JazzyRN

CNMC. worked in the pediatric ICU. it was grossly understaffed with high pt acuity. nurses would take 3 patients regularly and it was very unsafe. you rarely got lunch. coworkers were all so busy, it was hard to get help or relief. i would feel sick and anxious prior to each shift i work and found myself praying to make it through the shift. luckily it was only a travel assignment with and not a real job for me. i pray that things are better over there now for the sake of the nurses and their patients.

Have you ever had a patient .... So full of energy and life that you looked forward to caring for them whenever they were there? That was so brave in the face of illness, they never let it get them down? Always kept a smile on their face and their sense of humor when they were feeling sick or recieved bad news? You would negotiate to change your assignment in order to be their nurse that day? That could make you laugh/smile and instantly improve your outlook on your day? That felt like a member of your own family? That traded in their wheels for wings so unexpectedly it stole the breath out of your chest? I lost a patient this week that was so kind, caring, funny and unique that I will never forget him. Try as we might to maintain a professional relationship, once in a while a patient slips through and leaves an imprint on your heart that can never be erased. I learned so much from you J.M.C. about loving life and staying positive. I am so thankful that I had the opportunity to care for and get to know you. You will never be forgotten. R.I.P.

I think it would be extremely difficult to get an accurate answer to your question. Med errors occur both day and night and are grossly underreported. I think more important than trying to figure out what shift is reporting the most, its more useful to understand the underlying elements that can set people up to make mistakes. Things such as poor staffing, fatigue, distraction, systems errors need to be examined and corrected. I think medication errors are great learning experiences and make better nurses out of people.

Yes I found a preceptor, actually 2 great preceptors, one PNP and one pediatrician. Thank you guys for your help and concern. I'll finally be done this December!

I think it really depends on the situation and the reason why you do not want to work with a patient. But since you can't be more specific, there isnt much else to say

seizures are pretty simple. just ensure that there is oxygen and suction in the room. although they are rarely needed. just time and observe the seizure, ensuring the patient is safe, with enough padding around them so as not to injure themself. there isnt much to do. If they do not come out of their seizure within a couple minutes, then draw a whatever PRN med (usually ativan) is ordered for their seizures. dont bother trying to get vitals with a GTC because they are often hard to obtain and inaccurate. some will throw oxygen on a seizing patient, because they may desat a little but its usually not necessary.

i think you should let her go to school

I'm a PNP student in my 2nd semester of my program. I am looking for a great PNP preceptor in primary peds practice 2 days/wk for the short 10 week summer session. I am looking in the Washington DC area, including Prince Georges, Montgomery County, Howard County and Annapolis. I would really appreciate any suggestions. Thanks.

I just wanted to inquire about finding a preceptor. My school has encouraged us to find our own PNP preceptors for summer session if we would like to have clinical closer to home. I would really prefer a PNP instead of a pediatrician. I looked up a few of the pediatric practices I know of on the internet and found a few PNPs. I was just wondering if anyone had any tips on how to approach or inquire about a preceptorship from these complete strangers? Has anyone else gone through this? I am looking the in the Washington DC or Prince Georges/Montgomery county area, let me know if you have any suggestions. Thanks.

We used a similar form in my old job in NYC. It was called the protest of assignment form. People would still take the assignment, but where it becomes useful is if a bad outcome or event occurs, it should save you from personal responsibility and the hospital management will really have some big explaining to do. I think its great. Most hospitals in NYC have nursing unions, so there is no way someone could get fired for that.

We all make mistakes, don't beat yourself up about it. However I must say, if you are busy and don't verify a med with the MAR, that med should never be an insulin. Insulin is prone to making errors and can end up killing patients. In time you will recognize these drugs such as insulin, KCl, digoxin. One must come out of autopilot then review the 5 rigths and get a proper double check. Mistakes make us better nurses which is a positive that comes from that.

turbulent blood flow causes that vibration, perhaps your patient has some peripheral vascular insufficiency/disease. if this patient has some atherosclerotic changes in the vessels of this hand, then you occluding the vein with the tourniquet added an additional obstruction causing a greater turbulence which is the vibration felt

This letter is crap. So we are to believe that every evacuee is an alcoholic, drug abusing, ungrateful, disrespectful neglectful parent. There was no one that was a normal citizen down on their luck due to their homes and belongings being destroyed? This is really sad and just highlights how much racism and classist thinking exists in this country. I have a coworker in the US Health Corps that spent 2 weeks there helping out and had alot of encouraging and positive stories about the teamwork and the lovely ppl there.

if you think its not right for you, chances are that you are right. Listen to your intuition on this one. I was told as well, that I must do my one year of med surg to be marketable and its not really true. The nursing shortage is such that a lot of places will accept and train you on their specialty unit. I graduated and went straight into peds. i have friends that went straight to ICU, PICU, NICU, ER, hem/onc without that year of med surg. So I say get out there and interview on a less hectic unit. Good luck!

Yes there is we gave babies a formula called Alimentum, when they can't tolerate soy or milk formulas.

I personally think it is ridiculous to get upset if someone is asking questions during report. If I have a question, its because something is not clear to me and I will ask it right then and there, if I wait and hold my questions to the end, I may forget to clarify something. A new nurse most certainly will have alot of questions, we were all there once, and no one should forget that.

