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peter73's Latest Activity

  1. peter73

    Nurse hours per patient day

    Hello, I don't know where you are located at but at least in the states I've worked the nursing hours PPD are a formula of: A) straighttime- X hours per patient in the facility. B) wieghted- hours per patient acuity (ie. the higher the care for a resident the more hours they require, set up by case mix/rug scores) Some states have a set number of hours required by law for each resident, or general staffing guides. They can be set to include all nursing (licensed and CNA) or split hours (xhours for licensed and x for CNA) or even set just by licensed staff. None of these hours include staff that is not invoulved in direct care in some way Ie DON doesn't count, nor does the other "desk or clip boarders". Dependant on your location these staffing factors can be found in the regulations for your facility type, or averages for the area can be found on the CMS website in nursing home compare. Most of the time these numbers are set to be the MINIMUM staffing allowed. Facilities tend to "shoot" for the closest to these numbers without goining under to save $$$$$$. (at least that is what I and the other managers had to do or get the budget lecture) I hope this helped, peter
  2. peter73

    Any experiences with Down's syndrome?

    Although many children with Downs share alot of the same behavior, physical, and personality traits, they can not be lumped together as a whole. This is just like the typical COPD, FTT, add your own dx here, are all alike. Children may or may not have defects in every body system (in any combination), have the physical downs look, or the palmer crease. OR to add more confusion any one of the different genotypes of downs (trisomy, mosaic, translocation). The degree of disability will directly influence behaviors, as well as past experiences (just like with anyone). The degree of MR results in the child like sunshine personality, but also the agressiveness. Just think of any 2y/o you come up to with a needle...they are goining to fight esp. if they have had a shot recently. A child of 12 may be in the same comprehension level as a 2 y/o and not be able to understand the need for the shot other than that HURTS me --> it is BAD. A child that has experienced alot of pain from healthcare providers as a result of the many possible physiccal defects will react totally differently from the child that is in the hospital for the first time. The scope of MR in downs is HUGE. One child may be profoundly MR/DD, with little independant function. Another may be so mild that they drive, attend college, and funcion almost at a normal level or have none of the common or major defects seen in downs. The setting you pratice in may cause you to see more of a certain type of downs. For example in an ICU you may see the worst of the worst with severe and or multiple congenital defects, in early intervention you may see the whole specturm. Overall downs is a very diverse and extensive dx to deal with. I like to think of it like snow. Every one has the mental picture of a snow flake and it is pretty close to the same image for every one, but really no two snowfalkes are identical. just my two cents. Peter
  3. peter73

    LPN to RN compensation

    not many facilities will come right out and hand over the $$$, unless you are firm in requesting it, have your ducks in a row as to why you should get credit for your experience and what you are willing to do for them. This means lay your loyalty on the line. Let them know you really like your job, see yourself there for many years, and that you would hate to have to look elswhere when you are already know the p&p's, chating systems, doctors and thier different little requirments for thier patients, whould require less training and are a member of thier team. Ask highier then you really would be happy with and negotiate down, know the $-figure you would work for and stick to it. And if all else fails, and you are really not happy with the wage, politely and professioonall turn down the offer and look elswhere. Managment knows a new grad RN with several years LPN experience is worth more than new grad pay, but they are more than happy to take your knowledge and experience for free;) if you let them do it.
  4. I work 7p-7a and hav e a 3 y/o son. It works out great. He goes to daycare the mornings after I work. Terry leaves for work at 6:45 am. and drops him off. Chase gets picked up by Terry in the evening on the way home. That gives me time to sleep and I get Baby free time to do my thing, make dinner, and generally get the house in order. I used to work days. Set my own hours at 8a-5p at my desk job. I was really upset over the whole night thing and didn't know how it was going to work. Well I was very suprised that it is BETTER. Instead of Chase in daycare 5 days a week and a mad rush for dinner and family time when I got home from work, Chase only goes 2 or 3 days. ( work 3 12hr/wk, m-t-w/w-th-f)I have way more time at home and way more energy when I'm at home. I don't feel like someone else is raising my child anymore, and Chase still gets to go to "school" with other kids (He's an only child) Now if Chase had to be up and gone at 4am that would be another story. I wouldn't do it. I was lucky how the shifts worked out. Keep looking if you really want a change, something will always turn up.
  5. peter73

