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  1. NooNieNursie

    Sleep-night shift

    300 of seroquel is pretty massive. I find with seroquel the sleep benefit stops after 75mg, then it becomes stimulating with no further sleep benefit. It is after all, an antidepressant at low doses (like 150- 300mg) and only becomes more of a downer at much higher levels where its antipsychotic.
  2. NooNieNursie

    Sleep-night shift

    i used to have very bad insomnia. I also work nights 2x per week and long shifts. Now, I sleep 6 hrs on my long shifts (purely because of no time to sleep more) and on days off i sleep 7-8+ hours. And i had BAD insomnia. Light regulation is crucial. At the end of my shift i wear blue blocking glasses. You can go on amazon and research this. Buy the sunblock + blueblocking kind for the drive home. The regular blue blocking without sun blocking can be used on days you dont work. Thats another thing - you have to stabilize your lifestyle patterns. You can NOT live in the daytime anymore if you accept a night position. Every day you have to sleep approximately the same time. Iin my case, on my long shifts i hit the bed around 7:45-8am. On day off work, i sleep at about 6am. I never ever live in daytime and every day i wake up at 2pm. The stability of patterns is as crucial to maintaining a circadian rhythm as light control. You know to keep room dark which is good, but is it REALLY dark? I have 3 layers of black out curtains. I have a red curtain, a heavy brown curtain, and a normal blackout curtain. My room is dark when all the shades are drawn, literally black. Waking up at the same time every day, like going to bed the same time every day, is crucial. As stated, I wake up about 2pm, every day. My body does this naturally now, buti also use a sunrise alarm to assist on work days when doing shorter sleep/longer shifts. Upon waking make SURE you see very bright light, especially important in the dark months as a nightshift worker because the sun will start to set sooner than you can go out to see it to program your body rhythm. So, you will also need to buy a light box. Super bright light upon waking, as in a light box, is just as important to cement your circadian rhythm, as the regular wake+sleep times, and the darkness while sleeping. Finally, there is meds. I use low dose seroquel, which has helped extend my sleep from 6 hrs to 7-8 hrs. Almost all people find seroquel to be like MONDO for sleep. However, i bet if you do the above protocol I describe you probably won't even need it. The bottom line is, if you are night shift, you're NIGHT SHIFT. You cant ever live in day, not even on your day off, not even because you want to go to lunch with your friends. It will royally mess your body regulation up and you will never sleep. Night shift can be done but it takes a big commitment to controlling light and sleep times like a nazi. Most people are unwilling/unable to do this and just end up sleep deprived forever.
  3. NooNieNursie

    Am i potentially liable for this incident?

    Hi I was hoping to solicit feedback regarding an incident that occurred this weekend at work (subacute/LTC facility). I was supervising RN on duty. The pt in questions' primary nurse is also a RN. Pt had a fall event @ 1am. Physical assessment revealed a hematoma with scant bleeding to the back of the head. The pt denies pain, mental status is baseline, neurochecks are unremarkable. I paged the physician for the primary nurse with no response. Neurochecks were done as protocol throughout shift and remained unremarkable with pt voicing no complaints and no change from baseline. The physician was paged 3 times and never responded. I notified the family because of the nature of the incident. I explained the nature of the incident, our interventions, and we were awaiting for physician return call for further orders. The next of kin was accepting of this. I endorsed to the next shift to continue to try to reach the physician and continue neurochecks as protocol. When i returned to work i was notified the pt was sent to the ER and was found to have a subdural hematoma. The family was understandably upset and holding our facility liable. I do not know if they have any intent to take any legal action. My question is, am I legally liable for this pt's case? I'm not sure where culpability lies as I was supervising RN, however the pt's primary nurse is also a RN. In a worst case scenario if this case did end up in court, would I be held partially accountable for this case? I did not document in the notes, as again the primary nurse was a RN, who did her own assessment and documentation although she noted I, the supervisor, was aware and I was the one paging the physician. In a case such as this, if the supervisor holds the same license as the primary nurse, are both seen as responsible legally? Thank you.
  4. NooNieNursie

    Am i potentially liable for this incident?

