miko014

I agree, phenergan is nasty! No defense for not diluting properly - that's just asking to lose your license! I like the IVPB phenergan route - it might keep some of our seekers away. They do get mad, like someone else said, when you try to push at the far port or dilute. They like the quick hit! Maybe I can get my pharmacy to start diluting phenergan like that....

I'm not giving medical advice, but I will say this: Other posters have made good points...add these: First, if he has poor perfusion (ie the wave form on the SPO2 monitor is sucky) then the reading may not be accurate. However, if that is the case, it will usually read a false low. Second, the sat monitors the amount of O2 that is attached to the hgb that is there. If he doesn't have enough hgb, then his sat may be high, but the cells he has just can't deliver enough O2. In other words, the cells he has are carrying as much O2 as it is possible for them to carry, but they just don't have enough of them helping with the delivery. Make sense? Also, if his lungs can't handle the amout of O2 his body needs, then home O2 probably wouldn't help. You don't want to blow his lungs out!

Which is why dilution is important. I ALWAYS dilute stuff I push through a HW/HL/SW/SL (whatever you call it at your particular institutuion). The lines you should really worry about are the ones with larger priming volumes such as central lines, PICCs, Midlines, and IPs that are HL'd. Even if you dilute those, you're still going to have a good amount of med left in them when you start the flush.

I love the title of this thread. The answer is all the time. They will make you gown up for every patient in order to "prevent the spread of MRSA" on pts who are only colonized, but they won't pay for a sitter until AFTER someone falls (and in your case, not at all). How much money are we wasting with those gowns - not to mention the extra time to suit up and take it all off every time you go in the room? There is physically no possible way to be in 5 (or more or less depending on pt load) places at once, so there is no way to prevent every fall unless every pt has a sitter, and even then, I bet you'd still have falls. They say frequent checks are good enough, but I have caught people out of bed and about to fall within 5 minutes of me checking on them. I love when they can disable their own bed alarms. Anyway, all I am going to say is this: I feel no loyalty whatsoever to my employer, because with all their BS talk about "safety safety safety", when it comes down to it, the care we give now is not safe for patients or us nurses (or other employers). Most of us are stretched so thin that we can't even help each other out, everyone is stressed, and that is just asking for mistakes and injuries. If I am able to find a new job that I want, I'm not going to feel bad about taking it. They'll get my 4 weeks notice, and that's it. No way they're going to make me feel bad!

My bad, it just seemed like you thought I didn't want to to education or something, which is basically the opposite of my view of nursing. I love education, which is why I would love to work with outpatients, who get to be much more hands on with their care than inpatients. But I have no experience with kids period, so I would have no idea of what they would need as outpts (besides the stuff you do with the parents). I love kids, but I don't like the idea of them not liking me because I give them shots and they don't understand why. Does that make sense?

You seem like you're upset with me, and I'm not sure why. All I said was that I don't like working with kids because I can't explain things the same way I do with an adult. Even though some 4 year olds might be smarter than some of the grownups I work with, that's not the norm. I don't like poking little kids for IVs and the like. Clearly you are happy with your decision. Good for you. And I'm not talking about teenagers - I said that I take care of people 16 and up already. I'm talking about little kids who aren't able to understand why I am doing what I am doing. Maybe I am misunderstanding you, but you seem to be insinuating that I don't know how to educate pts. I don't think there was anything in my original post to suggest that I don't educate my patients or that I don't want to educate kids or their parents. Please forgive me if I have misinterpreted your statements. All I want is information from people who have made a similar change on what the biggest challenges are, the pros/cons, and whether they are happy with their decisions. For people who were uncomfortable taking care of kids but made the change anyway, how did it work out for you? For those of you who are uncomfortable around the kiddos in the healthcare setting (I know I'm not the only one), what do you think of all this?

