Latest Comments by delphine22

delphine22, ADN, RN 7,367 Views

Joined: May 25, '12; Posts: 308 (47% Liked) ; Likes: 368
Sepsis/Stroke Coordinator
Specialty: 5 year(s) of experience in Quality, Cardiac Stepdown, MICU

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    Quote from elkpark
    Getting called at all hours and getting "bothered" by the nurses is what the ICU physicians signed up for when they chose to specialize in critical care. If they find it unacceptable, maybe they should change specialties. I hear dermatologists rarely have off hours problems to deal with.
    I say this all the time. If they don't like it, don't go to medical school and don't be on call. I'm not the doctor. I worked in an ICU at night where if the pt came up vented from the ED we'd write our own sedation orders before the pulmonologist saw them in the AM. I wasn't comfortable writing for propofol or fentanyl on my own BECAUSE I'M NOT A DOCTOR. I always called, or my charge would call for me and write the order under his name. One time a nurse did it and the doc came in the morning and said "I didn't want fentanyl." He didn't push the issue -- but what if he had?

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    ICUman likes this.

    I'm originally from the NYC area and I still find her accent super annoying.
    The videos I've seen of her contain so many side conversations -- like about her family, and how to start a business -- that I find them distracting.
    But they are indeed memorable -- especially the lecture on ABG interpretation "Who's your baby's daddy?"
    She is irreverent and funny -- it all depends on how you learn.
    In my experience, I and my colleagues who used the online bank from Pass CCRN did fine. The questions very closely mirror the test, and the rationales are great.
    Laura will give you some pearls that you may remember elsewhere in your nursing career. If that's worth the time and cost of the lecture, go for it. But you can definitely pass without her. (Look up some of her videos on YouTube for a preview.)

    Good luck!

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    I can tell you that the majority of our CDI queries at this time (I do not do this job but just sat and talked with them yesterday) are related to sepsis, because it's difficult for the physicians to master and a high-value code that often gets missed.

    I work for a large healthcare corporation and they send our CDI folks a list of charts that must be queried daily, with detailed criteria, pre-worded queries, etc. But they are also told to use their nursing judgment, so you get to do that. It's exactly 50% being glued to a computer screen and 50% chasing doctors to provide education.

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    I can't really recommend a particular book because the spreadsheets are 100% what you make them.

    The point of the spreadsheet is to take all those different random points of "data" so you can turn that data into "information," something your colleagues can use and act upon.

    Besides dashboards provided to me by my corporate overlords, from which I can download large raw data Excel files, I make my own sheets for concurrent review. I only include what I need to know -- and as the months have gone on and priorities have shifted I've added and removed columns when I realized I needed certain data I wasn't collecting. I get my data from going into the EMR every single day. There are some reports that can pull the info I need but a lot of it is just digging.

    Any Excel Dummies book or online site can show you how to quickly make a pretty chart out of your data. I pull the data out separately and make it into some rows and columns, then highlight them all and right click to select which chart or graph I need. Then it's easy to play with colors and styles.

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    I would not get that certification. After you have been working in quality for a while I highly recommend the CPHQ certification (that does go behind your name) as that's a very respected certification in quality, also available from NAHQ.

    I went from the bedside to quality through the sepsis and stroke coordinator route.

    Basically a quality professional needs to have good bedside nurse understanding (so you can read charts and see what might have gone wrong) and ability to deal with all sorts of people, especially physicians, and getting people to do what you want, lol. Half of my job is cajoling physicians to document correctly, follow protocol, and gently educating them on how to do better when they've gone astray.

    Most people don't expect you to have prior quality experience for an entry level position, as long as you have solid bedside knowledge, excellent interpersonal skills and enthusiasm. Good luck. :-)

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    I think it depends on the leadership track you are interested in.
    If it is mostly nursing (unit director, with the eventual goal being a CNO) I would get an MSN in leadership.
    I am looking for leadership positions away from the bedside, for example in quality. So I am considering a healthcare MBA.

