FreshRN05

this is exactly what I don't understand.....my patient was very much alert and oriented...she knows what's going on and even her vitals signs revealed that she's in pain...the doctor even said it himself that she's experiencing tolerance with her pain meds...sometimes I wanted to think that these doctors are not treating her fairly well because of the fact that she's on Medi-caid.....Why do they have to see it as patient abusing meds if indeed these doctors knew what kind of pain sickle cell can give you...

Yesterday at work, I was really worked up with one of my patients who has a sickle cell anemia..She's 24 years old and had been dealing with it since she was about 4 years old...According to the other nurses at my work, she's a frequent flyer and a non compliant with her care management...she comes to the hospital almost evey other month...she's been almost in all the med-surg floor in the hosptial and almost all nurses and doctors has dealt with her in the past...Yesterday was my first time to care for her...Anyhoo, this poor lady is in so much pain (mostly joints and back) that she's been asking for her pain medicine every 2 hours on the dot (Dilaudid 6 mg IVP every 2 hours, together with benadryl 50 mg IVP)...She complain that 6 mg is not giving her enough comfort that she's wanting more...Her reticulocyte is at 6 (indicative of crisis)..So, I placed a call to the admitting Doctor and stated 6 mg is more than enough, instead he gave her Norco 1 tab PO for breakthrough pain...but still she was not satisfied and was still in pain...She's also on IVF and refused oxygen...she sats 96% on RA...During the shift another Doctor came and assesed her and discontinued her Dilaudid IVP to VICODIN ES itab q 4 hours PRN and discontinued her IVF as well...I asked the Doctor and said that this patient is taking advantage and knows how to use the system and that the patient is noncompliant..so they are not going to tolerate it anymore and will nol onger give her any IV pain meds. He also stated that if the patient is not happy about how they manage her care, she can leave the hospital AMA and look for another provider. I was in shock and in dismay...The patient is in pain for crying out loud! I've learned from school that if someone's in pain, you don't question them...you have to acknowldege it..sure this patient might have been a frequent flyer but with this sickling disease that no cure hasn't been found..how can you just stand there and say enough is enough...

$23 per hour????????? Wow! That's so cheap! I've never done travel nursing but I know a lot of travel nurses from work and they get paid at least $50-60 per hour...You might need to research more and maybe find another company........just my penny!

Wow, that's a shame..but then again AUF has gained its reputation as one of the top nursing schools in the Philippines......I wonder though as to why they would not transfer your credits??? Here in the US, subjects are not bluntly rejected but needs to go through verification processing first. Did the Dean tell you why? Where in Pampanga are you from? I was born and raised there, then migrated here after HS. And by the way what made you decide to pursue your nursing studies there? Good luck to you!:caduceus:

ok, this one happened just last week...I had an order to start TPN/lipids on my patient...Our policy is to use two seperate pumps for the TPN and lipd and to use a filter for the TPN...Well, I did all the IV tubing connection and filter together and connected it to the patient's midline IV access...Well, it was going fine at first then few minutes later, the pumps were going crazy beeping and I tell you I spent a lot of time fixing and restarting the infusion but it just wouldn't stop beeping...I was going crazy and finally I called my Charge nurse and asked her to check it for me.....To my embarrassment, my CN told me that I had connected the lipid to the wrong connector that's why the machine kept beeping.....I had accidentally connected the Lipid above the filter (lipid is thick so the filter was having a hard time infusing)....luckily, my CN was so kind and told me that she had the same mistake when she was starting out as an RN....I felt so stupid....but I told myself "hey, that's how you learn"....

In the unit I work at (Med-Surg...mostly post op patients or awaiting for surgery) we sometimes do team nursing. If I have 10 patients, I will have an LVN and CNA working with me...The LVN will do all the PO meds and treatments (dressing change, F/C insertion, G-tube....) then the CNA will do all personal hygienes, vital signs, I/O's....I do all the assesments, IVP, IVPB, blood transfusion and calling Docs for critical labs and any changes in our patients status and clarifying and implementation of orders....Now, we also do TPC (total patient care), in this case we are only assigned 5 patients with a CNA no LVN...

