LVN tips?

MedChica · Feb 24, 2015

Nah, it's not common. It's something that varies by facility. Computerized charting can improve efficiency. Some facilities have med aides. In a prior f/t, job, the nurses only gave OTC/PRNs.

This is kinda long:

- Make sure the cart's stocked and you've got everything beforehand: Cups, sanitizer, water, napkins, SCISSORS AND TAPE, bandaids, gauze, TAO, betadine swabs, syringes, etc... Go pull the IV stuff out of the med room fridge if you're going to have it put it up. Grab the narcs out of the fridge and set them aside. You will waste a lot of time running back and forth.

- TIMEWASTERS:

a. The phone.

Get away from the nurse's station. There's phones up there. They ring and interrupt everyone's day. Someone else will get it. When that phone starts ringing off the hook -- you need to be "somewhere down the hall". That way you don't have to stop and answer it -- because everyone will assume that you just 'can't hear it". Oh, I can hear it!! LOL

b. Family members.

Unlike a phone call, family members take up a large amt of your time with issues that are relatively unimportant....but, similar to a phone call, they tend to create more work for you. Regardless.

Everyone isn't one in the same. You've gotta feel them out but more often than not? You want to be thorough. You want to alleviate fears but brevity is your best friend.

I like to help. That's why I advise you as I am. To be brief, that is. Don't volunteer info. You give info that's pertinent to the 'pt issue'.

...because I've learned the hard way. LOL

Ex: Don't go over vitals unless it's relevant to what's wrong or they ask for it, for instance. Half of them don't even know what any of that means ... and if you just mention a single aspect of the pt's assessment - like, the pt's blood sugar - to give them peace of mind, they'll have something else to worry about, more questions to ask and you'll spend many, many more minutes talking longer than necessary about factors that don't even matter to the big picture. What's more, every time they come through, they'll probably be asking to see spreadsheets of vitals "for the previous month" and 'hmming' to themselves as though they know what they're looking at.

I was in the midst of my med pass last week, trying to get through my blood sugars. Gave meds and took my new admits b/s. Daughter starts talking about why the the pt couldn't be on glipizide vs insulin.

What?! I'm thinking to self, "Woman, c'mon...I'm trying to work here, okay?"

I said, "I - I can't recall off the top of my head...." The pt piped up, "Why not?" I said, 'Well, we learn a lot of things in nursing school, papa. It's been a long day and my brain is in a jumble, right now...ya know?" She laughed and was satisfied. Meanwhile, MEDCHICA was halfway out of the room. Hell, I said it AS I was leaving. There wasn't a pause in my stride. I don't have time for these people and 'medical small-talk'.

In truth, I actually did know the answer...HA!!! LOL Sometimes, it's good to be 'just a nurse'. I could've never gotten away with, "Uh, I don't know...." as a MD (or PA or NP)! LOL

I always deflect irrelevant 'out of nowhere/heres a nurse, lemme ask her to dispute or explain something I read on WEBMD or wiki' small-talk type inquiries.

You know what would've happened had I followed that woman down the rabbit hole?

A 4-25 minute discussion in the MIDST of my med pass where I'd end up showing her the MAR with the blood sugars, combing through the chart for the A1C and she'd be requesting that I get an order to take the pt off novolog -- before, eventually, demanding to speak with the doc herself (which is so not going to happen. The docs don't want to talk to these people. >shrug

- During report, figure out who your diabetics are. If possible. Different facilities operate differently. If there's a separate book for insulin/accucheck, you don't have to.

- There's no such thing as having 'too many' gloves. Designate a 'clean' pocket on your scrubs and stuff gloves in it. Don't put anything in your 'clean' pocket but gloves because that's going to touch the pt. I put random nurse stuff in the other pocket and keys/cell in my pants pocket. My 'clean' pocket is my LT shirt pocket because I'm inclined to stuff things in my right pocket since I am right handed.

- Don't start your shift flagging the MAR unless you have a med aide. If you're popping pills by yourself, it wastes time. Start the pass wherever the patients are. I flag as I go through the book.

Insulin to left. Meds/misc to the right.

- Buy a temporal (temporal) scanner. Readings are instantaneous. I frequently use pulse oximeters to pull instant pulse rates.

- NEB TXT? Put the albuterol in the masks whether the pt's in there or not. Slap it on them when they get in the room.

- Multiple sets of eye-drops, like timolol and regular drops? Give timolol. Give medication. Give regular drops.