    Not to be argumentative but you're describing a non medical scenario. The sleepiness of the gentleman is an early sign of brain injury. His friends did not know this. If they did they would have called 911 rather than let him take a nap and become a vegetable. In our setting we knew to keep the pt awake all night to monitor him. At no point did he become sleepy, remained freely communicative and baseline. Per my director our policy is to do neurochecks and report to the MD. In hindsight i could have called 911 ems, and i think in the future i will take that action simply because this puts unwarranted risk on me as the second layer RN.
  5. NooNieNursie

    Am i potentially liable for this incident?

    Exactly which is why i contacted the daughter, i was very clear he has evidence of swelling/with brusing on head but is otherwisestable. We are waiting for MD to return call. She was like "Oh, ok, i'll be there during day" Later i received endorsement they were furious. I had the primary RN chart the MD notifications as well as notification of family. I was hoping the family would demand an ER transfer where i could justify my actions as family request for emergent transfer. But they didnt. They still ended up blaming our facility and the MD. To my knowledge they did not blame the nursing staff, but in legal cases, that can easily change if they contort i violated a policy/procedure. My facility did NOT have policy procedure manual on unit. However, my director has verbally told me if pt is stable after fall event and evidence of head injury our only policy is to initiate neurochecks and contact MD. Pretty sure that does not hold up in court, however. My director told me my actions were appropriate and i followed procedure, but i am pretty sure she will say anything to get me to take the more "cost effective" solution (not transfering pts). If i am in violation of procedure, thats on the RN license on the floor.
  6. NooNieNursie

    Am i potentially liable for this incident?

    For an emergent transfer of course we call 911. This does not require a Dr's order. To get a CT scan to head when pt is otherwise stable, that requires a drs order. Now some Dr will give nurses room to make those judgment calls, but some Dr's will refuse to order a CT to the head after the fall unless pt is on coumadin, eliquis, xarelto, lovenox, heparin, etc. I've seen Dr order CT's after a fall to be done days later, as well. If i had just sent the pt w/o a physician order, and lets say pt sustained injury during transport or in ER, then i would have been liable for that. I'm sure the Dr would have thrown me under bus (as Dr is trying to do now, throw me under bus for NOT sending him out w/o order, bcuz HE decided to turn off his pager all night). I want to emphasize this pt had a primary RN doing neurochecks all night and was reported to be stable, no change in hematoma, no change in condition, no report of pain. How can i order a 911 EMS transfer for a stable pt? And again, getting a CT to the head require a MD order. I could have just assumed MD would be okay with that (and that was probable), but its also *possible* he wouldn't be, and there is always a small risk with anything, even pt transfer to ER. I've seen pts get injured during transport as well. If i had the legal authority to order diagnostic tests and transfers i would have of course ordered this pt to get a CT then. I do not have that ability, I am a nurse not a MD, and the pt was not unstable requiring 911 EMS call. The only thing i could have done differently was call the medical director. In hindsight i should have done that. But again, the pt was stable, as per report from the primary RN who was the one actually assessing and monitoring this pt.
  7. NooNieNursie

    Nurse in drug rehab

    By your own description she's presently in drug rehab. Rather than try to ruin her life why dont you support her in recovery and hope she actually can become a functional nurse? If she wasn't in rehab your actions/desire to stop her from working in nursing would make sense but it sounds like she knows she has a problem and is taking appropriate steps to be rehabilitated. Who is to judge and sentence her from ever working again , when she's actually attempting to rehabilitate herself?
  8. NooNieNursie

    Law suit against my facility...

    Hello, I'm a RN supervisor working in a subacute/rehab facility. There was an incident a few weeks ago involving one of our residents which resulted in injury. The attending nurse on duty was an LPN. Obviously for confidentiality reasons i am not able to give details regarding the incident and case . I have been notified the family is taking legal action against our facility. Since i was the supervising RN on duty and the immediate nurse was an LPN, i am aware legally i am responsible for the care and treatment of this resident. So obviously I am very concerned this may implicate me in the law suit, although to my knowledge I am not being named in the suit and it is only against my facility. I was wondering if anyone had any advice what i could expect from this? What would a worst case outcome be? If this case goes to court, would i have to appear in court? Would they take action against my license? Can this jeopardize my future in nursing? Any feedback you can give me regarding what to expect would be welcomed.
  9. NooNieNursie

    <NEW GRAD for a year now, NO JOB!

