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sameasalways

sameasalways

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  1. sameasalways

    "Y" tubing and transfusion reaction

    At our hospital we don't use Y tubing..I graduated 2 years ago and since this is the only hospital I have worked out I can honestly say I have never used "Y-tubing" to give blood... we use our IV pumps and a PALL filter. The blood is hung as secondary with a 250 cc bag of NS as the primary. We set the IV pumps to do 120 cc/hr for 30 cc as the volume. That takes about 15 minutes. We take the vitals. If the patient has a slight elevation in temp, we give tylenol. Then continue the transfusion at 180 cc/hr to 185/cc hr if no history of CHF. We set the primary bag of NS to flush at the same rate for 30 cc after the blood runs through so that the pt gets all the blood in the tubing. Then we take a final set of vitals. Almost everyone I have given blood to starts to get a slight temperature. If the temperature has a rise of over 2 degrees at our facility it is considered a transfusion reaction.
  2. sameasalways

    Pcts telling you to get it yourself

    First of all, I am one of the nurses who does help a pt on a bedpan if they need it and I happen to be in their room. If I am not running around with acute patients or a patient calling out for pain and the pt's room I am in wants water because they are out, I will get it. But the patient in pain or the more acute issue or having to call the doctor is going to be dealt with before I get water. I don't mean to sound lazy. If it sounds lazy, all I can say is that safety is first, and that it is the nurses who are leaving at 8 pm on my floor. The CNA's always leave at 7 on the dot. Every night. CNA's are not the only ones running around. Just because I am sitting on the computer doesn't mean I am goofing off.
  3. sameasalways

    pain management/pt upset

    I have only been nursing for 2 years but a few days ago I had something happen that really left me shaky and questioning things. I look forward to any advice. One of the post-op patients (orthopaedic) had an I/D of their elbow. It was the 2nd one done due in the week. I picked him up at shift change and he called out for pain. I looked at his pain meds and he had Demerol and Lortab. He had not been given Lortab since the day before. The report I got upon taking the patient did not address any issue about pain meds or issues with them. I was taught to stair-step pain meds and give the IV pain meds for breakthrough pain for a few different reasons which you are all probably all aware of. I went in before bringing pain meds and asked what his pain was on a scale of 0-10. He said "not really bad, its just my elbow and that is like a 7". I asked pt if there was a reason he had not taken any lortab since yesterday. He said shrugged it off saying "no...not really." . I asked him if it was because the lortab doesn't work and he said it doesn't work for him the way the demerol works. I brought him Lortab and I explained that we like to use the demerol for breakthrough pain and so that we can make sure the lortab is effective because if it isn't we need to get a different oral pain medication for him so he can be sent hom with a different oral pain med. He took the oral pain medication and at the same time his IV went bad. I was unable to flush it. while I was attempting to flush the IV I said "I hope I didn't come across wrong but I just wanna make sure that if the lortab doesn't work we can get you something different and because when you leave you won't have the IV pain meds available". He got very angry and told me that I need to start doing my job. I said, "sir, patient education is part of my job". He said, "you don't know how to handle MY pain!" I told him that alternating the oral with the IV med is standard practice. He said "you don't know how to handle my pain! have you ever had surgery before? huh? I was a CNA for years and if you aren't going to treat my pain I know what to do" I said "sir I never said I wasn't going to treat your pain. I just brought you something for pain" . Then he said something ( couldn't hear him as I was facing the computer documething his pain) about talking to the nurse supervisor. I asked him what he said and he said "nevermind! what kind of surgeries have you had? (yelling) and grabbing his leg saying he has had this and that done to his leg and elbow. I said "sir I don't appreciate your tone and yes I have had surgery before". He demanded "well what kind of surgeries?" I said I have had 3. And he said "yah well what kind!!!!". I said "That's really none of your business and I am not going to deal with this behavior". (he was yelling at me and acting very beligerant through all this). I left his room and immediately approached the charge nurse with this and I was actually shaking at the time almost crying. She said don't worry about it I will find someone else to take care of him. Well half an hour later a nurse tells me she is going to give him pain meds for me. I was confused and told her i just gave him pain meds. She said the charge nurse told her to give him IV pain meds. I said, Oh well he doesn't have an IV (I had told the charge nurse this) and she went in to the room said she would have to start one. I went on with other patients. She came out and I assumed it was taken care of. Then next thing I know the man is out pounding the counter with his fists yelling to the nurses statione (there wasn't a nurse there, only 2 doctors) that he wants his IV pain meds NOW. NOW! SOMEONE BETTER GET ME SOME NOW! and he slams his door shut. I was on the phone iwth the charge nurse who expressed frustration with me as I had already tried clarifying whether i was supposd to switch patients with the other nurse or what was going on because I thought we were switching but the other nurse said just to give IV pain meds. I told her what he had just done. 15 minutes later to 20 minutes later another nurse comes down and goes into the room. I said, "oh I think so so and so already was in there". she just shrugged and went in. I asked the the previous nurse what the other nurse was doing in there and she said "oh she had to start an IV..I wasn't going to try to start one on that angry man!". So Anyway, my question is, how should I have handled the fact that he hadn't had oral pain meds since the day before? I really don't want this to happen again. Also...if something like this happens and th patient becomes very upset and angry and beligerant with you, how do you react as a nurse? How should the charge nurse handle it? I feel like everything went wrong on so many levels over something that was ridiculously simple....I haven't had a patient react so angrily to me before over trying to assess how pain meds are working or not working for them. I often look back and honestly think I just should not have apologized if I came across the wrong way regarding trying the oral pain meds because for some reason that really set him off and that is when the behaviors started. I was told by the charge nurse just to give him his IV pain meds. I don't have a problem with that if that is what the patient wants..but I feel like the patient should know that if the oral pain meds aren't working we need to get them something else. (I of course told him that) but he was so angry it didn't matter. I feel like my charge and supervisor are just going to say "well if the pt wants iv pain meds give it to them" . Like I said, I don't hav ea problem with that, but I also want to know why from that patient so that if something can be fixed we can help the pain management issue more. I haven't had someone do this to me in this manner before. Thanks.
  4. sameasalways