- Flush IV lines. Flush PEGs often. A clogged PEG will slow you down greatly (beyond this, a lot of G/T pts are dehydrated so, unless theyre on fluid restrictions, you want to give them a good amt of fluid). TIPS: If you don't have a declogger or the declogger won't remove the blockage, A/D ointment slathered on the surface of a clogged tube itself helps (if it's that fabric-y typeof tube). Soda helps, too....

- If a pt's not in the room, I pop the meds/crush and label the packet, anyway. I sometimes pre-pop 6a meds on night shift. I pre-pop noon and 1p meds.

- Pt's in groups requiring multiple things (meds, accucheck, bp)? I grab a sheet of paper and put my B/P cuff on my wrist. I grab strips, alcohol swabs and those stick thingies in my 'dirty' pocket (I don't have a container). You should have gloves in your clean pocket.

I give one person their meds (because I can't carry that many cups). Put bp cuff on another pt. I go to my diabetics, glove up, take the b/s, roll everything up in the gloves when I take them off and record the b/s on paper. I back to the pt with the cuff and record that number. I slap a new set of glove on and repeat for patient 2-8.

I draw up 3 to 4 syringes at a time, label with tape and administer.

I try to hit diabetics that usually don't require insuline first. Also, during a med pass, I try to knock out the pt's who don't need bp's. Tips: Remember to fan the finger dry when you swab it. The alcohol can alter the reading. If the finger is heavily calloused, it'll be harder to stick. Pick another. Also, don't 'bleed' the finger for a blood sample. It's painful for the pt and it alters glucose readings as well. In addition to this, if you've got to stick a finger more than once, you should pick a different finger.

- I do one major med pass per 8 hour shift. I start around 7a and I'm through around 10a. Do you give noon meds at 8a-9a? No comment. LOL But, seriously, it depends on the med. I mean, it's not like you're going to give ambien at 4p. EX: for a 3-11p shift, unless BID/TID or a narc or something of that nature, everyone rec'vs all of their meds in one pass.

- If pressed for time, it's necessary to chart on status change, new/readmits, falls and those rec'ving ABT TXTs. I'm thorough when it comes to family issues, incidences and status changes. Beyond that? Meh.

The more you write, the more you've gotta answer for.

What was the problem with the pt, how did you successfully address it...and how did the pt respond to it. You've gotta 'follow up'.

Don't write a book: "resident remains on ABT f/u for UTI. T98.2(temp). 0 adverse reactions to ABT TXT." "Observed" or "noted". Whatever.

KISS it: "resident remains on fall f/u, day 3. at 220p, resident c/o headache & was administered 650mg acetaminophen to promote comfort. Well tolerated. 0 further complaints of pain a/o 1030p" ;

"resident with nonproductive coughing @ 11a. resident administered ml geritussin & 1 cough drop to promote comfort. Well tolerated. upon inquiry, resident stated that he is 'doing fine' @230p." ;

"CNA informed this writer of resident c nonprojectile vomiting@12p. Resident a/o to self, place, situation complaining that stomach still 'feels funny'. T100.6(temp). Bowel sounds heard @1st quad,

I like evenings. Know why? I can make one-sentence generic notes for the bulk of my people and pawn it off on them "being asleep", LOL:

"V/S: 112/78, P78; RR16, T97.9(temp). Resident c 0 s/s discomfort or pain, resting c HOB ^ & unlabored breathing as of 1030p."

I do rehab; I have 30 pts -- and I have to chart on, like, all of them! LOL So..."generic nurse note", it is.

If state comes around, dump the pre-popped pills and do the pass meds as you're supposed to. Maybe it's wrong to say it on here but ... meh. If you're taking 4 and 6 hours to complete your am or pm pass, you've bounced out of the '1 hr before 1 hr after' window, anyway. So, what difference does it make if you give a 12p at 9 when, doing things your way, ie., slow, it's 12p, your am meds are bleeding into your noon/1p pass and b/s checks and a small portion of your pt's haven't even rec'vd their 9a meds?

My pt's re'cv between 2 -10 meds apiece ... with drops ... patches...neb txts, etc...

... and I still have to do accuchecks, wound care, clean nephro tubes, give 2 bolus feedings, care for 8 PEGs. Let's not even talk about family members, emergencies and the work that needs to be done at the desk.

People say, "It's not a race."

...but it is.

