JRD2002

They are all 8 hour shifts and most of the ones offered to me were for afternoon/evening hours. The schedules require you to work every other weekend. They also have some split shifts where you would work half your time in the AM and the other half in the evening. The schedules that are available are the ones that have been vacated recently so it is possible that other shift times could open up. The schedules either rotate days off or you will have a fixed day off so in either case you would be able to figure it out ahead of time.

Any updates about working for this company?

IsisC has good advice...although I wouldn't bother with a head to toe assessment and just do a focused assessment on whatever problem the patient is having. Part of calling the MD is anticipating the outcome of the call. Before calling you should ask yourself is this a problem that needs to be solved now or can it wait? Try to think of possible causes for your problem and then assess your patient to see if any fit. After identifying the problem and possible causes start to think about possible solutions. Out of the possible solutions are there any that might not be appropriate for this patient? What data would be needed to come to a decision on a course of treatment. The more you talk to doctors you will begin to identify things that they frequently ask especially if you work in a specialty area.

I am guessing there is no rationale for that order and that the resident misunderstood the directions of his supervisor. Usually when no one can come up with a reason for doing something (nurses, MDs, pharmacists) it is usually because it is wrong.

I am also curious as to how they did it. I assume that since it is a mental health facility that more precautions are taken than most facilities to prevent suicides. I suppose it is a "if there is a will, there is a way" type situations. Sorry you are having a hard time dealing with this. Like everything use it as a learning experience and take something away from it so that maybe they at least didn't die in vain.

This should be on a recruitment flyer for your hospital...I'm packing my bags right now!

Thanks! Also a big thanks to those of you who constructively contributed to the post!

I am aware that this is a very controversial topic but am really just interested in learning more about the subject. I can make up my own mind about the morality of assisted suicide so everyone try to leave your opinions at the door. In the words of Joe Friday, "Just the facts, ma'am."

I just finished watching a Frontline documentary called "The Suicide Tourist" which followed a man that was diagnosed with ALS and was seeking assisted suicide in Switzerland. I found it very interesting and learned quite a bit. I was under the impression that a medication was administered to the person but it is actually poured in a glass and the person must drink it on their own. The only thing that the facilitator can do is to hold the glass if the person can not hold it on their own. In the documentary it also said that there are three states in the U.S.A. that have physician assisted suicide programs. Is anyone familiar with any of these programs? Or perhaps has worked in one before? I highly recommend watching this documentary. It is available on Netflix right now.

Can't tell you how many times I have gone into a patients room when they were sleeping and needed to wake them up only to realize I can't remember their name. Usually I try to peek at their name band. At least 50% of the time this scenario ends up with the patient waking up with me hovering over them...awkward to say the least.

........only if you limit your practice to nursing management/administration. Now it all makes sense...

It is most facilities P&P to change a Foley every 30 days. You gotta get over that fear about talking to jerky doctors especially when it is a safety issue with a patient. Chances are that if a urologist did come and place the Foley he would still be having hematuria. Sometimes there is just nothing you can do to avoid it. I just now realized you are a student which really helps explain why you are beating yourself up so much. When we start out in nursing we are focused on helping people so much that whenever you have to cause pain to a patient it makes you feel like a scumbag. You changing the Foley caused the patient to have some temporary discomfort and some bloody urine. If you had not changed it the patient could have developed an urinary tract or bladder infection or even worse his next Foley change would have to be done in the OR when they surgically remove it. You are also going to have to learn to leave work issues at work. You can't make it in nursing when you go home and obsess over what happened during your last shift.

I hope we never go to bedside reporting but I have been hearing that the main advantage for doing it is to involve the patient more in their care. There was another thread on this recently and they had some good points about some of the challenges of doing bedside reporting. To me it seems like the idea of a bedside report was come up by people who are too concerned with patient's perception scores and that haven't practiced bedside nursing in a while. It always amazes me that the people who no longer do patient care are implementing changes that affect current practice.

I would probably have gone ahead and replaced the Foley without talking with the urologist. Just because they had to consult one for Foley placement the last time does not mean that the patient will need a urologist every time it needs to be changed. Also if you did call the urologist they would probably want to know if you had attempted to place it and what problems you encountered. If you told them that you had not even tried I think they would probably be a little upset. I understand feeling bad about causing some hematuria. It occasionally happens and I usually feel bad about it myself. Hopefully though with a little irrigation and some time the bleeding won't be too severe. Don't beat yourself up over it.

