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MunoRN 43,532 Views

Joined Nov 18, '10 - from '.'. MunoRN is a Critical Care. She has '10' year(s) of experience. Posts: 8,053 (70% Liked) Likes: 20,348

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  • Jul 8

    Does that seem like a weird category title to anyone else? Isn't it kind of like opposite meanings? Is it like 'Miscellaneous"? Or am I misreading it?
    It's not important, really, but I'm just curious.

  • Jul 6

    Quote from josierickson
    Try working in EMS for 15 years and nursing for 7; you'll get it then....
    Sorry, there are people with way more experience than that who don't think that's ok outside a private conversation. A person's concerns has nothing to do with the number of years they work. Neither does aquisition of professionalism.

  • Jul 6

    Quote from Luckyyou
    I think it's funny. But I'm actually a nurse, and you're.... not?
    What does being a nurse have to do with her concern? Would a doctor wear a t-shirt with that on it? Or think that was ok to say outside a small circle? Dark humor is used by some to cope, but not publicly. As health care providers, we must maintain a sense of public decency. Frustration and stress does not give license to say and do whatever we want. I've worked in a unit where dark humor was used all the time, but never out in public.

  • Jun 16

    Quote from LovingLife123
    They were probably already declared dead. Brain death and cardiac death are two different things. If the organ team was involved, that child was probably declared dead a long time before extubation. The child was being kept alive while the organ procurement team was getting all their ducks in a row, which can take days. But in those instances, death is declared after a brain flow study has shown no activity. With an anoxic injury, that often happens.

    That's why I'm saying there is more to this and the coroner screwed up by not understanding the process. We all need to not place judgement unless we were there and know the details of the case.
    You clearly did not read the article. This was a donation after cardiac death case.
    Physicians at UCLA's pediatric intensive care unit told Cole's family that the child was not brain-dead but "would never recover normal neuro function and ... could never awaken," according to an entry in his medical chart.

  • May 9

    Quote from elli3
    Hi, im a nursing student so forgive me if this question is a bit elementry.

    If a patient has 2 separate orders for Norco that read:

    Norco 5/325 1 tab PO Q4hr PRN Pain (4-6)
    and
    Norco 10/325 1 tab PO Q4hr PRN Pain (7-10)

    Is it ok to give a patient a 5/325 2 hours after giving them Norco 10/325 if the patients pain is still in the (4-6) range. Do the orders stand alone or not?
    You have every reason to be perplexed by these orders. They are confusing and will be interpreted differently by different nurses which makes them unacceptable.

    I could easily rationalize giving Norco 5/325 then two hours later give 5mg hydrocodone (if the patient's pain had gotten worse) and "restart" the 4 hour time as if I had given the Norco 10/325.

    I could also see a scenario where you assess the patient's pain every 4 hours and give one or the other Norco then wait 4 hours to assess and decide again. Thus giving the Norco 10/325 every 4 hours would result in the patient receiving 1,950mg of acetaminophen and 60 mg of oxycodone in a 24 hour period.

    If these orders were to "stand alone" , the patient could receive 3,900mg of acetaminophen and 90mg of oxycodone in a 24 hour period.

  • May 2

    No, you aren't a moron. The morons don't ask.
    Welcome to AN!

  • Apr 30

    Why are travelers not an option? The difficulty with your suggestions is, it's really not the staff's job to cover the floor by picking up extra hours. Working their agreed upon FTE is.

    Call-in/pickup bonuses could help, since it would then benefit the employee to work extra.

  • Mar 17

    The Health profession and nursing training program is much more than providing loans for nurses. In fact only a small portion money is allocated as loans for nurses, and those loans require a 2 year service in critical shortage areas. This program is designed to help resolve health care disparities and ensure a future supply of healthcare workers. https://www.aamc.org/download/428928...stestimony.pdf

  • Nov 15 '16

    Many national and state hospital associations have model guides or policies on this issue. For example, here is Washington's: http://www.wsha.org/wp-content/uploa...Acceptions.pdf and here are the guidelines from the AHA: http://www.aha.org/content/00-10/gui...easinginfo.pdf

    Most of these guidelines follow the HIPAA requirements, which are protective of PHI. Generally speaking, I would only allow nursing staff to notify law enforcement of a fugitive if the nurse has a reasonable belief that doing so will prevent or minimize an imminent danger to the patient or any other individual. I would want to see that reasonable belief articulated in the chart and to have the nurse check with me, Compliance, Privacy or nursing leadership first.

    As for the OP, most hospitals do already have a policy on this: it is typically written and administered by Medical Records, Compliance, Privacy or Risk.

  • Sep 17 '16

    This has been done in LTC facilities all over the country. Many states have alarm elimination initiatives for LTC.

    The evidence shows that falls did not increase when facilities eliminated alarms. In fact many facilities reported that falls decreased when they eliminated position-change alarms. (The evidence on whether it decreases falls is weak. The evidence that falls do not increase is strong.)

    To quote one study "We took a tiered approach to removing positio-change alarms from our facility, monitoring the fall incidence rate for a period before, during, and after the elimination of these alarms. After discontinuing their use, we found a decrease in the rate of falls, and a decrease in the percentage of our residents who fell. Staff has easily adapted and reports a calmer, more pleasant environment."

    Another study says "Using real-time information provided by falls incident reports the ADON tracked and trended data on a monthly, quarterly, and annual basis. During the final quarter of 2005, that encompassed the months of alarm reduction and increased resident monitoring on the target unit, there was a 32% reduction in the quarterly average of falls for this unit, when compared to the average number of falls for the first three quarters of 2005.

