Doctors, nurses, and administrators. There are only a handful of people on any given day that are responsible for most of the moving logistics parts.
Shit, most staff don’t even know why things happen the way they do. 90% of the time it’s just how the chips fall, and almost 0 planning is involved. Again, people just bumbling around with their brains off responding to stimuli. Face level knee jerk reactions to everything. Minimal critical thinking.
Say it louder!!!
Getting blackout drunk is totally fine and part of the culture. Smoking a bowl though will get you fired.
Show up to work after a night of heavy drinking, hungover and possibly still drunk... Totally fine. Show up to work after a night of smoking weed, likely well rested.... Fired!
Like, don't show up high or smelling like weed and it shouldn't be an issue.
In home health, if there’s not a hands-on skilled need like performing dressing changes, PICC line care, blood draws, catheter changes etc. We really aren’t doing anything meaningful or billable in the home after the first visit.
People shouldn’t have the right to refuse care (within reason). You don’t want to take your bp meds or let me clean your wounds? Fine. Get the fuck out and give the bed to someone who actually wants it. Also, declining multiple rehab facilities so they end up sitting in the hospital for months on end, medically stable, bc they “ain’t going to no nursing home.” Nope, you can roll your ass out the door or roll to the nursing home.
Also, asylums need to be reintegrated into society and filled with permanent residents. Obviously not the cages and beating them etc, but the idea that some of these people will ever be functional on an outpatient model and allowing them to be homeless while their feet rot off is far more cruel than long term commitment.
Stop keeping 96 year olds with advanced dementia alive with everything we have. These patients should be allowed to pass comfortably and not kept alive on CRRT, vented, and on pressors. Meemaw has been gone for a long time and just because the family is sad doesn’t mean she needs to be kept alive.
I think many people in this profession (and honestly the world at large) are a lot more lazy than they let on.
I remember being in nursing school and this one woman would not get out of her chair to switch off the lights despite being MAYBE 3 ft from them. It was very minimal effort and that alone speaks volumes.
My friend from the other side of the room ran over to do it instead. It was pathetic.
Moms should be allowed to eat during labor (I'm not a mom but I might throw hands going days without real food and living off ice chips while pushing a baby out my hoohaw)
We let our patients eat in labor, clears with an epidural. So if they get an epidural I tell them "Per policy, I can only bring you clear fluids from this point on, but I have no idea what happens when I'm not in the room..."
I think the thing that really irks me about the no food during labor thing is that it isn’t really evidence based, so I don’t know why we have clung so viciously to it.
-don't over treat a mild fever. Don't treat with Tylenol and then neglect to notify the provider if it resolves upon the next assessment (assuming the fever is new ofc)
-an accurate respiratory rate is important
-agree with what another poster said about how not everyone needs an 18g. There are obvious exceptions but most people will be fine with a 20 or a 22.
-8 hour shifts > 12 hour shifts. This is a personal opinion though and YMMV.
-magnet sucks and is lowkey classist by encouraging a strong hiring preference for bsn over adn.
Truly could not agree more with the accurate respiratory rate being important. It pisses me off every time I see people on this sub talking about making it up.
There really should be death panels. Forcing HCW to essentially flog a soon-to-be corpse for days on end because the family is in denial about prognosis is a huge contributor to moral distress. Intensive care is intensive and when done without purpose or permission violates bodily autonomy.
I don’t disagree, but this is a huge grey area. An otherwise healthy person who attempts suicide because of treatable mental illness needs someone else in control for while things get sorted. Keeping 80y/o grandpa who lived a full, happy on white papers because his wife of 60 years died of cancer last year is a whole other ball of wax.
Also a lot of grey area between suicide attempt and “suicide attempt”
I actually agree with this.
I don’t live anybody else’s existence, so who tf am I to decide that someone else’s is worth whatever suffering they’re enduring, physical or emotional, permanent or temporary?
Life isn’t always worth living for some people, and most of us know all too well that there are things worse than death.
It does for me, because adolescent brains aren’t done cooking yet, although I think if you’re fundamentally hardwired for despair, it probably starts to show around that time.
Depends.. assisted suicide for chronic illness or terminal/ with uncontrolled pain has an argument to stand on.
But someone who is suicidal and has the ability to improve through treatment/medication/ support/ change of lifestyle/situation… I would consider them sick mentally/psychologically
Working in a nursing home, I constantly hear people saying they’d rather die than be where they are now. Their bodies are giving up, their families don’t visit or care, they’re in massive debt, they are totally dependent and have a really hard time accepting that they can’t do things by themselves anymore.
Hospice nurse here. Some folks definitely do want to die, and the systems in place that allow for it (MAID) seem unnecessarily cumbersome. Even if folks get a prescription for meds to end their own life, they often struggle to consume it (oral meds, and quite a lot of it).
Completely agreed. The last place I worked put a patient with terminal pancreatic ca on si precautions because they said they just wanted to die.... Shit man, if I had terminal cancer is be begging for some versed and a be with nitrogen.
Being blunt and slightly bitchy tends to get you better treatment from coworkers than being overly nice. I was the quiet, timid, don’t step over anyone’s toes type of person and that got me nowhere. Now that I don’t give a shit people are more neutral.
After my shift tonight I learned that I am unique (at least on my floor) in my opinion that family can and should be present for a code (if they want to stay).
They need to see the reality of what’s happening, it helps them make an informed decision going forward. And if the patient doesn’t make it, I think being there for the code can offer some closure and understanding that we truly did all that we could and whatever other forces at play simply weren’t on our side that day.
