shiccy

Is your job testing serum or hair? If its the latter, heres some scissors, and don't forget your arm hair!!

I'm a person that is very good (most of the time) of telling a patient what we're going to do so that they can prepare themselves accordingly. I have been hit less times than I have fingers on my one hand, never has it been more than a jab, and MOST of the time unintentional. My response every time is, "I know you didn't just hit me." I stop what we're doing in the position we're in (be it on the patients side, etc), look them straight in the eyes and say WITH authority, "You will NOT hit me again, do you understand?" I've never had a repeat offender. This also works well for those who are beligerantly cussing for no good reason. I had a confused patient that was cussing up a storm while I had a female RN helping do patient care. I let him get a few choice words out, and then finally said, "Look. We don't talk like this here. There's ladies here and they don't appreciate it. Stop cussing right now." He threw a couple more out, and a "who made you the boss" to which I replied, "We're going to go over this again." I had him a few times prior but this was the most lucid night he had had in a long time (pancreatitis r/t EtOH), and after that he had please and than you's coming out left and right.

Almost every trauma we get is put on Senna-S when taking PO b/c they are almost always on narcs and/or on bedrest (two hits for the ileus train)... Sometimes we enact a neuro-bowel routine (MOM on day 1, Ducolax day 2, Day 3 is bowel rest, repeat) if they haven't gone for a while and the docs are concerned. On a side note, has anybody tried crushing these freaking things for a person that is getting everything per NGT? AFAIK they're not contraindicated for crushing, but holy heck! The Senna A&B (I think) come in liquid, but the S does *NOT*. Such a pain (and waste of 10 minutes at minimum) As far as the "A" drug mentioned before, is that new? I've never even heard of it!

I take mine off when it gets heavy and place it where I plop for the night for long term charting purposes... We have computerized charting, but it's a pain to log off and log back in b/c it takes >3 minutes each time (multiplied out it becomes ridiculous). We have enough computers for each RN to have their own station on night shift, so sometimes between assessments my stethoscope comes off. Typically, though, it stays around my neck as it really doesn't bother me there. I've been wondering how well those clips for your sides work, but haven't wanted to pay $$ to get one. Unfortunately none of the inservices I've been to have given them away for free that I've been to yet

http://www.google.com/images?um=1&hl=en&biw=1333&bih=657&tbs=isch%3A1&sa=1&q=ear+wrinkle+cad&aq=f&aqi=&aql=&oq= I had to google what you were talking about. I had never heard about this before! From what they're talking about, the older gentleman with the crease near where a normal earring on a woman would go is what they're talking about. I'll have to look for that incessantly now! The only thing *I* look for is clubbing of fingers. I'm sure you guys/gals all know what that is, however it's indicative of chronic hypoperfusion, though it's a really late sign. The only problem is that my sister has the start of finger clubbing, has no health problems, and is only in her 30's so obviously both of these signs aren't 100% accurate :)

It's actually quite rare to find places that use heparin these days. From what I understand case studies have shown that using heparin to hep-lock vs 0.9NS has no advantages and can actually be very bad for a patient if the line is FLUSHED without aspiration, especially in those patients with coagulable states (this is what *I* learned in school). The disadvantage to 0.9NS is that in order to maintain patency you must flush Q12 or Q8 with a predetermined (10ml typically) amount of saline. I have never worked at a heparin-using facility, so I don't know if those people have to flush in the same fashion or not. Finally, all of our dialysis catheters are "locked" with Sodium Citrate now. I am not 100% familiar with this anticoagulant as the dialysis RN's are the ones that dwell the med in the catheters, however from what they have told me is that unlike heparin, when it's disseminated in the blood stream (aka if it was inadvertently flushed through the catheter before aspiration on accident, or if the med was unable to be removed via aspiration), it inactivates nearly instantly so there's little to no bleeding risk. I don't know if this is the truth, but from what they've said this is the reason they've made the switch. ... It keeps the line anti-coag'ed so it remains patent, but also is lower risk than 10k unit dose of heparin. Ps- I'd use your school's CINAHL access to see if you can find the studies I'm referencing. I no longer have CINAHL or I'd try to do it myself.

