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Canrckid's Latest Activity

  1. Canrckid

    Problem with charge nurse& MD's order

    WOW! Is this nurse in deep do-do! And rightly so! Where did she go to medical school? All sarcasm aside, she cannot "order" a medication.......if she so strongly disagreed with the MD's ordered dosage, then she should have refused to give it, or had him administer it himself. If the dosage was so incorrect, she could have had the pharmacist speak to him about the consequenses of that particular dose....DOes your hospital have a P & P regarding the use/titration of neuromuscular blocking agents? Maybe you should have one....Since the patient was intubated, the likelihood of any negative effects was probably small, as long as the dosage was given relatively slowly........ What dose was requested? I've given as much as 10mg at one time, was the dose higher?
  2. I too received an email from Sylvia today.... She is still researching the use of UAP's but would also like to know if there are hospitals out there that are training dietary and/or housekeeping personnel to do patient care.........If this is happening where you work, then post here and cc to Sylvia.Johnson@abc.com ------------------
  3. Canrckid

    New Treatments in Bladder Cancer

    PJM............. I work at a university based hospital here in California, and a large portion of our patient population are urological surgeries. A continent "pouch" can be created using a loop of small bowel and even connected to the urethra so patients can void normally after some exercises and training.....They are called "Kock" pouches, or sometimes "T" pouches, and may be possible in your friends case, even with muscle invasion. I'm assuming by your "profile" that you and your friend live in Pennsylvania........You can contact Penn Medical Center at: www.med.upenn.edu/health and click on "Medical Services"........the Division Chief of Urology is a Alan J. Wein.....maybe you can consult with him to explore your friends options......Good Luck! ------------------
  4. Canrckid

    giving UAPS badges titled under nursing

    ...........what a sneaky underhanded way to deceive the "public" (read: patient)! ------------------
  5. Barton.......... I have to disagree with you on some of your statements.......First of all, many of us (the public) didn't "choose" HMO's. If we were lucky enough to have an employer that offered health insurance at all, (remember, they are not required to offer it), HMO's were often the only choice available. If families paid for insurance out of pocket, they were the only plans they could afford, good/bad or otherwise. You can also bet that pharmaceutical companies make their money, whether we pay full price, or a small co-pay......imagine the profit if they contract with the HMO to supply a particular classification of drug to the exclusion of all similar drugs from their formulary. Though not a big fan of HMO's, there are some that do an excellent job of providing care, especially here in California where we have a long not-for-profit HMO tradition. It was when Wall Street got involved that Health Plans began to sacrifice patient care for shareholder profit. Anyway, I agree with one thing, if you take the profit motive out of healthcare, then and only then will we begin to see enough money available to begin to provide services for those who have NO insurance at all! ------------------
  6. Canrckid

    Nurse-Patient Ratios

    TessaG............ PLEASE!!!!!!!!!!!!!!!!! Do more than post here about your inappropriate staffing ratios! Didn't you read the post just before yours? Send your observations and errors that may have been caused, or treatments you were unable to give due to poor staffing to sylvia.johnson@abc.com. If we want the media to alert the public to how todays healthcare pratices affect the quality of care, we have to let them know whats going on! Canrckid ------------------
  7. Canrckid

    New Ventilators?

    ...........We use the Servos too......great vents, you're right, they have more modes, problem is, some Doc's don't know how to use them! ------------------
  8. Michael..... No one means to underestimate the help that "unlicensed" assistive personnel can provide to the RN's in the care of their patients. What we are referring to, is the practice of some hospitals and healthcare facilities to decrease the actual number of RN's involved in direct patient care and REPLACE them with assistive personnel that may/may not have formalized training.......all to save money. There is a definate place for CNA's at the bedside, and they often CAN be the first to pick up on a developing problems and bring them to the attention of the RN. I for one feel that the development of a new patient care model that incorporates assistive pernonnel can go a long way towards providing quality patient care cost-effectively. Thanks for all your support! Canrckid ------------------
  9. Pearl........ As Barton said, thanks for your support..... I hope you use some of that documentation and send it along to Sylvia Johnson at ABC news. I was also getting a little disappointed that more of us weren't passing this info along to the media......they can be a very valuable tool, and the most dramatic way to bring our "plight" into public awareness.........I know some of us might feel that this is some sort of "overkill", but we have been "working through channels", and "polite" for far too long! Our patients and our ability to adequately care for them is being jeopardized, and we have to move quickly and dramatically before conditions deteriorate too much further. Contacting our area legislators, local and national nursing organizations is an excellent start, but nothing gets them going like media attention! Hopefully, Brian's newsletter will spur a large onslaught of stories for Sylvia, and 20/20 will decide to "air" our concerns! NURSE POWER! ;-0....(can you tell I'm a product of the 60's)? Canrckid ------------------
  10. Canrckid


