melisgood

What is your view or experience with taking care of a patient on comfort care when you know the family and doctors are trying to assist the patient in dying? I took care of a patient who was on a morphine drip. He was a young trauma patient and the ventilator had already been removed and he was a DNR. The order was to increase the morphine every hour as needed by 2mg/hr. The family was requesting we increase it every hour or two (while they were at the bedside) and he did not have any obvious signs of increased pain. At the end of my shift he was up to 74mg/hr! The doctor did put a max dose of 80mg/hr. On one hand I understand the family wanting to end their pain of seeing their loved one like this, but on the other, I felt like I was assisting in killing this patient. What would you do?

Also, any advice on best place to take CE credits if unemployed? Would it make sense, if I decided 12hour shifts aren't for me, to stay home for say 6 months and then look for a job outside the hospital? Any specific areas other than home health that I should be considering?

Per diem may be something to look into. I'm assuming it varies by hospital, but are you scheduled specific days or are you on call? Also, do you usually work any floor qualified or only one specific floor? Do you have to attend staff meetings (unit specific) or are there per diem meetings? How much more is the hourly pay usually? Would I contact the nursing office or HR to inquire about possibilities?

Hello all,Here's a little background to help you help me:I graduated in June 2009 as a RN. I've been working on a telemetry floor at a near by hospital since graduation. I have a 2.5 year old daughter. After she was born I switched from full time to part time due to extreme colic and exhaustion on my part. I currently work 2 12-hour shifts a week and have full benefits. My husband resenty started a new job with a very good salary and benefits. We have been discussion the option if me staying at home after our second is due in a few months. I am really torn what to do. Part of me wants to stay home and enjoy being a mommy full time for at least the first year, the other part of me doesn't want to give up my position at work. The floor I work on is hard and we have a hard time retaining nurses. I have been temper to look elsewhere for employment in the past. I am leaning towards working through this pregnancy and then not returning after maternity leave. Is this frowned on by an employer? Is it better if I quit before maternity leave? Do I tell the board that I am inactive if I quit? What do I need to do to keep my license up tondate should I decide to return to work? If I did volunteer type work would that benefit my resume so there isn't a large gap in employment? What is the best type of nursing position for a mother with young children? 2 shifts a week isn't bad, but I'd love to work less than 12 hour shifts. Home health? If I go that direction will I have a hard time getting a job at a hospital 5-10 years down the road? I don't want to loose my skills or mess up and give up a good position. Please give me any advice you have to offer! TIA!

I stand by my belief that there is nothing wrong with responsible use. What I'm questioning is the risk of likely ones license. Does anybody know where the Bon stands regarding legal use?

Does anyone know if medical marijuana in California is an option for a practicing RN? It has been recommended to me from a doctor as an alternative to other medication, but I do not want to risk my license. If I understand the law correctly, if I get tested at work and come out positive I could be fired (as many people have been fired from other positions due to the federal government not making marijuana legal. Obviously, caution would be taken, as with any narcotic and I am talking about not being affected while at work. Has anyone approached the board of nursing about this? I am considering asking since I am not using, just considering my options. Tia!

Maybe I misunderstand accreditation? My understanding is CCNE or NLAC is good. NLAC accredits associates-masters programs and CCNE only BSN and above. ? Anyone care to comment on this?

I've narrowed down my choice of online RN-BSN programs to either Grand Canyon University or American Sentinel. They are both CCNE accredited. GCU would require me to take 12 5-week classes (60 weeks=36 credits). They charge $450/credit. There is also a $400 one-time electronic fee and $75/class online text book fee. Total cost per class= $1,458. Total cost for program= $17,500. Classes start about every week. I was told to expect to spend on average 10-12 hours/week/class studying. American Sentinel would require3 me to take 10 8-week classes (80 weeks=30 credits). They charge $370/credit plus $95 one time new student fee + $100 graduation fee + purchasing testbooks aprox $150/course. Total cost per class= $1,270. Total cost for program=$12,700. Classes start every 8 weeks. i was told to expect to spend on average 5-10 hours/week/class studying I am planning on getting $3,000/year reimbursed from my employer so I am looking for a flexible program that I can take 3-4 classes/year. I have a baby at home and don't want to take too much time away from her. Which school do you think I should attend based on this info? TIA!

