ElphabaRN

This kind of an approach led me down a long, dangerous battle with anorexia. This article cites no references, and goes against most things that the ADA advocates. *moving on now*

Since it is a NICU, I would not recommend wearing black. Given the critical illnesses you deal with, some families may see black as negative. I worked in an intermediate intensive care peds unit working with infants who had had major heart surgery, and we had one uniform rule: no black. No black bottoms, no black prints for tops. Just makes sense. I know black is slimming and all, but no. Just no.

flushing is basic, nurses need to do it. If the med was sitting in the line, you wouldn't have given it, the nurse following you would have given it. Have you ever noticed those fantastically confusing hard-to-read compatibilites posters on the back of your med room door? Um, the purpose of that whole thing it to warn you about certain meds that should NEVER EVER be in the line at the same time, because if they mix, they can form crystals, etc, etc, which can be a very serious complication. Not flushing is lazy. Just do it, it doesn't take that long, and do what you know and were taught, instead of what the nurse from XYZ nursing school does to save time. If in doubt with what you are being taught, consult a "Fundamentals in Nursing Practice" text or your state's nursing practice act. It is your license on the line, not whose skills you are observing.

Of course it is a MYOB moment. Other than the fact, that I am not a person that gets to just periodically be around him. I live next door to him in an apartment building, as do many other people. Ok, maybe this isn't a nursing moment, this is a "I have freakin valuable possesions, I sort of don't care to lose them or my home or my life anytime soon, because of a preventable fire". Ok, I am sorry I asked if I shouldn't be here.

I am trained as an RN, not working officially at the moment due to needing to care for family. But I still have my RN education, I passed with flying colors. But, I have a new neighbor as of yesterday. I just happened to go into his place yesterday to help him set up his TV, note to self=I saw at least 3 oxygen tanks. He doesn't seem to have it all together in the thinking department. His place completely STUNK of cigarette smoke. He had the "official" sign on his door saying DO not smoke, Oxygen in use. I alerted my management about this today. And, all they made him do is take down the sign on his door, so it doesn't call attention to the fact that there are multiple oxygen tanks in there. Oh yeah, he wasn't wearing the oxygen when I was helping him, but in addition to the at least 3 tanks I saw, there were nebulizer and inhaler items everywhere. So, even though it is not my place to be questioning a person I do not know about their health history, I still have a functioning brain, and I know that this entire situation isn't adding up to being letting me be reassured that there is no fire hazard. I am seriously worried about this. The apartment management obviously could give a rats a** about this. They probably flunked basic high school chemistry, to be able to know that oxygen is an accelerator. So, I don't want to drop this. Do I call the fire department? I have no clue who his home health company is. I don't want to step on his toes, if he in fact, is of the responsible type that turns off the o2 before lighting up. But, man. Suggestions on how to tactfully handle this from here?

I think you did everything that you need to, and yes, the nurse manager gets paid the big bucks to get to the bottom of this. But, like someone else said, I believe that a nurse can be an addict, and I also believe that patient's with a known history of drug abuse, do tell the truth at times, and they are not as hairy-scary as some might have you believe. Also, I just want to caution you about making too much of this. As you said, you are new. You are still on a straight upwards learning curve. New nurses want to do the right thing and earn the respect of their more experienced coworkers. I would say, do your best to put this behind you. If this nurse, is in fact, diverting, her truth will come out in its time. And, the patient, if she was lying, it was probably not the first time. If any more comes of this, I might wonder if anyone looked into the patient's past issues and how much she has demonstrated drug seeking, running out of scripts too soon, involvement with the law regarding drugs, etc.

I am interpretting this, also, that you have not passed the NCLEX? As far as that goes, I know it is quite a bit of money, but I took the Kaplan course, and I think it is why I had no trouble passing the first time. It is costly, but when you consider that it will cost you an additional $200+ to take the test over again, (I don't know what it costs to take the test now), having the Kaplan experience really was a no-brainer for me. Prior to my nursing degree, I had been a CNA so long, that during nursing school, I really had trouble making the switch from just collecting observations about patient's towards making critical thinking decisions that impacted their care. I think I really didn't "get it", until I took the Kaplan course, and had been working in a graduate nursing job for a while. Also, as was said, determining where you can take a refresher course may also be an option. Best wishes!