    Incidentally, this unit also experienced a reduction in the number of pressure ulcers identified for the final quarter 2005, as compared with the first three quarters of 2005. This could be the result of residents' toileting in advance of need, and more frequent ambulation and positioning, which were a part of the residents's individualized fall prevention plans.

    In addition, there was a 21% decrease in the CMS 'Prevalence of Falls' quality measure when comparing July 2005-December 2005 to October 2005 through March 2006. Both six-month periods shared the two-month intervention interval and subsequent evaluation. Additionally, the Director of Nursing has reported that the increase in activities on the unit has had an impact on the 'depression quality measure.'"

    From MASSPRO a Massachusetts Quality Improvement Organization, "The noise produced by alarms agitated residents so much that residents fitted with alarms did not move at all to avoid activating the alarm. This put them at greater risk for decline. Residents with dementia experienced an increase in agitation when fitted with alarms."

    Quality improvement in nursing homes: testing of an alarm elimination program. - PubMed - NCBI

    Elimination of position-change alarms in an Alzheimer's and dementia long-term care facility. - PubMed - NCBI

    Interventions designed to prevent healthcare bed-related injuries in patients. - PubMed - NCBI

    Nursing Facilities

    Nursing homes find bed, chair alarms do more harm than good - The Boston Globe

    http://c-hit.org/2013/03/20/state-nu...ive-carefully/

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549269/

    http://m.ageing.oxfordjournals.org/c...ng.aft155.full

    The problem isn't that the facility is eliminating alarms. It is that they did not take a planned, systematic approach.

  • Aug 5 '16

    I'm with the posters who've said talking about salary shouldn't be off the table. I don't walk around talking about it, but if conversations about equity and pay come up I'll disclose it. My point when I talk to people about it is always the same - knowledge is empowering. By knowing what people are making we're all empowered to negotiate better.

    When I was a student I asked my preceptors to talk about salary with me so I could get a sense of the market rather than depending on my employer to tell me what I'm worth. The phrase, "my market research has shown me that nurses are making X," is a surprisingly effective bargaining tool. One didn't want to discuss it, and I left it at that. The other agreed with me and asked me to keep in touch. Her information helped me negotiate for better salary, and in turn letting her know the outcome of my negotiations helped her in her next renegotiation. We both benefited. My cohort also shared information on our Facebook group so that we all had access to real-time info about what people were getting offered.

    I don't care if other people don't want to tell me their salary, and it's not something I drop into conversations, but in the context of helping each other out I'll tell anyone.

  • May 31 '16

    Does anyone actually know HIPAA? It is not against the federal policy to disclose patient location, including if they are moved to another facility or unit. You can also give a general condition of the patient. We have been puppets of hospital administration too long- follow the law, and the code of nursing ethics.

    Here are some topics for professionals:

    Disclosures to Family and Friends | HHS.gov

    Here is the law:

    https://www.gpo.gov/fdsys/pkg/CFR-20...sec164-510.pdf

  • May 30 '16

    OP, you mocked a mentally ill patient. You also do not know how the mother has handled him in the past. If you spoke that way to my child, my silence would be from surprise (in a terrible way), and requesting someone else would be reasonable and justified.

    And before anyone here jumps me saying I must be a parent who coddles poor behavior, my children are disciplined when they are blatantly rude. If I don't feel the need to do that in front of others, you wont see it, nor should you have to. They would apologize appropriately the next time you come in the room.

  • May 21 '16

    Quote from Anna Flaxis
    Meh, if you can't beat 'em, join 'em.

    "Well, the g-d Fentanyl didn't do s***, let's try some ******* Dilaudid."



    After an hour the pain relief kicked in?? I think better post-op pain control for your PACU patients would reduce the swearing you find so unpleasant.

    It isn't really okay to ask him, no, not for the sole purposes of addressing your own comfort levels as you've reported. He wasn't swearing at you. Unless it was offending another patient or there was a child nearby, it's a small sacrifice to make. And interestingly, it seems it might help cope with pain as PP's have said.

    Also, bear in mind the meds given peri-op can lower inhibitions, decrease ability to make decisions, temporarily change personalities and also cause loss of memory. As a PACU nurse you must have experienced patients telling you intimate details of their lives that perhaps they wouldn't usually? Similar sort of thing.

  • May 17 '16

    I agree that you might want to talk with a financial profession about your questions ... but here is my $.02.

    Some nurses don't understand the way the US tax system works. As a result, they misunderstand what happens when someone suddenly gets a paycheck that is larger than normal.

    1. The "system" doesn't realize that the big paycheck is unusual for you and that you don't make that much every pay period. So it taxes that paycheck at the rate appropriate for someone who makes that much money on a regular basis. When you eventually file your tax returns, that takes care of itself as your final tax bill is calculated based on your total earnings for the year, not how much you made on your highest-grossing pay period. So it looks like "all of it went to taxes," when in fact, you'll be getting most of that extra taxes back.

    2. Some people don't understand how the tax brackets work. They mistakenly believe that when you are "pushed into a higher tax bracket," that higher tax rate applies to all of your income. It doesn't. That higher rate only applies to the portion of your income that falls into the higher tax bracket. So yes, if the extra income you earn working overtime pushes you into a higher tax bracket ... that money will be taxed at the higher level. But it won't increase the taxes on the money that is in the lower tax range.

    So you will never lose money by working overtime and getting paid extra. It's just that the extra money you are earning might be taxed at a higher rate.


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