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If CMS were to survey the facility you would probably be cited for mixing dirty with clean. On our IC environmental rounds sheet, we have to check the clean utility rooms and ensure that nothing "dirty" is stored there and we also have to ensure that nothing clean is in our soiled utility room. When we check each PAR we have to ensure that no opened supplies "dirty" are mixed in with sealed packages "clean". We are continually reinforcing "Clean with clean and dirty with dirty". You write They have a sink and cabinet area that was there med station but they were moving it to a closed room. Is this closed room used for anything else? If not, perhaps this closed room could be dedicated to "dirty items".

The portable computer workstations we use do not have drawers. The nurses are hanging plastic bags from the side to store flushes, insulin syringes and such. The problem is they do not remove the bags and the next nurse dumps it in the basket attached to the workstation. I find too many of these bags and am wondering how other facilities deal with this. It's poor management of supplies and a potential IC issue if some item in a bag expires. Having syringes accessable to anyone passing by is a saftey issure. Thanks for your input.

We aspire to be a magnet hospital so therefore group huddles are to be done daily. If you miss the daily huddle then you're supposed to read-and sign- the huddle sheet that you missed. We receive a weekly batch of huddle sheets that include "thought for the day"; kudos to people who have demonstrated world class care; notes on gallup questions; etc. We can personalize our departmental huddles. One group in our hospital does a daily prayer; another group goes around their huddle circle affirming each other. On my floor, I try to do the huddle at the change of shift so to include both oncoming and offgoing staff. The thing is, we are all focused on getting report and hitting the floor before transport comes to take patients to the OR -or whatever the pace of that particular day might bring. A few times on particularly stressful days a few of us break out into what we call "the huddle dance". I've grabbed the Huddle Book and read the huddle during this stress relieving moment in which we are enjoying THE moment.. . and it works for us. Hope to hear more from you. I realize what an important role the daily huddle plays and just want to fire up my peers.

I'm the Unit Champion on our med/surg floor. As the designated "cheerleader" I'm looking for ideas to encourage better participation in our daily 'huddles'. I'm also supposed to help my co-workers understand the gallup poll questions that come 'round every spring and am putting together a bulletin board about that. Hope to exchange ideas with other unit champions.

Someone told me that when I'm stumped to try and work backwards. Example: The TIME MEAUSURED OUTCOME (The Goal)l for this dx would be: Pt will feed herself safely during hospital stay. What INTERVENTIONS (stuff that I can do) support this outcome? I can: *assess pt's abililty to feed herself at this time *ensure pt has dentures, hearing aids, and glasses in place *ensure proper body position *set up tray so that all containers are opened and placed so that pt can utilize left hand to feed herself *sit on unaffected side at eye level *allow pt to participate in feeding as able; provide verbal/visual cues; provide praise for all feeding attempts; increase tasks as able *encourage pt to keep food on the unaffected side of mouth with a rocking motion to deposit food *be prepared to intervene if choking occurs; have suction equiment ready Hm-m-m-...so now I'm sensing the NURSING DX (the problem) has to do with: feeding selfcare deficient related to CVA as evidenced by right side hemiparesis.:yeah: I struggled with the Nursing DX all through school:banghead:. I hated them:scrying:. Now I look at the doctors orders :Dand take my cues from them. For example; If there's an order for Contact precautions because the patient has MRSA in a wound I know I can do one on Knowledge deficit. New onset diabeties is good for knowledge deficit in performing acuchecks and insulin injections. If there's an order for IS I can write on Impaired Gas Exchange Pain is always a good one. You want the outcome to be that the "pain will be tolerable during hospital stay" I kinda like doing them even though my nursing verbage still needs improving. Good luck:yeah:You cn do it!!!!

