lisamcrn

:roll :roll The only reason I got the rn was because my campus is busy from the discharges from the main campus which is currently flexing people like crazy with low census. :roll :roll I still am amazed, they cooperated together their lunch breaks, their discharges and admissions.....I still feel like I left the twilight zone.

I work in our hospitals snf unit, we hold 18 bed and had 15 pts this am with 2 admits expected, 4 hoyers pts and 2 coming were also. Mondays always suck, always. Our clinical leader/charge is excellent, but extremely anal and nasty on Mondays--wonderful lady, and I understand her stress level on Mondays all to well. Anyway, our staff has been hit horridly by the flu. Only 2 floor nurses and the charge on today --Well the charge and other nurse both called in sick, leaving me stuck being charge with 2 wonderful float rns.:) Then after politely begging the house supervisor we got another rn. This of course was over our core staffing, but after the crazy weekend, it was wonderful. All three were excellent nurses, so nice and pleasant. They did no complaining or whining, reported wonderfully.........I had the best day being stuck as charge than I've ever had before. I just could nto believe how wonderful this was........what a day shoud be like. Nothing like the usual moaning, complaining, whining regular nursing staff that I have gotten used too and wear me down with their constant issues. The day was still insane, but so much better......I was so grateful to experience that, it renewed a lot of my faith in the day to day nursing experience. Lisa

A side off your original topic, but curious. I currently had a patient about 25 days out of a AAA with an epidural that the end of all resulted in paraplegia and on to renal failure currently on dialysis. Testing is indicating no 'found' reason for this occurring (ex nothing on mri etc) . She actually was doing preop testing for a hip replacement. They are currently under the impression of a preexisting condition..?? Do you have any experiences with this or similar?? Expectations are that she will not improve. Interested in your point of view, not the potential blame issue. I have hear the doc's discussion on this with the family and under the impression of all involved that there is no 'found proofable' explanation other than the obvious risk already involved. Lisa (who gladly gave birth to 5 without pain intervention for her own personal fears):stone

Our policy is that only nongroshong or the unusal from other facilities that are not groshongs are flushed with heparin bid and/or after an infusion or blood drawl. Groshong piccs are flushed with 10cc ns bid for unused ports, always after infusions or blood drawls and the groshongs should be good with only weekly flushes for outpatient used (per our protocol ex with cancer patients). Then there are the midlines and central lines etc that I'm too tired to go into. You would think we would do them all the same don't you for a standard of care etc.

No way would I bring it home, no compensation for that. SmilinBlueEyes, I love this quote from Chris Rock, it is great: "You KNOW the world has gone crazy when the best rapper is a white guy, the best golfer is a black guy, the tallest basketball player in the NBA is Chinese, the Swiss hold the Americas Cup, France is accusing the USA of arrogance, Germany doesn't want to go to war, and the three most powerful men in America are named "Bush", "Dick" and "Colon"~~~Chris Rock :roll :roll :roll

The teen mother had many issues and rooming in wasn't going to solve it. Unfortuantely she wasn't open to your teaching and the baby suffered for it. As rooming in being manadtory, well, thank god it wasn't with my 5. I kept all of my babies all day, late into the night and early in the morning. Probably no more than 6 hours average that I didn't have them because I missed them horribly. After 14 hours of labor with my first I couldn't even old myself up much less her all night. I had my twins in at night due the the fact I knew I wasn't going to sleep for months and their sister was 15 months old and needed a bit of rest before tackling that, not counting no t sleeping for 2 months before they were ever born. The 4th was joining 3 sisters and I had been there and done that and needed the rest. With the 5th I was going home to a 2 year old plus the older 3 and once again was plaqued by no sleep due to pain being pregnant. My kids range from 3-13, thankfully healthy little hellions. My point is that your expectations in general may not be taking into account the whole scenerio your patient my face once walking out your doors. I needed that bit of time to recapture some rest and accept the surreal wonder of that change that finally occurred.