    .........for all of you home health nurses out there who have to deal with PPS,OASIS and reimbursement reductions as a result of the Balanced Budget Act of 1997: If you haven't been reading the posts under the new forum topic related to patient safety/care, please do so! The media has expressed an interest in how recent changes in healthcare has impacted our ability to provide quality patient care.......so we all need to know how you are affected too! Please read the 20/20 thread, and post your stories too! Canrckid
  11. Canrckid

    Reply to Barton

    Brian............ Good for you! "Nurse-zine", is the perfect vehicle for getting out the word to all those "stressed out" nurses that they now have another route to express their concerns over patient care/safety issues. Please post Sylvia Johnson's verbatim reply to my email, so that those who wish to respond to her, know what she is looking for..... Canrckid ------------------
  12. Canrckid

    Reply to Barton

    Barton et al............ I was perusing another Nursing BB, and came across an individual who says she works for a major TV news magazine requesting some info on the use of assistive personnel to replace RN's at the bedside. I've emailed her explaining what our BB was trying to do and to ask if she might be interested in what we have to say about this and other issues and to ask for her permission to post her email address. I'm not sure if this is legitimate or not, so if this person does exist, I don't want to "alienate" her with unsolicited email. As soon as I have her relpy, I will post........ Waiting on "Pins and Needles"..... Canrckid ------------------
  13. Canrckid

    Reply to Barton

    Barton........... Yea! Here it is! Sending you her response. Make the best of it! Go ahead and post my name, email, and phone. I am interested in staffing issues involving nurses and techs, and am willing to hear from anyone who has a specific concern. I am most interested in hearing about situations that are ongoing, where patient care is being affected. Anyone may leave their number and a description of their concern and I will call them back as soon as I can. Sylvia Johnson ABC News 20/20 212-456-1421 sylvia.johnson@abc.com I will email her my thanks, and let her know about this bulletin board where she can read some of the issues for herself......in case there are those of us who are too "shy" to respond. And by all means, all of you pass this info out at your places of employment (discreetly of course!), so we can give input from places other than this BB. Canrckid ------------------
  14. Canrckid


    In my experience as an ICU nurse, sundowning is not only manifested in individuals with a known/diagnosed cognitive disorder.....take any elderly patient, place them in an alien environment, under the influence of pain and/or sedatives, then disrupt their normal sleep patterns........and when the sun goes down, all h**l breaks loose! They often "clear", as soon as the sun rises. The best that you can do, is to try to minimize the use of medications by starting with lower doses and increase as needed to effect. Remember, elderly patients don't metabolize drugs as readily, and their effects can be accentuated when combined..(eg, pain meds with a hypnotic). Try to keep them awake during the day and physically active, so they sleep more "naturally' at night without sleep meds. And of course try not to disrupt their sleep at night as much as possible. If they awaken confused, sometimes calling a family member at night to speak to them via phone helps to calm them down and re-orient them. Also, elderly patients often have hypertension, and again, pain/sedative medications tend to lower the BP, so what seems to be a normal BP to us, in an elderly patient who is used to higher BP's and has some degree of arteriosclerosis, now may have difficulty perfusing his brain. And, metabolic rate (therefore BP), tends to drop at night anyway.........As you can see, the problem is multifactorial! Hope this explains somewhat! Canrckid ------------------
  15. Canrckid

    staffing info needed-urgent!

    Leanne, ............what a day you had! Thank God here in California we have Title 22, which will not allow ICU nurses to take more than 2 patients, which is not to say that it doesn't sometimes happen, but at least not intentionally.......nurses may call in sick at the last minute for example, or absolutely no one can be found to work extra. My "cap" is off to you and your AHN, you shouldn't have to put up with that! Canrckid ------------------
  16. Canrckid

    staffing info needed-urgent!

    .It's been a few years since I've worked in a CSICU, but ALL of our patients spent the first 24 hours in the ICU and were all 1:1's. But then they were all on vents, had multiple drips titrated to cardiac output and SVR, and if they had concommitent valve replacements, also had Swans, left atrial and left ventricular lines.....some may also be on an IABP..........so I would think that if all or some of these things applied to a particular patient, they shoud be considered a 1:1 also. We had a closed unit, which worked out quite well.......We only did surgeries M-F, and were scheduled to work every other weekend, but would often request "first off if not needed" for those weekends. The other side of that coin was that we would have to staff ourselves if OT became necessary. It never really became a problem, because the net result was that we frequently got extra weekend days off, and everyone was reasonable about pitching in for needed OT......and the extra money was nice too! We were able to handle the emergent open-hearts this way too.......BTW, this was a 10 bed unit, and I think it also worked well also because all our routine open hearts were transfered to a CVTICU the morning after surgery.......Hope this info is useful! Canrckid ------------------

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