lizva101

Ok, just being silly I think, but if the asa is absorbed rectally, then would that increase the risk for bleeding? esp if at high risk?

Hi, I have seen nurses mix 2 together. The only problem I can think about - Pt may have severe reaction to one of those three medications, if all three are given you have no idea which med cozed it. And believe me, the MD will want an answer. You could always run it by the doc if you are uncomfortable, then he becomes a resonsible party. I would be very careful mixing drugs.

Oh, just had an entire post lost. So, very interesting thread. Thank you. Prevention. UTI's, if sterile technique and organism resistant catheters are used, how can medicare not pay for UTIs. And, should ALL patients be screened for UTI as policy in ED? That would be a good QI policy. Response to Medicare's demands... I think it is quite interesting turn of events. If the hospital were to dedicate a unit to pts with risk of skin ulcers, then that unit would have to have ancilliary staff dedicated to 2 tasks: repositioning EVERY 2 hours and Toileting every 2hours on every patient and proper skincare. Then , I would think that medicare would have to COVER the cost of the extra staff if they are demanding pts to be free from skin ulcers ect. 2nd unit --- dedicated to only isolation pts. I do think this is a good idea. Perhaps the hospital could make the staff more comfortable isolation protective gear! and then add that to the bill for medicare. If I wasn't allergic/sensitive to those yellow gowns and suffocating mouth gear I would go for it. I think tThey would be good for the patients, both for better care and morale. These new standards from medicare might give a lot of leverage to the hospital to start billing for preventative measures taken, i.e. more STAFF, new units, ect.... And I think it would be good for these patients to be better treated, a staff nurse simply can not give skin care and all the preventative measures necessary to prevent skin breakdown on every patient each day. And nursing assistants can not truly document effective preventive measures either as they are constantly being pulled in many directions and could not document effectively even if they were able to provide the care. Screening for skin breakdown pts could start in the ED (i.e. braden scale) and those who score could be admitted to the new unit. And their admission could be expediated. I work in the ED, and they say after 4 hours, skin on a normal young patient begins to be at risk for skin breakdown/pressure sores. And in the ED, pts can be on the stretcher for a very long time. I say, administrators -- take a good look at these new demands and face 'em head on. Fight a good fight.

You are right. that was overstated and an inane choice of words. I definately apologize for that choice of words. thank you.

It is so laughable to me that the people who wrote back are the people who enjoy weekends, and are also saying --- If you don't like it then change professions/locations. Thanks for supporting my argument. It is also interesting to me that there is offered so many weekend incentives, yes, they are great bonuses, and increase the monetary reward quite a bit, yet people are still required to pick them up --- and frequently. I know, gasp - what not work every other weekend? when I reread my post - I do the gasp. But yet that affects my job satisfaction and fuels my thoughts for alternatives. Is it so bad to consider something that is little more realistic? Staffing is there. Per Diem nurses are available. And there are nurses who prefer weekends. Yes folks, I realize that people get sick 24/7. Do you realize there is a nursing shortage? And yes, you might as well work at a bank then, ok. Do you know how many nurses are employed in different professions other than nursing. This programmed thinking does not help to increase the number of nurses available to care for the increasing number of sick. There is a lot of apathy towards this, but why do you think there are frequent job changes in nursing? Nurses gain invaluable specialized skills, then after 2 years, its off to another arena - many factors play a role, but ability to be available to family, apathy from management, etc. Nursing is a profession - I won't differ - but how much more respected as a profession would nurses be if they are not the victim of a broken healthcare system overseen by CEOs? And how much more time would be dedicated to training, advancement. Nursing is not just about where there is less management on duty, where there is extra pay is.. 12's, 8's, requests for overtime, weekend incentives, but requiring EOW for as far as you can see? Doesn't that limit that number of nurses who are going to go for the position? But then again, making requirements such as EOW, do help to keep nurses switching from one job to yet another, and that does help continue the cycle of the nursing shortage, and wala - you have offers of great weekend incentives!

