LifelongNursing

My comment may be a bit naive, so please forgive and correct me if I post something radically wrong. Personally, I've never wanted to pursue a job that has a very vague role, or a role that not many understood, such as the CNS. I'm a newly graduated nurse practitioner, and I'm still not exactly clear as to what a CNS really CAN do that ISN'T still vague at this point in our career field. Most professional development facilitators or clinical unit educators really all take the role of ensuring a smooth process of on-boarding and training new staff, but also ensuring that floor staff (and some providors) follow facility policy and audit the medical chart for restraints, pain management, etc, and TYPICALLY only require a BSN, sometimes an MSN, but should or would the CNS take this role and do this any better or different? Another example, diabetes educator. I've primarily seen nurses with BSN and a certification for diabetes as an educator/instructor for patients with new or uncontrolled diabetes and to help them with resources for their own management as well. From that standpoint would the CNS take this role? And if so, would that justify more pay or a new role altogether? I guess my question is, since most roles like those and more, are filled already with BSN/expert certification nurses, how does a CNS elevate that role (or would they?) or how would a hospital or facility justify bringing on a CNS ontop of the other roles already in place. I'm so naive, no insult meant, I'm just trying to clarify the role to learn.

Being a recent new grad myself, that was some of the findings I also experienced myself. Fortunately, I landed a job that paid actually what a new nurse practitioner SHOULD be paid. the 80K a year is embarrassing for our profession and somewhat of an insult for the NPs. With that said, there are many new nurse practitioners that work outpatient all their career then land a job within the inpatient setting and are lost, and vise vera. I'd be lost in the outpatient setting and therefore couldn't justifiy MUCH more than 80K. I only wish that NP schooling was more standardized, not a repeat of BSN school, and more involved with actually teaching more than diabetes, HTN, stroke, and MI management.

Are you speaking in regards like this example: You and the nurse you are reporting to found an issue, and should technically call the physician about it but the other RN wants to get report from other nurses first? Or, you offer to page the MD since the problem was found at shift change? Otherwise, no would technically be no reason to page the provider for the "next shift" while you are clocked out. But, to answer your question, it should not be a HiPAA violation only if it is/was your patient and it is/was your issue.

I think this is all on how one views it personally. During my last months of school and hospital rotations, I had an optimistic view. However, once I graduated, the early weeks after school, that optimisim turned right into the gutter. Now, after the average length of time it takes to get boards passed, NPI number etc., etc., I think I am one of the lucky ones that got a job relatively quickly and I'm very glad I'm in this field of healthcare.

I took those classes together. It was doable for myself, however, I learned later than I had one of the "easier" instructors for A&P and one of the "harder" instructors for micro, so if you have interest, go for it.

Indeed, but I disagree about the charge. It is part of the nursing reasoning and assessment when the patient is post Foley, or has an acute change in urine output.

Not in the least bit. The PT/INR work through various clotting cascades, and is not the end, all, be all, lab values to be concerned about when they are low. The only concern would be if the patient was on Coumadin/warafin therapy and those values were low. Other than that. No worries.

It is uncommon, but not out of bounds. It all depends on what the facility can charge and not charge under the "nursing" side of things that typically comes with the charge for the hospital room for the day/night. I used to work for a facility that wanted to charge the patient just for bladder scanning them.

You have the right idea, however, you must realize that the human body is not a machine, and therefore, we cannot expect precisely for it to behave so. Ideally, the INR and PT values do, in fact, reflect and have a positive correlation, but this is for the HEALTHY individual. You add liver disease, medications, infections, etc., things change quite quickly. For the basics, the PT can be "low" and the INR be "normal" or vise-versa. These are all normal fluctuations within the body during normal physiological changes. I hope I answered the question for you!

I would feel personally anxious, but it depends on how you look at it. Don't beat yourself up about it, but at the same time, understand that a PICC dressing that is soiled or out-of-date, should be treated with some urgency as that is a very large infection risk that, in some patients, can cause sepsis, and death without treatment. Yes, that example is extreme, but it DOES happen. As a new grad, you will learn time-management with experience, but even the most experienced nurses leave late as well. If you have crashing patients or patients that are "too busy" (I don't like that general excuse) don't be afraid to ask for help or, say to someone "hey, do you mind changing so-n-so's PICC dressing, its soiled and out of date, and I'm dealing with this urgency here...." But despite all of that, during report, you could point out the picc dressing needs changing and asked for help changing it "really quick" or something to that nature, to not put it off on the next shift but to take care of it during report. With that said, it happens and similar things happen all the time in nursing, don't let it become a habit.

I agree, pain does play an important factor in influencing the blood pressure. Good point! You are exactly right, I 100% agree. For the new nurses, this is definitely something to keep in mind.

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.