Women always want to know "where this is going". Most men want to play it by ear and just "see where time will take us". That is where the disconnect lies that women miss and simply can not comprehend.
This post is not health care related but a topic of discussion over this past weekend. It's more about relationships and how women could potentially ruin something good they have going on.
Many women even if they are financially stable and capable of buying expensive things for themselves still expect expensive gifts and trips from their significant other. This is especially embarrassing when the woman does NOT buy this stuff for herself but the expectation is others should buy it for her. I am specifically talking about the dating phase of relationships. Women start to become more demanding the longer the relationship goes on and start to feel more comfortable verbalizing how they truly feel about situations.
In my personal opinion I believe women should NEVER expect and especially never ask for expensive things regardless of the occasion (birthday, anniversary, Christmas, I don't care). If a man wants to buy you something expensive he will. The price of a gift is not equivalent to how much he cares about you. Many women just want these expensive things to be able to tell their friends and family that their boy friend bought whatever the item is for them. It's a showing off type of thing and it's really stupid.
Men don't like being told what to do. They like to feel like they came up with the idea themselves. Pressuring him to buy you something expensive for your birthday or an anniversary is probably going to make him not even want to do it or maybe he will do it BUT, only to spare himelf the drama that would come out of it if he did not purchase the item you wanted. It's really a lose lose situation. You may not get the gift you wanted but you will get the gift HE wanted to get for you or you may get the gift you wanted but for the wrong reasons. The same goes for pressuring him or giving him a ultimatum to propose to you. Why?! Why are you forcing a man to give you a ring?! If you tell him something like, "if we are not engaged by the end of the year this is over" and he proposes on new years eve, do you think he REALLY wanted to get you a ring and marry you at this point in his life?! Wouldn't you rather him do it on his own! No pressure. No ultimatum. Because HE WANTED to do it. Because he WANTS to marry you! Just because your girl friends, grandma, mom, dad, whomever is feeding you crap talking about, "you guys have been dating for 5 years and you don't have a ring". There is a reason for that. Giving an ultimatum is not the right way of going about this situation.
If you want to know why you don't have a ring maybe you just need to revisit the marriage talk with your boyfriend and see where his mind is at. Or even better have you even had the marriage talk? Have you been dating this guy for 5 years and not talked about marriage? Does he even foresee himself getting married? If so you need to know what he wants to accomplish before making that step in his life because often men want to accomplish a set of things before getting married, whatever they may be. If not...you just wasted 5 years of your life not having this conversation from the get go.
Furthermore, women also love to tell their boy friends how to spend their money. STOP THIS. Men hate this!! It's their money. They worked for it. They earned it. So they will spend it however they like. I understand to those women that are truly concerned, they don't want their boy friend going into debt and ruining their credit but, men have to learn these things on their own. They become resentful when you poke your nose into their financial business. If he wants to blow $500 on drinks at a bar on Sunday watching football with the boys, LET HIM. I guarantee he will appreciate it more than you scolding him about it. No man wants another mom. Stop acting like his mother.
Another HUGE mistake women make is when they start dating a guy and start to feel like he is "the one" or "oneitis" as I like to call it they drop everything and everyone and put all their eggs in one basket! They revolve their entire life around this guy. Spending all their free time with him and him only. I don't care how amazing this guy is, don't drop all your hobbies and friends for him. He is not going to do that for you! And the worst part is, if you guys break up, that is when you realize that you have no friends to hang out with and you have no extra curricular activities to do because your life revolved around this guy. Meanwhile, he will be out at the bar with his boys having a drink (or drinks) THAT NIGHT probably hitting on the hot chick sitting next him because he is in survival mode.
Ladies, please. Don't do this. It is pathetic. Great you found an amazing guy! Work him into your schedule. It's OK if you can't meet up with him every time there is a chance. If he likes you he will want to see you whenever it works for the both you. Just think about it. Many women will cancel plans they might have had all week with their girlfriends if this new guy all of a sudden wants to hang out at the same time you originally had plans just so you can see him. Now, if the tables were turned most men if they had plans all week to spend friday night at poker night with the boys watching basketball you better believe that he's not going to cancel his plans just to see you. What he might do is tell you he will come by to see you AFTER if you are free. You see the difference? You don't have to always be available. Men don't want to feel like they are your only source of entertainment. They term it "clingy". Both men and women don't like "clingy". Steer clear of that title because he will surely run just like you would if the situation was flipped.
I tend to be a little on the aloof side for a woman. That is why it is hard for me to understand this type of behavior from women. Trust is key. Don't mother your man. It kills the romance. Keep your interests and your friends. Don't be demanding. For God's sake leave his phone alone! Lastly, if you're dating him only to show off, you're in it for the wrong reasons.
I really would like to hear your opinions/thoughts/comments on this subject. If you agree or disagree. Please feel free to comment!
Until next time
-Norah
Sunday, September 29, 2013
Sunday, September 22, 2013
Don't just negotiate salary: know your worth.
Many of us are applying for jobs whether it is because you hate your current job and want out, you want to move up, you are relocating, have been laid off, or you just graduated and are entering the professional world for the first time. Every one of you has something special to bring to the table. When applying for jobs you need to know from the start what your salary limit is. What I mean by salary limit is how low are you willing to go in terms of getting paid. There is no point in applying for a job wasting YOUR time and THEIR time if they are not going to pay you the minimum you expect to be getting paid.
