Latest Comments by Double-Helix

Double-Helix, BSN, RN 29,474 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: 3,164 (53% Liked) Likes: 5,947

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  • 0

    Are you doing the primary care track or acute care?

  • 1
    Jordan1927 likes this.

    Remember that this question is going to be asked of hundreds of applicants, and the answers are all going to be very similar. The purpose of the essay is really not to see if you've got some deep, altruistic reason that you want to be a nurse. It's to assess your ability to communicate written information in a clear, grammatically correct, properly structured format. It doesn't really matter what you say. What matters is that you write in a way that demonstrates a good knowledge of the English language and understanding of the requirements of a professional essay. The admissions team will be looking for an structured essay that has an introduction, 3-4 body paragraphs, and conclusion. Something that has organized ideas and flows from one paragraph to another in a way that makes sense. Something that doesn't have typos, informal language, grammatical errors, run on sentences, etc. Something that shows you have a developed vocabulary without using a thesaurus for every other word. Something that shows you can make your point without spilling your whole life story or adding a lot of flowery, superfluous language. The content is less important.

  • 0

    Are "Code A" and "Code B" things you see written in the medical record, or are they things you hear announced on the PA system?

    Most hospitals use facility specific terms for public announcements to communicate certain emergencies without revealing the details to non-employees. Examples are "Code Red" to alert there is a fire or "Code White" when security is needed. Unless you see "Code A" and "Code B" written as part of the patient's advance directive, they probably have nothing to do with resuscitation at all.

  • 0

    Mine was 13 weeks in the PICU as a new grad. It seemed like enough. Though I had a very supportive nursing staff who were extremely helpful when I came off orientation. There was always someone willing to answer questions, give an opinion, or help with a task.

  • 14
    BCgradnurse, prnqday, audreysmagic, and 11 others like this.

    Of course it's cheating. It's also unethical, irresponsible, and arrogant to think that one is so good that they don't need the amount of education that expert educators have decided is necessary to become competent.

    It's really the responsibility of the FNP program to verify that clinical hours are being completed. If this misrepresentation of hours is so widespread, clearly the program isn't fulfilling their obligation to validate the hours submitted. Since you're not the preceptor for this student, nor an FNP instructor, I don't see what you could do about this (other than report the student to the school, but the time to do that would have been when you first learned it was happening). I would just make sure that if you are asked to precept any student in the future, you make it clear that you will only be signing off on the hours they are present.

  • 0

    Admitting physicians and hospitalists are both attending physicians. An attending physician is any doctor who has completed their training and been granted privileges to practice independently within the hospital. This distinguishes them from residents and fellows, who require supervision from the attending physician.

    A hospitalist is a doctor who only cares for patients while they are in the hospital, and does not provide outpatient or primary care. Once the patient is discharged, the dr/pt relationship with the hospitalist ends. When the patient is discharged, they follow up with an outpatient clinic or their primary doctor.

    The admitting physician, also know as the “attending of record” is the physician under who’s service the patient is admitted. This is typically the attending on service at the time that the patient is admitted to the hospital. This designation is primarily for billing purposes. Any physicians from the same group as the admitting physician who see the patient on subsequent days must bill under the same service.

    Examples: A child is admitted to the general pediatrics floor for RSV. Dr. A. is the attending on service when the patient is admitted and completes the admission documentation. The child stays in the hospital for 2 days, and it also cared for by Dr. B, who works for the same group as Dr. A. The child is also evaluated by the pulmonologist, Dr. C. When the patient is discharged, he goes to his primary pediatrician for follow up. Dr. A is the admitting physician- he completed the admission evaluation. Dr. A and Dr. B are both hospitalists- they only see the patient during the hospitalization. Dr. C is also an attending physician of the pulmonology specialty- she practices independently as a physician in the hospital.

  • 2
    Here.I.Stand and KariT like this.

