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Double-Helix, BSN, RN 30,628 Views

Joined Apr 5, '11 - from 'New Jersey'. Double-Helix is a Nurse, Children's Hospital. She has '6' year(s) of experience and specializes in 'PICU, Sedation/Radiology, PACU'. Posts: 3,312 (54% Liked) Likes: 6,387

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  • 9:58 am

    You would not be "performing a clinical skill you have been checked off on”. You would be providing care to a family member after receiving education from a registered nurse. The fact that you are in nursing school is irrelevant to your ability to perform PEG tube feeds for your father in his home. Your mother could do it, if she wanted to, as could any other member of your family. Unlicensed family members are taught to provide a wide variety of medical skills in the home environment.

  • May 25

    I agree with wtbcrna that it may create conflicts between your license and your job description. Similar to an RN working as a CNA, you are held to the standard of your highest licensure. So if you're in the ER and a patient needs an advanced airway, as a CRNA you might want to throw in an LMA. But your facility may not allow RNs to perform this skill, and you're being employed as an RN. It gets tricky.

  • May 25

    Quote from NurseCard
    Back when I worked with patients going to surgery, nurses would have
    the patient sign the consent, but NOT before the doctor has explained
    the procedure. The consent basically says "Dr Jones has explained to
    me blank procedure, and the risks associated with"...

    That was ten years ago though.
    What concerns me is that the OP stated: "I should have gotten the consent initially".
    This implies that OP thinks the "right" practice was to have the patient sign the consent form before the provider had even seen the patient, much less discussed the procedure. That is absolutely not the correct process.

    Also, the physician didn't notice the missing consent until the patient was discharged. That means that no pre-procedure "Time-Out" took place to verify the correct patient, procedure, and documents were present. This is also non-compliant with Joint Commission requirements.

    Wanna_be, did you realize that consent had not been obtained when you walked in and the procedure was being started? If you did, you're correct that you should have spoken up in the moment. Learn from this mistake and resolve to be more assertive in the future. If you didn't realize the physician didn't get consent, then it was an oversight, but the ultimate responsibility of ensuring consent was obtained belongs to the provider performing the procedure- not with you.

    It sounds like your experience revealed a lot of flaws in the processes in place at your facility. Unless these are corrected, this situation has the potential to repeat itself.

  • May 23

    6 weeks of orientation is not nearly enough for a new graduate in the PICU. If your lack of orientation is any indication of the support you get from the nursing department, I’m not surprised that you’re struggling. It takes, in my experience, at least a year to become competent caring for critically ill children and years to become comfortable. If this were just a matter of learning the ropes, gaining the experience and taking some didactic classes, I’d encourage you to stick with it for another 6 months and see how you feel. My concern is that your facility does not seem interested in giving you the necessary training and education to safely care for these patients. For that reason, you may benefit from gaining confidence in a less intensive environment- or another facility that will dedicate the necessary time and resources to properly training you.

    I’m also concerned that, while you clearly express lack of confidence and comfort caring for children who are intubated and hemodynamically unstable, you state that the “only other place you’d consider” is NICU, where the patients are after more fragile, more labile, and less sedated. IF you found a NICU that would offer you a decent length orientation, you may be successful. But I’m afraid that your unwillingness to consider other areas of nursing shows either a lack of understanding of NICU nursing or a lack of maturity- i.e. being more focused on having your “dream job” than taking the steps necessary to become a competent nurse. What’s more important to you: working in a place that allows you to learn and gain the necessary skills to safely and confidently care for patients, or being able to say you’re a NICU nurse? Think about this before you decide to make a job change.

  • May 23

    You’ll have to check your employer’s policies. Mine will allow exemption for medical reasons. I’m honestly not sure what happens if you don’t get the shot, but I know we don’t permit wearing masks for patient care (unless the patient is on precautions, of course).

  • May 23

    I agree that you need to disclose the situation to your supervisor and have another nurse take over as his key nurse. You are doing yourself and the patient a disservice by remaining his primary caregiver. Your feelings are understandable, and not something you should be ashamed of, though it might be helpful to talk through it with a professional to get to the root of the attraction and learn ways to cope with similar situations in the future.