    IV Starts

    We use the same type of IV cath. Took a while and some practice to get the hang of it. I usually tend to remove the needle then punch (or mash, when here in the South) the button to retract. I found that if I retracted the needle right away my hands had to do too many things at once and I lost the stick. Also, it helps to spin the cath arond the needle to break the seal before you start(spin it till it clicks back into place). Just what works for me. Good luck and practice, practice, practice! In no time you will be a full fledged vampire like the rest of us. :) peter
  6. peter73

    are doctors more valued then nurses?

    Value is in the eye of the beholder. our hospital will spend more to recruit one doctor than on all nursing recruitment. After all, people go to the hospital for expensive services provided or should I say ordered by the doctor. They make the money for the hospital. Nurses are the necessary evil. Hospitals can not function without nurses, but we are all expense and in some cases treated as such. Doctors are tied to a nurses value. Sounds funny but I think it is true. I have worked with Docs who treat nurses as dust under thier feet and the managment follows the leed. I have also worked with Docs that got the concept that in some cases all that stands between them and a huge malpractice suit is a NURSE, balancing condition, treatment, meds, etc. (after all, a nurse may have 8 patients and a doctor may have 100+ beteen clinic, in house, consults, etc on any given day). When the doctors recognized our value to them, they put the pressure on the hospital to keep the nurses happy, well educated and continuing to protect them from error. I have seen doctors go to bat for nurses in wages, hours, etc. The reason may be totally selfish, if you were the MD would you rather keep the experienced nurses in your specialty or have all new grads or floaters monitoring your patients? You have never seen anything as angry as a surgean who just realized that the unit was staffed with new grads and OB nurses floated to the unit. The surgeans banded together, cut back elective surgery, and put the pressure on to give bonuses and incentives to get experienced nurses in the specialty, on the floor. (not to belittle OB nurses or new grads. New grads need guidance from experienced nurses. Specialty nurses are highly effective in thier specialty, and I think we all realize that bieng floated to unfamiliar territory puts patients and our license at risk) When the doctors value the nurse judgment, experience and performance the hospital is forced to take a bite in the bottom line and treat the nurses better, or risk MDs changing practice setting costing them revenue. It is just the flow of power set up by $$$$. admin. -> MDs -> nurses : nurses -> MDs -> admin. After all, money maskes the world go round. Doesn't it? peter
  7. peter73

    What do you expect of a CNA?

    My expectations are simple, I think. I expect no less from my CNA then I expect from myself or any other nursing staff on the floor. 1. Professionalism. Treat the patient/resident as a person, be available to questions and concerns. Know when to refer them to another team member for answers outside your practice area (even if you know the biopsy was malignant it is not for a CNA to break the news). Carry yourself as the vital part of the nursing team, and never refer to yourself as "just the CNA" If you say/believe that, expect others to as well. 2. Responsibility. Accept and act on your duties as assigned and/or outlined in job description. Know your duties and plan your shift accordinly. If somthing is found outside the "normals" bring it to my attention. If you miss somthing or do not fully complete it, tell me. Do not "cover things up" I will find it. Every one gets bogged down at times and gets behind. 3. Duties. Ask for help. If you get behind tell me and ask for help. If you are ahead of schedule offer help to others. If you do not understand somthing or don't know how to do it ask. Know one knows everything or can do everything unassisted. 4. Conduct. Behave as a professional. No talking about other staff, MDs, patients at the desk or in a room. Arrive at work on time and in uniform. Breaks as assigned or as allowed (I don't care how many breaks you take if your work is done and done well and I know where you are), and let me know when you go. Don't fuss when I ask you to do somthing, there is a reason for it. Do not think that the nurses "sitting" at the desk are just in social hour. We are charting, calling MDs, reviewing labs, planning care, or looking up information etc. Even if you do not like someone personally, always be polite and professional. You are not here socially, you are here for the patients/residents. 5. Knowledge. Ask questions about conditions, proceedures, history, etc. The more you know about your patients/residents, the more you can understand why they may behave or respond in a certain way. That will help you to get your duties done, let you know what to expect and how to interact theraputically with them as well as avoid potential problems. The more you know the more effective you are. well, I think that is the basics I have learned so far in my travels as a CNA, LPN and Rn student (nursing home and hospital) peter
  8. peter73