Hi guys! I have a question for those of you working with a mix of age ranges. I have a job opportunity that I have sort of pushed to the back burner, and I wonder if some of you could share your experiences with me to help me decide whether I should pursue this or not. I currently work with adults only - the youngest pt I have ever taken care of was 16 years old (except for nursing school clinicals). I chose to work with adults because I like that I can explain what I am doing to them. Kiddos don't understand why they have to get a shot/IV/dsg change, etc, and all they know is that you are hurting them. I know that many of you have the gift it takes to be able to work with sick children, but I just can't do it. Now I have an opportunity at a clinic that handles newborns through geriatric. Have any of you gone from an adult setting to working with kids too? What did you like/not like about it? What was the hardest thing to adjust to? How often do you have critical situations involving the kiddos (I know I would be awful at that!) in an outpatient setting? I'm really nervous to proceed with this opportunity because of this, but it looks like if I decide to go for it, I might have a real shot at getting it. (It's not that close to my house, so I don't know if I'll take it either way, but this is the part that is stopping me right now.) TIA to all who reply, and have a happy and safe holiday weekend (it's not quite half over yet!!!)

That's true, I know I just need to take a deep breath and do it. It would be easier if I didn't have this promotion hanging in front of me. I know that would look great on a resume too, though. So I guess it's just frustrating because I know I want a change, but I don't know if the promotion would be enough of a change for me.

I have a couple of different options available to me job wise. I've been looking for something new for a long time, but of course have had no luck with any of the jobs I have really been interested in. There are a lot of reasons I want to leave my current job, but also several good reasons to stay. How do I decide if I should just suck it up and stay where I am (I'm in line for a promotion which would essentially be the same job I do now with a few extra responsibilities that would probably increas stress level, but also increase pay - and that would happen within the next couple of months), or should I make a leap into something I'm not necessarily excited about? It would be easy if something came along that I was really excited about, but so far I have missed out on all of those that I have tried for. The job I have now is the only place I have ever worked as an RN, and it's scary to make a change. But if I don't do it soon, I will probably end up stuck where I am forever, and that is depressing. It would be easier if I knew where I would ultimately like to end up, but I don't. Anybody have any advice?? I'm stressing out here and I don't even know what I want, haha!

First of all, thanks for telling us it's for class. I hate when people don't tell us that! What cultures specifically are you asking about? It really depends on your location as to who you're going to be dealing with. Besides the hispanic population, the Somali population is growing rapidly in certain areas. Also, there are areas of the country with high Asian populations. Plus everything in between. I think the key to giving culturally competent care is asking the pt what they want/need. You can't really say, "oh, I see you're from Mexico, so I'll just do everything my book says you want me to do" because everyone really is different. For example, I learned in school that Asian people tend to be stoic about pain. I'm stoc about pain, but I'm not Asian, and I have met people who are Asian who can't stand pain at all and scream at the top of their lungs. And think about Americans - we all expect something different! I think it can be incredibly stressful if you're just trying to guess what people want/need. Ask them, and they will tell you.

We have a very similar system. I like it and I don't. You basically earn the equivalent of 1 two week pay period per year. You earn vacation time for each hour that you work, so if you work 80 hours per pay period, you earn 80 hours time off per year. I'm not sure that I like that, because if you go on vacation for a week, and then get sick, you'd be down to a couple of days. What if there was an emergency. And you have to save up the time before you can even get sick! I generally keep 2 weeks saved up in my time bank, but I know a lot of people who struggle - think about the people who have young kids who get sick all the time. But then, it's nice as far as being able to take a random day off whenever you want to (though you have to schedule it like a month in advance, so I'm not sure you can call that "random", haha!) As for bereavement, I think our policy is for parents/siblings/spouses/kids/grandpaents. I think anyone else you can go but you get no bereavement pay. You get 24 hours of pay for the people on the list - either 3 8s or 2 12s. You are allowed to take as much time as you need but you can't get more than 3 paid days.

A little off topic, I guess, but...what gets me about the phone usage is people who don't get off when we are in the room trying to provide treatment! They don't think anything of answering and conducting a long conversation while we are trying to listen to their lungs. :angryfire I've gotten to the point where I just tell them, "I will come back later when you're done on the phone." I won't make other people wait for meds/treatments/etc while someone else has a conversation. If they complain about it later, I just tell them that they can't talk to me and be on the phone at the same time, and since wasn't important enough for them to get off the phone, they went to the bottom of the list after my other patients. Sorry for the hijack...we have mostly private rooms. Though I did get annoyed the other day with a patient who was complaining about the TVs of the other pts being too loud...they weren't. When we suggested she shut her door, she got all huffy. What a nightmare that was!

