daisey_may

My 2 cents is that is not a HIPAA violation... (you're generally able to give the condition of a patient to a family member if the patient does not say it's not okay) but I do know of someone who was fired because in an email, one employee asked another how a patient was doing after a transfer from admitting to the floor. HIPAA is has a lot of gray area, easily interpreted in many ways (especially if you are looking to give someone a HIPAA violation!). I don't even think the patient's name was used... Overall, I think it's good to be conscious of HIPAA in your situation (like no peeking in the chart or initiating contact outside of the hospital to see how a patient is doing) but I don't see how it could be a problem.

I have to agree with icyounurse about nursing as on-the-job training. I might have learned just as much being an aid on the floor I worked as a nurse as what I learned in clinicals. Plus, there are specialties that school just doesn't have time to hit on for very long. Just take in everything that you can, but keep your mind open when you get to the floor that your education is REALLY just beginning.

It surprises me that it is so different in different states and facilities!

What states allow RN's to pronounce death? And under what circumstances? Does anyone have any websites or any lists? Thanks, Daisey

I was 17 when I started the nursing program and 19 when I graduated with my ASN and started working as an RN. I will have just turned 21 when I get my BSN and I was told I was one of the youngest that the school had ever had. I was by far out of the majority. The average age in the class was around 36. There were student in their 50s and 60s who already had Master's in other programs and only a handful of "traditional" students like myself. I would say that most students were in their upper twenties. But then again, I went to a small private college that was connected to a hospital which tends to have a broader range of students. There are students I graduated high school with me who are going through the BSN program elsewhere, so your age isn't a problem. I have found working as an RN and being 19 and 20, if people use your age against you, it's only a power struggle. I worked as an CNA on a med/surg floor and as going to graduate from the ASN program within a month when I had a family tell me not to care for their family member because I was "too young to know what I was doing". I was almost an RN, but they trusted a older looking aid who has not yet been accepted in a nursing program to care for their family member. No big deal, but age does NOT always mean experience or that you are able to make better critical decisions. If people give you a hard time in school or at work, it's cheap and really has nothing to do with your skills.

Hello all, I'm a new nurse and have been working on a med-surg floor for a few of months. I'm still working on prioritizing and delegating. I go to my preceptor for help ALL the time. I make hundreds of notes. I love looking up strange dx's and medications to look up later. It is tough to call doc's sometimes, but if I write everything done and am ready, then there are no problems. And though i was afraid to approach the doctor who came to my floor for my patient (i would just wait for him to write orders, answer any questions he'd have and then figure out his ideas when he left), I have found if I approach them and ask "so what do you think is going on.." or something like that, I can find out so much about the patient. And the doctor's have taught me so much. sometimes I think how young I look helps me get off easy--everyone loves to teach me things. Because I worked as an aide with the aides I work with now, delegation is very difficult for me, but everyone on my floor helped me through nursing school and they are wonderful helping me now. I will say, though, switching from an aide to a nurse was a lot more difficult then I thought! But then again, prioritizing and delegating are my biggest problems. And when in doubt, I ask because it is ALWAYS better to be safe then sorry... And when I'm getting stressed, one of the older nurses always tells me that if I leave and my patients are pink, fuzzy and warm, then I did ok!

This happened the other night and it still makes me laugh when i think about it. I work on a med/surg floor. Sometimes our patients require telemetry and there are monitor techs that sit upstairs to watch our patient's hearts. The other night, the monitor tech called down and one of our aides answered the phone. I do not know if this was a new monitor tech or what. The aid looked up and said "patient Mrs. M is in asystole--whatever that means." Like it was said like nothing was wrong... We all looked back behind us where we can see right in this patient's room...where the little 90-something patient is sitting up in bed, blowing her nose. As we're crowding to her room, she looks at all of us looking at her and she yells "have i done something wrong?!" We busted up laughing. One of the nurses called the monitor tech again and said "the patient was blowing her nose, ...we have it figured out now. It was just so funny. The monitor techs never call to say "asystole" they say "call a code". And usually they say "check on this patient, something is wrong" or, "check the green lead--it must be off again". And that poor lol who was blowing her nose and looking at everyone staring and rushing in her room...

