liv2b

although cdiff is just contact precautions, a mask is appropriate when the contaminant may be aerosolized. if it is too hot for you, try not tying the mask too tight in these situations. random fact, an alcohol pad can temporarily reduce nausea and i've seen it work for my patients... and myself. also, the patient doesn't usually mind opening the window a little (they don't want to smell it either). distraction works both ways...the more i focus on them the less i need to worry about myself.

agreed with everyone above. you are about to get the long answer. j i'm a student involved in updating some skin risk assessment policy. the facility uses braden for as an indicator in relation to intervention performed, yada yada yada. bunch of hostility from the nurses on the floor about 'more paper work' (it's a good 10 min getting through all the clicking...) and how it is 'worthless' in identifying risk. it is. but a tool just provides a systematic way to look at skin risk and the qualifying factors that must be considered. the facility's definitions are based off reno's link [bradenscale.com] where they also provide interventions [http://www.bradenscale.com/newlevels.htm]. notice on interventions how it says to bump up risk if 'other risks are present." i.e...hip fracture, major surgery, "advanced age, fever, poor dietary intake of protein, diastolic pressure below 60, or hemodynamic instability." what about crone's disease or bowel surgery...their taking it in but with a 2 in gut, not much you can do. per the tool, tpn is a 3 on nutrition...many places fail to use the fudge factor of 'other risk.' any one of the risk factors on the scale may only take one point off or be well above 18 but is the cause of the ulcer forming. like those crazy care plans they have you do in school, the braden is all about systematic assessment so you don't over look something. at this facility, they use it to triggers nutrition consults (less than 3 on nutrition), ambulation/turning/30-degree positioning protocol (less than 3 for sensory, activity, or mobility), bowel and bladder training/linen changes(less than 3 for moisture), etc. the final score is calculated but you can still change the risk with the 'other risk factor' action to trigger consult with the wound care team. fyi- braden is always done with a complete skin assessment and looking at your pts skin. long term care (ltc) is different than acute care in terms of skin assessment. ltc has a bad rap because they can have poor ratios and not meet the needs of interventions. since ltc is not acute, nearly all of these ulcers are preventable. ulcers are major in-house complications, like pneumonia (get on your puffy), and medicare isn't paying for them anymore. a lot of ulcers are formed in acute care settings as well by the "other factors" previously mentioned, but also, it is generally given a low priority (note medicare isn't paying anymore). check behind head (pillow's not so soft after a while), ears (use foam on oxygen tube), bottom, or heels. nobody likes the anti-embolic stockings (ted hose, or the sequential compression device (scd) but that could help the low flow. remember: diabetes is the 1# cause of lower limb amputations. i got a little excited there. good luck!

Good Luck incoming class of 2010!

all you need to know about isu's fast track bsn program in boise: http://www.isu.edu/boisectr/p_bs_nursing.shtml. i'm currently attending this program and i love allnurses.com. this program has awesome staff and great students. students are all obtaining a second degree so they know how to study and have unique backgrounds (which adds to my experience). i feel like i could study with any one of them and be prepared for some of those difficult tests. i am at the half way point right now and i remember being in the same shoes, "where will i go", "does this program have what i need", or "how quickly will it get me out the door and on the hospital floor." i think it is best for second degree students and defiantly quicker (thereby cheaper) than bridging rn to lpn. obviously, i'm a fan of the program, but anyone who has been to college knows there are always bending; thankfully, it is only 4 semesters of bending. expect loans, do what needs to be done, and get that degree! anyways, there is a new building next year so that means everything will be shiny. the class last year had an admission ratio in the range of 20/60 and this year was much more favorable 20/30. i felt good about the quality of my team though. it seems like we have a lot of time in the hospitals and the lecture is driven toward practice...although it doesn't skimp either on the fluffy nursing theory (i got to meet jean watson!). i love how there are opportunities to give back to the community; many are involved in other ways but during the break, some students will volunteer running a health screening clinic. talking with other nursing students, it seems like they don't have the same opportunity to connect in clinical or with their professor; class size is small and the idea is to drive as much information into our brains as possible in a short amount of time. this program seems like one of the best kept secrets in the area. cheap tuition like isu but uses the same great hospitals as bsu. most students have families and are stressed between obligations there and with school work. talk to anyone of them and i bet they will tell you it is the right direction. also, make a point to 'interview' professor goodwin or professor quiroz; the faculty is warm and supportive. i will answer what i can but you really should get online, educate yourself, and come and check out everything before you make a decision. boise is amazing too and having moved here for the program, i loved exploring the 'big city' with many who have been here for some time. good luck!

