RNCCMMS

I thoroughly enjoy the responses to nasty docs lol lol lol

I'm confused about the push to use Tramadol. My pharmacist told me that it is usually only given postop if you have received a dose in the immediate postop setting-because the side effects are major-seizures, decreased respiratory status. And it is for moderate to severe pain and is short term. What happened to the pain steps- starting with the nsaids, and working up to the narcotics, unless it is immediate postop or injury related. If we start out with the opiates to treat pain from muscle pulls, osteoarthritis, etc, and they stop working, where are we going? The current heroin epidemic is being blamed on codeine addictions. When police officers have to carry Narcan, it's a sad day for us.

Talk to a financial person. When I was in high school, nursing school, and first working, no one talked about pensions, 401ks, etc. Back in my early days of working, everyone assumed nurses were going to marry doctors (lol), so no one offered pensions. If I had started in my 20s, putting money into an IRA, I would have a hefty retirement plan by now. As it is, I finally have a pension-but only in the last 15 years. My plan is to work as long as my health is good to make up for my inept money management. Paying off student loans is important, but so is putting money away now. Ask if employees where you work have access to financial advice. If one of your parents served in the military, you might be eligible to participate in USAA. They give great financial advice. Good luck!

1. Geographic location NJ 2. Pay rate $34.00/hr 3. In which area / specialty do you work? Clinical Quality auditing 4. What type of license do you have (RN or LPN)? RN 5. What type of degree and/or certification do you have? MS, CCM 6. How many years of experience do you have? 40 7. Are you full-time, part-time, or casual / per diem / PRN status? FT, medical benefits, pension, 401K (though the pension/401K is only in the last 15 years) 8. What shift do you work? Days-M-F, no holidays or weekends-(finally!) 9. Do you receive any shift differential? N/A 10. Are you a manager or supervisor? Neither currently though have done so in the past(don't want the headache)

The original poster was referring to taking a prescription drug, not tylenol, advil or maalox. I wonder what the Board of Nursing would say to this discussion.

Honesty and integrity are important, period. Stealing is stealing, period. It is a violation of the state nurse's practice act, period. If a fellow employee is ill, they can go to employee health to request assistance.

It seems this conversation veered off topic. The issue that concerns me is the suctioning with NSS..that ceased to be a standard of practice years ago. There is no evidence to back it up. Do RTs not adhere to the same standards as nursing?? I think the manager/head nurse/supervisor or whatever the title should be talking directly to the head of RT to work this out. There should be a hospital policy for the unit on suctioning which everyone should be following.

This thread is a hoot! I often wondered how some mds made it through med school, too :-)

Did anyone yell at House about compassion and treating people with respect. My husband would laugh and say "you know you're talking to the TV, right?"

I agree with Imarisk2. It's hard to care for patients who become friends. There is always the chance that the relationship offer is not what it seems. Hate to be so cynical, but years of life teach me to be careful. And she gave you an out "if it was appropriate with your job". FYI-It's hard sometimes to care for friends who become patients, too.

DeLanaHarvickWannabe I like your quote at the bottom of your post!

The ombudsman in your state would be the first place to start. You can research the state laws to see what the state says about the situation. Be positive with your comments. You don't want to be in a postion that anyone can retaliate against you for speaking up. Best of luck!

Reading some of these posts sure brightened my day! I have always thought I had 2 different personalities. My work one was kind and caring to my patients, not so much coworkers who didn’t pull their load or care for patients the way I felt they should be cared for. I used to tell my staff: “How would you want your mom, dad, or grandparents cared for? That’s how we treat our patients.” My home personality was kind, loving and caring for my children (even with a migraine headache); spouses not so much. My spouse would say “Do you treat your patients that way?” It’s always on the tip of my tongue to sarcastically say, “No, because they are truly ill whereas you complain about every little ache and pain”. Lol So, I guess a mental health person would have a field day with me. haha

If you have the opportunity, try to take a course in motivational interviewing. It's a great help in learning how to communicate with patients. I can understand asking financial questions but in the context of, "are you able to afford your medications?, do you have difficulty paying for your utilities?"..these are quality of life issues...then there is the questions about family, as in " if you need help at home, who would you be able to call?" It might help to preface your questions with "I am not trying to pry, but we want to make sure you have the resources and support you need upon discharge home". It's very important to learn how to set limits when comunicating with patients. If the setting is set that this is in relation to their plan of care, then you can gently say, " I would like to talk about you and your health care needs." Good luck in school!

I believe if you have a patient who signs a form preoperatively that they are aware they must have someone to drive them home post procedure and you have documented their cognitive status upon discharge, you should not worry. You can check with an attorney if you want to get a legal opinion.