I work as a CRN at NIH, and we take care of the inpatients, if you are looking for a postion without bedside pt care, you would need to apply for a position as a research nurse for one of the individual institutes. I enjoy my work there, you use the same skills you use in a regular hospital. However in my experience at NIH, I have not used many of the technical skills that I used at other hospitals, our patients tend to be less sick and more stable. But it can be stressful monitoring pts receiving phase I drugs, chemotherapy and biotherapies. We do a lot of transfusions, drawing labs, serial testing, pt education. Less of placing PIVs, foleys, NGTs, etc. Email me if you have any more questions

When you trying to get a IV in a baby thats a hard stick, have poked them a couple times and haven't gotten a cry or a movement in response from them...

yes i have seen it, called something different though in a few of the childrens hospitals ive worked in. joint commission has now identified it as a national pt safety goal, so im sure it will show up in all facilities now. but its definitely a good thing, decreasing the amts of codes

nope at this facility aides dont do fingersticks. yeah its scary because i have a feeling something bad is going to happen there. but management is unconcerned since they have been lucky this far to not have any sentinel events surrounding this issue.

There are bad apples in every bunch. There are techs that dont do their work and/or have attitudes when asked to do something. There are also nurses that sit back and instead of taking care of something themself, call a tech to do it when they are perfectly capable and have free time. I have seen both ends of the spectrum. From what I have seen from techs that dont do their work on the job, there is a lack of punitive action. People dont report them, dont call them on their actions and they continue to get away with what they are allowed to. Whats sad to me is that when the nurse is the one slacking, she really rarely ever has a tech stand up and ask why she isnt helping out. I have seen nurses try to intimidate techs with mentioning writing them up, to get them to do things that are unfair.What I hate the most is when I see a nurse go in to a pt room, see them soiled and walk out to page a tech to clean the pt up, while she sits down and checks email, meanwhile the tech is busy doing vitals on the floor or bathing someone else. Luckily most techs I work with are great and the ones that arent are allowed to be sub par by no one taking any action.

I work in a NYC children's hospital per diem. In this hospital when a child comes in as a DKA on insulin drip with fluids and Q1 hr fingersticks, they are placed on the floor. A nurse will admit and care for this patient along with her 4 or 5 other patients. The DKA pt is very time consuming with all the fingersticks, labs, urine dips, titrating insulin and changing IVFs or rates every hour or two. I see this as being dangerous. All of the other hospitals I have worked, DKAs were in the ICU until transitioned off the insulin gtt.I was just wondering what others have experienced?

It saddens me that there are so many people living in such ignorance. You want to know what the treatment of African Americans in the past has to do with today. You call it "dwelling on things". As an African American woman, try walking in my shoes and learn how it affects me daily and see if its easy to forget the past, when you are reminded of it everyday. I work as a travel and agency nurse and frequently work in new environments. I am constantly assumed to be the CNA upon arrival, by the staff mostly as well as patients/families at times. No one bothers to notice the RN on my badge. There are times where I have introduced myself as the new travel nurse or ageny RN, yet still certain people of the caucasian persuasion do not hear my words, because they already know in their mind who I am. I have dealt with racist families. Some who will outright ask for a white nurse, as well as those that will speak with a condescending attitude, attempt to question if I am doing things correctly and make complaints over minor things (starting an NGT feed at 1150, instead of 1200 or giving a 1800 med at 1820), just because they have a problem with my color. Taking it out of the hospital, to everyday occurences. Such as how when African Americans go missing, its not a big deal, not national news, often times won't make the local news. But when its a white individual, the story is all over CNN, The Today Show and everywhere else. Has anyone ever noticed when a crime is reported on the local news and the suspect is at large. When the suspect is black, that is always emphasized, looking for a black male, 6 foot, 200 lbs. However if its a white male, race isnt mentioned? Then they are just looking for a 6 foot, 200 lb male, wearing a red hat. Has anyone noticed when there is a crime commited by a black person against a white person, the press eats it up? However the same crime commited against people of the same race gets no coverage. Prime example, the story of that pregnant white woman, whose black police officer husband was arrested for the crime. The story had an incredible amount of coverage. About 2 months ago, I was standing outside of a restaurant in the parking lot with 2 of my friends talking. A truck of 3 white men drove by, rolled their window down and yelled "die ni**ers die" and kept on driving. I can tell you about how last year, I was pulled over for a DWB(driving while black). The officer claims that he thought my registration was expired. Although it clearly states on the back license plate, it expires 04/08. I was questioned about whose car I was driving immediately.He then went on to ask what I do for a living, and where I get enough money to afford my car (of course a black female cant possibly own a mercedes). After spending and eternity, running my license and registration after having absolutely no reason for pulling me over, he had to let me go. Im an avid spades player, I play spades on yahoo games frequently. I use the black female icon to represent me while I play. I cannot tell you the number of times I have been called the N word, whore, welfare queen, drug addict, or accused of having multiple children by many men. Usually this is set off by just winning a game. I could go on and on, but Im sure its pointless, as you will never make the connection to African Americans being enslaved and the negative/racist way that my people continue to be perceived and treated. Im sure we should just get over it since it was SOO many years ago and what we go through today is minor. Im never surprised when these white celebrities get caught using racial slurs, i.e. Michael Richardson, Paris Hilton, Dog the Bounty Hunter. Just reading the statement made by this poster and the users that thank her for her comments, its quite obvious the attitudes you have. Either you walk around with your head in the clouds and dont notice the prejudice and racism that exists in this country or I suspect that you yourself are a thinly veiled racist, just too cowardly to admit it. Open your eyes,get your head out of your @ss and realize that African Americans go through alot of nonsense at the hands of white people in this country, whether or not you encounter it in your everyday life, doesnt negate what IS happening.

yeah ive given clear tpn to a pt on a heparin gtt for some rare clotting disorder. they didnt want the MVI because of the vit K interference with the clotting factors

I agree with Ali. Those near drowners are so hard to deal with. Completely normal healthy kids that quickly go down the tubes. The families deal with alot of guilt and its always very emotional and unexpected. Ive seen a couple of these kids actually make a neurological recovery but die anyway because the injury to the lungs was too great. It gets me everytime.