From what I know, and my experience: 1) I had a BA in zoology that I received in 1998. It helped me greatly in getting into my BSN program. 2) My physiology course/learning, was older than dirt, by the time I started applying to nursing schools, so while I was waiting it out, I retook it (although, had to foot all the bill), raised my grade incredibly, and I think that it was this dramatic improvement that also helped my case for getting into nursing school. 3) It seems, at least around here, that all managers already have their masters, or else they are working on it. True, you may find a small rural hospital that has an ADN as a manager, but as someone else stated, the Magnet program will be eliminating this as an option, as of 2013. 4) I am also wondering, how a bachelor's in healthcare admin will help, in terms of getting an admin job. I never knew that there were bachelor's degrees for this actually. As for the specifics about obtaining a management position down the road, I think, a facility will require that you have taken the extra courses/hours to go from the ADN to the BSN, prior to any type of nursing management.

I am just wondering if any of you have any ideas. I love nursing, the 2 of the 3(:-() jobs I have had since I graduated I have loved. But, one I had to quit because the commute to this specialty hospital was too far, and it was non-profit, so pay hardly covered rent, and basics-literally. Number 2, was a seasonal job giving flu shots, which I have actually done the last two falls. I loved this, I loved only having one patient at a time to take care of, I loved the quick, small talk if you will, when I got them in and out the door so quickly, but alas, that was seasonal, and it is over. The other job I had, was at a small rural hospital, which sounded great, but I could not comprehend the management, as well as they didn't tell me about their extreme turnover, so there were virtually no more senior nurses to myself. I had people orienting me that had been nurses for less time than I had. Now, as of being graduated two years as of last week, I am in the job market again. I am stumped. I don't know what I want to do. I want to get into a job, love it, and be there for 30 years. I am just sooooo unmotivated, I don't know how to change this. The jobs I have been looking for, pay significantly less than I made at hospital #2, and way less than the flu shot job. And, I can't get excited about working for this kind of pay. But, I know it would be manageable work. I know I am focusing too much on the dollars, I have been good with what I do, I aced my way through nursing school due to previous CNA experience. I loved my clinicals, I loved having a reason to get up each day, and to be in school. What is wrong with me that I can't get this much excitement for being in the working world?????? Thank you for any advice. I don't want my education to go to waste, and I am fearful that if I don't work more seriously in the near future, that no one will hire me.

I just finished 3 solid months of giving flu shots. What I know, is that yes it is a dead virus so the vaccine cannot cause the flu, but if you get flu symptoms, it is because you picked up something else while your body was building immunity to the vaccine. Also, remember that sometimes the Flumist (nasal inhalation) is used for people afraid of needles, etc. and the Flumist is a LIVE attenuated virus. It does sometimes cause flu symptoms due to being a variation of the live virus. Also, to whoever asked when they will get the perfect vaccine that covers all strains? That is impossible to determine. As you know, viruses mutate, and what is prominent this year could change entirely by next years flu season, which is why flu shots are recommended every year. And is also, why, in some or more years, the strains in the vaccine don't match what we are exposed to throughout the winter. It is a crapshoot in trying to develop vaccines, prior to the virus mutating. They develop the US vaccine based on strains in the southern hemisphere, as well as the previous years US strains. This year it was Uraguay, Florida, and Brisbane for the shots I was giving. So, if those exact strains are what we will see, then the vaccine will do it's job. If there are mutations, well, that is when we can pick up the mutated version or a new strain entirely. The other fear alot of my patients had was the thimerisol preservative that is in the vaccine and all the hoop-la around that. If that is the case, the vaccine can also be packaged in a prefilled, thimerisol free syringe for those people that think they may have an allergy to it, or are concerned about autism possibility, which isn't even a proven things. It is just suspected. Thimerisol often used to be in contact lens solution, so people used to use it and have no problems associated with being exposed to it. But then all the anti-thimerisol people got the bad press out there and it has spread like wildfire, and there was not much I could do as a flu clinic RN, other than to state the risk of reaction or problem is exceedingly small, and they would be much better off to get the shot. And, as always, remember to wash your hands every chance you get, use alcohol gels, sneeze into your elbow, use masks as appropriate. May you all be well this flu season :)

He was dry. Nothing more. Copious amounts of urine since I left yesterday am until now.

