Piki

try wetting your finger tip with a drop of water first, almost always works.

At any given time we have at least several people in contact isolation on our floor at the hospital. When we do accu-checks, we use the plastic bag that holds the gown as a cover for the accu-check, and then when we are done, we wipe down the meter with antiseptic wipes. As far as inhalers, those would be kept in the patient's room, and their medications are kept in the med room instead of in their locked cabinet in the room. I'm not sure the protocol with a locked med cart, but I'm sure that you could ask someone for help at your SNF. Surely there has to be a routine protocol set in place.

We get enough ISUs and mandatory classes at work to cover the CEU requirements in our state (which is 30 hours to renew every other year)

Nothing! You're lucky to get a bonus!

1. How long have you been a nurse? 3 years 2. What motivated you to choose nursing as a profession? After being disillusioned in the corporate world in a high paying career, and then being a SAHM to my children, I wanted a job that would offer me part time, flexibility, and a chance to really make a difference in someone's day 3. What branch of nursing did you choose? Med-surg, with emphasis on caring for post surgical patients 4. What is the most rewarding aspect of your job? Really making a difference in someone's day or life, by being compassionate, meeting their needs, and having patients tell me how grateful they were to have me as their nurse 5. What is the least rewarding? Dealing with obnoxious families. And for some reason, it is almost always the adult daughters that are the worst. It's moreso the patient's families that seem to have unrealistic expectations. They don't understand how hospitals function or what the nurses actually do.

I cannot count the number of times we've had patients on the floor (we also routinely swab nares for MRSA upon admission/discharge) that have ended up having MRSA, or C-Diff after being on the floor for a few days. After everyone from staff and visitors have been in/out of that room. I honestly don't worry about it. As long as you are using common sense and precautions such as gloves when needed (such as you mentioned, while emptying a foley) there's no big worry. We had a patient on the floor that had been there for weeks that ended up finally contracting MRSA in her urine and then was put into precautions. What kills me more is the visitors that come in and out of the rooms and don't glove/gown up OR even worse, come out to the nursing station in their gowns and glove and lean all over the counter. We are always reinforcing/educating the visitors. I often tell patients that end up testing + for MRSA that they could have just as likely contracted it at Wal-Mart from a shopping cart. It's all around.

Re: the "letter" from Dr Stephen Frazer, here it is on snopes.com http://www.snopes.com/politics/soapbox/frazer.asp

wow, that's an early time of day to be passing so many meds. Here our daily meds are typically ordered at 0900 and 2100. Usually more a.m. meds. Certain meds are given @ 0730, such as protonix, coreg, insulins. Even with our big daily med pass @ 9 a.m. it is sometimes hard to get all your pt's meds passed on time (by 10 a.m.). The hospital where I did many student clinicals, the daily med pass was 8 a.m. I don't know how anyone could possibly get report, check vitals, and assess all their patients and give the meds by 8 a.m. That's just nuts! Another hospital I did clinicals at, their daily med pass was 10 a.m. which was more realistic.

I'm not old school (been an RN only 3 years) but we still do 3 glass cycles on our post TURPs or prostate surgery patients. I've also used granulex spray, so it can't be totally old school. It's the stuff that's sticky, brown and smells sweet. Comes in an aerosol can.

Protocol at our hospital is that larger bags of IV antibiotics (say 250 cc or higher) can be run as primaries as long as you flush before and after with saline. Smaller bags we will run with a small bag of saline as a flush. Since our floor is post-surgical, we get many patients that get multiple antibiotics or IV protonix daily ... most will still have primary fluids running, but some will not after a day or two. I cannot imagine running each separate antibiotic bag through primary tubing and changing that out each time out of the pump (besides the cost of primary tubing vs the secondary tubing). Protocol has that we change out a NS flush bag q 24 hours, and all tubing q 72 hours.

Why would you want to buy and bring in your own medical equipment? Glucometers every place I've seen have special hospital docking units to download blood sugars into the computer. Every patient here uses the B/P cuff in their room, as mentioned above, using it from patient to patient increases the risk of cross contamination. The only thing I bring in is my stethoscope and scissors, but really, we can use the scissors that come in the sterile packages for suture removal. And several nurses just use the cheap stethoscopes at work that are provided for patients in isolation. I honestly can see no benefit in spending your money on equipment that should be provided by your hospital, and also runs the risk of being damaged or stolen at work.