    The Unbelievable things our Pts DO..It is true

    It wasn't the DX that was wierd for me but the TX. I was on my med-surg rotation in school and had to give the worst "med" ever. This patient had come to the ED, presented with pnuemonia and was started on ABX. The treating resident did not take into account her renal failure of decreased liver function. She went to toxic levels of her ABX and it killed all and I mean all of her natural flora in her intestines. She was being treated after a long search for a donor, a stool donor. I went into the room with 300cc liquified stool and proceeded to put it down her NG tube. This was of course after reading the order multiple times. I new it was not a joke when the "Med" was sent up to the floor followed by the MD, who explained to the nurses then to the pt what was about to be done. I also had a post-op pt that had an 8inch vibrator removed from transverse colon. It had sort of climed it's way up. Surgean said it was still giong when removed...I have never thought of the energizer bunny in the same light since. :roll :roll peter
  9. I was working in a nursing home in MN several years ago. I was making my rounds between the units checking in with the new nurses, asking if they needed help or had questions...all was well so I was told. On my last swing around the building one of the more experienced nurses flagged me down and wanted me upstairs NOW. I arrived to a family screaming at the new nurse, while the Residents daughter was onthe pay phone calling 911. Come to find out the Resident had been c/o N&V since 4pm. Coffee ground emisis since approx 5pm, it is now 10pm. Resident is grey, weak, thready pulse, no real B/P to speak off, ABD tender and rounded, gums pale pale pink. The waste basket by the bed is holding the most recent emisis...clots and red blood:eek: :eek: By the time the Resident got out of there I was ready to kill this nurse. She thought the resident was faking sick for attention, gave her maalox for GI upset. Said she had identified the coffee ground emisis as partially digested lunch. She still had a job after this event. Another nurse did not know how to give ABX IVPB. So, she did not hang it. She dumped it in the med room trash can signed it off and told me she had run it without problems...the other nurse on the wing found it after she accidently threw her notes in the trash... Still had a job. I quit peter
  10. peter73

    Doc rage

    I got the worst picture of a Doc the first week of a job once. Had a patient dying, DNR/DNI. Respiratory distress all the way with resps 40+ gasping and labored. His eyes wide in that panic look. He was moaning between gasps and grabbing at my shirt, arm whatever he could reach. I called and attempted to get MS04 or at least atavan for comfort. The Doc really laid into me about this not being needed this is death and how bad would I feel if I gave the MS and he died shortly after... and he would be no part of it. It was my problem and I needed to accept death as God brings it. He would not push a patient over the edge to make a nurse feel better...So I had to march my butt back to the room and sit holding this poor guys hand while he gasped, trying to calm him. All the time I sat talking to my patient I kept thinking You get what you sow and some day it will be that Doc. He died 6 hours later, 6 hours of panic every time he was left alone, attempted to swollow or went into caughing fits. peter
  11. peter73

    What was most embarrassing moment as a nurse?

