nell

Daytonite, You are a California supervisor: please look up Title 22. I have to go to work now so don't have time to get a link, but in CA, a nurse must have documented competency for any unit s/he works on. And "A nurse is a nurse is a nurse" attitude as indicated by your "basic nursing care that you should have learned in nursing school" comment just doesn't fly anymore. Someone who has been doing a specialty such as Psych excusively for even 5 or 10 years is most likely NOT going to be competent to care for the kinds of patients on Rehab units these days. I'm pretty apalled at your entire post. nell

Yeah.:angryfire Is there no such thing as patient rights if you are old/on Medicare/on Medicaid? I am truly disgusted. nell

Every union is different. There can be different contracts with different facilities that have the same union. Our union has approved our cancellation policy. Our union has negotiated for on-call pay which in most cases is 1/2 of base pay and doubletime for hours actually worked during the on-call shift. I have heard of many facilities that pay a flat rate (like $2 per hour). Every facility will have it's own policy union or not. nell

Thanks AliRae. At least you have 5-6 hours to get something done before the next call. I don't suppose you are paid on-call time? Our policy has no set time block - they can cancel us for from 15 minutes to 12 hours at a time. Our cancelation notice is only 1 hour. I live 1 hour away if there is no traffic... Mulan, We have to give 4 hours notice if we call in sick. Emmanuel Goldstein, I love your monniker. nell

or is this common? Our unit is staffed according to patient census and acuity, so when either of those drops, someone (sometimes multiple nurses) are cancelled. In the past, the cancellation was for the whole shift unless the nurse asked to be called if there were admissions. Most of the time we are fine with just taking the day off. Now, we are being cancelled for any length of time and then expected to come in for the remainder of the shift. We are notified one hour before the start of the shift of the cancellation. So, at 10 PM we could be called and cancelled for 11PM to 1 AM and at Midnight we could be cancelled for another 2 hours, etc. all night long if we were the nurse with the lowest cancellation hours (we have a point system so that cancellations are spread around). According to TPTB, this is not considered being on-call because a nurse could just "not answer her/his phone and go in to work" where management would have the option of working her/him for 2 hours minimum and then sending her/him home. This is just unacceptable to me. Before I take drastic action (quit) I would like to know if this is actually commonplace and I would just be jumping from the frying pan to the fire. Thanks, nell

Well, here's some more video: http://www.11alive.com/video/player.aspx?aid=71528&bw= Sure hope she does half as well as Mom thinks.... nell

Gawd, how many hoops do we have to jump through. Med tests, PBDS, personality tests and BKATs....... Well, here's a little info: http://nursing.cua.edu/research/toth-BKAT-7.cfm#BKAT nell

Hi lizzyette, The hospital I work for contracts with a company that does extensive background checks, including credit checks. I had terrible credit (divorce etc.) and was afraid I wouldn't be hired - but I was. Whew! Good luck. nell

As with anything in nursing, there are differences from facility to facility - in fact most hospitals in my area don't have a newborn nursery - they do mother-baby couplets on maternity... We maintain a newborn nursery so that our parents have a choice of 24 hr rooming in, out for demand feedings or feed in the nursery (parents can decide at any time what they want to do). Another facility in this area with mother-baby opens a "holding nursery" only at night when they have parents who want the baby to stay in the nursery for all or part of the night. In our hospital, well baby nurses have 6-8 babies. Each baby gets VS and a head-to-toe assessment at the beginning of each shift - night shift weighs them as well. Babies less than 24 hours old get VS/assessment every 4 hours. Our nursery nurses are very good and pick up subtle changes that have turned out to be cardiac and other birth defects. They are much better at judging jaundice levels than me also. There is a lot of parent teaching - breast and/or bottle feeding, basic baby care, signs and symptoms to look for after discharge, etc. Our WBN keeps bili babies, so there is phototherapy to deal with. Also, occasionally a baby will be on prophylactic antibiotics for hydronephrosis or pelviectasis or on HIV meds. Newborn nursery nurses usually attend deliveries and need to know NRP (Neonatal Resucitation) for that reason and also because a baby can code anywhere/anytime. Newborns may need suctioning, oxygen, chest PT, blood sugar checks and labwork after admission or other times during their hospital stay. Most people think WBN nurses just feed and diaper babies, but there is much more than that. Besides all of the teaching, it is the nurse who finds abnormalities, monitors labwork, initiates treatments (like checking blood sugar when baby is "jittery") and often his/her actions, observational skills or intuition that saves a baby's life. Newborns are very different critters from adults or even pedi patients. Good luck with your decision. nell

