mpccrn 4,937 Views
Joined Mar 9, '08.
Posts: 539 (42% Liked)
Some patients are on the vent because of COPD or asthma exacerbation and may need to do some moving. Others might have a pleural effusion that needs tapping and then waiting for re-expansion before pulling the tube. Some are delayed extubation because the need another surgery later that day or the next and it saves reintubation. If a patient can move, so much the better.
I think one of the things extending length of stay on vents now dispite all the new technology is because of the technology. We have ventilator modes that do everything for spontaneous breathing trials and we are no longer walking vent patients in "bag and drag" fashion as we did in the 70s and early 80s. We have beds which also maneuver the patient with very little effort on their own. Even the old fashioned hands on CPT is a thing of the past. Patients are now coming off the vents and requiring extensive SNF stays with rehab to get moving again.
what is reasonable depends upon how reasonable the visitors are -- and it's all too common to have very unreasonable visitors. we have a lot of new nurses who bend/break the rules for visitors because "their loved one is sick." then when the family becomes a problem for the next shift and you have to suddenly enforce the rules, you're the mean nurse. i'm always hearing that "the other nurse let me" drink my big gulp in front of six npo patients, bring my kfc into the room in front of six npo patients, go out the fire doors, go in the fire doors, sit in the charting chair, use my cell phone, sit on the empty bed (when we have an empty bed), ignore the isolation garb, silence the iv pumps -- whatever. i used to think that surely no nurse would go along with some of these ridiculous requests, but unfortunately i've seen them do so. i haven't been able to get this across to the new nurses involved -- either they don't get it or they don't care.
we've had visitors piling into the rooms, and none of our rooms are private. when six or seven folks come to "visit" right after bar closing and immediately request snacks and beverages for themselves (the patient is npo), it gets loud and no one can sleep. even during the day, with two patients at every bedside, it gets noisy. one patient's visitors are yelling at mom because she's hard of hearing, and the visitors for the other five patients complain bitterly about the noise level.
what is reasonable would be to allow two visitors at a time for as long as they can comfortably stand at the bedside without agitating either the patient they are visiting or any of his/her roommates. as soon as they start shouting into their cell phones or wanting food/drinks, it's time for them to go. we'll probably never see those days again.
i guess i'm kind of wondering what you hope to accomplish here -- patient safety? "proving" to your preceptor that you know best? just doing your own thing?
i don't see anything wrong with doing vital signs every 15 minutes x 8 as your preceptor suggested. after two hours, the patient is either more stable or he's not. if he's not, continue to do vitals as often as you think you need to -- without "polite-ishly" declining to do as your preceptor suggests. just do it. if he is more stable, he does have an arterial line, ecg monitoring and possibly a pa, doesn't he? if you're paying attention, you can see if there's a change in his vital signs whether or not you were writing them down every fifteen minutes. if you see a change, then by all means step up the vital signs. but i see nothing positive to be gained by arguing with your preceptor about such a mundane matter. if their hospital policy is q 15 x 8, q 30 x 4 and then q hour, you're not, as an orientee, going to change their practice.
as far as hanging both kcl and kphos -- what was the potassium? if it was approaching 2 or even heading past 3 on the way south, it might be appropriate. it also depends on how fast she was running each of them. if the patient isn't getting more than 40meq of potassium over an hour, why not? it does make it more difficult to predict what your next k+ is going to be, but you do have the resources to keep checking, don't you?
whenever you take a new job, you have to learn new standards of care, new policies, new protocols and new politics. it is never good politics to tell folks at the new job that they did it better at your old one. it's never good politics to argue with your preceptor, although clearly they're not always right and there are times when it's necessary. (when your preceptor is about to "defibrillate" artifact, for example. or when the "fentanyl" she is picking up to push is clearly labeled "phenylephrine".
i don't see anything positive to be gained by telling your manager that her staff's standards aren't up to yours, either. but you do as you need to . . . if your new colleagues decide they don't like you, it's no doubt because they're all "eating their young."
hole in tubing......balloon rupture.....bad connections.......major equiptment failure........leaking tank/cannister or bad seal/connection to cannister.....can you hear it? if so it is an external problem if not act fast it may be a balloon rupture
As a recent grad, I will say that I believe - and I'm going to get flamed for this - that the old ADN way of being ON THE FLOOR and by the end of your training taking and managing a full load of patients was better.
