veegeern

Pain or sedation resulting in shallow breathing or slowed respiration rate? I've seen it with other procedures.

:yeahthat: Most of ours have multiple tablets, and many take them 1 at a time. A couple of our nurses will crush meds for these to save time, but I really hate to do this if the patient can swallow. :smackingf

Thanks to all who have already responded. I see that there a those who have either always been held to the 1 hour standard, or have gone to the 1 hour standard. As an entire floor, it is a challenge to give our medications within the 2 hour time frame, so I guess I'm also looking for ways that we can do things differently and comply with a 1 hour med pass. Any suggestions/strategies for speeding up a med pass? This is a busy (who isn't busy ) M/S floor. Right now it seems like I do a lot of my patient teaching r/t medications as I'm giving them. I usually have at least 1 patient/caregiver that states she didn't know xyz about that medication, and many times she's been on the med for years. Do you find it's better to give out the "quicker" ones first, and then move on to the more time consuming patients? Quicker being the patients that can swallow easily or don't have IV push meds that take several minutes. How are you handling dressing changes that have medications recorded on the EMAR or MAR and are due at the same time as your other meds? Have you found anything that works to minimize interruptions during a med pass?

An e-mail went out today from the Pharmacy head stating that a (hospital) corporate wide change went into effect today. Until today, a medication could be given up to 1 hour before or as much as 1 hour after the scheduled time without it being considered early or late. A 0900 medication could be given as early as 0800, or as late as 0959. Starting today, that 1 hour window was narrowed to 30 minutes. A 0900 medication could be given as early as 0830 or as late as 0929. Now, take it for granted that as nurses we all want to give a 0900 dose at 0900. This just got me to wondering...What kind of policies are out there? For how many patients are those nurses providing care? How many/what kinds of meds and accuities? Do the policies work? Anyone care to comment?

I have seen this with gravity flow, especially with INTs in the upper arm or when a patient is gettiing out of bed. Have only seen this happen with a pump when the MD ordered a rate of 20 ml/h, and then it only was partially up the tube.

My husband had a "different" odor to his breath before his thyroid cancer was diagnosed and treated. Don't know if it was the cancer or the impaired metabolism that gave off the odor. My grandfather had prostate ca. with mets to the bone. He had a very sickly sweet body odor that couldn't be washed from the bedding even long after he had died.

I took a quick count of nurses who also happen to be male in my rather small, rural, southern facility. I counted 13 without even trying. If any of them are gay, then their wives and children are in for a big surprise sometime later in life. :icon_roll And their sexual orientation sure isn't any of MY business. But I digress... My point was actually that I can't see someone calling any of them a "murse." These guys are "good ol' country boys." One's a rancher, one's a biker, one's a body builder, all but 2 hunt, and they all fish. Then there's the photographer and the computer programmer. They are sons, husbands, fathers, and grandfathers. Oh and by the way, they happen to be pretty darn good nurses, too. It's a shame that the society that we live in needs to place labels on people so that we can't see beyond sexual orientation, gender, skin color, ...

Funny how we never see things like this in the national news. As opposed to nurses that kill their patients...

Definitely oral care. Changing any tubing including feeding tubing runs a close 2nd. Usually gets done by certain nurses consistently, and not done by others consistently. Our assessment screen flags IV sites that are over 72 hours old (computerized charting). If you had to wait until after shift to finish charting, then this doesn't help, of course.

To the OP: I am so sorry that you found yourself in this situation. You say that you lost your cool, but I say that you kept it. You did what you had to do to protect yourself and to make the pt let go of you. End of story. You did not beat, torture, mutilate...out of anger. You did the right thing. Talk to a lawyer to find out how to put it in the right legal perspective. Seek counseling to deal with your feelings. Don't continue to be a victim. I was raised in martial arts. Dad, 2 uncles and 2 aunts are instructors. I was taught real world techniques and well as traditional arts for competition. I was also given a value system for using what I knew in the real world...defend others, defend self, and defend country. I also took self defense classes in college for my physical edu. hours. That said...if I'm being assaulted, I'm not going to be thinking about my license. AND if I am successful and have my health when it's over, they can have my license if they want it...after a fight of course.

as a new grad, i did both of these!:trout: i was in a hurry and failed to note that i had incorrectly connected the tubing to the cannister. fortunately, our wall suction has a one way valve, so the secretions didn't make it into the system. i now double and triple check my tubing. we used to have glass bottles for lipids. i was spiking the bottle, and my grip slipped. the spike broke off into the rubber stopper, and i had to call the pharmacy for a new bottle of lipids. the pharmacist had a good laugh and then told me that i was the first one he'd heard of doing this.

KVO fluids makes sense. Just had never heard of flushing with 50 ml saline. I have chosen to use 10 ml for certain abx and after phenergan. Thanks to everyone who replied!!

I'm in Georgia. Hep flush is only used for central lines in our facility. Saline flush only for peripheral IVs.