Every other weekend is just inhumane. We are expected to be caregivers and give our lives to service --- yet -- we also HAVE to work every other weekend. We are still although healthcare providers, part of the human race , who have family, and other interests necessary to maintain a healthy psych. There would be a lot stress in the field if it wasn't about who can cut it and who can't, if it were more humane. Not to mention --- Come on people. This is a profession, not a rat race based on who can stay up for 12 hours and hack an every other weekend job. Give me a break. I am so fumming -- The only non every other weekend position is OR, PACU, or day surgery. WHAT IS WRONG WITH MANAGERS/LEADERS THAT THEY DON'T REALIZE THAT EVERY OTHER IS NOT GOOD FOR RETENTION. I know the argument -- not enough staff. give me a break. Thats what per diem nurses are for. Make per diem positions less attractive, and gain more Staff Nurses. I mean come on, you don't have to be mensa to see the results increase retention, decrease nurse burn out. Some prefer weekends -- great. Let them work workends people. If it was a male dominated profession Let me ask You ---- Would they note that perhaps requiring every other weekend was a bit - shall we say nonprogressive? Would they allow for every 3rd weekend option? Just a point to ponder. There are enough nurses, just not enough willing to work in an archaic work environment. My next project -- To research effects of nursing morale, retention, performance by increasing some say over their schedule by oh 35%, specifically, reducing the number of required weekends. Think of it, half of lives (in weekend terms) are lost.

Thank you. I understand what you are saying. I think there are practices where there just isn't enough outcome data to decide best practice. But is there a body that is collecting data? I know nurses within facilities are doing great research and continuing to search for ways to improve practice. So some policies may be ahead of others based on more comprehensive clinical evidence. I just think that there may be a disparity within nursing caused by different practices.

Hi All, I have noted lately that many procedure policies vary from one insitution to another. Example : Some hospital policies say flush central lines with 3 cc heparin per shift, some say per 72 hours. Hospitals have different policies to prevent vent pneumonia, different policies for admin high alert meds, just look at the message boards and you will see different responses to clinical questions, many answers influenced by the respondents insitutional nursing policies. I really feel like there is such a thing as a best policy based on several factors, ie pt outcomes, pt safety, cost effectiveness. I also feel that as travel nursing is becoming so integrated, there should be a way to form uniform policies from hospital to hospital. I think this would cut down on the cost of staff training and would better the field of nursing. Does anyone know of any way to look into this matter? I am really interested if anyone has any background in this or if they have any input to add. Also, what do you think of this idea? I think it would be great, I think unit managers are always hunting for the most cost effective ways to improve practice but don't necessarily have the time to do the research. And if there was a body that would do the research for them, then maybe the managers would have more time to spend on the floor, rather than worrying about how to change and implement new policy. I would like to create a task force or join one addressing this topic. Any thoughts? Thank you.

hi, would anyone who has experience in these two specialties feel comfortable talking about it b/n email? I would like to have a dialogue about this decision. ty.

hi everyone! wondering, i'm very nervous about er. i'm nervous about prioritization and when I was on med surge, I often thought about ways to do things differently and that was stressful. Although I was a good nurse, I liked attn to detail and i think that bothered me about the med/surge floor; that there was lack of attn by some docs. In the ER, do u find that u take events home with you?> I was in the ER and I was a bit shocked that the pts were first assessed and then it was hurry up and wait. I don't know if I can deal with that mentality. On the other hand, I don't know if I would be able to stay awake at night in the ICU. I need physicla stimulation to stay awake. Both positions have day/night rotating. Any thoughts? Any experiences to share in either unit? Thank you

I'm a med surge nurse and have until Friday to decide to go to either ER, ICU, or OB. Please tell me your thoughts!! Has anyone went to the ER and realized it was not for them? Which is the most stressful unit? What if I get grossed out by ER? Has anyone gone to the ER and realized it was not for them? Was anyone nervous about the ER only to discover it was good for them? Note: If I choose ER, its a 2 year committment. Please help to decide. I like the ER because it will be exciting -- But tooo exciting??? I like the ICU because I can use critical thinking and keep skills up. I like OB because maybe I just need a break! :) TY for reading and please share your experiences with me TY in VA