mina123

Thank you so much!

What computer charting your hospital uses for level 3 NICU? I need to present some ideas for computer charting to my administration. Thank you for your time and response.

Does anybody recall how to get true calcium level for a pt? Google did not help me at all. Total ca level for my pt is 14.4, albumin level is 2.0. Also, someone please explain me the difference between ionized ca and total ca. If ionized ca means, free ca; what does total ca means? Thanks for the input.

First of all i did not publicly criticize anybody's job performance. When we have a charge position that charge should and yes her job describes her to follow with all the MD'S, lab values, call any critical result, put in medication orders and so forth. That's what the charge on our unit does. However some charge nurses completely leave the nurses hanging to do all the stuff and they are sitting around sipping on there coffee. As i mentioned in my post i already had 8am rapid response and intubation on the floor because no ICU beds were available. This charge nurse did not help me at all and i had 7 other pt;s wanting something or other. So yes it was crazy that day, and if i wanted to sneak behind her back and bad mouth her i would not have just casually in my conversation with my don IN FRONT OF A CO-WORKER SAID ANYTHING! meaning if i was ****** at her job performance or what not. It was just a blur of moment i said something and PEOPLE WHO OBVIOUSLY KNOW AND DO NOT HAVE SELF CONFIDENCE OF THERE JOB PERFORMANCE TOOK IT SERIOUSLY THAT IT WAS SAID AGAINST THEM! If any of the nurses goes and complains about my job performance i won't worry about what the DON has to say about it you know WHY? because i have 100% confidence that the DON will tell other nurses to mind there own business. What i am trying to say is these fake charge nurses know they are not able to perform any of the required duties then why do it at all??????????? If you are not able to handle your job let the assistant NM or DON know don't let the other 4 nurses on your floor suffer because you suck at your jobs. And in response of your favor i meant that i am not going to DON with the complain of F words and things like that which was said to me because again my DON is very strict and she might actually suspend them for few days and i don't want that for them on there record. I know i am a bigger person then them and if my heart is clean i really don't care what other person thinks!

Thank you for all your comments. Lesson learned. I like the advice of keeping the comments neutral from now on. I did not intent any harm to anyone but there are varities of personalities we work with and you never know who takes things personally or not. I have decided not to go to my DON this time and let it roll over my shoulders; i am not that type of nurse to go and get any body in trouble in this tough economy situation. My DON is excellent in resolving conflicts i do feel very comfortable with her, and i am a very strong personality everybody at work knows this but i am going to let this one go. However i am going to let both the coworkers know that i am doing them this first favor of letting this issue go, but next time they won't be that lucky. And hope they all are adult enough and professional enough to let this go and behave like good teammates.

I agree with NC girl post that;s very common in LTC I hope you are referring to night shift with that ratio, then it;s accurate ratio. Mostly blood sugars, no admissions at night and 6am meds. Most LTC facilities do smell like urine. In this economy if u need the money take the job keep your other options open, while still working there. I had a bad incident with one of nursing homes though. Used to work 3-11 shift 1:32 ratio, nursing assistants were very bad they would disappear on me and go on break without telling me. When they came back they smelled like pot smoke. I complained immediately to the owner of the nursing home and resigned the same evening. In between all this they manage to steal my purse and money and also my car keys. I called the local cops and everybody got investigated. So you do have to be very careful in picking your LTC facilities. Keep in mind the location of the place, staff u are working with. Some are good some i just don;t know how state keeps them functioning. Also most NH lacks supplies for u to work effeicently so if a person codes and your o2 tank is empty you are REALLY out of luck. So be careful in making your decision i won't do this for ever but because of economy u need to put your foot in door do so at your risk but always remember to leave the other foot on other end. Just my:twocents:!