We get a lot of theory and test-taking skills and not nearly enough hands-on. Not NEARLY enough.
i find some of the posts on this topic very interesting to say the least. i also see that there is an underlying tone of anger towards nurses that have more experience. i can understand this, but believe me, not all "older, experienced" nurses have forgotten what it is like to be new. that's why many of us, myself included precept and volunteer to work with new grads to help the transition.
my question comes not from their lack of organizational skills or the ability to handle more than 1 or 2 patients, but from lack of basic nursing skills. after 2 or 4 years, this is based on the program graduated from, many of these new grads still do not know how to use a manual bp machine, baths are things they try to avoid. bed making? forget it...the sheets are sideways and the patients are left up in the air with the siderails down. syringes are left on top of carts and the 5 rights are something used by police before an arrest.
this is basic stuff folks!!!
oh,by the way... the new grad that was drawing up 5cc of regular insulin was an honor student with an attitude. i had given her the job of checking the patient's fingerstick ( which, by the way she had no clue as to how to do), and drawing up, but not giving; thank goodness the insulin appropriate for coverage. i would be checking it and then going with her to give to the patient. she had nicely drawn up 5 cc of regular. she also had to use mutiple vials to do it. i hope they teach that this alone should be a red flag. after seeing this, i asked her why she drew up so much and she insisted she was correct. i had to review units vs cc with her. *****scary stuff!****
Here is some info about a conference that will be in Toledo in October.
Dear [interviewer's name]:
Thank you for your 4/17 letter. After careful consideration, I regret to inform you that I am unable to accept your refusal to hire me at your facility. This year, I have been particularly fortunate in receiving an unusual number of rejection letters.
With such a varied and promising field of candidates, it is impossible for me to accept all refusals. Despite Acme Inc's outstanding qualifications and previous experience in rejecting applicants, I find that your rejection does not meet my needs at this time. Therefore, I will initiate employment at your facility effective immediately. I look forward to seeing you, then.
[add your signature here]
*Have a great evening and sleep well, allnurses!
After 20 years I have worked on a lot of different types of floors and some of the easiest bored me senseless.
I have to say for me personnally the best places I have worked are the place where there is a good working atmosphere where you feel supported by staff who are educated and informed.
Where there are students who keep you on your toes, and keep you up to date with the latest research.
Where 'the open door' is really open and you can bounce idea's off your manager and feel supported and encouraged.
Where you get up in the morning and are actually looking forward to going into work and not feel sick at the thought.
and lastly a place where you feel valued, respected.
i'm sorry, but i'm not understanding the problem?
who gives a flying fig if this nurse is an rn???
nellie is your boss!
and the rn's boss as well!!!
with 42 yrs experience and a title of "clinical manager", you politely tell that new nurse to take any concerns to nellie.
what a brat.
All of my nurses know that you NEVER pass a call lite and they are just as capable of toileting someone as the CNA's. Yes, the nurses have work that the CNA's can not help them with BUT, a resident needing to use the bathroom is more important than any piece of paper. I answer lites when I am on the floor, I feed, toilet, you name it. I was a CNA back in the 70's and still am plenty able to still do the same work.
I interviewed an LPN several months ago for a noc shift position. She stated during her interview that she does NOT go on rounds, or change any resident as she was not trained for that. I told her it was expected of the nurse and she would not be hired. The interview ended there.
I could go on about this but, I think everyone gets the drift.
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