I cannot imagine having 9-12 patients on a med-surg floor! Yikes. I work surgical/tele med-surg, typically on days we get max 5:1 patients, sometimes only 4 (but you know you will get the first admission). Eves it is sometimes 5:1 or 6:1, and nights it is never more than 7:1. We often turnover half the floor in a single day (22 beds), we get a lot of admissions and discharges. Typically there is one aide to 11 patients. Once in a while there is only one aide(one aide only after 7 p.m. thru 7 a.m.).

Ditto except I work on a surgical floor and definitely prefer surgical patients over medical! We do get medical patients as well and of course many surgical patients come with many medical co-morbidities as well. I like post op nursing so much I started picking up prn time in our Outpatient Surgery unit. I'm also thinking about becoming certified in Med-Surg.

At our hospital, Respiratory is responsible for putting patients on their Cpap/BiPap and checking to make sure the equipment is working. Glad you called respiratory and no harm was done.

Just to add to the chorus.... No, no, no! You are not too old. I went back to school for my 2nd career in my late 30's and graduated nursing school @ age 41. 34 is young! I thought for sure I'd be one of the oldest in my class - not even close! I'd say I was about average age. There was a group of kids right out of high school, but the majority of our class was over the age of 30. There were a ton of students in their 40's and yep, even 2 50 year olds. It is never too late.

I'm about 22/23 miles away (depending on which sidestreets I take) - mostly interstate driving though, takes me around 25-30 minutes (depending on stop lights on the sidestreets)

1200 for a Diploma based program.

Most days, yes, yes I would.... Let me clarify... I hold a bachelor's and a Master's in other fields, and worked in the corporate field for a while. It's not all it's cracked up to be, definitely not my cup of tea. There is stress everywhere, in every field. I find it much more rewarding to make a small difference in people's lives -- tangible differences. You definitely do not see that working in a big company in the corporate world. I find more autonomy in nursing as well. Let me also add, that I *do* work part time. I think that makes a huge difference. I took a huge pay cut to work in nursing but my husband and I don't need my salary to live on, it mostly gets socked into savings. While it's a good paying field, there are plenty more fields where you can make more money.

the RNs have always done them here.

I too have used allheart before with no problem... until a few months ago... I ordered just plain white and blue scrubs and it took almost 2 months for all of my order to arrive. Very frustrating dealing with their customer service. I received part of my order fairly promptly, another part was clearly backordered, but the third item, I could not see that it was backordered or when/if was shipped. The phone # I found just directed me back to the website, no way to contact a customer service rep by phone. I had to write several emails to get an answer (not just a canned email response). I will never do business with them again. When I placed the order, I did not know it would take 2 months to get all of my scrub orders processed. I feel your pain! They are not reliable.

Honestly, who has the time?? I know at that time I am busy making first rounds and assessments. If they have a 7:30 (usually something like insulin or maybe a protonix drip, or PO) or 8 a.m. meds I usually give them first rounds. Luckily our daily meds are scheduled at 9 & 2100. Like someone else mentioned I wouldn't have a problem giving 9 & 10 meds together - we do have the window of an hour before and hour after. But as a rule, I don't have the time to be giving out all daily meds first rounds unless for some strange reason I only have one or two patients that have meds in the morning.

We deal with NG tubes all the time on our floor (lots of bowel surgeries and bowel obstructions). To check placement we use audible air injection. You have to unhook the NG tube from the suction, remove the small cylinder thing that goes between the patient's NG tube and the suction tubing, and use one of the big toomey syringes to inject air while placing your stethoscope over their stomach. You should hear a big belching sound. To flush, we use normal saline. 45-60 ml of NS into the syringe, and then flush the same way you did for the audible air injection. Then reconnect the tubing. I have never seen the aspirate method nor x-raying after NGT placement. We check placement at least q 8 hours on the floor. We also put in alot of NG tubes as well (RNs). Sometimes they come back from surgery with them placed. Hope that helps.

Yes, I always thank the CNAs every shift. I always appreciate the little things they can do for me (and vice versa).

We give all of our protonix IV in piggyback bags to be run over 30 minutes. Nexium isn't given at our hospital but where I did many of my student clinicals, it was the drug of choice and we gave it over 5 minutes with our instructors.

Part time - I work 20 hours a week (12 and an 8) - surgical tele.