dano

Modified 10,000 times over, I think I finally have one that works for me!

Yeah, forget a clipboard. I quit carrying my extern manual around today because I got tired of losing it 50x every shift. Week to week we have the same doctors for our patients in different pods on the floor so I'm usually sure of who to get ahold of if need be. I edited it up a bit and added items that are part of the daily assessment that I can quickly do at bedside. Everything else can be done outside the room at the chart without having to talk to the patient, which SHOULD save me a ton of time. Today was crazy! One patient with gastroparesis had his vitals go to hell 15 minutes before I got off my shift, we had 2 stat lab orders but no tubes to send them to the lab on my unit or the next unit over, had a patient go #2 all over the floor and himself. Other externs were gone by 3 but I wasn't off the floor until 3:30, or should I say 1530 lol. I am quickly learning to take everything in stride and give 100% of my attention to the task at hand, or else I don't do it well at all. I did have a few staff members and patients tell me that I am doing great and have made great advancements in my few days there, that made the end of my shift a little easier.

Allergies, d'oh! I could change age to DOB. Date I could just write at the very top, no biggie. As for IV's, I'm not allowed to touch them as an extern I so I left it off. When I'm a II we can, then I'll have to include it. Thanks!

I started working for a well known local hospital as a nurse extern I (some places call them nurse tech's, I've found it's not very uniform across the country). I've been in orientation for 2 weeks and worked 2 8-hour shifts so far. What a mad house, but I'm loving it! It feels great to have a job that actually matters (used to work retail) and the pay is none too shabby on top of it. Anyways, I have noticed that most nurses run around with a blank piece of white paper and just scribble nonsense onto it (I'm sure it means something to them after years of experience). I used to find myself trying it during clinical and it was just a mess. I finally came up with a standard format I write out every morning, and after work today I turned it into a printable Word document. Obviously it can also be modified for other times. I work either 7-3 or 7-7 so that's what works for me. Has anyone else done this, care to post yours or tell me what you included? I'm also curious if there's anything I'm leaving out that YOU would have to have on there in order to make use of it every day. I've sat in a few collaborative meetings and my RN preceptor's used my sheet instead of theirs because it was so detailed. I'd like to include as much as I can without making it super huge. Right now I can fit 4 of those on one 8x10 piece of paper with some space in the columns. Thanks gang.

Look at all the subjective and objective data and focus on the area that seems to have the greatest number of issues. If you have two separate diagnosis' picked out, pick whichever one meets more of the major and minor defining characteristics. When writing your R/T, ask yourself "is this something a nurse can help fix?" If you can't find something to place after the R/T then your diagnosis is probably a poor choice and you should consider another. You might have two diagnosis' that meet all the major and minor defining characteristics, but when you start writing out your R/T clause then it becomes evident which one would be the best choice.

Nope, I'll be at the main Henry Ford Hospital downtown. I do have a friend that got an externship at Oakwood though, and I believe my psych clinical will be there in fall. I was born there too. :)

I almost forgot about that. In probably any one of your course syllabi, there is a ladder of command for you to follow when addressing concerns about instructors. If your school doesn't have one (I doubt it though), then go straight to the Dean of the College.

I live with my mother, 87 year old grandmother, 20 year old bipolar sister and my 10 month old nephew. This place is chaos. I need to move out. On top of that, I drive 1/2 hour every day to school. If I lived in the apartments that I'm looking at now, school and work are a 5 minute drive away.

Regardless of what procedure you have to follow, the way she handled repremanding you is unfounded. Do not just "suck it up" and finish out the semester. The longer you wait to tell someone the less it will appear that you are actually concerned about the issue. I would speak the Dean of the College of Nursing first and let them know that even if you were in the wrong, she handled the issue very poorly. If that goes nowhere, talk to the Dean of Students. With an attitude like she appears to have, I doubt you're the first or last person that has received the same treatment from her. Someone needs to speak up.