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    A hospital near me has a position called Manager of Patient Experience. This person mostly dealt with the Press-Ganey numbers and training the staff on how to raise them but it sounds like something that could also be applied to your job.

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    redreba likes this.

    I work for HCA now and I can tell you the culture is definitely, promote from within. They have a lot of leadership development programs available. Make sure to ask about them in your interview.

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    caliotter3 likes this.

    Quote from SunnyPupRN
    If the MD does not want the med scheduled, perhaps call the MD who is on call for the regular MD and explain the situation, that the nurse refuses to administer the prn nausea med when the pt requests it, although no vomiting, you are concerned perhaps about reflux aspiration in your elderly pt and feel it would be safer if the med were routine. Be honest, of course.
    Be very careful going around one doctor by calling a covering doctor who doesn't know the first person was asked and explicitly said no. It's one thing to be a patient advocate but that's sneaky and dishonest. You do still have to work with these people. The only exception is going to an attending when you have a problem with a resident (md rssident) bc they are learning.

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    If i were that pt, I'd "fire" that particular nurse. Have them tell the charge they don't want that particular person caring for them again. Problem solved.

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    No, but I had a family member who was awake while intubated and self-extubated. His vivid description of the experience has stayed with me and I think of it every time I see a pair of frightened eyes look up at me as they try to speak, to tell me they feel like they're drowning while I assure them they are not.

    I don't "snow" my patient to make my shift go more smoothly. It's for their comfort, not mine. It's not easy to get to the "sweet spot" of sedation where they're out until we want them not to be. I did mention sedation vacations q shift which is my unit's policy. As for delirium, which do you think is worse -- being asleep and having no memory of the experience, or being in a terrifying twilight state where you can't communicate your fears and, being half sedated, aren't sure what's real and what's not, or whether you're even dead or alive?

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    Our unit keeps waffling because there's a push to involve the pt's significant other/decision maker in bedside report, especially if the pt is sedated or confused. Then there's a rule that everyone BUT one support person clears out between 6:30 and 7:30 am and pm. We are a locked unit so every visitor has to call in to gain access. Shocker, when we're all in report and have no secretary at night there's usually no one to answer the phone!

    One time I tried to enforce this, answered the phone (which had been ringing for a solid minute) during shift report and said, "I'm sorry, we're in shift change right now and can't admit visitors, please follow the signs and wait in the waiting room until 7:30 and then call back." It was a patient's wife who only had a short window to visit and he wasn't oriented. I felt like crap saying no to her and let her in.

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    Quote from Pprwrk
    The wipes can be used to also clean off foley caths and any tube/line/wire resting on the patient and extending out from the patient.
    Please note, according to Bard the CHG wipes or any CHG cleanser are NOT to be used on Foley catheter tubing as it can cause corrosion or remove the silver antimicrobial coating. They recommend castile soap wipes or their own proprietary peri care wipes (plain soap and water is OK too).

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    Nurses who want to do flight nursing need their paramedic license (at least in Florida). But it's preferred they have ICU experience first.

    The only paramedics I've dealt with in the hospital were moonlighting as monitor techs. And each one has been impossible to deal with. Arrogant in the face of being completely wrong, wanting to do much more than their scope, and just in general not happy people. Because they weren't where they wanted to be.

    If you want to be a paramedic, be a paramedic. But if you want to be a nurse, I suggest you focus on that. Don't take the course just so you can start a few more IVs than your fellow nursing students (because without OJT that's all it will be -- a few).

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    Sounds like a job in special procedures or interventional radiology. Those nurses basically act as part OR circulator, part cath lab nurse. Their duties are pretty similar to what you described -- pt comfort and safety, prep and recovery, lines, assist MD but not pass surgical tools or scrub in.

    Note: Depending on the department or the hospital, you can take basically no call or hellacious call. Our radiology nurses take one or two call shifts a month. Our specials nurses regularly work 24 hours straight without a break.


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