when giving report ( we do ours via voicecare...not nurse-nurse) you do not have to give head-to-toe report on your patient. Focus on what the patient is in the hospital for and if there's any changes in his/her condition...This is how I do mine: 1) Patient's name, age, gender and Attending Doctor and any Consulting MD's 2) Diagnosis, medical history, allergies 3) mentation (a/o; nonverbal.......) 4) IVF, IVPB, any abnormal labs and vital signs 5) Pain status and pain control med 6) any treatments (dressings, NG tube, TPN's.......) 7) any pending or planned procedures (AM/PM labs, X-ray, CT's......) 8) diet and activities (regular, NPO, diabetic/renal duet; ambulatory with or with no assist (one on one or any assistive device) Just make it short and simple...Trust me, the nurse listening to your report only wants to know the important stuff...they don't wanna hear a long story.... I carry my report/assignment sheet with me to help me with my report at the end of the day. Hope this helps.....GOODLUCK

well....let's see....I'd say the first 3 months I was losing weight because of stress (I lost about 10-15 lbs in 3 months) but guess what???!!!!!! I'm gaining it back and fast (and more...)...I'm soooo hating it...I have wedding to attend to in September and I just can't seem to stop eating....I'm no longer as stressed at work anymore....my time management has improved to the point where I finally have time to eat at work......Yikes!!! I actually am going to joing 24-hour fitness next week.....

what I've heard is that this person works every wednesday and thursday AM 12-hour shifts and then every other weekend 12-hours night shifts. So say if this week she'll only work 2 days then next week 4 days.....She works in Skilled Nursing Facility as an RN (only RN on the floor with LVN's and CNA's under her) in charge of 80 residents............I'm thinking is it worth it?

Have you guys heard of this type of deal? Apparently a Skilled Nursing Facility in Palm Springs, CA has this type of deal where you work 2 12-hour shifts as an RN and get paid 40 hours. Such a too good to be true type of deal...Then you work every other weekend, which means every pay preiod you get a total of 120 hours...too bad I'm far from this City or else I would go and apply at that facility....But serioulsy though, is there such thing? If there is, how does it work and what's the catch??? I'm seriously wondering...Any feed back would be much appreciated....

alcohol swabs IV tubing caps pen light pens (red and black) pencil highlighter syringes sodium chloride bandaids tape kelly clamp bandage scissor mints cell phone (unit allowed) critical lab slips blank piece of paper

From an ADN community college in upstate NY......$18900.00........

Hi, Your post reply caught my attention about switching to a non bedside nursing...working for an insuance company. I too graduated in May 05 and I've been working in a med-surg tele unit for almost a year...but I am more interested in possibly working for an insruance company. See prior to nursing shool I was doing billing (claims) for a medical office and I must say I really enjoyed doing it ( because I had no direct patient contant, mostly contact was on the phone). So what do you do as a UR nurse? How did you get the job and how well do they pay? I'm really curious and interested.

Ok...I just have a question.....when doing team nursing, your team should work as a team right??? It doesn't matter if you're the RN, LVN, or the nurse tech as long as we all work together to have a smooth and well accomplished day...But...what if one of your team mates just don't want to work as a team? How do you set the line straight? I just had a very unfair day last week with my Nurse tech....she was constantly on herr breaks and long ones too and she's nowhere to be found when needed....I had to do her job on top of mine (answering call lights, assisting patients to the BSC, refilling ice pitchers, changing bed linens)...I ended up not having any of my breaks and working overtime because I was behind with my charting and IVPB's.....Luckily my LVN was there to help me whenever she can and the night nurse who took over was kind enough to hang my 1900 IVPB's. I had one situation where one patient needed to be changed and this nurse tech was getting ready to go on her 9 AM break and I told her when she get back to change this patient ( I was assessing my other patients at this time and checking all my orders and IV meds) and after 20-30 minutes she gets back and questioned me as to why this patient was never changed and why I had to wait for her ( I frozed because I hate confrontation and I'm new to the unit)..I guess my concern is, she should have at least made sure that all patients are clean and have everything they need (ice pitcher, linens changed, bed pan etc, vitals) before she go on her morning break....Being a leader is something new to me and I don't like telling people what to do....So, can you all suggest to me how to be an effective team leader without sounding like you're bossing everyone around? Is this Nurse tech trying to manipulate me just because I'm new and testing how far I would go? How do you handle this type of situation?

in my home unit (ER overflow with tele), we have 5:1 (sometimes with tech depending on our unit census)...when I float to other floors, it's 10:1 (non tele) with an LVN and a tech; 8:1 (tele) with an LVN and a Tech who is nowhere to be found.....