nurseraphael

Our hospital changed to EMAR (electronic medication administration record) last year. There was a lot of grumbling and whining prior to and during the transistion by both old school and new grad nurses. we went through the bumps and now I cant imagine what it must have been like back in the dark ages of transcribing medications / yellowing them out / understanding other nurses scribbles on the mar . . . the record is straight forward . . clear communications - the next phase is physician order entry. No more calling the doc at 0000 to ask what he wrote in the admission orders. While scanning takes extra time, it saves time all over the place. no more looking through 16 pages of a mar to find the medication you forgot to give 4 hours ago. it is easier to schedule 3 antibiotics treatments so that they only overlap once a day.... and you can see the medications given to a patient over the last 24 hours when they are transferring in from another unit at a glance. It was the best move our hospital has made in the last year Just the other day the picis machine opened the wrong drayer and I blindly removed the med (i was in a rush) when I scanned the med it told me that the medication was not profiled! Do you want to profile _____? oops - error caught before reaching patient. We all make an occasional mistake - this helps to prevent that

Last time i looked at the budget - we were losing money. about 100,000/ monthly due to overtime, poor reimbursement rates, and capital investment in infrastructure to improve the quality of care . . . we run 4/5:1 on days and 5/6:1 at night for RN's and 10:1 for LNA's . . . it does not get much better than that and were loosing money - sorry to burst the bubble but reimbursements are going down and costs of labor / materials / services go up every day! Good luck on that one maybe we sell the cookies and milk!

Wow - no such thing as a paid holiday . . . we get time and half if we work, but nothing if we dont, new years eve, memorial day, July 4th, labor day, thanksgiving day and Christmas day... time and half stops and starts at 0000 - no bonus if your not on the schedule, and if you ask for it off and get called in last minute - no urgent pay...

one time on pediatrics we had a 10yo boy with a hernia repair and orchopexy who was recovering. His scrotal edema was - well uhh significant . . . his best friend said -"dude you got the biggest balls of them all" and promptly posted a photo on his facebook page! the next day mom got wind of it and really let those boys know whose wearing the pants in the family . . . it was funny but really troubling as well. Since then the hospital has an advisement in the admission paper work asking for patients and family to be careful what they post on line regarding patients conditions! not sure if this helps but it might

for CEU's check out Nurse.com | Nursing News, Nursing Jobs, Nurse Continuing Education, Nurse Community as well as http://www.medscape.com/nurses both offer printable certificates - for use when you get audited . . . you can use the same credits on all three states. be sure to attend pertinent offerings at your workplace and keep all of your certificates. keep everything in one place you never know when your gonna need to show your educational profile for the nursing ladder or perhaps a promotion. unit managers like to see at least 20 hours every year to justify a full yearly increase in base pay. as far as insurance goes - your nursing insurance does not worry about what state your practice in - but read the fine print. most insurance unless you are a subcontracted nurse, only kicks in when the hospital legal team decides to leave you out on the street for dead . . . and that can happen, especially if your testimony is not kind to their cash cow surgeon. I do carry insurance and always will - never trust the hospital administrator any further than you can throw a CT scanner.

get to know your Meds - pedi is easier - there are fewer - know your dose /kg and what to give each one for, you might also want to know what to use O2 for ! you will be fine. but if really want to know about pedi emergency's then take the ENA's ENPC course - it is far more comprehensive

I work Charge on a busy 32 pt med/surg floor. We discourage pacu from giving report during change of shift, but they need their rooms opened when more cases are coming out of the OR . . . I work 12 hour nights and often these admits are trying to get cleared out by 8pm so the RR nurses can go home. I will ask if they can hold til 7:45 then send them up. the ER just sends them on up - i have had them change a bed in the computer from dirty to clean - so they can transfer the pt to our unit. they come up and find they cant go in the room, we make the aide stand with the pt in the hall until the room is ready. I was told by the ER Charge that i was not marking my rooms as clean to keep the pt in the ER? that was apparently not true! Our Pacu is very good at communicating with our unit, it makes for a good working relationship - and for good scores on pt satisfaction . . . pay for performance is gonna be key the profitability of units in the near future.

