rtaz315

Thanks for the feed back, I will certainly take your suggestions and but them to work the best we can. We have a CIQ them working on this and reporting all evaluations, problems, solutions and suggestions etc. We have had a nurse suggest team nursing but have not tried it. We are also trying to track response time of all staff on the floor to see if one area is better than another etc. This is a project started after comparing our scores with two other hospitals in the surrounding area and considering patient replies to call backs after discharge. Staffing is sufficent most times, in hospital nursing there will always be the times you are short staffed but we pull together to try to make up the shortage. I work with a wonderful bunch of nurses and aides and could not have a better manager but administration would like to see survey numbers go up and set this team up to try to accomplish that. My problem has been finding document models of nursing that seem to work better. Does anyone know of a website or journal that would explain different models for managing medsurg? This would be helpful in having backup or proof that a model works better than what we currently have.

Does anyone have any feedback on better response time on a medsurg floor. I have recently been ask to research how to improve response time on a medsurg floor and have been unable to find anything on the net or in journals short of better staffing. The hospital I work for has a ratio of 1 nurseto 6 patients and 1 Aide to 9 patients. That is pretty much the standard for this area so I can't cry over staffing. We do use a Matrix system that does staffing based on number of patients rather than acquity of care. But still in extreme cases they will call someone in. Any suggestions or thoughts, it appears that our lowest scores from an independent company survey was response time for assistance with bedpans and medications not being given when expected by the patient.

I used the Hesi study guide and CD plus did Nclex review questions every chance I got. I am pleased to say that I passed the hesi first try and just graduated on May 12th. I start my preceptor for state licensure on June 5th and I am really excited. Good Luck and just keep answering any practice questions you can find and make sure you not only know the right answer but why the others are wrong. It is time consuming but it worked for me.

For vital sign check off's the only questions we had to ask before taking the blood pressure were -- "Do you have a preference as to which arm I take your blood pressure in" and "Have you had any procedures or injuries that may interfere with blood pressure readings in this arm?" And if we could not establish baseline from the client chart (provided by the instructor as a scenerio for your lab partner) "Do you know what your BP normally is?" The things you have listed we only inquired about if the blood pressure was out of range (hypo or hyper) to assess what the cause may be. You mentioned assessment -- are you only doing vital sign checkoff's or a complete patient assessment?

By the time I check VS in a clinical setting the introduction and initial patient assessment (head to toe minus VS) has already taken place (we start clinicals at 7a.m. and most hospitals in my area take VS at 10am and 2pm, unless the patient's condition warrents early checks on VS). When I do go in to check VS, I explain what I will be doing and tell the patient what their T, P, and BP are. Answer any questions they may have (that I am qualified to answer) and thank them for their cooperation. Perhaps it is because I have already completed an initial assessment and introduction before doing the VS but I have not had much problem with patients talking to me when I was checking VS. I have had several talking to others in the room or watching TV, however all of my instructors have taught that the hospital is noise by nature (visitors, equipment, pages, other staff in semi-private rooms, people in the hallways, etc.) and you have to learn to tune out the external noise and concentrate on what you are doing. They had us practice on family members at home with the TV on, Radio on, kids running around -- whatever it took and eventually I learned to close my eyes if needed and just listen. Sounds stupid but I promise it worked. If checking an Apical pulse I have explained to a patient that what they were saying echoed in the stethoscope and ask for just one minute to complete the VS check (if they are talking I always do that last). For Respirations, we were taught never to let the patient know we were checking Resp. because they would unconciously change their breathing pattern. If I have a talkative patient I pretend to still be listening to the heart and count the resp. at that time. Hope something here will be helpful to you. Just hang in there and keep practicing in all types of different settings, it will get easier.

Got in touch with my instructor and this is the verdict. EPOS means the client is meeting expected outcomes and A6A was misread -- should have been A&O for alert and oriented.Thankfully she was on the ward and able to verify this information for me. Again I appreciate the help and support from all of you.

I will call my clinical instructor tomorrow (who works at the hospital I currently have clinicals in and see if she can help. I appreciate the effort from both of you more than you know! The only thing I can find on the EPOS is Eindhoven osteoporosis study which could relate because the primary disease can lead to osteoporosis, but I don't know why they would have this as a routine procedure. I will let you know what I find out. Thanks again

The best help is knowing you have studied, you are prepared and the best you can do is all you can do. Also, remember that what you fail in now only opens the door to improvement for the futher. I wish you all the luck in the world and feel that you will do fine. So take a few deep breathe and do the best you can on your test. That is all we can ask of anyone. Good Luck!

I am currently doing clinicals at a pediatric ward. My patient had Acute Disseminated Encephalomyelitis. The nursing notes in the chart read as follows: meeting EPOS, A6A, MAE, PERL, Pulse + I know that MAE means moves all extremeties and PERL is pupils equal react to light, pulse + means all pulse are palpable but I do not know what EPOS, and A6A means. Can anyone help me with this? I have tried to find out in textbooks, diagnostic books, and dictionaries with no luck. I would appreciate any help you can give me. Thanks

Thanks the sites will be very useful. Do you know of any sites that offer drug card downloads or information? I have had trouble getting the clinical drug card information required for some of the medication. I am a first year student doing my first clinical rotation now. I currently use Lippincott's 2006 drug guide and Mosby's 2005 drug cards but still can not find all the medications I need cards for.