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LovingPeds MSN, APRN, NP

Clinical Pediatrics; Maternal-Child Educator
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LovingPeds has 11 years experience as a MSN, APRN, NP and specializes in Clinical Pediatrics; Maternal-Child Educator.

LovingPeds's Latest Activity

  1. With my senior practicum I was given the name, the unit, and a contact number. I had to reach out and introduce myself and schedule hours for preceptorship. I think it was the same way years later when I agreed to precept students myself. I received a phone call on my cell phone from students introducing themselves. It was not surprising, because I knew I had agreed to take on a student. In graduate school, I was assigned a preceptor for my acute care hospital work through the hospital. I had to contact doctor's offices myself to ask if anyone was willing for my primary care education. Some schools give assistance with preceptorship. Other schools have students on their own. It really depends on the school and the precepting environment.
  2. LovingPeds

    What should I do?

    I transferred to an ADN program for nursing. I had all the pre-reqs done for a BSN program and then some. This school required that you had an ACT within the past 3 years. My ACT was 4 years old at the time. I went to the school and asked them what I needed to do. I was told that my ACT score was really good and I did not need to retake it. Because that was what I was told - I didn't retake it. I then received a letter saying that I was not admitted due to an older than allowed ACT. I went to the school and told them that I had come to their office and did not retake the ACT because I was told my score was good and that I did not need to. They sent me to the college office to take the other option which was some type of basic literacy test. I passed with 100% and took the results back to them. They looked at my record and told me that I was "over qualified" for their program based on my completed pre-reqs and that they would make an exception to the admission date to let me in for that year, but not to tell anyone that they had allowed this. I understood because that could easily be construed as unfair. Schools make mistakes. Some times in the sending of transcripts, in records, or in advice. All you can do is talk to the staff, be polite and respectful in your conversation, and see what happens.
  3. LovingPeds

    Roommates

    I had a male colleague in nursing school who went through the same thing. He was married, a few years older than his roommate, and had small children at the time. He and his roommate became and I believe remain good friends. We didn't judge him for it. Nursing school is time consuming and tuition is expensive. The roommate appreciated the break on rent. He appreciated the place to stay. I don't know all of the details, but I know that his wife met the roommate several times. They had exchanged numbers in case of emergency. I don't know that they became good friends, but she did become comfortable with the roommate. The trick for them was attributed to two things: transparency and video chats. He was very open with his spouse when ever he and his roommate were studying alone or going out to get dinner alone. He never made it seem like he was hiding information. He also video chatted her twice every night he stayed over. Once when right before his kids went to bed to talk to them and then once before bed himself just to talk to her. If it was a late night like with clinical, he took the time to chat with her for a few minutes before she went to bed. I think his family stayed so involved that way that it was like he was home. Another thing that I think was very helpful was study groups. When ever possible they invited other people to study with them or to have dinner with them so it wasn't just the two of them all the time. It was just clearly a professional relationship based on circumstances.
  4. LovingPeds

    Already stressed out

    You are going through a difficult time in your personal life. I am sorry about your father, but I will be honest with you. There will always be a situation or a reason that comes into your life that will make nursing school seem like the "wrong time". Nursing does have a lot of reading involved. My suggestion for you is to look at your notes and topics from class. Go home after your class and focus on reading more about those topics. Part of nursing school is also learning how to focus your studying on the topics of most importance. If you decide to continue with nursing school, invest in one or two NCLEX review books. Take a some questions on whatever you're covering that week in class. What you get right, you know and don't need to study any further. What you missed, you know you need to read more on. It can also help you to narrow down the topics you're most likely to see on the NCLEX and thus on your exams. Don't let the stress overwhelm you. Take a deep breath. You have this. If someone thought you couldn't handle this, you would not have been accepted into your program.
  5. LovingPeds

    Vaccine administration Questions

    I work with the pediatric population. I approach vaccinations based first on age and then on their body language/response to getting a vaccination. For instance, all young children (especially 6 - 7 and under) I automatically have someone help hold starting at about 6 months. I choose the hold based on patient age and comfort. Most children around 9 when we start giving the HPV vaccine will sit nicely on their own and allow you to give it. If they seem nervous, I'll ask their parent or someone in the room to hold their other hand. Very seldom do we have to hold children for vaccination at that age. You do have people regardless of age who are not going to cooperate with vaccination due to anxiety and fear. That's not always specific to age, but more related to personality and phobias. I've had 4 years old sit and take a vaccine without help, holding, or flinching and had to hold 14 year olds down like they're toddlers. But in most cases, giving a vaccine to a 14 year old is very similar to giving it to a 34 year old. Very few people even as adults like getting a shot. It just depends to what degree they display that nervousness or displeasure to others so it's almost always a case-by-case basis. As far as quantifying the pain level of shots, I can't say that I can tell much of a difference between most of them. The HPV vaccine I always save for last because almost everyone tells me that one hurts. The others are very dependent on the patient's pain tolerance in general. As far as making it easier, I don't draw it out with explanations, but give them choices where ever possible. I basically go "You have to get a shot today. Show me your muscles. Look at those muscles. You have great muscles. You've got this! Which arm do you want it in?" If they are 4 - 5 years old, I'll give them the option between arms or legs. I've noticed they'll usually pick the thigh. I'll ask them questions about school or talk to them through the administration about anything but the administration and then tell them good job when done. Even if they were awful, I'll tell them good job! In very young children, we just get the process over with and they immediately get a sucker. It would amaze you how quickly most kids stop crying when they see it. In infants again we make the process as quick as possible and then they are cuddled and comforted. After care is very basic. I inform parents that mild fussiness, mild fever, and not feeling so well is a normal part of the shot process and can last up to two days. Anything other than that, they need to let us know about. Older children, I tell they may feel a little sore, but then encourage them to stay hydrated, busy, and to try to go about normal activities. Distraction works wonders. If they've had multiple vaccines from a catch-up schedule, I'll usually prescribe some Tylenol or Motrin as needed but in general we don't use it for routine vaccinations unless the patient is very uncomfortable.
  6. LovingPeds