Well, it is pleasant to know that my last 80 hours plus whatever overtime I've lost track of in the last 11 days running in circles providing care and teaching for my patients and their ridiculous families was for not. What the heck was I doing that for when I should of been having fun sitting around on my butt letting my 8 patients call lights bleep and bleep at the desk. I must be an idiot. :eek I agree this is the dumbest subject I've ever scene on the internet. I would certainly hope you don't go in to any medical profession or legal profession. You simply lack the integrity, compassion, and sense required for either at this point in your life. I suggest an adminitrative direction where you can debate and voice your ridiculous asinine ideas, project on others to follow in a enviroment that won't allow others to question your authority because you have some lengthy important sounding title. I'm sure there are hundres of places that available for you---just check out our government and corporate messes. Those leaders sound much like you.:roll:roll Lisa--aka just another RN, daughter of an attorney (yeah one of the rare honest ones) and mother of 5 who teaches all her patients and children to question ideas from people such as yourself:D

I do 4 10's. I work 07-1530 on the floor and then 1530-1730 in the office. Much better than 12's of any kind. If I running late I just don't get my office work completed and my NM works on some on my days off. I get the benefit of leaving on time, but miss out of loads of over time some acquire.

I have found that I quickly jot down of current info on my census sheet, this includes code status, chem strip schedule, ivs/lines, tube feding,appointment labs, diet, assist of __, therapies ordered, wts, I/O..just basic stuff, a spot for bm, treatments sites,prn pain meds and then I jot down anything unusual from taped report...this is all done in red. I leave a little blank to jot in my info collected. Then I have a small area to jot down my vs and assessment and all of my data is done in black for easy reference. I then take a blank piece of paper and make my notes on it for reminders to do or whatever and cross out as completed. Then I just dedicate my first few hours completing these tasks and assessments. This, o fcourse, is the ideal...it hasn't gone that way for weeks now...busy busy busy with 6 pts today..sigh..anyway. This is how my plan is formulated. Then I am one of those annoying people that continually talk to themselves throughout the shift and mumble my thoughts/plans of what needs to be done out loud. But I just keep going and will no longer let the attitudes or unexpected get my goat. When I am stressed (honest to god) I have now started humming some tune that I always remember. I hum this thru the unit going from room to room and while checking my meds....whenever. It is one way I focus on my duties and block out things/noise that interferes with calm. I have had a heck of a time getting used to the hospital setting with all the interfereces...dr., nps, therapists, dietary, pasotral care, whatever.....This puts me into my 'happy place' and I remain calmer and focused. My coworkers all like me and think I am a riot. Several just start singing along to my tune and it calms some nerves. Yes, this is strange advice. But, one thing I have learned about turning almost 33 and finally overcoming my fear of changing nursing fields from LTC.....I am a good nurse and I don't care what anyone but my patients, boss, supervisors think. When I am drowning I ask for help and delegate. I pass on to the cnas what they can do letting them know I am getting into trouble for time of pt X needs me a lot because of and they are great about assisting me with that. (with bladder scans, chems, o2 sats whatever is safe and permissable). I also always help out fellow nurses in a rough spot however I can. This assures me that I always get someone willing to help me when I am the one sinking. (except for one....what's up with her?? she always is done way to early with everything>>and never offers to help out others?? ) Above all, I always smile and roll with the punches. Ok...maybe wierd advice, but it has helped me.

Jammer it really isn't so bad. My floor is the skilled nursing unit and we are also regulated like a nursing home. We used to be a 30 bed now only 18 d/t the opening of acute rehab unit cut down on our max. I imagine our unit is the sister to you....sometimes I wonder what anyone is thinking when some of the pts I have had come in the door. Anyway, I also do the MDS coordinating and I've only been here for about 3 months. But, overall I like the pyxis system. We still have the med cart that is stocked by pharmacy and holds a few narcs that aren't in the pyxis. We log on with a password and then get what we need. The only problem is usually awaiting for pharmacy to put the med into the system, which only takes a short time. Our pyxis is used mostly for prn meds and we have the ability to override to get something if its a stat order. I think it saves time myself. You do one person at a time as you go. handy if you drop your med cup, like I did on Tues, and then have to get 5-6 new pills for your pt to get it from there instead of calling pharmcy. I think you will find it isn't so bad, the extra trips to the machine just become part of the routine. IF they keep med carts on your floor then I imagine it would work pretty similarly. If they take your med carts, that would just mean waiting in line for the pyxis like you have to do sometimes for the medcart. Lisa

