pandora72

Great article! My personal nursing hero is 'the OTHER Clara'....US Army General Clara Adams-Ender, the first woman to receive her masters in military arts and sciences from the U.S. Army Command and General Staff College as well as the first African-American nurse corps officer to graduate from the United States Army War College. Her humble beginnings in North Carolina in 1939, her rise through ranks during the 60's and 70's to her retirement as commanding officer at Fort Belvoir in 1993, the other Clara's life isn't in ANY history book I've read. This woman taught me that hard work, determination and dedication to nursing CAN pay off. She was selected as 2013 Living Legend by the American Academy of Nursing and named one of Working Women magazine's 350 women who "changed the world." I'm currently reading her biography My Rise to the Stars: How a Sharecropper's Daughter Became an Army General and I find her SO inspiring!

EXACTLY!

And let's not forget shaky hands. In nursing school I FREAKED when a Parkinson's patient in no acute distress read 76%. I was so embarrassed when I yelled for help, grabbed the O2. The RN came in and put it on his earlobe... 94% RA.

And NO amount of education on reading the pleth convinces them otherwise, does it?

And NO amount of education on reading the pleth convinces them otherwise, does it?

I can honestly say that I've never made a med error... YET! I'm not so arrogant as to think I won't. I'm sure it's only a matter of time. I have noticed a trend the past few years though, of new grads having higher instances of near misses. At one point precepting the new girl last year, I noticed she grabbed the wrong patient's med out of the fridge, same drug, same dosage, different patient. I said, "Did you even read that before sticking it in your pocket?" She was a little confused as she pulled it back out. She saw the name and said, "Oh! Well, duh. Guess I need to get my eyes checked, huh?" I thought "No you NEED be paying closer attention to what you're doing." And quite frankly her flippant attitude scared the bejeezus out of me. I watched her like a hawk the rest of her orientation.

I was under the impression the vagal response DECREASED heart rate. A vagal response (valsalva maneuver) can be used to stop SVT, right? Help me out here, cardiac people.... Maybe I should ask Dr. Google.

I would have replied, "What's a lunch break?"

my sister-in-law was pregnant with m/f fraternal twins several years ago and my dear mother-in-law informed us that they were not identical. i told her, 'well, of course they aren't... one is a boy and one a girl.' she looked at me like i was an idiot and insisted that a woman could have identical twins of opposite sex! i tried to explain that by definition identical meant they were the same and there are distinct differences between boys and girls... never could convince her otherwise.

absolutely not! when in doubt, don't give it until you look it up and/or clarify with the md. you can't imagine the number of times i have double checked the safe dosage range for a child's weight only to have it out of whack. understand though, that some medications have different dosages for the same weight based on what they are being given for ie antibiotic for upper respiratory infect vs meningitis. first, i call rx to let them know i think it's too high or not then call the md to let them know what rx and i are questioning. i always call rx before the md because sometimes it's a matter of a reconstitution error or crazy math that can be resolved between us. just always remember... one of those 'rights' is dosage. that not only refers the right dosage as prescribed by the doc but did the doc prescribe the right dosage? you give it, so you are ultimatley responsible.

LOL Solstice... Yep, got my IV bath in nsg school!

Seems Like I remember learning at an epidemiology conference a couple of years back that PA had just passed legislation requiring mandatory MRSA screening for healthcare workers. I asked the speaker what was the point in such a law, what were the consequences and what was to happen with those that came back positive.... she didn't have any answers.

that exact same situation arose at my hospital a couple of months ago when we went to a new computer system. there were quite a few changes in the way things were done and processed as a result. those changes left everyone in every department pulling their hair by the end of shift. the night time staff on our unit handled the situation just how you described and we have a wonderful relationship with rx and lab as a result. however, here's the irony... like you, rx didn't get the med profile done in a timely manner because pts weren't in the system because registration hadn't put them in yet. registration hadn't put pts in the system because the admission order hadn't been faxed to them when pts arrived from the pacu with the order (post op observation holds couldn't be admitted until the exact minute they arrived to the floor). our clerks had been trained to do this when they had their orientation on the new system but not the rn's. we had no idea we were supposed to do this and since we have no clerk at nights on the weekends guess what...? it ended up being our fault anyway! long story short... rx could do their part because admitting couldn't do their part because we had no clerk to do their part (which became the rn's responsibility who didn't even know it was a task that needed to be done in the first place!). see the conundrum? the bottom line is, everything seems to always falls back on us, doesn't it? all this leaves me wondering just one thing... is my local wal-mart hiring?

I was told the same thing when I started my first job. In my situation, it meant all the detail I had grown accustomed to in school wasn't necessary. My first few months on the job, I'd write a half page note addressing everything I had observed head to toe because in school instructors assumed if you didn't write something it meant you failed to notice it- if you didn't write HR RRR S1 and S2 noted, then you didn't assess heart sounds properly. In other words, 'if it wasn't written it wasn't done'. My co-workers insisted I was working myself to death trying to include EVERYTHING. Charting by exception for us means if it's a normal finding upon assessment then you don't have to address it in the progress note. Any abnormal finding should be noted (ie lungs with bilateral I & E wheezes). You also learn to narrow your focus depending on what the pt Dx is... you might not even write anything regarding bowel sounds in a pt on a regular diet hospitalized with COPD but would write several lines on lungs sounds, respirations, O2 Sat etc. I have to admit charting a book on every patient is a hard habit to break. I still find myself doing it sometimes, but when you have 7+ patients you learn to omit every word you can after you've had to stay 2hrs late following a 12hr shift to get your charting done a couple of times!

glad you liked it. not a lot of people appreciate the art of sarcasm and i am often misunderstood...but my twisted sense of humor keeps me sane (most of the time)