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glasgow3

glasgow3

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  1. glasgow3

    Medication administration confusion???

    There is an excellent article which I "googled up" entitled "Understanding the Basics of Medication Administration" by Nancy Brent, MS, JD, RN. Despite the rather broad subject matter implied by the title, the entire article focuses upon the matter at hand. I believe you will find her credentials and experience (listed in an About the Author section appearing below the body of the article) quite impressive. Simply put, my takeaway from the article is that nurses should not routinely be giving IV medications drawn-up by another nurse, nor should a nurse routinely draw-up medications for other nurses to administer. Now obviously, first and foremost we want what's best for our patients, however, we all practice within a legal/regulatory environment as well; I would not want to be in the position of defending myself in the context of a process which violates what this author describes as a Cardinal Rule. Actual administration aside, there are also potential legal issues arising from this process with the medication documentation which I didn't even consider until reading this short article. And lastly, if I were a betting person, I would bet that there isn't even a written policy addressing this unique medication preparation/administration process at the OP's facility; Sadly, I suspect that they would throw the OP under the bus in a proverbial heart beat.
  2. glasgow3

    Resigning: Counter Offer Advice?

    I would encourage the OP to research/Google up "counter-offer". I believe the recommended course of action in cases such as yours will be quite obvious.
  3. glasgow3

    Ask a question till reporting nurse can't answer one

    As a new grad ICU nurse who worked the night shift I was initially thrown into an internal panic when asked by the oncoming nurse, "...And was that a LEFT subclavian or a RIGHT subclavian?" But it wasn't all that long that my response would be, "First check the area of the left subclavian...if you don't see a central line there check the right side." Shortly thereafter, the such inquiries decreased dramatically.
  4. glasgow3

    Dwindling faith in this profession

    "While only having a bachelors (or less)" I believe that you are referring to those who have earned a "bachelor's degree" (or less); Ordinarily, I would not point out the lack of an apostrophe, however, I would have thought that an individual in possession of an advanced degree might at least use snarky comments in a grammatically correct manner. And yes, I am very well aware of how not for profit entities work. They hide behind their tax exempt status to enrich the few at the expense of the many. Simply put, many, if not most of them should lose their status in my humble opinion because in real terms they provide very little community benefit or charity care. And yes, hospitals are exceptionally expensive; I think we all know that the money "goes somewhere" as you put it. But some of us believe that the money could be better spent on caring for patients, rather than making a handful of leaches fabulously wealthy.
  5. glasgow3

    I wish they had to stay and watch the chaos

    A bit of historical perspective, if I may: In the past 20+ years or so there were a couple of periods where health care consultants swarmed the hospitals like the insects that they are. With stopwatches in hand, they timed nurse-patient interactions in order to determine appropriate staffing levels. Unfortunately, their methodology was insane if they sincerely intended to arrive at a fair result (which in my opinion was doubtful since they invariably promised huge cost savings to get the engagement in the first place.) I remember quite clearly having an imbecile with ZERO critical care experience timing me during the recovery of a fresh CABG and refusing to include any time unless I was physically touching the patient. Similarly, little or no attention was given to discharges, admits, codes, irate family members/patients etc.; the verbiage as I recall was they didn't account for "non-recurrent episodes"---as though were we working on an assembly line or as though such events were rare. These days the current crop of consultants and Powers That Be point to these benchmarks as if they were ever adequate in the first place. The OP's problem really has nothing to do with how the physicians admit or discharge their patients, rather he/she is operating in a system based almost solely upon financial concerns.
  6. glasgow3

    Is This Real, or Just a Fantasy

    Too bad the OP lives in MA cause I think I'm in love. Very original take on the patient satisfaction thing.
  7. glasgow3

    Vanco: give or wait for vanco trough?