    Go to LTC or rehab. Hospitals just aren't hiring right now.
  10. NooNieNursie

    Improved Nursing Employment Market Predicted

    Ok, so I suppose then if immigration is not a factor in the NE nursing job situation, it must purely be a coincidence that every single facility in my area is staffed almost exclusively by immigrants. At my facility, the vast majority of nurses are foreign. To say this has no factor in the NE job situation is foolish. It is obvious to anyone working here that immigration of foreign nurses is the major reason there are no jobs right now. The second reason is a glut of sub par nursing programs (which do not properly train students) pumping out new nurses (many of whom are also foreign born).
  11. NooNieNursie

    Nurse to Patient Ratio

    Yea, if it is a subacute/ rehab / transitional care unit 11 to 1 isn't so bad as the patients are usually (though not always) stable. If it is a LTC unit, that ratio is ridiculously good. IF it is acute care that is horrible and unsafe.
  12. NooNieNursie

    Nurse Manager Write-Up

    Oh and odds are the ICU attending threw a whiny fit at the NM because he didn't like the order, rather than being a man and taking it up with his colleague (questioning/whining at him why he made the decision he did). So the NM just took it out on you because she needed a scapegoat.
  13. NooNieNursie

    Nurse Manager Write-Up

    Um, if the drug is appropriate, if the dosage and everything was reasonable, if the MD orders it, if you verified the order with the MD and questioned it, if it is not against your scope of practice or rules/regulations/laws of the facility to hang that drip... there is A BIG FAT ZERO reason your nurse manager should be angry with you. The role of the nurse is to carry out physician orders (assuming prior conditions outlined above were met - i.e. the order is correct, you verified the order, it is an appropriate order and the doctor has not lost his mind, it is within your scope of practice/facility regulations to do it). Sometimes certain nurses forget that they are not doctors and it is not their job to stop physicians from performing the treatments their medical education leads them to believe is best. These nurses **** me off. Uppity managers. If she tries to write you up she has zero grounds to do so on, you did everything appropriately. I"m not a CCRN but this is beyond obvious. I see this attitude everywhere. There is a fine line between questioning the MD and using good nursing judgment, vs being a jerk/overstepping bounds.
  14. NooNieNursie

    Improved Nursing Employment Market Predicted

    Says who? Why are nurses entitled to good money? Every other single american worker has dealt with this hard truth already - the outsourcing (or emmigration) of labor. Nursing was merely one of the last disciplines left which was untouched. Now we are seeing that, just like all the corporations set up shop in china, all the medical corporations are facilitating / promoting emigration of haitians, filipinos, africans, and others who will work for less money, with less benefits, with poorer working conditions. When did the working conditions improve for the american factory worker? Oh yea, they didnt. The american factory worker no longer really exists. People who used to be factory workers just decided to go to college instead saddling tons of student loan debts, with the hopes of getting an office job, a sort of ponzi scheme on behalf of banks. College used to be elite, now it's a given, because it is like highschool part 2 - bare minimum to earn any kind of living. Conditions never will improve for nurses because just like every other single american figured out decades ago, there are too many people and not enough jobs, and guess what, people from third world countries will win as they bid lower.
  15. NooNieNursie