    Would like info on relocating to Langley

    Thanks one is in middle school and the other will be a sophomore in high school. As long as you live in York county you can apply to those schools? Are the areas zoned depending on where you live in York county? Thanks! It seems like the pay rate is not high enough at all to make up for the cost of living
  5. sameasalways

    Hospitals and salary in Richmond, VA

    Any areas at VCU that are notorious to stay away from? I am moving up there in June as well from NC. I have been at the community hospital I am in right now since September 2009. I know there are "bad" areas at the current hospital I am (for example) that even though I would like to work in that area, I stay away from due to the reputation...(bad management/bad cliques). Should I ask for more than new grad pay? New grad pay here is 20/hr. Thanks!
  6. sameasalways

    Nurse pay vs. cost of living

    it seems like I have noticed the same thing..I was looking at Charlottesville area and Hampton area near Langley AFB.
  7. sameasalways

    Time management issues

    Thank you so much for your feedback everyone..because people who are not nurses don't understand. I still consider myself "new" and have lots to learn..as a patient a few times in the past I always respected the nurse because I knew she saw me way more often than the dr and knew what was really going on with me..and thankfully most of my patients are the same way. I feel so much better now.
  8. sameasalways

    Time management issues

    You really made me feel better. I think my managers email freaked me out a little. It's scary in today's economy :-( I really never wanted to have to rush in a pt's room and try to evade their questions or concerns and I don't want to do things unsafely. There are things people do at work to take shortcuts..I am only beginning to see some of them... as in: *not flushing IV's, but documenting you did, and then they clot up and the next nurse comes on shift and has to re-start it *removing the catheter after 3 pm so that the night nurse has to ensure the pt voids *Pushing recall for assessments you never made *Not checking NG placement *Not noting how much output the pt REALLY had from their NG or wound vac, ect. *not listening to bowel sounds *not checking how long it has been since last BM *not doing heparin flushes after medication adminsitration through PICC or CVL I say these things because I have seen it happen. One nurse takes the flushes and does them but she uses the same flush for every patient and keeps it in the drawer so she can keep using it. I really don't feel safe not doing those things..but I know people do them. I think they just make up some of the admission question answers too (religious preference for example or living will), or they document that they showed the fall video when they really didn't. When a patient says no one has opened their abdominal binder since coming to the floor it angers me...on the other hand, it is evident to me that somehow I must speed up To be honest...after doing my job, I am so scared to ever have to go to the hospital..(as a patient).
  9. sameasalways

