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Double-Helix, BSN, RN 27,933 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: 2,881 (51% Liked) Likes: 5,187

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  • 4:22 pm

    You may find more assistance in the Nurses/Recovery forum.

  • 4:22 pm

    You must answer all the questions on the application truthfully. Lying on the application (including omission of information) is illegal and, if discovered, will result in your admission and/or license being revoked.

    That being said, you are only required to answer the questions asked, not extrapolate information. The application should define terms such as "medical condition" and "currently." For example, if drug addiction is defined as a medical condition, and "currently" is definied as within the past two years, and the question is: [FONT=Times-Roman][FONT=Times-Roman]a. Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable skill and safety?
    You may be able to accurately answer "no" to that question, as the drug use is not currently a problem, according to the definition, and does not affect your ability to practice.
    [/FONT]
    [/FONT]

  • 1:24 am

    Defibrillation does provide sort of an electrical reset for the heart. However, compressions do not restart it. The normal electrical activity of the cardiac pacemaker cells do that. The cardiac pacemaker cells are capable of spontaneously generating and sending out their own electrical impulses. During fibrillation, those cells are all firing at random, and therefore can't create a coordinated contraction of the myocardium. The electricity in the defibrillator interrupts that firing. The hope is that, once interrupted, the pacemaker cells will then start sending out coordinated signals, resulting in coordinated myocardial contractions and a return of normal rhythm.

    Compressions manually circulate blood while the heart is not pumping or not pumping effectively. Each second without cerebral perfusion increases the likelihood of neurological damage. Minimizing that down time is essential in improving resuscitation outcomes. Compressions are restarted immediately after defibrillation not to restart the heart, but in case the heart does not restart. The heart may have restarted on it's own after defibrillation, but delaying compressions in order to perform a rhythm check can be detrimental if spontaneous circulation has not returned.

    Does that help?

  • 12:52 am

    Sometimes doing "nothing", is actually everything. (It reminded me of this article I wrote about withdrawing care several years ago: http://allnurses.com/general-nursing...or-636831.html)

    This story brought tears to my eyes. It is patient-centered nursing care at it’s finest.

  • Jan 19

    Has the patient been evaluated by psych? Is there an agitation plan in place? It sounds like this child needs to learn some coping skills. Working with a psychiatrist to identify redirection and deescalation strategies that the entire care team can reinforce would be beneficial.

    In the meantime, allow the child a safe way to express her frustration. A stress ball, hitting a pillow, etc. But firmly explain that throwing things is not acceptable because you need to keep the patient and the staff safe. Everyone should be reinforcing this with her. "Jane, I see that you are angry, but throwing things is not allowed. Let's squeeze your stress ball and take some deep breaths together. Then we can talk about what is bothering you." Social work or the therapist can work on developing some rewards or consequences for good behavior, such as granting computer time when Jane demonstrates good coping skills and doesn't throw things.

    Physical restraint and seclusion (a form of restraint) are extreme responses and are likely to only escalate the situation further.

  • Jan 19

    That’s why I hate scripting. If every single nurse enters the room saying, “What can I do for you? I have the time.” it takes the patients all of two hours to figure out they are saying it because they have to, not because it’s true. Unfortunately in some places, the scripts are the standard, and nurses that are observed not using scripted language are subject to counseling or even a talk with the manager. Honestly and authenticity are far more effective, in my opinion.

  • Jan 19

    Sometimes doing "nothing", is actually everything. (It reminded me of this article I wrote about withdrawing care several years ago: http://allnurses.com/general-nursing...or-636831.html)

    This story brought tears to my eyes. It is patient-centered nursing care at it’s finest.

  • Jan 19

    That’s why I hate scripting. If every single nurse enters the room saying, “What can I do for you? I have the time.” it takes the patients all of two hours to figure out they are saying it because they have to, not because it’s true. Unfortunately in some places, the scripts are the standard, and nurses that are observed not using scripted language are subject to counseling or even a talk with the manager. Honestly and authenticity are far more effective, in my opinion.