    Improved Nursing Employment Market Predicted

    Here's reality. Nurses from many other countries come to america and compete with us for jobs. These people are used to (comparatively) poor working conditions and less wages, so the companies prefer them. Companies in america, particularly rinky dink rehab and LTC facilities hire insufficient nursing staff because they can get away with it. Even though more than enough nurses are available for hire, they simply CHOOSE to hire less nurses because that big fat CEO needs a brand new gold walking stick. Nurses are usually female and often are of minority backgrounds and are immigrants so they are easily exploited (compared to white male amercians, or a "WMA" as eddie vedder would say). In nursing, for some bizarre reason, it is considered completely acceptable normal working conditions to run around like a dog without taking time to tend for basic self care such as using a bathroom, eating, or drinking. These are considered luxuries in nursing. This perception on behalf of nurses that it is normal and acceptable to just work 8 or 12 hours straight without a proper break ENABLES these corporations to habitually understaff nurses. When you have a group of women, minorities, people who speak english as a second language from poor countries, who have been conditioned to think sub par working conditions are acceptable, is anyone really surprised when the corporations keep things the way they are? The end result is nurses cannot get jobs, and those with jobs are miserable usually because the working conditions are so poor. Originally we were told lies that the working conditions were poor because of a "nursing shortage", which sometimes this was true, but usually it was a complete lie. They cannot get away with that bullsh*t anymore since it is obvious most of us can't find jobs due to the companies refusing to hire, and yet we still see nurses in hospitals, rehabs, LTCs and other facilities being worked like dogs. It's just normal. I look around my area at ALL these crappy facilities which hire ignorant people who barely speak english, minimally trained at fly by night schools, some of which were not properly accredited by a state board of nursing, fresh off the boat because they are easily exploited. They grossly understaff nurses, undersupply units, and they just get away with it because they make a concentrated effort to avoid american emloyees if possible. I work a rehab center and I have watched this facility trade hands recently from a relatively good hospital company to a notoriously bad nursing home company. On payday today every single employee was underpaid, they cheat us out of hours, they cheat our rate, they hide our "benefits" from us so they can scam us. No one is paid a full 75 hours, even though we don't always take breaks and usually stay after shift doing hard work. The patients are not supplied basic things lthey need for dignified care, like peri wipes. Conditions for nurses at work are no better than they were when there were less nurses. This country is pretty horrible in general. I always knew it but now my eyes are wide open.
  16. NooNieNursie

    Nurse Fights for License After Sex With Dying Patient

    She is a dirt bag. She clearly likes attention, too, and drama. Why else would she tell a dying man that she cheated on him and is pregnant?? He has no need to know that, he is dying soon. You have a dying man and you are trying to make the remainder of his life better , not worse. How conflicted he must have felt before he died. I don't care if its brad pitt, how can you sleep with a DYING patient... and then mess with his head to the point where he kills himself? If this were a doctor and a female patient, the story would be outrageous. But because it's only a nurse, and a woman, it is somehow forgivable? Think about his wife! This is how she remembers her husband. HIs children must be so ashamed as well, and hurt. She should never be allowed to practice nursing again. She has proven herself unprofessional and incapable of behaving in a professional way. You know, medical professionals are people and sometimes you are attracted to a patient, sometimes a patient is attracted to you, whatever. You can't just throw out standards and morals, you must be a professional at all times. The fact it was a dying patient makes it so much worse, IMO. Again, think if it were a physician and a female patient who was dying. This conversation wouldn't even exist. It would be outrageous. She should never be able to practice again.
  17. NooNieNursie

    LTC to Med-Surg

    Good for you :) You give me hope that I can land a hospital position one day. I did LTC for about a year and a few months.... I've been doing subacute/rehab for the rest (I will have 2 yrs nursing experience in october). The LTC's were sometimes skilled, but my subacutes are almost always skilled with surgical wounds (cardiac surgery, ortho surgery), PICC lines, TLCs, IV abx, TPN, many PEG and colostomies, trach once in awhile...etc. We get some "normal" subs who are just there for PT/OT or LTC placement... but most of our subs are skilled care patients... pretty much semi-stable acute care patients who would have been in a hospital if this were several decades ago. I'm very afraid that being in rehab/subacute will mean I will never land a hospital job, which is unfortunate because the work I'm doing now is not all that different from what is done in a hospital on a med surg floor. Thanks for giving me some hope.
  18. NooNieNursie

    Nursing and sexual orientation

    Well like any other work place people will gossip about sexual orientation, it happens all the time. Especially if you work in a nursing home/rehab or similiar facility where it is small and conducive to gossip/backstabbing/pettiness. There are rumors about various people. It happens. With that said, no one is discriminatory... male or female nurses who are homosexual are allowed to go to school and practice as long as you are professional and your appearance is appropriate and groomed and such I don't think anyone really cares. Although gossip is to be expected, but that's true of any work place.
  19. NooNieNursie

