Colorado1

I don't see traction ordered very much anymore. Our hip fractures usually get an ORIF or TH by the next day so we reposition gently and keep a large ice bag next to the hip.

I was always taught to take antibiotic piggybacks out of the refrigerator for an hour or so before hanging, to let them reach room temperature. Now I work with some newer nurses who look at me like I'm nuts. They take them directly from the refrigerator to the pole. And yes, they are COLD. To my recollection, this can irritate the veins and cause vasospasms. Not to mention, many of our patients are elderly and frail so one would think this would be a chilling experience, to say the least. Any thoughts, documentation, articles, etc out there would be appreciated.

• Receive patients from PACU, monitor post-op vitals, set up PCA, fluids, review post-op orders, orient patient to unit and review plan of care • Obtain admission history, entering collected data into computer system • Educate patients specific to condition, including precautions, potential post-op complications, etc • Communicate effectively with patients, family members, physicians, and coworkers • Monitor patients closely for changes in condition and advocate as needs arise • Position patients with respect to proper alignment, using understanding of body mechanics • Enhance patient status to return to baseline function or better, using multi-modal approach and communicating with various therapies and resources (PT, OT, RT, ST, pharmacy, social work, chaplain, massage) • Manage pain effectively, implementing position changes, cold therapy, activity, timely administration of analgesics with consideration of prior function (chronic pain, assistive devices, emotional requirements) • Set up and maintain various components of orthopedic equipment: Cryocuff, femoral nerve blocks, CPM, traction and overhead frame • Maintain supportive relationship with coworkers and delegate as appropriate That's just a little to get you started- just what I came up with off the top of my head. Think about what you do in a shift and you'll be amazed at how much you can come up with!

We do walking rounds at shift change. Before I leave the room, I ask, "Is there anything you need immediately?" If not, then I let them know I will be finishing report on my other patients and I will be back within an hour. We also do hourly rounds to address pain, potty, and position and let them know someone will be around about every hour to meet their needs. As a rule, this works pretty well. But I don't get upset by a family member coming out to ask me for an extra pillow or something. Nurses get interrupted. That's just kind of part of the job.

For those "hard IV sticks"... close your eyes. Sit down, get comfortable, and close your eyes. Feel for the vein with your fingertips. You will learn to differentiate and find that sweet little bounce. You'll soon be "a pro". Often you can feel what you can't see. Of course, don't handle sharp objects with your eyes closed :-) If someone is just getting IV abx or fluids they don't need anything bigger than a 22.

Wow, there is a lot of anger and bitterness flying around here. Let me see if I can help by adding my two cents worth. First of all, our profession is exactly that... a profession. With this comes an expectation of a particular demeanor... professionalism. Present yourself in a caring, genuine way that conveys confidence and competence. Make it a personal rule to greet every patient with a handshake and a smile. It will start your shift off on a good foot and you'll be surprised at how much of a difference it makes. And take five minutes to pull up a chair and sit down to talk to your patient about how the day is going. Be an active listener and you can probably diffuse problems before they get out of hand. This can really help both of you. You will learn a lot and your patient will know you are invested. Threatening a patient, doesn't solve or improve anything. Communicate in a way that preserves your dignity, as well as that of your patient. When you do have a difficult situation, take some slow deep breaths and for heaven's sake don't say or do anything that will make things worse. Contact your shift manager, a patient rep, your department manager, charge nurse, or anyone else who may be able to offer some assistance and insight. If your facility has an on-site social worker that's another great person to utilize. Keep in mind we don't see patients at their best. Many patients are scared. Their health is declining day-by-day. They have no means to pay for meds and bills. Their doctor isn't giving them enough information in their two minute morning fly by. They may not have the family support they wish they had. They're in an unfamiliar setting with unfamiliar information. They have pain. They are sick. As nurses, we are here to treat the whole patient- mind, body, and spirit. What we do is important.

That really isn't a significant $ difference. Go for it. You'll be happier and more rested. Priceless.

Our pulse ox probes, SCD sleeves, and BP cuffs all go back to a company to be reworked. We have several recycle wastebaskets around the floor for cans, non-patient-sensitive paper, etc. Many of our lights (supply closets, locker room, etc) have motion activation sensors for on/off. The cafeteria has "green" plates, flatwear, etc. BUT up in patient care areas we still have styrofoam which drives me crazy.

Yes. I am an ortho nurse and am a member of NAON.

You guys are great! Keep 'em coming!

Our floor is getting t-shirts and looking for slogan ideas. Any bright ones out there? Has to have something pertaining to ortho.... bones, joints...

Ortho can be a great place to work. I've done it for seven years and love it. You really need to know how to work together on the floor. Get up and help your co-workers whenever you can because there will be plenty of times when you need them too. Manage pain before it gets out of control. Even when my post-ops come up with a PCA I give them oral narcotics to wean them off of it as soon as I can. They do so much better. Pre-medicate for physical therapy. Turn your patients every two hours, even if it's just a little tilt to enhance circulation! Teach them about incentive spirometry/deep breathing, ankle excercises, relaxation techniques, use of overhead frames, body mechanics, etc. There is so much to teach on this floor. It's great. And yes, they are not just ortho patients. They are patients who may have multiple health issues who have had ortho surgery. You really do manage a lot of care but it's fun. These people generally get better and go home. It's nice to be a part of their progress.

I have heard, more than once, contradictions in what Joint Commission requires when compared hospital-to-hospital. This leads me to believe hospitals sometimes use it as an excuse for implementation of new policies or procedures. I truly can't imagine them saying nurses need to provide the ratioale. In our facility, the Medication Reconciliation is printed whenever a patient transfers from ICU to another floor, and the night before the patient is expected to discharge (put on front of the order section for the doc). Our printout includes both home meds (in lower case) and all those taken in the hospital (IN UPPER CASE). Then when the doc comes in he simply checks the box in the "continue" column for any he wants to carry forward. If the patient's discharging, the nurse then makes these edits to the home med list which then prints out from the system. It's a great benefit to the patients to have such a clear picture of what they're supposed to take and when.

so in the middle of the night i go in to give a patient his pain pills. i hand him his water pitcher (ours are opaque with the logo and a big bendy straw). he takes his pills and immediatley starts sputtering and spitting... "that was piss". i was shocked!!! "what?" he said he peed in his water jug. when i asked him why in the world he would do that, he said he didn't think he could get to the bathroom in time. now maybe i'm insensitive, but i didn't even apologize. i figure anyone stupid enough to piss in their water pitcher on purpose deserves to take a good swig.

I press my uniforms and jackets, put on makeup, style my hair, keep my nails done, etc. It's part of my preparation for getting in to the mindset. Take care of yourself, then you can take care of others. That is how you look more professional. You will stand out in the crowd and always look more put together, even at the end of your shift.