Content That Anna Flaxis Likes

Anna Flaxis, ASN 29,164 Views

Joined: Oct 15, '10; Posts: 2,886 (67% Liked) ; Likes: 8,704

Sorted By Last Like Given (Max 500)
  • Oct 22 '17

    Quote from prmenrs
    Hypothetically, put the shoe on the other foot: you've got 30 minutes left in your shift; you need to close your charts out; answer those last minute call lights (@ opposite ends of the unit); check your charts in case some [damn] doc has sneaked an order in there you missed; gather your thoughts and brain sheet for report; take Mrs. "I can't go, Nurse!" off the pan for the eighth time today; check a blood sugar on Mr. "I don't feel so good."

    Night shift is drifting in; an admission takes 45 mins to an hour, minimum. How would you feel, getting a phone call for an admission? Seriously, you've just handed him or her an hour's worth of work, paperwork to follow. You also know this will put you overtime, for which admin will now question your parentage.

    I'm just saying give the freshly resuscitated customer a couple of moments to be monitored and then transfer him/her.
    While admin questions your parentage for taking to long to get the patient upstairs.

    Plus the 20 patients in the waiting room are getting mad for the 3 hour wait, and EMS is standing in the hallway waiting for that bed for their stroke patient.
    I have 30 minutes left on my shift as well, but need to get this one up so I can start the stroke patient.
    Plus the other 2-3 patients that still need to be taken care of. Guess what, they have been on the bed pan 3 times in the past hour and "just can't go" (or have been given lasix and keep going), one needs a blood sugar re-check since his sugar was 32 when he came in and it has been 30 minutes since the D50 was given, and stat orders just placed on all of them as well.

    The gripe is about floor nurses asking questions that don't matter to an ED nurse and truthfully nothing we can do something about, not about getting the patient upstairs.
    Nothing against you, but your post is a perfect example of what is being griped about.

  • Sep 10 '17

    Quote from suzil
    BTW, yes I also worked the ER and we WERE EXPECTED TO CHECK THEIR SKIN TOO!
    Yes, some places expect you to do a full head-to-toe assessment on every ED patient. Do you know why that is? Do you know why your employer may want you to listen to the bowel sounds of someone who limps in with a rolled ankle, or auscultate the heart sounds of someone who is there for a mosquito bite?

    It isn't because the worst case can happen every where at any time...

    I'm an advocate of the "appropriate" assessment as opposed to "a full assessment." In fact I think an carefully-considered, appropriate assessment is a full assessment (in that everything reasonable to consider has been considered), but a full head-to-toe assessment may not always be appropriate.

    If you know the answer to my questions above, then you will also understand why a full head-to-toe assessment can actually be done for mostly unethical reasons, as opposed to honestly needing to do a full head-to-toe assessment because a patient's condition warrants it.

    That's getting a little off-topic as far as people who "never" use a stethoscope, though.

  • Apr 6 '17

    Quote from blondy2061h
    Ativan 0.5-2mg IV or PO PRN nausea, vomiting, pain, anxiety, insomnia, patient request, RN discretion, or any other complaint

    Pharmacy didn't verify that order for some reason
    Former night nurse here. I can dig that order.

  • Apr 6 '17

    Well, now she might (know the real Paco USA was standing right behind her)

  • Dec 23 '16

    I think it's a real mistake to believe that an orientation is intended to be an all inclusive training program for a particular unit. Putting that notion forth just leads to unrealistic expectations on the part of the new nurse and the unit.

    The real learning occurs once the ties are cut and the new nurse starts taking patients. The idea that someone could be completely and adequately prepared for a Tele unit in even 12 weeks isn't reasonable using that logic.

    New nurses should be scheduled on days so there are plenty of resources around to help, but after more than a month of hand holding, it's time to leave the nest.

  • Dec 7 '16

    Quote from HMNguyLVN
    Wow , what a Jerk, Jerk Off, and yes PA are not MD should call him by his first Name.
    Always address people in the work-place by appropriate title, or by what they request you to address them as. A lapse of professionalism by one person does not rightly begat that of another.

  • Dec 6 '16

    Quote from lnvitale
    I see people complaining about the amount of NPs being created, however it is good that nursing is addressing the problem of healthcare provider shortage. .
    Speaking only for myself I'm not complaining about the number of NPs being created what I am complaining about is the lack of RN background, lack of criteria for appropriate applicants and superficial education that I, as someone who went through 2 well respected brick and mortar NP programs, believe NP programs are lacking. It disgusts me to hear this justified due to a lack of providers and time frames they are trying to fill to meet these needs. This is especially disturbing to me in my specialty, psychiatry, where we are treating particularly vulnerable patients who need and deserve quality prescribers who actually know what they are doing.

  • Dec 6 '16

    Family doctors are more critically needed than ever. NPs are not the equivalent to an MD no matter how much some think they may be.