Oops.... I'm a first year student. I totally posted this in the wrong spot. This is for first year RNs. :imbar Well kudos if anyone uses it. As a follow up, I would just like to say... 1) Thank you to all you nurses who are tolerant of your student ducklings.... 2) Keep it up....That from the students perspective a well organized nurse that is 2 years out of school is hard to find. In my limited experience, they are still running around answering phones, directing family to rooms, and generally, having a hard time prioritizing care. ...and spending too much time answering nursing student's questions. :) The best ones I had were 4yrs+ experience; they knew their stuff (student lingo and knew the new drugs well), had gotten to a point they used their real brain more than their paper brain, and I suspect that the 1-3yrs quit by that time if they hadn't become the embodyment of peace from a bleeding ulcer. When I grow up, I hope I don't have a critical student watching over my shoulder. haha. 3) Time management or controlled chaos? The wrench thrown into it is accomodating schedualed interventions for multiple patients, remembering stat orders, adjusting for priority, delegating as needed/able, and delivering effective care. ...All without a break or eating lunch on a busy day. How do you perform at your peak if you don't schedual a break in their too? Jumping from unit to unit, I see that some UNITS have developed effective coping and retained staff while others burn out. Any of you good ones hiring!? That is all...

Anyone have more to add to this list? This is a list of 'signs of the most critical'... Anything you missed on a guy because of of this machismo? I know this probably belongs on a differnt post but.... As a male student nurse, when assessing patients with the nurse on shift we often skip over the perineal area ...even when their is a foley! OMG... I've observed several nurses...female nurses are more comfortable checking both sexes but many haven't invited me over to explain whats going on and the guys just skip it all together ("the aid will do that"). Alrighty...

i was a bartender/drywaller before coming to school. saved enough that between loans it all works on a 20 hr/wk cna at assisted living. tending bar was good times...was in a different place too. saw and experienced people and diseases in their natural environment (alcoholism, smoking, excessive eating/habits of labor jobs). i always felt it was better i was their then someone else; i could exert some moral responsibility in a place where that was not highly regarded. i think it set me up to give more realistic education to patients and set them up for success. whatever you do, build on it for the future (could help to incorporate that for a resume but probably not...). i'm in an accelerated fast-track program...you need to be able to absorb it all. there are a couple students that worked in the lab or as aids and they definitely have a leg up. i’m learning as i go and i think the nurses like that i’m interested in everything going on. clinical experience was fun for me but they seemed burnt out already...like they wish they were getting paid for it. haha.

file03..do you run around barefoot or have you recently jump off a trampoline? i had a heel fracture that was killing me...just one side though. i volunteered w/ sports med for a while and you would see sprinters with metatarsal fractures (toward toes) and hurtlers with heel injuries. it's just a thought... you probably just work too hard. tread lightly.

