Double-Helix, BSN 25,733 Views
Joined Apr 5, '11 - from 'New Jersey'.
Double-Helix is a Nurse, Children's Hospital.
Posts: 2,695 (50% Liked)
For the purpose of school, do what you were taught there. For the purpose of real life assessment, there's essentially no clinical difference performing percussion before palpation or vice versa.
There's no need to resign from PRN/per diem jobs. If you stop signing up for shifts, your employment will automatically enter 'auto-termination' status for not working the minimum amount of hours that per diem employees are supposed to work.
I know auto-termination sounds negative to those who are unfamiliar with the term, but it's a neutral status and you'll be available for rehire.
Good luck in your application process. I'd brush up on recommended IM injection sites for each age group, as well as maximum volumes for each site.
Review stages of development and how best to communicate with each age group. For toddlers, distraction usually works best. For school age children, explaining in simple language before each step is helpful, and allow choices when they have them.
Also, listen to the parents. They know their children the best.
Whether or not it is a HIPAA violation depends on whether protected health information was released to this teenager. It's possible the child was in the rooms performing tasks but not provided any health information. However, I'm sure this is a violation of facility policy. From a liability standpoint, the facility would be at a huge risk if something were to happen to these patients, or this child, while at the facility.
Out of curiosity, how old is the Saunders book your using? It may be out of date. Also, you used it for a PN course. Is the book geared toward the NCLEX RN or the NCLEX PN? The two may be quite different in terms of appropriate interventions and scope of practice.
My first question is- what text book is your INSTRUCTOR teaching from? That's the book that you should be using to study for the exam, as that's where the information will be based. The Saunders book may be good for NCLEX prep, but I doubt it is covering the exact same material in your syllabus.
Second, as your instructor if you can sit down with your exam and go over the questions that you got right and wrong. Evaluate what kinds of questions you're getting wrong and see if you can identify why. Did you not understand the content? Did you fail to prioritize correctly? Do you understand the concepts but fell down on applying the information in critical thinking situations? This might help you see where you should focus and adjust your study techniques.
First things first, HIPAA covers protected health information. This is personal, identifying information released without consent. Gestational age, or a statement of "we just admitted 34 week twins" in no way contains personally identifiable health information. So no, it is not a HIPAA violation.
Though we tend to use the term HIPAA to be synonymous with "patient privacy", the two are very different. Hospitals usually have policies regarding respecting patient privacy that go above and beyond the scope of HIPAA. So while your comment about "going to admit 34 week twins" was not a HIPAA violation, it doesn't mean you might not face reprimand or disciplinary action from the hospital for violating patient privacy. However, given that your unit publicly posts signage identifying which rooms contain twins, I doubt simply informing another patient about the arrival of another set of twins would be considered that serious.
I'd say something like, "I'm going to assume you're an educated professional until proven otherwise. I would appreciate the same courtesy."
It is very likely that they will check references with your volunteer hospitals to verify that experience.
No one should have to provide a reason that they are calling out if they have sick time available. It's an invasion of privacy. If my contract allows me a certain number of sick days, it's none of their business whether I have the sniffles, or dysentery, have a sick family member, or If they do not have time available, they should be required to provide a doctor's note.
"Three strikes and you're out" is vague. People will call out when they aren't sick. There is nothing you can do about it. Set a realistic and fair policy regarding call-out limits and progressive discipline thereafter. For my facility, employees may call out five times in a rolling 12 month period. Unauthorized call outs after that result in a written warning, and progressive discipline up to termination. Implement a policy and enforce it.
Diverting is not the same as using. Someone could be stealing medication to sell, to give to a friend or family member, etc. A negative drug screen doesn't prove innocence from diversion.
OP, it seems you have a history of poor relationships with prior employers, and this isn't the first time that you've been accused of unprofessional/illegal behavior by an employer, including patients who are willing to corroborate those accusation. So you should know that the time to contact a lawyer is BEFORE anything is reported to the BON, not after. Ask for accusations or complaints in writing, and don't take any more of their calls.
What are your facility's policies regarding controlled substances? You said there is no policy against picking them up from the pharmacy. What pharmacy allows any nurse to pick up controlled substances for patients? Do sign for them? What's the chain of possession for those medications after the fact? What happens once the medications get to the patient's home? Is there a log where medications are counted and signed out? If you truly are innocent, documentation should support you.
We'd need a little more information. Are you looking for an ADN or BSN program? Have you taken any pre-reqs or no? Do you have a target area or are you willing to move?
I'd look into scented nasal clips or strips. There are several different varieties with many different scents. Most of them are relatively discreet and you could wear it with or without a mask. A new one that comes to mind is a company called Aromaid. Their clips are available in a few different colors to match skin tones so you can wear it without it being obvious.
These things happen. I'm sure you'll always remember to review labs from here on out. You're not the only one who overlooked it either. Both his doctor and the overnight nurse missed it to. Learn from this, and try not to be too hard on yourself.
I'm a peds nurse as well, although I do see my fair share of teenagers and occasionally adults. The IV's we place are primarily for short term use- sedation/anesthesia, radiologic contrast, blood draws. The only time we need 20g or larger are for certain radiology exams- usually CT angiograms.
Here's a few things I know:
1. 20g's are more difficult to thread than 22's or smaller. Because the bevel is larger, you need to advance the needle a bit more after you get a flashback in order to make sure your catheter is fully within the vein before attempting to thread. Otherwise it will blow.
2. Adult veins tend to roll more than peds veins. They have less supporting subcutaneous fat (this is especially true to hand veins) and it's not uncommon for you to stick a good looking vein and after you stick, the vein just isn't there anymore. You can help this by using your non-dominant hand to tack down the vein above where you're going to stick. You can grab another person to help with this until you're comfortable.
3. Unless it's a very sick patient, and you anticipate giving a lot of fluid/blood, a 22g will work just fine. If you're starting the IV, any size will allow you to draw blood. We draw labs with 24g IV starts all the time. A well-maintained 22g works just fine for repeated blood draws as well. And there is a lower risk of phlebitis from a large catheter in a a vein. So, especially if you're not comfortable with the gauge, there's little benefit of a 20g over a 22g.
4. Adult veins tend to have more rigid valves. When you're looking at a vein, look for areas that appear more rounded, almost like bumps along the vein. That's where you're likely to find a valve, and have a harder time threading the catheter. If you see a valve, go above or a good bit below that spot.
5. My favorite veins for adults are the cephalic vein- from the forearm up to the anticubital space- and the medial ante brachial in the forearm. Hand veins can work as well, just watch out for valves and make sure they are stabilized when you stick.
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