    Quote from KariT
    Lol, I didn't realize that giving free medical advice to people as nurse is a huge no-no.
    As a nurse, giving your opinion within your area of expertise may not be a "no-no." But by that point, most nurses have gained enough experience that they "know what they don't know". For example, I'd feel pretty comfortable answering questions from my sister when her child is recovering from anesthesia. Not so much when my grandmother asks me if the dizziness she feeling is just a side effect of her blood pressure medication. It absolutely could be a side effect, but as a professional, I can't make that assumption. I don't know her full medical history and, in addition, cardiology and neurology are outside my area of expertise. As a student, everything is outside your area of expertise and you should avoid answering family/friend questions- for your protection as well as theirs. Because if Grandma has a stroke after you reassured her that her symptoms were normal side effects, you don't want that on your conscience.

    If you can relax a little while still being successful, go for it!

  • 1
    KariT likes this.

    Quote from KariT
    Everyone in my family such as my grandparents, cousins, aunts, etc keeps talking about how their excited for me to become a nurse and help them out medically as well.
    First, put the kibosh on this right away. Once you are in nursing school, everyone and their best friend will come to you with questions that are not within your scope or knowledge to answer. Once, while I was a nursing student, a friend from church called me because his mom had fallen down the stairs and they couldn't get her up! I quickly advised him to call 911. Your family will try to ask you questions they should be directing to their doctor. You'll do well to learn a few go-to phrases like, "I'm still learning and I don't want to be responsible for giving you the wrong advice. Please call your doctor."

    Second, do you want to be a nurse? It's completely normal to have some anxiety and anticipation when you're starting a new journey- particularly one that you expect might be challenging. But I wonder if part of your hesitation is because you think you're entering the program for the wrong reasons- like pressure from your family- and not because it's the career you really want?

    If you're confident that nursing is where you want to go, then I think you can chalk up your feelings to normal, expected nerves that come with a big life change. Heck, last week I got the paperwork to finalize a mortgage contract and found myself on the phone with a lawyer discussing how I could get out of the whole thing! Of course, I had done a lot of thinking and planning before deciding to purchase this house, and I knew that it was a good decision, but the reality of the commitment still inspired a little panic. I suspect that's what's happening to you. It will be okay. You're a good student. If you're making B's while only "doing enough to get by" then you've got more than enough potential to be successful in an RN program. Congratulations on your acceptance!

  • 2
    TriciaJ and Here.I.Stand like this.

    In your original post, you state that the "recommended ratios" are 1:4. In your first reply, you state that when you "quote the laws in our state" no one is listening.

    The difference between laws and recommendations is significant if you are trying to convince the hospital to give you additional resources. Hospital policy is not law. Recommended staffing ratios are not law. If you do have state laws governing staffing ratios of high risk ante/postpartum patients (this would be very unusual), then you have grounds to report the hospital to your state Department of Health or accrediting body. But, state laws rarely micromanage nurse staffing within hospitals- particularly to such a specific population- and I would be very surprised if there's actual legislation about this situation. More likely, the hospital is guilty of violating it's own policy recommendations. Or rather, they are trying to twist words to make it appear as though they are compliant.

    Without a state law or the representation of a nurse's union, you're going to have a hard time making any changes. I would suggest starting by contacting other Magnet institutions who have similar patient populations and investigate how they plan staffing for newborns. I'd also recommend learning who is responsible for updating policies and procedures and see if you can get a committee together to revise your staffing recommendations specifically to include newborns. You may have better luck by advocating for the addition of a nurse tech rather than a change in staffing ratios. The nurse tech may be able to be pulled from the hospital's current staff pool, which would be cost effective. You could also market the proposal from the viewpoint of improving patient satisfaction (and subsequently improved reimbursement). Administration may see this more favorably than "nurses who don't want to work hard" (their perception, not mine). The tech could answer phones, open the door, take vital signs, assist with calculating I&O, toileting, answering call bells, etc. This should help lighten the work load for the RNs so they can pay more attention to the medical/nursing needs.

  • 5

    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.

  • 7

    RNs should not obtain informed consent. That is the responsibility of the physician. Is that typical process for the place you’re working?

  • 5

    What has your research shown you? Did you consult your text book? Google?

