I am a nursing student and have been feeling like we do the same things everyday at clinical: assessment, bed, bath, adls, vs, meds, & the rare NG or foley. Today I asked my clinical instructor when we will be advancing to more complex tasks. She replied something to the effect of, "Honey this is it. This is what nurses do. We are here to flip, turn, crush, and smear." That caught me a little off guard.
I know how vital all of those things are to patient care, and realize that the things we have been doing in clinical are the building blocks of nursing, but our classroom instructors keep saying, just get through these basics and then we'll get to the "good" stuff.
So my question is: What's the "good" stuff? In your everyday lives as nurses do you feel like you do more of the "good" stuff or more of the flip, turn, crush, and smear?
How are you supposed to get meds in someone who has difficulty swallowing or a gtube?
get them presribed as liquids however not all drugs can be made as liquids
the reason not to crush is that the drug is not licensed to be adminsterd that way those that are slow release or entric coated
in the uk we are not meant to crush, not meant to use food like yohgurt, jelly(jello) pudding to get pt to take tablets but we do. as a senior nurse said to me there are the rules and then there is real life and patients who need the drugs and we have to be creative to get them admistered
that's interesting. in my nursing program, we are being told not to crush pulls, and the pill crusher in the med room was removed. supposedly it is a jcaho violation...just wondering...
i worked in hospice/pall care one day for clincals and most of the meds were crushed and put into food for the pts. it was very common on that floor. i have not heard about it being a violation or heard that in school either????
I was told that they can be crushed, but they have to remain in the package that the pill originally came in. For ER or eneric-coated, we aren't crushing... So we ideally would smash the packet with the end of a "hammer" with the pill still inside, and bring the meds to the bedside and individually place crushed them in the cup in front of patient so they know that it came from "official" pharmacy packaging with label, etc...
I was told that they can be crushed, but they have to remain in the package that the pill originally came in. For ER or eneric-coated, we aren't crushing... So we ideally would smash the packet with the end of a "hammer" with the pill still inside, and bring the meds to the bedside and individually place crushed them in the cup in front of patient so they know that it came from "official" pharmacy packaging with label, etc...
It's funny, but I did that same thing as a new employee at this one hospital almost a year ago, and was told by my preceptor that that's not how it's done, you take it out of the package first. LOL, I guess I was right after all.
If pill crushing is a JCAHO issue, it's a new one because just last summer my last facility obtained brand new pill crushers for each department, and they are very "Is this JCAHO-approved?"-oriented.
just realize that being a new nurse....ME lol feels routine, but eventually you will be able to see "outside the box" and look at everything that you do as a nurse. When you first start you are very task oriented, but as time goes on there are more opportunities for more unique pt care situations and learning experiences, it is unfortunate that we don't get all the fun stuff in clinicals, unfortunatley some of my fun stuff came as a new nurse! Just be patient and keep your eyes open for any new expeirences you can get your hands on
I have to agree and disagree with your clinical instructor. On one hand basic nursing cares are what most clinical nurses do, however I chose to work in ED so I could do more 'fun' stuff.
I love cannulating, venipuncture, inserting foleys and NGs, defibbing a dying patient, putting on POP backslabs and all the other fun stuff that ED allows you to do.
As a student you will probably never get to do any of these things but as a qualified RN, depending on the area you work in, you will certainly have the opportunity to learn new clinical skills and extend yourself.
Getting your basic cares down to a fine art is all part of the learning process, don't give up hope for the fun stuff yet
To the OP: maybe you have a future as a critical care nurse, ER nurse, or labor nurse. Or you will return to school to become an NP or PA. If you follow the latter path, you won't have to deal with stupid nursing care plans or diagnoses any longer, either.
i called one of my classmates and she said the same thing as someone above....that we can crush pills still in the packet but that she also remembers us being told that the pill crushers were removed as jcaho violations. maybe our instructors just don't know what they are talking about....jmho
Many times the people who can't swallow also can't understand what you would otherwise need to tell them about their meds. It is highly unlikely ... I've never seen it happen, that I had a bunch of crushed meds and suddenly the patient doesn't want one of them so I have to go start over.
My experience is more of the demented people with a peg tube and there's no other way to get the things in there. Oh and by the way, docs who know a person has a peg tube do NOT need to order colace. 'Cause I am just going to give prune juice instead!
I did meet a few family members who wanted to know what all their loved one would be getting which is why having the MAR in my hand when on the floor is a good thing. That way when I get ready to do meds I will know if there's a problem and what I mash doesn't ever have to be done over.
And yes I have a problem with people who don't clean their stuff. I don't care what people's houses look like but for gods sake you wash the pill crusher and if you put noxious crap in the sink, you wash it down too. And if you open 48 little wrappers off needles and syringes you put 'em in the trash can that is right next to the med cart, where they belong.
So yeah, there is always more to nursing than simple tasks, there is simple cleaning too! And a lot of thought goes into what you do, so that you're able to explain it to others.
Mulan
2,228 Posts
what are you flipping?