AngelRN27 1,909 Views
Joined Aug 11, '12.
Posts: 152 (30% Liked)
Thanks for the advice, BuyerBeware. My choices are limited because (1) I need to stay local and (2) as per what I've been able to find on my own, there aren't really that many ACNP programs out there, at least not in my area. There are PLENTY of MSN programs (with varying tracks/"concentrations") but it's not too easy to come by a program for acute care. If it weren't for my specific end-goal, I'd go straight into an MSN program, but I don't think that any MSN programs will truly help me in attaining an ACNP as it now stands.
Again, I welcome any suggestions for other schools/programs out there... or if anyone that has pursued the route of ACNP has any advice at all, it is most definitely welcome. Unfortunately, I don't personally know any ACNPs so I don't have any mentorship as of now. Everyone is really going after FNP in my area and within my networks.
This thread should be moved to LTC; LTACH is not the same as LTC/SNF/Rehab/Nursing Homes.
The rationale behind starting distally and working proximally is that if you blow/damage a proximal vein (further up) then all veins communicating with that vein will run into that same clot/occlusion/injury. Therefore, whatever is being administered through that IV will not reach central circulation, OR could cause further harm if leaking into tissues (depends on what happened to that proximal vein).
I have been working at my current LTC facility as an RN for 6 months. I was just moved to the 11-7 shift approx. 3 weeks ago. The nurse-patient ratio you mentioned in the OP seems standard for this shift.
Night shift "responsibilities" are pretty much as mentioned above. A few meds at 12am (usually just a couple of nebulizer treatments) and then a relatively small med pass at 6am (mostly Omeprazole and Synthroid). In between you have miscellaneous paper work as well as chart checks which require a meticulous eye and a good knowledge of your facility's protocols/procedures, which will come with time and practice. Other miscellaneous tasks include hanging new piston syringes for feeders, changing feeds as necessary, cleaning/organizing/re-stocking med carts, possibly making the morning shift's assignment (depending on your facility), checking resident appts for the following day, refilling any low meds or narcs, etc.
You'll be fine, good luck!
I assume by "site" the NG, you are referring to insertion? (that's not really a term we use in the US) Personally, I have been working ICU/Step-down for 3 years and have never even heard of an MD inserting an NGT, that's like having an MD get a peripheral line for you! LOL. Anyhow, here RN's insert the NG with a medical order, verify on the spot via the classic method (air bolus and auscultation of the stomach) and then order CXR by protocol to positively verify placement. Tube feeding/med administration can begin after CXR confirms placement, if need be. My hospital does not require any in-house education for insertion of NG tubes. Usually, the newbies will ask for support anyway, but we do not need any sort of approval by our educator to insert as our nursing license covers this. Good luck!
If you have issues with the tap water, your facility needs to fix that. The gut is not sterile, no need to use sterile water IMO.
I could maybe see it in a neutropenic patient, maybe.
My facility does not require us to contact the MD about refused meds until it has occured for the same med x3 as another poster mentioned. If this was the protocol at my facility, I would be calling the doc at least once a day! One incident of refusing meds shouldn't be reason to call a doc (depending on the med, of course). Also, not every "refusal" is legitimate. You have to know your residents... some residents are just confused or need to feel some sense of control in order to reduce anxiety. There are several residents at my facility that will always refuse meds if given at a certain time (i.e. before dinner) but will gladly take them if offered again right after their meal... it all depends...
At my facility we are allowed to give meds in the dining room is they are PO. Nothing invasive can done though, so no sub-q's, IM's, finger sticks, or even BP's allowed.
I do all my diabetics first and rarely miss any of them before they are moved to the dining room. If they are, I wheel them back to their room after already having their meds ready, do anything I have to do such as a finger stick or BP, then give meds and return to dining room... I haven't really had any issues thus far...
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