Hi Melissa, If you PM me, I can email you our code policies. Our crash carts have modules that are filled and sealed by pharmacy or central supply with expiration dates that are monitored by us on a regular basis (I forget what is daily and what is weekly). Thus, there is no counting of drugs. I sort of think that going through the crash cart to count/restock on a regular basis is good for knowing what's there and where things are, so I also have a Flash video of our crash cart if you are interested (it's 755kb). I have inventory sheets of what is on the crash cart, forms of who's on the code team and what their responsibilities are. As far as code med sheets for weight ranges, I know there are some programs online that let you input the weight and print out a sheet for an individual patient. We have laminated sets of code med cards (one card for each weight range) that hang on the monitor at each bedside (weights change and the individualized ones need to be updated on a regular basis as the baby grows)- if you don't find something suitable before next Wednesday, I can find out where ours came from, or maybe get a copy. Also, I can get a code record sheet at that time if you still need it then. Best of luck in this endeavor and I hope you are moved up the clinical ladder bigtime for your efforts. nell

Dixie, I am so sorry you are going through this, and I understand how much you love your son. I think the Narcanon and Salvation Army suggestions are probably good. My son was in a local mental facility after threats of suicide. Even though it is part of our local hospital, it was totally inaproppriate for him. There was no counseling, no anything except situations a teenager should not have had to deal with. I'm sure people in my town wouldn't believe how bad that place is, at least for a suicidal teenager. It was quite difficult to get him out of there and I knew I could not have him put there if he tried again. It was very rough for a long time, but he is doing well now, thank goodness. My point is that from your observations and your son's report of availability of drugs, he is not in the right place and if I were you, I would do everything I could to get him into a program that will actually help him. Not a place where people go as an alternative to jail - with no intention of getting clean. Best of luck for you and your family. nell - who never gave up on her son

Wow, I wonder what the cost issues are with unplanned extubations? - collapsed alveoli, traumatic reintubations, what else? The neobar is great - you really have to work to accidentally extubate if the correct size neobar is properly applied. Steve: I'm having trouble picturing how that x-thing works - it looks like the wing-thing has a place for the tube to be attached and the wings go on the cheeks? Where does the x go? thanks, nell

We have a Neo who has done research on hyperbilirubinemia and for serious phototherapy he wants blue lights and however many it takes to get a reading greater than 35 (our new lights are >35 each). We check and document the reading each shift. nell

mawjood, We use the Neobar: http://www.neotechproducts.com/store/detail.php?sku=NT-5&session= We used to tape something like this (scroll down): http://www.dhmc.org/webpage.cfm?site_id=2&org_id=116&morg_id=0&sec_id=0&gsec_id=3103&item_id=8117 We used Duoderm under the tape to protect the baby's skin. Nell

so midwives don't test the infants of diabetic moms? or lgas, sgas or preemies? and how "high risk" are you talking? how do you know those babies didn't suffer any harm? where harm from low blood sugar shows up is in learning disabilities and maybe autism. as far as "our grandmothers" doing it that way - - - people used to live in extended families and/or groups. there was usually a lactating woman around to feed the screaming/starving infant when the mother's milk hadn't come in yet and the colostrum wasn't enough or the mom just couldn't produce for any reason. the rich had wetnurses. today we have bottles. thank goodness our hospital doesn't allow any of those nutty "alternative" feeding practices, although the lactation consultants still try to pull a fast one now and then. one of our long term preemies visited a while ago- the lc got her to syringe feed the kid after discharge and a year later she was still being fed by syringe! then there's the practice of giving iv fluids instead of that nasty unnatural bottle when the mom wants to breastfeed exclusively and the kid needs hydration. an iv is soooo much more natural. in 20 years of neonatal care, the "nipple confusion" i've seen has been the result of flat or inverted nipples that the kid just can't get a latch onto. it's not confusion, it's physiology. nell