  • Jan 19

    Quote from NotAllWhoWandeRN
    We are waitresses, working for tips. Except we don't get to keep the tips.
    Working for reimbursement, you mean. Forget tips. Most hospitals are just hoping they get paid for the whole meal.

  • Jan 19

    That’s why I hate scripting. If every single nurse enters the room saying, “What can I do for you? I have the time.” it takes the patients all of two hours to figure out they are saying it because they have to, not because it’s true. Unfortunately in some places, the scripts are the standard, and nurses that are observed not using scripted language are subject to counseling or even a talk with the manager. Honestly and authenticity are far more effective, in my opinion.

  • Jan 19

    That’s why I hate scripting. If every single nurse enters the room saying, “What can I do for you? I have the time.” it takes the patients all of two hours to figure out they are saying it because they have to, not because it’s true. Unfortunately in some places, the scripts are the standard, and nurses that are observed not using scripted language are subject to counseling or even a talk with the manager. Honestly and authenticity are far more effective, in my opinion.

  • Jan 19

    I work in a procedural area, so the bulk of our patients arrive after 7:30am. Our huddles are done each morning at 7:15. We have a template that gets updated each day/week as things change. It includes safety issues and reminders related to recent events, any hot topics- such as a JC visit, inservice, practice changes, new equipment, mandatory education, etc. and a run down of any patients who might be particularly complex (hx anesthesia problems, difficult IV stick, multiple procedures, custody/consent issues... A brief period at the end allows staff to raise any concerns or ask questions.

    Huddles are still frequently used on inpatient units as well, but they will often do 2-3 huddle times- morning, afternoon and night, to cover all shifts. The daily huddle info is also posted (ours is done electronically but you could print out the template and hang it somewhere) to allow staff who couldn’t attend huddle the chance to review the information.

  • Jan 19

    Has the patient been evaluated by psych? Is there an agitation plan in place? It sounds like this child needs to learn some coping skills. Working with a psychiatrist to identify redirection and deescalation strategies that the entire care team can reinforce would be beneficial.

    In the meantime, allow the child a safe way to express her frustration. A stress ball, hitting a pillow, etc. But firmly explain that throwing things is not acceptable because you need to keep the patient and the staff safe. Everyone should be reinforcing this with her. "Jane, I see that you are angry, but throwing things is not allowed. Let's squeeze your stress ball and take some deep breaths together. Then we can talk about what is bothering you." Social work or the therapist can work on developing some rewards or consequences for good behavior, such as granting computer time when Jane demonstrates good coping skills and doesn't throw things.

    Physical restraint and seclusion (a form of restraint) are extreme responses and are likely to only escalate the situation further.

  • Jan 19

    Whether or not the pay is "fair" depends on several factors:
    -The job market in the area
    -Demand at the facility
    -Cost of living in the new area compared to old
    -Specialty skills/certifications required
    -Non-monetized benefits such as schedule flexibility, shift preference, paid time off, insurance package, tuition reimbursement, etc.
    -Your willingness to accept the salary

    I'm not surprised to see that you were offered less $/hr as a new hire at an outpatient center than you are currently being paid in a specialty area of a big hospital with 6 years of seniority. The issue is whether that salary is something you're willing to accept after weighing the other benefits- such as a M-F job. If you're not comfortable with it, you have every right to counter offer, as you have done. Just be sure you can justify why you're requesting that salary, if asked. The facility is, of course, able to negotiate, refuse to negotiate, or rescind the offer. What they will do depends on how badly they need the help, how many other qualified applicants are interested, and whether they feel that your skill set and experience justify the pay.

  • Jan 19

    Did you ask the school officials (such as the Dean of your program) why this date was chosen? The first step in addressing any problem is getting the facts. You may find that this date was dictated by factors outside the control of the nursing faculty. Or you may find out that the date is flexible, and you can gather a group of students to propose an alternative.

    Two life lessons that will serve you very well in your career and life:
    1. First, seek to understand those you disagree with.
    2. When you bring a problem, also bring a solution.


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