ontocrna

Question: Pt. seizes for many minutes and yet needs to be straight cathed 10 minutes following status epilectic state....750cc out.....shouldn't pt have been incontinent of urine in seizure state of great length? What am I missing? Conscious pt on either side of the lengthy seizure asked to be straight cathed following seize with no remarkable gu hx to explain necessity...pt. just didn't like the bed pan option and I can't figure out how pt. didn't lose the urine while having a valid seizure of substantial length?????

You're going to find HIPPA violations everywhere you work, for example admitting a patient to a room that already has a patient in it....all that patient's business is out there for the other person to hear and we think pulling a curtain will keep it so we aren't violating HIPPA. Short of cutting someone's ears off, what are you going to do? That's not advice to perpetuate a bad practice but feasibility of practice is a consideration. We simply don't have another place to go through admission with someone. I find a good rule to follow is, if you wouldn't want something done to you personally or your close family member, then you probably shouldn't be doing it to someone else. Also, if you set a tone for your own practice, I find others follow blindly so your actions may effect change without making a big stink about current practice.

When in doubt I always consult our pharmacist and in some cases phone the physician to ask for clarification (as with the above mentioned Kaposi Sarcoma pt.) I document that I've done that as well!

Quick question.....had to float to another unit...found a sundowner on the floor next to his bed...'bout killed my back getting his dead weight up to the bed with two other nurses assisting.....anyone have an easier way without a lift available? Could have used a wheelchair or bedside commode within reach but figured one transfer was better than two. Pt. was uninjured by the way.

It's illegal to work off the clock as you wouldn't be covered by your employer's malpractice insurance if something were to happen.

Similarly we can pick our shift, are the first one's on call or low censused or to float where I'm at, but I find we are also the first one's to get OT because of our flexibility. Crazy since paying me OT actually costs more as my base pay is higher but true. Also, since I float first, I was actually oriented to all the different units so where full timers on med-surg may have been low censused I can pick up in ER, OB, Ortho, etc. and get more hours. They actually prefer to do that because I'm a trained body instead of an uncomfortable wall flower outside my unit. Frankly, I'm a body so no one cares if I get OT. They are just happy to have someone who'll do whatever, where ever, whenever that isn't hung up on what policy dictates as far as staffing. I always say thank you for thinking of me and calling me while doing my job without complaint and I never go without work as opposed to our full timers who are now taking mandatory low census to survive this economy. They'd rather avoid dealing with the complaints that come with people that are forced outside their box and thus present a greater liability for them.

Do you guys have all this in writing? I've gone to the beloved handbook and there's nothing in there about being available when on low census. On call states very clearly that you have to be sober and available and arrive to the hospital within set time limits per specific unit needs. I tend to go by the book because it's the only help you get where I work. Just wondering if all these descriptions are all based on past practice or written as policy for you?

Anyone else experience this? Shift is 7p-7a. I get a low census phone call this evening "till 11p". So how is that not on call status? I can't have a margarita with dinner! I still have to have a phone on me so they can determine my status beyond 11! All this means to me is I'm on the schedule till 7a and I can't do anything until then and I'm not going to get paid time and a half if that changes like a person on call would get. Low census to me should mean for your whole shift otherwise it's just on call, right? Lastly, I can't really say no to whatever change is made beyond 11 because after all I'm on the schedule till 7a. Granted I don't have big plans but I'd really like to just have the shift off tonight and not get the dumb wake your bum up phone call at 11 to tell me that they aren't going to call and wake my bum up anymore throughout the night. I should get paid for my hassle as an on call nurse if it ain't the whole night! How does your hospital do it?

What professional organization do you belong to and how does it benefit you? By this, I mean how does it really benefit other than looking good on a resume? I am befuddled by the lack of conservative professional organizations for nurses. While I respect political diversity, I am finding a great lack of representation for conservativism among nursing organizations. In fact I cannot find one that doesn't take my money for the liberal agenda in my state or on a national level. Would love to hear if others are finding a similar situation (where you are) and what you are doing about it.

I tested last Thursday and tried the pearsonvue trick. It kept me occuppied and hopeful over the weekend if nothing else. By checking repeatedly, I found that my results were available earlier than expected as well. Turned out the trick worked and I found that I had passed so for those waiting, good luck and maybe this will help ease your stress while waiting.