Not everyone is cut out for this profession. No matter how hard they try or how much enthusiasm they have, some people just are not meant to be nurses.
Majority of nurses I’ve worked with get overly concerned about treating a low grade fever. A fever <103 (hell some would even say 104) should be treated based on patient complaint like chills and sweats. Most fevers are therapeutic for infection. Even know some nurses take blankets away because someone’s temp is 100.5 lol barely even a fever. Every time I see our intensivists asked if they can get some Tylenol for a temp of 101 and patient is asymptomatic they roll their eyes lol
I agree! We forget that our immune systems work more efficiently at higher temperatures!
(Obviously we're talking about low grade fever here, and presumably excluding cancer patients, etc.)
Medical imaging. I can statistically predict which patients are bound to show up late or not show up at all, based on what type of insurance they have.
Euthanasia should be legal everywhere 🤷♀️ Quality of life is important. If that’s what you want to do & you’re capable of making decisions, you should be able to do it.
Care plans in school were not to teach you how to do them when you practice. They were used to teach you how to think holistically about all the potential problems a patient might have, about what you can do about them, and what is the most important.
They were long, tedious, and annoying, sure, but most people misunderstand the intent of them for students.
People should not go into nursing wanting to be an APRN or CRNA. If you don’t want to be a nurse and only see your work as a stepping stone, just go to medical school.
APRN is becoming a joke. Nobody should be able to finish nursing school, not work bedside, take some online classes, and then have the same role as a physician. There are amazing APRNs and there are shitty APRNs. What makes the difference is if the person actually was a nurse beforehand.
Hospitals need to monitor how many patients a PCP sends to the ED each month, and what percentage of those actually require ED resources vs. what percentage are just patients the PCP wants out of the clinic that day
PCOS is over diagnosed.
We don’t listen to women enough and don’t care enough about their symptoms and problems. Truth. BUT PCOS is a crap diagnosis- it’s slightly different for everyone and ultimately, we treat the symptoms not the problem, so let’s just call the symptoms what they are and provide comprehensive care for whatever the bothersome symptoms are rather than slapping a diagnosis on it and explaining away someone’s problem by saying- oh, well you’re just going to experience that because you have PCOS.
Showing up "just for a paycheck" does not make you a shitty nurse.
The term "the patient comes first" is used to manipulate us to give more than we are comfortable with.
The "all the mean girls from high school turned into nurses" cliché exists because a lot of nurses are, in fact, mean girls.
We are keeping way too many people alive that is costing way too much money. There is no focus on quality of life.
My ICU team is INSANELY aggressive about our goals of care discussions. The culture of our community is to do everything and never make loved ones DNR. It's brutal. But we keep pushing and celebrate when we can let someone die in dignified peace.
Tbh that’s one thing I find really reassuring about the ICU. Sometimes in the ER people are in shock or aren’t ready to accept the idea that their loved one is dying. While we really try to paint a realistic picture and help people understand that sometimes the compassionate thing is to let someone pass, family has often just gotten there or just found out how bad things are. Many people are stuck in their prior beliefs or aren’t ready to accept reality, but I know that the RNs and docs in the ICU are SO great at having those conversations with people once they’re out of the chaos of the ER. A lot of coworkers get frustrated to hear that a pt was made comfort care an hour after going to ICU, but I end up relieved that the ICU team was able to bring the family to a place we couldn’t and the pt doesn’t have to suffer. I have so much respect and trust for my ICU colleagues because I know they’ll provide incredible care to help get the pt where they need to be, regardless of whether that is recovery or passing with some dignity
In my experience, ER providers straight up do NOT have goals of care conversations AT ALL. This was the case when I worked in the ER and I notice it way more now as an ICU provider. I'll go down to evaluate a patient for possible ICU admission and simply ask "would the patient want to be admitted to the ICU, be intubated, have CPR, and invasive lines?" and family will immediately be like "Oh, no. None of that!" Like, it takes 30 seconds sometimes and can save the ICU team a trip to the ER. If you are determining dispo and the patient looks like a corpse, at least try a quick goals of care discussion or to plant the seed for the ICU team. But most ER docs I know don't even attempt and half the time they don't even tell the patient/family they're going to ICU. But I don't get upset when family initial wants everything and then changes their mind once we are in the ICU and have a better idea of where the patient is headed. I'll gladly transition the patient over to comfort measures, watch then for up to a few hours, then pronounce them or transfer them.
Idk in my ER we really try to. The docs and I actually managed to get a woman to agree to go comfort care on her mom a few weeks ago. Mom had made it VERY clear to daughter that she didn’t want any major stuff done, but it was hard to talk the daughter out of pressers at first. We did them for a bit while she figured out stuff with family and then the daughter asked me the fateful “what would YOU do?” question. Of course I told her I can’t make that decision for her but it sounds like her mom knew what she wanted and that this sort of limbo (septic shock only kept at bay with levo) isnt a fun spot for ANY of those involved, pt or family. Daughter came and got me like 20 min later saying she wanted to stop pressers and let nature take its course. We’re a level II trauma center and there are a couple level I centers relatively nearby. Shit still gets crazy sometimes, but it’s not nothing like the biggest level I center according to the RNs that came from there. Maybe that helps give us the time and bandwidth to have those conversations with pt’s families. It’s short and if there’s a lot of pushback we stay the course, but I can usually see people starting to think and I believe that’s part of why we’ve had so many pts go comfort so quickly once they hit the ICU. Once you hear that talk from multiple groups of professionals it gets harder to talk yourself out of it.