First off, as someone else posted, Haldol is *NOT* contraindicated in the elderly, as with *all* antipsychotics/anxiolytics/narcotics/etc it should be used under extreme caution and with strict monitoring. It's better to have a closely monitored patient WITH Haldol than a person without that is throwing punches, abusing staff, and possibly hurting themselves/loved ones. To be quite honest, many if not all practitioners will use Haldol hands down first choice over any other benzo's. The main reason is it just plain works for those that you can't get calmed down. The other is that benzo's actually can INCREASE anxiety/restlessness in those that have dementia. As for the original poster, I'm sorry but I'm not going to be any help in this circumstance other than saying that I'm sorry this happened to your loved one. It's hard to go through the mental anguish on BOTH sides with dementia/etc. This being said, this is kind of a "medical advice / legal advice" thing I wouldn't touch/comment on with a ten foot pole (and quite honestly dances on the lines of violating the TOS asking "what you should do" about possible "abuse" or "negligence" of a loved one.) I'm honestly quite surprised the topic is still open, because I've seen many other topics closed for much less, but all done appropriately so. I guess the only thing I can suggest is to ask questions. Also an INR of 2.3 is therapeutic for most patients. This said, please look at the common side effects for medications he's taking. Trauma doesn't have to be very much when you're talking about altered coag times. Hope his condition improves!

We have text paging as well. We don't have computerized ordering yet in our hospital, so when we text page, what *I* would do is put a room number and the reason for the page. The PA's in house would make a decision on whether it was important or not to call back immediately or "asap". It creates less aggravation for them when they call back for something unimportant between stitches. A room number alone is not a violation. Name, room, and MRN/DOB *is*, though IIRC txting is encrypted so unless the pager is lost it shouldn't matter.

Coming from not only ICU but also vascular unit, it would be simply unrealistic to do this for our patients. We look at feet/use dopplers every 30 minutes and then every two hours until transfer to the floor. It's just not feasible to do hospital corners with these checks.

When I was first reading your post I was asking myself, "I wonder if you've made it clear that what she is doing is ridiculous?" I guess the way (if you're interested in furthering the relationship) is to NOT talk online, but on the phone and just give her a, "Here's the deal. This is really bothering me, and I want you to hear me out." The first thing I would do is make sure she knows that what she's doing by video taping / snapping photos is in some places absolutely illegal, but also exceptionally rude. Everybody has the expectation of privacy when they're in the hospital, and *I* have the expectation of not having people come find me at my house after taking care of their loved ones. Posing the question, "If you were at work, would you find it appropriate for people to snap photos of YOUR name badge?" The ultimate finale to your conversation is this: If she refuses to listen to reason, refuses to change her way, and YOU find it unacceptable and not good for your mental health (I wouldn't think it would be), then I would definitely tell her, "I'm sorry, I understand you have health problems, but from what I can see you're trying to blame somebody else for your issues. You need to realize these are people that are trying to help you, and the only reason you're getting the impression that they're being jerks is solely because you're being an a**hole to them first. Very few people are in the nursing or medical profession for reasons other than wanting to help others get better and further their lives. Until you can realize and accept this, and stop being such a horrible person every time you're admitted to the hospital, for my mental health I'm not able to be friends with you. You are the exact reason why some days healthcare professionals have a horrible day at work. If it wasn't for people like you and you're disparaging attitudes towards others and having the mental image that we're there to attempt to hurt you on a daily basis while admitted, then our jobs would be so much more enjoyable. Please revisit your attitude, check it at the door when you get admitted, and maybe realize that being a bit more humble and less of a bi**h is a nice quality to have. Until that time, though, I don't really think I have anything in common with you anymore. I'm sorry that God gave you an illness that you are disabled from, however had you not had treatment from this disease, you would probably be dead right now. If you are thinking this is a proper and amazing alternative to the way you live your life right now, then make yourself a DNR-CC or DNR-CCA and leave it at that, and leave it in God's hands." Alternatively you can ask her to see a psychologist, however I highly doubt she will. I'd never EVER be able to tolerate that. And when I'm confronted by MY friends that DO have disparaging comments about healthcare, I fully listen to their complaints, and then give them both sides to what COULD have been happening. If they refuse to listen to it, I change the subject and move on. Finally, you don't need toxicity in your life. Cut that complaining jerk out of yours. You have to deal with enough of that s**t at work yourself.