ROFL. The foley caths ones are the best, followed closely by the charting bloopers lol Thanks for the laughs!:yelclap:

Be professional, document carefully what patients tell you about their pain, when the med was administered, what relief the patient received. If anyone asks you about patients and their pain med usage, advise them pain assessment is the 5th vital sign according to JCAHO and you are assessing this in your patients. If no one has said anything, it's because they either don't believe it or have checked out the documentation and found no issues.

ANA is definitely the first one to join..as you progress through your career and decide on a specialty, then that organization is good. Like HouTx, I also have the ANA dues automatically taken from my account. Best wishes for a long and happy career!

I understand your frustrations with your clinical experiences. I am from the "old school" diploma program through a hospital. We worked full 8 hour shifts in each clinical setting and not just day shift lol And I had a 6 week orientation program in my first job. I understand this is no longer the case. It might seem like following a med pass is not a good learning experience, but...did you know that this med pass needs to be completed within a certain time frame? Did you know certain drugs have parameters, like taking a pulse with Dig, checking an INR with Coumadin, what is the blood level for the pt on Phenobarb? While you are following this nurse, ask questions..like why is the patient receiving this med, have you noted any side effects, what are the state regs regarding a med pass in this setting? Bring a list of questions with you each day. Be curious. Look up the meds you see being passed-a great opportunity to learn what type of meds geriatric patients receive. Do you see any potential issues? SNFs also have pharmacist reviewers who review patient files to ensure there are no interactions or problems. See if you are able to review this report for the unit you are on-a great learning tool. When I worked in LTC, I learned a great deal from my pharmacist reviewer. With her help, we were able to reduce doses or eliminate completely for many of our residents because as we know livers do not detoxify the body as well as we age. Review the care plan for the patient-see if you can help identify any problems that are not addressed or whether any of the goals are being met. Then you can discuss this with your instructior and brainstorm how to improve the patient outcomes. You can practicing assessing patients also..review your findings with the RN to see if you are on target. One thing I learned through the years, is that complaining did not achieve much, except the person complaining was ignored. Remember to come with a solution when you see a problem. Good luck to you and your fellow students. Don't give up :-)

You might want to network with your state DON organziation. Ask the more experienced DONs how they manage this issue. The charge nurses should be working with the MDS coordinator on careplanning. From my years in LTC/skilled nursing, staff nurses did not have the time. It was one nurse for 30 residents on LTC on days and evenings and one nurse for 60 on nights. If your nurses only have 8 each..wow, that's good staffing. Ask your MDS coordinator what she means by "poor charting". Don't the nurses chart by exception? I agree that if a resident is started on an antibiotic for a UTI, the nurses on the floor should add that to the care plan. Don't the units have weekly care plan meetings to review new issues? When you meet with residents and family/caregivers to review plans of care, they can/should be updated then. We used to have the resident or family sign the care plan with us showing they agreed to the actions. Best wishes to you!

volunteering is a good way to get experience in health care as the previous writer indicated. for the future: http://owl.english.purdue.edu/owl/resource/719/1/has some excellent info on resumes.

I agree with Mr ChicagoRN. The objective should always focus on what skill set you possess and how it will help the organization achieve its goals. A cover letter should focus on those aspects of the job for which you are applying that you meet-stress strengths. Know the hospital mission statement/vision/philiosophy and show how you would be an asset in helping them achieve their goals. If you received any recognition in previous jobs, include that. http://owl.english.purdue.edu/owl/resource/719/1/has some excellent info on resumes. Best of luck!

I include mammograms, scopes, etc in my definition of preventative care. Regular physicals are necessary..but how many people have you heard say "I only go to the doctor when I am sick"..by that time, it could be too late. In NJ most of these preventative services are mandated by law, (there are currently 50 of them)so if you do business in NJ as a health insurer you must cover them. I understand that many other states do not have such stringent laws..shame on their legislators. Another area I did not touch on is the fraud in Medicare and Medicaid, and in private insurances-that also drive health care costs. There are so many aspects that contribute, that it can be mind boggling-where to start. I guess if each of us does our part, eventually others will follow suit.....:)one can hope

most of the math that is needed in nursing school involves drug calculations using simple arthimetic skills or basic algebra(ratios). typically in facilities, the pharmacy figures the doses and rates for you, but it is a good idea to understand and be able to to do it yourself, as a double check, in case of errors. a lot of the equipment used does the calculations for you once you enter the parameters. you may have to do height/weight conversions between pounds/kilograms and inches/centimeters.