Of course negotiating pay is for those with experience. If you are just starting your professional career your focus should be on which company is going to build the strongest foundation for you so that later on when you do have experience/expertise you have opened many doors for yourself to move up and out into another competitive big name company and make those big bucks. My BEST advice for you and anyone that does not have professional experience or is a novice to the field you are applying to if you have two job offers and one pays 60 grand and the other 45 grand but the 60 grand company is a small name company and the 45 grand company is a big name company GO FOR THE 45 GRAND option! Trust me! The pay off will be greater in the future! Focus on building your resume! Many people make this mistake because they are focused on instant gratification. They want the money and they want it now! It's a big mistake. Truly.
Now back to my experienced folks going for that next job. You have experience. KNOW YOUR WORTH. You need to be prepared. DO YOUR HOMEWORK!!! I can't stress this enough. Do you know the percentage of how many people actually negotiate salary when they receive a job offer? Not very high! It's about 35% and ladies we are the worst statistically! Main thing you need to do as the interviewee is do your homework. Get on the internet and research about your company find out how much people are making in positions similar to you. How much is the average pay in general for the position you are interviewing for not just in your company but in the job market. Research HOW TO NEGOTIATE salary if you are not a good negotiator or not sure what to say!! Make an outline. Have it ready for when you possibly get that phone call so you don't forget why you are so great that you deserve more than they are offering you! Most employers are offering you less than they can afford to give you from the get go because they are expecting you will negotiate salary. They have already created a cushion for themselves. Yes, they are clever. So it's money you just lost by not asking! The worst they can say is no. It's NOT a big deal. They want YOU. That is why they are calling and offering YOU the position and not the others. Get the thoughts out of your head of: "I don't want to be demanding", "thousands of people applied for this job", "I'm sure there are others that would take this position for the salary they are offering" ect. Those are irrelevant at this point. You were recruited for a reason! You have expertise that others cannot bring to the table! This is your time to brag! So speak up! Tell this HR rep how amazing you are and what you are going to bring to this company and why you should be paid more. THEY ARE EXPECTING YOU WILL NEGOTIATE. They are already prepared, don't miss your opportunity!! I can't stress it enough. Be prepared!
Ok, so you did your thing and told them how great you are and what you will bring to the table and they will not budge on salary. This is not when you give up and just accept the job. There are PLENTY of things you can negotiate and SHOULD negotiate such as: benefits (effect date? most companies start 30 days after hire date. Negotiate for start ON start day), sign on bonuses, relocation assistance, bonuses (yearly), severance (not for everyone), education allowance, professional development money, opportunities for advancement, technical support (if you need to learn new computer programs ect.), work schedule, and your start date. Nurses, this is especially important for us because the majority of hospitals are unionized so our pay is fixed by years of experience. This is when the other factors come into play. Negotiate away and don't forget to mention all your certifications!
Now, you have got this amazing job. You negotiated your salary amongst other things on the list and now you are 5 years into your job and you find out the Sarah your coworker who has the same education and experience as you is getting paid significantly higher than you. You have a problem with that and want to approach your manager about it. Research suggests the BEST WAY of handling this situation is NOT to go to your manager and say, "I found out from Sarah that I am making X amount less than she is and thats not fair". Let me tell you something if you didn't know already. THE WORLD IS NOT FAIR. That argument is invalid and it will put your manager in defense mode and more than likely work against you than for you. There are many reasons that Sarah maybe getting paid more than you such as: maybe Sarah negotiated pay and you didn't or maybe you got a sign on bonus and Sarah did not. These are just examples. The best way to approach this issue is to go to your manager and talk about how you feel that you work very hard and that you excel in your field (listing examples of course) and you feel that your pay is not up to market value (of course you should know your market value!). This tends to result in better outcomes. I can't promise it will result in a salary change but research suggests this is the best way to do it for those who have been successful in getting a raise.
Many people are uncomfortable negotiating salary or money in general. The philosophy is "I should just be happy I got offered the position". Well ya, you should be happy but, you should also know your worth. You have been selected for a reason and you deserve to defend that and ask for what you are worth. This is not a taboo. Employers are expecting you to negotiate. If you don't, they win; and statistically they do win, approximately 65% of the time. So go out there! Get that job! Most importantly, know your worth!
A good book to read for my readers out there:
"Getting to Yes" by Robert Fisher and William Ury
Some helpful links:
http://www.gse.harvard.edu/about/administration/careers/documents/SalaryNegotiation.pdf
http://www.forbes.com/sites/susanadams/2013/08/05/negotiating-your-salary-in-a-difficult-economy/
http://www.businessinsider.com/harvard-professor-gives-tips-on-negotiating-2013-8
Happy job hunting!
Until next time.
-Norah
Of course negotiating pay is for those with experience. If you are just starting your professional career your focus should be on which company is going to build the strongest foundation for you so that later on when you do have experience/expertise you have opened many doors for yourself to move up and out into another competitive big name company and make those big bucks. My BEST advice for you and anyone that does not have professional experience or is a novice to the field you are applying to if you have two job offers and one pays 60 grand and the other 45 grand but the 60 grand company is a small name company and the 45 grand company is a big name company GO FOR THE 45 GRAND option! Trust me! The pay off will be greater in the future! Focus on building your resume! Many people make this mistake because they are focused on instant gratification. They want the money and they want it now! It's a big mistake. Truly.