Hi, I am currently starting a project for my BSN that will hopefully be able to made policy at the hospital I work at. At the hospital where I work, there is no policy about offering any pain alleviation prior to an IV start. Many of the hospitals in my area already have a policy in place. It seems that lidocaine prior to starting an IV is used in some areas of the hospital and not in other places. Does your hospital have a policy? What do you use for pain relief and what are your feelings about using and offering it? Do you consider it a standard of care to offer pain relief prior to an IV start? This project is in it's early, early stages of research and from discussing it to other co-workers, I've had mixed feelings about implementing a policy and I'm curious how other nurses feel about it, too. Thanks, Daphne

Oooh! I have another one. This one wasn't me either, it was a co-worker. I was on orientation still and had a hispanic patient who spoke Spanish and could not understand English. Her husband was with her, but he did not speak or understand English, either. I was busy in another patient's room so my preceptor went to go talk to my hispanic patient. I was walking by the room and peeked in to see my preceptor reading from an English to Spanish translation book with difficulty and the patient and her husband were smiling at her. Next thing I know, she starts bowing and backing out of the room. The patient and her husband, who weren't quite understanding her spanish, looked very confused. I was laughing so hard and then the patient and her husband were, too. I asked her why she bowed, she said she was frazzled, but everyone was laughing.

I graduated high school two years ago and can not take the blame for this one: During a senior debate class, a girl who was notoriously not very bright was asking me about what the cold war was. As I started to explain it, she quickly interrupted me and in a calm, serious manner asked-" wait-is that the war where they fought with the ice bullets?" I was dating my now fiance at the time and we were both in that class together. We busted up laughing so hard our sides hurt and sometimes still refer to that time as one of our funny high school memories...ice bullets...:lol2:

I would personally be nervous being responsible not only for 42 patients, but 42 acute patients alone. Remember if you are uncomfortable, it's probably not right. It is your license that will be on the line. I would speak to someone about having more nurses on staff. If two nurses are what's agreed are needed, then there should be two nurses at least. It's not your job to find someone to work with you, it's your supervisor or manager's job. If another nurse is not available, then the manager or supervisor should work with you until someone else is available. Just my

For us we have: purple arm band: DNR red arm band: Latex allergy yellow arm band: fall risk, along with a yellow sheet above the bed and a yellow leaf outside the door for fall risk we also have different yellow bands for lab that have 10 or stickers that show that a pt has been typed and crossed for blood/ blood products. Then a sticker is taken off this arm band to take to lab for a unit of blood/blood products. We'll hang a sign above the bed that says: no b/p's, IVs or lab draws in the ___ arm It's interesting how the colors have different meanings in different hospitals! We also have white boards in the room that sometimes have information about how pt transfers, diet, fluid restriction, etc.

For me, my RN-BSN is mostly online, which I found working a lot of hours easy to work around. But, if you have class time or clinical time that you need to do, then it may be beneficial for you to cut back your hours at work. It will definitely depend on how much of a work load you will be able to take on. And maybe you can talk to you supervisor now about some options for you. I'm sure other employees and/or supervisor have received their BSN and may be able to give you some advice, especially specific for the area that you live in. If you're not going to be in school for a year, otherwise I wouldn't wait later than the summer of next year, when you will probably be signing up for classes, to address work and school issues with your supervisor.

Welcome! Why are you embarrassed that you feel anxious about being a charge nurse? And I'm curious--where do you work where you are the only nurse for 42 patients! My stress level would be through the roof! You have a lot of responsibility for so many patients... Have you spoken to your manager about your concerns about being the charge nurse?

It sounds to me like maybe some education is in order. Especially if you are worried about this happening again, I would speak to the manager or maybe just the charge nurse about what is within the LPN's scope of practice. I know only because I just graduated and we covered delegation and what was within different medical personnel's scope of practice. It surprised me the number of RNs on my floor who did not know what an LPN could and could not do and it has to be reviewed every time an LPN floats to us because sometimes we need to consider our assignments a little differently. Especially for the charge nurse who may by making assignments, education may be needed to teach or simply remind everyone what is within your scope of practice. Perhaps you may be able to "trade" tasks that can help an RN who does some of your IV push meds. But I think as it was mentioned before, picking your own battles may need to happen. And--it was no excuse for the charge nurse to grumble and mumble to other co-workers about pushing an IV med. That was unprofessional and uncalled for. Maybe education may help, but don't take it personally--and don't let someone push you around! You know what's right and what you did was the right thing to do! :)

There is a lot of gray area. It surprises me that you breached pt confidentiality, leslymill, because I thought that discussing the patient within the healthcare team was not considered breaching pt confidentiality. Wouldn't knowing the other doctor's plan of care for the patient be on an need-to-know basis for the client, especially in home health care? As for the situation i had discussed in the original post, as I thought about it, because a HIPAA violation was not legally made, I'm beginning to wonder if it was an excuse the hospital used for termination. I believe there is more to the story than what we were told, and I'm not going to go probing. It is my understanding that giving a reason for termination is more of a courtesy than a requirement. I do not believe that this occurance will help the morale within my unit because none of us see the fairness, and many of us are worried about how HIPAA can be interpreted. Just can't be too careful.