I don't even know what happened at work yesterday but two of the co workers got really angry at me and started double tagging me in the break room. This is what happen. I work on a very busy med surg floor. We only have one assistant NM who is very good at her job and when she is working she takes cares of calling all the doctors, all critical lab values, any other issues with pt or pt;s families in a very smooth way. Basically when she is there the unit runs perfectly. But she only works three days a week that leaves 4 days out of week when someone else is in charge position. Now any one of the floor nurses is picked up randomly to be charge for that day. When any other charge nurse is there besides my NM i don't feel comfortable working with them. Because it seems like with a load of 8 pt's in morning shift i am also unit secterary, calling all doctors, managing disruptive families, and doing my usual pt care and passng meds responsibility. 8am i already had a rapid response with other craziness. MY DON asked me i looked so frazzeled i then in calm manner with one of other coworker standing next to me said i don't like when our usual assistant nm is not there, when some one else besides her is in charge all hell breaks loose. I did not by any means applied that other people in charge are not doing there jobs well; my only implication for that statement was it's just chaotic and crazy when someone else is in charge. So the charge nurse for that day and the other coworker who said everthing to the charge double tagged me in the break room and started saying F words and things like go to other floor and work. I remained very calmed and polite and explained how i felt. And even after my break on floor i talked to them very politely. But now i feel they are going to spread rumours about me which is not true at all and try to sabotage me. I have not said anything to DON yet. Should i wait and see what happens or tell the DON what took place??????

No we had ruled out everything very quickly no septic shock wbc was 9.2, no MI ck and trop normal, no stroke s/s at all, no pulmonary edema (-) xray and no dvt. It's just mind boggling though because his B/P and HR is elevated at same time. Usually in state of shock one is high and one is low. We just don't what really happened the doctor , cardiologist and me were wondering what just happened?? It's driving me crazy and i like to know my why and how something happened??? any more suggestions???????? I was thinking may be since the pt is post lap chole something is going on in his liver or with his kidneys btw bun and creatinine are normal so lets just say liver, pt was not able to metabolize the drug too well got acute reaction from the morphine per se and as soon as we gave lasix pt urinated and all v/s started coming back to normal. This is just my thought i don't know though still confused????????? I was thinking pulmonary edema at first too but no rhonchi no crackles just loud audible wheezing which completely gone after lasix!

I had the strangest morphine reaction with my pt yesterday. Just quick background elderly asian pt, 3 day post op lap chole had been receiving 2 mg of morphine from past 3 days without any problems. In our facility we do not mix morphine with saline dilaudid is mandatory mix with 10 ml of ns but not morphine. So i gave my pt 2 of morphine for his pain, within 15 minutes he started severe shaking, chills, temp of 101.0, b/p 180/100, svt and hr of 130 to 140, sats of 82 on 4 litres of 02 audible loud wheezing. Called rapid response team pt was fine after 1 hour of intervention with iv laisx, solumedrol ,pepcid per our crazy house md, stat ekg and chest xray showed nothing. Everything came out negative. So what happen to my pt? Some doc said it might be morphine reaction but in morphine reaction your resp depresses, b/p falls they can have nausea, vomiting which is common with morphine reactions. Has anybody else seen this kind of reaction with morphine, md also said pt does not have bronchospasms and really nobody knew what happened????????????????????????????

Thank you both very much. I am also a pediatric critcal care nurse. Just yesterday i got recognized in front of 300 people in a great ceremony for being one of the best pediatric nurse and being thanked by numerous families for taking care of there sick child as one of mine. I was in tears; only wished this other hospital can see our hard work and dedication but as you say good deeds always comes back in some way or another. Thank you !

Since last week nurses on my floor, me and other nurses work surgical floor are so unhappy with our management. We have wonderful group of nurses and aids on our floors. All of them very compassionate to our pt's and families. Great care from everyone day and night. Inspite of all this our manager who micromanages the unit is very unhappy with our jobs. We all feel like such failures and its not just me this is throughout the floor. We have got together and have talked to our director and unit manager we all are trying our best but the management still wants more and more. We work on a very busy hospital surgical unit. NO positive reinforcement, no apprecation for hard work done not that most nurses wants been appreciated everyday but by end of the day a simple thank you is all we need. We are out of our wits at this point any advice from anyone would be helpful!

Hi everyone i live in nj (south nj) to be specific. I was wondering if anyone can tell me a good NP school in this region. I don't like on-line nursing programs never worked for me, i like to attend classes personally just easier learning for me. I have A.A.S, and my Rn. I also have B.A degree in political science with minor in logic. So i was wondering if anyone can please give me any info on about how i can get my NP the fastest and easy way where it does not take me years to finish my school. Nurse for last 10 years; age 35 now; experience in acute hospital setting peds and adults. PLEASE, PLEASE some one reply i want to start classes this fall.

