Content That klone Likes

Content That klone Likes

klone, MSN, RN 61,657 Views

Joined Apr 2, '03 - from 'Denver, CO, US'. klone is a L&D. She has '10+' year(s) of experience and specializes in 'Women's health, research, lactation'. Posts: 10,869 (54% Liked) Likes: 25,684

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  • Sep 29

    Actually the divorce rate for nurses is somewhere in the middle, way below bartenders and dancers.
    One of the main reasons I went to nursing school was because I knew my marriage was not going to work, I needed a 2 year degree stat to support myself. All 4 members of my study group were in the same exact boat.

    Whatever personal issues you two had, it was not achieving a NURSING degree that empowered her to leave. She was making her way out of a problem relationship.

    My condolences, divorce is painful. Blame her, blame nursing, blame the universe. But it's time to move on.

  • Sep 29

    Wow - OPs story is chock full of instances that appear to reflect the Charge Nurse 'practicing medicine without a license'. This is a violation of every state NPA. OP is a tough spot. Going along with Charge Nurse in these instances would make her complicit - RNs have a duty to intervene/act when faced with illegal or unsafe situations. My advice? Get very familiar with her NPA - discuss violations with the CN (yep, I'm sure that will NOT be fun) and be prepared to provide written documentation to the DON. Sometimes it takes a lot of courage to act with integrity.

    As for the comment about rural hospitals.... " No doctor on site = not a hospital" is so NOT TRUE. The situation described by OP is normal for small rural facilities. I have worked with many rural hospitals. They may not have continuous on-site physicians - or pharmacists, or RTs, or any other ancillary staff because they can't afford them. Physicians in those communities are used to getting called in to the hospital and they respond very quickly. In many instances, the (volunteer) ambulance is also dispatched from the hospital & so the physician is called at the same time. There are many ways to organize health care.... it's the height of arrogance to assume that only urban facilities know how to do it the "right" way.

    Some rural access hospitals may only have one RN on site, assisted by LP/VNs and CNAs .... but this does not mean that they do not provide the highest quality care that is within their ability to deliver. That derogotory comment is insulting to our colleagues that staff rural hospitals. I have had the great pleasure to know some of those uber-generalist RNs, competent to deliver babies, manage ED arrivals, assist with surgery, manage ventilators, draw labs & ABGs, arrange transfers to higher acuity facilities, while ensuring that all of the other inpatients (from pedi to geriatric) get the care they need. Remember... the only reason hospitals exist is to provide NURSING care - because everything else can be delivered in alternate settings.

  • Sep 29

    Tough situation. I see that other posters are recommending you switch jobs; that is an option, but I understand your concerns about how it looks on your resume. Really, I suspect that particular decision depends on how much real power your charge nurse actually has. I don't really like the fact that her review of your performance is factored (strongly?) into your merit raise; but it is entirely possible that she doesn't actually hold much real power over you when it comes right down to it outside of the annual performance review.

    If you can effectively bypass her while doing your job, contacting doctors, etc, all while maintaining decent working relationships with the rest of your coworkers as well as your boss, then the issue of a reduced merit raise or icy but ultimately powerless charge nurse might be worth putting up with temporarily to avoid junking up your resume. It's almost certainly smart to avoid flailing out to whatever job will have you soonest, because you don't really want to find yourself in the same position (more or less) a few months from now in a new position - if you look for a new job, be as picky as your circumstances allow you to be given your current concerns about your resume.

    Quote from Roggae
    ...She ended the discussion stating she believes we're both great nurses and asked that I talk with my charge directly.

    So here I am now. I need to talk to the charge. Does anyone have any words of advice to offer in dealing with confrontation? Especially at a new job and with the charge nurse nonetheless?
    Given that you don't already have a job lined up, this discussion is nearly inevitable. I would suggest you do the following:

    1 - Frame things as neither of you being at fault. She does things one way; you do things another; and there's nothing wrong with that. Don't criticize her judgment directly. You don't need for her to admit fault; you just need her to back off. If you turn this into a personal issue or a pissing contest, you might wind up with a charge nurse gunning for you and just waiting for you to slip up so she can report it - not good.

    2 - At the same time, don't cave in to her. You practice on your own license not hers, and it is important to you as such that your own judgment is your ultimate guide in taking care of your patients. You appreciate her guidance, but still intend to call doctors yourself as you see fit. Etc.

    3 - Make sure you keep good relationships with your boss and other coworkers. Offer to help out; be friendly; show strength and competence. It's hard to be the only person who dislikes a coworker, even if you're the charge nurse. Your judgment so far appears sound, so I think you can probably maintain a good name despite a your charge nurse's influence even as a relatively new hire.

    Basically, don't be a threat, and don't be an easy target either.

  • Sep 27

    Quote from BeenThere2012
    Not sure about this...Ive hit veins before in the deltoid...not often at all, but still possible.
    Check the CDC guidelines. Aspiration in the context of deltoid injections is not EBP.