  • May 22

    Erikson’s “intimacy” doesn’t just apply to romantic partners. What is her social circle like? Even if she’s busy with school and work, she may have a support system of fellow students and co workers.

  • May 22

    I suggest your friend post here and share her thoughts first. Although you state this isn’t a “homework” question, we encourage all posters to do their own research and/or thinking first. So post what you (she) has come up with so far and we can offer direction.

    Or, if your friend is really a new nurse, she should direct these questions to her preceptor.

  • May 22

    I suggest your friend post here and share her thoughts first. Although you state this isn’t a “homework” question, we encourage all posters to do their own research and/or thinking first. So post what you (she) has come up with so far and we can offer direction.

    Or, if your friend is really a new nurse, she should direct these questions to her preceptor.

  • May 22

    Quote from EllaBella1
    I would have paged the surgeon to ask if it was ok and gone from there.
    To add to this, ask the surgeon to put in an order that “nursing may place NGT” and make sure that your facility doesn’t have a policy that specifies otherwise.

  • May 22

    I suggest your friend post here and share her thoughts first. Although you state this isn’t a “homework” question, we encourage all posters to do their own research and/or thinking first. So post what you (she) has come up with so far and we can offer direction.

    Or, if your friend is really a new nurse, she should direct these questions to her preceptor.

  • May 22

    I agree with wtbcrna that it may create conflicts between your license and your job description. Similar to an RN working as a CNA, you are held to the standard of your highest licensure. So if you're in the ER and a patient needs an advanced airway, as a CRNA you might want to throw in an LMA. But your facility may not allow RNs to perform this skill, and you're being employed as an RN. It gets tricky.

  • May 22

    1. Pressure bags are disposable because of infection control reasons, not because the effectiveness decreases after each use. You can use the same pressure bag for multiple fluid bags.

    2. You’re going to use as many pressure bags as you need to deliver the products/fluid that the patient needs to remain stable. But if your patient is so unstable that they need that many, pressure bags aren’t going to cut it and you better be getting your hands on a rapid infuser asap.

    3. Generally you don’t re-inflate, though you’re correct that the pressure drops as the fluid level decreases.

    4. This will depend on the brand of bag and your facility policy.

    5. Not sure what you’re asking here. The rate achieved by 300mmHg vs 400mmHg will vary based on the product/fluid, the type and size of IV catheter and the type and size of IV tubing. The increased rate may or may not be clinical significant depending on how unstable the patient is and what’s infusing. Again, if you need to be infusing that rapidly, you should be looking at options other than pressure bags.

  • May 22

    1. Pressure bags are disposable because of infection control reasons, not because the effectiveness decreases after each use. You can use the same pressure bag for multiple fluid bags.

    2. You’re going to use as many pressure bags as you need to deliver the products/fluid that the patient needs to remain stable. But if your patient is so unstable that they need that many, pressure bags aren’t going to cut it and you better be getting your hands on a rapid infuser asap.

    3. Generally you don’t re-inflate, though you’re correct that the pressure drops as the fluid level decreases.

    4. This will depend on the brand of bag and your facility policy.

    5. Not sure what you’re asking here. The rate achieved by 300mmHg vs 400mmHg will vary based on the product/fluid, the type and size of IV catheter and the type and size of IV tubing. The increased rate may or may not be clinical significant depending on how unstable the patient is and what’s infusing. Again, if you need to be infusing that rapidly, you should be looking at options other than pressure bags.

  • May 22

    1. Pressure bags are disposable because of infection control reasons, not because the effectiveness decreases after each use. You can use the same pressure bag for multiple fluid bags.

    2. You’re going to use as many pressure bags as you need to deliver the products/fluid that the patient needs to remain stable. But if your patient is so unstable that they need that many, pressure bags aren’t going to cut it and you better be getting your hands on a rapid infuser asap.

    3. Generally you don’t re-inflate, though you’re correct that the pressure drops as the fluid level decreases.

    4. This will depend on the brand of bag and your facility policy.

    5. Not sure what you’re asking here. The rate achieved by 300mmHg vs 400mmHg will vary based on the product/fluid, the type and size of IV catheter and the type and size of IV tubing. The increased rate may or may not be clinical significant depending on how unstable the patient is and what’s infusing. Again, if you need to be infusing that rapidly, you should be looking at options other than pressure bags.


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