Indy 8,107 Views
Joined Apr 27, '04.
Posts: 1,485 (26% Liked)
Okay, so ... when I draw a med, if it's insulin, the needle is permanently attached to the insulin syringe. You can't take that one off and put another one on. So yes, I gotta recap it to walk to the patient's room with it. Afterwards, the flippy thing gets flipped, so it's safe between the injection and the throwing it away. I may ask my preceptor about the possibility of drawing the insulin at bedside; however I worry about forgetting to put the bottle back in the fridge.
The lovenox syringes are a horror in and of themselves. Oh wonderful, they have the automatic button that sends the protector flying out over the needle -shoop!- but the caps are stuck like superglue, and the needle is teenytiny and very easily bent. So uncapping it, for the first time, is unbelievable. I still can't figure out just exactly how much strength to use to get the thing OFF without damaging something else (needle, my fingers) in the process. And if you screw it up, it's a counted drug that you can't use in a different syringe - so throw the whole thing away and sign off on it. Not to mention the paperwork if you stick yourself.
Now, when using a regular old syringe to draw up a med, yes, I change needles afterwards. However, I have been taught to scoop-recap, use the cap to twist the old one off and throw that in the sharps container. I know from phlebotomy that you can stick the needle in the little groove on top of the sharps container to twist it off without recapping, and it drops neatly in the container. But umm, that thing is nasty. I don't want my sterile med coming anywhere near that surface! So how are you gonna get the first needle off without recapping or sticking yourself?
Okay. One year in and I can see in myself the urge to nitpick on others' reports. Bleh. There's a person or two that - they aren't any newer than I am- their reports are so far below substandard that I almost wish they wouldn't tape it. Really. So for these special people I limit my questions to specifics that I know are being left out, each time, that we actually do expect to know and pass on. Such as, telemetry readings have been... ?
I'm desperately hoping the people that leave this info out, will figure it out, after the nth time I ask them, or others ask them, that we need this info. I asked each and every person who was new after me, do you have a good "brain" and do you need one if you don't? I briefly explained the purpose of said "brain" as a tool for organizing both the shift, and the shift report.
Honestly, students have been more accepting of different "brain" formats than the new nurses I've encountered since springtime this year. One of our worst nurses to take report from, seriously blew me off with any advice I had for her, on her first day or two. Being nice sometimes seems to me, that it gets me nowhere. And I can't help trying to be nice.
So. I'd say, definitely try to learn from people that ask you questions about your report. Sometimes it'll be as simple as you missed something because you didn't know better, and that'll be the end of it. That's happened to me a couple of times. Also, try to know what you did and didn't do... as in, no matter whether it's day or night, the next shift really needs to know what is leftover that they need to focus on- before it's so late in the shift that they come close to missing it as well. Such as, Hi I admitted this patient an hour ago and I know x, y, and z about the plan for the patient and did this about it, but you need to take off orders. That's a good way to alert the next nurse that 1- no time to do it all on this one, 2- you did glance at the orders so you have a clue, and 3- what they need to do.
One thing that makes me itch is people who read the MAR's or admission form to me. Eep. I can read. Tell me, if there's a new med that I need to know about before I have time to look at the MAR, or what the drips are, but otherwise... if it isn't outstandingly different or unusual, no need to read the MAR. Of course there are some old school nurses who read the MAR and consider it a perfectly acceptable way of reporting, but I've worked with them and I see through that. In my mind if that's all I get from any nurse, I'm thinking they actually don't know jack about their patient.
Ok. Now that I've gotten that off my chest, and seen a little from the picked on, and the oh-god-I-wish-that-nurse-would-give-a-decent-report side of the fence, by all means take the other posters' advice and don't let people interrupt your report or make you feel bad more than once about the same thing. There are some people you truly can't please.
Maybe also take a serious look at your job and the amount of stress you are dealing with. Is there a way to change that? I came to work one day on the unit that I eventually left, saw the staffing, got really close to tears while talking to the offgoing charge nurse about it. He said, not unkindly but sorta bluntly, "well if that's the way you feel, you really should look for another job." It was good advice.
The key for me to get resps counted in the volunteer clinic that I worked in, was the old thermometer. It's an ivac, but it used to take a minute or so to read. No one wanted to use it but me. While the pt's quiet, I look at 'em, smile, look at watch, and when done, resps are correct.
I dunno if the providers even looked at the resps in the VS section, but hey, I was a student, and it got done.
Another method: if you're using manual bp cuff, you're probably taking a radial pulse. Simple: just hold the arm after or before you are done and look at resps while they still think they gotta be relatively still.
I've tried ultrascopes, and they sure are cute. I've tried master cardiology too, they feel so nice... I do have to correct you though; something that does not amplify the actual sound beyond normal steth acoustics (i.e., something non electronic) will not help a person who's really got a hearing problem. I tried quite a few non electronic ones and I heard two things: jack and squat. My left ear is conduction-style deafness and my right ear has a combo of conduction problems and nerve damage.
Basically, what that means is the bones are trying to grow together in my ears (those cute little suckers whose names I forget) plus some old people used to like to call me up and scream at me when I worked at a call center for over a year. Fun. So no, ultrascopes aren't the answer to everything. But they're prettier than electronic scopes.
By the way, if you're just a little hard of hearing, do be careful with the volume setting on the thinklabs (or any) scope! Keep it as low as you need to hear, so you don't get used to a volume that will ultimately damage your hearing. I'm having this argument (discussion) with my husband lately. He likes mine, I let him have my old one which barely works, he thinks louder is always better. Okay, so he does have to listen through dog and cat fur, sheep wool, etc. so he may have an excuse.
I don't let people with normal hearing use mine - except for my husband because he talks too much, it's easier to give in. One exception; I have had a couple patients who were older, hard of hearing, and had interesting sounds to listen to, so I let them. :-) Oh, with the electronic, also watch out for verifying NG tube placement. Turn the volume on down further than normal 'cause if it's placed correctly, it sounds like a harley cranking up.
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