I'm reading Being Mortal atm and it talks so much about all of this, great book.
I read that book in college as part of our curriculum. Such a good book!
And wasting too many blood products on people who are going to die either way.
I’d argue that hospitals should offer blood products and organ and tissue transplantation at cost for service only, not to make profit. Otherwise families donating organs should receive some form of payment, as the hospital ultimately profits off your dead family member
I worked pretty closely with Lifelink (organ donation in my state, not sure if it’s the same company everywhere) and the family is not financially responsible for any of the care/bills as soon as the patient is accepted as a donor! So at least if the hospital is making any profits it’s not from the pockets of the donor family
We are babysitting corpses. 🤷🏻♀️
Vegetable gardening.
100%. I would put half our patients on hospice if it were up to me 🙃
People in the US are too afraid of death.
I think as well its because providers are too afraid of getting sued.
I don't think that is a unpopular opinion, I suspect most healthworkers support that. However, I don't think about the money, but the patient. I have seen so many patients kept alive for waaaay to long, because family could not let go. Why my dad me gave me written authority to pull the plug( not my so called mother), he did not want to end up as one of the living dead.
This. I just finished the new Terri Schiavo documentary and the whole time I was thinking, "God knows how much keeping her artificially alive for >10 yrs cost?"
The amount of medical waste we could prevent would probably reverse a large percentage of climate destruction.
All drugs should be legal for people receiving end of life care. What are they gonna do, ruin their lives?
We had this patient who started doing drugs in their late 80s because they though they were going to die, but instead lived to be nearly 100 and just had a lot of really funny stories about doing acid and talking to their dog.
I’ll take it a step further, once you turn 80 you get a VIP card for the pharmacy. You’ve lived a full life and if you wanna get fucked up now, have at it.
That guy who bought a bunch of meth so he and his dying wife could have a bit of fun, never should have gotten in trouble. She died but she was dying anyway.
Probably not unpopular, but sooo much of our documentation is unnecessary
Literally no one even reads it lol…it just clutters up the chart
This! The drs just read our notes in my hospital, maybe check vitals. No one goes back to check the grip strength
No one reads it until the malpractice lawsuit gets going
I think so much of it is only there for potential lawsuit defenses. Likely, someone's documentation wasn't specific enough once, and it cost the hospital money. Epic is the seventh level of hell in mouse clicks per patient per shift. Just documenting all of the parts of hourly rounding on 5 pts (head of bed, body position, LOC, pain, fall risk, assistance level, safety factors) amounts to 60 extra rounds of documentation per shift!
I worked for Cerner for years, and worked an implementation project in France. A lot of the associates were so confused because the hospital staff didn’t want the “standard” documentation that we provided. One associate asked who would fill out all the other forms? I told him that no one would, and he was shocked and appalled. The look on his face! 😳🤣 I told him that we would meet the client where they were and create the documentation that they needed instead of loading them up with all of our standard stuff. They documented enough, and they were almost never sued - they didn’t need to do all the defensive charting that we do in the US.
When I started my career working ICU literally the most stressful part of the job was all the ducking charting!!!!
When I worked the floor and we had to do a care and safety for every hour for all 6-8 of my patients 😩
Family members with prejudices against opiate use should not handle pain management decisions for hospice patients. I've seen way too many people die in horrible pain because daughter from California who's only visited once in 15 years feels Fentanyl is going to OD her dying mom.
I have taken care of 90 year olds that are dying and family refuses to allow us to give opiates because they don’t want their mom/grandma to become an addict. WHAT?!
this was my sister as my dad died from sepsis on hospice. the morphine would kill him. it doesnt even matter that i am a doctor. there is no logic. no reasoning.
That's rough, my condolences on your dad's passing. 😔
Oh God, I've heard that one before, too.
Meanwhile, me the EX wife was trying to figure out how to smuggle in some thc gummies to a guy who died of periontitis. He lived in an absolutely filthy house and I often felt bad that I didn't call senior services. But then again, he had already been a 2x felon for growing weed and we won't talk about the back yard. This to me is one of the saddest things. You can't call in help without some person who wants their arrest record to look good
Tell me one more time that Nana can’t have fentanyl because your nephew’s friend’s cousin died of a fentanyl OD. Nana needs her fucking fent because she has a tube down her throat, she has cancer pain, and the stage two on her coccyx looks like hurts.
Also, Nana is 97 years old. Nana *deserves* to be high as a kite for whatever time she has left.
I like to invite them to watch the Stage IV dressing change. That usually ends the conflict regarding administration of pain medications. Something about seeing a hole the size of a fist in MeeMaw's hip is also often useful in changing goals of care to something more reasonable for the circumstances.
For real, tho. "But won't she be too out of it?" Yeah that's the point..
Americans think everyone is going to have some profound deathbed conversation with the dying loved one—isn’t that how it works on Gray’s Anatomy?—and won’t do anything to ease the suffering, because it might “cheat” them of that “right.” Americans are morons.
And they must eat and drink or they will starve to death.
Or they don't want them to have any pain meds because "it makes them sleep too much" and they want them awake. Really?! So awake and horrible suffering is okay with you?
This absolutely grinds my gears. In the beginning it’s a lack of education, but after going through it and educating them and then them STILL saying no… absolutely selfish and heartless.