  • Sep 26

    Here is my step-by-step process for newborn screening:
    1) Heel warmer on foot (I use the one without the Hugs tag)
    2) Swaddle baby so all extremities are secure except the foot I'm about to draw blood from. (This increases comfort so baby wins, and decreases baby squirming. One extremity is easier to wrangle than four, so I win as well.)
    3) Tilt crib up to let gravity work for me.
    4) Assemble all my supplies.
    5) Roll my state lab paper into a tiny cylinder to make it more manageable, and secure the roll with paperclips. Sometimes fighting that stupid paper is harder than managing a screaming baby.
    6) By then, it's usually been around 5 minutes, enough to get the heel nice and warm which as previously mentioned helps tremendously.
    7) Make sure I stick the right spot that's over a capillary bed.

    If baby has a binky, I use that, or if I'm in the room with parents, I have one of them glove up and put a finger in the baby's mouth to suck on while I'm working. A calm baby is a vasodilated baby. I can get my work done faster, the baby has undergone minimal trauma, and parents feel involved in baby's care and can see exactly what I'm doing. Win-win-win.

    The first time I did a PKU it took me 20min. It was horrible for me and for baby. Now I can have all my drops filled in under a minute. Hang in there. You really will get better with practice.

  • Sep 26

    Quote from Julius Seizure
    how big are those? how many ml?
    They are 30ml according to the website.

    They are also FOR EXTERNAL USE according to the website. Check out this picture at the top of their website:

    If a facility is using these for IV flushing, that's a HUGE infection risk, IMO -- there's no way to maintain sterility! Not to mention, it says NOT FOR INJECTION right on the unit!

    If your facility is using these for IV flushes, please stop immediately and discuss with Risk Management!

  • Sep 25

    It also violatesThe Joint Commision National Patient Safety goal 3D as the syringe is already labeled as to its contents.Manufacturers state this in their literature and and in their instructions for use.

  • Sep 25

    I found a good and really entry ISMP document titled "ISMP Safe Practice Guidelines for Adult IV push Medications....see section 3.6 It's a PDF and I can't figure out how to post it..It explains that the NS prefills or any prefills such as Heparin can only be used to flush VADs.The FDA says NO for reconstitition,dilution or administration.Perhaps someone more tech savvy than I am can help here.

  • Sep 24

    With the level of responsibility required to perform well, I respectively 100% disagree that entry level degree should remotely be decided on providing stable employment to those needing it now.

  • Sep 23

    I work with our Supply Chain Management folks - they refer to this (RFID locators on equipment) as "Asset Management Systems". We're starting to include this in most of new mobile equipment contracts. It's wonderful to have a better way to locate IV pumps, gurneys, wheelchairs and such .... hunting and gathering is too time consuming.

    Some of our facilities have "nurse locator" systems. This information has proven to be valuable also.... like the time a family complained that nurses "never even came into the room". We had data that clearly indicated how many times each staff member had entered the room - and they were exceeding our hourly rounding standards.

    Technology is not all bad

  • Sep 21

    They are generally referred to as "RTLS" or Real Time Location Systems.

  • Sep 21


    Here's some that a quick google search found:

    Things to consider

    Using WiFi to Track Clinical Assets | Healthcare Informatics Magazine | Health IT | Information Technology

    RFID vs. WiFi for Hospital Inventory Tracking Systems


    Hospital Asset Tracking | Real-time Locating | Versus RTLS

    Healthcare Asset Tracking & Management | STANLEY Healthcare


    I don't know anything about the above companies.

    When I googled this I did discover that Cisco has "The Cisco Location-Aware Healthcare Solution." I couldn't copy the link, so just google that. Cisco is one of the best companies for computer networking, so I would expect their product to be top notch.

    I also found that Philips has an asset tracking product for healthcare. That is also a highly regarded company.

    If you have an IT person or a biomed person, enlist their help with this.

    Good luck with your project. It sounds like it will be very interesting.

  • Sep 19

    A bird in the hand...

    I would want to have three questions answered soon:

    1. How long is the contract?
    2. Can we negotiate the hours closer to 40, or add incentives for OT?
    3. When do you want this contract signed by?

    Jobs for a new grad are hard to find, generally speaking. A satisfactory salary is even tougher to find. This opportunity has a lot of positives.

    A two year contract with time-and-a-half for any hours over 40 per week would be quite an attractive offer. Looking for a bedside type job in order to keep your skills intact becomes much less stressful when you have a steady income and are continuing to build your resume with RN experience, regardless of actual job description.

  • Sep 19

    I don't know, it sounds like a pretty great deal to me. They must think a lot of you. And since they are creating this position, surely you can insist on a decent work week, with a reasonable amount of call. In terms of practicing your new skills, I wouldn't worry about that. Skills can be re-learned if they get rusty. The job description that you gave sounds like a fantastic opportunity for a new grad.

    I do not believe you have any reason to feel indebted to your employer. Do not take this out of guilt. However, be very very certain that you can actually find a position as a new grad. Some markets are oversupplied with new grads right now.

  • Sep 17

    I'm a huge fan of business-casual. I would not wear scrubs, but I would take them along and leave them in the car.