    Days you are glad you are a Nurse

    Work rehab/subacute. Today I have an orientee. She was working on her med pass independently, I had some time to spare so I was able to comfort a confused patient. It was nice. I used to work LTC and I miss that a lot. Ms J has mild-moderate dementia and CHF and the combination means she gets anxious easily (oxygenation isn't the best, plus her confusion causes a lot of anxiety, in a cycle she gets very worked up and anxious). Ms J was her usual self, confused demanding to leave the facility and getting quite emotional. I put her on O2 (as she had worked herself up so badly she was short of breath) and sat next to her and was able to spend 15 minutes talking to her. The combination calmed her down very well. She became happy and contented after a long conversation where I asked her about her family and her history, while receiving oxygen therapy. She was calm the rest of the evening. That made me feel good to see her go from so distraught to smiling and laughing in 15 minutes. It makes me feel good when new nurses tell me how much I help them and teach them, even though these aren't patients it makes me feel like I"m doing something important when I teach newer nurses. But the time when I am most grateful I am a nurse is when I see how miserable and bored people at desk jobs are. Every time I hear about people talking about their 9-5 cubicle life I am sooooooooo glad I work as a nurse, where I am active and doing things that actually matter as opposed to riding a desk killing time pushing papers feeling completely emptiness about my work and job.
  20. NooNieNursie

    Nursing school sucks!

    I would point out that the OP isn't simply griping about how hard nursing school is... the OP is specifically stating that he isn't understanding the lectures or the assignments and seems to be suggesting that all students feel this way in his class. This is not the usual nursing school angst, this sounds like it might mean his program sucks. None of my classmates felt this way. Sure there were times when we didn't understand assigments or lectures but our instructors always seemed competent more or less and we always could get things clarified. The only time this wasn't true is when we had a ****** professor (pat, I'm looking at you , evil wench). But, other than that one crappy professor, ALL OF OUR OTHER professors were great and we could come to them and ask them stuff and get answers and clear direction and the lectures made sense etc etc etc. The only time this wasn't true is when we had a crappy professor who was crazy and didn't know anything. SO, given that the student feels this way and all his classmates do, it might actually be the school. The key is whether or not everyone feels this way, IMO.
  21. NooNieNursie

    Nursing school sucks!

    I am working for 1 yr and 10 months now and I can say that when I was in nursing school I didn't have an experience like this at all. Most of my instructors were great, none of them were horrible, and yes the work was hard but this is to be expected - you are training to be a medical professional it requires a lot of study and effort. If you are finding that your teachers are poor and the work isn't clear, and if this sentiment is mutual among all classmates, might I suggest that the school you are attending is crappy? It happens, some nursing schools suck. Mine was great and all of my classmates agree. If you are the only classmate having this problem with understanding lectures and assignments perhaps the issue is that you are simply not picking up for some reason. If this is the case, go to your professors, your advisor, and tell them your issues. THey are there to help. But like I said, if EVERYONE is feeling the same way as you (not able to understand lectures, not able to understand projects) it might be possible your school just isn't good.
  22. NooNieNursie

    Are there really RNs that need a job?

    1) where is this facility (state plz) 2) How fast can I move there? thx.
  23. NooNieNursie

    Synthroid makes the heart beat faster?

    The thyroid gland regulates metabolism, including sympathetic nervous system activity thus affecting heart rate. Bradycardia is a sign of hypothyroidism, tachycardia is a sign of hyperthyroidism. If a patient has untreated thyroid disease their heartrate will increase when given theraputic synthroid. However, if the patient is pushed into hyperthyroid by the synthroid, they may experience an abnormal elevation in heart rate. The physician should be following the patient's TSH t3 t4 if she is just starting this medication. I would relay this finding to the physician (newly on synthroid, now presenting tachycardia).
  24. NooNieNursie

    Patients talking politics to me...

    I don't want to get into a fight/argument here, but I will just say that there is a big difference between a patient talking politics, and a patient being abusive toward staff (whether it is racially or otherwise). In which case I would just tell the patient that sort of behavior is not appropriate and report it to my supervisor. You are describing a case where the patient is abusive toward staff, which was not even the topic until now. IF the patient was just saying vaguely racist statements about a politician or media figure in that case I would just smile and ignore and finish whatever procedure I was doing. You are not going to convert a racist in a medical stay.