    We’re happy to help with homework, but we do ask that students do their own research first. Then, when you ask your question, share what you have learned and what your thoughts are instead of just asking the question.

  • 4
    NanaPoo, chare, Here.I.Stand, and 1 other like this.

    Quote from cleback
    Correct me if I misunderstood, but incident reports are for internal use of the facility, not part of the medical record. So a nurse deleting your statement and adding hers would not be falsifying a medical record.
    While incident reports may be intended for internal use, they are still legal documents, and are 100% discoverable in the event of an investigation or lawsuit.

    Quote from Fyles
    So, the next day I get a text from my DON, stating that there's not enough information in the I&A, and that she needed GOOD witness statements saying what "possibly" happened.

    Save those text messages from the DON.

    Also, it sounds like the DON needs some education about what an incident report should include. You never want to speculate about what caused an injury if it wasn’t actually known. You state what was seen, heard or said and that’s it. It does not “look better” if the facility comes up with an explanation for the injury- in fact, it can be damaging. In an recent inservice about this very topic, I heard about a case about a patient who experienced a medication error and later developed a complication. Notes by a resident on the case stated that the complication was a result of the medication error. The case later went to court. Even though expert medical witnesses testified that the complication was entirely unrelated to the med error, those notes in the chart were so damning that the case was settled.

    As long as your original I&A was saved, there’s an electronic trail. Don’t put your name on any other reports or notes except the ones you wrote the day this occurred. Your feelings about this are absolutely right. I don’t blame you for considering finding another place to work, either.

  • 3
    amoLucia, KThurmond, and caliotter3 like this.

    Can you swing a per diem CNA position in addition to your current job?

    Ask your instructors how job prospects have been for the recent graduating classes. Did they all find work relatively quickly, or are many of them still searching? Only you can decide if the pay cut is worth it, but if your job prospects are generally good and new grads are finding positions fairly easily, then I’d be more comfortable staying in your current job. If new grads are having trouble finding work, then the networking and “foot-in-the-door” benefits of a CN job may be worth the pay cut.

  • 7
    OrganizedChaos, chare, idialyze, and 4 others like this.

    I don’t think OP provided nearly enough information to make the assumption that the nurses on the unit don’t teach because they possess inadequate knowledge. I agree with meanmaryjean that it’s rather unfair to say in this scenario, or any other. OP didn’t actually say that he/she was assigned to a nurse on the unit who refused to teach. The statement was:

    Quote from SRN2018
    I'm only 2 days in and I really dislike the way the nurses have approached having students in the unit.
    This makes it sound like the issue is more about unit culture, not individuals. With only two days experience, OP certainly hasn’t had enough interaction with the nurses to generalize that all of them are unwilling to teach. My guess is that this a unit that is feeling understaffed and overworked. They may have had poor interactions with clinical rotations in the past. Notice, I didn’t say poor interactions with nursing students, though that may be a possibility as well. Not all nursing instructors are good at communicating with the floor nurses. I’ve seen instructors show up with a class, assign the students to patients and send the students to start their daily tasks without ever checking in with the floor nurses. The floor nurse doesn’t find out until a couple hours into the shift- when she has already started planning her day and pulling up medications- that a student wants to assume partial care of that patient. Or it could be that this particular unit gets clinical students from four different nursing schools throughout the week and is simply burned out from being asked to constantly accommodate nursing students without any compensation or recognition for the extra work it adds to their day.

    SRN2018, my advice to you is to communicate clearly and respectfully with the nurses on this unit. Introduce yourself in the morning, explain your role and your goals for the day. THANK HER for the opportunity to be on her unit and ASK HER to let you know if you can help her with something or if there is something you may benefit from watching. Even if the nurse doesn’t teach you directly, observe her practice, listen to how she communicates with patients and physicians, write down questions to research later, and make yourself available. When you’re finished your assigned tasks, check in with her to see if you can help. Don’t be caught sitting at the nurses station or chatting with your fellow students. If you can’t find a nurse who needs/wants help, ask a CNA. They are a wealth of information for a new nursing student and often very grateful for the help.