Now back to my experienced folks going for that next job. You have experience. KNOW YOUR WORTH. You need to be prepared. DO YOUR HOMEWORK!!! I can't stress this enough. Do you know the percentage of how many people actually negotiate salary when they receive a job offer? Not very high! It's about 35% and ladies we are the worst statistically! Main thing you need to do as the interviewee is do your homework. Get on the internet and research about your company find out how much people are making in positions similar to you. How much is the average pay in general for the position you are interviewing for not just in your company but in the job market. Research HOW TO NEGOTIATE salary if you are not a good negotiator or not sure what to say!! Make an outline. Have it ready for when you possibly get that phone call so you don't forget why you are so great that you deserve more than they are offering you! Most employers are offering you less than they can afford to give you from the get go because they are expecting you will negotiate salary. They have already created a cushion for themselves. Yes, they are clever. So it's money you just lost by not asking! The worst they can say is no. It's NOT a big deal. They want YOU. That is why they are calling and offering YOU the position and not the others. Get the thoughts out of your head of: "I don't want to be demanding", "thousands of people applied for this job", "I'm sure there are others that would take this position for the salary they are offering" ect. Those are irrelevant at this point. You were recruited for a reason! You have expertise that others cannot bring to the table! This is your time to brag! So speak up! Tell this HR rep how amazing you are and what you are going to bring to this company and why you should be paid more. THEY ARE EXPECTING YOU WILL NEGOTIATE. They are already prepared, don't miss your opportunity!! I can't stress it enough. Be prepared!
Ok, so you did your thing and told them how great you are and what you will bring to the table and they will not budge on salary. This is not when you give up and just accept the job. There are PLENTY of things you can negotiate and SHOULD negotiate such as: benefits (effect date? most companies start 30 days after hire date. Negotiate for start ON start day), sign on bonuses, relocation assistance, bonuses (yearly), severance (not for everyone), education allowance, professional development money, opportunities for advancement, technical support (if you need to learn new computer programs ect.), work schedule, and your start date. Nurses, this is especially important for us because the majority of hospitals are unionized so our pay is fixed by years of experience. This is when the other factors come into play. Negotiate away and don't forget to mention all your certifications!
Now, you have got this amazing job. You negotiated your salary amongst other things on the list and now you are 5 years into your job and you find out the Sarah your coworker who has the same education and experience as you is getting paid significantly higher than you. You have a problem with that and want to approach your manager about it. Research suggests the BEST WAY of handling this situation is NOT to go to your manager and say, "I found out from Sarah that I am making X amount less than she is and thats not fair". Let me tell you something if you didn't know already. THE WORLD IS NOT FAIR. That argument is invalid and it will put your manager in defense mode and more than likely work against you than for you. There are many reasons that Sarah maybe getting paid more than you such as: maybe Sarah negotiated pay and you didn't or maybe you got a sign on bonus and Sarah did not. These are just examples. The best way to approach this issue is to go to your manager and talk about how you feel that you work very hard and that you excel in your field (listing examples of course) and you feel that your pay is not up to market value (of course you should know your market value!). This tends to result in better outcomes. I can't promise it will result in a salary change but research suggests this is the best way to do it for those who have been successful in getting a raise.
Many people are uncomfortable negotiating salary or money in general. The philosophy is "I should just be happy I got offered the position". Well ya, you should be happy but, you should also know your worth. You have been selected for a reason and you deserve to defend that and ask for what you are worth. This is not a taboo. Employers are expecting you to negotiate. If you don't, they win; and statistically they do win, approximately 65% of the time. So go out there! Get that job! Most importantly, know your worth!
A good book to read for my readers out there:
"Getting to Yes" by Robert Fisher and William Ury
Some helpful links:
http://www.gse.harvard.edu/about/administration/careers/documents/SalaryNegotiation.pdf
http://www.forbes.com/sites/susanadams/2013/08/05/negotiating-your-salary-in-a-difficult-economy/
http://www.businessinsider.com/harvard-professor-gives-tips-on-negotiating-2013-8
Happy job hunting!
Until next time.
-Norah
Sunday, September 15, 2013
You inspire me...
Many people join the healthcare field because they want to make a difference. They want to "help" people. They want to make some sort of impact on peoples lives. Often I believe we do. More than we think. People just don't know how to explain their gratitude for something like that because it is very emotional for them. However, more often than not I believe my patients inspire me more and affect me more than I could ever affect them.
I had two patients today that inspired me to a point that they made me emotional when I would go in their rooms. It wasn't anything they said to me specifically about myself or the care I've given them. It was simply them just being who they are. Both patients in fairly bleak situations. One in for kidney transplant rejection back at square one with end stage renal disease doing dialysis and the other with ovarian cancer that metastasized.
Both of these patients were in such high spirits. SO incredibly sweet. Smiling. Happy. As if they just gave birth to their first child and nothing could be better. I know very well that this is a coping mechanism and eventually there will come a day that they finally cry or get sad but their personalities won't let them dwell too long in self pity. They have the personalities of enjoying the moment while it lasts because tomorrow is not promised. So instead of crying the day away in self pity regarding their diagnosis they are chipper. Thankful. Welcoming. I can't put into words how it affected me today.
Especially the patient with ovarian cancer. Every time I went into the room the patient was SO sweet. Always smiling. Positive. Thankful. It was so inspiring. Especially when we live in a world that is becoming more and more selfish. A me me me type world. It is so exquisitely refreshing to come in contact with people like these patients I had today. They don't use their illness or diagnoses as an excuse. They don't use it as a crutch. They don't use it as an excuse to have a nasty attitude to their families, friends, health care team, ect. It's amazing.
