Ortho_RN

Everyone says Aspan standards are quidelines and that they are more like suggestions on how to run the units.. But when a lawyer gets involved what do you think a lawyer is going to pull out and use... Our hospital dances around this also... Lately we have been running a PACU with 3 RNs with 25-30 case loads and these cases range from simple cystos to craniotomies and everything in between.. We are suppose to have no more than two appeach... We get intubated patients VERY often and they are "suppose" to be 1:1 until airway is out, but ha they arent.. Peds cases are suppose to be 1:1... ICU cases are suppose to be 1:1... But it never works that way because we are so short staffed... Night coverage is one person, with a backup person for an emergency.. We are to utilize the OR nurse if needed.. Hard to do if they have another case... We all love our jobs but are tired of getting the shaft and putting our licenses on the line and we are looking at who we need to contact ourselves

During the week after 1130 we have a primary call person and a secondary call person.. But basically the secondary person will never be called unless things are just out of hand... Weekends its pretty much the same..

We usually don't allow family in the recovery room... I don't feel it's a place where family belongs.. No privacy, totally in HIPPA violations. Families like to be nosey and watch other things, and things do not always go smoothley...

I personally would say the biggest issue is when a patient wakes up fighting, trying to get up, and you are physically trying to hold them down.. is that going to be possible with your neck???

Wow.. what an interesting conversation... I see both sides... But as a person with Narcolepsy, who actually "needs" the medication I cannot take it... It DOES cause and increase in HR, mine would run 130s-140s after taking, and it did cause a crash in the evenings, I would get a BUSTING headache... I was told my body would get used to it... Never did... I worked nights and that is what made me actually go and get diagnosed (what a concept). I keep it in my purse for those days in the PACU where I can't keep my eyes open.. But I agree if you can't tolerate or adjusts to nights maybe that isn't the shift you need... Not every person who works nights has problems sleeping... So I doubt there would be NO night shift workers..

Our hospital, if you work day shift, then if the night shift has holes days is required to cover it... so your schedule can be all mixed up... They do it since working day shift is a priveledge

It would be nice to have an assistant in Pacu.. Heck, it would be nice to have a secretary..

I'm so tired of hearing this from our hospital... We are a non-profit hospital that basically takes anyone, so obviously we end up eating alot of the cost for treatments... Well the suits that work upstairs have decided that since we are in the red, that the floors need to take patients if they need beds regardless of staff.... The surgical floor had 18pts and was staffed with 1RN 1LPN and 2 PCAs... That is too me unsafe, I would not have taken responsibility for 18pts, and the RN is a new grad out of school maybe 8months... I work in PACU, and now they have taken away one of our shifts b/c productivity is low... We had 30 surgical cases yesterday and had only 3 RNs... How is this safe... We are "suppose" to have no more than two patients.. One if its intubated, one if its a peds patient... But does it work out that way.. NO... I had a pt who came in for a simple lap choley.. no complications, except she has a seizure disorder, but her last seizure was a week ago...Well she decided it was time to have a seizure every 30mins... So I basically could NOT turn my back on her... ANesthesia comes in with a big belly case that is still intubated and wants me to come take report and take it.. I told him no and the circulator could stay with it until I got my patient to ICU or another nurse was free.... I am not putting my license on the line b/c the hospital is having money issues.. Because I guarantee when I do something and have to go in front of the board of nursing, is this hospital going to stand behind me.. Heck no... So it is CYA... And if the docs and anesthesia don't like it then they can complain... Sorry this is so long... I have just about had my mental limit... I LOVE working in recovery, I left 3yrs of Orthopedics to do pacu in January... and I actually for once feel like I am where I belong... But this political crap makes me hate my job... Tell me there are good places out there that actually value the patients and the employees???? Also we dont really have anywhere to voice our concerns too... IF we do it in person, then we are placed on the list of people to find a reason to get rid of them.. UGH.. its just so frustrating..:angryfire

Nice to know I'm not the only one.. People at work think I'm crazy... I would much rather drop a NG tube than start a foley any day... Most of my co-workers are quite happy to trade out :)

Ok, I looked and it had nothing to do with AF.. They have noticed a trend of Esophageal Erosion in these patients..

I will have to check tomorrow.. but our hospital will no longer administer those drugs, probably b/c of that connection... But I will read the memo tomorrow

So is it not normal for you to remove airways from your patients??? Our CRNAs leave patients with us intubated all the time... We remove airways.. and have even replaced oral and nasal airways when needed?

Just realize that the real learning begins in the real world.... School prepared you for the basics, but its totally different when its right there in front of you.. Learn everything you can from preceptor... They will be more than willing to help you if you are willing to "learn"

We have to discharge out of phase 1 quite often.. If Same Day Sx says they are busy and can't take the patient then we have to do it... Then they leave at 5:30 so any outpatient cases after that we must send home..

We send patients straight up to ICU if they are going to be on vent... No point in wasting time moving the patient and the vent twice... Nothing to recover when they are on a vent...

Actually they are "Standards" not guidelines...

We had a patient who was Total Shoulder Sx and she stayed zonked for 2 days, and finally the doctor had enough and told us to give her Narcan... Keep in my family is all freaking out because momma won't stay awake long enough to chew her food.... We go in give the narcan and as always patient wakes up automatically, swinging her arms around, yelling.. and then proceed to projectile vomit everywhere... But not 10mins after we do this and get her calmed back down the family asks.. "When can she have something for the pain???" !!!!!!

We have 2 RNs for 17 patients.... Way too much for an Orthopedic unit..

What exactly does a MDS coordinator do??? I saw an opening recently here for that position...

Does Gentiva pay per visit? or do they do hourly rates??? Is anyone familar with this company as far as what they want your case load to be etc... What would you say the biggest difference between places like Gentiva, Amedysis, etc... compared to Home Health based out of a hospital??

I have a question... I presently work on an Orthopedic surgical unit at a local hospital. Where mainly we get traumas, and total joints.. But occasionally we get outpatient procedures overnight for pain control... We are getting a day surgery center in town, which is going to be mainly used for our Orthopedic doctors. Well I'm very interested in this center, I am presently working on my resume to send to the clinic. My question is... What happens when you have patients that are having poor pain control??? Or what if a patient becomes unstable or the docs just want observed overnight??

I guess our hospital is own the lower of end of pain medication. We very RARELY ever see an epidural on an Ortho patient, however we did just have a patient with one who had a Bilateral Knee Replacement And he ended up with a partial ileus yesterday.... One of our docs gives very little pain medication, the most is about 2-4mg of Morphine IM Q3-4hrs... and then they have Tylenol.... And to be honest his patients seem to do better than those we want to stay gorked out with tons of medication... And he still uses CPM machines on his Knees, and they do great.... Do ya'll reinfuse your knee drains?? If so what kind does your hospital use?

Our pain medication regimen is dependent on which doc does the surgery... But usually for most of our total hips and knees, they will have a Morphine PCA (1.5mg Q10mins) or Demerol PCA (10mg q 15mins) They are turned off on Post op Day 1... Started on Routine pain pills for 24hrs, then pain medication becomes PRN.... Most also have Valium and Phenergan/Kytril ordered if needed.....

Orthopedics... can have up to 8-9 patients on a post op surgical floor

We can have as many as 7-8 on day shift..... Night shift has had as many as 12 a piece.... Which is WAY too much... I think this is what stresses me out so bad.... I'm so physically tired.... I had 3 admits the other day, which fresh surgeries take ALOT of time... Especially when you have to watch their breathing extra b/c the OR gave them 5-8ccs of Fentanyl... :)