i agree health care is unsustainable as we know it. when you figure an individual may pay into their health insurance plan (if they have insurance) for years, what they actually pay won't cover the cost of their care if they become chronically ill. chronic illnesses are costly. a contributing factor to the increase in health care costs is that we live longer, usually longer than the amount of time we paid into medicare and social security. the longer we live, the higher the chances of chronic illnesses. prevention is key with education starting in elementary school and continuing. this is where nurses can make an impact. those who work in the hospitals are limited in the amount of time they have to educate their patients. nurses in other settings like home care, outpatient, doctor offices, schools, employee health can provide education. we pay doctors based on a fee for service which means the more they do, the more money they get paid-another driver of health care costs. some states and insurance companies are struggling to build patient centered homes where pcps provide the needed care and focus on prevention. but pcps don't want extra work that they have to pay for-like staff, equipment, electronic medical records systems. individuals need to take control of their own health, but it seems people are not motivated. within my own family, a large number are obese. they will say "i need to lose some weight and exercise, but this hurts, that hurts, i can't live without my pasta and bread". we can not motivate people to care about themselves, that has to come from within themselves. all we can do is provide the information and resources and offer support and encouragement. check this article out on how people hide assets, so they can collect medicaid in their declining years: [color=#606420]https://www.cms.gov/medicaideligibility/downloads/annuities.pdf "individuals who might have paid for long-term care costs themselves or would have purchased private long-term care insurance have turned to various methods of estate planning and asset sheltering activities as a means of qualifying for medicaid coverage of their long-term care expenses." some of those on medicaid are senior citizens. some are legitimately poor and can not pay for their health care/medications and still eat. (the largest portion are disabled children). but there is a large portion of seniors who give their assets to their children, so it is not used for their care. my feeling is if you want mom's money and home, then you should take care of her, not expect the taxpayers to do so. medicaid's look back period is 3-5 years..it should be 20. this article written in april 2010 by the kaiser family foundation shows how stressed medicaid will be going forward: [color=#606420]http://www.doh.state.fl.us/alternatesites/kidcare/council/8-3-10/27_medicaidbeneficiaries.pdf here are some articles on who comprise the medicaid population: "the medicaid program is in effect three distinct health care programs, each with a different beneficiary group and different proportional uses of funds. the percentage of total spending devoted to each of these efforts varies greatly from state to state, because state officials may exercise considerable discretion about which of these three programs to encourage. the three groups are as follows. (1) low-income elderly people represent 13 percent of medicaid beneficiaries, but their use of services accounts for 32 percent of all medicaid expenditures. this aspect of the program provides primarily long-term care. most of these senior citizens were not poor when they retired, but their incomes have been eroded by inflation, loss of spousal income, or other factors. as they age, one-fifth of the elderly find themselves alone in nursing homes, forced to look to medicaid for support that is not provided by medicare.5 (2) the severely mentally retarded, the blind, and the physically disabled represent 15 percent of medicaid beneficiaries and generate 36 percent of all medicaid expenditures. medicaid provides medical care and nursing home services for persons with severe, permanent disabilities and higher-than-average needs for medical care. this group includes an increasing number of people with acquired immunodeficiency syndrome (aids). (3) low-income children from single-parent families and their parents comprise 72 percent of beneficiaries; their care represents only 32 percent of all medicaid expenditures (based on 1993 stats)" [color=#606420]http://content.healthaffairs.org/content/12/1/132.full.pdf "jointly financed by the states and the federal government, in 2010, medicaid covered nearly 53 million people and accounted for about 16 percent of all health care spending.[color=#606420]1 it accounts for 17 percent of all hospital spending and is the single largest source of coverage for nursing home care, for childbirth, and for people with hiv/aids.[color=#606420]2 it covers one out of four children in the nation as well as some people with the most significant medical needs.[color=#606420]3 while children account for most of the beneficiaries, they comprise only 20 percent of the spending. by contrast, the elderly and people with disabilities account for 18 percent of enrollees but 66 percent of the costs.[color=#606420]4" "over the past three years, despite rising enrollment due to the economic recession, nationwide state spending on the medicaid program dropped by 13.2 percent (equivalent to a 10.3 percentage point decline in the state share of the total costs of the program) as a result of the added federal support provided to state medicaid programs through the american recovery and reinvestment act of 2009 (the recovery act).[color=#606420]5 in 2009 alone, due to this action, state medicaid spending fell by 10 percent even though enrollment in medicaid climbed by 7 percent due to the recession.[color=#606420]6 however, this enhanced federal medical assistance percentage (fmap) support is set to expire on june 30, 2011. " [color=#606420]http://www.hhs.gov/news/press/2011pres/02/20110203tech.html this is a difficult time for everyone, but maybe we can achieve some of the goals of health care reform, before we are broke.