nimbex

we must be certified, test and 3 check off's prior to being able to do. The units allowed to are; all ICU's, PACU, special proceedures, ER, L&D we have a form, we must do vs every 5 minutes during, then your usual post Q15 x 4 so on. includes GCS. Must have suction, O2, heart monitor, crash cart nearby. These patients are a 1:1 until the vs hit 30 min. appart.

I know this is a few days old but from personal experience, as soon as you are deposed.... legally swear in, with lawyers from BOTH sides, the first question asked is "do you have personal malpractice insurance", you can't lie or hide it. I've been named in a suit. As long as you follow hospital policy, the hospital WILL protect you, mine did wonderfully. If you violate policy and then are named, the hospital has no obligation to defend you. If you live on the edge and take risks, than GET insurance, god knows you'll need it. From experience, although named as primary defendent, the lawyer and plantiff will not go after your measly assetts, they want the millions awarded by jurys, or enough pressure for the hospital, with vast insurance and resources to settle and pay out. My hospital lawyer said, labor and delivery, peds, then ICU is the most often sued, L&D, is sued quite frequently. Doesn't mean you should avoid it, just follow policy and document thoroughly. if you want more info on the process fell free to pm me

we are required to enter into the computer our patient acuity's each 12 hr. shift. I haven't done it in 6 months, I charge 3 of 7 days a week.... no one has asked. think they amount for anything in my facility???

well we play pranks on each other when the other is in charge.... not a qualifier for your committee. But our hospital has an activities committee that has a sign up board and does every sport from volley ball to soccer to baseball, they organize cruises, day trips for baseball and football major league, do day gambling trips and so forth. Plus we do so much internally in our unit like a girls sleep over, celebrate holiday's with pot luck and all chip in for the b-days.

I can't direct you to literature, but inspite and despite any literature, EVERY situation is different, every family reacts different. I do what I feel in my head and heart to be right at that time. I've removed, as well as called families into codes. Sometimes you just "know" what to do. good luck

have you seen an allergist and had your daughter worked up? possibly with allergy treatment you would be able to choose any pet that is right. The flip side is what will you do, if your daughter becomes allergic to the new pet?

Our write ups has a "I disagree" slot to check, then you write why, it is automatically then forwarded to the next chain of command. I would call HR, their purpose is to help mediate through situations like this, as well as insure your record as an employee is correct. let us know

Dead people have down regulated receptors!!! :-) your's are going a mile a minute, relax and enjoy the challenge... worst case senerio is a retest. not so bad. you'll do it.

Devil's advocate here.... Could the patients be comming late... due to constantly WAITING?? I have seen MANY doctors due to various problems and have NEVER been seen on time, mind you I arrive ON TIME. I expect the same courtesy. It is different if the doc sticks her head out in the waiting room and announces "I'm sorry to keep you all, several patients have needed more of my time... thanks for waiting". Might solve the problem.

Sorry, forgot to add that you should spend the time as well as the other staff (no matter how exhausted you are), to fill out incident reports on any and all meds missed so management can get a TRUE picture of how this adversly affected patient care.

Some facilities have specified forms others do not. Having been forced to go this route a few times I could tell you what was included. I no longer have a copy of the pre-printed form, this is from memory and not meant to be all inclusive. First call direct supervisor and list the acuity with staffing ratio. If unsatisfied with response and you feel unsafe alert your supervisor you are using the chain of command and calling the next person. Do so, then if response has not changed, you then alert this person that you "are docmenting the conversation and will accept the assignment under protest. you refuse to be held accountable for any meds, treatments that you were forced to delay during prioritizing, and you will not be held accountable should a patient be harmed due to lack of staffing ie. waited to long for call bell to be answered, decided to walk to bathroom without assist and fell. You then write a quick summary of patients, especially all the high accuity things going on, number of staff and their exp. anyone who is willing to sign, have them sign it now.(yes some may back down later after management pressure. Do ask for a meeting ASAP with the head supervisor to discuss how to prevent in the future. Hand the form into this person after making a copy for yourself (no patient identification HIPPA ya know). I hope this helps.... sorry to hear you need it, I'm sure others will have some good ideas too.

Just FYI, the incident report can be admissable in a court of law. PRN gave some great advice.

yes, been there too! How scary and frustrating for you. Worked psyc. where 70 yr. old little ladies would kick my butt, needing 4-5 of us to "take them down" and medicate them. Have been in charge when one of my nurses had been verbally threatened, with a fist flying near her face, this person had her mental faculties. For her, I called the sheriff, with this nurses insistance, he came up from the ER, explained to her VERY plainly that one more threat from her would equal charges filed by the nurse, AND she would have a warrent for her arrest in place PRIOR to leaving the hospital. That straightened her ugly demeanor out FAST!!!!! Management hinted that this approach was a bit strong, and I reminded them of this law called work place harrassment, management being required to protect their employees. Patient sang a different tune, and all was dropped. Bottom line, your management is required, by law, to protect you from patiets who are oriented from harming you. If the patient is confused, it is the MD's responsibility to protect you and the patient from harm by either medicating them or medicating them AND restraining them. If the MD refused, immediately contact the supervisor and tell the MD and supervisor that you are documenting responses in the medical record. Follow through!!! We had a nurse not too long ago that was punched in the face, MD and family refused to medicate or restrain.... nursing staff documented this and refused the assignment, called risk management at home.... risk management spoke with MD and supervisor... the family was given the choice to comply with care which equaled meds and restriants or sign out AMA. You DON'T have to tolerate this..... I'm thinking of you, having been there, it's very tough when all you're trying to do is CARE for your patients.