My thoughts exactly - This CMA has been doing shots in another state with no supervision!

I do perdiem work for a wellness company administering flu shots. The Company sent me several subcontracted RN's, LPN's and a CMA. I did not think much about it until I got home and looked up the title CMA, and realized this is a technician level certification (non-licensed). I cant find any solid information for my state regarding scope of practice or, if I can delegate this task to them? my gut instinct is that a MD would have to delegate and oversee this task, and as i read on the Pearson website (their certifying body) that their role is to assist the physician. This person is scheduled for other clinics, I have asked him to find out if he is allowed to practice autonomously in our state . . . he stated to me that he has a national certification - and thought that he could give IM injections as an independent subcontractor? any thoughts. BTW my state board of nursing states that there are no provisions in the state nursing practice act aloowing or restricting CMA's - simply put there is no language to provide me guidance in the act!

No, I was holding off on posting to this, but the nay sayers have arrived... I find it unprofessional, perhaps its because I am a guy, but would prefer that everyone come to work do their job and be a nurse - not a cartoon character. Put up a few decorations - but take them down on the 2nd of January please. BTW - I love christmas at home and all the decorations around town

EMTboy does not sound like a team player . . . I am an RN as well as en EMT - been an EMT-I for 11 years and a nurse for 4. There can often be a divide between RN's and EMS becuase of what they can do in the ED and they can Do on the street - It is just the way it is . . . but no excuse for not playing on the team! Best way to solve issues with these folks is direct and in a private conversation . . . that way they dont have to try and look tough in front of their cadre. if that does not work, then its best to avoid him for now - then one day he will need your help and just thank him for asking, and smile as you walk away . . . that way he can just think about what it means to be part of a team.

I agree with you, and would not want to poke holes in these parts a well. I have asked a friend or two who had these sorts of things done . . . and tell me that it is pleasurable? It may be for them - but not for me and if your in my ambulance or in my hospital bed and it interferes with good care, it is coming out . . . and getting clean

I have been using a PDA since nursing school and now I use my iphone to check any meds i am unfamiliar with - it is a lot easier to look it up in a digital format than to look through a book. there many free apps out there as well as paid apps. you may also have resources on the computer to look these meds up quickly - never give a medication without knowing what it is for - the proper dose and the common side effects, as well as knowing when not to give! the more frequently you do this the more comfortable you will be with the medications you give. I have looked up meds that i have given many times before, and have found errors in the MD order - they make mistakes - and we have to watch for them

in our hospital a the criteria for calling a "RRT" Rapid Response team includes "ineffective communication" this can be called by the nurse or the family, or any member of the staff that feels that a patient is de-compensating and not getting appropriate care. I will always call the attending first, but i have called for a rapid response when I don't get the response that is needed from the MD. I find that our hospital encourages nurses to exercise their autonomy especially when a patients condition changes - even if their assessment was blinded by a bit of anxiety. Better to be wrong and have a live patient than to have been intimidated and have dead one!

It Really depends on the location of the piercing in relation to the urinary meatus. I would not remove the piercing if it does not appear to be infected and the catheter insertion will not be hindered, you may also want to consider the need for catheter care. I may even consult the physician as to his/her opinion. A UTI is may have its origin at the meatus but the problem is not really at the tip - it is further up the tract. removal of the the piercing may in fact cause further infection by leaving the piercing unable to be cleansed. at least with a ring or bar in place the area can be cleaned and sanitized with each shift's catheter care. Some piercing are in fact placed through the meatus at the tip passing through both sides of the meatus in the glans, however a majority of penile piercing are along the shaft on the underside . . . "for her pleasure" the former i would remove because this would further trauma to the site due to pressure. as to whom removes it? I would ask the patient what they want done . . . we remove all piercings we can find on trauma call in the pre-hospital setting because the may need to go to MRI or CT - have had to remove clitoral piercings on a teen from an MVA - that's uncomfortable - especially with mom riding up in front of the rig....