Our facility protocol is to flush IV sites q 8 hrs with 3 ml NS if the site is not being used. We also flush with 3 ml NS before and after IV med admin. Had a patient receiving multiple IV antibiotics. The patient's site was being moved about every 24-48 hours r/t infiltration and/or pain at the site. The night nurse passed on in report that a Nurse Anesthetist (spelling?) suggested periodically flushing the site with 50 ml NS to preserve the site. Does anyone know if there is any evidence for this practice? Thanks!

I personally can't imagine coming back into nursing after that many years, and I'm basing my opinion on the volume of new information that I've had to assimilate since I became a nurse almost 3 years ago. After 30 years, I think it would be like starting all over from the beginning. How would you even know what you didn't know?:chair:

Have gotten a few chuckles...and a cringe...out of these! A newly hired RN with many years experience was providing patient care one shift. Our PCAs will often place used thermometer covers in a tray on the dinamap cart (even after being told not to do this). The RN was using the covers from the tray instead of from the box attached to the side of the dinamap as she took vital signs.:barf01: In our 3rd semester, a fellow student was going to put tylenol elixir in the buratrol (spelling?). She was failed right then and there.

As for me, I don't know if I would like peds or not. It was okay in nursing school, but I've never actually taken care of them as a nurse.

This was my point exactly. What do peds nurses know about all of the adult cardiac rhythms, meds and dosages...and all the other dxs that we have on our internal medicine floor. What do we know about peds dxs, meds, doses, etc...It's a safety issue.

Thanks to all who replied. You all are voicing what I'm thinking. Even though I'm a very independent person, it's nice to have validation at times. From what I've seen so far (almost 3 years with this hospital) this seems to be the norm rather than the exception for doing business. If I want to be trained/oriented and stay within my comfort zone,then I'll have to transfer to L&D, Cath Lab, ER, CCU...Floor nurses are treated as generic nurses. AND as there are no openings in theses areas, I'm now looking at other options.

FairlyThere has it right. I'd only add that you need good communication skills and LOTS of patience! Oh, and everything that you see the nursing assistant do...become as quick and proficient at it as they are. It will save you lots of time, effort, and linens when you're the one going to assist the patient.

Long story short here...Census has been low on our adult medical unit for around 1 year. Pediatric's census is up and down, so they've been bumped from floor to floor. Now, they're with us, and possibly will stay. Peds nurses are being crossed trained to recover heart cath and stent patients. The peds nurses on the floor are doing all that they can to take care of the kiddos. This means that the peds nurse is taking care of anywhere from 3 to 12 or more patients. Many of them have taken care of adults, and chose to take adult patients if their census is low. I (and most of my peers) have never taken care of peds patients. We have not had orientation to peds, nor do we have the experience to take peds patients. At this point, we are expected to take peds patients prn and when peds does not have an RN scheduled (mostly at night) to be the charge nurse and do admin assess for both peds and adults. At this time, I'm the only nurse that seems to have an objection to this. The others have been at the job longer and have more experience. Their attitude seems to be resigned. I spoke with my manager about my concerns. I said that I believed that this was a safety issue for peds as well as adult patients. I was told not to say anything because the CNO was looking at saving jobs, and that I could "take the pull" (float to another floor) if I wanted to avoid working in this situation. (That got me taking 6 different patients on 3 different floors in a 12 hour shift.) Am I missing something here? Please tell me that it's not like this everywhere. I like hospital nursing, but I need something else...

I was the new med-surg (also BSN) nurse almost 3 years ago. Where is she with her organizational skills at this point? When she receives report, does she know where to begin? Forgetting for a moment that there will be endless interruptions, can she make a "schedule" for her shift? During my preceptorship/orientation, I did not learn how to organize and prioritize because my preceptor did that for me. It took me 6 months to 1 year to figure it out for myself. I wish that I'd had somebody to do what you're doing. I found that before I started my day, I had to take some time to make a grid of patients and times that meds were due. I didn't list the individual meds, but I did list PO, IV, TP, etc... If the med was not in the med drawer, then I listed the actual med, route, and dose. Then, I added dressing changes and looked at care that could be grouped together. By getting this big picture of the routine care that I needed to provide during my shift I was able to handle new orders, admits, discharges, etc...more efficiently. It did take me a little more time to get my day started, but it made everything from charting to re-organizing on the fly easier for me. It also took away some of my stress and a lot of time that I spend "spinning my wheels." After about 6 months, I was able to wean myself off of this crutch (the grid). Hope this helps. Thank you for taking the time and effort to realize that the nurse is having difficulty and caring enough to try to help.

:yeahthat:

Are you just referring to reconciliation at admission, or reconciliation b/t units also?

After our latest inspection this became our policy, also. For instance, we nurses were mixing large dose of Zofran and putting them on a pump instead of standing there and pushing them "forever." Now, we split the dose and dilute it with 10 ml NS. The we push each syringe "forever."