trrinatl

Justins boot socks, made for cowboy boots, they are rugged and they provide GREAT support, they don't LOOK like support socks and the actual foot part of the sock wears out before the calf part gets floppy and loose.

I've never done much Ped's nursing except during my ER work years and my Ped's rotation in my FNP program. BUT, I can tell you something that I found to hold true. Most guys are just big kids anway, given the chance, we'll "shoot" a basket with a wet paper towel, or go "bowling" down the hall with office keys. Guys THINK differently then females and sometimes see things from a different perspective (not a bad thing, just the way we are wired). I can honestly say that my Peds rotation in grad school was my most fun. I had a great preceptor who gave me lots of space, but mostly I found out that kids love me. Trust me, i'm not cut out to be a peds nurse by any means. Maybe it's cause I'm a big chubby white guy, they all think i'm Santa or something (LOL!). I will never forget the 18 month old that came into the MD office. He was crying and holding his teddy bear, snot running down his upper lip, his shirt covered in slobber. He rounded the corner from the triage room, spotted me in the hallway, and made a sprint toward the leg of my brand new dress pants. About 3 minutes later, I was able to pry him off my leg, now covered with more upper airway secretions than I care to remember and he puts his arms around my neck and proceeds to tell me about how he didn't want a shot for his ear. (he presented with ear pain and ultimately was Dx with otitis media). After having a short converstation with "teddy" about how we only give shots to little boys who are very sick and they can only get well that way; he decided that he'd let the triage nurse take his temp and ascultate his heart rate (and clean the snot off his face). My clinical preceptor just smiled and said "your a natural". BUT I know in my heart that the moments of joy I had wiping snot off my new pants could not compare to my love for adult critical care. In my ER assignments, I've spent way too much time huddled under sterile drapes with GI Joe figures while some youngster got his laceration sutured, I've crawled into "forts" made of bed sheets and side rails to give TD shots, and I've made jet neb adapters out of foam cups so that toddlers would actually get their asthma meds instead of having them screaming and infusing the room with albuteral. Kids are fun, but just not my cup of tea.

First of all, YOU have to decide for yourself if nursing is a field that you would like to enter. When I told my family I was going to nursing school at 21, EVERYONE was against it. My mother had visions of a Notre Dame football playing medical student....needless to say THAT didn't happen. Now that I've been out of school for 22 years, they have a COMPLETELY different perspective. I've be called the "Sears Certified Doctor" in the family. With that being said, do some research. Volunteer at a local hospital or nursing home, ask your local homeless shelter if you can volunteer at their clinic day, see if there is an indigent care clinic in your area that accepts volunteers. Get into the experience, get your hands dirty, shed some tears, hold some hands, and see if it's for you. Secondly, nursing school is difficult. Lots of papers, lots of studying, lots of tests, lots of clinical. You'll need full support of your family. There will be days that you'll have an 8 hour clinical and then come home to write a paper AND write a care plan AND study for an exam the next day. Talk to the nursing students in the program you are reviewing. Get their opinions, good and bad. Look at the curriculum with some of the students and some of the professors. Is it an accelerated program that's 21 hours each semester, or is it a relaxed program with fewer class commitments. Honestly talk about your ability to manage a 21 semester hour course load with clinicals, papers, and exams. Last is the financial obligation. If you have the means for having your degree paid for by the military, DO IT! Most come out of school with huge student loan bills and tuition reimburstment commitments from work sites. I just finished my Masters in May; I was lucky to ONLY have to borrow 20K to get thru the FNP program. So you are VERY fortunate. The only other thing I would add is food for thought. If the military is willing to pay for your education, FIND SOMETHING TO GO TO SCHOOL FOR! Don't pass up the opportunity for a free education. I would guess that from you GI Bill benefits and your age, you were involved in part of the Gulf War crisis or something comparable. I'd just like to say THANK YOU for keeping America safe and free.