Hey Everyone, I've been doing hours and hours of research on RN-BSN online programs. I've narrowed it down to Grand Canyon University, Chamberlain University, University of Texas Arlington or American Sentinel. I am still compiling info on these colleges...pretty much have all the info on GCU. Can anyone tell me first hand experiences with any of these programs or maybe something you've heard from a colleague? Any advice or tips are appreciated. TIA!

I injured my back doing nothing in particular. I have made it very clear btw that i am not blaming my work fornyhis injury. I run and have a young child. It was a progressive tightening and stiffness in my lower back that turned into sharp stabbing/spasming pain. After about 4 days and it only getting worse, even after a couple chiropractor visits, I went to the docs. Drags were done and my spine is fine, it's just bad back spasms/tightness. I called the nursing office yesterday and asked if it were possible to be put on light duty. They transferred me to employee health and the NP I spoke with told me she wanted the note my doc wrote excusing me from work (because I mentioned it) and she said I need to go back to my doctor and get a note saying when I can return to work. This message was given to me by the NPs secretary and I told her I felt good enough to work and the doc wrote the note in case I wasn't feeling up to working. I left the NP a message saying I felt ok to come in and didn't want to start this process. I also notified the charge nurse the night before my shift to ask for a lighter patient load if possible. I showed up for work this morning with a back support hidden under my scrubs. I got a call 30mins into my shift from the NP at employee health telling me I had to give her the note and go home for the day. Obviously my supervisor wasn't happy having to call in another nurse to work my shift and she said I didn't go by policy because I should have called her. I understand what I started now and kinda wish I kept my mouth shut. I'm not back to work for a few days so I plan on making a doc appointment to get a note to return to work. I'm worried my back pain is still bad but am worried I need to go back to work. My supervisor specifically said my doctor needs to write ok back to work without restrictions. What if I need light work for a while? I work on a step-down floor and it's very heavy. Any advice? Tia!

I called my charge nurse this morning and told her. She said there is a social worker on the case already and she will pass on the info to her if they need to contact me. Thanks for all the replies.

I went home today from work wondering if I should report what my patient said to me. She was crying and told me her mother was going to get her husband arrested. I asked, "why do you think she'd have him arrested?" and she sobbed, "because he hits my child...She's 7 years old." Should i report this? Also, in report I was told rumors of the husband treating her badly. Should I have asked her if he ever hits her? I feel like I should have done more. Is it too late?

So, long story short, I'm unhappy with my job. I got this job right after school after getting my ADN 2 years ago. I work on the busiest floor of the hospital and it is very difficult to keep up and finish on time. Often we end up staying overtime past our shift without being approved to get paid. I have been thinking about giving my resignation and completing my BSN while staying home with one year old daughter. I currently have a part time position, which I love so I'm worried about leaving a good thing. I'm miserable lately and find myself sick the day before working and having to take Xanax to fall asleep the night before a shift. Do you think it will make sense to a future employer that I quit to stay home with my daughter and continue my education? Any online programs that you can recommend? Will i need to do clinicals? What kind of studying/tests/papers should I expect? Tia!

So, my best friend just so happens to be a lawyer and I spoke with her today about a class action lawsuit. On my floor they also have a book were supposed to sign for each pay period stating that we took our 2 15 minute and 30 minute meal breaks and that we are waiving our rights for our second 30 minute meal. We are told if we do not sign we won't get paid. We only take one 15 minute and one 30 minute break and have never been offered a second 30 minute break! I haven't signed this book in months....and I don't think I will. The truth is even if we were offered a second 15 or 30 minute break during our 12 hour shift, no one could afford to be away from charting and patient care that long for fear of staying even later! Anyone know of a lawsuit like this and how it ended? I would like to make a positive change instead of just running if I can. Also, my union rep suggested I fill out a form during a crazy shift that's for objecting to patient assignment due to high acquity and workload. You include how many new admits, blood transfusions, NGTs, pain mess etc during your shift. I am going to encourage others on my floor to fill this out when I see someone complaining or running around like a maniac (every shift). This should be interesting to see how this ends.

What is a time stamp? We do paper charting and rarely do we chart as we go. We write what time something happened, not what time we are actually making the entry. Whoever stays over usually finishes up paperwork in the back. So, what should I do?