I got an externship at one of the largest and most respected hospitals in the Detroit area! The charge nurse of the unit I did my first clinical on (internal medicine) told us she was looking to hire some externs and she picked two of us for the unit. I'm finishing up my second semester of my BSN program and will be graduating in spring 2009. The externship is 48 months so that will work out perfect. It's a dream job for me. The pay is excellent, tuition reimbursement and you pick your own hours up to 40 hours/week. It also means I get to leave my crappy retail job that I've been at for almost 7 years. The one thing I've learned on here and from other nurses is that having a staff you can work is an absolute must. I love my charge nurse, the case manager is awesome, most of the nurses are amazing to work with (a few are grouchy but none I can't stand), and the nursing assistants are friendly and as helpful as can be. I'm even more excited because I'll finally be making enough money to move out my own. :w00t:

Post CVA quadriplegia would be correct.

I didn't really say that! If he was prescribed something he was allergic to and his record clearly stated the allergy, I wouldn't have a problem calling the doctor an idiot because that's just...well being an idiot. I approached him nicely about it, I would expect the same in return. Not to sure that's the way it goes though, this is the only time I've had to communicate about a patient thus far with a doctor.

Well someone failed them in their education. All I could think about was the what-if's. What if I said nothing and he ended up right back on our floor shortly after discharge for the same problem? That was motivation enough for me.

So if supposedly the wipes don't do anything besides clean the skin, what's more cost-effective to clean the skin with? I see boxes of wipes all over the place. I can't imagine using gauze pads + water or cotton swabs being much cheaper. Perhaps in the grander scheme of things that's why we use them, cost. JMO though, I'm running on very little sleep right now so this might not even make sense.

If there's one thing I've learned from listening to my instructors, it's that you have to really have a gut feeling that the order is not right before you say anything and I had that feeling. Turned out I was right. If I was not so sure I might have had a more difficult time.

I've always been under the impression that all we're really doing is pushing away dead skin cells from the injection site for a more proper penetration of the needle, not really to kill bacteria. That's nothing I can cite a source from though, I'd love to here more on this. Imagine me trying to argue with my clinical instructor that I'm not using wipes anymore because I read studies saying they're useless. Think she'd hang me? LOL.

I'm in my second semester of my BSN program and in my third week of clinical. I had a patient that had come in with epistaxis. He was on some trial drug for hypertension and he ended up needing 4 or 5 pints of blood. They couldn't say it was the drug that caused it but it was their best guess. I got the discharge papers later on after we came in and he was prescribed 325 mg aspirin daily (prophylactic for MI) along with some other stuff, but the aspirin order caught my attention. I was like . He's in here because he was bleeding you idiots, plus his nose was still bleeding when he was discharged, just not much. I found the doctor down the hall and said I think the dose is too high and could cause him to bleed more. He actually politely said I was correct and they put him on 81mg daily instead. My instructor was all like "Yay go Dan!" It felt kinda cool. I had no problem walking up to the doctor and stating my case, it just made me feel all warm and fuzzy inside when the doctor actually agreed. It's the first time in my clinical where I feel I did more for my patient beyond basic care needs.

I sent my professor an e-mail last night and she told me she has decided to throw out that question. I guess I wasn't the only one who complained.

