Latest Comments by Double-Helix

Latest Comments by Double-Helix

Double-Helix, BSN 23,102 Views

Joined Apr 5, '11 - from 'New Jersey'. Double-Helix is a Nurse, Children's Hospital. Posts: 2,689 (50% Liked) Likes: 4,662

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  • 1
    KarenMS likes this.

    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.

  • 11

    I'd say something like, "I'm going to assume you're an educated professional until proven otherwise. I would appreciate the same courtesy."

  • 0

    It is very likely that they will check references with your volunteer hospitals to verify that experience.

  • 5

    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.

  • 4

    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.

  • 2
    nlitened and jsfarri like this.

    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?

  • 0

    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.

  • 4
    canoehead, quazar, Here.I.Stand, and 1 other like this.

    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.

  • 1
    Lev <3 likes this.

    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.

  • 0

    In order to generate business, you'll need to be a certified instructor in BLS, ACLS, and PALS through the American Heart Association. TNCC and ENPC are through the ENA, so I'm not sure how you go about becoming certified to teach those courses.

    Then, if you want to offer classes independently, you'll likely need to get approval from the AHA. You'll need advertising, a facility where you can teach, materials such as CPR mannequins or simulation dummies, instruction booklets, monitors capable of displaying various rhythms, intubation equipment, etc. It will be a huge financial undertaking, so you'll need to be prepared for that.

    I'd start by speaking to other AHA instructors in your area. See how they do it. Do they rent facilities and equipment? Are they employed by a training center or a hospital? If they are independent, do they operate financially through an LLC? And certainly, speak to a professional in the business/legal industry.

  • 0

    On top of the reasons stated above, when a patient is receiving care at a facility, it's necessary for the facility to have a record of that visit and medical information (allergies, emergency contacts, etc.) in case that patient experiences any medical emergencies while in the facility.

  • 0

    This is a big undertaking. Kudos for being ambitious. I do want to let you know that changing policy and developing any kind of tool for widespread use is a task that will require more than just a nursing student. Tools like this have to be proven to be valid and consistently applied. You'll want to get some of the staff from the hospital on board if you really want to take this beyond a theoretical project.

    Some points about PICC line indications:
    - It's not the number of antibiotics that require a PICC line, but the frequency and duration. Also of consideration is the kind of antibiotic. Some, like vancomycin, are more damaging to veins, and in a patient with poor peripheral veins may blow through so many standard peripheral IVs that a PICC is a better option.

    -Patients may be discharged home with PICC lines for long term antibiotics or other medical therapy. Clearance for discharge is sometimes, but not always an indication for removal of access. My other concern is that, sometimes, the patient may not be discharge ready for one reason or another, but no longer needs a PICC line. Making "clearance for discharge" a necessary criteria may miss those patient's who still require admission but no longer need central access.

    -A patient with poor peripheral access (think veins damaged by chemotherapy, or vasculitis, etc.) may be candidates for PICC lines for that reason alone.

    - Blood transfusions, administration of concentrated electrolytes, and need for frequent blood draws are also indications for a PICC line that aren't addressed in your tool. Here's a quick list of PICC line indications- Why Choose a PICC

    I think you've got a good start, but your tool requires some tweaking. How are rounds conducted in this hospital? Does the nurse participate in bedside rounds with the physician? I wonder if a more attainable goal might be to get the staff nurses to encourage a daily discussion with the physician during rounds to assess the continued need for central access. The tool you develop can be used by the nurses to facilitate the discussion.

  • 0

    Without experience, the jobs you'll find in the medical field will be things like unit clerk, secretary, PCT, patient observation (1:1 aide, patient watch), and patient transport. You can also look into your state laws and see if you're eligible to get your Nursing Assistant certificate after a certain number of clinical hours. All of those jobs may give you the chance to get your feet in the door and network.

    However, if what you're really looking for is income to pay for school, your best bet is to get a job that allows you to make the most money in the least amount of time. That may not be in healthcare at all. Restaurant service, working weekends and Friday nights, might be the most profitable.

  • 0

    What sort of help are you looking for? It sounds like you've done all that you can do in terms of studying and trying to be successful. Are you trying to get advice on how to deal with this instructor? Well, if you need something from her in terms of help in the class, then you'll have to address her and the attitude you think she has toward the students. If you don't need anything from her, then just keep your head down and keep doing working hard. Perhaps you can form a study group among the students to support each other and help each other learn. If you're trying to speak to her directly and meeting resistance/disinterest/disrespect than I suggest bringing your concerns to your faculty advisor or the program director.

  • 5

    Let's think for a minute about what HIPAA is. Health Information Portability and Accountability Act. While what it actually is, and who and what it covers is a very detailed topic, the short version is that a HIPAA violation involves releasing or sharing protected health information without the consent of the involved party.

    So now you can answer your own question. If the parent was not a patient of this provider, nor a patient at the hospital, they are not protected by HIPAA. Arrests/criminal actions are a matter of public record and not at all related to HIPAA. Inquiring about one's neighbor who was arrested, regardless of where they were arrested, is in no way related to HIPAA.

    This story sounds like the "Lemonjello and Orangello" twins. Everyone says they have heard of patients by those names, yet no one can provide proof that they exist.


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