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perfectbluebuildings BSN, RN

Pediatrics
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perfectbluebuildings is a BSN, RN and specializes in Pediatrics.

I am a quiet introvert most of the time, but I like Allnurses because it's a place I can open up about work and life and you all just "understand" in a way that it's hard for people outside the medical field to do. And, of course, no one but other nurses "gets" that sense of humor I've developed through the years. 🙂

perfectbluebuildings's Latest Activity

  1. perfectbluebuildings

    Nurse Sick and FIRED: Exploring Nursing Absenteeism

    In my facility (not a hospital), nurses are only one part of the entire diverse staff; it's not primarily a healthcare setting, so the nursing department is tiny. However, it is required that there be an RN available on location 24/7. There are a total of two full-time night shift nurses. There are a few PRN nurses who are supposed to be able to work either night or day shift, but of course that is not usually enforced (they work pretty much only day shift). In other words, if an illness or emergency occurs with one FT night shift nurse or her family member(s), the other night shift nurse almost always ends up working extra to cover. If that can't happen for whatever reason, it's like a mini-crisis in the department and very VERY difficult to find that coverage and very guilt-tripped on the nurse to be "sure" she can't work. So, yes, it is basically impossible for especially night shift nurses here to call off, unless it is a hospitalization-level type illness. The other employees (non-nurses) seem to be able to call in with no real consequence and no expectation to find coverage for themselves. It's never as much of an issue for anyone else than for the nurses. I agree that nurses are supposed to be superhuman, no matter the work setting.
  2. perfectbluebuildings

    Any report tips out there?

    One thing you didn't mention, that you probably already do anyway bc it's so basic, is any medications the patient received and about what time they received them. It's so helpful to know e.g. if they've had any pain medicine, or a first dose of antibiotic or anything for fever... well, you know. :-) Thank you for this post; I think I will learn a lot from it as well.
  3. perfectbluebuildings

    Just got the passive aggressive CC email. Advice please!

    This reminded me of this scene in the office, with Jim imitating Stanley... Not making fun of your problem at all I hope it doesn't come across that way!! But all this "cc" talk made me think of my favorite show.
  4. perfectbluebuildings

    Oxygen order changes

    That sounds absolutely ridiculous. Will it be the RT having to call the doctor all night about O2 changes, since that department came up with the policy? I am guessing not... I am guessing, somehow, that all of that responsibility will fall on the RN. And seriously... like you say... O2 requirements can change hour to hour, even minute to minute for some of these kids!! Whoever came up with that policy has obviously never worked a night shift with pediatric respiratory patients. The order at my last place of employment was, titrate O2 to keep sats>90%, sometimes "up to [4L/8L/50% etc]." then notify the MD if higher concentration of O2 was needed. But it sounds like they want you to call every single time a patient falls asleep and desats, or needs extra O2 after trach suctioning, or has a rough CF night, or anything. I hope that policy does not last long for you all because that's absolutely ridiculous. Good luck.
  5. perfectbluebuildings

    Did you contract anything from a patient?

    My first RSV season as a nurse... YES, definitely!!!! Having a kid's snot fly into your face (more specifically nose, mouth, even eyes) will do that :) Then after about a year, I developed the pediatric nurse immune system of STONE, and it's a gift I still treasure
  6. perfectbluebuildings

    Pysch nurses, how often do you do these things?

    I do a lot of physical and mental health assessment, and as the only nurse in the facility on my shift, there is a lot of autonomy in the job as far as monitoring physical symptoms and providing nursing care, and figuring out when a resident needs to go for outside care, as well as trying to figure out when the issue is more psychological than physical. Many of our residents are incontinent and do require help and reminders for showers and basic ADLs, but it is mostly the direct-care staff who provide those needs. I do basic wound care and assessment, very minor injuries most of the time, and monitor for more serious issues before they get worse, i.e. a resident who got a concussion from self-injurious behavior of repeated head-banging, convincing the doctor they needed to be treated and trying to parse which symptoms were from the head injury and which were more "attention-seeking"/psychosomatic in nature. I use a lot of psychiatric/behavioral interventions and communication skills. We do not have anyone with trachs or G-tubes or any other "complex" medical equipment, as the setting is not safe for that type of patient (behavior issues, peer-to-peer aggression, etc.) I use my assessment skills quite often and in a very different way than when I worked in the hospital, and I enjoy it. I do not use a lot of the technical skills of typical acute care nursing i.e. IVs or other things I was used to doing. But I like being the advocate for these residents, that just because they have a mental health diagnosis does not mean there is not something else physical going on (beyond "attention-seeking" that some of the staff think is going on), and figuring out when a nonverbal patient is just upset or whether they are actually having a physical issue/illness, and deciphering what that issue may be. I don't know if that rambling response helped answer any of your questions or not; I apologize if not. I just wanted to give you a clearer picture of the nurse's role in this type of setting and how the skill set you use differs from acute med-surg care.
  7. perfectbluebuildings

