Latest Comments by Whit2389

Whit2389, RN 1,178 Views

Joined Mar 11, '10. Posts: 30 (47% Liked) Likes: 21

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    I would imagine that if it's one of your patients you are to go out but not all the patients will have the same nurse on call. Just my guess. And a lot of places only reimburse if the drive is over 30 miles away. Definitely ask for clarification.

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    Perhaps you could have an A1C results as a goal instead of accuchecks. Or ask the facility to print you a copy of the glucose levels.

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    tsm007 and vintagemother like this.

    You need to chart relevant information. If a patient fell but not on your shift then he/she is being followed up on r/t fall. You need to chart the specific situation going on, the relevant assessment findings, and interventions to prevent the issue from happening again. Falling is a safety issue. You could state something along the lines of "Mr. Smith fell yesterday at 7:00AM, neurochecks continue and are WNL. Patient in bed resting with no s/s of distress noted at thos his time. Bed is in low position and call bell within reach at all times"

    If the patient were to fracture their elbow during the fall and is having pain then instead of no s/s of distress you would chart "fall resulted in a fracture of L elbow. Pt states pain level 8/10. 3mg Dilaudid administered PO per MD orders at 1300. At 1400 pt states "pain is 3/10".

    If the fall results in an open wound then you either say you did whatever the doctor ordered (wound cleaned with NS, dry dressing applied per MD orders) , if it didn't fall on you to do the treatment then just chart that the bandage is intact.

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    icuRNmaggie likes this.

    I. Going through the same thing. I struggle with the 6pm-6am shift, but the only difficult part is the 8pm med pass. Like you, I am responsible for all the things you listed. I have a different "preceptor" every time I train. I only trained for 4 days before they tossed me out on my own. I told them I needed one more day of training and I requested to train with one of my favorite nurses there. I asked her if she would teach me a "real world" med pass and show me the tricks of the trade instead of going by the book so that I am not drowning. My first 8pm med pass wasn't done until after 1am. If she passes me on any great tips tomorrow then I will share them with you. Good luck and I really truly feel your pain! (By the way on the 6pm-6am shift I am the only nurse and no med techs, anywhere from 40-55 patients and about 10 scheduled mess each, plus prns, breathing tx, finger sticks, blood sugars, and gtubes).

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    I'm a home health nurse

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    Quote from dreamer30
    Did she have the anemia or just the disease? I was told there is a difference.
    She has type SD. It is a variant form of Sickle Cell Disease. There are several different hemoglobin variants,however they all receive the diagnosis of Sickle Cell Disease and the majority of them consist of anemia. My daughter does have the chronic anemia, her baseline hgb is 8 but has gotten as low as 3. With many of the variants you will see that some of them have more immune system issues. Sickle Cell Disease is also more severe in people with asthma.

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    OCNRN63 likes this.

    Quote from ChronicSG
    So I finally start tomorrow with a preceptor! Let's just say though that I started goin. To my unit ahead of time to meet the nurses. They're all seeming to be fantastic. They're already warning me though about the sickle cell patients...
    What did they warn you about sickle cell patients?

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    Quote from dreamer30
    I agree with what everyone else said about SC pts being in constant pain and you are not the nicest person when you are hurting but it doesn't give u the right to be rude to people.

    On the other hand maybe they are mad at the world because they have SC. I would be. It could have all been avoided if there parents would have taken the time to just ask if they have that gene. I'm an African American female and when dating I always ask if it runs in the family.
    Very true, but it's not always that simple. When I was tested for sickle cell trait I was told I did not carry it. My daughter was diagnosed at 14 days old with sickle cell disease.

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    Not_A_Hat_Person likes this.

    Quote from Cola89
    It's probably more of a cultural problem than a sickle cell problem. Rude people.
    Because people without sickle cell aren't rude?

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    Not_A_Hat_Person likes this.

    It's because children with Sickle Cell are taking more serious than adults because they are not perceived as drug seekers. This came straight from both my children's hematologist, as well as our regional Sickle Cell Social Worker. They see a child in pain and they see pity, they see an adult in pain and they see a drug seeker. These children are often directly admitted to the hospital if it is after office hours, no emergency room necessary. However, at 17 they are bumped to an adult hemotologist and therefore they visit a regular hospital and not a children's hospital.