Backstory. . .pt admitted for pneumonia. Hx fr 5 years ago included a mass in her colonwith mets to liver. Her eyes were very jaundiced. A physician mentioned to me that cxr showed worsening pneumonia. Next time I am assigned this pt I'm told at report that the am colonoscy had been cancelled the night before because pt unable to complete prep due to N/V. Later in the am the surgeon called and asked me why procedure was cancelled. I told him what I'm been told. He wrote orders for pt to consume 4L of golytey plus tap water enemas plus obtain consent for colonoscopy for next am. He mentioned dropping an NG tube if pt unwilling to drink prep. Geez! Daughter of pt calls and states that, as POA, she doesn't want anything done that will not improve prognosis of her parent. Surgeon talked with daughter and she signed consent. Colonoscopy was done. Bowel was almost completely blocked by mass in third quadrant. The surgeon wanted to schedule a repeat colonoscopy plus stent placement for the following day and ordered mag citrate +enemas X 2+obtain consent. I was told in postprocedure report that Respiratory had been called immediately after procedure and that that pt had been put on rebreather mask. Pt was returned to unit and RR ranged between 24-30 each time I counted. HR stayed in the 80s. O2 was at 96% on 4L humd. She had no c/o pain but it was obvious to all of us that she was going downhill. The surgeon came it to see pt later in the day and planned to proceed with 2nd colonoscopy if pts respiratory status improved. He ordered an EKG and chem 7 to be done. I called primary physician group and requested that pt be seen. I felt that doing more would only make her last days worse. Meanwhile, I took the mag citrate in to pt and encouraged pt to drink it. Pt wasn't interested in complying nor intrested in resuming liquid diet. I know that it's important to hydrate after a colon prep but it just wasn't happening. There was an order for pt to be NPO p midnight for the planned procedure. An oncologist came to see patient and cancelled the procedure, talked with daughter and DNR forms were signed and placed on chart. I felt much thankfulness toward this doctor. My pt wouldn't be subjected to another colon prep +enemas. Then the lab called with a panic value on Potassium; 7.4. I called the primary care group and reported this value plus mentioned that pt's IVfluid was 1/2 NS +2o of K. He had me change the fluid to NS. By the time he came to the unit it was change of shift. I didn't see the orders he wrote but know that they included redoing the lab work and Kayexcelate and Insulin.He also wrote for morphine. I go home. I keep thinking about what I didn't do. Urine output. Other than one incontience change done prior to pt's colonoscopy, I don't know if there was anymore urnine output during my shift. On the graphic sheet the CNA had charted "inc". Her 1/2 NS + KCL rate was 70 mls/hr. I remembered last year as a brand new nurse being told that you don't hang IV fluid containing potassium unless you know that pt has voided. My hope is that when the labs were redone it would be found that the K was WNL. When someone is DNR, our focus becomes palliative. I feel that I missed a beat re the urine output. I'm thinking that a straight cath might have been ordered. I don't think the pt would have wanted it but it might have eased pt. Thanks in advance for reading this. It was my first experience being an advocate for a patient. Istarted outplanning to ask about IVfluid with K and started rambling about my pt. I don't know if patient recovered or if pt died. One nurse told me that sometimes a procedure, such as the colonoscopy, "activates" the cancer cells and it spreads agressively. Considering there were mets to the liver already plus the worsening pneumonia, I think it's over.

I had a pt who needed yet another Potassium run. She told me that it had burned when a previous nurse had run the potassium. Being a new nurse, I went seeking advise on what rate to run the potassium. I was expecting the nurse I asked to tell me to run it slow but she came into the room with me and set up NS going through a pump and primary line connected to the IV site. She then set up the postassium going throug another pump with its primary line connected to the NS tubing at the port closest to the IV site. I don't remember what rates she set the pumps at but I do know that the patient had no complaints of burning sensation:yeah:. Can someone help me with what the rates might have been? Would I use the same set-up with a mag run?

I've been licensed since 3/08. Other nurses will see me "stressed" by the craziness of the moment on the med/surg floor and the usual word of advise is simply "breathe". I was standing next to a dinamap one day and figured I'd check my heart rate during a busy, anxious moment. My pulse ox was 92% and my heart rate was 124. I thought to myself, "I better breathe". I scooted into the staff restroom and did 10 deep breaths, with my eyes closed so that I could focus on just calming myself. I returned to the diamap and redid my pulse ox. I was pleased to find my O2 up to 100% and my heart rate was down to 88. My working mantra for myself has become "breathe baby breathe". I still continue to be anxious but at least I can be proactive instead of just freezing up or spinning in circles. I try to stay in front of the clock re meds and interventions and am getting better at charting as I go. The simply breathing helps get me through the simotaneous nursing home transfer transport arrival, post ob arriving to unit , transfer from ICC, and pt requests for pain meds NOW PLEASE, all occuring in the same 5 minute block of time. Good luck and BREATHE.

Embarrassed myself and got hauled into my directors office because I didn't follow procedure re how my facility utilizes air mattresses. I have started shifts with patients already on specialty beds but have never put one on a bed for a patient myself. I had rec'd report on a patient and no mention was made about a specialty mattress and I was puzzled when I saw one in a blue nylon bag on a chair int the patient's room. I checked and didn't see an order for one. My charge clarified for me that I don't need an order for an air mattress and asked me why the patient had been admitted. I told her the pts age and admitting diagnosis and she suggested I go ahead and put it on the bed. I delegated this to my NT and asked her to let me know when she would do this and I would help her so that I could get the experience. Next time I went into the room the mattress was already under the patient. A few hours later I got a call from the oncoming charge nurse who asked me where the mattress was. When I told her she quietly said, "It's dirty". Turns out that our clean specialty mattresses are stored in transparent plastic bags and when the patient is d/c'd the mattress is placed in a blue nylon bag and stored in our dirty utility room until the contract company picks it up. That particular mattress had been in my patient's room almost 24 hours when I noticed it and incorrectly decided to utillize it for my patient:banghead:. Ok. Now I know. I'm not trying to pass responsibility to charge nurse or tech; I made the call. There is going to be a time when I ascess a patient and determine that a specialty mattress is needed. I'm hesitant to ask about this, though, because of this recent flub of mine. I know that it has to do with skin assessment (pressure ulcers) and the patient's physical condition (stroke, contractures). I was thinking that this was done once a patient was admitted to the floor and the primary nurse did the admission assessment but yesterday I saw a nurse setting up a mattress prior to an admission. I'm hoping someone can give me some insight into criteria for specialty mattresses so that I can stop feeling awkward and embarrassesed. Thanks in advance!!!