PM's documented their 150 ml of the urine output-yes they should have reported it to me, at the very least, called the MD to report it, but they didn't, but my watching it for the first few hours of nights, and there was only 50 more ml, then I did act. I did do what I thought was within my capacity, including consulting 3 more experienced nurses. And 3 MD's, who didn't want to take responsibility and tried to say it was the other doc's responsibility. The whole system broke down. But, in a small community hospital, with no ancillary staff on at night, the US couldn't even happen til 0600. And the surgeon was without common sense, and lets just say, my first two phone calls trying to reach him, I found myself talking to his EX-wife, very scorned, saying we needed not to reach her in the middle of the night, and that he moved out last fall. God forbid would a doctor care to actually have the correct contact numbers for us. The surgeon left her last fall for a 22 year old surgery tech, and then left that person for "a 28 year old bar maid". Oh the drama. TMI:uhoh3: Just hoping that this patient was dry, and it was nothing more. But, if there was nerve damage from the epidural, how would that present, I thought that would be the culprit IF he had a full bladder and was unable to empty.

Urine output in 16 hours postop was 200 ml. I know, way below recommended 30 ml/hour. Pt was not edematous, had IV fluids running at 125/hour, patient didn't seem to be dry, vitals were good, no complaints or dry mouth, had had morphine PCA, but that was discontinued on pm's due to N+V. Foley manipulated, balloon secured, patient turned on side, foley in was a 16 french, only minimal output. We took it out, put in 18 french. Still no urine output, just a small clot, another nurse took that out, ouch, put in a 20 french, still no urine output, just a clot. It appeared that bladder was full of clots from initial traumatic insertion down in preop. So this patient had spinal block for surgery, ortho doc did not want to address it, medical doc said she didn't have the rights to this patient, because she was never told to follow in the hospital, called crabby surgeon back, got order to consult the medical doc, and "I can't do anything about his bladder". Medical doc TKO'd the fluid rate, to remove current foley to see if he could pee on his own, which he hadn't after 2 hours. Is he just dry? Was the nerve block doing this? Is he blocked ? Is it just the general trauma of having a tube shoved up where it doesn't belong, multiple times? Well, medical doc ordered a bladder ultrasound, which showed NO urine collected in bladder, per the tech, unconfirmed by radiologist when I left. So, now, they say, lets check his chem panel for kidney function and electrolytes. My shift was over, I don't know how those were. But, being a new grad, I have no idea how a post op can be getting maintainance fluids like that, with meager UOP. Oh, the last order I heard was that they were trying to get some doctor, that would be able to do a cystoscopy. (Long story, small hospital, only urologist is out of the country until next week,) the general surgeon said he didn't want to touch the guy, but he did say lets call the gyno(!!) and since he does these on women, would he be willing to attempt on a male. Or do we need to look far above the bladder. Figure out fluid balance, figure out other fluid losses, so maybe he just didn't have urine to pee. Hemovac total was 280 ml, and a 300 ml emesis on PM shift. So, that is 580 right there, and the hemovac output happened after the 4 hour cutoff, so we couldn't reinfuse. Knee's are great when they go as planned. But, this one isn't, and being a young nurse, I am petrified they are going to come back on me and blame me for the way things were handled, and their medical staff that were too busy being unavailable to be able to decisively know what to do with this patient. I hope day shift isn't ready to hang me..... Any words or encouragement or advice, or personal experience would be greatly appreciated.