Wow, I initially just wanted to get that paper brain out there but I've included a bunch of posts from Allnurses that deals with the same stuff. By no means is this exhaustive...Just a summary of what I had a chance to read. *Long term care (30+ pts, less critical, little need for schedualed paper brain?) https://allnurses.com/forums/f22/new-ltc-how-do-i-organize-226012.html Some main ideas from the post: Creating priorities Organizing your day Difference between school and "real life" nursing Reliance on long term interaction for baselines *NICU/PICU (single room, few pts, critical) https://allnurses.com/forums/f224/how-do-you-organize-your-day-175388.html Some main ideas from the post: Unique single room setup for NICU/PICU: place paper brain next to each baby. Good for nurses covering you. *Ortho? https://allnurses.com/forums/f38/help-how-do-you-organize-your-day-278694.html Main Ideas: Move from less stable to more stable patients Use right side of patient list for med times...and timed tasks (step down)? Check off system Thats all I have... Anyone else have good posts to ref?

thats awesome janfrn! thank you for your experience on the matter. i came across one a "paper brain" and posted it here: [color=#0068cf]https://allnurses.com/forums/f224/organize-your-day-paper-brain-311060-new-post.html any ideas for improvment? notice this nurse puts everything down and not everyone wants to do that. these sheets really help with charting when you might need to know when you intervened. and they are more clear than writing it down on the back of a patient list.

I know people in school that work...they are stressed. Kind of like working on the floor... Before I go into managing it, let me just say you must do everything you can to maximize your potential for sucess. Given this, what are your priorities. We compromise between family and career to find something that works for us. Maybe look at the question different: have you exhausted financial aid, loans, special scholarships? Maybe night school to take some prereqs (physiology) out of the mix (extends your schooling...more interest on loans...crappy job for longer). Work in a hospital so that concepts in school will come easier to you and you don't struggle with concepts as long. Now to manage your time. Not everything you learn in school will apply to the job. There is busy work...there is need to know. Ultimately, you are in charge of your education...don't jump into trauma if you just want to learn EVERYTHING on the job. Fluffy theory is good if you want to teach other students fluffy theory. Meds do interact, change the body, but you have your regular meds and the ones you give people in the jungles on Venus. Ulitmately, I think schooling is really just about creating priority. Priority for your values, priority for care, priority for your time. Good luck..It's not a job; you will LOVE being a nurse.

Total reality check... My nursing profs hadn't been on the floor for better than a decade! Ah. I found good nurses on clinicals during school and stuck on them like...warm protein. :) haha And, I think you informally apply to that first floor you work for someone to take you under their wing. Some places seem to culture people able to do that and some places do not. Move on but don't move out. :)

i'm so sorry. i am reposting that last one because i was experiencing technical difficulties. [color=#333333]:crying2:sorry about the long post...i'm chronically wordy. wow...really wordy. hope you can follow... [color=#333333]ok...first this isn't my sheet; i can't upload the original excel because i just scanned it in. i'm a first year and still trying to develop an eye. tune your paper brain to your unit. i'm really trying to learn this mrs. bridgetjones and don't know how to upload it here so will someone pull it and upload the image until i find out how to... i remember using computers had a black screen with green type; and it never strained my eyes like monitors now. :) screens are better but we're using the same basic programs to chart...haha. [color=#333333]anyhow... on the questions: [color=#333333]1) l/m may be liters per minute (the o2 above could be sat levels po2) for those being weaned or to schedule step down after general anesth. [color=#333333]2) blood gas may be part of an arterial line for continual monitoring but that is a "special circumstance" that would take too much room on a sheet like this (maybe make a fill in below pain for spec. values)...in my opinion. bg is blood glucose and in a sensitive individual, new regimen, someone changing meds, or someone on watch from doc (>400 or whatever policy) these values need monitored or will be need spit out on report. the bg under diet i believe is also blood glucose for meals (ie. am and noon for morning shifts) for bg stable patients with morning meds. blood gas would better fit down by labs...lots of space under gfr to write it in. [color=#333333]that reminds me of a point i missed on the first post...stop reading if you become easily agitated [color=#333333]; my purpose for the paper brain is to 1) organize my day (not everything is on regular schedule (some docs like to be "special") ...maybe make reg time boxes bigger to accommodate more for those times? anyone have improvements yet?; 2) have it all there so i don't need to rely on my faulty memory (and w/ all the distractions, increase pt/nurse ratios, etc) it is nice to have something for quick reference for holistic care, and 3) provide better report (more holistic) when someone wants to talk history or whatever and i don't know about something. sure you can break out the chart but if you are just learning or want to more; it's nice to have it all there to connect the dots. main idea: i haven't seen a charting system that was oriented to us doing our jobs the best possible; the primary purpose you may feel that you 'hate charting' is because it is meant to cover your butt in court. [color=#333333]another point; don't rely on your paper brain when you have a real brain. if you aren't redundant about safety, you will make mistake in transcribing values. you will make critical mistakes if you aren't the type of person to double check yourself (math, interactions, vitals for meds)...especially if you're just putting everything together. i think we can also become lulled into "following orders", and though we share less responsibility for our actions, we are not abdicated from the role as advocate. [color=#333333]finally, you know that the longer you have been practicing the less this post becomes relevant. if you don't use this paper brain, it just means your awesome mom2bears. some nurses have developed esp and can empathize where their patient is at..."oh she is coming off ____ so i will need to get in there and make sure she is ok." you will know use charting more effectively, develop prognosis, and become more in tune with the medical model machine and (hopefully) we will come to empathize better. [color=#333333]thank you for reading.