    Quote from glasgow3 1) The order was poorly written; as mentioned earlier a Vanco trough should be drawn immediately before (normally understood to mean less than 30 minutes before) the scheduled dose. Since the daily scheduled dose was timed for midnight, a true trough draw should have been scheduled for 2330. Since it was actually ordered as a trough (as opposed to just a scheduled lab) the physician's order should have been clarified. Yes, & No. I have seen many, many Vanc orders during my career written just like this. 1) That you have seen many poorly written orders is hardly the point; If you can produce an authoritative source that states a Vanco trough should be drawn at a time other than as I described, I would be interested. I don't believe you will find such a source. More germaine to the current discussion, had you carefully read the OP's later clarification, you would have learned that the scenario was NOT as originally described: That is, as it turns out the order was NOT for a 1600 trough for the midnight dose. An actual trough drawn eight hours before the scheduled daily dose would yield a misleading value because that is way too early. Due to the potential for underdosing the next dose, the order (had it actually existed as originally described) should have been clarified. 2) The lab was "backed up" for a timed draw is NOT an acceptable excuse for it not being done until several hours late; an occurrence report should have been prepared and all notifications made per your facility's policy and procedures. (At that time you could have clarified the physician's intentions and what he/she wanted you to do now.) Again, Yes & No. The lab being backed up is NOT EVER an acceptable excuse. But the P&P's are in place for us to use. I can almost guarantee calling the MD would have resulted in the MD telling her to just call the Pharmacist. 2) The facility Policy and Procedure manual no doubt required that an occurance report be made for a timed lab draw as late as described; such reports invariably require that the provider be notified and actually contain space to document that this had been done. It is of no significance whether or not the provider took the news of the late draw well, or threw a fit, or told the notifying nurse to call pharmacy. The point here is that the provider has been notified of a significant deviation from the provider's order. That said, that would have been a perfect time, early in the evening, to "gently" clarify why the trough was ordered so early in relation to the scheduled dose in the first place. Catch? 3) Pharmacists never "decide how much and when to give" Vanco, but rather with a physician's order they may follow certain preapproved protocols. In some facilities only specified pharmacists may make these adjustments. In any event the "pharmacy dose" must be determined by the protocol/calculation. If the late draw conflicted with the dosing protocol they should clarify with the provider. Sorry, but having been on Vanc myself. Your statement is 100% incorrect. My MD ordered the Vanc, but it was ALWAYS the Pharmacist who Dosed. Pharmacist are Doctors of Pharmacy. Most know their Drugs. 3) I have a great deal of respect for pharmacists and I am well aware of their extensive professional preparation and also which degree they have earned. But the "iv Vanco, pharmacy to dose" order related by OP is proof positive that pharmacists may NOT dose a single mg of anything without a physician's order. Now the actual dosing methodology is invariably a product of the approval of one or more facility committees comprised of physicians and pharmacists etc. Make no mistake: the physicans know that the pharmacists have the bulk of the expertise BUT the pharmacists do not have free reign in a hospital setting. EVER. When I run codes it may appear to an outside observer that I am ordering and dosing emergency drugs, however, I am actually following well defined, evidenced based protocols which have been approved by several committees. Any material deviation and I am toast. 4) The nurse is always the "last line of defense" in med administration; If you weren't satisfied with pharmacy's explanation, seek guidance/clarification from the provider before hanging the med. 100% Correct. She should have NEVER hung the Vanc without clarification/guidance. 5) All that said, I'm fairly certain that the physician merely "misspoke" when he/she wrote for a Vanco "trough" and that he/she fully expected that a dose would be given at midnight per protocol. It's the pharmacist's responsibility to determine whether or not that late draw will interfere with his dosage calculation. I honestly don't think the "Physician" misspoke. Whom ever sent the Vanc to the floor should have never done so. The are reason why a Trough is being drawn. In my past experience of Vanc it has been the Pharmacist who wrote the on going orders for the medication and troughs. 6) In any event, when you know you have an issue early in the evening, it's best to resolve it then. 100% Correct. But with all of this said. Who really wrote the order? Was this the 1st order for Vanc? It doesn't seem so. Could it have been the Pharmacist whom wrote the order? Anyways. The Vanc should have not been given until the trough was drawn, not after. That trough is no good and now the patient has a lab charge that is basically bogus. I personally believe that the OP really should read up on her medications before giving them if she has any questions. (4 (5 (6 Sure glad I was given 100% on my last 3 points; with only 50% on the first 3, I might have failed and had to repeat the course or something.
  8. glasgow3

    Vanco: give or wait for vanco trough?