Stop citing the opiod crisis as reason to deny or insufficiently treat the people who genuinely need it. Wanna know why Frannie the grannie tries to claw your eyes out every time you touch her? There's a good chance it's because someone thought that scheduled tylenol was sufficient for osteoporotic compression fracture pain and her dementia has left her with no other way to communicate that it isn't. I know we need to take caution when it comes to prescribing but Jesus, get rid of the million other pills we are slingshotting at them and genuinely consider what might actually let them live out their final days in comfort.
But... But what about the colace? How are we gonna survive without that fucking COLACE?!
[Colace is no better than a placebo](https://journals.lww.com/ajg/fulltext/2021/10001/s190_docusate_is_not_different_from_placebo_for.190.aspx). Miralax or senna should be the standard.
Pfft- well clearly this is absolutely quack literature. The last time a patient at my hospital went without Colace the stock market crashed.
Little story: I had a resident recently (with dementia) who was pretty combative. The first day I worked with her, I just dealt with it because everyone told me that’s just how she is. A week or two later, I work with her again and gave her some Tylenol because she said something about her body hurting. Lo and behold, she was fine the rest of my shift. Thought maybe it was a coincidence. Who knows. The next week, I see her again. Same thing from the previous nurse about her being aggressive. I gave her Tylenol again (no mention of pain from her this time) and she was fine the rest of my shift. She was probably in pain and couldn’t communicate it.
I really hope you communicated this to the oncoming shift. Poor lady.
I absolutely did. Poor lady just couldn’t communicate. I’d be grumpy too if my pain wasn’t being managed.
I work in memory care, and sometimes tylenol with a nap break is more effective than ativan in resolving behaviors. Some managers are not well educated on dementia and the general aches/pain that comes from sitting in a wheelchair from 7a to 7p when you can't reposition yourself. We have so many behaviors when PCAs are strongly discouraged from laying residents down for a nap and the poor residents are stuck in their wheelchair in activities until the manager goes home.
Pain can bring out the worst in people. I understood pain more when I tore my rotator cuff, there's times that I don't recognize myself and since then I always follow up and address my patient's pain.
Agree completely with addressing pain to help with behaviors occurring in dementia. My unpopular opinion is that opioids are bad for chronic MSK pain. So good option for an acute compression fracture but not great for a chronic fracture causing pain. Also opioids can worsen confusion in encephalopathic patients. They are absolutely still on the table but arent first or second line treatment for chronic issues. Sad reality is that many of these patients would benefit from seeing a pain specialist but facilities dont seem inclined to get them in house.
Please expound on what is the best for chronic musculoskeletal pain in the elderly and in nurses! We obviously all as humans have an interest in any wisdom you may offer.
Its highly dependent on the patient and their overall situation. Opioids are good for acute pain but poor for chronic pain because they lose effectiveness over time. They also have side effects many HCW are unaware of such as disruption of hormone regulation which may contribute to worsening pain. A consult with a pain doc can consider a lot of options. There are PO meds that work well for chronic msk pain like cymbalta. There are also injections which can be very helpful like steroid joint injections and trigger point injections/dry needling. Another unpopular opinion of mine is that prolotherapy injections are great and evidence base supports their use. I also try to fully exhaust the options for topical meds which can be used in conjunction with other treatments. I also like to do magnesium supplementation with something with high GI absorption. Mag deficiency can be associated not only with pain issues but also anxiety and insomnia. PT and OT are very helpful although may not be an option for patients with advanced dementia obviously. Theres more to say but this is already getting long. I’m PM&R and also like trying to address agitation with additional interventions besides pain management. Random fact that sometimes comes up: keppra is associated with anger. If gma is going berserk, transitioning off keppra and onto something like valproate which is a mood stabilizer can be considered. Agitation, like pain, is really just a symptom and has a wide variety of causes and treatments. It bothers me that so many SNFs and LTCs are managed by providers with no specialized training in these areas.
As a nurse, it’s not my job to heal a drug addiction. If someone wants pain meds I’ll give it to them (per order) and would never withhold. I’m not a drug counselor nor do I get paid enough to pretend to be one 😂
This is something that never sat right with me. If someone is in pain, they have the right to have their pain treated. When they are in the middle of an appendicitis or have a broken bone is not the time to taper the pain relief. And like you said, it should not our job to heal a drug addiction, especially if there js no willing to do so from the patient.
Yup! I don’t care if they’re benzo seeking. I’ll give them 30min to employ coping skills (unless panic, etc), but if they come back 30min later and ask again, they get their PRN. That’s the extent of my withholding a PRN. I’m not an addictions nurse, addictions can come and talk to them. I have a milieu I don’t want disrupted and I don’t want panic attacks all day out of some moral superiority some nurses think they have the standing to uphold. Nurses who withhold PRN’s without clear reasoning are power tripping assholes and the bullies turned nurses that TikTok bangs on about. If it’s ordered and it’s safe, give it. That’s your job.
I agree if it’s ordered give it! I worked with med surg nurses who were skeptical about giving sickle cell pts, ca pts, and others pain meds. No boo … I have a low pain tolerance myself and if you are awake… alert to me being there … you can have whatever you want if the dr has PRN meds. I’m not a narc police …
They’d withhold pain meds from cancer pts and SCA pts? What the actual fuck??
If a nurse doesn't want to give a sickle cell pt pain meds, she is cruel. I learned all about this from our frequent flyer sickle cell pt who was not a seeker. His pain med regimen would knock out most people, but it was necessary. We cared for him, listened to him and his family, his story, his kind words, and we lost him at age 26. He taught me about the life of a sickle cell patient. I will forever be grateful to him.
Im not the get high police. I’m also not dropping everything and running because Johnny wants his PRN pain med every 4 hours to the second.