You can't really entirely fabricate your own. NANDA has a list of nursing diagnoses that you can pick from which are approved nursing diagnoses. Pick a diagnosis you think you are seeing (i.e. acute pain, impaired physical mobility). This is usually the easiest part. In assignments you are typically given a case and you can figure out what the diagnosis is by reading the info. The next step is the RT (related to) clause. This is what likely caused the problem in the patient. If you chose acute pain, you might say "related to tissue trauma (surgery)" or if you chose impaired physical mobility, you might say "related to fractures." The last step is the AEB (as evidenced by), which may also be what you can manifested by. I've never heard of it that way, but I guess it works the same. It's the observable or recordable data indicating that the patient is suffering from the condition stated in your first part, the diagnosis. For acute pain, you may say "as evidenced by description of pain rated 8 out of possible 10" or for impaired physical mobility, you may say "as evidenced by inability to move left forearm." It's really not that hard once you have it down. I'm only in my second month of nursing school and I feel confident about them already. We had tons of practice in our fundamentals class with them and it helped. The mistake you're likely making that results in it being a medical diagnosis is the start of your statements. It should never be a medical condition. "Osteoarthritis related to..." is not a nursing diagnosis. Write out your nursing diagnosis and then read it over. If you see any medical conditions listed in it, you've likely wrote it wrong. Remember, the nursing diagnosis is created so the nurse knows what they need to heal or aid the patient with. A nurse cannot fix osteoarthritis, but they can fix pain. If your diagnosis starts with something the nurse is unable to help with, it's either a non-NANDA diagnosis or you picked a medical condition. Hope that helps some.

Men and nursing. It's a hot topic, and does have some psychological aspect to it (social stigma of only females being nurses, etc).

I do believe you're not allowed to use staff or teacher names here, might want to edit that out.

All through high school I wanted to be an ER doc. After getting some field experience and talking with doctors, nurses and the like, I decided I didn't want to go to school for that long and to work that many hours. Sure the prestige and pay are nice, but that's all you get. Your life is work. I'm not like that. I live life to have fun and nursing gives me that option. I can still care for patients and actually as a nurse you get to see them more. It's a job that requires independent thinking and gives you a feeling of worthwhile that no other job can touch. Plus the pay isn't bad lol. I'd like to be a PA one day, I'm actually only two classes away from completing the prerequisites. I wanted to be a nurse before a PA, I didn't chose to be a nurse just to be a PA. I've only learned more about the career over the last two years and it seems like the path I intend to head down. I'm still 2 1/2 years away from getting my BSN so time will tell. :)

Funny you should ask. I have a mentor who is a doctor and I was actually e-mailing him back and forth about becoming a PA. I think it's what I plan on doing for a post-grad degree. Here's what he sent me, and what you may find helpful whether it be understanding what a PA does or how they're different from your typical doctor: A PA can go into a general practice field and do well but they simply won't have the background experience and education that an internist will have and, as a result, may miss more complicated diagnoses and get a bad rep. Personally, I don't like seeing PA's for checkups because if I have a question that my experience can't answer, odds are they won't even be able to guess at an answer. PA's can also go into surgical fields and many work along side CT surgeons doing more of the basic work of harvesting vessels and closing the incisions when done. Here the PA's do a lot more than the residents are allowed to do. Our department is hiring a PA to handle a lot of the floor work and to assist us with doing tracheotomies and other routine procedures because we're just too swamped. Here is where it gets good. A CT surgeon spends a minimun of 7 years in residency after 4 years of med school and then puts in around 60-90 hrs/wk doing long cases and taking care of very sick people. He'll make $400,000 plus but the lifestyle is extremely demanding. Ultimately, he is responsible for the outcome of the surgery and if it goes bad he may get sued. By comparison, the PA is a master's equivalent. He works 40-60 hrs/wk cutting and sewing. He deals with little if any of the pre-op and post-op crap and never gets called at 3am because the patient is having problems. It's repetitive work but it's usually considered the fun stuff and it takes a highly skilled person to do it well. I'm guessing the salary is closer to the $120,000 range.

I'm with you too, but I've always been serious about college. In high school I wasn't wasting my own money by screwing off, I would be in college. I'll spend 3 hours in a lecture in the nursing building and then go to the student center to eat lunch and I feel like I left campus.

Hrm. Interesting. The way she taught this part of analgesics in class she made salicylates sound like they're not NSAIDs. I know Aleve is naproxen, I have an anaphylactic reaction to it myself so I'm well aware of its generic name. If anyone recognizes the name, it was Dr. Vallerand who is an author in the Davis Drug Guide that gave our last two lectures. Maybe she's just more book smarts than lecture smarts.:roll