HopeItWorksDNP

Working in the ER, I instruct the new grads: "You've always seen worse." No matter how bad the patient it, you cannot show it to the patient. Your job is to remain calm so the patient remains calm. When I started, I tried to keep a smile on my face in the patient's room even if it was fake so the patient would not know how nervous I was. Eventually, it stopped being fake. It comes with experience and time. Don't be too hard on yourself.

I've done more than my share of caths on large women during my time in the ER and have found a few things that seem to help. Like the other poster said, take help. The other nurse can help spread the labia and help spread the legs further apart. Put the patient in Trendelenburg position so the abdominal "apron" falls back towards her head and out of your way. Be aggressive with your swabs. I've found if I apply a little more pressure when cleaning, sometimes the meatus seems to react to the cold and pressure and shows itself. And lastly, don't be afraid to really get in there. I've worked with many new nurses who were very tentative about moving the tissues around. On us larger ladies, the labia get fat just like the rest of us, and the meatus can be much deeper. Don't be afraid to get your hand in there and spead til you find it. You aren't going to hurt her. And lastly, PRAY!

It's not the Y-chromosome. I can only remember you if I see you in the same context I saw you in before. If you return to the ER, I'll recognize you and remember what your last visit was for and your family members and how we treated you. If I see you out in public, I can't remember if you were a patient, a school teacher from my younger days, someone I worked with in a factory years ago, etc.. I just need people to stop moving around and stay in the place I first met them!

Just have to correct you (as a longstanding LPN) with no malice intended. I can do IV pushes in my state. Not sure where you got your incorrect information. We just can't push particular drugs like chemotherapy, thrombolytics, etc. But I push meds everyday and am working within my scope of practice. I am also perfectly capable and within my scope taking telephone orders and verbal orders. I can assess a patient all day and night long, as long as they have been assessed by an RN within the last 24 hours. Just wanted to make sure you understand what is one state's scope of practice does not hold true for all. And by the way, if some new nurse used the term "why don't you just become a freaking RN already" with me, I'd chew 'em up and spit 'em out. That kind of attitude is exactly why some LPNs go on the defensive with new RNs. And when we are working side by side on a patient that is going bad, and you don't know what to do...don't expect me to save your ass (even though I can)...I'm not an RN!

I frequently take ibuprofen to help with my sinuses. I don't like the side effects of Sudafed or other decongestant and have found the ibu does just as well in shrinking inflammed sinuses. It also helps when my ears are feeling stopped up. Its the wonder drug!!

Ok. I guess I'm different. And its not intentional. Sometimes I wish I could cry so the family would know I truly do care. But I can't. Something in me says I have to be the strong, solid one. I stand there with an arm around the family member and a box of Kleenex and will sell my soul to do for them what they need, but I CANNOT cry. Same way when someone in my family dies. I'm the one taking care of everyone else and not letting myself go. Taking care of my dad, my mom, my siblings...meeting with the funeral director, etc. But I just don't cry. But the day I got a phone call that my dog died? Absolutely could not hold it together at work. Went to the bathroom and cried like a baby. Back to the job, thought I had it together. Went into a room to discharge a pt with a sprained ankle and broke down in front of them. Very unprofessional, I know. Fortunately, they were dog lovers and had recently lost an 15 year companion. So they didn't complain. So anyone want to analyze this and tell me what the heck is wrong with me??

Big, big decision to make. Will have all pre-reqs to BSN program finished at end of fall semester. Have been LPN for 5+ years. Committed relationship for 3. School I am currently in does not start another BSN program until next fall (that's one year from this month). Then I will have 2 years to finish program and then hoping to get into DNP program shortly thereafter. My only child is now freshman in college. Time to work on me for a change. Question is: other schools in the state have BSN program starting in Spring semester. I have until Sept 1 or Oct 1 to apply to these programs. High expectation of getting accepted. All of these schools are 2 to 4 hours away which would require relocation on my part. SO is not willing to move due to career issues and having young son of own who is very much settled in this community/school system. Promises to be here for me if I choose to relocate for 2 years and will visit on weekends. Will stand behind me regardless of decision. Relationship is of course not free of problems. Have had times over last 3 years when I contemplated getting out, like everyone does, I'm sure. Currently, things going well. Question is: do I put my goals/aspirations on hold for another year, which will make it 3 years before BSN is obtained or do I take a chance that we are strong enough to survive this and go for it so I can be finished in 2 years? I know this decision is mine and mine alone; but need some input from those wiser (and possibly older? Did I mention I'm already 38? Time's a wasting!) Thanks in advance!!

Is that covered by Worker's Comp?

I always look into the nose first to see which side appears the most open. Don't use ice on the tube but do use KY jelly to lubricate well. Chin to chest and have pt suck on ice chips if alert. To easy to aspirate if drinking water during procedure. And don't hesitate. If you act like you're nervous about putting it in, its going to make it that much more traumatic for the patient. Never fun.

There are lots of meds LPNs can push. I push pain meds, antiemetics, etc. everyday. My original post was several years ago. Since then, my facility instituted a IVP class. As LPNs you can't push thrombolytics, cardiac meds, chemotherapy, experimental drugs, etc. I can't remember exactly what the BONs statement says, but that's most of the drugs we can't push. We can't push IV meds on an adult weighing less than 90 pounds or on peds patients. Of course we can't do anything with blood products either. This is just my interpretation so you really need to check the TN BON to be certain. Just thought I'd share what I can recall with you.

Jasco.com sells Can't See through me pants. I love them! They are a little thicker than most whites so they last longer too! And not expensive at all.

I've recently picked up a PRN job taking care of a pt with a trach. Orders are to give HIT and CPT tx's every 4 hours as well as a saline neb. Doesn't specify what order. What's the appropriate order to give these treatments in order to get the best result? For those of you that don't know what HIT is, like I didn't, it's giving breaths by the ambu bag to optimize lung expansion. Don't know if HIT is just a name my agency uses, or if its a common term I wasn't familiar with. Thanks for your help.

I'm in Tennessee. Today our med/surg floor had 4 patients and none in the unit! But then we admitted 3 in the last 2 hours of my shift in the ER. So go figure? We were talking about the low census today. I just figure its the calm before the storm and when flu season hits this year its going to be horrible!! Pts putting off seeing their PCPs because money is tight then ending up in the hospital, dehydrated and very sick. Enjoy it while it lasts!

Oooh, I've got a funny brief story! Or at least its funny to me! Had one of "those" husbands always coming to the ER with his wife and her migraines. Very demanding, arrogant, rude, even intimidating when the stay would start getting too long. Very manly man...tough guy...didn't take squat off of anyone but was always dishing it out and bullying everyone on staff. Then one day it was his turn. Must not have been expecting a trip to ER for sutures, Td, and antibiotic shot when he got dressed that morning. And he must have forgotten he was wearing that pair of hot pink Hanes Her Way panties when he let me give the antibiotic shot in front of his coworker! God has a funny way of delivering justice....and I LOVE IT!

In my ER, usually hours after the code, when the doc is finishing up his paperwork, he says, "Nurse Nancy, what time did I pronounce?" I provide him with the time I recorded the code ending, since he never actually says, "time of death 2132" and usually doesn't remember when it ended. He usually just says "that's it" and then asks us for a time later, so I guess we do call time of death.....