It sounds to me that even if you did advocate for your patient more that the hospital administration and the MD would have still discontinued the order. You did the right thing by investigating the medication more to help you make a more informed decision. I agree with an earlier post that your facility needs some education on DVT/PE prophylaxis. Lovenox has become a very common medication in the acute care and rehab setting. From your post I really feel that DVT/PE should have been a primary concern since the patient is obese, was bedridden for 3 weeks, and is beginning rehab. I would also be concerned that even if they were given Lovenox therapy they may not have been given adequate dosing. In high risk individuals I frequently see orders for Lovenox 1mg/kg q12 hrs. You said they ordered an 80mg injection stat after PE became a concern. This would be adequate for a 176lb high risk individual. BTW I read your other post too and giving two Lovenox shots at the same time is perfectly acceptable especially when dealing with higher dosages. I believe the highest dose in a syringe that my facility carries is 90 mg. BTW your coworkers sound like a bunch of nitwits when they tell you something and have no evidence to back it up.

If it is ordered as an IVP and you give it in a 50mL bag of NS and administer as an IVPB then that is a med error. Is it one that will cause harm...no...but an error none the less. Also agree with not leaving a narc hanging unattended with a patient. I also agree that the original poster was not interested in what other people had to say on the subject and only was looking for people to justify their actions...sorry you did not find it...you are wrong...we are right...the end.

Leaving a tube laying around will not cause hemolysis. I worked for 5+ years in a lab before becoming an RN. It was common practice to draw an extra clot tube. These extra tubes would sit in a rack by my computer and would get used if additional tests were ordered during the day. I have spun down tubes that are 8+ hours old and they were fine. I agree that the high rate of hemolysis seen in ERs is due to collecting samples from peripheral IV sites. In the last few years our techs have started doing most of the IVs and collecting blood samples, which I am totally against. In addition to probably not being adequately trained I feel like that is asking them to do too much. Not to mention that most patients would probably prefer and feel safer with a nurse performing the procedure. Whenever the ER would call us back saying that they could not get anymore blood on the patient and several nurses had tried, I would usually be the one that had to go down there. Whenever I walked into the room and saw no dressings on the patients arm I would ask the patient how many times they had been stuck and usally they would reply that they hadn't been stuck after their IV had been started. If the patient had a huge vein...and I am talking about one that I could see as I was walking through the doorway, I would usually go find the nurse and tell them where they could stick him at to get a blood sample. Of course I would only do this when they weren't getting slammed. If they refused I would pull them aside and tell them that if they did not go and at least try to stick the patient that I would write them up for unprofessional conduct.

This is my thinking on this subject...say that you gave an IM injection and upon aspiration you had a little blood return. I would think that the chances of the entire dose of medication entering the vein would be very slim if nonexistent since the angle of the needle would be 90 degrees to the vein. This would be much different than doing an IV injection. The CDC stopped recommending aspiration due to a lack of data documenting the necessity of this procedure. This is probably primarily due to the conventional teaching to aspirate all IM injections. I think you should do what you feel comfortable with. Just because there is no data showing a need to aspirate available now doesn't mean that in 10 years it will be the same...especially since more and more nurses are not performing aspirations. That being said I and many nurses I know have never aspirated blood when giving an IM shot.

Thanks for the info! Guess I will go fill out the application...hopefully they don't require a face to face interview in San Antonio...that would be an 8 hr drive for me

If you have been studying like they recommend then watch a movie, go to bed, eat breakfast, take a deep breath and take your exam. If you haven't been studying like they tell you to...best of luck!

I received a mailer from Angel Staffing looking for nurses to administer the H1N1 vaccine. Does anyone have any experience with this company? They are paying considerably more than the other companies I have looked at. Any information would be great.

My hospital has hired the Studer group for the past 2+ years and instituted rounding probably about 8 months ago. There are negative and positive aspects of the Studer group in my eyes. They are really big on explaing the plan of care and any testing or procedures as to help alleviate anxiety, which is great since I think there were quite a few nurses...myself included...that didn't really explain what was going to happen until right before. In my opinion the customer service aspect is a little too over the top. If a patient experiences any delay of care during their hospital we are to apologize and then if they are still upset we can give them a gift which include gas cards, movie tickets, and meal vouchers just to name a few. They also want you to thank the patient for choosing your hospital. I am not sure why I have such a problem doing this...maybe it's because it sounds so preprogrammed and fake...or maybe it's because half our patients rarely thank us for what we do. Overall I do think they have a positive impact on patient perceptions. As for rounding I do think it cuts down on call lights, decreases falls, and improves overall paitent satisfaction but so does asking "Can I get you anything else?"...which I think a lot of nurses fail to realize.

I work med/surg and I just love it when a laxative like mag citrate or lactulose is given in ER and during transfer the desired effect is achieved at the worst possible time...

I bet your techs just love coming to work...

Then maybe that would have been a better place to post???