Really, I'm not a salesman. Order CUSTOM Nike shoes (all white for you student?!). My fav is the blue ghost flames with candy green metalic flake. This girl in class ordered them...sweet shoes, comfortable, good air flow, good grip to lower slip, etc. How to: You-tube instructional video: http://www.youtube.com/watch?v=fD7g0t0NoAM www.nikeid.com $100 + SH, made in china

sound of music, i feel so bad for you. that must be really frustrating to be spread so thin. i think it is good that you expect a level of professionalism (faces...ability to perform basic job description (vitals). sound of music what follows may not be for you, your looking to help her get up to speed... if i had just come in to the discussion, it would make me really annoyed to read so if *the reader* doesn't want dr.phil all over in *the reader's* personal situations, please don't hate...i got a lot of love to give. i believe that we all have an ability to see 'better' with perspective and that we are not always able to step back for that. ok serious time: i think parents or maybe people who have been the "boss" of a business can really do the whipping best (when it is needed...aka sound of music's situation ). that's because they know you can't throw people to the side like trash (not talking about you sound of music)...you have to love your kids or worker bees because it will 1) cost too much to adopt or 2) they might never have someone take the time to teach them what they need to know. yes you’re not their parents, yes they may hate you for it if their not in the right attitude (receptive), yes this will probably not work. --------------------------------------------------------------------------------- in a previous post, i mentioned the other side to maintaining authority in professional relationships...empathy and the personal experience as the low man on the pole. reaching people where they are at to find what motivates them, selling the job to them, and setting them up for success. fact of the matter is, some people are too immature for the responsibilities they have been given. for some people, you can work with them to get them there; ie. do they care that they are compromising the lives of others (patient, your career, etc). assess that first right?...what do you have if not that! do not pass go...do not collect $200...send directly to incident report. ok...the boss needs to crack the whip. like teachers give tests...parents lovingly provide direction (not tests :) ). we provide feedback to guide and empower others for positive change. there is always risk that it could burn us...trust them and they have a kegger while you’re on vacation or the aid slacks while we're tied up in an isolation room. we have hope that that change is possible and realize/prepare ourselves for the risk mentioned. to sum it up...sorry! is a parent that is too stressed out at work to play an active role in their child's life really being a parent...spouse? we all gotta do what we gotta do... but sometimes we just think that and fail to realize the best for our lives. a nurse is s t r e c h e d, but we are kind of the boss/educator: we are the last link for patient safety...we are possible potentiators of positive change. ----------------------------------------------------------------------------- assess your patients...assess your crew. some help may be older than you, but age does not always confer wisdom.:yeah:i applaud those that think that would be easy/quick fix...in a cheesy- chester the cheetah smiley face kind of way. ...good luck sound of music, et al, i hope things get better.