LifelongNursing, ADN, BSN, RN 898 Views
Joined: Aug 9, '17;
Posts: 21 (43% Liked)
; Likes: 28
I would listen
Couple of things:
Don't forget pain control plays into your scenario.
Don't be afraid to call the admitting service if you have questions about how an order should be utilized. IMO you took prudent steps and made some good decisions but someone could technically come along and say the hydralazine PRN should've been utilized when the clonidine failed to bring the BP within the ordered parameter. I notice coworkers sometimes spend significant time wondering what to do and worrying over something when we do have the option of getting a definitive answer. There's a good chance they may have told you to hold off and you would've had the opportunity to get more specific instructions or parameters if necessary.
I agree nothing further needs to be done about it at this point.
To be fair, managing BP to the gold standard of under 160/90 is not always feasible. A family member of mine is allergic to 2 different classes of cardiac drugs for symptom management, and she is maxed out on all other doses. Resting BP is usually around 169/95. The cardiologist didn't have any other suggestions either. Always good to get a history and check for understanding before delving into education.
I've just had the pleasure of being a nurse for years. You'll learn many common dosages of common medications very quickly. Lexi-Comp is a great resource as well. As a nurse, you have plenty of options and decisions to make to, in order for you to be the nurse you want to be. If EVER something is in question or not sure about, research, research, research.
At this point there is no need for further action, only a learning moment. Based on the dosing, if the patient had a 167 systolic, and the order was for 20 mg IV hydralazine, you could
1. Give the 20 mg hydralazine and see how it affected the patient
2. Held the order and get a new order for 10 mg IV hydralazine instead.
Typically doing option one is more beneficial, as you could call the practitioner, and say that you've tried option 1, and it was too much, that you thinking lowering the dose would be better.
You shouldn't get into trouble, there will be PLENTY of future cases where you would not be giving an ordered medicine
Glad you are into nursing!
It depends on how much the hydralazine and clonidine dosing were. Just because a patient says his BP normally runs at 170/90 does not mean we, as nurses, cannot or should not have a tigher blood pressure control in our patients. Outside of orders to keep a certain high level of systolic, we should get that Bp down under 160 systolic. In fact, if the patients bp is 170/90 normally, the patient nor his primary care provider are managing his BP adequately and would have been a perfect time for education.
One hour after giving his clonidine would be a perfect time to check the blood pressure.
Hope that helps!
Not sure on the specifics of the facility but you can certainly search CMS guidelines for payment and reimbursement. If they require it, it will be there. However, in most cases, SNFs and LTACH hospitals give the patient a TB test in order to be compliant by certain personal or private insurance. Also, it may be "out-dated" policy from the SNF itself. Often these are warranted because of high-risk to exposure depending on the area of the state or county. However, if your area is certified low-risk and CMS and private insurance doesn't require it, then the SNF should stop or change their policy.
I do not personally participate in the "cosmetic" side of nursing, however, I do know from personal experience that many who do, enjoy it. With that said, I think it is important to point out that often these types of businesses want you to "sell" or "upgrade" a patient's procedure, leading to a possible conflict with the ethics within the nursing field.
Certainly, pursue your passion, just remember to do no harm!
If you strive to be a charge nurse, you will one day. There is no specific combination of experience that will ultimately guarantee you to be a charge nurse. I'll say, from being a nursing supervisor myself and loving to teach new nurses, eagerness will go a long way. The eagerness to learn, keep patient's safe, asking questions that demonstrate critical thinking and "just doing it" certainly will build your experience enough to the point of you being confident to being a charge nurse in an emergency department.
Often being a charge nurse is not necessarily knowing what to do with the patients, it is knowing what to do with the staff. For example, knowing the strengths, weaknesses, and personalities of each staff member and refining your charge nurse abilities to match those as well as being open to other ideas other than your own.
With that said, I think it is a great idea to pursue being a charge nurse, especially in the emergency department and experience and certification will go along way, however, so does skills, knowledge, personality, and your ability to stay calm be just as important.
You may need to call to set up an in person training, however, typically your employer sets this up.
You typically don't get trained once and done. You need to be observed several times and then do them routinely to stay proficient.
I was trained through bard access systems and their website for online is Bard Access Systems | Clinical Training | Course Catalog
I'm starting to study for my CCRN, and have read how wonderful Laura Gasparis' videos are. Anyone have a copy they would like to sell?
Or, know of another good series? I'm a visual learner, and typically need something to follow as a guide. I have the Pass CCRN book, but am pretty overwhelmed at first glance. 2 years of tele/stepdown experience, including lots of Vents, critical drips, ET intubations: so I will benefit largely from the certification but lack the traditional ICU experience. Though I have checked and do qualify for the hours to sit the exam.