Does you facility offer any charge classes, anything like conflict resolution classes? Because you have the clinical skills to supervise, doesn't mean that supervisory skills are automatic.... it's SOOOOO tough!!!. Sometimes management forgets that nurses need training like the above to succeed in difficult situations. Because while in charge you have so many more responsibilities, you MUST delegate more. Be comfortable in that, taking on more, because it's "easier" than dealing with these people is almost hiding from the problem. I know you can do it!!!!!!!! Wish you well, we all deal with people like this, let us know what happens.

we have an agency nurse that works labor and delivery, and cardiac surgery, now cross training to our CCU. How's that for a variety?

sorry in advance.... no couldn't and can't spell (apologizing) think it's right now, remain unsure. Yes it's not a skill I have, dont' plan on adding it..... just not a priority to me. but whoa, can I fudge the simplest of words.... so ... simply sorry.

Lilmamita, in my humble opinion, any organization that suits an individuals goals and gives an opportunity for growth, networking and personal contact is worth while. No organization can change the world, nor should it aspire itself to.... and if an organization is of a majority of "beautiful", smart, ethnic, or of similar interests so be it.... it's irrelevant. It's a group of like minded or similar people who gather for common interests. and if any good, no matter who the good reaches, comes about.... than its a win-win!!!! My Phi Theta Kappa group was a nationally recognised honor society.... that had goals to improve society, in any way we could... . we helped our community, in small steps, sometimes only a few families or streets at a time...... does this negate the value because we didn't change the world... I hope not and I don't think a million person march can make the same difference as simply feeding and clothing a family, maybe a neighbor hears about it and decides to sponsor another family and word spreads about families in need and now 5 or 6 families are sponsored. It has to start somewhere.... imagine the idea stopping at.... well we can't feed the whole city so why bother??????? So I whole heartedly agree with you. and hope that more people want to get involved and improve.... ANYTHING just do it.

I was a member of Phi Theta Kappa, I was vice president and went to regional meetings. this group supported networking, professionalism and personal integrity. Our local chapter did volunteer work with clean up days in the community, blood drives, adopted poor families at the holidays and so much more. THis is not specific to your organization, but I believe the fundamentals are the same.

I couldn't negotiate bonuses, but I hagled until I received a better hourly pay.... try that approach.

goto human resource, find out what their take is. If this really comes about, file a grievance..... you don't need a union to do so, do not sign your eval, and go up the chain of command. geeze, I can't even imagine a but hole saying something like that, let alone doing it..... no, nevermind, ....... I can- that's the sorry part. good luck

RNCENCCRNNREMTP, thank you for the info. Sometimes I think that pharmacy is just being difficult. We don't run NTG greater then 200mcg/min... then add either natrector, nipride, dobutamine or amrinone, based on reasons. thanks again.

Okay, in our cardiac surgery, EVERYthing runs into the swan . In our CCU, there is a rule against running them together, unless access is a problem... here's the kicker though... so sorry, I can't find literature as to why, our pharmacy states it's the NTG that results in heprin degrading requiring higher doses and thus taking longer for a therapudic PTT.... BUT.... as I said... can't find a lick of evidence to support it. Anyway, the hell with anyone who tries to be supperior, especially at your expense.

hey, while I'm getting the admission settled, you please do the admit pack..... you, please check on room 3 and write their vitals down...... keep it up as long as they're just sitting. In return be a buddy and just help without someone asking you, once a few know you've got their back.... they might be tempted to keep your load equal because your there for them, this takes time. I've learned that our one nurse who only takes care of his patients is now helping me at times very much..... I've helped carry him for awhile, when everyone has left him "because he never offers to help"...... it was great to see it happen!!!!! Not suggesting you're not already helping.... sometimes the best way to get it EVENTUALLY, is by giving it for a bit.... If this aggressive team player bit doesn't work.... then you're forced to "suck it up" or say NO... or even nicer.... I've had 3 and 4 patients for the last few shifts.... I need a break tonight. Very tough situation..... good luck

well still up from working last night, it's 1130. Have to work tonight. been on nights for 6 of 8 yrs. nsg. so, have a hubbie on day shift schedule, with 3 kids. I wake up, shower and eat dinner with the family, which is my breakfast..... do this for a stretch. then, I have to sleep, get up and sleep that next night..... doen't happen. So I sleep when I'm tired.... spend as much waking time with the family... and if needed... havea romantic evening with hubbie on first night off, then when he goes to sleep I stay up until 1 or 2am. Try to wake up early so my next day off I'm closer to the "day" schedule of the family. I just listen to my body, some days I give up sleep for them, some days I sleep for me. It's a give and take relationship. If your significant other cannot understand or compromise..... you need to consider the switch to days for harmony in the house or have a heart to heart talk. I tried days because I thougt it would be best for the family, but it wasn't best for me..... which made family relations worse for everyone.

Having worked in a Cardiothoracic ICU, open heart surgery, I can tell you all the staff that went on to their CRNA chose this unit because of the accute post op, which is very similar to intra op and counts and the needed experience for a CRNA. When we do emergent open hearts on nights, it is common for the receiving nurse, who will not have another assignment to go into the OR and manage the IABP or BIVAD. We crack chests at bedside during codes and insert IABP at bedside. this is the best experience a nurse can get prior to thier CRNA. If you are blessed with a pediatric unit that does invasive cardiac surgery, tetrology of fallot, and malposition of the great artery, even ventricular septal defect repair..... and your TRUE LOVE is pediatrics and you wish to specialize in peds. CRNA, than go this route. However a pediatric ICU that does not do invasive corrective surgery, will not prepare you for the CRNA requirements. Choose your hospital wisey. Good luck