vernonleon

of course there is all kinds of great information posted in response to the ops question, but i've got to throw in my little bit that's a bit of a tangent but still on the topic of lovenox. make sure you warn your patient that he or she may begin to bleed from the injection site, even some time well after the injection was given. some folks get really, really scared when they see unexplained blood on the fronts of their gowns.

One of my patients coded during my last week of orientation, then another nearly coded my second or third week off of orientation. Today one of my co-workers patients coded. As is the usual case both of the patients who coded died. Both of them were quite advanced in age, and both of them showed signs of impending death (decreased intake, worsening function of multiple organ systems, etc.). In all three cases, including the one where the patient did not code and did live, I have gotten the worst sort of adrenaline rush possible. Today my skin started tingling after the code, and I have gotten at least a bit nauseous after each code and the near-code. I am on a med/surg tele floor, and it seems like there are an awful lot of codes on my floor. I know I have put a whole lot more time in over the few months that I have been out in the nursing work force compared to my time in school, but I do not remember any codes throughout my education. I was on one step-down unit at a university medical center with complicated patients, so I am surprised that I did not see any codes there. What I really want to know is how many codes any other first-years on med/surg telemetry floors have experienced, including with patients that are not yours. Today's code was a little bit easier for me, in part because it was not my patient and also because I had already been in a code. My other question is, have you gotten used to it? I have not been so upset about the death of the patients in either of the codes as I had been with the process of the code itself. I know now that the my patient would not have been coded had I acted more appropriately on the information available to me. I do not necessarily believe that the patient would have lived had I acted differently, but had I done a better job of communicating with the family about their wishes when the patient began to go downhill we could have at least gotten a DNR order in place. I spent a whole lot of time thinking about what went well and what did not, and I have learned from the process. I think I've managed to get on the nerves of our cardiologists by being a bit hypervigilant, but better to be hypervigilant in the learning phase than to be undervigilant. Anyway, any shared experiences would be appreciated. And one last thing. We have students on our floor now, and having gone through the first-time experiences of being in a code after starting work, I really want to invite students into codes so that the whole experience is less traumatizing once they have to deal with it on their own. Does this sound like a good idea? Should it happen, I would assign a role to the student (probably recorder, compressor, or ventilator), and direct the student as needed during the code. I know it is an intense situation and you have to act fast, but with adequate direction I think students can perform specific tasks in code situations without affecting the outcomes of the code (of course mileage will vary per individual).

Does anyone think this might be nothing more than a way to artificially boost a schools NCLEX pass rate? At my school we had to do ATI every semester, then we had an ATI comprehensive exam at the end. But, nobody was held back for not passing the ATI comp. I think people had to re-take the test (at home), but that was it. Our first-time NCLEX pass rates aren't the absolute best (mid to high 80s). At the same time, about 90% of the class goes straight through the program to NCLEX on-time.

I just finished my M.S.N., and I'm one of those accelerated non-RN to M.S.N. people. I don't quite know how to report this on my resume. To date, I've written in M.S.N. as my only nursing education, all with an expected completion date. Now I'm done with my program, and it's time to get real about finding a job, so I'm asking for advice about this. Of course my transcripts will not show my degree until February/March, but the date should be December 2008. So that's another complicated part. Here's what I have : M.S., Nursing, San Francisco State University, 12/23/2008, GPA x.xx/4.0. B.A., Psychology, etc. *Note: GPA is inclusive of coursework including pre-licensure courses. Here's an alternative scenario I've thought of: M.S., Nursing, San Francisco State University, 12/23/2008, GPA x.xx/4.0 R.N. Licensure Requirements, San Francisco State University, 12/23/2007, GPA x.xx/4.0 B.A., Psychology, etc. *Note: M.S. GPA includes only coursework, R.N. Licensure Requirements GPA includes only licensure courses. Maybe I'm just overthinking this, but I've had one call from a potential employer who was unclear about my education (and I can see why that would be). Aside from how to report my education, I also have some reservations about reporting my M.S. because my transcripts will not show it for some time. This particularly concerns me in the case of employers who want transcripts with the application (seems rare, but it happens). Any advice on this, particularly from managers, would be greatly appreciated. Thanks, Vernon

BTW, cyclothymic/cyclothymia is a disorder unto itself. It describes a disorder in which an individual has never had a major depressive episode or a full-blown manic episode, but who has had both dysthymic (mini-depression) and hypomanic episodes that are ongoing for at least 2 years, and who has not been symptom-free for more than 2 months during those 2 years (my shortened version based on DSM-IV Tr).

My mother had schizophrenia. She was lucky in that it was very episodic; knowing what I do now I think it's possible that she was actually bi-polar, but who knows. The whole thing with schizophrenia, or any other mental illness, is that there is no normal presentation. I worked in a psychiatric rehab before I started nursing school, and I worked with people in their 40s and 50s who you would not pick out as having schizophrenia when they were doing well, if they had been lucky enough to escape TD. I have also seen people their 20s who have such severe schizophrenia that, even at their best, they were living in a world apart from this one. I don't know about severity and heredity, but we definitely know that heredity is far from the whole picture with schizophrenia from twin studies since less than half of identical twins of people with schizophrenia have schizophrenia. I would guess, and this is purely a guess, that those with less severe schizophrenia would pass on less severe schizophrenia to their off-spring (or maybe even have a lower chance of passing on schizophrenia altogether).

'k, I'm an ignorant Californian, so I must ask: What is "tack-a-lawdy?"

Which of the hospitals in NOLA is the community/public hospital? I'm thinking about moving to NOLA from San Francisco, and I have no idea about the hospitals in NOLA, beyond a couple of names. Also, how welcoming is New Orleans to outsiders? I've never been to New Orleans, but it sounds like an interesting place.

It also seems like this would decrease the time to the catheter clotting-off from having the blood flow into, rather than around, the catheter. In an emergency situation with no other option at the moment it seems like it would be fine, as long as a better solution (alternate site, central line if appropriate) could be employed.

If you have a license in any U.S. State, you can work for IHS (or any part of the federal government, i.e. VA) that you want to.

What about in a community setting? I'm a very green RN and witnessed for another nurse who was disposing of meds that one of our clients brought in for disposal. I did not witness the chain of custody; I just happened to be around when the bottles ended up in the medication room. I did witness, and sign off for, the disposal of the meds (it was oxycodone and lorazepam), but I felt very uncomfortable with it afterward. I would not do this again. I do not know what the P&P is for this situation, or if it even exists (in which case it would be a nice project for me).

Not that it matters, but in CA RNs can administer vaccines without physician oversight. At any rate, I honestly have trouble believing this. If it's true, I'd send your mom in with a hidden camera & start a big ol' lawsuit. No need to hold a job if you're being treated as bad as this sounds.