paulwalkman

I'm sure you already know the answer since last year ago but I'll answer anyway. If your patient has an inr of >3.5 hold the medication and call the position immediately. Some docs will allow up to 3.5 but that's on the rare patients and should be in his notes. The patient is at risk for bleeding out; A hemorrhagic stroke or bleeding from colon cancer, etc. On the other hand is the inr is

Thank you. Funny, very funny, but could you answer my inquisition please? I'm still not sure what's up.

Thank you for that last mention. Since PaO2 is assumed during routine testing, how would it specifically be tested? Does an arterial blood sample need to be taken to get the ABGs? Early in my career I had a jerk doctor ask me 10 minutes after he wrote an order to put a pt on 3L O2 because her PulseOx was 88ish. I told him the PulseOx and he repeated 3 times successively louder each time "what is the PaO2!!?" I asked "if labs had to be drawn and he yelled back, "No, You go tell me what it is...NOW!" I had to get the charge nurse to talk to him. I just never thought to ask again.

The issue with using the phones in the hospital is the WiFi. iPhones cannot turn that off (as of 2 years ago). Most other phones have a selection to turn of the WiFi and the 2G/3G/4G. In addition to Davis Drug guide I would suggest looking over Skyscape.com. The have a lot of programs that you may find useful.

as a nurse, you gotta-do what you gotta-do. in my experience nurses & pts are ok with butt wiping and butt washing and even putting in a catheter, but some people get anxious about washing the male and lady-parts. i talk to my patients when washing them and encourage them to wash as much as they can to promote independence. i always ask if they would rather wash their own perineum when i reach it or if i can get started (washing the perineum). my patients appreciate my direct questioning and it’s either a yes or no. even if i had a "hot" patient i am not in that mode. after i was in a huge accident at 32 years old i was usually told to wash my own from what i remember and when i was coherent i would not want a male nurse wash me whether or not i was able. when i started walking the rehab i was on had mostly older stroke patients and a nurses aid always asked each person if they need help in the shower. i was asked by a beautiful aid, about 19 or 20 years old if i needed help in the shower. of course i said yes! i had to wash carefully because of the unhealed scars so i could justify to myself that i needed her, but i ended up telling her “no” because i didn’t need her to help, and i would have felt dirty after the shower because i took advantage. consciences suck‼! paul

Hey Katkonk How did you like supplemental Healthcare. I think the pay is low so I'm tryinbg to get perspective. Thanks. Paul

I did Travel Nursing in Texas over the summer. I was with a terrible company that called at 5 or 5:30am and sent me to a random hospital in one particular network. I was expected to hit the ground running...running for my life. I had to find the hospital and then find everything in the hospital for work. Unfortunately, travelling is not for first job experience. most places I know of want at least 2 years experience before yo can travel. I don't know about general agency work, but I woul assume it's nearly the same. Paul

The pay in Texas is very low in general. I don't think it's the company also being cheap because your pay would likely be lower.

Stay away from Ay.a Healthcare. I heard Cross-Country is goodAnyone know about Nightengale Nurses?

There was a study comparing physically exhausted sleep deprived drivers against typical drunk drivers. The sleep deprived drivers were worse off. Not that I'm prtomoting drunk driving, but DEFINITELY don't drive sleep deprived. Paul

Six days in a row are definitely too many. I wrote that post in October 2008, and I kept averaging four or five nights per week. I worked like that until December 5 2008. On my way the home at 8:00 AM on December 5 after working several shifts in a row, I fell asleep while driving and hit a tree. The next thing I remember were some paramedics telling me are going to take me to a local hospital. I told them “not a chance, I need to go to Cooper!”, which was the nearest trauma center. I had blacked out were several days due to a subdural hematoma. I also crushed my left calcaneous, which is replaced with the cadaver calcaneous, crushed my right ankle, where they put in four plates, and had massive internal bleeding. They cut the open sternum to pubic bone to find the bleeding, and remove my spleen. Ten days later I had the first conversation that I remember. I also developed sundowners syndromeI This always anoyed me when my patients had it. Everyday I was told what hospital I was at and every night when I was asked, I thought I was at the hospital I worked in. I kept trying to get out of bed to see patients. I didn't understand that I was the patient. Not good! I remained in the hospital until December 28, 2008. I remained in a wheelchair for a little over three months and I have needed two additional surgeries on my right ankle. With luck, I will be off crutches by 2010. I guess my tips would be: don’t work too many days in row, make sure to get enough sleep, and try not to work night shift. Maybe it has been a blessing in disguise. I can’t do shift work at a hospital anymore, so I am back in school to get my nurse practitioner degree. Paul

if this physician doesn’t have a previously used or pertinent contract, you can check some of the lawyer sites. some of the sites that give formats for resume’s also have non-specific contracts that you would use to make a contract more specific to your situation. it’s best to create an out, or reason for postponement in payments that you could use if needed. check out his practice/work and try to come up with an appropriate salary for the year you graduate. make a list of any and all questions you have after reviewing the unsigned contract and speak to a lawyer. i made a basic contract with my father to pay him back the money i needed that was above the loan max given by the bank so i could always pay my mortgage/bills/etc. on that same note, borrowing money from family of friends is normally a terrible idea, hence the contract. always keep at least one copy of the contract. once it’s signed, it’s signed. i also had a 10k sign-on bonus to work for a year at my hospital. i didn’t have the needed out on either contract, but was given lenience in both contracts due to a terrible debilitating car accident. (i still can't stand). -paul