People like this make me want to give them the world and I would if I could. I could tell these patients are great people in general because their rooms were packed to the brim all day long with visitors. People they had not seen in years coming to visit. What that tells me is that these patients have touched a lot of people in good ways. Regardless of what it was it was enough to make an impact for them to be concerned about the patient being in the hospital.
They made me think about how that is my goal in life. To touch people in a positive way. Make a difference and be remembered in a positive light. It doesn't matter what it is whether it was helping someone write their resume, get a job, holding a door open, going with them to a doctors appointment, being there to listen when they were going through a hard time, partying with them on an important occasion, setting them up on a blind date that they end up marrying, whatever...it could be anything. It's just the goal of making a positive impact on anyone I come in contact with even if it's just a smile.
I'll go out of my way for someone I have just met.That is just me. I don't expect anything in return nor do I want anything in return. If I help you do something, get something, achieve something I am sincerely doing it because I WANT to. I don't want credit for it. I don't want you to pay me back in any fashion. I am just happy that you're happy and that I could help.
I am incredibly delighted I had the privilege to care for these two patients today. They have impacted me in so many ways and they don't even know it. That is the greatest pleasure of service professions. Often our patients impact us on a deeper level than we impact them. How do you thank someone for that? It's too emotional to even say or write out. I wouldn't even know where to begin...all I know is,
thank you would be a prodigious understatement.
I am eternally grateful.
Until next time.
-Norah
Thursday, September 12, 2013
A lesson on ethics: you have the right to refuse!
Many people that become hospitalized and become a patient feel like they have lost control of their life. Everyone is doing everything for them including making decisions without consenting the patient. New medications, lab draws, starting an IV, placing a urinary catheter, lifting your gown up exposing your body etc. It's just wrong.
I always empower my patients to speak up! Especially to doctors. Patients all of a sudden become mute when the doctor walks in. Especially in teaching hospitals with it's a whole pack of doctors that come in and are all talking to each other while poking and prodding at the patient not even acknowledging them as a human being lying in that bed. I always tell my patients, "bring that up to your doctor when they come in", "tell them you are still in pain", "tell them that you want that tube out today not tomorrow".
What happens is the doctors especially forget that what is medically the right thing to do doesn't always coincide with what the patient wants. In this situation as healthcare providers our job is to EDUCATE the patient on the benefits/risks of doing or not doing what is medically advised in a given situation. It is then the patients choice whether they want to do what is advised or not. Patients have a bill of rights. On that bill of rights one of them is PATIENTS HAVE THE RIGHT TO REFUSE. Let me say that one more time, patients-have-the-right-to-refuse. As a healthcare provider whether you agree or not you need to respect the patients wishes. You did your best. You did your job by educating and advising the patient that their decision is not what you recommend based on your expertise and knowledge and leave it at that. Sometimes it really is just a power game and it's sad and infuriating to me as a nurse.
I was observing a situation today where there was a young patient in her mid twenties who just had a kidney transplant. It is standard for a kidney transplant patients to come out of the operating room (OR) with a urinary catheter (foley). This is a usually a silicone tube that is placed through the urethra into the bladder and secured by inflating a 6-10 ml ballon at the tip of the catheter inside the bladder so it does not slip out. The purpose is to drain urine into a bag so that we as healthcare providers can have a precise count of urine output for this patient as it is an indicator for how well the new kidney is doing after being transplanted.
Sounds very important right? It is. However, this patient since she arrived on the floor at about noon was in hysterics over this catheter. It was causing her to have bladder spasms that were sending her flying through the ceiling. She was not even my patient but she caught my attention because I had the 2 patients in the rooms on either side of her room. Inherently I went in out of concern thinking no one had attended to her pain. I find out what is going on and speak with the nurse taking care of her. She told me the MD was already aware. I looked at her puzzled and asked her what the MD was doing about it and she told me they tried to manipulate the catheter but the patient freaked out and would not let them touch it because it hurt so bad. Sometimes depending on where the catheter is sitting in the bladder it can cause spasms, so simply manipulating it can fix the problem. In this case the patient could not tolerate even the slightest of movement of the catheter. I stepped out of the situation because she was not my patient and did not want to get involved. About 2 hours later I hear her screaming. I couldn't help but think to myself, "what the fuck is going on?!?!?!" I walked out of my patient's room next door to the patient's room that is screaming bloody murder and I see the nurse caring for her again and ask, "what is going on?!" At this point I am seriously concerned. The nurse tells me that the doctor ordered for a muscle spasm relaxer called ditropan and she already had a dilaudid PCA and was also going to be given Vicodin. So I am thinking ok that should do that trick hopefully. Wrong. Another 2 hours pass and it is now almost 5 in the evening and I am just returning from my break; as I am walking passed this patient's room I see her standing at the edge of the bed doubled down holding on to her belly just crying and pleading to please take out the catheter. At this point I am seriously boiling because I just do not understand why the doctors have not pulled the damn catheter out!!! The patient is not even asking she is demanding that the catheter be taken out and they just keep "educating" her on why they need to leave it in completely disregarding that she is in extreme discomfort. All the education in the world will not solve the pain issue!
This is crazy!! Is what I was thinking to myself. She has the right to refuse care! If she does not want the catheter and she is COMPLETELY oriented and knows what the hell is going on she has every right to get it taken out. It doesn't matter if you want precise urine outputs. There are different methods to get precise urine output. The patient can walk she can use the bathroom and pee into a hat. The urine can still be measured. The doctors already maxed out all alternatives by trying different drugs and asking her to relax and take deep breaths. If a lawyer got involved in this case the doctors & nurses and everyone directly involved in this patient's care would horribly lose. All it would take is the patients bill of rights and the argument that the urine could still be precisely measured without a foley. To say the least, I was livid. If that was my family member I would have gone up the chain of command. If that was my patient I would have advised them to do that as well.