I'd MUCH rather clean smegma out from under an uncircumsized member than to dig stool out of a lady parts for hours. It's amazing to me how liquid stool seems to flow directly into the ovaries from the labia. Sometimes I wonder if we need one of those pulse irrigation devices to get it all out. Basically, it's a body part, just wash it and get over it. It's no more nasty than gross toe nails or leg ulcers or funky pits. Randy:uhoh3:

Okay, IMHO your old manager was a WITCH. Just had to get that off my chest. I went to a meeting this past Feb at a Pri-Med convention in Florida and there was a two hour long lunch meeting related to this very issue. The issue was mainly patients coming into the ER and rec'ing Plavix before cath, bleeding associated with the cath and then having to make the decision to take them to CABG with their coags high. (i have the report it you'd like it I can try to send it to you electronically) BASICALLY, what they found was that if you give them plavix within 5 to 7 days of OR they tend to have worse outcomes. Interestingly, the room was loaded with cardiologists and Thoracic surgeons and very few of them used that as a treatment standard. As I see it. There IS a problem giving patient's Plavix close to CABG, BUT FIRING someone is not the answer. It's an opportunity to look at the hospital's policy to determine a way to keep it from happening again. The Cardiologist and the Thoracic surgeon and the Pharmacy need to be on the same page. Set up a Pre-op CABG protocol and have EVERYONE follow the same protocol. If there is a deviation, DOCUMENT IT IN THE PROGRESS NOTES for Christs sakes (Pt will remain on plavix unitl 24 hours before surgery 7/21/08, related to new stents and risk of stend failure due to clots). I have to remind doc's all the time to DOCUMENT what's going on so I don't have to read their minds. As I see it. Your manager miss a chance to make a HUGE improvment in the Telemetry AND the ICU of your facility. She SHOULD have asked to to head up a work group to see what the best practice was across the area and to write a proposal to submit to the Medical Excutive committe to see if you could get a meeting with them to discuss the new protocol that you and she could have authored. What a way to get recognized for not only saving lives, but for being a great manager. Obviously, she missed the boat. I think you did a smart thing by leaving the facility, wanna come work with me in Atlanta, we have a new job opening in our department as of yesterday, LOL Randy

I've worked with computer charting at the VA about 7 years ago, I type pretty fast so the narrative charting was a breeze. As far as "known paper" charting, there is a learning curve to anything you do. I remember getting my first desk top that was as big as an SUV and wondering why I couldn't just use my old electric typewriter. I also remember going from a manual typewriter to an electric one, I smashed the crap out of the Right side of the electric typewriter for about 4 days looking for the return lever (I"m sure there are VERY few of you that even know about manual type writers and manual returns). Just like the thread about cell phones and other technology, it's here, it's gonna stay here, we may as well adjust. The BIGGEST suggestion I could give is to brush up on your typing skills and if you have ANY input in the selection of a computerized product, INSIST that it has spell checker as part of the program. It's one thing to see messy handwriting on a chart in court and have to defend yourself for possibly misspelled words, it's a WHOLE different story when you have to look at misspelled works and poor sentence structure that is typeset. Randy:typing

I have used propofol a couple of times for CS but generally for vented patients. The information about half life is confusing, the same source says that it's 30 to 60 minutes, then another place in the same source says it's 6 hours. So even if the patient is sensative too it, I"m much more worried about hypotension than long term airway management. Usually bagging them for a couple of minutes is all you have to do. I know we have had some patients in our ICU that went "nuts" usually either DT's or a mix of some bad street drugs; propofol works great as a short acting agent to get them under control until you can get pharmacy to put your ordered drugs in the Pyxis. The best use I've ever see was a 19 year old male prostitute that was standing, naked, in the middle of his ICU bed. He was swinging his IV bag by the tubing and had already DC'd his Foley (bet THAT hurt the next time he had a trick!). He had his pulse ox cable and was threatening to hang himself from the ceiling, all because his hospitalization for a CHI from a assault made him miss is regular weekly well paying "john". He forgot he had a second IV and the charge nurse managed to get behind him and slide about 4 cc of propofol in his line. In about 30 seconds he just kinda wilted into a naked pile on the bed at which point in time he aquired a new hospital gown, 4 point restraints and a dose of geodon.

