Latest Comments by LTCangel - page 6

LTCangel 5,317 Views

Joined Nov 8, '05. Posts: 85 (49% Liked) Likes: 138

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    Hi everyone, I have been a lurkeron here for a couple of years but in the last few months I have been slightly addicted I have been a nurse for almost 16 years. I started my career as an LPN in LTC. After 1 1/2 years a was hired by one of the local hospitals. I worked there on the Orthopedic/Joint Replacement unit for 14 years.

    I was recently(3 weeks ago) terminated from my job for tardies. Many of these were in my opinion trumped up charges to get rid of me after I filed for FMLA due to Fibromyalgia. To add insult to injury, they are now fighting my for my unemployment. Imagine all those years of loyalty and they don't even care if my family eats. I went back to school 2 x while continuing to work full time and remained loyal to my unit and stayed there even when I had more options open to me. I am now an RN,BSN. I am also working on my Master's degree and may become a Geriatric Nurse Practioner.

    Today I had a wonderful interview at a LTC facility. Guess what? It was the very first place I worked at right out of school! Except it smelled nicer and they are better staffed and I really hope i get the job. I'll keep ya posted on that note.

    I am from Southwestern WV. Yes I am a redneck, don't hold it against me! I am also a redhead! I am married for 22 yrs now and have 3 children. Tyler(21), Lakin(20), and Jacob(almost 18), he's also the only one left at home.
    I am 41 yrs old and yes I started young having kids(that's the way we do it down here!-just kidding).

    Anyway, I feel like I am getting ready to start a whole new life. I was getting so burnt out at the hospital but I wouldn't leave cuz of the pay and the insurance. Sometimes god just has to give us a swift kick so we'll listen and see what other wonderful things he has in store for us. Oh, my name is Lisa. Nice to meet you all!

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    sallyrnrrt likes this.

    In our facility in WV a signed TO or a written and signd doctor's order is sufficient to make a pt a DNR. Sometimes we would get NH pts admitted and their DNR orders did not come with them. The admitting nurse always asks this question of every pt or family member. If I came across a pt who states they are a DNR but do not have their papers with them or a POA who states the same but has no papers than I would call the doctor to come and evaluate the situation. If he/she was not familiar with the patient he would come and talk with the pat and family members to determine the situation and then write a DNR order in the chart. If a telephone order was taken it needed to signed within 24 hours and Social Services is contacted to draw up official papers or the family would bring in the official papers. If the Nursing Home had neglected to send papers then we call and ask them to fax a copy for the chart. But in the meantime a signed TO or a written order for DNR is sufficient. It would be a horrible thing to code a pt who had requested wishes not to be resucitated. There are not any specific color of any DNR papers unless they are facility specific. A blue armband and a blue DNR sticker on the front of the chart, I believe are universal.

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    In my hospital when a new order is written or a new patient is admitted, the unit clerk scans orders to the pharmacy, puts orders in the computer for labs, diet, activity.etc. and then the chart is given to the charge nurse. The charge nurse then looks at these orders, checks them against what the pharmacy has profiled on the emar and what the unit clerk has entered in the computer and if everything checks out will note them electronically and on the paper chart. The floor nurse will then see a new order pop up on the emar and should also get a copy of the written order in the box(each pt has a slot in the med room to place copies of new ordres). The floor nurse can see if this order has been noted or not. If it is a med that needs to be given urgently the floor nurse(RN) can go ahead and note it(after checking the original order) and give the med. The night shift nurses do 24hr chart checks. They only go back 24 hours, it would not be feasible to go back through the entire chart,they are checking the paper chart with the electronic chart. Now, even with all of these safeguards mistakes can and do happen. As nurses, we need to use our common sense and our critical thinking skills as they pertain to our patients. When teaching students, I believe you have to teach them the old tried and true way and when they are orienting on their first nursing job they will be taught by their preceptor the policies of the hospital and the fastest and most effecient way of doing medication administration. Hopefully, they get a preceptor who cares enough to actually show them how to do it right with the patient's well being in mind.

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    On my unit we generally pull foley's ASAP without bladder training. If the patient has trouble voiding after the catheter is removed, we will sometimes see orders to reinsert foley and bladder train for 24hours and then remove foley again. It really depends on the doc, some of them do not believe bladder training is beneficial. Personally, I have bladder trained pts who never felt fullness of their bladder when foley was clamped and on the other hand I have had pts who are very sensitive. So I think it is hard to say if it is beneficial for all pts but it doesn't hurt to try.