Had a lady tell me not long ago that she is allergic to rubbing alcohol. This after 4 or 5 days of being in the hospital and having it used on her about a million times. I was about to start a new IV and she freaked out and wouldn't let me get near her. I tried to explain that we had used it "multiple times" since her admission and she had not had any problems, but no. She just remembered she is "deathly allergic" to it.

Interesting...I wonder if he has a severe case of cholinergic urticaria. That kills me! I wonder if these people who are "allergic" to tap water read the labels, since most bottled water says "bottled from a municipal source" in tiny letters on the back of the label. What does that mean? At best, it's bottled tap water. It probably comes from a garden hose in someone's back yard! :chuckle

I kid you not, pizza. Not me, a pt, lol. She had so many allergies she had about 10 allergy bands all danging off of one band on her arm, and among the 9,000 other things she had listed was pizza.

Wow, you got to orient? I didn't. I came in and my name was on the board as being in charge. They handed me the census and the pager, said good luck, and let me go. I am in charge fairly often now, and I can say this - I HATE when they give the charge nurse a full assignmnent. I don't think they should do that EVER, on any shift. A reduced assignment, a half assignment, or no pt assignment are the way to go. At least on my unit. We have some very sick, very busy pts, and the rest of them are high turnover. It's not uncommon to go down to only having 2 pts and then going back up to 5 before the shift is over. If the charge has pts, then they can't be around to help others. Plus, they have to work with the assignments, admissions/discharges/transfers, paperwork, etc. If you hate being in charge, talk to someone about it. If you don't get the answers you want, maybe it's time for you to look for something new. I don't think they can force you to be in charge, or at least, they shouldn't be able to.

I agree - I would never go anywhere if I had something nasty on me, and I wash my hand thoroughly before I leave work. I also wash all of my produce and such very thoroughly before using it - whether healthcare workers touched it or not, it's already covered with who knows what kind of crud. Think about the salmonella outbreaks and such that start with spinich or something. Do you think a healthcare worker caused that?? Also, not only are hcws not the only ones with dirty jobs, we're not the only ones who wear scrubs. Vet techs wear them, dental hygienists wear them, heck some crazy people just wear them because they like them!

I know someone who does that, and it does sound good. But I don't want to do oncology anymore right now. Since I have to get a new job anyway, I want to try something else for awhile. That's a good suggestion though. Thanks!

I've been to the derm, tried all the solutions. That's why the doc said what he said. The cotton liner is a good idea, but not really practical with all the isolation pts we have. In other words, I don't think it would make a difference to use them for the times I know I'm going to be wearing gloves a lot if 2 or 3 of my pts are in isolation and I have to wear gloves every minute I am in their rooms. I would prefer to have some pt contact, but I will give it up if I have to. At this point, it's not worth the risk of me getting an infection, and it's also not worth the pain and worry about my skin. I have applied several places and it's always the same - they want experience. Either case management, outpt setting, office, etc. There is one place that said they would take me, but I need 6 more months of experience in my current setting before they can because of their requirements. Who knows if they will still have an opening 6 months down the line, and it's not pt care related at all, so I'd rather get something I would actually enjoy (or at least not hate) now, instead of waiting 6 months and then maybe finding out that there are no openings available.

That's a good idea. I should look into that. Thanks! I do have a BSN now and will probably go on for my masters at some point, it's just not feasable right now. I think they said somethig about putting something under the gloves but they said that for infection control purposes I can't re-use anything like that. They said that's a no no because I can wash my hands between pts but can't wash the liner. Good suggestions, all! I really appreciate the help! For those of you who went from inpt care to outpt, how did you do it???