Our corporate office is in Texas, and most of our hospitals are in California, Trust me, Texas may be southern, but they are MILES ahead of the Bible thumpers in Ga.

Maybe I have a distinct advantage of working in a corporate facility. I live in Ga but corporate has a very Texas/California mindset. We actually have sexual indentiy written into our discrimination policy. So basically, it's Okay to be GAY here. I would have been shocked by the nurses remark and immediately would have taken steps to correct the problem. I have no problem calling the charge nurse or the nursing supervisor. Trust me, If i had made a racial or ethnic remark, my butt would have been packing, so I view it the same way. I'm gay and completely out at work. It's funny, even the straight guys at work joke around and we have fun. They often joke about me having my "work wives" and want to know how I have all the women eating out of the palm of my hand when they can't get a date with any of ladies. I can joke and tease with the best and as long as it's good fun and no one gets hurt, it's a great way to pass the time on the shift, but when it becomes derogatory, all bets are off and it's a new ball game. I'm lucky in that the "straight males" are the first to come to my defense in those situations and frequently are the first ones to stand up for me.

I remember the fun days of clinical 22 years ago in nursing school. The first clinical I got into trouble because I Xeroxed the pages out of the drug handbook instead of hand writing them (which I thought was a waste of time since I had hi-lighted the stuff that was appropriate for my pt). I soon found out that if you study your skills and peform them well, they pretty much left me alone. Sometimes they would try to "find" something wrong and would keep on and on and on and seem to get more and more frustrated when you DID know the answer. Once I remember this MEAN Med Surg instructor that had me hostage in the med room for 45 minutes over giving an ASA for a pt with a temp of 103. I had already been under the hawkeye during collection of blood cultures and ordering IV ABX from the pharmacy. I finally said, OKAY, just tell me I'm a moran and belittle me so I can get on with giving this patient the med that they need for their fever. She backed off and left me alone. Sometimes you do have to stand up for yourself, but keep in mind, it comes with a cost. As a nursing instructor for a local program, I came up with a new approach to those old time NURSING CARE PLANS. I told the students, No careplans this week, instead, I have a new approach. Go into the patients room, do your assessment. Tell me the top two priority problems they have today, what you found on assessment that made your rank them highest, what you are going to do to fix it, and what you are going to assess at the end of the shift to see if it's changed. After a couple of students didn't know that pain at 9/10 with diaphoresis and resp rate of 26 was a higher priority than some crappy nursing diagnosis of "alteration in self image" we soon got everyone on the same page. Just as they figured out that pain was the bigger issue, they also realized that they didn't have a clue as to what the patient had ordered for pain or where their IV site was located. VERY quickly they learned that being able to think on your feet and problem solve was MUCH harder than writing care plans. At the end of the semester they all agreed that care plans were much easier, but that they learned MUCH more by having to be prepared on the spot.

I've been yelled a couple of times in 20 years of being an RN. Usually , i'm the messanger and just relaying info. In 20 years I've also found two great ways for handling the situation. If the doc is on the unit and yelling at me, I simply walk to the phone and call seurity and tell them that I have a hostile individual on my area and I feel that my safety is treatened. That seems to take the wind right out of their sails. Usually the staff sitting around they the doc views as an audiance is quiet willing to become witnesses. If the doc is on the phone screaming I simply say, "I can't understand what you are say with all the screaming on the phone, I'm going to hang up now and when you can, call me back from a quieter environment" (but I always make sure to have another nurse listen into the screaming and cursing just for CYA)

A friend of mine recently was looking into traveling. He just went to Craigs list and posted a request for information about the local hosptials. With some computer savvy he imporvised a Pros and Cons list for each facility. He was able to weed out the whining and crap stuff from the real stuff pretty easily and was able to determine that the hospital for the travel assignement was not a good idea.

