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Charting MVU's
We chart them every 30 minutes. I am not certain, but I think that our educator said we actually chart a little too often, that as long as there aren't any problems, you can do "summary" charting on them every hour.
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How are pitocin orders written at your facility?
Our orders are pretty lengthy, but basically they state : begin at 2milliunits per minute and increase by 1-2 milliunits every 15 to 30 minutes. Starting in May, though, we will go to new orders that state : begin at 0.5 to 1 milliunit per minute and increase by .5 to 1 every 30-45 minutes. Which to me is awesome :) We are also stopping all elective inductions before 39 weeks. There must be a documented medical reason (not just subjective) to schedule.
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I made my first med error, stupid me, why report it!??
You absolutely did the right thing. Everyone makes mistakes. Now, you have learned from it and will be hypervigilant. If someone else learns from your mistake, then that's a good thing :)
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11-7 "No-Skills" Argument, Psych/Detox Nursing
I was a charge nurse for three years at an inpatient psych unit based in a regional hospital. We had pt's with medical/surgical issues all of the time, along with their medical problems, we were dealing with psych issues such as detox, psychosis, etc. That does take lots of critical thinking...lol. I did IV's, recovery from procedures, etc., along with keeping an eye out for sign/symptoms of withdrawal, contraband... I may not have done cardiac drips, or tons of medical procedures, but it keeps you on your toes. I now work in a labor and delivery department of the same hospital. I've been there for about a month. Didn't actually hit the floor until the middle of March. I have used tons of my psych training, along with learning all sorts of new procedures. I LOVE it :) Best of both worlds. I was a little concerned about the whole psych to floor nurse transition, but if someone has the ability and desire to learn, it can be picked up fairly quickly. I juggle one labor pt, as opposed to 25 psych patients, but that one takes every bit of my concentration. It's nice to be able to do so much bedside nursing. I spend the majority of my time in the pt's room, which I think is very therapeutic (sorry about spelling...it's not yet 5 a.m. and my brain is still foggy). One of my pt's family member asked if I was a doctor (we have to wear white coats). It was so funny because the pt said "If she was a doctor, she wouldn't be in the room all of the time. I've only seen him twice." l
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would you even attempt this?
YES!!!
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cervical exams?
The very first SVE that I did was actually not at the best time, and things weren't going so well. The baby was having late decels, and mom was in tremendous amount of pain even with epidural. I listened to my preceptor, did the exam as she was getting other things ready, and I know I looked at her with an odd expression on my face. I was totally trying to be cool about it, and finally told her "Hey, check this for me will you?" I couldn't feel anything except for the baby's head. I felt and felt trying to find the cervix. I felt so inadequate that I couldn't find it. Then, lo and behold, my preceptor did a SVE and said the pt was complete...lol. That's why I couldn't find the cervix. The severe pain was caused by the baby being ROP. FYI...the very next pt that I checked was complete as well!
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Floor nurses that make clinicals a bad experience
I enjoy teaching new students, and sharing information with them just as I share information/education with my patients. Teaching is GOOD. If you help one person, you may in turn help many. I am always nice to students, and remember what it was like to be one. I will give opportunities, and help as much as possible. It's also nice to have an extra pair of hands. I want every student to have a good experience, and be a good nurse. It doesn't have to be an awful experience to go to clinicals, or to be a new nurse on the floor, but more often than not, it is. It can be the most difficult experience of your life.
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How to be faster/more efficient?
You are really just setting yourself up for an impossible ideal. I remember when I tried and tried to get done as early as some of the nurses that I worked with. They seemed to have everything done on time, have time to chat...etc. While I worked my tail off and never had a moment to take a pee break, much less eat or chat. Come to find out later, "shortcuts" were being used, that I would never consider. You will notice that usually, those folks that seem to be able to sit around a lot, aren't going to share their tips with you because they are not doing what they should be. Too much is expected of nurses. We can safely do only so much, and they always want more. That's why I now work in labor and delivery. Safety is much more valued there :)
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Am I being realistic? Nursing school at 45?
You are never too old. When I was in school, I had several classmates over the age of 50 and one that was in his 60's :)
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Are you bothered by the noise of the AM shift staff?
Dave, I swear you work at the same place that I do...LOL. It sounds EXACTLY the same.
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Question for the Psych nurses and others.
I'm a charge nurse on a hospital based acute psych unit. You are exactly correct in your concern. I see it all the time. Fortunately, my hospital has addressed this concern to some degree. We have two floors now. One floor is seperated into depression/geriatric psych...the other floor is general acute psych with all of the acutely psychotic patients, violent behaviors, etc. I work both floors routinely. The problem is that when you seperate the population, you end up with an entire floor of acting out psychotic patients which isn't safe for anyone either. With money issues the way that they are, I don't see this problem getting fixed anytime soon.
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Night Shift Rounding...Will your pt code in the meantime?!
Don't rely on the telemetry monitors too much...lol. I remember when I was new, I thought they were wonderful (still do), but once, they removed a monitor when a pt left the floor and telemetry called an hour later to state they weren't getting a reading (we couldn't view the monitor readings on the floor). No system is full proof. Like someone else said, anyone can code anytime. Just try to be prepared and do your best. Sometimes, it's just a matter of it's someone's time to go and nothing is going to stop it.
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Arriving early and not clocking in
I think that it is different for each person. Some of the nurses where I work come in 45 minutes early to orient themselves to the pt's. Some breeze in and clock in on time or a couple of minutes late. Either way, the pt care is about the same from all...lol. I just think it is a personal preference. I don't come in early because I'm not going to work extra without being paid for it. I don't think we need to encourage a culture where nurses work without pay. Having said that, if a certain nurse wants to come in early and it makes them feel better, and they aren't actually working on the floor...why stop them? Just don't expect it from everyone.
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My feet hurt!
Try new balance 622. They are the only shoes that have helped my feet and I've just about tried them all. I tried the sketcher shape-ups, but when you are tired, I have trouble balancing and looking like I'm not drunk...lol. They are cushy...but can't see wearing them for a double. Good luck!
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first job interview in Psych Hospital. Please help!!
I work as a charge nurse on day shift for a psych unit in a hospital. I frequently interview prospective nurses, and the previous posts pretty much covered the important points. Just let the interviewer know how excited you are at the prospect, and that you are eager to learn. Have an answer ready as to why you want to work in the psych field. Also, being a team player is critical as we all have to watch each other's back :) You never know what to expect, and there's usually never a dull moment! Good luck to you.