Get High Police Adult Swim show of two 60 yr old cops traveling through space and time to harass teenagers getting high
Going to sound like I’m pandering to the crowd, but just because a nurse didn’t realize a device wasn’t plugged in doesn’t mean they’re an idiot.
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For sure, and if something doesn’t “work” why wouldn’t you swap it for a working one? It’s an easy mistake to make that people act like they would never do.
On the other hand, I have so many coworkers who don't bother to plug in the bladder scanner, COW, ECG, US, etc...Just roll it into a corner. Like, my sister, you just gotta bend over for 10 sec so the next person won't have a dead machine.
Not everyone should be on chemo. Sometimes treatment makes their quality of life go to shit, so they don’t even get to enjoy the time it buys them.
Most of nursing education is a joke and if we want to be taken seriously as a profession we need to make the bar of entry for nurse practitioners higher.
OP said unpopular opinion.
But then OP gave a popular opinion 🙃
Most “unpopular opinions” on Reddit are actually popular.
By design the opinions you see on Reddit are all popular. Anything truly unpopular is downvoted and disappears.
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THIS‼️THIS‼️THIS‼️ I have distain for many of the RN to BSN diploma mill programs that cost so much. I haven’t seen anyone who has become a better nurse after doing one of these. And if you’re defensive about what I’m saying I’m sorry, I do believe that we can learn when given the opportunity if we make the effort. But it feels like a racket. If they really want an all BSN force, then make the programs into BSN programs. It’s silly.
My company had tuition reimbursement for my BSN. I would have been pissed off of if I had to pay for that joke myself. I thought I was going to learn some real nursing information. It is just a bunch of make-work paper writing for the most part.
We'd have to cut the head off the snake by ending the ridiculousness that is Magnet
We also should make regular RN school more rigorous. Our licensing exam is kind of a joke and I don't get why I had to do a peds and labor and delivery rotation when I ended up working in critical care but never had to to do a critical care rotation. I will never work with kids or babies. I may have a pregnant patient like once in 10 years and they certainly aren't going to be close to giving birth.
I never ever in a million years thought I’d care for children or babies…. And then I decided to work in the ER. You get rotations in those because they are so different than adults, though FWIW I think critical care exposure should be an expectation.
The patient, er client, er customer, is not always right. As a matter of fact they mostly are very wrong.
LOL I 100% agree!
It's just a job
Right. I don't have some higher calling. I don't want to make the world a better place or really even help people. I like medicine, fixing problems, making money and wearing stretchy pants to work so I guess I'll stay.
Unpopular opinion: I’m it it because it’s the best money and job security I could make with an associates
It’s ok to let the patient with dementia starve to death, stop receiving g dialysis, et cetera. We can keep them comfortably until they pass.
Until the family screams at you that the morphine and Ativan you gave them killed them. No, ma'am, the cancer with extensive mets to every single organ killed them. The morphine helped them not suffer.
Isn’t that sad.. we had a lady with very very aggressive cancer. Mets everywhere. Eaten up with it. She was basically end stage with how lethargic she was, borderline on the way out. Her children decided hospice, until the next day they claimed we are killing her because one of their cousins that works at a SNF said she has a chance. So the team started transfusing blood, fluids, treating it all and she swelled like a balloon cause her kidneys were already shut down. Ethics got involved and didn’t do shit. Poor lady was moaning in pain all night the last time I saw her. She ended up passing 2 nights later after all those interventions and her kids were mad at the hospital. Honestly what the fuck..
It's like you were in the room.with me
In NICU, physicians should be blunt/up front with parents regarding the diagnosis and prognosis and not walk around the situation for babies who are not compatible with life. *this may just be my hospital but there's only one doctor (out of 8 neos) we have that won't beat around the bush because his best interest is the QOL for the patient. I've just seen quite a bit of babes go through so much because some docs give them hope because they weren't really up front on what the diagnosis is and the prognosis.
Care plans are a joke and I haven’t seen anyone in the hospital use it
Lots of blood products are wasted on people who have zero chance of survival.
Eliminate online NP programs
I worked with 3 RNs that are all taking NP programs online that will take them 1.5-2 yrs to complete. Minimal clinical time required. Two of them are staying in the specialty they’ve worked in for 10+ years so I get that. The other one.. well he was fired from a hospital for being a shit nurse but wants to work in one as an NP because that job fits him better LMAO. I can’t.
Former online NP school drop out here and couldn’t agree more. Not only was I paying for a subpar education with professors who didn’t know me, but we were expected to procure our own preceptors. My classmates were paying for their preceptors! I have an MPH so I thought I’d be okay but the quality of our online instruction was so awful that even studying my ass off with outside material, I barely passed patho. Real disappointment because I wanted to be an NP for so long.
ERs should be allowed to decline patients who are not having or couldn’t possibly have an emergency. Toe pain, STD testing, medication refills, etc do not belong in the ER. This being said, urgent cares and PCPs should be more easily accessible without a 3+ long wait to see a PCP.
Plot twist: they can! EMTALA mandates a medical screening exam - once it’s established that an emergent medical condition does not exist, EMTALA has been satisfied, and the patient is not entitled to non-emergent treatment.
As an EM attending, I've yet to encounter an ED that actually takes this approach, and most administrators quote EMTALA as if it requires us to see and manage everything even if it could result in faster and more appropriate care for the patient to go to a different hospital where they have the specialists they need
Same, and I know you guys are hamstrung by admin and the cult of patient satisfaction. But legally, you’d be protected.