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    Please tell me what test there is to check for an active crisis.

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    Quote from RNinIN
    Not necessarily on am pill pass. I work prn at a facility where they have scheduled multiple residents to have all morning meds at end of 3rd shift. Makes for a full med pass. And too many things given together that shouldn't be. And some like levothyroxine and omeprazole that should not have 10 others given with them, crammed together so that day shift nurses don't have it so rough. DON states that how it is to be. I quit trying to change things back as they always reverse my changes and I'm only prn. Medical director even told me to not lose sleep over it.

    Oh wow! that's, odd.. I could see if the shift ended at 7 or 8, but not at 6. You'd think they would just have you guys take on other things such as finger sticks or medicating the early risers only.

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    I'm still in orientation. Our night shift is 10p-6a.

    When we first arrive we do narc count, clear off the med cart, receive medications from the pharmacy delivery guy & do the paperwork on those and fax them to the pharmacy. We do our 11:00 med pass anywhere from 10p-12a which mostly include sleeping meds, antianxiety meds, and pain meds. We make rounds, do the midnight census, check our wanderguards for our wanderers, etc.. Make sure our pt who get O2 at night or use cpaps are all set up. We do neurochecks if a patient has fallen and chart on them, chart on our medicare patients, chart on anyone receiving antibiotics, etc.. hang IV fluids or medications. We do a 24 hour check on all new doctor's orders (get the order, compare it to the mar, mark that it was checked and correct or mark if it needs to be clarified). Trust me, the doctor does not want a 2 AM phone call about the correct dose of simvastatin on a stable patient. So then we have gtube & peg tube feedings. Sometimes an Alzheimers or behavior patient will cause a huge ruckus and wake up half the hall so we then try to meet all those patients requests. We write lab orders into the lab book, the lab lady comes at about 4am to draw blood but we have to draw if it's from a picc. A lot of times we will also be asked to draw if the pt is combative or a hard stick. We complete any incomplete admissions paperwork or duties that show up red after midnight (which means they weren't done by other shifts). Defrost the refrigerator, check equipment (glucose machines), check refrigerator temps. Begin AM med pass between 4a-5:30a. Complete trach care. Document, prep patients who have appointments in the morning (get their charts copied, showered, dressed, etc..). Get our early risers up. If the oncoming nurse is running late then we start blood sugar checks. Every once in while there will be a wound treatment but most the time we just check the bandage and reinforce as needed. And that's just off the top of my head, I'm sure I'm missing some things..

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    ASPIRING2BGREAT likes this.

    Btw, I too just started my first job at a LTC facility. They told me 3 to 5 days orientation but I told them I definitely wanted 5 and would let them know if I was ready then. I spent all of 4 days taking extreme notes, asking a million questions, training with 4 different people. Tonight is my first shift on my own, and while I am SUPER nervous, I do feel prepared. I trained on 2nd shift and hated it. Third seems to much better for someone new at LTC.

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    purplegen1 likes this.

    If they are understaffed then odds are they will end up wanting to float you from hall to hall. If I were you I would request two days of training on each hall, then inform them of the hall you feel most comfortable on and tell them you want one more say of training on that hall. That's what I did and I found it very helpful to learn how the entire building functions as a unit. Each nurse does things differently and it was helping seeing how each nurse did each thing differently. I also ended up training on a different shift one time since there wasn't anyone to train me on my primary shift. This was helpful too, and also gave me the comfort of knowing I wouldn't freak out if I had to work a double on a shift that is not my regular shift.

    If you don't like passing medications then see if you can switch to 3rd shift. Most medications are scheduled during the day, so night time med passes are much smaller. Usually a few pills passed right before bed (ambien, anti anxiety, etc..), and then in the morning you may have thyroid pills and protonix (anything consumed on an empty stomach), plus prn pain meds or duonebs through the night. This leaves more time to go through patient charts and get to know your patient and learn about their disease processes. Once you become comfortable with knowing your patients, becoming more oriented to the unit, etc.. you can switch to a different shift with a heavier medication load.


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