Latest Comments by CASTLEGATES - page 4

CASTLEGATES, ASN, BSN, RN 6,675 Views

Joined Aug 27, '09. Posts: 433 (40% Liked) Likes: 482

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    Quote from GilaRN
    Unfortunately, addition is a small part of the process as you have to know the proper formula to utilise and how to perform a dimensional analysis. This typically involves multiplication and division with a touch of basic linear algebra.

    A spelling error may cost you some money and pride; however, I do agree that screwing up a dosage calculation is potentially fatal. All the proper spelling in the world cannot make up for a lethal medication error. Both are important concepts; however, I can appreciate the underlying concern regarding mathematical errors. Of course, the OP could have simply come out and explained his/her stance instead of nebulous one liners.

    I am getting old and dense, and have great difficulty reading between the lines sometimes.


    Utilize

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    LovebugLPN likes this.

    We've got tons who can't spell, either. I don't understand how they get through a university if they can't spell basic words!

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    There's also the phenomenon where the same consistent dose begins to illicit withdrawals unless the dose is increased. My brain is lacking the term at the moment but it's seen with many opiates. Here's an article on dispositional tolerance-maybe that's it.

    One does not take into effect the liver exercising and metabolizing it more rapidly as it gets used to being hit with opiates over time (which is why some can pop 20 percocets and not die while a non chronic user, the acetaminophen would kill them-their liver gets accustomed to breaking down acetaminophen).

    http://www.toxicologyassociates.com/...0TOLERANCE.htm

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    mountainview210 likes this.

    Narcotics Anonymous Basic Text
    Alcoholics Anonymous "Big Book"
    Gorsky-anything he's written regarding relapse prevention
    Staying Sober
    Living Sober
    Codependent no more

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    zephyr9 likes this.

    My opinion doesn't matter since it's a federal program (too big for me to change so acceptance is easier for me).

    It's a harm-reduction treatment for chronic relapsers. 1. it wakes up the "monster" and may promote drug seeking
    2. on the other hand it may prevent drug seeking.

    individual experiences very so much that all opinions are spot on :O)

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    PNCC2001 and LadyTiger44 like this.

    One thing I've seen with an upswing is the resentment for "therapeutic communication" ...You know that mirroring that came out in the 80's that angers intelligent people "I hear you saying...." Validating, so to speak. I've had a couple dozen say "If they do that crap on me again, I'll snap"! If you've ever gone to a marriage counselor, shrink or therapist, it does irk you and feels demeaning like you're a psych case and they're not REALLY listening. Hey, I did it, too-it's how I was taught!

    What PNCC2001 said above; these are people! You don't pull that crud on your family when they've got challenges. I listen to them, say "That makes sense" or wrap it up in a gist statement using whatever relaxed communication skills I have (I use humor and slang-whatever it takes to get them to smile) as long as they know I "get it" they'll open up more.

    I also say "I can relate to that a lot." I also ALWAYS tell them they're a good person with lots of potential and this is just a gas station for a refill or an initial fill up but the road test is once they get home. We give them the tools they need but they need to bring them in their belt and learn how to use them.


    As long as they get the point you heard them and are genuinely interested. I never parrot what they just said saying it again.

    I never forget they're my neighbors and related to me given enough genealogy. It's never them and me, it's we as a community trying to help others move up and make our community stronger. We've all got to live, drive and work together at some point!

    just my two rusty cents :O)

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    k31kozumi likes this.

    One point; I've gotten many jobs because I asked for the interview; ask to get in there and interview and acknowledge they may have already had a decision or a preference. Many have better offers or no shows and they just might like you better in person than on paper. Tell them you're recovery friendly and how you get along with others. Most are full of dysfunction so accenting your stabilizing factors is good. I can count several staff on board who also asked just for a quickie interview and are working there. You never know what's meant to be till you do the footwork and see. I'd ask to talk to the manager (your would be boss) cause they have clout over HR. It can't hurt; costs nothing to see if this is the one for you :O)

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    k31kozumi and mustlovepoodles like this.

    Then you're familiar with addictions! Kudos! The challenge you'd likely face (I'd say) are of codependence, then. Many families are challenged with that. Don't let it skew your judgement and you'll be just fine. We've got lots of staff who love addicts because of being family and they've come around to making healthy decisions. Same goes for those in recovery; setting limitations, etc are key.