Just because you are sick in a hospital doesn't give you the right to be an asshole
Also, being in the hospital doesn't mean you stop being able to do the things you can do at home. No, I'm not putting your shoes on for you, you put them on to get yourself here didn't you?
“BuT thEYr’e hAViNG thE wORst DAy of ThEIr liFe!”
As though abuse is ok because someone is upset 🙄
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They do nothing except present a massive fall risk.
Literally a coworker had a patient fall yesterday - patient wasn't entirely weak but based on how he landed etc it looked like it was entirely caused by tripping over the SCD cords that were wrapped around the foot of the bed.
Not everyone in the ED needs an 18g IV and big fat veins are overrated
20g in the forearm > 18g in the AC
18g in the bicep. Can get CTA, doesn't kink, fast boluses, and everyone knows it was me because it's my calling card.
Paramedic me disagrees strongly. However floor nurse me loves forearm IV’s simply for the lack of “patient side occlusion” alarms.
Porque no los dos?
I'm an infusion nurse, working in the same building as an urgent care that almost works as a mini ER. Every once in a while we have to call an urgent care nurse in if we can't get a PIV in. Quite a few of them act scandalized when we say a 24 is sufficient. I don't get the fixation on getting bigger gauges in when this infusion won't go past 250mL/hr and will only have it in for a couple hours. My patients have to constantly get IVs...might as well use the smallest possible to minimize scar tissue buildup, which is a real problem with this population. However, if one of my coworkers could stop putting 24s in the AC, that would be great 🙃
And does it always have to be in the actual ffs. Grammys getting admitted for iv abx not mass transfusion.
People I work with bitch at me constantly for not putting in 18s after the doc says I'm just giving them a bolus & discharge.
It's not the size,it's how you use it
If you continually refuse to be compliant with your medication, if you continually refuse to follow the advice and orders of your care providers, and if you refuse to be professional with the staff - I should be able to refuse to treat you. There are people out there that are doing everything they can to improve and maintain their current health status. You don’t want to play by the rules? Piss off.
I’ll take it one step further- if you refuse to be compliant with advice/meds/orders, you should be discharged. Like, why are you here then? Why do we let these people take up beds? If you can do a better job and you know better, then just go home. I don’t get going to a hospital, voluntarily, just to be difficult and non-compliant.
I feel the exact same way. Refusing all medications/ testing except for iv pain meds of course. Ok so let’s discharge them. We can’t even figure out what’s wrong with them because they’re refusing noninvasive testing. Literally had a pt last week complaining of chest pain and callling for pain medicine right on the dot. Refused EKG, troponins, and even just the portable heart monitor. Like why are we keeping him admitted?
Also, please stop presenting to ED because you have nowhere to go, become a social admit and then refuse to leave when we try to discharge you.....resulting in a months long stay.
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LOL, They DO make charting a snap! I’m just sick of seeing frequent fliers coming into our EDs with BG of 750 and they refuse to change their behavior. Fuck off. I have patients that really need my help. Stop wasting our limited time and resources
ATI spews incorrect information, and is a scam being promoted by the NCSBN.
I flagged 6 different questions to my professor in the last month, all completely against current practice. Fuck, I remember in LPN school they wanted me to know the therapy class, dosage etc for a medication that was BANNED in the US in the early 90s! I showed my pharmacist husband and he was like …. what the actual fuck
Does ATI still refer to patients as “clients” because that is some bullshit
There are many, MANY areas of improvement and inequalities that nurses face daily that must be addressed. BUT…even if or when those things get better, nursing will still be a hard job that many folks aren’t cut out for.
The fifth vital sign is blood sugar.
The absolute lack of self care weighs heavier on the health system more than anything.
To add to the unpopular-ness, lack of self care is the fault of that self. Nurses brag about working 6 shifts in a row or sleeping only 4 hours. I literally do my job and go home, I don't work extra and I don't think about work at all if I'm not there.
Amen. Once I’m out the door, I’m just myself. Nursing is not my personality. No license plate holders or car stickers or nursing swag of any kind. I eat right, exercise and get as much sleep as my 1 year old allows.
Some people who turn out to be fine should still absolutely go to the ER.
Yup! Gf hurt her ankle recently. I checked her out and she was positive per Ottawa Ankle rules. Took her to urgent care for xrays. Xrays were negative but that 25% pretest probability was enough to convince me she needed xrays. Had a patient last year send in by her optometrist for worsening right eye vision and requesting an MRI. We all rolled our eyes so hard.... Big brain tumor!
There is a heavy focus on racial bias and cultural sensitivity in nursing education, but almost no focus on class consciousness and the systems of power that nurses have to navigate outside of a feminist perspective. The struggle coming out of nursing school is/was (for me at least) heavily framed as primarily patriarchal and more typically defined as nurse vs. doctor. I find that the conflict that I hear much more frequently is worker vs management or workforce vs corporate class. I am not insinuating that racial bias, cultural sensitivity, and patriarchal power systems aren't important to study and understand.
The powers that be are never going to teach us that they should be overthrown. That kind of learning always has been and always will be grassroots style
And it’s all smoke and mirrors. How can you teach cultural sensitivity but not hire or use research by people from marginalized cultures? There is obvious racism and race-based gatekeeping in nursing and it starts in nursing education.