The argument the doctors and the clinical nurse specialist all had was "she is exaggerating". IT DOESN'T MATTER. You have to take everything for face value in terms of pain in the hospital. How do we know 100% she is exaggerating! WHAT IF there truly is a serious problem?! What happens if there becomes a complication and for the passed 7 hours everyone did nothing about it because they felt that she was over reacting. My question was WHY can't we pull the foley catheter out and give her 6 hours to pee on her own like we do with everyone else and follow what the RESEARCH suggests and if she doesn't we bladder scan her. If she is over 300 mls of urine in her bladder the foley has to go back in?! What is the problem? I don't get it?!
This situation boiled down to a power struggle where doctors and specialists were completely tunnel visioned. Only thinking about how they need to get a precise urine output and not thinking about the human being involved. Essentially what they were saying to this patient with their actions was we doing care if you sit here writhing in pain with this catheter in because we care more out the urine output that your comfort.
If I were a lawyer on this case I would hang these people with their words because ethically this situation was wrong on SO many levels. I left work frustrated, upset, and sickened by this situation. I just can not believe it.
As a nurse it is MY job to advocate for my patients. I feel MANY nurses are too scared to speak up and push back at the MDs when they are simply being irrational. Just think about it if that was you or your loved one in that situation. Would you just go with the flow? Agree to everything the MD wants to do? As a COMPETENT nurse it is your JOB to suggest better ways to handle the situation if the MDs way of doing it isn't working. YOU are the one with the patient for 12+ hours. YOU know the patient better than anyone. YOU have to deal with all the bs. Speak up!! Often as nurses we get a gut instinct that something is wrong. In this situation even though the patient was not my patient I just felt like something was horribly wrong here and everyone was just blowing it off.
The most important thing to remember as a patient and a healthcare provider is the patient has the right to refuse! We cannot force or impose a treatment on a fully alert and oriented patient. Even in the "confused" patients situation it can be a sticky situation to force treatment on them if they are refusing. Have good judgement. Think to yourself, "if I was put up on the podium in a court of law to explain my actions in this situation would they be valid?", "what does the research say?", "what are the patient's rights in this situation?", "could I possibly lose my license over this situation?". Remember, the court is going to judge you on the five areas of ethical standards as defined by the nurse practice act: nonmaleficence (do no harm), beneficence (keeping the PATIENT'S welfare as the primary goal of care. Promoting good and preventing/removing harm ), autonomy (the law of oneself/self determination/having moral responsibility for your actions and understanding patients right to autonomy/respecting it), justice (what is morally/legally right), and privacy/confidentiality which are self explanatory.
Don't forget the reason why you chose to be in healthcare. If the reason was for money, prestige, or because your family told so...you are probably the person not speaking up and not realizing what the patient perceives is best for them may not meet eye to eye with what YOU perceive is right for them and that is where the problem lies.
If learn how to balance that and understand it you are golden.
Until next time.
-Norah
I always empower my patients to speak up! Especially to doctors. Patients all of a sudden become mute when the doctor walks in. Especially in teaching hospitals with it's a whole pack of doctors that come in and are all talking to each other while poking and prodding at the patient not even acknowledging them as a human being lying in that bed. I always tell my patients, "bring that up to your doctor when they come in", "tell them you are still in pain", "tell them that you want that tube out today not tomorrow".
What happens is the doctors especially forget that what is medically the right thing to do doesn't always coincide with what the patient wants. In this situation as healthcare providers our job is to EDUCATE the patient on the benefits/risks of doing or not doing what is medically advised in a given situation. It is then the patients choice whether they want to do what is advised or not. Patients have a bill of rights. On that bill of rights one of them is PATIENTS HAVE THE RIGHT TO REFUSE. Let me say that one more time, patients-have-the-right-to-refuse. As a healthcare provider whether you agree or not you need to respect the patients wishes. You did your best. You did your job by educating and advising the patient that their decision is not what you recommend based on your expertise and knowledge and leave it at that. Sometimes it really is just a power game and it's sad and infuriating to me as a nurse.
I was observing a situation today where there was a young patient in her mid twenties who just had a kidney transplant. It is standard for a kidney transplant patients to come out of the operating room (OR) with a urinary catheter (foley). This is a usually a silicone tube that is placed through the urethra into the bladder and secured by inflating a 6-10 ml ballon at the tip of the catheter inside the bladder so it does not slip out. The purpose is to drain urine into a bag so that we as healthcare providers can have a precise count of urine output for this patient as it is an indicator for how well the new kidney is doing after being transplanted.
