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frankie,RN 7,232 Views

Joined: Oct 9, '11; Posts: 399 (31% Liked) ; Likes: 342
RN; from US
Specialty: peds-trach/vent

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  • May 29 '13

    After having worked in several LTC facilities over the course of six years, I have encountered a handful of nurses who do not call the physician with glucometer readings that exceed 400mg/dL as a time saving measure.

    They'll document the blood glucose as 399mg/dL, 380mg/dL, or some other number that falls just below the 400mg/dL radar, and they'll administer sliding scale insulin as if the result fell between 351 to 400mg/dL.

  • Nov 5 '12

    I am so happy nurses are voting for Obama it shows they are smart.

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  • Oct 24 '12

    Quote from CountyRat
    I remember the President's remark very specifically. The tone of the statement was what caught my attention. Mr. Obama put a strong emphasis on the work nurse; as in, "he could not [even] get a job as a [mere] NURSE! We have to change that!" Words in brackets are my additions to convey the tone of the President's comment. I believe that is what Mr. Obama was trying to convey. If you prefer, read the statement without the inserted words. What do you think? I must say, it rankled this old nurse.
    If you are going to quote our president, please be accurate. your "quote" is no where near the actual text or tone of that part of the debate. Regardless of what you think he meant, we can at least be clear on what he said.

    OBAMA: You know, I was having lunch with some-a veteran in Minnesota who had been a medic dealing with the most extreme circumstances. When he came home and he wanted to become a nurse, he had to start from scratch. And what we've said is let's change those certifications. The first lady has done great work with an organization called Joining Forces putting our veterans back to work.

  • Oct 24 '12

    Quote from BPeng
    Obamacare is going to effect nurses with ADNs and diplomas by banning them from working in hospital settings. Those who have an ADN or diploma will be grandfathered into the system. But I don't know if that will kick them out if they try to change jobs or not. This is going to encourage those with ADNs and diplomas to go back and achieve higher education. I personally think it is a good idea because you need the critical thinking skills to achieve the best possible outcomes for patients. But some of the best nurses I know only have an ADN. We will see what happens. Hope this helps.
    This post is completely inaccurate. No nurses are banned from working anywhere in the United States based on their level of educational attainment, and no legislation has recently been passed to make BSN degrees the minimum entry level for nurses.

    North Dakota was the first state to enact laws that made the BSN degree the minimum entry level degree for RNs. This law went into effect back in 1987 and was repealed in 2003 because so many nurses fled North Dakota.

  • Oct 9 '12

    Too busy to explain? How much longer to say "it's like a nurse's aide" rather than "same thing as a nurse" ? Too busy? Didn't want to take time to explain! Puh leeeze!!!

  • Oct 4 '12

    This is now my new favorite thread.

    Quote from hiddencatRN
    We have a place to chart narratives everywhere I've worked. "Patient updated on plan of care, given meal tray, ate pills off floor at own insistence. Family at bedside."
    My note would then continue: "Educated patient that she should not continue to eat pills off of the floor. Informed patient that nursing staff would not purposefully administer oral meds via the floor. Patient voiced understanding. Educated patient to not lick doorknobs. Informed her of the risk of mouth MRSA. Patient also educated not to lick faucets, toilets or friends' oozing pustules. Continued to educate patient on the risks of mouth MRSA. Informed patient that after touching friends' oozing pustules that she should wash her hands prior to putting fingers in mouth. Informed patient regarding hospital policy to deliver meals on trays rather than on floor. Patient will likely need further education regarding risk of mouth MRSA. At this time, patient does not appear to be open to education on mouth MSSA. Hospital system approved "Things to not lick while you're in the hospital!" handout provided to patient with relevant passages highlighted. Patient voices ability to read. Encouraged patient to request assistance as needed for avoiding inadvertent tongue to doorknob, toilet, floor, faucet contact."

    (For the record, I'm completely undecided if I would chart patient insisting on taking pills that fell on the floor or not. Probably would depend on my mood that day.)

  • Oct 4 '12

    The patient can complain that the nurse made her lick the doorknob or some equally silly thing. Should the nurse document in order to prevent every potential complaint? The answer is no. That is not the purpose of the patient care record.

    The mouth is not a common site for MRSA infection, due to the mouth's own defenses. Sure, it's possible but not highly likely. If the person did develop a MRSA infection in her mouth at some later date, there is no way to know whether it was caused by taking those pills or drinking from a contaminated faucet, or touching her friend's oozing pustule and then sticking her finger in her mouth, or any other cause. The cause would not change the course of treatment anyway.

    If the patient starts behaving erratically, then it would be worth documenting. But an alert and oriented person choosing to take pills that have been dropped on the floor is not really "crazy". People drop pills on the floor all the time at home and still take them. That doesn't make them mentally ill.

    You're free to document whatever you like, but I don't think it was necessary in this case.

  • Oct 4 '12

    Why would you document it? How is it pertinent to the patient's nursing diagnosis, plan of care, or response to treatment?

    I suppose if the patient was admitted for a spinal cord injury and was suddenly able to get out of bed and retrieve dropped pills off the floor, it would be significant. If the patient had been obtunded all day and was suddenly alert enough to climb out of bed and pick some pills up off the floor, then it would be significant.

    If there was no significant change in the patient's status, why would this be pertinent information to document in the medical record?

  • Sep 11 '12

    LOL! I like this one.

    How many hours of sleep do you get? Do you have certain rules that household members must follow?

    Any time management tips for sleep deprived nurses?

    Click Like if you enjoyed it.

    Please share this with friends and post your comments below!

    Want more nursing cartoons?

  • Sep 2 '12

    To OP -Not to disagree with you but a lot of other specialty nurses would argue with you. However, I will concede a tie with med/surg and LTC. They are both overwhelmed specialties needing the generalist insight and time mgt skills that the nurses need to possess.

    And just FYI - what I DID in MS eons ago, is now the level of acuity that I see in LTC today. HONEST

    So kudos to MS and LTC.