Maybe not illegal but certainly may introduce certain situations where this is unethical. She cannot possibly recommend the flu shot to each and every person on any sort of social media without first knowing each person's background, medical history, etc. At the very least, I would say this is not a good idea generally on social media without giving a disclaimer of "always ask your primary healthcare provider" etc.
I want to add a different perspective to this post. Sometimes if a person is positive all thectime, they may use positivity ad euphoria and try to accomplish herculean tasks until reality sinks in and the situation becomes a sinking ship.
My point is that, as nurses, we just need to be rwal and honest, finding that light within our patients thst give them hope. Sometimes we have to say medications and tasks need to wait....I really need to spend tome with this patienr....and i do not mean idle chit chat....i mean rwal life discussions thar greatlt impact important healrj care decisions.
In the past month I have sat at tje bedside with 6 patiejts who haf life altering diagnoses and each one just felt very depressed and alone from others. They felt God betrayed them. One asked me to pray with them.
I have had tearful discussions with patients. I have helped change patients perspectives about their outcome of a particular life altering diagnoses because i found within th the spark that gives them hope.
Happiness from being positive can only fuel a person so far. What I have found, though, is by talking with patients who feel hopeless, desponded, alone in their decision making, after spending time with them- sometimes medications will be late when you do this, but the reward you feel by making a difference in people's lives this way is very much worth the time and effort.
Balancing work and school certainly can be daunting for everyone, however, each person is different. Find your strengths and know your weaknesses. For me, balancing school, work, family, writing, website and youtube channels for Lifelong Nursing, a second job, and trying to find free time is very very difficult. Time management is ultimately key. If you have time to sit down for 20 minutes and look over school work, prepare resources, and read an article or two, go for it. Waiting around each time you have a bit of free time will only delay and hurt you in the long run. Hope that helps a bit.
My wife and I are long-time nurses and have worked a number of different jobs with different patient populations, all of which were learning experiences for the both of us. One common theme we have noticed is the nurses' ability to voice their concerns. Nurses are very vocal and in this day and age, being vocal in the healthcare setting is important but it is how and when we are vocal that is most important.
According to Andriakos (2017), relishing the joyful moments in life by drawing attention to them through speaking about them become important in increasing our happiness our lives and decreasing the effort it takes to do so. Spreading some cheer by intentionally brightening up and being vocal in the workplace can go along way. Smiling just for 10 seconds can improve your mood almost instantly (Andriakos, 2017).
This concept is just as important to understand when being negative or being vocal in a negative way. For example, many of us already understand and think of the above paragraph as being motivational and a good way to bring yourself to being in a good mood. However, not many of us realize this works the opposite way as well. Of course, we do not walk around the work place thinking "I wish I was in a worse mood, I think I'll frown for 10 seconds to worsen my mood almost instantly."
It is human nature to find ourselves feeling blue or angry often over situations we almost have no control over and when we voice those situations, we draw more attention to it, and unknowingly began to spread the negativity and "de-cheer" many people who overhear. In each of the work places my wife and I have had the pleasure of working, there seems to be a very familiar trend. The nurse that is vocal about negative events in their personal life, their patient they just had that asked a "ridiculous" question or the family member of a patient that was being unnecessarily difficult. Being vocal about these negative interactions often come up at the nurse desk or other common areas that employees gather to perform their job. Overall these negative conversations not only can put the nurse speaking about it in a worse mood but also the person the nurse is having a conversation with, as well as, possibility de-motivating staff (Ho, Delin, Kin-Hung, Chan, & Lee, 2015).
It is easy to have conversations to make yourself feel good about a situation or to bring attention to a particular event inside (or outside) the work place but do so in a positive way. Nurses today are role models. We are taught that both in nursing school and after graduation, however, some forget that. Being a role model is important to ourselves, our co-workers, and more importantly our patients (Ho et al., 2015).
Being mindful is step one in being the best role model possible and it starts with you, the nurse. Spreading our joy to others through positive motivation, exemplary actions, and choosing how and when we relate a negative situation or idea can reduce the impact of the negativity thus increasing happiness and motivation in the work environment. Be positive! It is important that we all learn from each other and our patients on how to be a nurse and how to treat others respectfully while still voicing our concerns.
I completely understand the need to be prepared and keep your ducks in a row by applying early. However, there is no need to. If you have one more year left of school in your BSN program, then I recommend completing that, and then passing NCLEX. If you apply now to any graduate school and do not attend for a year, then you will have to reapply.
However, as with most people, I would definitely recommend getting at least 1 year of nursing under your belt before applying to any graduate program. Within the first year of nursing, you will learn SO MUCH, and go through several changes in both feelings, confidence, and understanding of how patients and health care operate. This information is vital when completing a masters or doctorate program, however not technically required.
For the PMHNP programs, you are almost guarenteed to get in with only a good GPA and the required pre-requisites. Good luck!
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