    EPIC, documentation & time management advice

    oh okay...thanks (WDL/WNL..I had only said WNL before). The Meditech system doesn't have a box to check for WNL/WDL...but you can click "recal" and every box will be checked that the nurse before you checked. The problem is that the nurse before you probbly hit recall too and some of the stuff is completely inaccurate. So if your not careful it ends up being wrong. Its terribly redundant..but it is all I know. I will be moving soon and wonder what type of documentation system the new place will have..(wherever I end up working).
  10. sameasalways

    Time management issues

    Hi, I have a sheet that I have all the basic pt info on and I have to document prn meds given and as soon as i give it I write the time given that way I can redocument that the pain was taken care of within the 60 minutes of giving it.. from 7-3 I usually never hav ea problem keeping up. I get report, look at the computer grid, see what meds are due on who and when, and take care of anyone with insulin or pain first..then with each pt I give the 8 am pass which is small and document on them at the same time. By 10 am all my dressing changes and all 8 am meds and assessments have been done. by 1030 to 11 pm all 10 am meds are done and I am just documetning all the PRN MEDS i have given and checking charts off from the new orders written on all the patients or calling the dr if I have to. Also we have an am meeting at 10 we have to go to and give report to all the other staff. Then I usually am gettin ga post-op at this time as well and trying to track down equipment for the new pt and set the room up. Its uusally lunch time and I am either getting a post op, or one is on the way, or I have just gotten one. These are also considered "new admits" so there is a huge huge questionnaire that has to be done as well as a falls video, and admission assessment and education on using everything, plus all the new orders to check off and trying to get their pain under control from surgery and documenting all their vital signs every 15 minutes. There is another med pass at noon and there are clocks to document on at : 8 am, 10 am, 12, 2 pm, 4 pm, 6 pm. Each of those clocks has a lot of redundencies and I copy/paste/push recall for everything except a new admission or in the 8 am clocks which are huge and the 1600 clocks which are huge..and I push recall but change everything to what is REALLY going on with the patient. Sometiems the scanners go down, and other things that can set me behind are the pharmacy not sending meds up in time or me having to call them or call the doctor or an issue/complication with a patient. Sometimes the patient needs PRN meds every 2 hours and that is a lot of PRN documentation. When I get back from lunch its time to do the 2 pm clocks, 2 pm med pass and the I/O's for the am shift. I do all that and also by 3 pm you pick up two new patients. So the pt load goes up to 6 and it is all new documentation. If you don't have six, you can get another post op patient/new admit..I think it is worse to get that..I would rather have six patients than have all the extra stuff that goes with the new admit/post-op. On the other hand, you MIGHT not get that new admit/post-op so youa re taking a chance on fewer patients vs getting a post op. Also if you have any discharges or new admits you have to do all that paperwork too. That will really set me behind. So for example on the one day I had 3 discharges and a postop all before noon. I was put on call at 3 so I didn't have to pick up new patients from 3-7 like normal but because there were so incredibly many discharges, everyone was running around like a chicken with their head cut off and I was asked by a few people to help with little things here and there even though it was after 3 pm. I removed PICC line for someone, finsihed a discharge for someone, made sure the dishcarge paperwork was done for the other patient, and had to get ahold of casemanagement to get a prescription for a walker for the patient that was getting discharged. That way the nurse coming on woudln't have to do anything with the discharges except one and all she had to do was take the papers in and have them sign rather than having to fill all the med times and follow up appointments out