Sounds very important right? It is. However, this patient since she arrived on the floor at about noon was in hysterics over this catheter. It was causing her to have bladder spasms that were sending her flying through the ceiling. She was not even my patient but she caught my attention because I had the 2 patients in the rooms on either side of her room. Inherently I went in out of concern thinking no one had attended to her pain. I find out what is going on and speak with the nurse taking care of her. She told me the MD was already aware. I looked at her puzzled and asked her what the MD was doing about it and she told me they tried to manipulate the catheter but the patient freaked out and would not let them touch it because it hurt so bad. Sometimes depending on where the catheter is sitting in the bladder it can cause spasms, so simply manipulating it can fix the problem. In this case the patient could not tolerate even the slightest of movement of the catheter. I stepped out of the situation because she was not my patient and did not want to get involved. About 2 hours later I hear her screaming. I couldn't help but think to myself, "what the fuck is going on?!?!?!" I walked out of my patient's room next door to the patient's room that is screaming bloody murder and I see the nurse caring for her again and ask, "what is going on?!" At this point I am seriously concerned. The nurse tells me that the doctor ordered for a muscle spasm relaxer called ditropan and she already had a dilaudid PCA and was also going to be given Vicodin. So I am thinking ok that should do that trick hopefully. Wrong. Another 2 hours pass and it is now almost 5 in the evening and I am just returning from my break; as I am walking passed this patient's room I see her standing at the edge of the bed doubled down holding on to her belly just crying and pleading to please take out the catheter. At this point I am seriously boiling because I just do not understand why the doctors have not pulled the damn catheter out!!! The patient is not even asking she is demanding that the catheter be taken out and they just keep "educating" her on why they need to leave it in completely disregarding that she is in extreme discomfort. All the education in the world will not solve the pain issue!
This is crazy!! Is what I was thinking to myself. She has the right to refuse care! If she does not want the catheter and she is COMPLETELY oriented and knows what the hell is going on she has every right to get it taken out. It doesn't matter if you want precise urine outputs. There are different methods to get precise urine output. The patient can walk she can use the bathroom and pee into a hat. The urine can still be measured. The doctors already maxed out all alternatives by trying different drugs and asking her to relax and take deep breaths. If a lawyer got involved in this case the doctors & nurses and everyone directly involved in this patient's care would horribly lose. All it would take is the patients bill of rights and the argument that the urine could still be precisely measured without a foley. To say the least, I was livid. If that was my family member I would have gone up the chain of command. If that was my patient I would have advised them to do that as well.
The argument the doctors and the clinical nurse specialist all had was "she is exaggerating". IT DOESN'T MATTER. You have to take everything for face value in terms of pain in the hospital. How do we know 100% she is exaggerating! WHAT IF there truly is a serious problem?! What happens if there becomes a complication and for the passed 7 hours everyone did nothing about it because they felt that she was over reacting. My question was WHY can't we pull the foley catheter out and give her 6 hours to pee on her own like we do with everyone else and follow what the RESEARCH suggests and if she doesn't we bladder scan her. If she is over 300 mls of urine in her bladder the foley has to go back in?! What is the problem? I don't get it?!
This situation boiled down to a power struggle where doctors and specialists were completely tunnel visioned. Only thinking about how they need to get a precise urine output and not thinking about the human being involved. Essentially what they were saying to this patient with their actions was we doing care if you sit here writhing in pain with this catheter in because we care more out the urine output that your comfort.
If I were a lawyer on this case I would hang these people with their words because ethically this situation was wrong on SO many levels. I left work frustrated, upset, and sickened by this situation. I just can not believe it.
As a nurse it is MY job to advocate for my patients. I feel MANY nurses are too scared to speak up and push back at the MDs when they are simply being irrational. Just think about it if that was you or your loved one in that situation. Would you just go with the flow? Agree to everything the MD wants to do? As a COMPETENT nurse it is your JOB to suggest better ways to handle the situation if the MDs way of doing it isn't working. YOU are the one with the patient for 12+ hours. YOU know the patient better than anyone. YOU have to deal with all the bs. Speak up!! Often as nurses we get a gut instinct that something is wrong. In this situation even though the patient was not my patient I just felt like something was horribly wrong here and everyone was just blowing it off.
The most important thing to remember as a patient and a healthcare provider is the patient has the right to refuse! We cannot force or impose a treatment on a fully alert and oriented patient. Even in the "confused" patients situation it can be a sticky situation to force treatment on them if they are refusing. Have good judgement. Think to yourself, "if I was put up on the podium in a court of law to explain my actions in this situation would they be valid?", "what does the research say?", "what are the patient's rights in this situation?", "could I possibly lose my license over this situation?". Remember, the court is going to judge you on the five areas of ethical standards as defined by the nurse practice act: nonmaleficence (do no harm), beneficence (keeping the PATIENT'S welfare as the primary goal of care. Promoting good and preventing/removing harm ), autonomy (the law of oneself/self determination/having moral responsibility for your actions and understanding patients right to autonomy/respecting it), justice (what is morally/legally right), and privacy/confidentiality which are self explanatory.
Don't forget the reason why you chose to be in healthcare. If the reason was for money, prestige, or because your family told so...you are probably the person not speaking up and not realizing what the patient perceives is best for them may not meet eye to eye with what YOU perceive is right for them and that is where the problem lies.
If learn how to balance that and understand it you are golden.
Until next time.
-Norah
Thursday, September 5, 2013
Quickie in the work place
It's the whole grey's anatomy/scrubs myth the nurses and doctors hook up on the job. Is it true or is it not? I'll leave that up to you guys to decide but just like any other job such as office jobs and things of that sort, there are always the wild ones.
Just think about it. 12 hours especially if your working nights. A lot of these doctors are there for a lot more than 12 hours. They practically live, sleep, eat in the hospital. They even have sleep rooms with beds! What other job would make it so easy to have sex if you wanted to? I'm just saying. Then you have young fresh single nurses. Everyone in the medical field generally is not shy to talk about "private parts". We see them/touch them all the time. That usually is not a barrier.
