gypsyd8, MSN (8,090 Views)
Joined Nov 28, '07.
Posts: 260 (60% Liked)
I work in the ICU. The patients rooms are where one goes to fart.
Obviously every one farts . I never fast in front of my coworkers or patients. I go to a private area or bathroom. Yes some people can't hold it but we are all adults. Its not a big deal but be discrete of you can.
Anticholinergics like benadryl are implicated in dementia.
My facility has instituted this test. I emailed with the developer of the test in order to request study materials, (something like the test plan for the CCRN) and received this reply:
"If you are taking a BKAT, go to the BKAT Webpage at www.BKAT-toth.org and choose the BKAT that you think you would/will be taking. READ about it. Keep reading until you find the part about ‘content areas’ [this is towards the beginning]: These are the things to study. Also, close to the content areas are three actual questions on-line to give you an idea about the BKAT. To see them, click on the yellow star.
If you are currently working in an ICU, you may order any BKAT you wish. Since you are at the BKAT Webpage, click on ‘To Order’, and read. Please note that it takes 3-4 weeks to receive your BKAT(s) after you have been approved as eligible. The time delay makes it unlikely that a BKAT that is ordered to memorize answers will arrive soon enough: This is planned, on purpose.
To be eligible, you must be currently working in an ICU as a RN or a critical care educator. To order the MED-SURG BKAT, you must be currently working in a med/surg unit and be a RN.
Remember: BKAT means basic knowledge, not CCRN. Also, BKAT may NOT be used for hiring, firing, or screening. Please report any abuse to email@example.com"
Nope. Tedious, not hard
Our profession does not justify our abuse. No-one, ever has the right to detain me without compensation.
And me and my family come first, before the hospital or anyone in it.
A snowstorm so bad that essential personnel are being asked to stay at work and work extra? Are you forgetting who you are and what you do? What if you went home and your relief refused to come in ? Or what if the hospital had no one to come in? Who would take of the patient. What if all essential personnel refused to work extra? Firemen, paramedics, doctors, police, electric utility men and snowplow drivers. A bad snowstorm could be considered an emergency. And this happens maybe once a year? There are labor laws about sleep but you need to get over it. Find another profession. If you worked at a retail store you could take several days off.
I work with a nurse that likes to write things such as "Pt says that Nelly RN told her last night to take 15mg of morphine and this SN informed them that its actually for 5mg" "they complained that Nelly RN was rude, and they were not happy with care from that nurse"
I have been the recipient of this kind of charting and it infuriates me, because for one, I may have never told them to take that much morphine and have no idea why they are associating my name with saying that, and for two, there may be a lot more around the situation, maybe they are mad that they wanted ativan and the doctor couldn't prescribe it, it doesn't mean that I was actually rude.
So I would add to that list, Don't chart issues that you didn't witness!
I saw this while on break last night and did not have the time to articulate a fair response. I do not want to come off as disrespectful, but something about this really rubbed me the wrong way. The first issue I had was this:
"Any seasoned pro will be able to tell you about the numerous times in which they were on their feet all day and not once stopped to consider a break."
This statement is not only untrue, it is actually wrong due to the implication (by the previous sentence) that this is somehow desirable. A "seasoned pro" will not be on their feet all day, and seasoned nurses take their legally mandated and justified breaks. There is nothing wrong with this. This is actually the desired state of affairs. Perhaps the author did not intend it to be interpreted this way, but as a read further it appears that the author has internalized some form of corporate sycophany.
My second quibble was with the repeated use of the word "task" to describe the activities we perform in the course of our professional duties. I suppose technically the things we do could be called "tasks" but honestly I never heard them described this way. In nursing school we learned the nursing process, and were repeatedly admonished to avoid becoming "task oriented." The theme of a problem solving process that uses critical thinking has permeated my work as a nurse for more than ten years. It was reinforced when I went back to school for by baccalaureate, and again when I returned for my masters, where nurses were repeatedly described as "knowledge workers." I have never hear the work I do be relegated to a "task list" until I learned Cerner, so maybe that is why I notice it now.
Finally, some of these seem like simplified versions of reality. "Avoid taking shortcuts."
Why? If something can be done more efficiently without sacrificing safety why not take a shortcut? Is it because it would allow the nurse to take their legally mandated and justified breaks? Please understand I am not talking about (for example) scanning a patient label and all the meds outside the room in the hall somewhere and then administering the medication. This is something that is routine practice at a facility I used to work at and students were actually being taught this practice by the staff nurses they were following. This defeats the whole purpose of barcoding and scanning patient wristbands and medications, it is the modern equivalent of signing off the MAR before med administration and is a dangerous practice. I bring up this example because there is actually a fairly nuanced conversation that could be had about positive deviance in nursing (Clancy) and the old adage to "work smarter, not harder." I have also had experiences where any deviation from protocol is harshly punished, even if there is a positive outcome. I think there is a place in between following policies, procedures, and protocols for the sake of following them and flagrant violation of standards designed to ensure safe practice. It is our job as nurses to find that happy medium.