    My Body Is Not My Resume: Exploring Nursing Dress Codes

    Yes, I do not understand the idea that a ponytail or bun is "unprofessional". I have thick curly hair and that is the best way to keep it "tamed" while at my job. Even then, because it is so curly, little "strands" tend to frizz out at my temples no matter what I use to keep it smooth, and I don't like that it does that at work, but, just can't help it. I have worked with lots of nurses with their hair up in ponytails or buns; it never crossed my mind that some would see it as unprofessional. I guess something to think about for me? I'm not sure what else to do with my hair at work besides a ponytail or bun, any suggestions? Also I do like tattoos when they are well done; they can be so beautiful. I don't think I could pull one off, but I love the look of them, and the kids where I work think they are pretty "cool".
  8. perfectbluebuildings

    Why are they called, "Chucks?"

    I opened the thread thinking the same thing!!!
  9. perfectbluebuildings

    Bizarre Co-Worker Rant!

    Yes my workplace (not a hospital) is with kids. In front of the kids, we address each other or talk about each other as Mr. or Ms. [first-name]. With each other (no kids around) we address each other just by first name. It's just different unit/workplace cultures EVERYWHERE I think... I'm sorry this person has taken it quite that far a little ridiculous I think. Also, if it helps, at least you know it's not personal; she reacts to EVERYONE that way so it's not personal against you- though it does make for a difficult work environment. I used to work with a CNA who had some weird quirks that would make her so upset for the rest of the shift, but then the next day she had forgotten all about it and was her usual self. IDK if your co-worker is like this too but I'm sorry you have to deal with it. :-(
  10. This was a common thing for some patients/families in a pediatric situation where I used to work, most specifically with older teenage boys who had severe delays and resultant incontinence... some of the parents preferred to use an appropriately sized child's diaper to wrap around their child's penis and then a regular brief over that. It was just their usual way of doing things/their preference, and most of the time these children had excellent skin integrity, so it obviously wasn't causing them any problems. I don't know if that is similar to what is done in LTC or not... Of course we would not do this unless the parent wanted to (in this case, the patients could not make their own decisions.)
  11. perfectbluebuildings

    How to trick the one you love into staying alive

    I have similar situation with my partner/boyfriend of five years. He has gained almost 50 lbs in those five years and is now obese; he has been diagnosed with diabetes, high cholesterol, high blood pressure, etc; not to mention drinking too much which I know is bad for all of these conditions. He tries to eat healthy for a while but finds it too difficult after a while and just goes back to what he wants. He tries to cut down on drinking for a little while but then slides back- I have talked to him about getting help for it, but he is embarrassed and ashamed about it and absolutely refuses. He works 8-hr night shifts and is always tired so it's really hard for him to get exercise in. He is not old chronologically, but his health is that of someone much older, and I worry about him all the time. I love him so much and I want him around for a long time, and he is in denial about his health and about the seriousness of his diabetes and his weight. I don't have any idea how to help or do anything and it scares me. I've talked with him about it here and there but it's hard because he is so ashamed about it and I think feels helpless about it all, and cuts these conversations short as quickly as he can. I know he is a grown man and it's his responsibility, but I can't help but want him to improve his health, for his sake too- he would feel so much better. I just don't know what to do. So I sympathize with you. I don't have any good solutions. But I hear you and I empathize very much.
  12. perfectbluebuildings

    What's your best 'Nurse Hack'?

    YES!!!! This is the best "nurse hack" I've read yet!!!!!
  13. perfectbluebuildings

    What's your best 'Nurse Hack'?