There are literally at least 10 different threads on this. Use your google skills to search for your specific area, and/or please please please use the search function on the boards

Ca++carbonate is well known to give what called reflexive dyspepsia. That's why on the commercials for things like Zantac they tout how the relief comes quick and stays away rather than other "chewable" alternatives. Personally it gives me extremely acrid eructations and then any reflux I had comes back just as bad if not worse a few hours later. Ps - I'm not recommending any medications over any others, but the reflexive dyspepsia was explained to me as such: Your body realizes that the acidity isn't where it wants to be when the Ca++ carbonate starts working, and turns on MORE pumps to return pH back to where it wants to be, sometimes not turning these additional pumps back OFF right away. Hence worse than when you first started.

I hear that all the time, but it's not the families that say it, it's people that I work with INCLUDING RN's that I went to school with! I never understood it. Course I'm also the one that calls a SPO2 waveform by its monitor name, "Pleth" (As in, "His sats are in the 80's with a good pleth (waveform)).

Couldn't agree with you more. Both my signature AND initials look exactly the same each and every time I write them (sans the VERY infrequent times I screw my signature up). Because of this and the fact that I'm pretty sure they keep *darn* good records of who has which patient on whatever night, it's not that hard to figure out who is who. This paired with the fact that both my sig and initials are *very* individualistic, it's not hard to tell who is who. I have completely given up on making my signature legible. If I were to write legibly, my signature contains 13 characters NOT including title. This would take half of the night with the nights I've had recently. (point in case, I counted 2.66 pages of orders, each with 3 locations for orders, all 8 spaces written by myself, all of which required separate phone calls to separate docs, all at different times, signed by myself.) It would have easily taken me twenty minutes vs. the 15 that it probably took me to scribe all the orders I *DID* receive had I written out my entire name. Not feasible. My name *can* be shortened, but that's not the name on my license, and therefor it's NOT a legal document if I *did*. Ergo, short scribbled but individualistic is the key for me. PS- Our program that we can look up hospital MD's privaleges now has a scanned in area for each and every doc's sig to be scanned in so we can compare it to notes JUST for instances like this. They *should*, IMHO, however HAVE to rubber stamp everything they put on. Especially since some groups (cardiology, ortho, etc) that have 20+MD's/NP's/PA's in ONE group coming through on any random day.

haha In addition to your diabetes term, we have a lot of people around here calling it just "sugar" as in "My mom had sugar" I have heard, "Dilauda", or "Dillydaud" instead of Dilaudid.

I've never been fired/hired into the same field, so I DON'T know how THAT feels, BUT I have been fired/hired in the service industry before. First off, congrats on finding a new job because that's a super hard portion of the process. Secondly, it's something that you will get over, but it'll be some time. It's kind of like a PTSD type thing for me. I was completely blind sighted myself, so the only thing I saw I could do was buck up, DON'T do what I did to get me fired, and go on from there. PS- I was fired for a BS reason myself, and quite honestly if I wasn't so young when it happened, I could have had a very nice payout from the company for a hostile work environment. Long story short I was prodded on the shoulder and SCREAMED at that if a person died on my watch (mind you NOT healthcare, AND *I* was doing my job, but that's all I can say) that I would be held personally responsible for negligence (which they would have NO ability to do towards me what-so-ever, but I didn't know this at the time. Finally keep in mind people get their just desserts. The person that had me fired was in the end fired himself. Not for that particular instance, however in the end said person had to find a new job.

IIRC Nuvigil is what my coworker was placed on as well for this same disorder. I have NO problems sleeping during the day, but my neighbor has three German Sheppard dogs they leave outside in their fenced in yard. This wouldn't be a problem, however the fence where they bark at passers by is right next to my bedroom window. It's one of the things that will wake me up when I sleep (one of the VERY *few* things, even with a fan on). My problem is that I am never EVER able to get up enough energy to do anything until day two after working, and I rarely can get myself to do exercise because I feel so freaking "blah" after working like we do. I *do* take melatonin, but not consistently. If it's time for you to go to bed, it works WONDERS. Be aware, though, you'll have the most VIVID dreams that it's ridiculous. I've actually had dreams that were so vivid that in the morning I couldn't tell if they were real. 99.9% of these dreams are not nightmares, although I do have them with the melatonin from time to time... Point in case, I had a dream that my dad passed away and my dream took place weeks after his death. My dad is very much alive, however it was so distressful that I woke up and called him immediately. I'm actually tearing up right now because of the whole thing. In any case, I hope this works for you. I would be really interested in knowing whether the nuvigil works for you or not...