So, what is it about hooking up on the job? Maybe someone you have been eyeing for a while. Someone that you have been flirting with. Hell, maybe it is your husband. My deduction is the moment has to be right. It's usually never planned. It's in the moment. People enjoy the rush of the idea that its taboo to have sex in the work place which makes it THAT much more exciting. The person may not even be someone you will ever sleep with again let alone date. It's an experience at the end of the day.
I know A LOT of nurses or healthcare people that may read this and may think I am crazy for even talking about it but, I am a young nurse and have only worked at university teaching hospitals that tend to be young in general in terms of doctors and nurses. I have heard all kinds of stories.
I am not here to put anyone on blast because whoever those persons maybe enjoyed that moment. I am not here to judge them. We are all grown adults. I'm sure this happens everywhere. Every job. Take firefighters for example. They are known for having sex on the job. They have beds too! I know of a person who worked at a fast food restaurant that had sex in the walk in freezer. People get creative.
Don't be so uptight if you're feeling uncomfortable reading this. It happens. EVERYWHERE. Professional jobs, professional people and non professional. We are all sexual beings. Sexuality doesn't discriminate depending on profession, status, money, race, or color. If the time is right, the situation is right, and there is an attraction there is a strong chance it will go down.
This is why I simply don't understand why people in the media blow things out of proportion like the senator ( I won't name him) that was "sexting". Now, I know he was married and everything but, if you paid attention that wasn't what the big frenzy was about! It was simply about the fact that he sent scandalous photos of himself to ladies. It's hard for me to believe that at least half the people criticizing him about it are not guilty themselves of sexting.
I guess the take away message is, if talking about sex or being sexual makes u uncomfortable you have to figure out why. I am not saying go out and have sex at work. Just learn to get comfortable with yourself. This is just an interesting topic that I thought I would discuss because it does exist and it does happen. Keep it classy folks.
Until next time.
-Norah
Sunday, September 1, 2013
Save the drama for your mama
Nothing is worse than having to work with a person or persons that are all drama. That one person when you get to work and you immediately think to yourself, "ugh, I am working with her/him". Working with a bunch of women is notorious for drama in the work place. Personally, I would love to work with a bunch of men because they are little to no drama. Nursing is still a predominately female profession that is slowly starting to change and I love it.
Today was a great example for me of why I love working with men. At the end of the shift we do shift report where the day nurse gives report to the night nurse about the patients that he/she took care of that day. When I get report from night shift in the morning ALL I want to hear is the pertinent information! I don't need you to tell me what fluids are running, what they are running at, allergies, code status ect. That is all stuff I can find out myself by ONE glance at the electronic medical record (EMR). I want to know things that have changed, things I need to look out for, that the patient likes to take their pills with chocolate milk, that they like one light on not all of them on, that they use a walker to ambulate, that they are a stand by assist patient, that kind of stuff. Why? Because that is the kind of stuff I can't find out on my own looking in the EMR. All the other stuff is "task" type things. The task type things are all in the EMR. I don't consider myself a task oriented nurse. I like to put the big picture together. Making sure I know how my patient likes to take their pills is JUST as important to me as making sure my insulin drip is programmed correctly.
Male nurses or murses tend to be this way, which is why I love giving them report. Because by the end of my 12 hours the last thing I want to do is spend an extra 45 minutes giving report on information you can find out yourself in the next 12 hours. Some people don't grasp that concept very well. The male nurses almost always have my same philosophy on report. Just give me the highlights and I'm good.
Then there is the female nurses...they ask 101 questions about the patient. I know some of you might be thinking, "evidence based practice says that one of the best ways to reduce errors is good hand off reporting". I completely agree. A good hand off report consists of the things that can be missed and are pertinent to the situation. Things like double checking drips, discussing medication reactions, any dressing changes or missed doses that need to be followed up on or significant lab results. Things of that sort. I shouldn't have to list all the allergies and tell you that the patient is running D5 1/2 with 20K at 50 mls/hr. Things of that sort are in the EMR and are things you will be looking at anyway right at the start of your shift when planning your day/night out. Some nurses want that type of report so they don't have to go look in the EMR for that information. THAT is bad nursing. How can u be sure that the nurse gave you the correct settings for the PCA if you never took 3 seconds to double check it in the EMR and just trusted the day shift/night shift nurses report. Understand where I am going with this? It's not that I am lazy or a "bad nurse". I just don't rely on people giving me the information I need. I can get it myself and be sure that it's accurate.
Also, change of shift is not the time for the on coming nurse to start assessing their patients when we go into a patient's room to introduce the next shifts nurse. That is just bad etiquette. Furthermore, if in that time when you go and introduce yourself you notice something is wrong like the IV is infiltrated or the amiodarone drip is programmed wrong this is NOT the time to confront the nurse who missed the error. DISCRETELY correct the error and then when you are OUT of the patients room approach the nurse privately and tell him/her.
I have seen many nurses argue in front of patients over errors. I am horrified in those situations and usually end up walking out because I want nothing to do with that. That is extremely unprofessional. Especially when nurses or managers drag patients into the argument. Many nurses especially female nurses feel that need to prove their competence by putting other nurses down. Everyone makes mistakes regardless of how big or small the mistake. You maybe extremely competent, but no one will ever want to hear what you have to say if it's always in a condescending manner.
