u/No_Sky_1829

This is not an earth-shattering situation by any means but I'm quite literal and obviously try to follow the guidelines so this confused me. TLDR: was I wrong to insist on doing obs for a patient as per their clinical review status, despite the doctor telling me not to?

At my hospital we have a 4 tier clinical review system. Tier 1 is full resus. Tier 4 is palliation so we don't do obs, generally treatment has been ceased unless it's for comfort. Tier 3 requires us to do obs and call for clinical review if concerned.

Last week I had a patient who was transitioning to palliation but being discharged home. The doctors had written "not for obs unless concerned" in the notes but left the patient on tier 3 clinical review. This particular patient was tachycardic 110 so previous nurses were doing obs once per shift and I had messaged the intern about the HR. Patient was also T2DM with orals and sliding scale, so we were checking BGL TDS and giving sliding scale. Adding he also had a new positive MCS with foul smelling urine via IDC and no treatment documented (which was commenced when I questioned it)

The doctors rounded and the senior doctor told me off in front of her team for doing obs. I responded that they are tier 3 and it says there *-points to screen-* to call for review. "Only if you are concerned" I was told. Well they are tachycardic, so I was concerned. I was told "look at the overall clinical picture" so I said "can you write a note to say you are not concerned about the heart rate" and I was told not to "chase the numbers". That just really annoyed me so I clamped my mouth shut to stop myself saying "so is it just the vibe of the thing?" ala The Castle 😂😂

Like, I just don't get it. How am I supposed to know I'm concerned if I don't do obs? Do I just go with "Well he feels a bit warm, is breathing a bit fast, seems to be uncomfortable, seems very VERY sleepy"?? There are guidelines there telling me to escalate for XYZ parameter, the patient has some QOL and was not terminal. I spoke to the NIC and we continued doing TDS obs as per ward policy, and I documented that in my notes. WWYD?

I'm a nurse and I haven't done night shift in 3 years, I was diagnosed with ADHD 18mth ago. I'm thinking of going back to some night shift and I have questions!

\- How do you manage your medications around night shift?

\- How do you manage your sleep schedule?

\- Do you remember if it was easier to cope with nights after you were diagnosed and medicated?

\- Any other insights, tips, tricks you care to share?

I'm a nurse and I haven't done night shift in 3 years, I was diagnosed with ADHD 18mth ago. I'm thinking of going back to some night shift and I have questions!

- How do you manage your medications around night shift?

- How do you manage your sleep schedule?

- Do you remember if it was easier to cope with nights after you were diagnosed and medicated?

- Any other insights, tips, tricks you care to share?

Inspired by a post on an American sub, where taking meds for personal use was a fireable offence 😯 Add: it's been on my mind lately because a colleague asked me for advice about antibiotics for a UTI. I think she was planning to take some from work. My concern was that she should get proper medical advice. I didn't consider that it might be a sackable offence and I would never ever cause someone to lose their job over doing something like that.

What's your workplace policy or culture around nurses taking meds at work? If you have a headache can you take a Panadol from the drug room? If you accidentally take a card of Melatonin home would anyone notice? Would you be fired if you were rumbled taking a non-controlled drug from the med room?

I've seen different policies in different workplaces. One place, we had a staff med box and we had to get even a Panadol signed out of it. On the same ward there was NEVER stock of Melatonin, they vanished as soon as the med room was restocked and it wasn't the patients lol. I've occasionally come home with Ondansetron or Panadol in my pocket, not deliberately, I just stashed a PRN as I was running around liked a blue bottle fly.

What's your stories?

I've looked at the EBA (I'm in VIC) but I can't tell if that means any extra pay. All I can see is "missed meal break".

It was the morning tea break and I was stuck in imaging with a patient for aaaages (had to stay with them for reasons). The in-charge gave me an overtime sheet to fill in but I'm not sure what if anything is due.

Can anyone tell me? I'm sure it's not much anyway but I'm just curious.

Typo : proud moments 🫣

I came home from work today feeling my super powers. I looked after a patient 1:1 who has been super aggressive to staff in their 3 week admission. Security called several times every day. Spitting, punching, throwing things. Verbal aggression & threats. The whole family is super irrational and egging the patient on. Home life must be absolute chaos. It's been escalated to the TOP-top levels of consultants & execs in my major metro hospital, who are about to legally take away the decision making capacity. Patient is in 4 point restraints and furious about it.

And baby they were like a lamb for me. Not at first, I copped my share of verbal abuse and threats of violence. But I was just calm and rational and by halfway through the shift they just basically went "ok I'll behave". I was able to give all the care they needed and we chatted for about 2 hours about their life (born into a biker gang, so have never known anything but violence and crime). Was able to release some of the restraints, take off my face shield and gown, and it actually ended up being a really interesting evening.

And I'm just really proud of myself for being able to turn them around like that. Who knows how quickly it went downhill after I left but for those few hours the room was calm and that miserable angry person had what was probably a rare taste of normality.

Now I want to hear your stories of what you did that made you feel your nursing super power 🙏🙏

I can't seem to find a good jacket that fits my Cairn. He's a long boy, neck to base of tail is 50cm and his chest girth is also 50cm. We're coming into winter here so I'm looking for something a bit warm and light waterproofing

Every coat I have tried is

- fits his chest but too long in the body

- fits his body but too big in the chest

Any recommendations?

I've worn out yet another pair of shoes. Please no suggestions for lightweight sneakers, they just don't work for me. I have wide feet and chronic foot pain so I have to buy carefully

I've work out 3 pairs of Hoka and 2 pairs of Algeria Kelli

I'll get another pair of Hokas unless someone has another suggestion? After 3 pairs in a bit sick of them plus the soles squeak on the floors of the ward 😳🫣

It made me smile 😁

https://www.facebook.com/share/r/1E686DUJMa/

Am I the only one that finds the nursing workflow in this (admittedly very complex) software very effing poor.

I have to look in soooo many screens to find the information I need. If I don't look on care compass or in orders I don't see the pathology orders. It's impossible to find unusual assessments like PVR, visual acuity etc. If I don't scroll right down to the bottom of the med chart I don't see the IV orders that were charted mid shift. We got a screen a while ago that attempts to pull together a nursing workflow but it's rarely up to date. We can order eg vital frequency first patients but I had a patient today who was two days post-op with half hourly obs still ordered.

I've just come from a messy shift and 50% of the messiness comess from trying to find the bloody information I want. I'm so frustrated with it

/end rant

It's there any point in doing a graduate certificate in an area if you don't actually work in the area? I'd like to move into an area that gives more regular day time hours (radiology, endoscopy, dialysis). Is working towards a qualification enough to get you a role in that area?

What are the core must-have things you put on your planner?

I'm not a student but I do have ADHD. I try to do a good planner but I always seem to miss something 😩

I hope this link works. I'll revise if not

https://www.facebook.com/share/v/1BBko4BSsL/

Is it a thing any more that they have a small fleet for nurses to use? All the community nursing roles I see advertised at the moment state something like "must have reliable vehicle" or "access to own car"

I used to see Bolton Clarke & RDNS cars zipping around. Are they a thing of the past?

Who is your number 2? All us folks have such excellent taste in music, it makes me curious to see the next band or artist on the list 😄