Content That MissM.RN Likes

MissM.RN, RN 7,332 Views

Joined: Jul 20, '11; Posts: 169 (33% Liked) ; Likes: 125

Sorted By Last Like Given (Max 500)
  • Aug 14 '15

    Yeah, that happens sometimes. I wouldn't feel bad, for it isn't a TERRIBLE mistake. The nurse probable should have asked what you needed it for, and then dolloped some out into a medicine cup, or given you the individual packets.

    My concern is that using Vasoline with oxygen could cause burning or irritation, because it truly is a petroleum product, which can interact with direct flow oxygen.

    I think the Nurse overreacted, and shouldn't have spoken to you like that. It was rude, condescending, and inappropriate, and uncalled for.

  • Jun 19 '15

    With the new types of briefs available, they do not hold moisture next to skin. It is wicked and held in gel form...much like Pampers for babies.

    Using a towel is just going to contribute to moisture and dermatitis breakdown, unless you stand there and change it immediately. I know that you, nor anyone else, has the time to accomplish that.

  • Jun 5 '15

    Attachment 18323

    I have only worked in one ICU that had these locked IV boxes available to deter drug diversion.
    It seems to me that if narcotic diversion and narcotic waste diversion affected a facility's profits, hospitals would be incentivized to hire more nurses, upgrade their equipment and add a supplemental dispensing unit to the pyxis.
    I suspect that the profit margin is higher if the patient is charged for 2 mg of IV dilaudid, even if half of that is wasted.

  • Jun 5 '15

    Quote from subee
    How does a witness know what you're wasting. Any decent addict would have emptied the liquid in a vial and replaced it with water. Technology will help us in the future like litmus papers that will indicate whether the drug was actually a narcotic or not, but until then, witnessing wastes is a waste of time.
    If hospitals would provide the necessary support, nurses might actually be able to witness waste when the med was withdrawn from the pyxis. A charge nurse should be available for witnessing narcotic waste. It is also really inconvenient when the med room is located far from the nurses station in a large ICU or ED.

    I don't know how many times I have had no choice but to remove a 2mg dilaudid carpuject when all the patient needed was 1mg because no one was available to witness narcotic waste. Then I would have to ask a coworker to witness the waste at a later time, or vice versa, I am witnessing the waste of something in a syringe for a total stranger who may have easily diverted the medication. If audited, it would look suspicious that we did not waste the drug when it was removed from the pyxis.

    Rather than stock 1mg doses of dilaudid and versed, hospitals stock 2 mg doses. The lower doses are available from the manufacturer. I have asked about this and I was told that "there isn't enough room in the pyxis to stock both." Having to waste narcotics constantly is not an efficient use of a nurse's time, especially in very busy understaffed units.

    These are systems problems that lead to nurses becoming lax about witnessing narcotic waste and that make it very easy for a diverter.

  • Jun 5 '15

    10% of nurses are addicts? Add in other vices ie chronic tardiness, catty, bullies..what's the percentage of upstanding solid citizens?

  • Jun 5 '15

    Geeze, I'm so naive.

  • Jun 5 '15

    Although I have been absolutely been made a fool of several times by drug diverting nurses, I have noticed some patterns and behaviors that suggest diversion.

    One is the "quick waste" when everyone is very busy. The nurse will demand a witness and try to rush the nurse who is the witness. I heard a story about a very rude and intimidating endo nurse who did this and she actually had a secret pocket inside her scrubs. Ask to see the medication before you log on to the pyxis, every single time.

    Never pull medication from the pyxis for someone else to administer during an endoscopic procedure. If a procedures nurse knew she did not have access to the pyxis in your area and expects you to just hand over versed and demerol for concious sedation, that should arouse your suspicions. Don't be a pushover.

    If the patient is jumping off the table in the Cath lab, or any other procedure, despite repeated doses of concious sedation, suspect diversion.

    Another is the nurse who volunteers to medicate your patients for pain, or change the PCA, ativan, versed or fentanyl drips. Diverting waste is supposed to be the most common method of diverting drugs.

    If your Ativan, Midazolam, Fentanyl, hydromorphone and morphine drips run dry but the pump says the volume to be infused should have lasted for hours, and the amount infused is not consistent with the rate, report it. Check this at the start of your shift. Also check the port on the bag for a hole or drips. Report inconsistencies or pharmacy may suspect you for another nurses diversion. Also be alert to coworkers, patients and visitors who want the curtains closed. This gives them an opportunity to use a syringe to withdraw from the IV bag.

    I worked with a nurse who volunteered to go on every transport and who would withdraw an excessive amount of sedation and analgesia carpujects from the pyxis to take on the transport. She was caught when she overdosed at work.

    Frequent discrepancies with po meds in the pyxis and a particular nurse who volunteers to correct the discrepancy with you as her witness, and can do that with very quickly as if she's had a lot of practice doing so. If something feels off, trust that feeling.

    Patients who are in distress or under sedated despite repeated documented doses of sedation and analgesia or high rates of IV sedation and analgesia.

    An attitude of indifference, mood swings, irritability, sarcasm and defensiveness, chronic lateness, falling asleep, sloppy appearance, disappearing from the unit, and a deterioration in the quality of work, and doing the bare minimum while leaving an excessive amount of taskwork for the next shift - all of these signs point to diversion.

  • May 7 '15

    What I'm picturing is a teacher without tenure being laid off and then losing their ability to drive as well, that kind of thing could destroy lives.

  • May 7 '15

    While flipping through the channels my LOL (in her 80s) sees a kardashian on tv, then turns to me and says, "I f***ing hate stupid women."

  • May 7 '15

    Quote from shermainenevels
    No there is not.

  • Apr 29 '15

    The transition from student to registered nurse can be difficult for many just beginning their nursing career. There are many things not taught in school, as well as the fact that school teaches an ideal world that doesn't exist in reality. However, if report is one of your weaknesses, what are you doing to organize yourself and your thoughts? There are many examples of "brain sheets" used by other nurses when giving report- these can make sure you have all of the information needed right at your fingertips without having to remember it off the top of your head. Do a search here and you should find quite a few examples- just pick one that works or tailor it to your specific needs.

  • Apr 29 '15

    I dont think you are in a position to turn a new grad job down? There will never be a perfect new grad job. Passing up on this one does not guarantee that the next offer will have a better manager.

  • Apr 29 '15

    Quote from calinewgrad
    True, but honestly she was intimidating in the sense she was asking questions to me that I wasn't expected in a new graduate interview. I was really nervous that day and some of the questions (even basic), I could not answer, but she helped me think them through though. I think what saved me was even though I couldnt come up with an answer right away, I voiced by thought process and she lead me to the right direction..
    She actually sounds like a great leader. She asked you tough questions, then helped guide you through to the answer.

    Hmmm...a nurse manager who challenges her staff and gives them the tools to succeed. Sounds awful!

  • Apr 26 '15

    The only nurses who say they've never committed a med error are either fresh out of school, or lying.

    Also, there are two kinds of nurses: the kind who've made a med error, and the kind who will.

    Learn from this, and move forward. You did all the right things in following up on your mistake, and the patient is could've been a lot worse if you hadn't caught it as quickly as you did. You did fine. And I think it's a safe bet that you'll never make another one like it.

  • Apr 26 '15

    I gotta say...this is why making myself a DNR scares the crap outta me. Too many nurses who have no idea what DNR truly means.