    Are you calling 911?

    It sounds like you did a very thorough assessment. This possibly could be used as a learning experience in order to develop a policy plan for these types of emergencies. From a liability standpoint, if the unforeseen happened and this child did have difficulties, became unresponsive, or stopped breathing on the 3 minute ride to the ED or in the event of a traffic delay in time of arrival under those circumstances, then nursing staff could be held negligent for failing to notify or wait for 'appropriate medical transport'. Especially if the documentation mentions the word 'lethargic' after a child states "I have breathing problems". You have enough to qualify an emergency call for medical transportation. I have to attend several 'conferences' a year on limiting malpractice liability per my employer to meet requirements for malpractice insurance discounts. They present a lot of interesting cases. This just seems similar to one of the cases reviewed from an office setting where the nurse accompanied a 'sick but stable' child to the ED by private vehicle. There was an accident on the way to the hospital which wasn't far and the child suffered significant injuries in the accident. The nurse and her employer were then sued for malpractice after the family's attorney blamed the 'emergency' for the accident (and their erratic driving) and then claimed that the child's condition was too bad to have been driven by private car and that there was negligence in failing to provide 'safe and timely access to appropriate emergency medical assistance' when they failed to call EMS for transport. It ended in a settlement and the end result of the insurer's recommendation that if a child is 'sick' enough to require medical presence in transport then they really just need EMS transport. The moment you decide they're sick enough to need a nurse with them while being taken, you've already decided they need close medical monitoring. It would be best to just make the call and wait out their arrival in the nurse's office rather than risk the unknown in a vehicle on the road away from any supplies that may help you in case of emergency. Good job handling a tough situation! Glad the kiddo was okay.
  7. LovingPeds

    Classmates who cheat

    You can't tell by grades alone. You have to look also at content, but grades reflect that knowledge of content. Say someone makes 98% on everything antepartum I give them on two exams and then on their intrapartum test using a new test bank they miss every single question that refers back to that same antepartum content they had a nearly perfect score on previously. What are the odds that they knew the questions versus actually knowing the content? You either know the content or you don't. You don't have that much of a difference between test questions on the same content if you know the content. They only other logical change is the change in test bank source for questions.
  8. LovingPeds

    Pediatric vaccine gone wrong

    I can't speak for their actions or reactions. Take it as a learning experience. Every one here has had one. If it ever happens again, you can specifically mention that he didn't get the full dose and show your preceptor and the physician the CDC recommendations for partially administered doses.
  9. LovingPeds

    Pediatric vaccine gone wrong

    I never use the deltoid in a child less than 3 years of age unless they're having to be caught up and have a great number they have to get. I have had to give up to six vaccines for kids who are very, very behind. This is usually children who are around two or older. We always try to use combination vaccines if we can so as to not give as many shots. With six shots, it's sometimes necessary to space them out into the deltoid. I would not do this as a matter of general practice in toddlers though. The vastus lateralis is a larger muscle and is much easier to control for vaccination in busy little bodies. We do allow parents to restrain. I usually allow parents to make the decision for how to hold the child. They can either hold the child in their lap or we can lay the child down on the exam table. I'm comfortable either way so I give the parent the choice. They know their child and what may be easiest/most secure for them better than I do. Either way, with the thigh the parent is responsible for holding their arms and hands. I control the legs. I do not start until I am satisfied that the parent is in complete control of those little hands and arms. If the parent is not in control, then a nurse will hold the patient. If the parent lets go on any of the vaccines, a nurse will hold the patient. You have to have good control of what ever area you are giving the vaccine to. If you're giving it in the deltoid, then you need to hold that arm with one hand and give the vaccine with the other in addition to the parent holding. Never rely only on a parent or anyone else to solely hold and control that area for you. When you give the vaccine, place your wrist firmly against the patient's muscle and hold it there. Then use a downward motion for the injection without moving your hand. That way if the child moves unexpectedly, you still have control of that syringe because your hand has been steadied. It's a similar technique to bracing with your hand while looking in ears. If this child received a partial dose, then he wasn't fully immunized. Any dose less than the full 0.5 mL is not valid and will need to be repeated. Honestly, all of this is on your preceptor. They should have stepped up to help. They should not have let his child leave the office without that full MMR/varicella dose or any of the others. If it gets put into his record as a full dose, this child will not receive these invalid vaccines again as he needs to. The ease comes with experience. Don't let one bad experience stop you from giving pediatric injections.
  10. MDs are not "so above you", but you have to realize they also often managing a lot. They need you to be organized when you call them so that you aren't calling them dozens of times for what they will consider to be "little things". This comes with time and experience. Something I learned as a floor nurse was to ask the provider at what point would they like a call back with an update. Update them on the situation. Read back your orders. Then ask them point blank "This patient is having multiple seizures, when would you like me to call you with an update or are there any specific changes you would like me to call for if they occur?". For instance, call if the seizure is lasting more than x number of minutes or if seizures are occurring more frequently than x number of minutes apart, significant changes in respiratory status, etc. This patient was seizing multiple times. Once this was something the provider was aware of, there isn't a need to call for every seizure unless there is a change. This is one way to get on the same page that will also give you some parameters as a new nurse. It's easy when you're first starting out to get overwhelmed, nervous, and a little scared when a patient is not doing well. "Hold all antibiotics until labs" means just that. Hold ALL antibiotics. Otherwise, they would have specified to hold X antibiotic until labs.
  11. LovingPeds