I went to a podiatrist who dx my foot pain problem as plantar fascitis. He showed me how to use water proof tape to fashion a "support slipper" on the sole of my foot which gave me relief. Basically, you tear strips to cover the sole horizontally, then vertically from the ball of the foot to the heel. Once this is done you tear one long strip to outline the lateral sides and heel. This piece was used to catch the ends of all the other pieces. It was quick and easy to fashion and I probably didn't use a whole role of tape during the period of time that I was using this remedy.

I thought Nursing School was stressful; especially the Skills Tests and Exam days. I graduated in January 2008 and by June had gone from an almost size 16 back down to a lovely size 12. I attributed this to my anxieties of facing NCLEX and working as a graduate Nurse. I didn't enjoy solid food at lunch break so I started drinking one of those nutritious drinks. In August I noticed that my hair was no longer super thick . I've been dying my hair since 05 and it didn't seem to be breaking-- just thinning. I"ve been googling, looking for info as to what I can do to reverse this. I'm thinking that the stress combined with my diet is at the base of this hair loss rather than the hair dye. I'm looking into diet, supplements, stress reducing activities, and will mention my situation to my doc when I go for my next check-up. Anybody experience similar manifestations of stress? What did you do??? Thanks in advance for your advice.

I started back to school at age 50 while working 3 part-time jobs that fit around college classes. I may well have been the oldest in my nursing school class of 51. I was 54 when I passed NCLEX and started work as a Med-Surg nurse. I've been off of orientation since June 4th and will turn 55 on June 19th. A lot of my patient's are my age and it's a reality check. If I don't take care of myself, I could be where they are. I am more aware now of how my diet, exercise, and rest as well as my stress management impacts my own health. When I am on the Floor, my age never enters into my mind. I'm just a novice nurse who's trying to transition ASAP into a confident, skilled, compassionate nurse. I was told by my preceptor, who was about 15 years younger than me, NOT to tell pts that I was a new nurse but rather that I was new at the hospital. If I had stayed in my "other life" I'd be retiring now and beginning to travel. As it is, I've embraced nursing for the rest of my life and will endeavor to turn to dust as one. The only regret I have is that I didn't have a chance to do this when I was younger. I'd love to have more time to explore the many different perspectives of nursing. Hm-m-m-m, well, I also wish I had better computer skills. We're switching to Cerner charting and I feel so dumb. The younger people seem to grasp the training instantly and I'm not wired for this stuff:banghead:. I know I will "get it" with practice but will feel like a stumbe-butt at first. Big sigh.

I love SoundofMusic's schedule!!!!!!!!!!!!! I'm going to copy it and use it. I hope it will help me "anchor" the shift. There's so much going on during the med surg day shift and this schedule beats what I was using to keep me on track. What I seemed to have missed during Nursing School was all the "interruptions" that seem to mess up "my" schedule. I guess part of this was due to the time of shift that I had clinicals. An example of this would be yesterday. I had my pt assignment and was receiving report when I got a call that I could bring up two of my pts that were scheduled for hemodialysis. I"d rec'd report on one of the pts and had been told to order her an early breakfast tray because the departing nurse hadn't been able to get thru to the nutrition dept. I hadn't had a chance to meet much less assess these pt. It was crazy but I got through it. Turns out the dialysis doctor wanted all the pts done early so he could leave early----bending the schedule to fit his needs. Getting report and having to lightening fast get someone's trifold done so that they'll be ready for early morning surgery was another "interruption" to my plan. That trumps other stuff I need to do. Getting 2 post ops (within 20 minutes of each other)and needing to do discharge teaching for another patientis yet another challenge to maintaining some sort of plan for my shift. My preceptor told me that as I learn to prioritize I 'll start thinking of situations in a sort of "although that XXXXX is important and needs to be done this XXXXXX trumps that XXXXXX" and it will keep my priortizing more fluid. My so called plan has to be flexible. I tell myself that I am a novice nurse and that this time of my practice is to be used to transition into a med/surg nurse. I will be awkward at times and make goofs in prioritizing and be incredibly stressed. It is hard and scarey but I love it. I look forward to the day when I'm not new at nursing and I can relax into my profession. Thanks for the helpful bits of info.

I'm 54 and should graduate from an ASN program this semester. You want it? Focus and go for it.

Dear Indigo, I'm a fourth semester nursing student and am taking my Trends in Nursing class. We have to do a presentation and I decided to focus on the respirators that nurses would be wearing while caring for patients in respiratory distress during a Pandemic. I've been reading the posts here and visiting the sites that you reference. Thank you for making me aware that this Pandemic is for real. I hope to become involved in helping my hospital/community prepare for thie inevitablity of this.