and take the pICC line out. The thing I hate most is when I have a wound vac change or wet to dry wound packings because you have to try to somehow fit that in between the 8 and 10 am med pass and it can be hard. I actually enjoy doing wound vac changes, but it really sucks all the time out of your day. Oh and when the doctor comes you are supposed to drop everything and go in the room and stand there. I left late the other day because i had to help the doctor with a procedure for an ileiostomy while he put a few sutures in and used the electro cautery machine, and then also the same day aroudn the same time I had just gotten a post op right before he came up and then was time for lunch so i had to do the ileostomy thing with the dr instead...and then my patient was supposed to get blood but needed a blood warmer which i had never used so that sucked even more time out of my day...with all the clocks that you have to add to the system for blood administration and getting the machine, calling distribution, setting it up ect. Plus I had to remove a flexiseal which i had never done and the physical thereapist had accidently broken the two tubes that you use to inflate it with and to irrigate it with. So the charge nurse told me to print out the policy and that it "isn't hard to do". Well I had never done it. No its not hard to do but it was broke and the lady was morbidly obese and I I wasn't sure if I would be able to get it out. I wasn't comfortable with it due to that but I did it anyway and no it wasn't hard to do but I just feel it wasn't right to be in that situation and neither one of them even would look at the flexiseal to see what I was talking about. Or the past times I had a psych patient who would become agitated, kick scream grab pinch pull her NG tube out pull at her foley, try to walk around the hall into everyone's room and I am having to physically restrain her with 4 others for 45 min because her O2 is dropping and her HR is way up. That pretty much sucked the time out of my day. And yah of course getting two extra patients at 3 and getting report at 3 again..trying to get the fingersticks and I/O's and meds done at 1800.. trying to get the huge 1600 clocks done while all this is happening. I get overwhelmed around 5 pm..I am not gonna lie. Oh of course the hospitalists come in and write more new orders around 4 so try to get those checked off and implemented and documented as well. Fax all the new orders to pharmacy. My manager knows its tough..because everyone from 3-7 says the same thing. If I have a day that is no complications, there isn't a problem..honest. But when all these things happen then I am majorly behind. I left at 830 pm that night with the doctor and blood/blood warmer and flexiseal pt.. My boss said she wants to see me succeed and I know she does. This situation makes me feel incompetent to the point that I am nervous about working anywhere else because what if I am even worse somewhere else? And I know I will move in 4 or 5 months like I said I have had so many nurses say to me "why do you stay on that floor" or one of the doctors wanted me to work in the OR and I was gonna take the job but I knew I was moving soon and I coudln't do that so it is the only reason I didn't but when i shadowed and went through the PACU the PACU nurse (we see them all the time because they bring us our post-ops) was like "OMG!! You are trying to get away from the ______ floor aren't you!!! haha". Yah the floor is hectic even the manager says so.. even the surgeons know it. Some floors the charge nurse checks off all the orders and calls the doctor if a paitent is having an issue. And those floors don't get post-ops either. We get jealous of that. A lot of the nurses on the floor stay because the manager is truly exceptional and also like everyone there says, if you can make it there you can make it anywhere. Our manager says we won't have to check off our charts if we wanna take six patients all day but I think from 3-7 when we have six patients, maybe the charge nurse SHOULD be checking off orders if she can. I just hope my next job is better than this...I don't even know what to look for. I am so lucky I have a good manager and if it wasn't for her I know I would have went somewhere else in a heartbeat.
  11. sameasalways