This does seem to be the theme with LTC's for some reason. It's a shame they're run by what seems to be one head person and nothing gets done because of this. What I would suggest, and have heard, is that you complain higher than the DON if that's possible, which usually it is. I had a similar issue with a ancillary staff person that has been in the business AS an ancillary staff for >25 years. To make matters worse everybody knows she's the way that she is. I am a person that doesn't put up will BS. If you can't act like an adult, that's fine. I don't really care, however at the same time I refuse to be your friend if that happens. I'm cordial and courteous as I can be to everybody. That being said, what ended up being the final straw she was trying her hardest to get me written up for signing off orders after *I* processed them -correctly- and putting things back where they needed to be. Long story short after speaking with a FEW supervisors they have all sat down and talked about it. It happens that there's a personality conflict - ie- she just doesn't like me or my personality. I didn't do anything wrong, but it didn't make the lateral violence any less real. I guess what I'm saying is DON'T take it. If they are doing things to make your job harder, call them out on it in a diplomatic way. NEVER get cornered or caught in a room by yourself with them because they can make up any lies they want about you and disseminate as they see fit. Finally, DO take the issues if they continue to the DON, even IF they're friends. If it continues, then take it higher up. If others are interested in having the lateral violence stop as well, having more than yourself complain if things don't shape up is something that MUST happen. Good luck. I'm still working on my issues, but at least it's out in the open after I opened the can of worms with my supervisors. After that happened, things calmed down considerably. I'll never be this persons friend, but at least I don't have to deal with her being a jerk.

What others have said - you're not alone. What I would suggest, and I have no idea who you are / what your situation is, but if you're single, consider travelling and/or getting yourself a job out of town. I know it stinks to move, but sometimes you have to do what you have to do. This said, also, there *is* the possibility that you are a type of person that is a poor interviewer if you HAVE had interviews. I would suggest, in that case, to go to your college and see if they have a 'how to interview' seminar type thing. I know mine did at the library. They teach simple, yet stupid things such as "how to shake a hand correctly" ... it's a science (NOT KIDDING), how to smile ... always, and how to sit, stand, dress, etc. You might also need to revamp and make your resume pretty. Many universities also help with this, so ask them! (yes even after graduation). Finally, stop focusing on the fact that you are a new grad and focus on the fact that you're looking for a good job, eager to excel in your field, and are COMMITTED to working at a place (any place) long term. Stroke their egos, tell them "I've heard so many good things about you and how much your workers love working for a great place, etc etc etc." And if all else fails, and if you've only been looking for acute care, try to get a job at an LTAC, LTC, or ECF. Sometimes LTACs pay is just as good, and you don't get the super critical patients that you do in hospitals. Plus you get your experience they're looking for, and are able to move to a hospital in the future if you wish. Finally I know it's frustrating, but look up. You'll find a job in the end and it'll be awesome (and very stressful), so stick it out, and realize all the things school DIDN'T teach you! haha.