There are no gloves that make it go away completely (it's the irritation from my hands getting hot inside the gloves that causes the problem), but there are some that are better than others. The ones I'm using now are okay. If I'm doing something really quick like pulling a pt up in bed or dumping a urinal, it's fine. If it's something that takes a few min like starting an IV, then it starts to get a little tricky. If it's a full blown clean up or if I have pts in isolation (gloves aat while in the room), I'm screwed! I think the school nurse thing would be kind of cool, but I have no peds experience. I think I want to go back to school and get into Occupational Health and get into a clinic somewhere, but that's not possible right now. I mean the going back to school part. Occ health is so hard to get into without a masters. That's why I want the outpt experience now. If I do have to wear gloves with them, it would only be for a short time and not nearly as frequent as it would be in the hospital. Thanks for your support, I really appreciate it!

Isn't it amazing that they can refuse to be discharged??? Talk about ridiculous. We recently had a pt who was supposed to go home but refused to leave for 3 days - and they just let her stay! She was a real piece of work, too. She would use her call bell and if it wasn't answered within about 30 seconds she would scream out into the hallway "nurse, nurse! hello, I need my nurse!" and if that didn't get her what she wanted, she would go, "charge nurse! get me the charge nurse!" And she would do this about every 10 minutes. And know what she wanted? Graham cracker (even though she was so nauseated that she needed frequent doses of phenergan), cheese, tissues, chapstick, her table moved to the other side of the bed, etc. Talk about crying wolf. Her nurse told her not to yell out but she wouldn't stop. And they just let her keep doing it! Lucky I wasn't her nurse or the charge nurse when she was there. Lucky for her, I mean. I didn't get involved because her nurse was "handling it", but I would have had security up there super fast! It was ridiculuos. She was acting like a child (and she was no child!!)

This is going to be a fairly mild vent, but I need to blow off a little steam. I have been trying to get a job working with outpts (that don't require too much use of gloves - no wound care clinics or anything like that) for over a year now, and everything I have tried for, the job has gone to someone with "experience in this setting" or "office experience". I've been in the hospital now for 6+ years - am I ever going to be able to get out?? Also, I'm kind of being pigeonholed into my current field, and I want to try something new. People keep telling me about jobs for Oncology this or Oncology that, but I dont want to do chemo anymore! I can't handle wearing gloves all the time. I'm going crazy - among other things I have a horrible rash on my hands that I get from wearing gloves, and with cold weather it's only going to get worse. The emmployee health doc at work said that my hands are possibly a "career ending problem". It wouldn't have to be if I could get something where gloves aren't used so often! I was really close to getting a job in a clinic that would have been PERFECT for me, but of course, someone "with previous experience" got it and I was the second choice. I don't think the person who got it will be quitting any time soon, so I'm moving on. But a lot of places are not even acknowledging the fact that I have applied. I'm really sad and frustrated that these places will not give me a chance. Is there anything I can do to make myself look more appealing to them? I asked at the last one (the one I didn't get) if there was anything I could improve on for next time I apply for something, and they said that my resume and interview were great, and all it came down to was her "experience". Anyone have any sage advice or words of encouragement??? TIA!

Isn't it funny how that has flipped? It used to be that they needed us, and they showed a bit of respect. Now they are looking at it the other way - we need them. And we will do whatever it takes to get them to come to us rather than someone else. I hate that healthcare has become a moneymaking venture. I think they know it, they are just secure in the fact that we are not going to do anything about it. I have had my share of threats, but have not actually been assaulted by an A&O pt. I can handle it when they don't know what they're doing. I can tell you though, if it happens, I will get the results I want, or else I will get a lawyer. But then, I'm only one person. I doubt it would make much difference. I fully support prosecution for anyone who harms anyone else - healthcare related or otherwise.

Somewhat related question - I have found that a lot of docs in my area use a TSH as the only lab draw as a r/o for thyroid issues. That seems incomplete to me. The other day I heard a few of them talking and one was like "oh yeah we wanted to check the thryroid" and the teaching guy was like "oh, add a TSH to the labs." I've been hearing things like this a lot lately. But I thought what I was taught (a loooooooooong time ago) was that you needed a panel with a TSH and T3/T4. I wasn't going to say anything about it, but then this thread popped up. And also, I have a friend who has hypothyroidism who has a normal TSH, so I was just wondering whether I am being overly critical or not.