Thanks for expressing the craziness that all of us waiting to test are feeling! I test on Thurs. morning. My scores on practice questions don't seem high enough and all of the information is running together like mud! Just thinking about it makes me want to vomit! One little tip from Kaplan that has really helped me (for those yet to test) was to make lists or focus pages. I have a list of 20 most common drugs (Mag sulfate, oxytocin, lithium, digoxin, etc.) and all the info on them. I have one on electrolytes, abg causes, standard/transmission precautions, major labs, obvious positioning ("good lung down"), and one for just memory aids (B=Brain/Babinski's versus K=knee/Kernig's). My favorite one is a glossary I've made for obscure terms (like Hirschsprung's disease, serum sickness reaction, and dysthymia) as I've gone through studying. That way I have a short review of major stuff I know I'll see on the test to peruse just before I head in. It condensed key items down a bit. Good luck all and happy testing!

I wouldn't take a position just to have a position. It looks terribly unprofessional to leave a position as quickly as you take it for a better one if you find yourself unhappy with your decision. It doesn't leave you great references in the wake behind you either. I have found that employers are more impressed if you ask what the position has to offer (retirement, insurance, vacation, sign on bonuses, health incentives, education reimbursement/professional development opportunities, magnet status or evaluation procedures, etc.) and reflect that you intend to weigh it against other options. (Wouldn't you want to hire a nurse that actively utilizes a strong decision making process?) I tell employers I am actively seeking positions and where and when those interviews are expected to take place so that every card is on the table. I let them know that I intend to follow through on applications that I've put out if interviews aren't actively scheduled as well. That lends well to giving the employer a time frame for the decision making process and it conveys that I follow through. I think honesty and exposing what it is you are looking for helps the employer to get the fit they need as well. I have an idea where I want to be in five years and I expose that plan to employers. I feel that is fair to everyone involved and professional. I've watched so many nurses land where they fall and then they wonder why they aren't happy where they landed.

Our school made us aware that there were funds available about two weeks into my last semester. I applied and didn't receive anything for over six weeks or longer if I remember correctly. I actually received my funds two days before I graduated and attended my pinning ceremony. It took so ridiculously long that I considered actually not taking the money just so I could make whatever work decisions I wanted to without any strings attached. I did take the funds and within another six weeks I received a letter stating how much time I had to work and what paperwork I had to fill out for them to verify that I had fulfilled my end of the deal. I wasn't impressed with the process. I am still considering just giving it back to avoid any further hassles. It made me feel like such a heel to check in on it for weeks on end....the cashier knew me on sight and I felt terribly embarrassed. For me the whole process wasn't worth the time and effort. Now that I am looking for a job...I want to do what I want to do without having to worry about what they want me to do. I have decided to interview and take whatever job I like without regards for it and if it doesn't fit their criteria, I'm going to give the money back!

Not endorsing this as ethical, but have seen students that have done it this way. Take all your prereqs but one at one school and then transfer to another community college for your last prereq. Get a 4.0 in the last prereq and you have a 4.0 GPA. All the other stuff just shows up as transfer credits and don't factor into your GPA for that school. That 4.0 GPA is what is used to get into the nursing program. This is how the younger kids coming out of highschool have been getting into programs with point systems that weigh more points for students with health work experience or previous bachelor's in other areas. They can compete with giant GPA's. And honestly, the people that come in through the back door are just as successful in the program as the second degree students. They just outsmart the point system.

Hey, I got into this field for flexibility. What I didn't know going in was that the education to get into it is NOT flexible. I have small children at home and found nursing school was very time consuming with a very taxing schedule. I found that you are basically at their mercy till you're done and that three different babysitting ideas had to be available to accomodate the changes that came up. I became nocturnal to study. I prayed for no one in the house to get sick during it and I made my husband take days off from work when someone did get sick. You need a huge support system to get through it. That said, there are several part time options with flexibility available to an RN. Per diem and on call are always options too. Places that staff based on acuity often offer flex schedules.