    When I was A student I was performing incont. care on a elderly woman who had soiled herself with loose. Under the watchful eyes of my instructor I was trying to do it by the book. Needless to say, my little lady was having to good a time...she started to moan, gasp and shake. I dropped the wash clothe saying all done. And almost knocked the instructor down getting out of the room. I was laughed at all year for that. The the time I was working as a CNA in a nursing home. I got pulled to the young adult unit (16-60y/os). I was happily starting my tioleting when I found what was a big problem upstairs, vaginal bleeding. I went right to the nurse, who happened to be a good friend of mine and reported the large amount of bleeding and clots...as I talked in my concerned i found a problem vioce she smiled then laughed. I was like what??? what's so funny? in between the laughing she said, Peter, you moron it's her period. :imbar I thought I was going to die This was also the resident that I asked to roll towards me. She replied "I would but I'm a quad" Which color shirt do you wnat?, replied, "I'm blind what color are they" and the best in the shower...Gee, You have a big indent in the top of your head...replied "yeh, that's from the gun when I tried to off myself" Or the time as a charge nurse when I was helping a CNA transfer a REsident to bed and tripped. The resident and I fell on the bed and the resident proclaimed "I finally got you in bed with me, I hope you don't break my hip":imbar :imbar the list is endless peter
  12. peter73

    Practical jokes at work

    This sort of thing is why my friends at work call me evil... top of the list.. had a patient in restraints while up in w/c. She attempted to escape and almost strangled herself, flipped the chair and all... so the next night being April 1st... I put the patient to bed early, stuffed a pair of stockings with washclothes, placed them in the pants she had been wearing, flipped her wheelchair over on its' side right next to the bed, wrapped one "foot" in the frame in a rather very broken way. I then put a slipper on the other "foot", dropped the other by the chair and poured and splattered thickened cranberry juice on the floor and rubbed some on the w/c and bed with my fingers. I pulled the curtain halfway, turned off the light and pulled the alarm. A few seconds later i ran to the desk frantiic for the nurses to all come help quick and call the supervisor... After the shock, they loved it and have repeated the stunt... I also had a patient expire, after the bed was empty, it was padded with pillows, sheet pulled over the "head" I reported that the body remained in the room and family was on the way to view. After report i snuck back to the room and turned on the call light sitting next to the "body" I then crawled under the bed and lay in wait. The night nurse came in mumbling somthing about the light must be shorting...when she got right up next to the bed to turn off the light I grabbed her by the ankles and gave a little tug toward the bed. Thank God she had on her depends:eek: I also like the chocolate stunts.. I usually put it in a damp washclothe or towel and smear it around. I walk out in the hall and say to the next staff I see, can you put this in the bin and toss it at them. Doctors freak out the most:D Unfortunattly, everyone is on to me now and I can only get the new hires. peter
  13. peter73

    Gender biasing by MD's

    I have seen this happen many times. An attending that insisted that the female nursing staff refer to him as doctor. As in " doctor, John Doe has spiked a temp of 102" And would yell if they even suggested an order, I and the other male nurse were told to call him "Bob" and he would ask if we needed any orders for our pt. MDs I have worked with who are notorious for being rude and condisending to nurses never took that tone with me or the other male nurse. I have had doctors find me to give orders or question a pts cond. after speaking with the pts nurse. The ladies that I worked with on the floor always told me that I was given special treatment by not only doctors, but other nurses, admin. and pts. They said that I started the job with a higher level of respect than a female nurse recieves and I recieved more respect faster than female staff. Because of this I have always felt I have to be twice as good at what I do then expected, or I am only being treated this way because I am a man. peter
  14. peter73

