HalfmoonMaggieRN

No. You're not revealing any personally-identifiable health information by recording the name and location of the patient/client.

This reminds me of the old "sick-day rules". Insulin-dependent diabetics were taught to give 50% of their usual insulin dose on days when they were ill and would likely not be taking their usual diet. I'm not a diabetes educator, but my recent reading supports the idea that the body's sympathetic response to the stress of illness will increase the blood glucose level, and subsequently increase the amount of insulin needed. The usual insulin dose should be taken. In these days of glucometers and home testing for BGLs, I've most often seen patients in the community instructed to monitor their glucose levels more frequently on these days. They may be given an alternative scale, but in any case they would almost certainly be given BGLs for calling the practitioner. In a hospital, request new orders from the practitioner. An intermediate or long-term care facility may have standing orders, and your assessment will tell you when these orders are insufficient.

Most of the nurses posting here are focusing on alternative work settings. My experience and opinion is that you will need to work in a supported setting prior to moving to a more independent role. The head of my college's nursing department told us that our degree and license would not make us a nurse, but would give us the skills necessary to learn to be a nurse. In the same vein, she strongly recommended that our first position was that it must be full-time for at least a year. Her rationale was that your experience will be judged on the basis of the length of your experience. Most will not take the time to fully evaluate the quality of your preparation, mentoring, and orientation (for that is truly what your first months of work will be). So, a nurse looking at your clinical skills and nursing judgement may think, "Why, he's been a nurse for two years. What's his problem?", judging you more harshly than deserved when you may have had neither the length nor breadth of experience required to attain the skills of someone who's been a nurse for two years (of full-time work). Work settings requiring more independence such as community health/home care or clinic/offices should and usually are limited to those with some experience in the job classification in which you will be working, though I've seen exceptions made for those who were working in the same setting in another role prior to becoming an RN. Discussions of options for entry into practice options for RNs often advocate much longer and more formal orientations than the cursory ones offered by most employers of newly-licensed and/or employed RNs, which sometimes seem to have the goal of a completed checklist and an uneasiness on the part of both the new graduate and the mentor. There are dozens, if not hundreds of options for an experienced registered nurse, and an acute hospital setting is a good one for gaining that. It will also expose you to nurses in other clinical and non-clinical roles with a range of hands-on care responsibility. Please consider this. If you choose the right unit in the right unit for you, you might be surprised to find that the experiences you had while completing student clinical rotations give you a limited view of the nurses's work world!

It depends upon the agency and its caseload, the availability of per diem and/or "volunteer" nurses, and the contract (if there is one) stipulations. In my experience, patients and/or families are asked well ahead of time if a visit will be needed (There may be a family member who is available on a holiday to do the wound care, for example because the holiday may not be a work day.). I've also seen the ordering practitioners called for orders to change the frequency of care on only the holiday, though I've never felt completely comfortable with that practice, especially for Medicare patients (for utilization reasons). A family member or the patient may be competent to provide an alternative procedure one time only, for example a simplified dressing. After per diem staff is scheduled and full/part-time nurses are asked if they want to work on the holiday, the number of visits is compared with the nurses available, who will likely be able to provide care to a larger number of patients since assessments/teaching that might usually be done on that day can be scheduled by the case managing/primary nurse for another day that week. In scheduling visits, per diem and volunteer nurses would be loaded with visits before "mandated" staff are assigned, and mandated staff often (in my experience usually) are able to be "on-call" after those visits are made. So, my answer is that if you are a full-time RN you will probably be obligated to work some holidays (Some contracts or policies may contain the perk of fewer holidays [i've even seen an agency contract requiring nurses with over ten years' service to work only one holiday a year.]. The number though, will likely be fewer than you would be required to work in a health care facility, since little of the care there is discretionary, and your day may be lighter and/or shorter.

Obese people usually know they're obese, and stating the obvious only serves to make the patient withdraw from contact with the health care system and its providers. This is counterproductive on two counts. First, it doesn't allow us to continue education and counseling efforts. It also makes us helpless to prevent the complications to which these patients are prone. Education regarding the risk of complications and weight loss efforts can be provided without attacking the patient's self-esteem. Many of the commentators here hint that they harbor a belief that they can compel a patient into success by pounding him/her with "the truth". Some of them even write of disciplinary methods which might be appropriate for a recalcitrant toddler without the mental maturity to accept a reasonable justification for following a parental directive. Children comply only when they're susceptible to the parents' control. When the control is removed, they revert to natural behavior, since they lack the reasoning to recognize the consequences of their behavior. Unless you're sending the patient home with around-the-clock security to guard the kitchen door, these methods will fail. In fact, emotional eating, a problem for many of these patients, may increase after a non-therapeutic encounter such as this. Adults who lack a source of external control must be otherwise armed. Education and emotional support are vital during the long process of weight reduction, and the emotional support may be needed for a lifetime. You are all correct in your belief that honesty is always indicated. If you become a nurse, there will be many times when the thing that comes into your head to say is may be the truth, but when you gain the insight that comes with experience you will recognize that there are many truths, not all of them therapeutic. Right doesn't always make right! Feel free to contact me, stephanyjoy!