This happened to me today. My patient's IV infiltrated during a blood transfusion within the first hour. It was a brand new IV that I personally placed specifically for the transfusion. I was closely monitoring the IV because I just had a feeling it would infiltrate because this patient did not have the best veins in the world. Sure enough an hour into the transfusion it infiltrated and it was 30 minutes before I was getting off shift. So of course I needed to start a new IV again to continue to transfusion but I only had one arm to work with because the other arm was off limits due to an AV fistula. I notified my charge nurse of the infiltration and her response to me was, "you didn't check to see if the IV was patent (working) before you started the transfusion?!" in a very condescending manner. Clearly, she wasn't listening to me when I told her I had started a brand new IV just for the transfusion. So, I repeated myself when she asked me that question. Her reply was, "oh", in which I politely replied telling her I was just coming to inform her and that I would be starting another IV on the patient before I left. Tone of voice is everything. Watch your tone and be careful of your facial expressions. Make sure they match.
At the end of the day being a nurse can be stressful and the last thing that is needed is extra drama on the floor or unit you work on. Save the drama for somewhere else. Learn to be a team player. Don't put your coworkers down to other coworkers and especially not patients. It's not a good look. You are only hurting yourself by doing it.
Be considerate at change of shift. If you know you want all the nitty gritty details, get to work early, find out your assignment, and go sit in front of a computer and get all the minute details you want. Put a smile on your face and keep it positive.
Until next time.
-Norah
Today was a great example for me of why I love working with men. At the end of the shift we do shift report where the day nurse gives report to the night nurse about the patients that he/she took care of that day. When I get report from night shift in the morning ALL I want to hear is the pertinent information! I don't need you to tell me what fluids are running, what they are running at, allergies, code status ect. That is all stuff I can find out myself by ONE glance at the electronic medical record (EMR). I want to know things that have changed, things I need to look out for, that the patient likes to take their pills with chocolate milk, that they like one light on not all of them on, that they use a walker to ambulate, that they are a stand by assist patient, that kind of stuff. Why? Because that is the kind of stuff I can't find out on my own looking in the EMR. All the other stuff is "task" type things. The task type things are all in the EMR. I don't consider myself a task oriented nurse. I like to put the big picture together. Making sure I know how my patient likes to take their pills is JUST as important to me as making sure my insulin drip is programmed correctly.
Male nurses or murses tend to be this way, which is why I love giving them report. Because by the end of my 12 hours the last thing I want to do is spend an extra 45 minutes giving report on information you can find out yourself in the next 12 hours. Some people don't grasp that concept very well. The male nurses almost always have my same philosophy on report. Just give me the highlights and I'm good.
Then there is the female nurses...they ask 101 questions about the patient. I know some of you might be thinking, "evidence based practice says that one of the best ways to reduce errors is good hand off reporting". I completely agree. A good hand off report consists of the things that can be missed and are pertinent to the situation. Things like double checking drips, discussing medication reactions, any dressing changes or missed doses that need to be followed up on or significant lab results. Things of that sort. I shouldn't have to list all the allergies and tell you that the patient is running D5 1/2 with 20K at 50 mls/hr. Things of that sort are in the EMR and are things you will be looking at anyway right at the start of your shift when planning your day/night out. Some nurses want that type of report so they don't have to go look in the EMR for that information. THAT is bad nursing. How can u be sure that the nurse gave you the correct settings for the PCA if you never took 3 seconds to double check it in the EMR and just trusted the day shift/night shift nurses report. Understand where I am going with this? It's not that I am lazy or a "bad nurse". I just don't rely on people giving me the information I need. I can get it myself and be sure that it's accurate.
Also, change of shift is not the time for the on coming nurse to start assessing their patients when we go into a patient's room to introduce the next shifts nurse. That is just bad etiquette. Furthermore, if in that time when you go and introduce yourself you notice something is wrong like the IV is infiltrated or the amiodarone drip is programmed wrong this is NOT the time to confront the nurse who missed the error. DISCRETELY correct the error and then when you are OUT of the patients room approach the nurse privately and tell him/her.
I have seen many nurses argue in front of patients over errors. I am horrified in those situations and usually end up walking out because I want nothing to do with that. That is extremely unprofessional. Especially when nurses or managers drag patients into the argument. Many nurses especially female nurses feel that need to prove their competence by putting other nurses down. Everyone makes mistakes regardless of how big or small the mistake. You maybe extremely competent, but no one will ever want to hear what you have to say if it's always in a condescending manner.
This happened to me today. My patient's IV infiltrated during a blood transfusion within the first hour. It was a brand new IV that I personally placed specifically for the transfusion. I was closely monitoring the IV because I just had a feeling it would infiltrate because this patient did not have the best veins in the world. Sure enough an hour into the transfusion it infiltrated and it was 30 minutes before I was getting off shift. So of course I needed to start a new IV again to continue to transfusion but I only had one arm to work with because the other arm was off limits due to an AV fistula. I notified my charge nurse of the infiltration and her response to me was, "you didn't check to see if the IV was patent (working) before you started the transfusion?!" in a very condescending manner. Clearly, she wasn't listening to me when I told her I had started a brand new IV just for the transfusion. So, I repeated myself when she asked me that question. Her reply was, "oh", in which I politely replied telling her I was just coming to inform her and that I would be starting another IV on the patient before I left. Tone of voice is everything. Watch your tone and be careful of your facial expressions. Make sure they match.
At the end of the day being a nurse can be stressful and the last thing that is needed is extra drama on the floor or unit you work on. Save the drama for somewhere else. Learn to be a team player. Don't put your coworkers down to other coworkers and especially not patients. It's not a good look. You are only hurting yourself by doing it.
Be considerate at change of shift. If you know you want all the nitty gritty details, get to work early, find out your assignment, and go sit in front of a computer and get all the minute details you want. Put a smile on your face and keep it positive.
Until next time.
-Norah
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