Or what about a quad who does not feel any pain or anything as a matter of fact below there neck needs dialudid for pain in there back or spine !

Sorry eriksoln; I appreciate what you have to say but I strongly disagree with what he had to say regarding sometimes in life being right is useless. Good god if i follow that quote I would lose all self-respect for myself. But regarding what you said being cattering to these pt's and many doc's and nurses do just THAT because its easy-- give them there dilaudid they will shut up for hr and two and the whole process starts all over again. I wonder what they do outside the hospital setting obviously they are doing illegal drugs to support there addiction so in a way we professionals are encouraging these drug dealers to sell more whatever they are selling. Do you see how just giving in to them eventually now or in future can affect us or our childern. I am a non-judgemental nurse and a great one at that but Yes i don't care about my job they can fire me if they want but I will not back down in making pt's and some docs realize that they have this addiction!!!!!!!! I was not worried for all these years but it seems like now more and more people are flying frequently to our hospitals just to get high!!!! Meantime my pt's who are acutely having problems are ignored because i am too busy making my freaking addict pt's HIGH!!! OHHHHHHHHHHHHHHHHHHHHHHHH I AM SO MAD:angryfire

Most of these dilaudid orders are give dilaudid IVP 4mg q 1 hr or maybe q2 hr. This is ridiculous !!! That means in my 12/hr shift i am giving this pt 48mg of dilaudid I just think this is crazy!!!!!!!!!!!!!!!

Recently i have been noticing a great amount of IV dilaudid addict patients. Nurses what in your opinion we should do? Giving the pain medication for post-op and other acute pain issues, i understand very well that we have to manage pt's pain. But the frequent flyer to our hospitals just bacause they are addicts in my opinion is encouraging these pt's and making a dilaudid/morphine society out there. Yesterday, i refused to participate in this with one of our MD's and demanded that this particular pt be sent to rehab for narcotic problem. Most of these pt's have pyschological issues to begin with. I refuse to be manipulated with this pt group and support there addiction in name of pain and medicine!!!!!!!!!!!!!!!!!!!

IMO the highest degree you have should be signed as or put next to your signature. It's no use putting Rn, Bsn, Msn and whatnot next to your name because it's just assumed if u have your Msn obviously u have your Bsn. I imagine the same can be said about MD's; if they signed every degree,license they have; between nurses and md's signature there is no place to write notes:yeah:

The only solution to this existing problem i think is to do what they have done in other asian countries. Make the nursing program 4 years mandatory that is u have your BSN, and that's it. NO RN's no LPN's just BSN. The whole confusion of what an lpn,Rn, or Bsn can do is resolved. Ask any philipino nurses who have recently come to america Do you know what an LPN is? And they will look at you like ? In countries like india and philipines there is no such thing as lpn, rn its only nursing degree with a BSN. Ofcourse to do this and avoid the present nursing shortage that means for the congress to grandfather all present lpn's to Rn's and RN's to BSN. And then we start a fresh batch of students of nursing only with mandatory 4 year degree program. I don't even know how this whole lpn/rn thing started here in states. Some genius sitting in congress was like hmmmm let me think we can start an lpn school with one year so these nurses can work in our nursing homes and such, then we will make a 2 year program throw them some more knowledge,care plans , iv meds and we got a whole new bunch of nurses to work for our hospital system and make us millionares. And we all fell into this whole scheme of lpn vs Rn. So in my opinion to resolve this whole conflict for god knows how long its going on stop all the BS and make BSN mandatory and grandfather people who already were screwed for all this time!!!!!

