Spring_Peeper

When Fluids Push Back

Thanks for the explanation, Rehabme. I'm starting my first rehab night shift tonight (just shadowing tonight), and I was curious. I don't know if the four Ps are part of our program, but I'll find out soon!

Pain, personal needs, and position are self-evident, but what does the hourly "possessions" check entail?

Commenting on my own post, in case other nurses are interested... I researched the topic at my nursing school's library and found many interesting articles. Here is the info about one particularly comprehensive article, for those who want to look it up: [h=2]Laser Tattoo Removal: Benefits and Caveats [/h]Adatto, Maurice A. Medical Laser Application19. 4 (Dec 2004): 175-185.

Hi everyone, I am a new nurse looking for a job, and one prospect is to be a laser operator at a laser tattoo removal salon. I'll be interviewing soon and have been reading what I can find about this procedure online. There doesn't seem to be any research on where exactly the ink goes after the laser breaks it up, and what the long-reaching effects are. Some articles say macrophages pick up the pieces and they are "flushed out" via the lymph system. However, I can't find medical research to back this up. Tattoo inks contain things like iron, cadmium, lead, lithium, and zinc - I wouldn't expect macrophages to pay attention to these metals. Do they flush out through urine/stool? What if the metals actually lodge somewhere in the liver or spleen? Couldn't that be dangerous down the road? Tattoo ink ingredients are considered cosmetic by the FDA, but if they are going into the person's system, that isn't just cosmetic anymore. When I envision what might be happening, it seems to me laser tattoo removal is like putting an unknown amount of particles of unknown substances into someone's bloodstream. I want a job, but I want to know what I would be getting into with this one. I am wondering if any nurses out there who do this procedure can tell me how it effects the body. Are the patients followed up on after they walk out the door? Thanks in advance.

My first job is in LTC, too. In case I ever want to leave and apply at a hospital, I am keeping track of acute problems I've had the opportunity to deal with, so I can talk about them in an interview. Lots of interesting things have happened and I've only had my job 5 months so far: hemicolectomy pre- and post-op; pre- and post-op cyst that required surgery; pneumonia; cellulitis; pleural effusion; uncontrolled A-fib; gastritis; pre and post DVT... And I also keep track of the stable patients and the meds used to keep them stable. Maybe if you made a list of what you are learning about it will help you see the positive side of your job? Best wishes.

That does sound discouraging. Where I work, when an admission is expected, they put an extra nurse or med tech on the floor to help for that shift. What happens when you ask your nursing supervisor for support?

If there is already a thread on this, please tell me. I didn't see one. I'm a new RN at a large LTC and am learning the ins and outs of communicating with doctors on second shift. We have one doctor who is excellent and we have a phone tree in place to communicate with him every evening when needed; he gets forwarded from unit to unit addressing his residents' issues. However, a few of our residents have other doctors that don't seem to care about their needs at all. They rarely actually visit the facility, we just have phone numbers to reach them when acute situations arise. About a month ago, we tried getting a hold of one of these doctors to report signs of infection and didn't get a call back for 3 days. ***** Yesterday we tried calling for a different issue, different patient, and doc didn't pick up the phone, hadn't called back by end of shift. What kind of BS is that? Who are these doctors answerable to? At what point is this lack of response considered negligence? Granted, our protocol requires us to notify them for every incident and skin tear and maybe that gets annoying to the doctors, but sometimes we are calling for orders. Any advice? I already asked the head nurse if we can suggest that a certain family get their loved one a new doctor, and she said no way will the family hear of that; so-and-so has had Dr. What's-His-Name for a million years, they are never going to change doctors.

I understand how it could be illegal to not pay an employee for a mandatory inservice. However, at my facility it turns into a patient safety issue to have staff called off the floor while on duty, for a "half hour" mandatory inservice (especially when in reality it turns into 45 minutes off the floor). Staff are told to "bring their lunch," the expectation being to get the inservice done during your "break" which then isn't really a break, so how is THAT legal? I understand administrators need to meet their goals, but there must be a better way.

Maybe your resume needs some tweaking? Does it reflect the level of acuity of the patients you cared for? Maybe you need to specifically say if there was higher level equipment you used at your facility (maybe they are assuming you are not familiar with IV med administration, etc.). What is it they think you lack, I wonder? Best wishes. If hospital work is what you dream of, keep trying!

That place sounds poorly managed. Not all LTCs are like that; try another one. Best wishes with your little one.