Many years ago, I was a newly-minted professional nurse who also had previously earned a baccalaureate degree in another academic discipline. I had no interest in attending my college graduation, to be held the day after the pinning ceremony. Nothing, however, could have kept me from my class' pinning ceremony, which was at least as important to me as my graduation several years before had been. I don't have enough information from your posting to make this assumption, but I'm hoping that you don't view your nursing education as "vocational training". That would be a detriment to your nursing practice, and a loss to both you and your patients.

The documents attached to some of the comments here are more than nursing care plans. They're academic exercises with the goal of teaching the students to put the nursing process into practice. Most of the verbage is documentation of the assessment data, followed by the (much shorter) actual care plan. Practicing nurses do not document their assessment and plan, but simply the resulting interventions, goals, and evaluation criteria. I'm not certain that the fact that the former is an academic exercise is clear to the students, and the discrepancy between the theoretical basis and practice intensifies the challenges faced by the newly-graduated RN.

Boog's Girl has succinctly described the steps of the care planning process. The exhaustive listings of some of the posts: "every single lab value", "every single medication and their interactions", your assessment and your patient's medical diagnosis(es), all are the stuff of these 20 and 30-pagers monsters!!! As students, we pigeonholed our plan information. We followed the pattern of the care plans we had seen in our textbooks. In reality though, all of that detail and focus prevented us from seeing the whole picture, minimizing our efforts. As our clinical skills become more sophisticated, we followed the same nursing process we used in our student years, but there was a more natural progression through the care planning steps. (Remember having to "show your work" for math problems, though you were skilled enough to arrive at the correct answer in your head?) I also recall, as a student, having trouble wrapping my head around the continuity of the steps of the care planning process. Data collection and assessment were jumbled together, and weren't we planning as we listed our interventions? As a practicing professional, I eventually realized that the reason for my confusion was that the process truly IS a fluid one, and that our academic exercise was complicating a simple process.

I see how it would be possible to get 30 pages if the assessed needs of the patient were viewed in an extremely focused and isolated manner, and when beginning to write care plans this will probably be your approach. As you write more of these however, you will see that it is possible to use more comprehensive/holistic diagnoses, under which interventions from dozens of more narrow diagnoses can be listed. Note: The pencil in the eye reaction to the 30-pager sounds about right, though!

There are, as is usually the case, (at least) two sides to this issue. While "client" admittedly has the connotation of a business relationship, there is also the perspective of control in the therapeutic relationship. Some writers have discussed the appropriateness of the use of the term "client" for out-patients/community health, etcetera, mentioning that hospitalized PATIENTS are sick. I believe that a higher degree of dependency is appropriate in the nurse-patient relationship in the hospital than would be desirable in the community, where it is important to empower those for whom we're providing nursing care. I recall resisting the use of "client" for hospitalized patients, and though I still am somewhat negative about it, I can live with this much more easily than I could calling those for whom we're caring in the community "patients". If you've ever worked in a medical practice (or, for that matter, been a PATIENT of one!), you know that it is not desirable for us to emulate the practitioner-patient relationship of the medical model!!!

The subjective data provided by a pain scale is only part of your assessment. As you mentioned, objective data will allow you to see the larger picture. In noting that some patients' activity and behavior are inconsistent with the pain they're reporting, you have really answered your own question. Documentation of these objective signs is, admittedly, more time-consuming than simply recording a patient's description of pain using a pain scale. You need to document the patient's activity, body posture and whether the musculature is tense or relaxed, the rate of respirations and respiratory quality---regularity, depth, and whether they're labored/unlabored. The volume and quality of the patient's speech will give other caregivers additional information. Document quotations if the patient's words provide a glimpse of the patient's mental and/or emotional status at the time the pain is being reported or pain medication is requested. You can make the documentation process less difficult by doing a periodic observation of the patient for objective signs of his level of comfort, and tallying the results for documentation. For example, you walk past the door of the room every 15 minutes (or whatever interval is practical and/or appropriate for the stability of the data). So, the symptoms of pain are subjective, but the signs of her level of comfort are not. Take advantage of them to draw a more accurate picture of your patient, and you may feel less frustrated about the incongruity of the objective and subjective data you've assessed.