kiminco

Thanks in advance for your replies and opinions!! We are going live with a new computer documentation system (Epic). We currently computer document mostly "by exception" with some narrative, depending on the nurse. With epic, we have an option for doing a full head to toe assessment and my manager feels this is necessary and we can use "WNL" as defined by the screen and hospital if a pt meets this criteria. My manager wants to take away WNL on the repiratory and cardiac screen (so even if the patient is WNL, I will still have to chart breath sounds clear, no murmur, ect) and are debating on what to do with other systems. The question is when do we do a full "head to toe" assessment? Technically when a patient (I work in pediatrics) comes in and they are alseep and we do not arouse them, their neuro/msk are not "WNL" or we won't know if they are until we wake them up. Do we defer charting until patient is ready to leave the pacu and they are mostly back to their baseline or do an "abnormal" assessment charting on arrival then do another documentation of assessment when pt is leaving the pacu? I hope this make sense. This is a big debate with my manager and I, since she is more "old school" and not very comfortable with charting by exception (less is more) and I want to decrease the amount of charting we do on our patients. Thank you so much!

I have been in the PACU (pediatrics) for about 2 years now and floated there off and on for the past 5 or so. I really love it. Just enough critical care to keep me on my toes but not so much that I am burned out. Coming from the ER you should be fine. I have to say that in our PACU, airway is number one. We do a lot of jaw thrusts, bag mask ventilation (most of our kids come out extubated) until patients are more awake and able to keep a stable airway. Coming from the floors this was more new for me but you should be up for it! Good luck!

I feel as a peds nurse although the child comes first, you are taking care of the whole family. If a parent wants a break, I make sure I can get them one. Whether it be me sitting with the child for a few minutes while I have someone else watching after my patients, working a deal with the parent to find the best time for both of us, getting a volunteer to come and sit with the patient, if it is an infant and they can come of out the room, but them in a wagon and bring them to the desk where all the nurses can keep an eye on them. I agree, unless it is impossible for the family to be at the bedside, they should be there as much as possible, but everyone needs a break and were are there to take care of everyone which gives the child the best care possible.

I can not believe anyone would say that to you. Men are a great role model in Pediatrics. It can be especially difficult for teenage boys (or even boys over age 8 or 9) to have a female nurse help them with certain things and I rely on the very few male nurses that we have around and they are wonderful. You are not "old" at 43 and being a dad is even better! Go for it and never work anywhere near that clinical instructor. She had no right to say that!