"Don't rush tasks." Well this I can agree with, to an extent. I have felt for some time that it is better to be late (administering medications, for example) and correct than on time and in error. Time and time again I have been leisurely preparing my patient's meds when I find one that should not be administered for one reason or another. When I have been rushed and given everything early the physician invariably discontinues a medication after I have administered it. I still hate being late, though, and sometimes rushing is necessary. Again, nuance. there is no right or wrong answer here. It depends on the situation.
Right after "don't rush" is "manage your time effectively" with the suggestion to "break each day into different periods of time, in order of importance." That is not how nursing works. We do not prioritize our days by periods of time. We prioritize our patients, from most acute to least acute and go from there. Then, they change. The quiet one who never calls is septic and the one on the call light every five minutes is a drug seeker. Or, the one you think is a drug seeker actually has a dissecting aortic aneurysm and the quiet one needs to be transferred to a lower level of care. It is an ongoing process of assessment, diagnosis, outcome identification and planning, implementation, and evaluation. It is literally impossible to break each day into different periods of time in order of importance. Each day is different.
"Don't be afraid to ask for help." Okay. Don't be afraid to offer it, either.
"Set your own targets." I seriously need help on this one. I wake up, shower, get into scrubs, go to work, clock in, and do my job for twelve hours. Those are the only targets I need. The admonition not to "wait for someone in management to allocate you certain goals" makes no sense to me. Management does not do my job, and I am happy when I do not see them.
I suggest my patients for transfer when they no longer belong in the unit. This is not because I want an admit, but because throughput is important so people do not die waiting for a bed. I transfer my patients when a bed is available for the same reason. I call the ER or OR or cath lab for report when I am ready for the same reason. It is not because I am itching for that trainwreck of an admit. If I am having an easy shift I will allow myself that. I will take care of my patients and leave on time contentedly knowing my patients were cared for, they got the appropriate medications, physicians were made aware of important issues, my charting is done and I didn't forget anything. Anything extra I do only when I am told, it is required and/or there is additional pay involved.
There is nothing wrong with that.
Come to California. Lots of places hiring
Been there. I didnt get a chance to run.
Very true. An incompetent creepster manager will favor people who resemble himself -
the incompetent nurses who are adept at
lying,covering up problems, faking data and pretending that everything's rosy.
The worst of the worst are then made charge and given control of scheduling. This blind leading
the blind is found in level nothing community hospitals.
Experienced staff witness the negligence and say whiskey-tango-foxtrot. Their credentials
and experience are belittled from the start.
Upper management will back their weak little protege because this unethical behavior serves
Competent staff who identify serious practice
problems are labeled a problem.
If you encounter this in your professional life, I have one word for you. Run.
Gotta keep grandma alive so those social security checks don't stop. In my area we also get a lot of IHSS "caregivers" who have never worked a day in their lives, and get paid to mooch off grandma in addition to their own welfare cheques. They never, ever allow natural death, even when grandma (or worse-their own kids)is in a permanent vegetative state.
I didn't call security on the husband that time - in hindsight, I wish I had. She had been my patient earlier in the week but wasn't my patient that night, but I should have stood up for her anyway.
I can tell you exactly how we're intubating people with DNI orders. Family calls EMS about unresponsive patient. EMS gets there, notes patient is obtunded and not protecting his/her airway. Family plays dumb about living wills/DNI/whatever, asks EMS to help the patient now because they want Daddy to live, and EMS intubates. Everyone gets to the hospital, RN is doing admission history and asks if patient has any sort of living will/portable DNR/HCPOA forms... and someone finally says "He has some sort of papers, we'll see if we can find them" as vaguely as is humanly possible. The papers finally get there, conveniently on the day we are planning to extubate Daddy anyway - and they are DNR/DNI papers, of course. If EMS can't ask the patient, we're relying on the families to be honest - and some of them just aren't.
You do realize that 87 is a perfectly acceptable age to die right?
People aren't supposed to live forever.
Well, we eventually let the patient go. As everyone pointed out, they have the right to do so.
I just felt like this pt really didn't understand what exactly is going on.
My force comment was a related to a psych patient who was on a hold and transferred out to another facility.
I say didn't quite understand because this pt (87 years of age) was of Korean ethnicity. Especially the older generation, They have a tendency to believe they are fine if they "feel" fine, such as not showing any s/s of sickness. I know this because I had a similarly aged patient few months back who came in with severe sepsis. Rectal temp of 104.7. Korean speaking only. Refused treatment because he said "I'm fine, I feel good, I go home." BP started at 150s/80s, and after couple hours he suddenly started dropping to 100s/60s, then minutes into 80s/40s. We got a translator to explain to him and still refused treatment. After few more times of getting to convince him, he eventually agreed when he stated "feel weak, tired". We threw a central line in him, and upon closer inspection, he's actually had multiple central lines inserted, started pressors.
We did not force him, he just didn't understand or was in denial until he actually started seeing/ feeling s/s of it himself.
Back to brain bleed pt,
I guess I just felt like he didn't really understand the full extent of what was really happening.
Or maybe I just don't understand why he refused...
Maybe another question is what you would have done in this situation? Would you have liked for this pt to stay in the ER even though can't treat? Any other possibilities?
I'm just trying to have a discussion.
(I don't know much about the pt, all I know was he was Korean speaking only, 87 years old, came to er for fall and laceration to back of head.)
Ain't the Way to Die
I know a pretty decent agency in California if you want to pm me
Do something about it
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