    1) The order was poorly written; as mentioned earlier a Vanco trough should be drawn immediately before (normally understood to mean less than 30 minutes before) the scheduled dose. Since the daily scheduled dose was timed for midnight, a true trough draw should have been scheduled for 2330. Since it was actually ordered as a trough (as opposed to just a scheduled lab) the physician's order should have been clarified. 2) The lab was "backed up" for a timed draw is NOT an acceptable excuse for it not being done until several hours late; an occurrence report should have been prepared and all notifications made per your facility's policy and procedures. (At that time you could have clarified the physician's intentions and what he/she wanted you to do now.) 3) Pharmacists never "decide how much and when to give" Vanco, but rather with a physician's order they may follow certain preapproved protocols. In some facilities only specified pharmacists may make these adjustments. In any event the "pharmacy dose" must be determined by the protocol/calculation. If the late draw conflicted with the dosing protocol they should clarify with the provider. 4) The nurse is always the "last line of defense" in med administration; If you weren't satisfied with pharmacy's explanation, seek guidance/clarification from the provider before hanging the med. 5) All that said, I'm fairly certain that the physician merely "misspoke" when he/she wrote for a Vanco "trough" and that he/she fully expected that a dose would be given at midnight per protocol. It's the pharmacist's responsibility to determine whether or not that late draw will interfere with his dosage calculation. 6) In any event, when you know you have an issue early in the evening, it's best to resolve it then.
  9. glasgow3

    Bladder training

    I think you may benefit from reviewing the current recommendations regarding indwelling urinary catheters.
  10. glasgow3

    Can they force me to work weekends during jury duty???

    The rights and protections for an employee called to jury duty may vary widely from state to state. Therefore, an attorney who specializes in employement law in your state would likely provide the most reliable answer to your question.
  11. Great news there!!! So I imagine all of the government organizations, quality organizations, healthcare employers, vaccine manufacturers and all others who are advocating mandatory vaccinations will be perfectly agreeable to dispense with all of the special barriers to lawsuits for those seeking damages for flu vaccine complications. Right?
  12. glasgow3

    Infatuated with colleague - need counsel

    God I love it when Guttercat says stuff like "de rigeur"; I think she wants me.
  13. glasgow3

    I feel like I'm wasting my time :(

    Perhaps a bit off topic, however it's a sad commentary when grade inflation results in an overall GPA of 3.33 and a nursing GPA of 3.48 being regarded as "mediocre". When I entered nursing school, admittedly many years ago, many fine students were disheartened to learn that their heretofore outstanding GPAs were about to "take a hit" in nursing school because it was so demanding. I have long cautioned that ACLS courses that can be passed with minimal preparation, professional board exams that can be passed by correctly answering 75 multiple choice questions correctly, certification exams that can be passed by novice practitioners etc. eventually takes their toll: It's quite difficult these days for high performers to distinguish themselves among other consequences. But never fear. You SHALL be able to attain whatever level of education to which you aspire. In the current environment all you need is the willingness to open your checkbook very wide and/or to incur a suffocating amount of nondischargable student debt.
  14. glasgow3

    New Bill Eases Work Visas for Foreign Nurses

    no to renewing their visas.
  15. glasgow3

    Mandated Flu vaccine?

    I could give you a recent extremely serious complication from one such vaccine, however, I can't because of the remote risk of a potential confidentiality breach. But trust me, things beyond just feeling like crap for a few days most certainly CAN happen.
  16. glasgow3

    When a nursing home shuts down.

    otherwise, even if you had some written support, since state wage and hour/labor offices and state employment offices won't help you with benefit issues, you'll need attorneys and courts. forget that part of my previous post. some states have some protections in their labor laws for these situations because they basically consider accrued vacation and pto as wages that must be paid while still others consider only a portion payable because pto is actually a combination of sick time, holiday pay and vacation pay. so if you live in some states, their offices might be able to help you without having to go to court. so ask them when you ask the other questions.
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