Hey, Ivanh3, I have to disagree. Obviously you have trie many of the products, which makes your opinion that much more important, but my Verizon XV6800 Smartphone uses the Pocket PC software and I have NEVER had a problem with it. The battery, even when used often, outlasts my 12-hour shift. I will agree with the statement that the original Pocket PCs crash often and hav bugs during the processing. I have mentioned a lot of assets in my previous column but I can't stress enough that, especially for school, it comes with MS Office, including Power Point. -Paul

i agree with rngolfer53 who said “you wouldn't go to an attorney for a nursing question, right? same thing applies in reverse”. definitely check out your contract with an attorney. determine if there is a time period when they have to hire you. is it within 1 year after graduation, 6 months after passing the nclex? that will tell you if they broke contract. i heard you mention your concern that they might not want to hire a 24y/o with chronic health problems. if you are healthy enough to fulfill your shift responsibilities with or without proper assistance that would not put a serious burden upon them you have no problem. you might have a great legal standpoint. you don’t have to be the person who always lifts the bariatric patients or takes care of the patient who is out of her mind screaming. i don’t know what chronic health problems you have, but have you doc write what limitations may be. if you apply again and they say they won’t hire you because you are sick all the time and can’t handle a patient load the way they want you to, they just violated the ada law, (american with disabilities act) the hospital would owe you the fulltime salary that you would have been earning up until that point and the money you would have made if you worked there full time for 2 years (i believe you mentioned the terms of your contract were working for them for two years). and, they would no be allowed to collect the $20k you borrowed for school because it was given to you without the plan to hire you anyway. the $20k was more of a grant, that would not be paid back. i have had a very similar situation happen (let’s say to my best-friend), so i know i am very close with the situation given in this post. but with not being hired (ask if it is because you’re sick-look for a yes) hire an attorney and get another job on his advice. relax. i’ve been there. you need patience, not frustration. good luck, god bless! paul

Pocket PC, Blackberry, or Palm? That became an obvious answer after some research. Let me give you some details. I bought a Pocket PC in my phone; a Smartphone. Aside from a phone and a 3 megapixel video camera/camera there are many other features. Products for any of your questioned items can be purchased at Skyscape.com, but so much comes with it. I have purchased many products I continually use and get updates anytime I sync with my laptop. The Smartphone products are very easy to use and most are low cost and when the yearly subscription runs out you keep the program but just don't get updates for that particular program. I also have a sync with MS Outlook on the Pocket PC/Smartphone. During school that would help download test dates, clinical days, other calendar questions. Of course you would have phone numbers, but also everything else you entered into MS Outlook about the person/company, short Notes you want to remember. Email can also be downloaded FOR FREE when synced. Pocket PCs/Smartphones will download any important file you placed in the folder associated with the Pocket PC which is created when software is installed. It's nice to be able to take notes on you computer, look at a zip drive, MS word full of your research. Also, you have Power Point presentations you or your group have been working on, and can use Excel to segregate the patient's meds names from use/effects/side effects/dosage/ etc. on your Pocket PC that were, and still are, in your computer. It also comes with Adobe Reader, required for some teachers' work, and Windows Media Player. It's not iTunes, but you can transfer the music/videos. If you have enough money buy the use of Internet Explorer. In other works get the POCKET PC/SMARTPHONE. -Paul

Not to be a smart ass because I'm considering becoming a CRNA, but don't you have the patients unconcious? Paul

I'm kind of worried about a similar circumstance. I got a $10K Loan Repayment bonus (sign on bonus) that was to be given in smaller amounts over 9 months if you work for a year full time in the position you were hired for (and I think it included the shift). The last payment, the 9th month exactly, was not given to me-no reason I should not have recieved that in my pay. Unfortunately, I was in a massive car accident because I was working too many 12 hour shifts in a row on very little sleep. This was two days after I should have been paid. I was in a different hospital for about 1 month and, now, 2 and1/2 months after release I am still in a wheelchair. From what I understand I will have home therpy and inpatient therapy over the next 2 months. Then I will go back to work. My dilema is: should I ask for the $3,000 , and when, or would that incline them to demand all of the money back. Many of the nurses, including the manager I work with saw me and the shape I was in (although I don't remember all of it). Would that count as some special circumstance regarding the $10K sign on bunous even though there is not mention of getting out of the deal? I do plan to return to work there again. Although, I won't be doing as many extra shifts. Paul