  • Dec 6 '16

    Quote from AAC.271
    Wow. There are more people applying than residnecy spots? How is that possible..... we have a physician shortage so why do they keep it so low on purpose tou have toask.
    To protect their profession from becoming over-saturated and easy for anyone to get into, unlike Nurse Practitioners have.

  • Dec 6 '16

    Quote from Anna Flaxis
    Assuming this is not a rhetorical question, to put it simply, the smaller the sample size, the less precise the information is.
    I understand, and agree with everything that you have said in both of your previous posts. If we are going to continue to teach this paradigm, then yes, further study should be done.

    The problem is this. No one seems to know where this came from, and why it was originally included in the ATLS curriculum as there is zero evidence to support it. Nor does anyone seem to know why it was removed. Unfortunately, both medicine and nursing continue to believe, and teach it.

    And thus the intent of my previous post. Don’t you think that there should be some evidence behind what we teach and practice?

  • Nov 22 '16

    Quote from HeySis
    How about we talk to our patients instead of each other, ask them about where they live, what they do, who's waiting for them? do they have kids?

    So still an easy and relaxed conversation and they are not just listening in, but participating.
    I'm trying hard here to not get annoyed at the suggestion "how about we talk to our patients instead of each other". Perhaps you didn't mean to sound condescending but that's how I interpreted the wording "how about" and perhaps you weren't implying that I don't talk to my patients and ask them questions. I specifically wrote that I do talk to my patients. I've done many
    c-sections lately. The surgical drape prevents the patient from having the surgeon/OB/gyn, OR scrub nurse and nurse midwife in her direct line of sight. The patient usually see their surgical caps above the drapes, but that's about it. The surgical staff of course mostly have their eyes directed at the surgical site but even if they were to turn their heads in the patient's direction and address her, the patient wouldn't see their faces. I however for obvious reasons sit next to the patient's head on the non-surgical site side of the drape and can speak to my patient and have eye contact with her. So yes, the patient and I generally have patient focused discussions. Sometimes just chit-chatting about mundane/everyday topics like for example the questions you listed and sometimes if the patient wants to know; explaining how the surgery is progressing.

    Some patients actually don't want you to talk to them and they don't want to answer questions but prefer to just listen to what others are saying and some want the room to be as quiet as possible and just relax/doze off. Some want to listen to music but no conversation. They/we are all different.

    If the patient clearly expresses that hearing the rest of the team chatting away is soothing/ comforting as it reassures the patient that the surgery is undramatic, I'm not going to fault the team simply because it doesn't meet some people's idea/standard of professional behavior. As always, it's of course important to talk to your patient and find out what he or she prefers. The patient gets to decide.

  • Nov 22 '16

    I agree with previous posters that discussing the outcome of the election in front of patients was inappropriate. There are some potentially divisive topics like for example politics and religion that are best avoided altogether in the workplace, especially so in front of patients.

    Not to defend the staff who discussed the election, but I do wonder if the fact that the campaign had been so vicious and the voters so polarized might have contributed to the inappropriate conduct. Less than 24 hours after the result was in, I assume many people were still reeling from shock of the election outcome. It might have made people who wouldn't normally talk about things like politics in front of patients become more "loose-lipped" as they were processing the result of the election.

    As I've already mentioned, I don't think that politics and religion are ever suitable topics for staff to discuss amongst themselves in front of the patient. But I do think that there are times when staff discussing less incendiary topics in front of patients can actually be beneficial. Of course it depends on the patient, we all have different preferences but as a nurse anesthetist I find that patients often find it calming when the medical team around them are relaxed enough to discuss their dinner plans or child's birthday party or whatever. I've had many regional anesthesia, minimal or moderate sedation, surgical patients express that they get scared when the team is all quiet and focused on the job. Even though I'm talking with my patient, the silence from the rest of the team, makes the patient fear that something's not going well since the team is concentrating so hard instead of talking and sounding like they're having a routine day at work. Some patients certainly prefer this quiet focused on the "task at hand" approach, but some definitely don't.

  • Aug 31 '16

    Something I have learned from my experience in the diagnostic role: you miss some. You do your best but some will still surprise you.

  • Aug 25 '16

    Quote from Been there,done that
    Per NIH "no compelling evidence for routine cultures or empiric treatment with antibiotics. Further research is required." This is my kid we are talking about. Use sterile procedure, culture that green and yellow stuff, determine if and what antibiotics are necessary. I would expect the same for my patients.
    I don't have time right now to research it, so I can only offer anecdotal "evidence." We had a male in his late teens who had an abscess in a sensitive area. Surgery was called to I&D it. After the procedure the ER doc asked the surgeon "what antibiotic should I discharge him on?" Surgeon replied "I just drained the abscess. Why would he need antibiotics?" No culture was sent. In the absence of cellulitis, I see almost no one from the ER sent home with ABX (or having had a C&S done) with an abscess I&D.

    FWIW, the surgeon did use sterile technique.

  • Aug 25 '16

    I do I&D's as a clean procedure. I do not culture or script abx unless there is a complication.