I was in pre-med prior to changing degrees. I realized how little time MD's get to spend with patients and how long their days are. I was in it to help others, not to pad my wallet, but also wanted something that I'd not be a 'starving artist' type individual. RN is enough to keep you happy and working, but definitely isn't something to make you exceptionally rich. Not ALL MD's are like this, however many are - You're very overworked, way more than a nurse is time-wise. Us nurses get the luxury of doing our three 12-hour shifts (or 8hrs shifts if you do nursing at a doc office) and then get to go home. We don't have call (unless you sign up for a position that has this), and they can never MAKE us work when we're not scheduled. Emergency Room MD's are never on call, and only work when they're in the hospital. Also, they NEVER see out patients ... they're strictly ER docs. Physicians are on call for their practice on a set schedule, obviously, but when you're on call you will get the people that will call for the most mundane and ridiculous things. You will also will get calls throughout the night from floor staff when patients aren't doing well. When you're on call this type of communication happens ALL NIGHT LONG. I've seen docs leave at 11pm (I work nights) and the same doc is back into the same unit at 5:30am. And they do that routinely. I guess if you're looking at money, this is totally the way to go. If you're kind of an anti-social person, and don't really care about things like being with your significant other hardly at all (except the one or two vacations you SOMETIMES allow for yourself), then MD is the way for you to go. If you are one of those people that money isn't really the most important thing in life to you, and you'd rather be happy, I'd suggest the RN route. I know I'd never be able to be happy working like a dog like most MD's do.

Google is your friend, but many places have rules against talking about such things

Bard may test foley's in the factory, but latex and rubber are fickle things. They change very quickly with levels of moisture and temperature. If your supplies are on a cold truck for a long time, there's a chance the rubber/silicon can warp or even crack (for the person that had said they have 3 foleys/year that rupture. I guess what my thought process is I've never seen a difference with foley's pre and post inflation after testing. Something that has to be said, as well, is that if your hospital policy states to NOT test the foley, then DON'T. This is something that can change after you are out of school. If your hospital does NOT have a policy on whether or not to test the balloon before insertion, and you learned to do it in school then at least by Ohio law you SHOULD test it as it's officially the authority on whether or not to do something if your hospital policy doesn't exist. IF your hospital doesn't have that policy in place, then you can advocate to get it INTO policy. This being said, I've not put a TON of foleys in (they're usually done in ER/already done from day shift for the new admits), but the few dozen I've done I've never had one that wasn't intact.

I don't know if this is a possibility for you, but have you tried finding another job part time to supplement your income? Obviously the new job would have to be willing to work with you on your schedule to overcome conflicts with your current job, but it's not something that can't be done... Another option is being per diem. Finally, if you wanted to tell the current job, "Stop filling the spots w/ RN's or I'm going to have to find a new job part time and you're going to have to work around my schedule more" type of conversation. It seems silly to pay an RN to do the job of a lower compensated individual (I'm assuming so if I'm wrong I apologize) but what happened in OUR hospital is *all* LPNs were informed they have to work towards their RN by "x" date or they wouldn't have a job anymore. Also ASN-RN's were informed in order for the hospital to go to Magnet they would have to possibly get their BSN soon as well, but no finite plans were in place last I checked. It makes more sense to have more ancillary staff b/c it takes more time off RN's and LPN's, but some administrators think that eventually eliminating jobs such as LPNs, Unit clerks, etc. will save money and lives in the long run by replacing them with "higher education" individuals. ... which is not true, and is actually POOR for patient satisfaction. Coming from a person that worked on a floor of 20 patients with 5 RN's and (at most) 2 NA's, there were MANY times where there was nobody in the station for a long time, so having a person like yourself to do be on monitor duty would be a huge help to us, but alas it's not in the cards apparently for our hospital. Hoping it's just a "your floor" thing and not a hospital wide trend.

EBP from my understanding is that instilling actually creates a higher risk for instances of pneumonia. Interventions that I've seen is adding a heated circuit to the ventilator line, or if the patient is on t-piece, adding in moisture helps. Some advocate for more frequent Sx, but I don't really think that helps much. As said above the Inh mucomyst is sometimes ordered, percussion, etc. Resp neb Tx's by themselves sometimes are effective.

The pneumococcal vaccine is a government standard of care. It doesn't treat the patient for pneumonia, and IIRC doesn't actually give a good amount of immunity for a few weeks. The reason why it's important, however, is that if a person qualifies for it then they area already at a higher chance of getting the illness and possibly dying from it. This being said, if it were me and it was not on the new MAR then it should be carried over for clarification for the next shift so it can be taken care of before discharge. It's ultimately day shift's responsibility to make sure that it was given prior to discharge, HOWEVER it's also your responsibility to make sure day shift knows you didn't give it and it might be an issue. Ultimately if it comes down to anybody it'd be the person doing the discharge, so technically you're off the hook or should be.