Allaroundnurse

:balloons: It's time for nurses (all nurses) to quit fighting as to what type of a degree or non-degree is best. This is what has made room for PA's and MA's in the medical field. We as nurses have to have a unified front. Mom I can empathize with you for your goals for your daughter and I can see your point as well as the points of many of the responses. The patient doesn't care what type of degree is taking care of them. I have worked with many APRN's - LPN's and if you are a true NURSE there is little difference in your care to the patient. The major difference is in knowing what to report to who. I have come up in the ranks from an Aide to LPN to ASN and am in the process of getting my MSN. Too many of us get NURSEitis and get caught in the trap of what type of educational background we come from instead of what kind of care we deliver. Mom take heart, and be there for your daughter. Remember that she will be your daughter for the rest of her life, but a student (hopefully) just for a few more years.

Makes you feel all warm and fuzzy and glad you became a nurse. It almost makes up for the 1am CHF calls for Acute nurses, the 10kg "but I only drank 1 glass of water" days, and my favorite, "OK WHO RAN OVER THE BICARB TANK TODAY?" days. To know that we do make a difference and it is appreciated makes me proud to say "I AM A NURSE AND I MAKE A DIFFERENCE!!!" Never, but never say I am just a nurse, we save lives every day!

Boy do these words sound familiar. Been there myself a few too many times. The key to a good turnaround is the patient schedule and who is in charge of it. As long as nurses let the pct's run the schedule we are going to be run off of our feet. One of the tech's challenges is to get the shift on faster. This is not always a good thing. When you set up your schedule you need to look at times off. It is best to have at the minimum 15minutes between patients and at least 30 but preferably 45 minutes to turn the machine around. (15minutes for the patient and 30 minutes for the machine). When you do this there is less stress and everyone benefits. Try this to see if you can get buy in. If there isn't buy in by the team it won't work. The nurses have to take charge of the schedule and no one can call a patient in without the nurses approval. :balloons:

I wish every nurse would be like you and ask!! Your acute dialysis nurse should help you. There is a book that is published (it will fit in your pocket) the 2003 version was put out by Bone Care (they make Hectoral), I'm sorry to say that I don't know who did the 2004 version, and it has which drugs are dialyzed out. The antihypertensives are held if the patient has a problem with having low B/P during treatment. Ask the patient if they take their B/P meds prior to going to their treatment in the outpatient facility. Naphrocaps are a vitamin and vitamins usually dialyze out, if the chronic nurse (the outpatient facility nurse) did good teaching the patient can also tell you this. The binders (renagel, phoslo, tums, magnabind) there are a few more, are given with food to bind with the phosphorus in the food so that it can be excreted in the stool. That is why we call them binders, the other reason is because these meds can also cause constipation (with the exception of magnabind -diarrhea). http://www.davita.com is a good web site to visit to get information for the health care professional. Again talk to your acute dialysis nurse and ask for an inservice on medications and dialysis. If I can be of any assistance please let me know.

Tums can be used as a binder, it binds with phosphorus to be gotten rid of in the stool, if it is being used as a binder it is not PRN, it is with meals, if you give it at any other time it does not act as a binder and will increase calcium levels. You don't mention what the patients calcium level is but: if it is low they may be using it to raise the level so, if given with meals it will act as a binder and will not raise calcium. It is better to give it between meals or at bedtime if you are trying to raise the calcium level. This is not the norm for dialysis patients but it can happen. Milk is OK but there is a limit of usually 1/2 glass a day, again it will depend on the calcium levels. The unit that the patient dialyzes at will have the labs. They are usually drawn at the least every month but can be every week so give them a call. http://www.davita.com is a great resouce tool to get current information regarding chronic kidney disease and end stage renal disease.

Been there and done that!! So I know how you feel. My doc gave me some great advice, this was after the 3rd phone call and I thought I was hemorraging after my first BM at home. He told me to take my pain med and go to bed. When I woke up. It was time to do my in and out cath, by this time the pyridium had started working so that I didn't have that "urgent" feeling anymore. Time does help and you have that on your side by giving yourself 5 weeks before starting back to school. Remember, pyridium does turn everything, and I mean everything, underwear included so no good stuff for a while, orange!!! Good luck

I know how hard it can be. Our program closed after 9 months. We restarted it on Memorial Day. The hospital that we work out of was glad to have the program back. Get in touch with the Office for Victims of Crime (OVC) and your Rape Crisis program. Our program is paid for by the Coroners office. It is important that you work with the DA's office but you do not want to be biased. Keep your chin up because it does get better.

I was just wondering how your studing is going? I want to take the CDN also but just haven't gotten to it yet.

Most catheters have the capacity on the clamps. We have started using cathflo activase and found that it works better if you can leave it in overnite. Any other declots we send to the surgeon or to Interventional Radiology. Plavix 75mg qd also works good. As far as your problem children: I have found that they respond better to having them weigh several times a day (I make them a chart with Kg converted to #) and my 5-6K wt gainers are now down to 3-4K over the Weekend. If all else fails instead of shooting ideas......

I agree that it will take you 6 months to feel comfortable in the unit. Our training program for new grads with no dialysis experience is the same as for a PCT at first. You go through the didatic where you learn the why then work with an experience PCT preceptor to learn the how. We try to use the same work rotation so that you are only with one preceptor. Once you are able to turn 4 patients and this can take from 6 to 8 weeks, you start learning how to respond to problems like low B/P, chills, etc. from the Charge Nurse. Once you are comfortable with responding to problems the CN starts on troubleshooting the machines. Then you start charge nurse training. Here you will learn about assessments and what to do with EDW and access problems. Sometimes you can get more of all of this while you are training depending on how fast you learn the PCT aspect. For the first 6 months you are never the only RN in the building so that you can ask questions. Remember that nurses are usually always slower than the PCT's. The only exception is a PCT who goes back to be a nurse. As a nurse we are constantly assessing as we work so that always takes longer. A PCT's challenge is to try to get faster so don't let them make you feel like you can't keep up. They will be able to work faster. Hope this helps. Remember to ask questions and don't feel that you are asking stupid questions because there are only stupid answers.

I have been a S.A.N.E. for over 1 year now and we are currently restarting our program. In our program the SANE is the person who does the exam and the rape kit. We also do alot of teaching and are an active part of the SART in our area. We have a well rounded group of SANE's with alot of OB/GYN experience including a Midwife. It is an area of medicine that of course nurses are better than most MD's. The MD's in our ER are standing on their heads they are so happy the program is being revamped. So hang in there if you are having trouble. When the MD's see how much of a help you are they will be glad you are there. :roll