RDLVN · Feb 26, 2015

Nah, it's not common. It's something that varies by facility. Computerized charting can improve efficiency. Some facilities have med aides. In a prior f/t, job, the nurses only gave OTC/PRNs.
This is kinda long:
- Make sure the cart's stocked and you've got everything beforehand: Cups, sanitizer, water, napkins, SCISSORS AND TAPE, bandaids, gauze, TAO, betadine swabs, syringes, etc... Go pull the IV stuff out of the med room fridge if you're going to have it put it up. Grab the narcs out of the fridge and set them aside. You will waste a lot of time running back and forth.
- TIMEWASTERS:
a. The phone.
Get away from the nurse's station. There's phones up there. They ring and interrupt everyone's day. Someone else will get it. When that phone starts ringing off the hook -- you need to be "somewhere down the hall". That way you don't have to stop and answer it -- because everyone will assume that you just 'can't hear it". Oh, I can hear it!! LOL
b. Family members.
Unlike a phone call, family members take up a large amt of your time with issues that are relatively unimportant....but, similar to a phone call, they tend to create more work for you. Regardless.
Everyone isn't one in the same. You've gotta feel them out but more often than not? You want to be thorough. You want to alleviate fears but brevity is your best friend.
I like to help. That's why I advise you as I am. To be brief, that is. Don't volunteer info. You give info that's pertinent to the 'pt issue'.
...because I've learned the hard way. LOL
Ex: Don't go over vitals unless it's relevant to what's wrong or they ask for it, for instance. Half of them don't even know what any of that means ... and if you just mention a single aspect of the pt's assessment - like, the pt's blood sugar - to give them peace of mind, they'll have something else to worry about, more questions to ask and you'll spend many, many more minutes talking longer than necessary about factors that don't even matter to the big picture. What's more, every time they come through, they'll probably be asking to see spreadsheets of vitals "for the previous month" and 'hmming' to themselves as though they know what they're looking at.
I was in the midst of my med pass last week, trying to get through my blood sugars. Gave meds and took my new admits b/s. Daughter starts talking about why the the pt couldn't be on glipizide vs insulin.
What?! I'm thinking to self, "Woman, c'mon...I'm trying to work here, okay?"
I said, "I - I can't recall off the top of my head...." The pt piped up, "Why not?" I said, 'Well, we learn a lot of things in nursing school, papa. It's been a long day and my brain is in a jumble, right now...ya know?" She laughed and was satisfied. Meanwhile, MEDCHICA was halfway out of the room. Hell, I said it AS I was leaving. There wasn't a pause in my stride. I don't have time for these people and 'medical small-talk'.
In truth, I actually did know the answer...HA!!! LOL Sometimes, it's good to be 'just a nurse'. I could've never gotten away with, "Uh, I don't know...." as a MD (or PA or NP)! LOL
I always deflect irrelevant 'out of nowhere/heres a nurse, lemme ask her to dispute or explain something I read on WEBMD or wiki' small-talk type inquiries.
You know what would've happened had I followed that woman down the rabbit hole?
A 4-25 minute discussion in the MIDST of my med pass where I'd end up showing her the MAR with the blood sugars, combing through the chart for the A1C and she'd be requesting that I get an order to take the pt off novolog -- before, eventually, demanding to speak with the doc herself (which is so not going to happen. The docs don't want to talk to these people. >shrug
- During report, figure out who your diabetics are. If possible. Different facilities operate differently. If there's a separate book for insulin/accucheck, you don't have to.
- There's no such thing as having 'too many' gloves. Designate a 'clean' pocket on your scrubs and stuff gloves in it. Don't put anything in your 'clean' pocket but gloves because that's going to touch the pt. I put random nurse stuff in the other pocket and keys/cell in my pants pocket. My 'clean' pocket is my LT shirt pocket because I'm inclined to stuff things in my right pocket since I am right handed.
- Don't start your shift flagging the MAR unless you have a med aide. If you're popping pills by yourself, it wastes time. Start the pass wherever the patients are. I flag as I go through the book.
Insulin to left. Meds/misc to the right.
- Buy a temporal (temporal) scanner. Readings are instantaneous. I frequently use pulse oximeters to pull instant pulse rates.
- NEB TXT? Put the albuterol in the masks whether the pt's in there or not. Slap it on them when they get in the room.
