RunnerRN2015, ASN 14,445 Views
Joined Jul 6, '11 - from 'NC, US'.
RunnerRN2015 is a ER nurse.
Posts: 815 (36% Liked)
As a black nurse in a very white state, I've dealt with this more than once. During my tour of Nursing Home Hell, two of my patients had notes in their charts and the nurses' station that said "Caucasian caregivers only." Oddly enough, one ended up with a Filipina nurse, and had no complaints.
Honestly, it didn't bother me. They were old, they weren't going to change, and I wasn't going to make their bigotry my problem. If they don't want me, they can't have me.
There is no harm in reconstituting a Protonix or other med at the bedside and giving it immediately. Changing syringes would serve no purpose.
I can see the reasoning when a med is reconstituted for later use, but even so, such a syringe should have an appropriate label added regardless. Why would it matter if it was a "normal saline" syringe or a plain one, if it was labeled?I
Meds mixed in a normal saline bag are kept in the original fluid bag, no?
Just don't use your normal saline pre-fills to reconstitute ANY medications.They are for flushes only and you should be using normal saline from a vial to reconstitute medication or dilute medication.The Institute for Safe Medical Practice has a warning out this bad practice of using the pre-fills incorrectly.
GN status is dissolved after your first nclex attempt. Either you pass and you are an RN or you fail and you are a general citizen until you pass the nclex. She's unlicensed assistive personnel. If she acts like anything more she is out of line. She is not a nurse.
Would I be in the wrong for treating her like a medical assistant and not a graduate nurse?
Graduating from nursing school does not make someone a nurse. Someone can only claim to be a nurse if they pass the NCLEX. After 6 years and 5 failed attempts to pass NCLEX there is no reason to treat her as a nurse much less be afraid to exert authority over her. You are licensed and she is not. Do not allow anyone to convince you otherwise.
I know it was a long post to read so thank you I appreciate your input!!
I also go with the fact that it's against company policy to combine personal and professional contacts.
When confronted with, "well my other nurse did it!" my response is that *I* am not comfortable risking my job, but other coworkers might not be as concerned about getting fired.
I always make it about the company/professional boundaries situation, never about the fact that I really wouldn't want to friend the person even if it were permissible!
Just stick with "Sorry, it's against company policy."
OK, now the truth. I go home to a messy kitchen, fry some eggs at the most, feed the dogs, check my allnurses bookmarks one last time, then crash. I do brush my teeth.
When the area around an IV site is puffy there is a 99.9% probability it is infiltrated. A patient may not complain because just mild "puffiness" does not cause pain. Even an alert oriented adult patient may not complain of any pain when an IV is infiltrated.
Inflammation means reddened, swollen, hot, painful. So the area would not get red, hot, or even painful unless an infiltrated IV was left in for several days and the area eventually became infected. Of course the area is swollen, that is what infiltrated means. And if it became extremely swollen it would start to cause pain.
Infiltrated IV fluid is gradually absorbed into the subcutaneous tissue. The site looked less puffy as you slowed down the IV because the body was absorbing the fluid.
Google subcutaneous IV fluid. There is times when IV fluid is intentionally infused subcutaneously in people, and it is often used in animals. You were giving a subcutaneous IV infusion
Puffiness is a concern no matter what type of fluid you are infusing.
Sometimes it is hard to tell if an IV is infiltrated. Comparing the extremity, the area with the IV, to the other non IV extremity, is a helpful way to tell if you are not sure.
When in doubt, take it out. Or ask for a second pair of eyes to look at a questionable IV site.
It's hard to imagine two people having such a petty disagreement. Oncoming shift could easily take care of it, but I wouldn't mind clearing it on my way out the door, either.
And if the off-going nurse is just starting to chart after shift change, that makes me wonder if the "mess in room 3" was just the final straw on a whole heap of other messes left behind.
The moral of the story:
Be careful what you put in your mouth!!
Yuck! Sorry for the distasteful headline.
I wanted to share an experience with my fellow NPs here.
So I'm doing rounds the other day and had a young girl, 22yo, hospitalized with sore throat (weak admit btw). Anyway she was running fever 103, tachycardic 115s, 14k leukocytosis at time of admission, so she did meet sirs criteria. Anyway, the NP who did her H&P checked her for strep, mono, the usual work up. All of which was negative. Despite being on abx (unasyn) in the hospital and previously on amoxicillin for one week from an urgent care center, she had little to no improvement.
So I'm reading the H&P and can't find the sexual hx (was never asked). So I enter her room, do my usual exam, throat is quite erythematous, no pustules, no exudate. I obtained her sexual hx. New sex partner 2.5 weeks ago, + oral sex, unprotected.
We swab her throat for GC. Next day later she is + for gonorrhea. Given the hx I obtained from her I empirically treated her for gonorrhea anyway. I discharged her later that day and part of DC instruction was to dump the new boo, lol, and have him treated.
So the reason I'm sharing this is to encourage you all to really think about your differentials depending on your patients age and symptoms, especially the new NPs coming out of school. Sore throat in a young person has many differentials, which can easily be overlooked as an STD. Always do a thorough history and physical, like they say you can diagnose 80-90% of problems with a good H&P.
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