Just an observation...depends on where you work. In floating I can honestly say that different parts of our hospital don't even feel like part of the same building. Some staffs gel and some have a bad apple that taints the whole bushel. You have the choice to do what is right. And by the way, interesting case of a nurse helping out with a code on someone elses patient got sent to BON because she missed her own patients code in doing so and the patient died. We have a CYA attitude in this field and it contributes greatly to our ability to be a team.

morphine sulfate

Pet peeve...flushing the line into a trash can. Do you want someone sticking something into you that you just ran into a trash can? Prefer to run it into the sterile iv tubing bag that you just opened. Pumps can't run a big enough bubble into someone to hurt them. We clear the line so we don't have to hear the pump alarm and because it eases patients concerns about air bubbles. Use the principle that air rises...drop the bag lower than the line, let the bubble rise to the end and out or milk the line or make sure your ports are up so bubble don't catch in them as you run the line.

Have you considered a Kaplan review course that nursing students take to pass their boards? They are pretty comprehensive.

google ackley and ladwig careplan constructor

Hey, go to google and search for "ackley and ladwig careplan constructor". go to the sight and go under "start a new plan" and go to the alphabet "P-Z" and you get a screen with an option "tissue perfusion, decreased". Then take the dx below it to get the generic plan for it. Client outcomes are listed and interventions with rationals are there. Betty Ackley was a professor at my school and they've basically put their textbook online for free as college is so expensive and textbooks are difficult for students afford. Keep in mind this is generic and you need to tailor it and make it relevant to your patient. And as for pain coming second...reason that out...if you correct the problem of tissue perfusion will you still have pain and think abc's (airway, breathing, circulation are always priority as the result is ishemia of tissue if left untreated). Part of good nursing is knowing how to find information because none of us know everything! Peers, colleagues, professors, doctors, professional journal, hospital websites, etc. are all good tools when you are in doubt.

Thanks, I checked those websites and really not much on ototoxicity or dosing beyond 5 days there or on any other website I've seen. I'm going to call the pharmacist next.

Standard dosing for zithromax/azithromycin is usually 3-5 days decreasing from 500mg to 250mg/day. Why would a doctor prescribe 10days of 500mg zithromax for URI/strep. Client returned to doctor 2 days later complaining of tinnitus/hearing loss. Doc told her to keep taking it for the full course. Aren't macrolides ototxic? Can that be permanent? Isn't 10 days too long @ 500mg? Client is allergic to PCN so Amoxicillin isn't an option. Just concerned for client's hearing. Anyone with experience with this?

I am finding that the higher your grades are, the better chance you have of getting into a program. I would stick with as many A's as possible because programs change their entrance requirements often. My CC gives points for entrance and then uses the GPA. The higher the GPA, the more points and so on. Also, some are starting to use the NET scores as a discriminating factor for entrance. I believe that big universities (not all) can be less difficult to enter into because of the pool of people you are competing with. The average age of nursing student at a CC is 31 versus high school grads at a university. Please don't see this as ageist, but most older students have been around the block and tend to be a little more concientious in their studies. This makes the pool of people you are competing with have higher GPA's in a CC which makes the clinical portion more difficult to get into. The universities also have bigger programs so their programs have a larger pool which can water down the overall GPA pool. These are generalization though so shop around. Not all school are equal. Also, there is nothing different about a RN-BSN completion program and a general BSN program. They are usually the same classes. However, after two years in an ADN program you can get a licensce and work while you go after the completion program. The general program doesn't allow you to get your license till the whole four year program is done so you can't pick up shifts as an RN.

Finally tonight, Friday 6:30 p.m., finally I made contact with the right person at the college. Spent all day on this and I am exhausted. Bottom line...I'M IN! I start Monday morning. (Jules, I got a letter saying that I wasn't accepted because I didn't have a high enough GPA when I have a 4.0.) I got a stern lecture about how the college wasn't really in error (I'm not certain how they figure that!) but that I was "reluctantly" allowed to register for a seat to start Monday in the program. It was weird. They wouldn't admit to a mistake or that they were wrong in any way in their calculations. I am somehow the bad guy for catching the mistake and asking if it made a difference in my status as a candidate for the program which of course I knew it did. So anyhow, they didn't admit to an error and yet they said I could start. No complaints here! I just hope that because I asserted myself a little that I don't walk in with a big black X on my forehead. I don't want any negative comebacks for all of this from the professors. They had to add a seat to the program for me. Hopefully, I'll be welcomed with open arms and not as a troublemaker. I tried to be super sweety pie nice through all of this. I was a tad flustered today by 6:30 though and was questioning their math, nicely though. Hope all of you out there struggling to get in advocate for yourselves...no one else will as demonstrated by this whole fiasco. Happy nursing!