    Breath sounds-advice please

    You can know for sure with a CXR showing changes to the density of the lung tissues, esp the lower lobes or left lobe in the case of aspiration, elevated WBC is also a good clue, also, the character of the sputum if any may lead you to an idea if it is pnuemonia or CHF. Sputum C&S can be done but is difficult in elderly pts. due to frequent difficulties with cough/deep breathing. Often you must suction for a good sample and this causes increased secretions and can make resps more difficult, I try to aviod this unless MRSA or VRE is suspected. Some Docs also order blood culture. The s/s of pnumonia are often atypical in the elderly but once you see it alot, you can pick up on the differences found on assessment in CHF and pnumonia rather quickly. If further tests are not ordered, the MD is relying totally on your assessment info for the DX or going with her/his best guess. No CXR = No confirmation of pnuemonia. If you are just flying on S/S I would look for cough, fever, purulent sputum first, but, these may all be absent. Next would be change in mental state, chills, chest pain, dyspnea, tachypenia, lethargy and loss of appetite or vomiting. Other conditions may exhibit exacerbation in major infection also, ie- blood glucose goes through the roof. Any or all vital signs may change form base line. It is not uncommon for a resident with a normal temp of 97-98 degrees drop to 95, or have funky B/P and/or pulse. peter
  15. peter73

    Breath sounds-advice please

    stprdi_01, Lung sounds are a tricky thing to get the hang of until you have actually heard the abnormals with another nurse who tells you the lable that goes with the sound. I can give you the definitions I have been taught, crackles: are the sounds made by the aveoli as they pop open or closed when made sticky by fluid or exudate as in CHF or consolidations of pnuemonias. The thickening of the bronchi as in bronchitis. crackles may be heard on insiration or experation. ( crackle and rale are the same thing) The sound of crackles is like the sound of hair being rubbed between fingers or a large amount of bubble wrap being twisted. They do not usually clear with a cough. May be positional. Wheezes: are the sounds made by the narrowing of the internal diameter of bronchi and smaller branches of air passages. They may be on insiration or expiration. They sound like a sigh, sick whistle or musical tone. They usually clear with coughing. Wheezes are auscultated in ashma and COPD. Also known as rhonchi in some regions, in others rhonchi are wet gurguly to course sounding wheezes. Lasix would be prudent if the Resident is in distress, has CHF, does not have pnuemonia. Oxygen should be applied for o2 sats below 90% and is symptomatic for hypoxia; confusion, SOB, cyanotic lips/nail beds, etc. Also for comfort, sometimes just the O2 and cannula on a distressed Resident is enough to calm them to normal breathing patterns, increase comfort. I hope this helped some. peter
  16. peter73

    New nurse feeling low2

    hey shavsha, Keep this in mind next time that happens. Some, not all;) more experienced nurses hold new nurses up to the same skill standards as a nurse who has years of experience. It is not that you are not a good nurse, you are a new nurse; the difference is years of personal experiences and upper level critical thinking and skill only learned on the floor, working with other nurses with this knowledge. As a new nurse you can be expected to have the general and basic knowledge required to function safly on a nursing unit. The key is basic meaning basiic skill and knowledge, after all that is what NKLEX tests. When I was a new nurse I ran in to a few of the critical experienced staff and one was the nurse manager of my unit. It was nursing hell. This really helped me to defuse the situation: I got the experienced nurses to think of themselves as my mentor, guiding me to higher skill and knowledge. Which is what they did. When ever one of the critical nurses started to chew me up and spit me out I would remind them that I was a recent grad and they never explained this situation or just touched on this, etc. I would then simply ask them as a nurse with years of building knowledge and skill to explain what they would do and why so that I can learn to be as good as them. This got me the knowledge I needed to function at a higher level as well as not gete eaten alive by some of the nursing staff. It also gave the nurse in question a feeling of your submission to them, a good thing, if the nurse is a charge nurse and then feels as you will follow her direction. I will bet that most of us have been in a situation like this, and it is not that we are bad nurses, just new ones and someone forgot you don't graduate with years of experience, skill and confidence under your belt. Don't be too hard on yourself. It does get better. And just a note; for all nurses: Please, please remember how you felt as a new nurse when you have new nurses needing guidence. peter