After 3 nights (12s) in a row anyone might feel like a zombie. It was a good idea to buy blackout curtains. If you wake up at night, or late afternoon, and stay up to 6 or 7 (my hospital does 7-7) than you body will gradually get used to the new hours. You might not be as wiped out after 3 12s after you keep the night schedule for a few months. When my alarm goes off I think I'm in hell, but after a cup of coffee and a shower I feel better. I've worked up to 6 nights in a row. Three were scheduled, two were overtime and I forgot that I had to work that last day. -Paul

My education was much less than 50K. It was a little less than 30K, but that number increases drastically when you add the cost of living to it. I was in an Advanced Second Degree BSN program. It was a lot of work squeezed into a short time period. I had no time to work and make any money. I had to take out additional loans for the cost of living. I can see how someone would end up with 50K of loans to pay back. Good luck with that. -Paul

I ave my BSN. As far as pay goes, I get $1.00 more an hour and extra $$ for overtime/bid-shift. I would say that getting a two year degree is more cost effective if you wanted to remain a floor nurse. If you wnat to go into management or further you career by getting a masters in anesthesia or become a NP, than getting a BSN right out of school is definitely the better choice. It all depends what you want to be when you grow up:). My plans are to eventually get a masters in anesthesia, so the extra $$ spent on education was worth it. Also, I already have a bachelors in biology and chemistry, so going back to school for an associates didn't make much sense to me. It's a personal choice and I don't think either is the wrong way. I do, however, notice that no more LPNs are being hired in my institution or some of the otheres I originally looked for a job. The LPNs are not losing their jobs, but they are sort of being phased out by not hiring anymore. Given that knowledge, I find it would be much more beneficial to go for the extra semester or two to attaina two year degree rather than a practical degree. I mean no offense to any LPNs that read this. It's a generalization and an observation. -Paul

Let me correct myself. I meant to say the acuities of these patients are similar to the ICU or CRITICAL CARE of a local hospital.

I work on a floor with usually 28 pts on tele 12+ new stroke patients, a few post-Bariatric Sx patients and 1 or 2 vents on 7p-7a. It was a nightmare at first, but I got tele certified, saw a bariatric Sx and took a competency test (no CEs) from our institution, and will be taking a ventilator class soon. At first I felt like a chicken with his head cut off but I quickly learned to group as many things together as possible, do the most important things first and make a sheet for a quick head-to-toe assessment. I've almost memorized that sheet and with everything else I usually get done close to on-time. By the way we usually have 6 pts or 5 + an admission. The acuity of most of the patients is similar to that of a rural or local hospital. Unfortunately, admissions ruin any plans that you tried to set to accomplish tasks and nursing is 75% paperwork. I get the quality and quantity of information I need from a pt to do the paperwork, but I wish I could spend more time with the pts. Good luck to all. -Paul

i was offered my first position as a night shift nurse on a very busy medsurge floor. we have bariatric, stroke, tele, and vent patients. i was wondering what to do on my days off. what do you do on your days off to help you keep the night shift hours? i plan on going to the gym a few nights per week and watching a little bit of tv, but that won't take me past midnight, well...maybe 1pm if i watch jay leno. what is there to do for the rest of the time? i heard it is best to try to keep the similar hours to the 7p-7a shift. if anyone has any suggestions about what to do while staying awake in the middle of the night please let me know. thanks -paul

PDAs are great. I used one throughout school. One of the main decisions to make, aside from what software to purchase, is whether to use Palm's version or Window's Mobile. Window's mobile is integrated into your phone. It will eat up the battery quicker but you only have to carry one thing. Palm has virtually the same programs, just a different OS (operating system). Using a Palm means that your phone will be seperate (with the exception of a few phones) so the Palm batterries may last longer but you most likely will not have your phone with you or it will be an extra item to carry. Both Palm and Windows mobile have options to connect to wireless internet which may comein handy at the hospital. -Paul

hey, i just graduated a 2nd degree program and i explained to my current girlfriend, whom i met after graduation, why i hadn’t dated in almost 2 years. we had a small class, less than 20. granted i loved the ratio of women to men and many of the women were attractive, dating one of them just didn’t seems smart. we had several different clinical rotations and the group members changed. if i dated anyone of the girls and it didn’t go well things would be a mess. there is gossip no matter where you are and what you are doing, but i have to be able to count on any one of my fellow classmates to “have my back” and assist me at any given time. if there was gossip about a relationship i would not feel comfortable when i need a classmate’s help.