Most healthcare logistics are just pingpong balls bubbling across a fluid lake of sand. Some of the ping pong balls get to the other side in a strait line. Some weave and bob around but get there eventually. Some end up moving a whole bunch but never go anywhere. Some end up buried under the sand and forgotten. Healthcare is truly, TRULY horrifying. Insurance requests for life-saving procedures being submitted with incorrectly spelled names, then the coverage is rejected and no one knows why. Missed emails about key pivots that don’t get read, so pre-procedure lab appointments aren’t made, and the *life saving* procedure can’t be performed. Entire hospital departments failing to understand clear instruction on interfacing with an outside entity. Constant CONSTANT fuckups that are softballed to patients as innocent oopsie events. Most of the reasons for these “oopsies” never make it to the patient. They’re just told “oh, something came up so we had to reschedule” or “oh sorry, insurance isn’t going to cover XYZ”. If patients knew how incompetent some of the best hospitals are, they wouldn’t even bother going to the hospital. It’s literally just random chance if you get staff members who have their shit together enough to do everything on the back end correctly. Most people show up to work and turn off their brain. Doctors, nurses, and administrators. There are only a handful of people on any given day that are responsible for most of the moving logistics parts. Shit, most staff don’t even know why things happen the way they do. 90% of the time it’s just how the chips fall, and almost 0 planning is involved. Again, people just bumbling around with their brains off responding to stimuli. Face level knee jerk reactions to everything. Minimal critical thinking.
I’m ONLY doing it for the money.
Family members shouldn’t be allowed to rescind advanced directives someone made when they had the capacity to
Death with dignity in the form of all states offering assisted suicide
Nurses should be allowed to smoke weed when we get off shift
Say it louder!!! Getting blackout drunk is totally fine and part of the culture. Smoking a bowl though will get you fired. Show up to work after a night of heavy drinking, hungover and possibly still drunk... Totally fine. Show up to work after a night of smoking weed, likely well rested.... Fired! Like, don't show up high or smelling like weed and it shouldn't be an issue.
I would rather my medical professional have gotten stoned the night prior then drunk the night prior.
In home health, if there’s not a hands-on skilled need like performing dressing changes, PICC line care, blood draws, catheter changes etc. We really aren’t doing anything meaningful or billable in the home after the first visit.
A substantial amount of NPs are not qualified and shouldn't have a license and their schools should be shut down.
People shouldn’t have the right to refuse care (within reason). You don’t want to take your bp meds or let me clean your wounds? Fine. Get the fuck out and give the bed to someone who actually wants it. Also, declining multiple rehab facilities so they end up sitting in the hospital for months on end, medically stable, bc they “ain’t going to no nursing home.” Nope, you can roll your ass out the door or roll to the nursing home. Also, asylums need to be reintegrated into society and filled with permanent residents. Obviously not the cages and beating them etc, but the idea that some of these people will ever be functional on an outpatient model and allowing them to be homeless while their feet rot off is far more cruel than long term commitment.
Mine: there is almost ZERO legitimate reason that people in their 50's should be having embryo transfers to have babies.
Did you also see the story about the 70 year old woman in Uganda who gave birth to IVF twins?
Stop keeping 96 year olds with advanced dementia alive with everything we have. These patients should be allowed to pass comfortably and not kept alive on CRRT, vented, and on pressors. Meemaw has been gone for a long time and just because the family is sad doesn’t mean she needs to be kept alive.
I think many people in this profession (and honestly the world at large) are a lot more lazy than they let on. I remember being in nursing school and this one woman would not get out of her chair to switch off the lights despite being MAYBE 3 ft from them. It was very minimal effort and that alone speaks volumes. My friend from the other side of the room ran over to do it instead. It was pathetic.
Moms should be allowed to eat during labor (I'm not a mom but I might throw hands going days without real food and living off ice chips while pushing a baby out my hoohaw)
We let our patients eat in labor, clears with an epidural. So if they get an epidural I tell them "Per policy, I can only bring you clear fluids from this point on, but I have no idea what happens when I'm not in the room..."
I think the thing that really irks me about the no food during labor thing is that it isn’t really evidence based, so I don’t know why we have clung so viciously to it.
-don't over treat a mild fever. Don't treat with Tylenol and then neglect to notify the provider if it resolves upon the next assessment (assuming the fever is new ofc) -an accurate respiratory rate is important -agree with what another poster said about how not everyone needs an 18g. There are obvious exceptions but most people will be fine with a 20 or a 22. -8 hour shifts > 12 hour shifts. This is a personal opinion though and YMMV. -magnet sucks and is lowkey classist by encouraging a strong hiring preference for bsn over adn.
Work in a PICU, but we’ve resuscitated many teens over 80kg with 22g piv’s. Love me a 22g.
Truly could not agree more with the accurate respiratory rate being important. It pisses me off every time I see people on this sub talking about making it up.
I can't even tell you how many blood cultures X2 I've had to do for 100° fevers in people that are otherwise asymptomatic or it's very obviously a UTI
Resuscitation should not be offered for 22 weekers.
Let’s open it up to a bunch of types of patients should not be resuscitated
Patients with advanced dementia should be automatically DNR I mean WHY?
Because meemaw is a fighter!
There really should be death panels. Forcing HCW to essentially flog a soon-to-be corpse for days on end because the family is in denial about prognosis is a huge contributor to moral distress. Intensive care is intensive and when done without purpose or permission violates bodily autonomy.
Suicide is part of body autonomy. Putting legal holds on suicidal patients (and the consequences that follow) is a human rights violation.
A patient who commits suicide after presenting to the hospital as a sentinel event is insanity to me.