- Multiple sets of eye-drops, like timolol and regular drops? Give timolol. Give medication. Give regular drops.
- Flush IV lines. Flush PEGs often. A clogged PEG will slow you down greatly (beyond this, a lot of G/T pts are dehydrated so, unless theyre on fluid restrictions, you want to give them a good amt of fluid). TIPS: If you don't have a declogger or the declogger won't remove the blockage, A/D ointment slathered on the surface of a clogged tube itself helps (if it's that fabric-y typeof tube). Soda helps, too....
- If a pt's not in the room, I pop the meds/crush and label the packet, anyway. I sometimes pre-pop 6a meds on night shift. I pre-pop noon and 1p meds.
- Pt's in groups requiring multiple things (meds, accucheck, bp)? I grab a sheet of paper and put my B/P cuff on my wrist. I grab strips, alcohol swabs and those stick thingies in my 'dirty' pocket (I don't have a container). You should have gloves in your clean pocket.
I give one person their meds (because I can't carry that many cups). Put bp cuff on another pt. I go to my diabetics, glove up, take the b/s, roll everything up in the gloves when I take them off and record the b/s on paper. I back to the pt with the cuff and record that number. I slap a new set of glove on and repeat for patient 2-8.
I draw up 3 to 4 syringes at a time, label with tape and administer.
I try to hit diabetics that usually don't require insuline first. Also, during a med pass, I try to knock out the pt's who don't need bp's. Tips: Remember to fan the finger dry when you swab it. The alcohol can alter the reading. If the finger is heavily calloused, it'll be harder to stick. Pick another. Also, don't 'bleed' the finger for a blood sample. It's painful for the pt and it alters glucose readings as well. In addition to this, if you've got to stick a finger more than once, you should pick a different finger.
- I do one major med pass per 8 hour shift. I start around 7a and I'm through around 10a. Do you give noon meds at 8a-9a? No comment. LOL But, seriously, it depends on the med. I mean, it's not like you're going to give ambien at 4p. EX: for a 3-11p shift, unless BID/TID or a narc or something of that nature, everyone rec'vs all of their meds in one pass.
- If pressed for time, it's necessary to chart on status change, new/readmits, falls and those rec'ving ABT TXTs. I'm thorough when it comes to family issues, incidences and status changes. Beyond that? Meh.
The more you write, the more you've gotta answer for.
What was the problem with the pt, how did you successfully address it...and how did the pt respond to it. You've gotta 'follow up'.
Don't write a book: "resident remains on ABT f/u for UTI. T98.2(temp). 0 adverse reactions to ABT TXT." "Observed" or "noted". Whatever.
KISS it: "resident remains on fall f/u, day 3. at 220p, resident c/o headache & was administered 650mg acetaminophen to promote comfort. Well tolerated. 0 further complaints of pain a/o 1030p" ;
"resident with nonproductive coughing @ 11a. resident administered ml geritussin & 1 cough drop to promote comfort. Well tolerated. upon inquiry, resident stated that he is 'doing fine' @230p." ;
"CNA informed this writer of resident c nonprojectile vomiting@12p. Resident a/o to self, place, situation complaining that stomach still 'feels funny'. T100.6(temp). Bowel sounds heard @1st quad,
I like evenings. Know why? I can make one-sentence generic notes for the bulk of my people and pawn it off on them "being asleep", LOL:
"V/S: 112/78, P78; RR16, T97.9(temp). Resident c 0 s/s discomfort or pain, resting c HOB ^ & unlabored breathing as of 1030p."
I do rehab; I have 30 pts -- and I have to chart on, like, all of them! LOL So..."generic nurse note", it is.
If state comes around, dump the pre-popped pills and do the pass meds as you're supposed to. Maybe it's wrong to say it on here but ... meh. If you're taking 4 and 6 hours to complete your am or pm pass, you've bounced out of the '1 hr before 1 hr after' window, anyway. So, what difference does it make if you give a 12p at 9 when, doing things your way, ie., slow, it's 12p, your am meds are bleeding into your noon/1p pass and b/s checks and a small portion of your pt's haven't even rec'vd their 9a meds?
My pt's re'cv between 2 -10 meds apiece ... with drops ... patches...neb txts, etc...
... and I still have to do accuchecks, wound care, clean nephro tubes, give 2 bolus feedings, care for 8 PEGs. Let's not even talk about family members, emergencies and the work that needs to be done at the desk.
People say, "It's not a race."
...but it is.

WOW, Honestly this helped me so much thank you!!! God Bless. I'm going to keep this in mind forever for my whole nursing career aha.