Well, I'm not sure what to think now. I gave my first iv push phenergan just this afternoon. It was given in a central line. The order called for 12.5-25 mg q 6 hours. My drug book indicated to dilute 25-50 mg with 9 cc of saline and to give 25 mg or less/2 mins. The pharmacy instructions on my MAR indicated to dilute the 25 mg and give over 2 mins. Another nurse stated they usually diluted it. I gave the 12.5 mg and with my drug book and the pharmacy instructions as reference I did not dilute this dose and gave over 2 minutes. My pt. had no problems indicated or c/o during or after receiving this.......but, did I really screw this up or what?? Lisa

Oh the hours I spent combing out my girls' super long hair. Going thru everyone every night for almost two months. Oh my god! YUCK YUCK. I really should of made them cut off their hair, but it's too beautiful and they were in tears when I suggested it. I think what finally made the difference was using the otc crud and comb, then shampoo, then the mayonaise and comb and shampoo along with all the cleaning. Alone the comb or txs and cleaning didn't do it. I'll have nightmares tonight of lice.......yuck.

Well unfortunatley from personal experience when my oldest daughter got this last March I tried everything and with 5 kids in the house of course it had spead by the time we realized one was infested. I used all brands and types of over the counter stuff, perscribed stuff, homeremadies. While it seems to take care of it, it keep reoccuring, starting with my oldest daughter. My house was more santized/deodorized/disinfected etc than you could believe,you name it, everything was sprayed and vacuumed (all furniture), bedding washed and rewashed and all hair items boiled (4 daughters with long hair..couldn't throw all that stuff out lol) or thrown away. There was nothing I didn't do. After the sixth or seventh week I went into a rage. I put the otc stuff on each child and went thru their hair then I put mayonaise on for a couple of hours, and I personally scrubbed and combed thru all heads, rewashed all bedding, school bags, coats, gloves...anything I could think of....and that was the end off that. Disgusting but true.....it didn't hurt and I think it helped!

Also here in Iowa we have Medical Assistants that have attended I believe a 9 month diploma program. They are popular in the clinic setting...I have seen them give injections, take VS, and do simple labs. And usually are mistaken for a Nurse. Also for my above post, CMAs take VS and then report them to the nurse. Lisa

In my State CMA's are CNAs with six months experience, I believe have 40 hours of class time in the med aide course, and then have 12 hours of med passing time/teaching with an RN. Rather scary at that for a person to be passing meds. Facility # 1 I worked for would have a CMA pass meds, do all txs. if did not involve a Stage 3 area or greater, chart what they did or things they could obserb, all which had to be cosigned by a nurse. Narcs could be counted with a CMA/Nurse combo, they could not remove a narc, but did pass them. I was 'reassured' frequently when myself and other nurses got very adament regarding what they should/shouldn't do that this fell into the state guidelines and that the facility educated them on how to do things correctly. Facility #2 : CMAs passed meds, do chem strips, all txs if skin intact or just an simple skin tear and edges were approximated, could not go near the narcs and did not chart anything other then on the MAR. Facility #3: CMAs pass meds, do no txs, narcs or charting except on MAR. They did some txs in the past, but that was stopped.--I don't know why as I've only been there a month. I think each state has their own specifics, BUT each facility will create their own policies for the CMAs regarding the needs they need at the time. And the nurse assigned to those res/pts is ultimately responsible for all the CMA does/doesn't do. I've met some very good ones that I trusted, but for the most part it was just something else to worry about. Lisa