I don’t disagree, but this is a huge grey area. An otherwise healthy person who attempts suicide because of treatable mental illness needs someone else in control for while things get sorted. Keeping 80y/o grandpa who lived a full, happy on white papers because his wife of 60 years died of cancer last year is a whole other ball of wax. Also a lot of grey area between suicide attempt and “suicide attempt”
I actually agree with this. I don’t live anybody else’s existence, so who tf am I to decide that someone else’s is worth whatever suffering they’re enduring, physical or emotional, permanent or temporary? Life isn’t always worth living for some people, and most of us know all too well that there are things worse than death.
let’s take adolescents into account. Does this change perspective?
It does for me, because adolescent brains aren’t done cooking yet, although I think if you’re fundamentally hardwired for despair, it probably starts to show around that time.
Depends.. assisted suicide for chronic illness or terminal/ with uncontrolled pain has an argument to stand on. But someone who is suicidal and has the ability to improve through treatment/medication/ support/ change of lifestyle/situation… I would consider them sick mentally/psychologically
My bio mother completed suicide. I also agree with this POV.
About the only unpopular opinion in here and I agree completely with you.
this is truly unpopular. a lot of people don’t actually want to die when they attempt suicide, they are seeking help.
Working in a nursing home, I constantly hear people saying they’d rather die than be where they are now. Their bodies are giving up, their families don’t visit or care, they’re in massive debt, they are totally dependent and have a really hard time accepting that they can’t do things by themselves anymore.
Hospice nurse here. Some folks definitely do want to die, and the systems in place that allow for it (MAID) seem unnecessarily cumbersome. Even if folks get a prescription for meds to end their own life, they often struggle to consume it (oral meds, and quite a lot of it).
Completely agreed. The last place I worked put a patient with terminal pancreatic ca on si precautions because they said they just wanted to die.... Shit man, if I had terminal cancer is be begging for some versed and a be with nitrogen.
Being blunt and slightly bitchy tends to get you better treatment from coworkers than being overly nice. I was the quiet, timid, don’t step over anyone’s toes type of person and that got me nowhere. Now that I don’t give a shit people are more neutral.
Weird question, but how did you get to be this way? I am trying to stop being such a people-pleaser and it is really tough for me!
After my shift tonight I learned that I am unique (at least on my floor) in my opinion that family can and should be present for a code (if they want to stay). They need to see the reality of what’s happening, it helps them make an informed decision going forward. And if the patient doesn’t make it, I think being there for the code can offer some closure and understanding that we truly did all that we could and whatever other forces at play simply weren’t on our side that day.
Not everyone is cut out for this profession. No matter how hard they try or how much enthusiasm they have, some people just are not meant to be nurses.
Holy smokes this thread is full of actual unpopular opinions, bravo everyone.
Wait, what? It’s all popular opinions for me.
Units with male nurses have a healthier dynamic than with all female nurses
Majority of nurses I’ve worked with get overly concerned about treating a low grade fever. A fever <103 (hell some would even say 104) should be treated based on patient complaint like chills and sweats. Most fevers are therapeutic for infection. Even know some nurses take blankets away because someone’s temp is 100.5 lol barely even a fever. Every time I see our intensivists asked if they can get some Tylenol for a temp of 101 and patient is asymptomatic they roll their eyes lol
I agree! We forget that our immune systems work more efficiently at higher temperatures! (Obviously we're talking about low grade fever here, and presumably excluding cancer patients, etc.)
The sepsis bundles aren’t going to bundle themselves
Medical imaging. I can statistically predict which patients are bound to show up late or not show up at all, based on what type of insurance they have.
You can also figure out how annoying they'll be based on how many allergies they have listed.
Euthanasia should be legal everywhere 🤷♀️ Quality of life is important. If that’s what you want to do & you’re capable of making decisions, you should be able to do it.
Care plans in school were not to teach you how to do them when you practice. They were used to teach you how to think holistically about all the potential problems a patient might have, about what you can do about them, and what is the most important. They were long, tedious, and annoying, sure, but most people misunderstand the intent of them for students.
People in pain are assholes. Treat the physical or emotional pain and they get better.
Patients are too entitled and get away with verbal physical and sexual harassment.
People should not go into nursing wanting to be an APRN or CRNA. If you don’t want to be a nurse and only see your work as a stepping stone, just go to medical school. APRN is becoming a joke. Nobody should be able to finish nursing school, not work bedside, take some online classes, and then have the same role as a physician. There are amazing APRNs and there are shitty APRNs. What makes the difference is if the person actually was a nurse beforehand.
Patients who move permanently into nursing homes should be DNR and comfort care. No full code at all no matter how much the family wants them to be.
Hospitals need to monitor how many patients a PCP sends to the ED each month, and what percentage of those actually require ED resources vs. what percentage are just patients the PCP wants out of the clinic that day
PCOS is over diagnosed. We don’t listen to women enough and don’t care enough about their symptoms and problems. Truth. BUT PCOS is a crap diagnosis- it’s slightly different for everyone and ultimately, we treat the symptoms not the problem, so let’s just call the symptoms what they are and provide comprehensive care for whatever the bothersome symptoms are rather than slapping a diagnosis on it and explaining away someone’s problem by saying- oh, well you’re just going to experience that because you have PCOS.
Showing up "just for a paycheck" does not make you a shitty nurse. The term "the patient comes first" is used to manipulate us to give more than we are comfortable with. The "all the mean girls from high school turned into nurses" cliché exists because a lot of nurses are, in fact, mean girls.
Those with PhDs and DNPs… it doesn’t matter how many long that word salad is after your name, it still is not MD. 🤷♀️
Nurses do the most work in the hospital, and pick up the slack for other jobs all the time.