pinky22786

Yes pharmacy is the one that sets the time. More times then not we have to start or give meds at non scheduled times due to not having med available on the floor. Wonder how that fits in to the new definition of practicing medicine. Thanks for your responces. I will be looking further in to this when I go back to work. Just wanted to make sure I'm not wrong in my thinking.

I have just found out that during our last department meeting that we as RN's are not allowed to change a med time. This information is all hear say from multiple people at the meeting as I was working that day and the minutes have not been sent out. Its said this way of thinking came down from pharmacy, as they feel changing a med time is practicing medicine. One example is BP at 6am elevated and there is BP medication due at 10 (timing for daily meds). We are not alowed to give the medication early at 6am with out a doctors order. That is the main example discussed. Another one is if on nights the pt wants their meds at 8 rather then at 10 (timing for hs meds) this essentially would need a order or per our director documentation on pts request. I don't have all the facts but it seems that this is only on daily and BID medications. I don't see RN's adjusting TID and QID, more then the half hour window before and after schedule time, if they do then yes that would be an issue. There are many times I have held a BP medication due to a low BP at 10am and given it later in the day if the BP increases and if med is BID depending on how close doses can be given. This is nursing judgement as is giving a medication early. Do we need a order to hold medications that's changing the MD's orders and can be taken as practicing medicine. Taking this part of nursing judgement away will mean alot more calls to doctors that are going to get very annoyed. If there is a issue with certain RN's talk to them directly don't take a vital part of our jobs away. Has any one else had issues with this? What are the rules at your hospitals?

Medication error was found during code. I'm not trying to pin anyone just pointing out where I felt the ball was dropped. Yes techs are not responsible for assessments but they should have passed on the family concerns. I'm at work now and feel better about situation. Like I said before its frustrating as it was a preventable code and I'm being hard on my self as I gave the medication that led to the code. No I did not question the dose knowing pts history. People are human and do make mistakes. It was written up and I will let what happens happen.

I work on a med/surg with 6 pts per nurse. Pt was there for a minor diagnosis another nurse saline locked pt prior to going down for MRI as I was at lunch, pt assessment WNL when I handed her the MRI check list, just prior to going to lunch (after the code that RN reported pt being tired but interacting appropriately so no major flags there). Pt came back from MRI and US was there with in minutes to do their exam. I visualized pt coming back from MRI in wheel chair as I was entering another pts room and nothing seemed out of line for further assessment. I entered room about 30 minutes later and observed pt as dusky and family reported concerns (pt was breathing and pulse) and went to grabbed Charge nurse for another set of eyes and vital sign machine. We do not have continues vital sign monitors just every 4 hours. This is when the sats were observed as 40%. Medication was extended release narcotic. I am just very frustrated as this all could have been prevented if the proper checks were done correctly and the fact that I gave the medication that caused the code. We unfortunately rely on others to do their jobs correctly to do ours correctly (ie 24 hour chart checks). We work as a heath care team and to think the RN can have eyes and ears on each pt at all times is not realistic on Med/Surg and when concern is raised it needs to be passed on.

I had to code a pt today, only my second code. My issue is for the 30 minutes before there was a ultrasound tech in the room and prior to that pt was in MRI. Family states reporting concern to the tech but nothing was reported. Pt was dusky and sats of 40%, when I went to go give meds. I know they are there to do a job but pt was clearly not doing well. Am I holding the techs to a higher stander then I should or did the ball get drop in a big way for the second time leading to the code? First was the 24hr chart check was not done right, medication dose was triple what it should have been. Also how do you calm down after a code. I feel horrible and just have a list of what ifs and mistakes. It does not help that I was the one that gave the medication that ended up causing the code. Oh and family was throwing around the sue word well before this. I'm emotionally drained and needed to vent.

I was reluctant to medicate per the standing order but when I went to give the medication and seen the state of the pt I was fine giving it. Pts arm was starting to twitch was the only sign of agitation. When I spoke with the doctor and asked the rational for changing the order to standing her response was we want the pt comfortable. I guess she did not want to miss the little signs of discomfort. Is this a normal practice for hospice care? I cant put a finger on why I am so hung up on medicating around the clock for a pt in the dying process. It's not the fear of causing them to pass or being legally responsible. Its more medicating when not necessary, yet now reading the responses giving pain medication to a dying pt is like giving nausea medication to a pt prior to them eating or taking medication that has been nauseous. Its anticipating the discomfort and medicating so they do not experience any. I understand this with the help of the responses. But who is to say they will experience discomfort? Better comfortable than not. I look for the s/s of discomfort on a large scale, not the small such as they eyebrow movement. I hope I can take these lessons learned and apply them to the next comfort care pt I have and feel comfortable medicating when s/s are not there. Thanks!!!