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    When I First began working in the hospital 14 years ago we used preprinted paper care plans that went hand in hand with the patien's diagnosis and this is what we charted off against at the end of the shift. I didn't find them annoyinf at all and they made sense because they were simple and we could also add or cross off things that we did or did not need. Now we are computer charting and we have to enter care plans that are already loaded into the computer. They make NO SENSE whatsoever!!! I hate them but at he end of our shift we have to check mark parts of the care plan that we utilized or make a comment as to why it was not implemented. They are now very useless to me and everyone else and most nurses pay very little attention to what they are even clicking on they just want to get finished. So, I guess my opinion is they can be useful but in today's world but with comuter charting they mostly are not or at least not at my hospital!

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    I began as an LPN in LTC and I always feel that is was a very important and rewarding experience. I worked as a CNA many times when we were short staffed(which was often), and that experience really helped me when I got a job in the hospital where I am now(14 yrs), because we do direct patient care. The CNA's taught me so much and working with the elderly confused patients taught me to love and respect Geriatric pts. They cannot help what they do and we just need to be patient and understanding and relaize that if they weren't confused they would never want someone cleaning them up when they are dirty or sick. So I suggest to just try to focus on the good you are doing and realize that it will help you so much when you are a nurse. I also went on to school and became an RN so I feel I can relate to all aspects of Nursing!:redpinkhe

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    3rdcareerRN and jahra like this.

    Hi, our Joint Replacement program recently became certified as a Joint Replacement Center of Excellence by JCAHO! It was a lot of hard work and we had to meet many standards of care on a consistent basis for months before they came to certify us. We have a wonderful group of Orthopods who specialize in all areas of Orthopedics, but we only have 3 who do Joint Replacement. Each week we recieve 8-15 joints a week. Our main Joint Replacement doctor has a very regimented order set that is standard for all of his patients with very minor changes when needed. Everyone starts on Coumadin 5mg the first night of surgery and it is then regulated via sliding scale to reach INR of 2.0-2.5. Every patient must stand at the bedside first night of surgery, 3 doses of antibiotics within 24 hours of surgery, ted hose and foot pumps for everyone, PCA pain pumps of Morphine or Dilaudid, percocet ot Lortab for btp, routine orders for stool softeners, GI prophylaxis, itching, indigestion, and nausea. Goal is discharge to home on Post-op day 3. Each day PT BID and they must learn steps before discharge. We also so blood reinfusion for the knee replacements on the night of surgery in which they recieve their own blood back that is draining into a closed, sterile system known as a Constavac drain. Each pt has a femeoral nerve block that they keep until day of discharge. IVF's and PCA pumps are DC'd on post-op day 2 unless pt is having bad side effects and then adjustments will be made to pain control. We treat our patients as if they are healthy and nit sick so they can have the best attitude possible for recovery. We encourage them to do their own ADL's and dress in their own clothes. Each patient must attend a Joint Replacement class 2 weeks before surgery so they will know what to expect. Education is carried out on admission and throughout their stay. On 3rd post-op day they are discharged to home with Home Health who will provide PT at home for a couple of weeks and then they graduate to OP PT. Nurses come into their home and draw blood for their Coumadin therapy which they continue for 6 weeks post-op. Our program is very successful and we have many repeaters who come back and have a second Joint Replacement on the opposite knee. We have an extremely low infection rate and high pt satisfaction scores. There are some more elderly patients who do need to go to Rehab for a week or so depending on their progress during their 3 day stay. In the 13 yrs I have been working on this unit, we have grown and have patients coming from other states to have their Joint Replacement. The other 2 Orthopods follow this same basic routine with some minor changes. I hope this helps anyone who is interested in this subject.
    Thanks, orthorn

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    When I prime an Iv line I tyrn the cassette upside down until the bubble is about halfway filled then turn it back upright and let it fill all the way and finish priming the remaider of the line. This usually always works. I keep an empty syringe in case I need to pull air out or back primr into the secondary bag.

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    Quote from orthorn1969
    I Don't Think Most Pt's Would Understand This Technique And Besides They Need To Be Getting Out Of Bed As Much As Possible
    TO ENCOURAGE ROM AND DEEP BREATHING. ON OUR UNIT WE ALSO HAVE PROBLEMS WITH FEMALE PT'S COMPLETELY EMPTYING THEIR BLADDER WHILE IN BED.

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    I Don't Think Most Pt's Would Understand This Technique And Besides They Need To Be Getting Out Of Bed As Much As Possible


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