    Time management issues

    I have been working for a about 14 months on the busiest floor in the hospital (does everyone say that? haha) where I started as a new graduate. When we first started (I had another new nurse start at the same time), we were not leaving until around 9 pm often (for a 7-7 shift). Leaving at 8 pm was "early". Well, like I said it has been a little over a year, and for the past few months now I am almost always leaving at 7:45 to 8 pm..or so I thought. The other night I had 7 patients from 3-7 and I had to stay until 9 because at around 5:30 they gave me a transfer from the ICU. (This ended up being 7 patients). We use Medi-tech for our computer documentation. Anyway, I sent my manager an email because she said that whenever we leave late like that we need to send her an email or a note under her door explaining why. So I did, and also because the charge nurse gave me the 7th patient when there was another nurse that only had 5 patients. My manager wrote me back saying she pulled all my time sheets since July and that I am supposed to be leaving between 7:30-7:45 and that I am only doing that 70-75% of the time, so I need to make a list of what is making me late and meet with her so she can make sure I am making use of my resources. Honestly this is really freaking me out. I have been wanting to leave the floor and the hospital for a long time because I feel like I barely get a lunch and sometimes don't have time to use the restroom even once during the day. I am moving in about 4 months and I knew this six months ago so I felt it woudln't be prudent to look for a different job and then have to leave that job in six months time to start at another one. Plus I really at the time wanted to see if I could handle this job and stick it out and learn even more. I know I have talked to the girl that started at the same time as me and she usually leaves around 7:40. Like I said, I thought the past few months I have been leaving around 7:45 to 8 on average. There are the times you have a really bad day and get caught up of course. But the nursing assistants have been treating me so much better the past few months and I thought I was finally starting to get better at the time management. Now I am seriously doubting myself and I don't know EXACTLY what is causing me to be held up but often times I am still in the hall documenting on the computer waiting to give report while I document or I have one patients meds to give or I have a few patients I/O's to collect so I can document them Or I have some charts to check off before I can go. When this is all going on, often I don't give report until 720 pm and there have been a few times that I am there giving report at 730 pm. I can give report whenever the night nurse wants but I don't want to leave my computer in the middle of documentation to go to the nurses station to give report when they can see I am right there. I think sometimes they think I am busy so they just go get report on their other patients first or are getting their information together since I am not "bugging them" to get report. In the meantime, my pager often times goes off or PARTICULARLY when a specific charge nurse that works from 3-7 is on, I will get paged by the secretary to go to a patients room when it is after 7 pm. Maybe I am partly answering my own question...Maybe I need to make it a priority to give report ASAP..even if I am not finished documenting, so that this doesn't happen. The bad thing is, when that specific charge nurse and secretary are working (they are tight) then even if I have given report, I will still get asked to go to a room for an IV beeping or whatever "because it's right there". This is the same charge nurse who gave me 7 patients that night and the same charge nurse who comes in at 3 and goes to lunch between 530 and 6 or who is too busy checking off a chart when something is going on that I don't knwo what to do about. I sound like such a complainer...but I am trying (along with a few other people) to figure out exactly what the charge nurse does. It is hard for some of us to understand not only because we aren't charge nurses, but because some charge nurses are REALLY helpful and a few seem to just sit there..there is a difference when you work with some of them...and it can make your life easier or harder. But I guess that is a seperate issue from the time management stuff. Maybe I should have titled my post "hard time adjusting after first year of nursing". The worst part is, now I am seriously wondering if I even belong in the hospital...I have never felt so incompetant in my whole life and I always thought I was a hard worker and try so hard to put the patients first and their safety first...I didn't want to be the nurse who never makes eye contact and tries to rush out of their room ASAP but maybe that is what it takes? I have talked to night nurses and they say they don't know how we do it on day shift there..even other floors say they woudln't work this floor (but I am honest when i say I believe the manager is one of the very best in the hospital). I feel bad and incompetant and I never thought I would feel this way a year after starting.
  12. sameasalways

    EPIC, documentation & time management advice

    Wow I FEEL stupid but what is "WDL"? We use Medi-tech and I wonder how similar it is to EPIC documentation systems?
  13. sameasalways

    Patients as customers????

    We were taught to refer to them as "clients" but also upon being hired you are given a psychological test of some sort and some of the questions and some of the questions when hired or in interviews (I interviewed at a lot of places) were regarding "who are the customers at the hospital?" The answer really is "everyone". The doctors, the patients and your coworkers. If my patient doesn't do well with morphine, then I call the doctor and get them what works for them. Is that customer service? Or just good nursing care? There is a fine line, true. But the patient often knows what works best for them and when healthcare providers don't listen it isn't very helpful for anyone. On the other hand, there is a difference between the patient who knows what works for them and what doesn't versus the patient who thinks they are staying at the Hilton Plaza.
  14. sameasalways

    Would like info on relocating to Langley

    Any ideas on schools in these area for middle school/high school age kids? They are more into academics and music/art than sports. Thanks!
  15. sameasalways

    Would like info on relocating to Langley

    You guyz have been SOOO helpful!! Thank you so much it was exactly the type of information I needed! I appreciate it!!!
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