Yes I understand respirations are not a reason to hold medication during comfort care. And I was ready to medicate at any request of the family or signs of discomfort. So now my issue is how would you handle disagreeing with a order in the middle of a shift, hold the medication then have the doctor be upset with you and know that your director also wants you to medicate so they may not back you up in your decision to hold the medication. Is it proper to ask to switch a pt with another RN that was willing to, yet that feels like you are abandoning the pt and the proper care they deserve.

What do you do when a pt becomes comfort care. Heres my situation: Doctor ordered pain and anxiety medication q2 prn. Pt was not showing s/s of distress and family was not asking for the pt to be medicated. My issue is a social worker kept pushing me to medicate q2 weather it was needed or not as that is what the hospice nurse suggested. Ok I am not a hospice nurse and have never experienced hospice care so I dont know if that is standard for their care. This is my first pt to go through the process of dying with for more than a hour. My understanding of comfort care is to keep the pt comfortable as well as the family, not to medicate the pt to hurry the process(resp were I was glad I left 4 hours early as previously schedule but I dont know if I would have followed the orders. I documented well but still dont feel right about this for two reasons: we are not here to make the decisions to help the pts along that is for the family and pts wishes, then what should I do if I dont agree with the order yet my director does not support me. I was put on call today but I was going to refuse to take that pt today but what to do when your in the middle of a shift and dont agree with orders?

There has been 2 times that I have felt bad about not responding to a accident outside of the hospital. Both were minor and want the opinon of other Nurses if I should have done something. I am one year out of school and have worked in a urgent care clinic as LPN and now on med/surg as RN. First was one year into nursing school and I think that I had just passed my LPN test. My husband and I were at a hockey game when a puck came into the crowd and hit a elderly man in the face. He stood up on his own without any problem and sat back in his seat. There was minimal blood that I could see from my seat and with in 2-3 minutes First Aid Staff was on site. This one I dont feel bad about as he just had a laceration and what was I supose to do hold pressure on his nose as he was doing already. He came back to his seat with in 10 minutes of leaving to be checked out by First Aid Staff. My husband just does not let me live this down. Then today I was at my brothers wedding and 2 children were jumping on a trampoline and bumped heads. The mom went over and pulled the little boy off and was carring him to a chair. You could see a small bloody nose but he was acting as a kid would when injured. The mom was holding pressure and checking his mouth out. I did not respond as she was doing everything I would have. Then my sister-inlaw called her mom over to check him out as she is a nurse too with much more experiance then I. She went over and checked his mouth out and then let the mom continue as she was. If the situation does require more I have steped up and said something and assessed more indepth. Dirt bike accident, rider went over handle bars and landed flat on back, said to call ambulance to transport but they dissagreed and took rider in by private car. Turns out rider had multipul compresion fractures and was place in cspine once they arived at the ER. I just feel like I have done something wrong when I do not respond. Yet when its something simple and I have assessed from a far and do not feel like it requires additional attention then what the people are doing already, I should not interfere just because I'm a RN. What are your opinons?

i agree that i am being held at a higher standard now that i have my rn and will act as a rn if the situation occurs. i am just really surprised that i am not being recognized in any fashion of my accomplishments. even to the point that i don't know if i can put rn behind my name at the clinic. yes the pay increase would be really nice as i am losing a significant amount and that is what the issue started out to be. yet it has now come down to the fact that i have worked four years to get my rn and i have to now wait another three weeks to be recognized as such. it's very difficult and i did not expect to feel this way. but as a recent grad just one month out, putting all my time and the effects that school had on my life personally...i figured it was going to be different. some of this may be due to the fact that the previous owners were more involved and it felt like a family now it's oh sorry this is the standard response that we are to supply when this question is asked, no consideration for your specific situation.

i currently work at a clinic that was purchased just a little over a month ago by the hospital that i just happen to get a job at as a new grad. i just found out that my license is active on tuesday meaning i passed the nclex that i took on the third. so legally i am a rn but according to the hospital i am still a lpn at the clinic and will be so until the end of my residency yet in three weeks when the residency starts i will be a rn in residency at the hospital. let me step back in to the clinic to work any type of shift before the end of my residency i will be a lpn. i don't get it!!!! i understand how residency applies to the hospital but as a lpn i do everything that a rn does at the clinic except ivs which in the past 9 months i have only seen 2 situations that required a iv. i have worked plenty of shifts on my own without a rn and have not needed to contact a rn during that time and felt i did a great job. so why can they not look at my situation and reconsider and recognize me as a rn at the clinic. there is a cna that transferred up to ma during this switch and they are not making her do the required residency that is normally done. is this normal to not consider a new grad rn as a rn until after the residency program.

I too had the same feeling. Look at it this way, did you do so horrible that the computer would shut off at 85ish, most likely not it would have given you more questions to try and pass. You most likely passed like I did but just do something to get your mind off the results. Good luck.