Maybe some of the confusion as to what the CDC guidelines mean has to do with how the lipids (change Q 24 hours) are infused. In any NICU I have ever worked in, the TPN and Lipids are separate bags and tubing. Therefore, per the CDC guidlines, the TPN tubing is changed Q 72 hours and the Lipid tubing is changed Q 24 hours. (Bags for both are changed Q 24 hours.) In other settings, I have seen the 3-in-1 solution in which the Lipids are mixed in the same bag as the TPN. In this situation, since there are Lipids in the tubing, the recomendation is to change the tubing Q 24 hours. nell

A nurse I work with calls it "Performance Penalty". nell

Our current ophthalmologist’s orders: Proparacaine 0.5% once, followed by Cyclomydril (Cyclopento 0.2%/Phenyleph 1%) x2 10 minutes apart. These orders are not a NICU policy - they are the preference of the MD doing the exam. nell

Wow, one of the premises for the nurse-patient ratios here in CA is that having reasonable ratios actually ameliorates the nursing shortage. We will occasionally have a short shift due to sick calls, but for the most part we have adequate staff. Many of our nurses fled from another area hospital that stretches the ratios to the legal limit. CA law allows up to 2 level III kids/nurse and up to 4 level II kids/nurse. We rarely pair a vented or recently extubated kid with another and if we have to, it is the least hands-on baby in the unit. We don't have many "stable vents" - if they are "stable", we are weaning them with the potential of making them unstable. Vented with any drip is a 1:1. 2 NCPAPs with lines is a maxed out assignment. Usual feeder-grower assignment is 3 kids, 2 if they have anything else going on (As & Bs, procedures) there would only be a 4th kid if there was no choice and it would be on nights (when there are fewer parents to deal with) or for only part of a shift i.e. a discharge. If we are expecting a 32-35 weeker, the admit nurse may have another patient; if the kid is Some times all he** breaks loose, but most of our staff pitch in and even the well-baby nursery will help if we are in a bind. We can often get someone to come in or our manager will come in if needed. We are a 16 bed mixed level II-III. We do HFOV but no ECMO, Nitric or any but the most minor surgeries. We do have a very demanding parent population. How can you all safely care for your patients with the kind of loads you have? Do you have unplanned extubations? Lose lines? High levels of NEC? Infections? Med errors? nell - grateful for where I work.

When I did pediatric home care (CA & Oregon), we were responsible for keeping the patient's equipment clean but NOT for doing any household chores. We didn't even vacuum/sweep the patient's room - well, often they were set up in the living or family room.... There were some families that I would do household laundry or dishes for as a favor when the parents were overwhelmed (most of them worked outside the home) but only when the patient was asleep. Awake time is for assessments, treatments, therapy, developmental or educational work. I can't for sure remember if we drew up meds for the family to give - since I can't remember, I'm thinking NOT. I've never heard of RNs or LVNs being expected to do household cleaning - the patient is what you're there for. I agree with other posters - try another agency. nell

Excellent response, Humbled_Nurse. Anytime the PBDS question comes up, we should pull up this post - it says it all. nell

Wow, if they tried that here, I'd be out the door. I graduated in 1977 and none of my credits would count now. If I had to go through 4 more years of school, it wouldn't be nursing school. minus another nurse and counting... nell

mixy, I would have a problem with several parts of that form also. Good for you for actually reading the forms before signing them. I'll bet you will be one of those nurses who uses their critical thinking skills instead of just blindly carrying out orders. Too many nurses are passive and just go along with anything without questioning whether it is right or not. Tazzi is right - nursing school is not the military. As someone who just had another reaction to a supposedly beneficial/harmless med, I would definitely want to decide (or my SO if I was incapable) on any treatments whatsoever. nell

Wouldn't it be nice if hospitals treated their workers fairly and unions weren't needed. Around here there are at least three different kinds of unions - a national one that represents different kinds of workers, a statewide one that represents RNs only, and (my personal favorite) individual hospital-based ones. Three large and very different facilities in our area each have their own hospital-based union. These tailor their contracts to the specific needs of RNs at each facility. It's a lot of work for the officers, but they are very in touch with the needs of their members. Generally, dues are less and rarely, if ever, spent on lobbying. good luck, nell