I work on the telemetry floor. After every shift someone (if not multiple people) stay late after clocking out to finish paperwork. There is simply too much to do in one shift that on most days we can't cram in all the nursing care and paperwork that is expected of us. I was recently written up for failing to complete an intake/output form on one of my patients and missing a few orders on patients I took care of. Of course I feel horrible for failing to do what is expected of me at work. I was told if it happens again I will be suspended and then fired. I spoke with a couple seasoned nurses on my floor and asked for advice and they told me to simply stay after my shift. I did just that the next day for fear of losing my job. I told my charge nurse that due to receiving two new admissions in the afternoon and all the paperwork associated with that I was going to be staying at least 45 minutes past my shift off the clock. We actually get written up if we clock out overtime without written permission from our charge nurse. This week I even saw a nurse on the phone with a doctor past clock out time. I ended up staying until 8:30 that night finishing up paperwork and was never offered to be approved for overtime. They frown on asking for overtime so I've given up on asking because no one else does it so it looks bad to ask....as if I am failing to do what other nurses on my floor are able to do. What am I to do? Since others on my floor stay late I feel like I too should work for free, but end up being so tired and discouraged I am considering looking for work someplace else. I do not want to ruin my reputation as a nurse and I definitelydo not want to be fired! Any advice on this topic is greatly appreciated!!! And while I am willing to get help with my organizational and multitasking skills, I honestly do NOT think this is the problem and multiple nurses on my floor say they are just as discouraged and overwhelmed as I am. It is a well known fact that our floor is the busiest in the hospital. Should I just bite the bullet and stay after my shift off the clock to finish paperwork? What would happen if I simply refused to clock out if I still had paperwork to do? Of course I would abide by the rules of telling the charge nurse an hour or two before the end of my shift how much overtime I thought I needed. If she tells me I should be able to get it all done in time (which is what usually has happened in the past), is there someway to document this and how long I ended up staying anyways to finish up my paperwork? I have only been approved for overtime I think twice and it was for only part of the time. In other words, I would say I had 30-45 minutes of work I needed to finish and I would be granted 15 or 20 after having to hear some comment about how overtime is frowned upon and how I should be charting as I go, etc. I would then clock out after the approved overtime, and stay off the clock to finish. This problem is so bad, that some people even come before their shift to look up labs or review a chart or two and then clock in. If I leave work for the next shift to do (such as completing entering orders, adding up the intake/output sheet, changing IV fluids or tube feeding), the next nurse is upset with me and gives me a look like "what were you doing all day". WHAT SHOULD I DO? ANYONE ELSE DEALING WITH THIS?!

Hi, I have 1.5 years experience as a telemetry nurse. I am trying to decide on my next step. A lot of the nurses on my unit are getting their PCCN certification. I was told you have to have your license for 2 years to take the PCCN exam so that date will be coming up in a few months for me. In your opinion, should I do this, or start on my RN-BSN first? TIA!

i don't remember what medication it was, but it's how the doc wrote the order so i just copied it to the paper MAR. I wonder if we'll get dinged for that. It's so annoying too because i never see orders written that way, it was a doc i don't usually work with. ugh

every evening...

Yesterday The Joint Commission came to the hospital and I was one of the lucky ones they choose to follow and ask questions to for like 45 minutes! I had to give a "tour" around our unit and explain how things are done and where things are. They also reviewed one of my patient's charts. I'm wondering, is QPM an acceptable abbreviation? The guy who was following me made a note of it and said he needed to look it up and see if it is an acceptable abbreviation. I know it's kinda silly, but this has really been bugging me and I can't seem to find the answer online. I looked on the Joint Commission website and only found a list of unacceptable abbreviations and it wasn't on there. Anyone know?

Wow....so many responses! Thanks! I will try using a form going system by system to get report and then use the pre-printed sheet with all my patients listed as my todo list and note taking during the day. At the end of report I will update my report sheet on each patient and end by skimming my paper to include highlights of the day. And yes, I will find my inner shark! What bugs me the most is that this nurse was a new grad hired at the same time as me a year ago! He has his bachelors and I only have adn, but we both passed the nclex and work on the same unit!