I know it's been a month since you had originally posted. I am so sorry that you are going through this. It is hard enough to be newly diagnosed with something that has affected you so much at work! And then to go back and not even receive the support you thought you would have makes it even harder. I hope that you are doing well and something has been worked out between you, the hospital administration and your co-workers. What added stress that you do not need on top of everything else! I hope you hang in there and keep us posted about what is happening. :icon_hug: Take care, Daisey_May

It's interesting you bring up drinking beer and diabetes. It doesn't have much to do with bulimia in that teenagers drink beer deliberately to lose weight, but it certainly is a side effect. Before I was in nursing school, I was under the impression diabetes only affected older people (the commercial---"If you have diabetes, and you are on medicare, your testing supplies may be covered..." comes to mind and is probably what gave me this impression) so the teenage, young adult and even older--are populations that may not receive as much education about what diabetes can do to them in the long run. And if , and when, they do receive education, the indestructible mindset may take precedence over what may happen to them down the road. It's sad, especially since the number of children diagnosed with Type II outnumber newly diagnosed Type I's. I don't work in pediatrics, but there are quite a few younger diabetics that end up the med/surg floor I work...and this certainly opens my eyes...

I had not heard of this before, but unfortunately I'm not surprised. My heart goes out for these patients though because I'm sure other problems exist--or soon will, even with education. It's frustrating enough sometimes trying to teach someone with DM I or II about the importance of being compliant with accuchecks and diet but on top of body image issues...I'd be afraid almost where to begin! I'm sure these patients know the possible debilitating effects of DM, especially when it goes uncontrolled, but to chose the side effects of weight loss over the stress their bodies are put through it'd be hard to know how to help these patients.

In our system, MDs usually have the last say in clinical decision making, but RNs should be expected to participate. Participate, collaborate all in the patients' best interest. Advocate? I'm not sure if that's the best word for it, but the main point, as I see it, is that nurses' shouldn't shy away from influencing health care decisions about their patients. I think that you brought up a very good point! 'Nurses as advocates' does make it sounds as though nursing is completely separate from medical professions and MDs. Advocating seems to only really come into play when talking about theories. Otherwise, nurses and MDs and other medical professions should be collaborating together and everyone should be (theoretically) patient advocates (in the non-legal sense). I suppose that when I thought of myself as the patient's advocate, I was standing separate from the rest of the patient's medical team...but really I should view myself as a collaborator because everyone should be an advocate...

I have only been a nurse for a month or two. The more I'm reading about HIPAA, the more I am finding that this is a gray area. The fact that this has happened so close to me makes me concerned--rightfully so with a brand new license in my hands.

Hi, I have a question about HIPAA violations because I am not familiar with procedures. I know that each case may be a little different, so anyone who has experience, let me tell you what happened. I have a co-worker who was fired recently because of a HIPAA violation. This co-worker of mine is a secretary. A friend in another part of the hospital emailed my co-worker and asked how a patient was doing who just transferred upstairs. The secretary said the patient is fine. No names, no room-numbers, nothing else was involved in the discussion about the patient that I know of. This email happened a little more than 6 months ago yet was first addressed within the last few days. I assume this was an isolated occurrance and as far as anyone knows, the person in bed control has had no repercussions from the incident either. I do not know how the process works, but my co-worker was terminated without suspension or any sort of discussion about what had happened. I guess I'm curious about how the process works and what happens. It was more than a surprise to many people on my floor.

It depends on what you are looking for. If you want to work in cardiac, then work there! Med/surg can kind be thought of as the catch all floor between medical and surgical patients. Med/surg can give you an awesome background if you are just looking for experience, but you will learn a lot on both units.

Congrats to you! Yeah, that minimum question thing was really bothering me! Wasn't it getting to you? Oh and I hear you about still so much to learn! A couple of weeks ago, a patient asked me to leave the room because I "looked to young" to take of her (I was still working as an aid and hadn't started orientation). Instead, the patient wanted the older aid, who, granted was old enough to be my mother but was still doing pre-reqs for the nursing program. I had already graduated. It broke my heart and I tried not taking it personally. I had done a lot of work and I had yet to show for it. I guess that was what I was thinking about when I said that. I still feel that strange addiction and sense of something missing when I'm walking around with an *empty* bookbag. I feel as though I should still be studying...

I just found out this morning that I passed my boards!! I was so nervous because it hardly took an hour--first one in and first one to leave-- and the test cut me off at 75 questions! It feels good to finally be over and done with those. Now I can officially tell my friends that I might be too young to drink, but I can pass out those narcotics! It's good going to work and feeling confident that I know what I'm doing.