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  1. Silly_Sally_RN

    Code Blue

    The patients on my unit get a purple DNR band if they are a DNR or a white and purple band that says MODIFIED DNR if they want something, but not everything. If I walked in on a patient who wasn't mine and noted they weren't breathing, I would look for the band. If I didn't see it, I would yell for help and start CPR. We also have the DNRs/Modified DNRs written on a white board at the nurses station. Occasionally it is written on the white board in the patient's room, but not always. There are also a few patients who don't have a code status documented in their chart. They are considered a full code should anything happen. You could also get in trouble for not starting CPR sooner. Every situation is different, but we've had DNR patients code and family changes their mind and wants you to do everything to save them.
  2. Silly_Sally_RN

    As seen on TV

    Amen, NurseNancy25! I hate that I started watching it (1 downfall of only working 3 days a week), but I keep tuning in. Sometimes I think it would be nice to be a nurse at Grey Sloan (or whatever the name is now) because the doctors do all your work. There was major eye rolling in the episode with the pregnant nurse this fall.
  3. Silly_Sally_RN

    As seen on TV

    Keep an eye on the IV pumps on Grey's Anatomy. They frequently are programmed for Dextrose 5% at 100 mL/hr and Gentamycin 3 mg/kg/day. McDreamy had 4 pumps with these settings when he died.
  4. Silly_Sally_RN

    As seen on TV

    Can we include movies? I love watching While You Were Sleeping during the holidays, but it gets me every time when I hear a vent in the background of Peter's ICU room. Peter, who's in a coma, is not intubated and does not have a roommate. I guess the sound people thought it wouldn't be "real" enough if there weren't medical sounds. There also is an episode of ER where the nurses strike except for Carol (I think because she was management). A trauma comes in and the patient winds up dying because Carol hung the wrong blood. Turns out the patient in the trauma room earlier that day needed blood and something happened (can't remember what), but the blood wasn't given. New patient comes in and Carol accidentally hooks up the prior patient's blood. In addition to being the wrong type, I cringe at the thought of how long the blood was sitting there (and how poorly the room was cleaned)! A common thing I notice is how patients, especially those in comas, are always on their backs (unless plot dictates - a Grey's Anatomy episode comes to mind). There must be tons of HAPIs in TV hospitals!
  5. Silly_Sally_RN

    Where were you...9/11

    Taking the first test of the year in my A&P class, senior year of high school. Another teacher came into the class and told the teacher he had to turn on the TV, planes had crashed into the Trade Towers. That effectively ended the test. We watched the TV the rest of the period. As we moved to our next class, those students who knew were trying to tell others what had happened. I remember telling my sister to get her teacher to turn on the TV as planes had crashed into the towers. When I got to my next class, my teacher didn't know and didn't believe us when we told him. We had a performance coming up. We practiced, but as soon as we were done, we turned on the TV. He said "I didn't believe you guys!" (Why would we lie about that and why would we all have the same lie?!?!) By that time, the towers had fallen and Flight 93 had crashed. Some of the teachers tried to conduct class as usual, but most let us watch the news. It is crazy to think that it is history now to all the people in grade/middle/high school. This was news for me; it's my history.
  6. Silly_Sally_RN

    New nurse staying way past 9:30 pm on day shift

    First off, 9 med/Surg patients is insane! Are you including admits or do you have 9 patients at 1 time? I don't know if I could do 9 patients. Secondly, when does your shift end? Are you staying 3-5 hours after a shift? I could see management having issues with this as you would be working 9-15 hours longer than planned. I'm not being mean, just worried. Are the other nurses staying late, too? Being new is hard. I'm guessing you are on day shift by your mentions of rounding with the providers. Is there any way you could go to nights where it is a little quieter (although the belief that patients sleep at night is a myth!)? This might allow you to get a better grasp on time management. The downside is you may have more patients. Are your co-workers busy all day, too, or could you ask them for help? I struggle with asking my co-workers for help because I feel like I should be able to be super nurse and do it all myself, but that's not reality. Do you have computers in the room? Charting in the room can help speed up charting (you aren't getting interrupted by co-workers, doctors, etc.) and can help with some of the things you feel like you forgot to chart later on. You can walk out of the room knowing you have taken care of the charting for that patient. Do you have a mentor? Is there a new grad program? Anyone you can talk to? I would consider talking to my manager to see if I could have a little more orientation or do night shifts, if possible. Whatever you do, don't take meds out for multiple patients! That is just asking for a med error. I am imagining scanning a patient for their nightly insulin and then mixing up the syringes! Our Novolog sticker come up as Novolog, but don't fill in the dose (because of the sliding scale). It would be SO easy to mix them up! Having feeding tubes is always going to slow the process down. Some of my co-workers will give multiple meds at once through the tube. I don't because I don't want to be the one who clogs the tube!
  7. Silly_Sally_RN