I definitely agree that an LPN should not be working in an acute care setting wherenow a days, there mostly are IVP meds. And for this particular reason hospitals have stopped hiring LPN's. But If I have an LPN who is willing to learn; wants to know the WHY'S before why something is being done I will be the first RN to explain everything to you. Heck my nursing assistant and unit sect who are currently nursing students ask me all the time if something i am doing ;if it is worth learning,to call them and show them. And on many occasions i have; i love to teach if ONLY you are willing to learn. AND no it's not an LPN'S fault at all as pagandeva2000 you say it's the state board's fault, its where they have mixed all the duties of LPN'S and RN's together and this whole thing is now so out of control that nobody knows what they are doing anymore!!! I know most LPN's rather just do there own IVP or there initial assesment, actually all this does not make any sense at all. If you are capable of doing care for a pt for entire 12 hr ofcourse you know what the hell you are doing!!!!!!! Any lpn can do an ivp or assesment its not brain surgery but as you say it;s not the LPN'S FAULT its the system fault and we don't get angry we just get frustated in the system on how it is managed!!!!!!!!!!!!!

No the problem for an RN supervising an CNA VS an LPN is not the same. Rn's are still supervising LPN's who are Licensed professionals. Everytime an LPN asks us to do an IVP meds it takes time away from my pt load, especially if u have a pt who is on q2 hr ivp dilaudid. Anytime an LPN gets an ER admission we still have to do your entire assesment, put in standared of care and do care plans for that particular pt meanwhile my ER admit is just chilling in his/her bed! Now supervising an Cna is easier all they are asking me is to help them with big,obsese pt's or pt's who can't turn themselves. Big difference in supervising an LPN and a CNA. Also when i am doing your IVP meds if anything happens to your pt it becomes my responsibility therefore MY LICENSE!!!!!!!!!!!! Which if u say you really worked hard for so did I! When u are asking me to do a Lasix IVP on your pt u better me ready to give me your pt's blood pressure and his/her k level. Lots of LPN's just say "I don't know", Do u see where this frustation comes from??????????????

Urinary tract infections big one i have noticed when i do hospital nursing; maybe also due to long shifts nurses we don't drink water; hold our urine for too long and when we have to pee we still are using hospital toilets; i take all the precautions TRY to drink enough fluids thru my shift but somehow still end with them each time i go back to hospitals for work!!!!!!!!!!!!!!!!!!!!!!!

Just today called the md because of my pt's blood sugar was 525. The order states Call md for blood sugar over 400. Md(endocronologist) says" just give the pt whatever amt of insulin you want to give; and hanged the phone. I was like WHAT THE :hdvwl:! Called the chief attending of the hospital c/o and few minutes later got the perfect insulin order from endo!!!

IMO every thing in america has to be politically correct. Equality for all and all that BS. YES MD's should be insulted if they consider nursing and medicine same. Nobody goes to 10 years of hard, tough schooling and difficult exams destroying there personal and social life to be called a nurse in the end. MD'S are MD'S and nurses are nurses. Respect your own place and work with them. Nurses and doctors are always going to be at this war in health care system. They have far more knowledge and education then we do I would be greatly insulted if i went to medical school and they intercept that with nursing. If everybody is so insulted about everything go get the highest possible education and be done with it!!!!!!!!!!!!!!!!!!!!!!!

I was an lpn for five years before getting my RN four years ago. I worked in hospitals as an LPN and was sick of asking an RN to do my IVP meds, my intial assesment and so forth. I like to work independently so i went back to school and finished my RN. While in school for RN i realized there is infact a big difference between the RN and LPN programs. RN program teaches you to be more of a critical thinker, to look at lab values of pt, assesing your pt more carefully and looking for any unusual cues, also there is much more pharmacology in RN program then in LPN program. So yes there is a difference between an RN and LPN. There is a reason why LPN's cannot do IVP meds or there first intial assesment. Members of state board of nursing are not stupid and there is a reason for what's in your state practice act for job description between an lpn and RN. Maybe if you are a good learner you can have these skills with your years of experience but i still think there's more theory and detailed learning in an RN program ALSO this does not neccessarily mean all RN's ARE SMART!!!!!!

per infection control 99% of nurses are carrier of MRSA in there nares. It's not a problem now when we are young and healthy but when we get sick OR if we get some immunosuppresant diseases that's when it becomes a problem. Yes most nurses are carrier but does not mean u actively have MRSA. Just like in case of T.B. some are active carrier some are passive.!!!!!!!!! AND true if they let people who are carrier of MRSA go there won't be anybody left no nurses and no doctors!!!!!!!!