In my facility (in NH) the LNAs chart meal intake and BMs electronically. They are the ones that pick up meal trays and toilet people, after all. Sorry to hear you have redundant tasks at your place.

In addition to what others have mentioned, we mention whether the resident is skilled, on hospice care, or on 15-minute checks. We also mention if they haven't had a BM in 3 days, what we did about it and whether there were any results. It's always possible the incoming nurse will be a float, so we report accordingly. The floor nurses pass along a census sheet which has a column for each shift - the way I use mine, the notes on it are exactly what I pass on in report. This is different from the unit report, which is just for acute events that the supervisor needs to be informed of.

Is there a deadline for responses to your poll? High on the list should be better compensation for nursing assistants.

WittySarcasm, good idea about an order for patient/family teaching. I didn't know that was an option.

In my facility, which is a county nursing home, nurses supply their own pens, highlighters, sharpie markers, penlights, and bandage scissors, although there is one resident with his own designated bandage scissors kept in his designated wound care bin. There are no flashlights on the unit because, the nursing supervisor told me, whenever they are provided, they "walk." I use my own stethoscope by preference. Fortunately our two Dynamaps each have a handheld thermometer on them as well, and we have one handheld o2 sat monitor for our unit. We have 50 residents on my unit, but about 300 in the whole facility. Sometimes it is difficult to find the handheld thermometers but we don't have a problem with theft of those. We sometimes run out of washcloths by the end of the night but on other days there is a plethora. Large briefs are kept locked in the med room to make sure only residents who need them get them. amoLucia, I appreciated your post about waste.

Thank you for that great link, CapeCodMermaid. I made a copy to keep on my clipboard.

I hope you don't give up nursing just based on this experience. That kind of heavy med pass would take a while to get the hang of; I imagine every day goes a little faster, doesn't it? Because you get to recognize the residents and where to find things, and which key goes to what. Don't despair! Sounds like the other nurses are chipping in to help you get it done, and that's great. It does sound strange that the CNAs don't do vitals.

I was worried what it would be like to start my nursing career at a nursing home, after reading the unhappy posts other new nurses have written. However, after my first two weeks of orientation at "my" nursing home I am still SO happy I decided to take this job! :redpinkhe There are a ton of meds to give, that's a fact, but in the process I am getting to know some wonderful elderly people and I am working with staff with hearts of gold. I think one of the most important things we can do in LTC is just give a genuine smile to every resident we meet, and it is such a joy to get a smile in return. I know, I sound idealistic, don't I? :) After 7 years of working toward my associate's degree a little at a time, I am in bliss to finally practice nursing! And by the way, HUGS to all you nurses who put up with orienting us new nurses. :yelclap: It is SO important and you are appreciated more than you will ever know!

I used to be an aide on a LTC unit. As I was tucking a gentleman into bed for the night, I said, "You look so cozy." He said, "Well, come on in! I know a couple more girls we could call, too." :loveya:

I'm a new nurse on an LTC unit. One day I was making conversation to get to know one of my elderly ladies. One thing she told me about herself: "I like ice cream as much as I like the boys!"

Hi PsychNurseWannaBe, How is your patient doing? Can NG or parenteral nutrition be considered part of a necessary wound treatment? Or would the patient not allow that either? I'm a student, so forgive me if this is a dumb question...

:w00t:Congratulations on graduating and getting a great job offer! My 2 cents: If you accept the job and hubby keeps his job (which it sounds like he is happy with), you will both have a job AND each other. Sounds like he is well-established in his career and is getting job offers from "headhunters" without even looking, am I right? Whereas you are just starting out and aren't going to have as many opportunities at first. You have a husband who supports you PLUS a great job offer. Accept the gifts and enjoy!! You can move to the land of no snow someday, together, when you have a couple years under your belt and you're in demand, too! Best wishes, whatever you decide. :redpinkhe

Can anyone refer me to any scientific articles about swabbing nares for MRSA? Thanks in advance.

From my patients, what I like best is when they have a genuine smile for me when they are discharged. From my coworkers, what I like best is when they are smiling and relaxed when it's time to go home, and say, "Thanks for a good shift." From my supervisor, what I like best is an accurate evaluation that shows they've actually been paying attention to my work, and compensation in keeping with that evaluation. From management, what I like best is monetary bonuses or gift cards to gas stations. I have enough tote bags and water bottles!