Galaknore, you asked for opinions and I'll be happy to give you mine, but again, it's just MY opinion. That and 1.50$ will buy you a cold soda at the gift shop, so again, it's just my 2 cents worth. When I first started working in hospitals 25 years ago, the "Farrah Fawcett" and "Barry Gibb" hairdo was all the rage. Hard to believe, but I used to have "wings" that were permabonded to my head with Aquanet, GOD I LOVED THAT STUFF. Over the years, I've had everything from the curly permed mullet to the "high time flat top" and now, it's simply buzzed. I get the charge nurse in my ER to buzz my hair with the trauma clippers every Thrusday night (hey, that's tonight, gotta get it done before I leave in the AM). I would say check with your HR Dept and the Nursing department to see what the hospital policy has to say with regard to hair style, ear rings and tattoos. Have fun with it, tell the HR director that you want to have a "Dragon sleeve" tattoed on your left arm and you are afraid that will scare patients, maybe you'll just get a mohawk instead?!?! Watch her laugh, then watch her squirm when you hold your straight face. Honestly, I would feel cool with it if someone came in with a mohawk to care for me, they'd probably be coming in to remove my nipple rings for a CXR in the ICU, however, I'm sure my mother would not feel comfortable with that same nurse taking care of her or me if either of us were in the hospital. Sad but true, people sum you up and make an assessment of you in about the first 10 seconds they see you. You are gonna have to do LOTS of fast talking and impressing in 10 seconds to get some folks past a hair style. Agian, the option is yours, just keep in mind some of the obstacles that you may be putting in your own pathway.

I experienced this same thing and decided that I had to "take ownership of my piece of the problem: allowing it to happen". I came up with a very simple solution. At the beginning of the shift, when i'm asked to help turn or pull up a patient, I inform the females that my patient needs pulling up also. We can do "her's" first, then mine. Usually by the end of the shift we are working as a team and things actually go much better. Last night, my neighbor hated doing Accuchecks so I did her's on one of her patients, since I HATE priming feeding tubings, I gave her the option of doing that for me as "payback", she jumped at the trade off and we were both happy. The one nurse that I used to have problems with got a good dose of "Randyizing" not long ago. SHe asked me for help and I simply said, "I'm not going to be able to help you tonight. When you ask me for help I always come to help you, but I need for you to remind me of one situation when I asked you for help and you weren't too busy, or tied up to help." She thought for a minute and just turned around and walked away. Later in the shift she came up to me and we had a nice discussion about how she realized that she had never assisted me in the past and that I was correct in my assessment of the situation. Now the ball was in my court to make this a positive or a negative situation. I looked at her, smiled and said, "my patient needs to be pulled up and turned, let's do him first since we are right here and then we'll catch your patient." My theory is, if I'm good enough to help them, they are good enough to help me. Randy

Yikes, what an awful situation. First of all, there are may avenues to take, but the best way to handle it is to take the "high road" and keep things strictly professional and legal. Go to your HR department and ask if there is a two week notice clause for orientees. Many states have different rules, but always go by the hospital policy. If you follow hospital policy,they cannot make you a "do not rehire" when you leave. If you DO have to give a two week notice, type up a very professional letter to your department manager with an effective date and final work date. Express your concerns by quoting hospital policy related to floating and being assigned to the code team, be sure you find the actual written policy and you can even attach copies of the policy to your resignation letter. Also express in your letter that you fear you'll be given unfair patient assignments due to your resignation and you would like to have written documentation as to the hosptials policy on refusing assignments and abandonment. If you are not under any stipulations for a two week notice, then STILL write the same letter, but make it effective immediately, also quote the hospitals WRITTEN policy on termination during orientation not requiring a two week notice. Make copies of the signed letter and file it away. If there are any issues, you have all the documentation you need to head directly to your attorneys office with a nice little case. The one thing they forget to teach us in nursing school is to ALWAYS follow the hospitals policy manual, even when self terminating, and ALWAYS keep copies of documentation. It'll be the best thing you ever do for yourself.