    Slushies for patients who don't want to drink (esp good with kids): Microwave two-three popsicles (unwrapped of course) in a styrofoam cup for about 45 seconds (or depending on your microwave- till they're soft enough to scrape off the stick but not liquefied). Pour in a little Sprite, crush up the popsicles in with the Sprite, you have yourself a very refreshing, rehydrating drink that patients may actually be excited to drink (again I work in pediatrics but everyone loves slushies!!!) Also... snack, cold drink, etc can make a big difference to patients (who are not NPO/sedated of course!!) I've found that when I have time to take that minute to ask them about that and bring it to them right at the start of the shift, results in a whole new attitude and positivity of interaction that lasts the rest of the shift... I don't know why it works but it seems to!! Which makes the whole shift easier with said patient/family, usually saving time in the long run, even though takes that extra minute at first. Obviously NOT possible every shift by any means, but it is something that if you have time, makes more difference than you might think. Never run when you can walk... Never stand when you can sit... Conserve your energy!!! :-) Have your patient gulp ice water (if possible) while you're placing an NG tube. Make sure at the START of your shift that all emergency equipment you might possibly even remotely need for that patient, is in their room and functional. Such as: suction open with appropriate suction device for patient attached (and saline bullets available, if applicable), oxygen source on with mask available, bag-valve mask if patient has a trach or unstable airway, a new pulse ox probe if the one the patient has is falling apart/not sticking well. Oh and of course a large basin if the patient has ANY hx nausea; NOT one of those tiny little emesis basins but one of the big ones, you know what I mean! Sometimes taping the med-port shut on a G-tube that is receiving continuous feeds... is a good idea. That sucker can pop open easily on some patients then your formula is all over the bed. Be sure to unclamp appropriate clamps on feeding tubes, IVs, etc after you start a new infusion or change something i.e. hanging an antibiotic, giving a GT or IV push med, etc. If you work night shift: Learning how to be as silent as possible with your assessments if patient is sleeping... always have a good penlight you can use for light to see what you need to see. ALWAYS ALWAYS ALWAYS check your IV sites regularly, and carefully... infiltrations happen fast and you can't completely prevent them, but being very attentive to the site means you catch it earlier. Also making sure the IV site is as stable as possible helps a lot... as much strategically placed tape, Tegaderm, armboards, etc that will help, different ways of positioning the tubing, etc, though ALWAYS MAKING SURE you can see the site itself to assess it!!! If a patient (or their parent/family member) says all of a sudden that, "Something is really wrong... I just don't feel right/he just doesn't look right..." PAY ATTENTION bc more often than not, those feelings turn out to mean something (in my experience). You can never have too many pens in your pockets!!! Those things grow legs. Also, your stethoscope. Keep it with you all of your shift; be VERY wary of "lending" it to someone for "just a minute" you may never get it back haha. :-) Do your best NOT to let people interrupt you while you are preparing your medications. I might add more later. Although this post is extremely too long already haha... I like this thread!!
  14. perfectbluebuildings

    What's your best 'Nurse Hack'?

    Time management; time management, time management!!! Learning to prioritize and delegate and multitask- that is a huge part of nursing that you DON'T learn in clinicals, but it's invaluable- actually, more like absolutely necessary- in real life nursing. The only way you can learn it is by watching some of your more experienced nurses, and seeing how they structure their shifts, and then trying to model it yourself. Be sure to let your preceptor know this is a skill that's important to you and you'd love to see how he/she does it. Maybe even ask for a copy of his/her "brain sheet" (every nurse has one!) And always having some kind of "plan", like the "brain sheet" I mentioned earlier where you have all of your patients written down, along with the hours they get meds, when their treatments are, when their pain meds or blood sugars or whatever other things might be due. Also try to determine which are your "sickest" patients and go assess them first, even though it's scary!! Because if you catch something small with them early in your shift, it will be a LOT easier to deal with than if it blows up later, and even if it DOES blow up later, at least you know their baseline assessment and can provide better emergent care. And don't be afraid to ask your preceptor questions, that is part of what they are there for. Not in the middle of a code or a delicate procedure obviously, but later on out in the hall or in the med room or whatever. Write them down if you need to. Learn where the bathrooms are... sometimes you just NEED a 2-minute or a 30-sec break, and you can go in there and be assured of privacy. YOU ARE GOING TO HAVE BAD DAYS. Probably a LOT of them. Maybe even some TERRIBLE days. You will get through them. You will learn from them. You may cry in your car on the way home, think you're stupid, think you shouldn't be a nurse any more. But not every day will be like that. And then in a year, the new grads will start asking YOU questions, and you'll actually be able to answer them, and you'll realize you're making it. You'll have that difficult patient and be able to handle him/her along with all of your others, and actually feel that you were a good nurse for them that day. One thing to remember though, all through your time as a nurse... you will never stop learning. OK I think I've rambled enough. Good luck to you!!!
  15. perfectbluebuildings

    Is spending $80,000 on a private ABSN school a waste

    YIKES, no, please save your money!!! There are so many wonderful programs out there that cost literally a fraction of that price and are just as good if not better!!! In the end, your first employer after nursing school does NOT care where you went to nursing school, just that you have a decent GPA and you pass the NCLEX!! And any employer after that will pretty much just look at your job experience. It's amazing that you've saved that much up!!! PLEASE save it for the future!!! :-)
  16. perfectbluebuildings

    Not bullying!! But need help to grow a backbone around a certain co-worker.

    I know I quoted/replied to several of you already, but I really, just wanted to thank you all for the new perspectives and the support; you have given me reason for introspection and ideas about how to handle the situation, that I would likely NOT have come up with on my own. And, it feels nice to be validated that I am not just "silly" in seeing her as an unpleasant coworker. I will try to be professional and not try to please her because that is NOT MY JOB, as you all say. Just, thank you a lot. I don't start threads often, and I know my OP was extremely long, so I really appreciate your awesome and well-thought-out responses VERY MUCH.