I work on a telemetry floor (step down unit). It's one of the busiest floors in the hospital. We have 3 patients if we're assigned to trach/vent and 4 if regular tele patients. During the day shift it can be a struggle just keeping up with new orders and interacting with the patient's families. The majority of our patients are total care. Rarely would I have the time to write out report at the end of my shift for all of my patients. I do not know of any standardized form on our floor...if there is one, no one uses it that I know of. Everyone has their own method of taking and giving report. Some write down hardly anything, others (like the nurse I was giving report to yesterday) have a separate form for each patient divided by system. I made a form like that and I found it difficult to have each patient on a separate sheet of paper. I take report on a single sheet of paper with all 3 or 4 of my patients listed. It's a printout that we are given at the start of shift that has the patient's name, age, gender, Dx. I take report and write the info down in catagories such as Hx, allergy, tele (HR, rhythm and rate), and IV. On the left I write skin issues or anything else pertinent to the patient such as abnormal labs or test results. On the right side I leave a section for things I need to do during my shift: Rx times, IVPB, pain meds (with frequency and times given) and any tests or procedures being done during my shift: EKG, 2Decho, CT scan, UA or stool I need to collect, etc. At the very bottom of the page I make another column for each patient and I use that for notes during my shift....I put the time and what I did...such as 0920: called Dr Smith about BP=188/96 or 1230: dressing changed. I feel like I am doing things in an organized manner? I highlight anything major that happened during my shift, such as 0920: called Dr Smith about BP=188/96 or any abnormal labs (which I also write down in the notes section). I do seem to write a lot more down than other nurses, but I'm not sure if that's a good or bad thing? We are still stuck with all paper charting and I hardly ever have time to chart as things are actually happening...I go back a couple hours later and look over my "notes" and document off of that. Should I be doing this all different? Any tips? I know this guy was being a ****, but I'm also willing to change how I do things. Thanks!!!

Hey Everyone! I just had a very frustrating experience last night while giving report to one of the night shift nurses. He was very rude to me and has been this way before. Apparently he doesn't like the way I give report and gets annoyed if I leave out details and he has to ask me questions. I was giving report on a patient diagnosed with a near syncope episode and leukocytosis/UTI. I told him I didn't give the patient's thyroid hormone until the afternoon because pharmacy was waiting for a shipment and that's when they delivered it. He looked surprised and said, "well, you know you're supposed to only give that in the morning on an empty stomach right?" and rolled his eyes and then said "ok...anyways....keep going..". When I was done giving report he said. "Hmm, this interesting, (as he scanned what he wrote down) you seemed to have given me all the information except for what I actually need to know." He then went on to list questions about if the patient had had a CT scan or troponins drawn and if she was on antibiotics. I told him sorry I left that out, and that the troponins were negative, and no CT scan was ordered. He looked over on my sheet and said "I notice you have written down the patient had a 2d eccho done today?" I told him yes but that the results weren't back yet. I realize I left out important information, but once prompted I knew the answers! It's not like I had no clue what was going on with the patient. The truth is that my other patient's were sicker and this patient was probably going home the next day. I gave a less than perfect report on this patient, but in the end he had all the info he needed. I have less than 1 year experience as a nurse and I am still learning.....I hate days when I work so freakin hard and then the night shift just tares me to shreds! Question #1: What can I do to improve my giving report skills? Books? Suggestions? Question #2: How should I handle a co-worker being rude to me in front of a patient/family in a situation such as this? TIA!

Also, we were trying to decrease her HR since it was 130-140. She had been throwing up a lot (before I put the NGT in yesterday and took out 600ccs) and he was treating dehydration and trying to increase her circulating volume and pull fluid from her tissue (edema in legs) into her vascular system. This increase in circulating volume should decrease her HR if I understand correctly. The order was to repeat the plasmanate (albumin) if HR>130 after the first one was given.

Next question though: When hanging a 1L NS bolus do you leave it wide open without a pump? On our floor with so many pt's having CHF we usually use a pump to monitor for fluid overload so a bolus is given much slower. I ran it at 600cc/hr. She had a triple pump and a double lumen picc line. In one line she had Dilaudid PCA/Normal Saline and the other was TPN/lipids. So the pump had NS, TPN and lipids taking up all three pumps. I started the 1L NS bolus where her Normal Saline@85cc/hr was infusing. Because there were no more pumps and i've never piggy backed albumin I was saving that for night shift. Should I have done something differently?