    Vanity Plates?

    I would probably consider it if the money went toward nursing scholarships in my state. That's actually a really good idea.
  12. LovingPeds

    allnurses has Become so Politicized

    I'm one of the few people who doesn't do facebook or instagram. I think my life is probably better for it. I miss some things, but a lot less stress/drama. 🙂 I'll get this book to read. Thank you for the recommendation!
  13. LovingPeds

    allnurses has Become so Politicized

    In order to look at yourself through a different lens, it requires always first the exposure to a catalyst of change which allows this. Otherwise, you see yourself in the same circles you always have without change because nothing has changed. By someone helping me to 'expand my viewpoint', it could just as easily be active on my part by reading a book, an article, or discussing it first hand with someone. I did not mean to imply that it was someone else's responsibility. I meant that I would never otherwise come to some of this knowledge without that catalyst because my own experience limits my own personal exposure of the topic (the very basis of white privilege) and, therefore, that exposure from others' experiences (at least for me) is important in order for me to better understand.
  14. LovingPeds

    allnurses has Become so Politicized

    This is probably the most important conversation that we should be having - how we can make AN more comfortable for POC and marginalized groups. If I'm honest (and this does come from a place of privilege) I may not recognize microaggressions that I probably make myself. I try to treat everyone fairly, but until someone points out to me how something is perceived or wrong, I may not recognize it on my own. The only viewpoint I have is my own until someone helps me to expand it or to see if from a perspective I may not have considered. I welcome these conversations because they help me grow as both a person and a nurse.
  15. LovingPeds

    allnurses has Become so Politicized

    I agree to an extent. Lively debate helps people grow. The thing about lively debate though is that, even when it's personal, it's never taken to spiteful or catty place. Growth, self-discovery, and reflection will stop the moment that personal attacks are made on that person's character, intellect, etc. because few will even bother to listen to a view point (no matter how valid) that is expressed that way. A tone doesn't have to be polite, but it shouldn't be disrespectful either. We're all supposed to be either professionals or aspiring to be professionals and there is little tolerance for disrespect in professional discourse. Nothing shows a person's true colors more than personal attacks on a person rather than continued conversation on a topic. ☚ī¸
  16. LovingPeds

    Nurses Refilling Prescriptions

    Yes, this is okay and acceptable. I can give you an example of a similar inpatient scenario. Working inpatient pediatrics something as simple as ibuprofen is weight based. Our order would be something like "ibuprofen 10mg / kg every 6 hours PRN for pain" or "ibuprofen for weight and age every 6 hours PRN for fever". It was up to us to write the dose and update it as needed if there was a large weight change over time. For age meaning not to exceed the recommended dose for that age or to use the adult dose if adult weight. For instance, if the child was hospitalized for 6 months and gained 5 pounds in that time, the dose could be updated to reflect the order. It's not prescribing to do that. The order itself is weight-based. Joint Commission even saw these orders and said nothing about them on numerous occasions. What you are doing is updating an existing order to reflect a current weight. This is very common in medical fields or with medications that require weight-based dosing. You are not technically prescribing or writing an order as you have an order for the medication in place by a provider only requiring you to reflect current weight in dosing. With chronic diseases, the providers often prescribe with the intention for these patients to be on this medication until they see them at the next follow-up unless complications occur or they specify for X amount of time. Refilling medications as you are is not uncommon in these types of situations usually based on an office protocol put in place by the providers. As a provider, my nurse often refills medications using a protocol set by our office as to which medications can be refilled and for how many times before we need to see them back. I as an authorized provider designate for her to refill the prescription for me based on the protocols we have set. She sends the refill in my name to the pharmacy because I am the authorized provider whose protocol she is following. She is not writing my orders, she is independently following my orders. This protocol helps me. If I had to approve every refill myself before it went to the pharmacy there could be delays in people getting their medications. I often times don't see these notifications until the end of the day or the next day depending on how busy we are in the office.