    Feeling unsure

    May I ask what you felt never really clicked? It might help us give more directed advice. The unknown is scary and your feelings of uncertainty are certainly understandable. I knew I wanted to teach and I knew I didn't want to work full-time on my floor any longer, but as the start date of my educator position grew closer, I thought to myself "The floor's not really that bad." It was because I knew the floor; I was one of the nurses with longevity on my unit and had seniority. But once I started my new position, I knew it was the right decision.
  8. Silly_Sally_RN

    Shift Differental

    My facility offers night differential between 1900-0700. Day shift gets about an hour of night pay, depending on when the shift change happens. Very few floors here have an evening shift; a majority of the shifts are 12 hours. We also have a weekend differential, which is paid from 1900 Friday night to 0700 Monday morning.
  9. Silly_Sally_RN

    NSO Insurance

    I have insurance through NSO. Thankfully I've never had to use it. I know a lot of people will say you don't need it, but I would rather have the peace of mind. NSO does more than provide malpractice insurance. They will reimburse costs of helping people (like if you use your first aid kit at an accident) and will help with your medical expenses if you are the attacked at work.
  10. Silly_Sally_RN

    Quit while on orientation

    I would see if your employer has a policy on how much notice is required to leave in good standing. I know my facility has one and requires licensed professionals to give 4 weeks notice.
  11. For the GI system maybe you could talk about dehydration, prolonged vomiting/diarrhea, nutritional deficiencies, and anorexia/bulemia and how they can lead to electrolyte imbalances which can lead to cardiac issues.
  12. Silly_Sally_RN

    New Clinical Educator

    I taught clinicals for a semester while in grad school. Hope these help you: 1. Realize you can't do everything. I had to watch each student pass meds and assess a patient at least once in the term. I felt like I needed to be there everytime each student passed a med, which is impossible. I know you said they can't pass meds just yet. Will they be able to later in the semester? I had to trust the nurses on the floor and explain to them what I was looking for when the student passed meds. 2. Talk to to the charge nurse when making out assignments. I did this to see which patients would provide good learning opportunities, which may not want students (we had student 3 days/week and mine were day 3 - some patients were done with students by that time!), etc. 3. Know what your access to the EMR is versus the students' access. We had differing views and it was frustrating. Are you teaching in a facility where you already work? If you are, be careful not to use your employee access while instructing. They explained to me that it was a HIPAA issue since I was an employee of the university and not the hospital at that point. 4. Volunteer for anything! I told the nurses on my unit to let us know if there was anything going on - foleys, dressings, blood sugars, procedures, therapy, etc. My students loved getting involved, even if it was only watching a procedure. 5. Be prepared for going back to the basics! I struggled initially when they would ask questions (ex. Why does x med cause y reaction?). I had been a nurse for years and that information had become so ingrained that I had to stop and think about why I did what I did. (Even though I wanted to say "because that's they way it is"). Your students are at the conscious incompetence level - they know they don't know the information. You are likely at the unconscious competence level where you can do something without thinking about it. Along with that, I tried not to ask questions while they were performing a task. I was taught that beginners have difficulty crossing learning domains (cognitive, psychomotor, and affective). I would ask questions before going into/upon leaving the room and let them focus on the task/patient when in the room. 6. For post clinicals, we took part of the time to debrief. We also talked about labs, tests, etc. to help students understand better how everything was connected. MyAimIsTrue suggested SBAR which is another great idea. A co-worker arranged for the students to tour the lab, central supply, and pharmacy, which I felt was helpful for them to understand why it takes a while for a certain lab to come back/med to come up or why the central supply people may not understand which foley supply you are talking about when you call them. 7. Be prepared for the time it will take to grade the paperwork and do evals. I loved teaching but the time commitment was too much when combined with school and work. I would love to get back into it at some point in the future. Have a great time!
  13. Silly_Sally_RN

    Epic Charting

    Our version of EPIC allows you to alter other's charting, but it leaves an audit trail that is clearly visible. There would be a red triangle in the upper right corner of the cell. If I clicked in that box, I could see what was charted, when, and by whom, and when, what and who changed the charting. The IT department/computer people should also be able to track who was in the chart. When I teach EPIC to the new hires, I tell them the only reason they should ever change someone else's charting would be an obvious error and they aren't around to correct it themselves. My example is when my CNA mixed up the HR and RR. I called the aide to confirm and then changed it. I specifically tell them that if they try to alter someone's charting for the purpose of getting another person in trouble, it won't work.
  14. Silly_Sally_RN

    Got a new nurse in trouble

    I would speak up. If holding a med is what is in policy, that is what you need to do. If a surveyor came and saw you "borrowing" meds, they would have a cow. Especially if they asked you what the policy was and discovered you were not following it. You should not be "borrowing" against another patient's meds to cover. We had a nurse who was fired because of a similar situation - hung the right antibiotic at the right time, but had the wrong patient's name on it.
  15. Silly_Sally_RN

    It Never Occurred To Me.

    Great article! Thank you for sharing. I agree it is very hard to come on shift and get told in report that the patient is awful/demanding/rude, etc. I like to talk to the patient and make up my own mind. I have found listening goes a long way!