    It takes time. If you've gone to meetings and you "get" the winning by losing concept and letting things go, you've got most of it. I find I can apply any part of the 12 steps to any part of my life including work. I stress about staff who got fired, staff writing each other up but as a whole it's not MY problem and I'm just doing the next right thing and I need to be reminded "when in doubt, do nothing." I guess that doesn't count for prescribing, though (hahaha)! When in doubt, call your doc :O)

    Communication and preventing staff splitting seem to be the major challenges (and those in recovery who are insane and not working their program for healthy decisions).

    Imagine your family members affected when you're treating. They're human and they've been robbed of their coping skills. One point; you can't disgnose in the middle of PAWS since some will present with schiz and bipolar when it's judt acute decompensation with someone who's got no skin and no coping substances. Crutches like trazodone, etc help depending on how long your program lasts...that's my 2 cents! I love the field and the chaos...staff are sick in every place I've been to but acceptance is key...stick on their side and they won't forget it. Betrayal or thoughts of betrayal to staff working in addictions can cause lots of dysfunction. blah blah blah :O)

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    nursing rotations would kill you if you've got issues since all rotations including code brown need to be done in school

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    I wouldn't know; I'm highly unethical and immoral. :O)

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    fiveofpeep likes this.

    I have decades and I agree that's years of experience is BS with this power trip catty game common in this field. Patients name, SS# address, picture and anything else that will anger JCAHO is OK in my book (kidding). Some places put a rolling shade over the board so other patients aren't privy to it and place it in a secured room.

    I suggest water boarding for those posting years of experience. Newbies after about 2 years are sharper cause they've got the latest stuff out there than what I did during the civil war.

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    Disregard for the law is a trigger for mental health and society issues (safety). Having said that, there's no assault or murder attempts most are OK but in any case when these questions come up, call the board. The board will be able to tell you now better than what we can recollect when we were being licensed.

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    I worked with a mental health NP who did that, was on meds but also wouldn't recall verbal or phone orders so I told her I could no longer take orders from her and dealt with the doc. I let the doc know her recall was poor....but she was a magician with the meds. Just keep yourself safe, stay away. Report to the board if it becomes a safety or licensing issue and they'll have her evaluated.

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    Regarding the study; it's perceived autonomy. It's the nurses digression whether or not to alert the doc and flexible sliding scale orders may be classified as dependent but the orders are open to your professional assessment. In that respect, ICU over ER for my experience had it hands down. I was following orders but making more critical judgments of what and how much to follow. My ER days, doc says do it, it's done then they move on. ICU it's up to you what pressor to use (sometimes the orders give you a choice of pressors and choices of drips and you match to what the UO, CO and swan are reading...all depends on the facility and trust of their staff.). Wean to extubate...how much peep to drop? What settings? We did all the vents, too so it was wide open. We did call resp to extubate once we had em on blow by though. We'd call the doc (per orders) to remove CT's once output reached X or less, etc. It was a lot of work, lots of thinking but fun. I think it all depends on your sliding scale orders and if they depend on them. I'd say it's impossible to do a study since facilities vary and states vary so vastly with what you can and cannot do. The state I'm in, we can't do squat...a couple states out west, you ran most of it.

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    12 hour shifts don't use any less staff than any other shifts; they make the numbers equal out regardless (unless there's overtime). I've been at it a couple decades...throw all the shifts at me you can! Gimme doubles 5 days a week in this economy and I'm happy! Over 12 hours the mistakes do rise substantially. It's too bad we can't to it where I am; the union has infiltrated like a cancer! I used to love Fri Sat Sun 12 hour nights and get the differentials with plenty of time to wrap it all up by the end of the shift.

    Once the economy settles, I'll have more seeking power to find a place that offers 12's. For me, not offering it is a deal breaker...unless they can be flexible. More than half the staff want it but the oldsters are stuck in their ways (wait, I'm an oldster)! They can do the clean up shifts, though since typically 6 12's and an 8 make it a pay period put the 8's in to back the other odd 8's and everyone's happy. I've done scheduling lots; it's just a matter of giving staff what they want and everyone's happy. Self scheduling is the way to go for staff retention....my opinions, though...everyone's got one :O)


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