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  1. twarlik

    How soon to give a prn??

    I'll give PRN about 30 minutes early if needed. However, with pain meds I try to see if the patient's pain is really being controlled. If a pt is consistently needing pain meds early, then I'm on the phone to the doc to see if a change can be made.
  2. twarlik

    Computer charting-what do you think?

    I assume you don't have computers at the bedside? We have a computer in every pt room and just chart as we go. No need to write anything down; just chart what you do when you do it. Sounds like your hospital's system is a bit flawed.
  3. twarlik

    Computer charting-what do you think?

    I've done both and prefer computerized charting. I think it makes information much more readily available for everyone to access; our physicians are able to pull up vitals and assessments from their offices now. I can actually chart a full assessment in our system in about 5 minutes or less. Very easy to use. Doesn't sounds like a very good system if it's taking you 30-60 minutes per assessment. I think it's rather short sighted to say that computerized charting is the "worse thing to happen to patient care." If the system is well designed, it should improve patient care not take away from it. The problem is the design not the concept. Todd
  4. twarlik

    New Grad - Big Decision!

    Who are "they"? Yes, day shift is busier. You also have much more support and resources that new grads need.
  5. twarlik

    New Grad - Big Decision!

    Is the night shift job a 12 hour shift? I worked 12 hour nights for two years and loved it. I think the majority of people can adjust to nights with little difficulty. Remember that there are many other differences between working nights and days other than the sleeping schedule. I personally think new grads are better on days in the beginning since there is much more support available. This idea that new grads have to start out on nights is just crazy. Night shift is usually a skeleton crew with very few resources for the novice nurse. However, if you're a new grad with a good head on your shoulders than nights can often work out fine. Good luck with the NCLEX! Todd
  6. twarlik

    Work and Nursing School - is it possible?

    I worked 20-30 hours/week while in nursing school. It if definitely doable. I second the opinion of one poster who suggested working in a hospital if possible. I worked as a nurse tech and got invaluable experience. Of course, having a 19 month year old at home is a different story and not something I had to contend with. I think at the end of the day, you do what you have to. If you want it bad enough it will happen. Good luck! Todd
  7. twarlik

    Portland ABSN programs...any thoughts?

    I work frequently with UP graduates and students. They are always very well prepared and get a lot of good clinical experience.
  8. twarlik

    First two weeks on the floor...

    What sort of things were you doing for her? Were they things like fluffing her pillow and filling her water pitcher, or more serious tasks? I've found that those "time consumers" often benefit from having me make strict hourly rounds. I tell them when I will be back and what I will be bringing with me when I return (pain meds, fresh coffee, etc). Once we develop trust, they stop calling so much and are no longer consuming my time. I put them on my schedule rather than the other way around. Good luck! Todd
  9. twarlik

    How do you get the courage to work overtime?

    I can certainly understand. I work 40 hour weeks as well and am usually hesitant to pick up overtime for the same reason. I just love my days off too much! Are you able to work half shifts? Sometimes I will stay for the first 4 hours of evening shift to help them out. That way, I get some overtime and I don't have to come in on my day off. If your hospital is anything like mine, they will be happy to get any sort of help they can get. Good luck paying off those loans! Todd
  10. twarlik

    Nervous!! Advice please!

    If you ever stop asking questions or get to the point that you think you know everything, that's when I would start to be concerned. You're going to have a huge learning curve this first year. Soak up as much information as you can. Find an experienced nurse who you look up to and make them your mentor. Watch them with their patients and see how they organize themselves. Above all, have confidence in yourself! You know far more than you think you do! Good luck! Todd
  11. twarlik

    What Do You Do....

    Good answers, TxPonyChic. I would add that for the 2nd question (low BP), I would first look at the patient and see how they're doing. Are they walking around and doing fine, or are they feeling faint? How does this blood pressure look when compared with their previous pressures? People walk around with pressures in the 90's, so I don't think it would be necessary to call a RRT for that. I frequently see patients with BP's in the 70's and 80's after dialysis who are doing fine, so it's always important to evaluate the information you have while looking at the whole picture. A BP doesn't tell you anything without looking at the patient first.
  12. twarlik

    When you don't know the answer.. what do you say?

    All excellent answers! Don't ever be afraid to tell a patient or family member that you don't have the answer to their question. Better to be honest with them than try to fake it and give them incorrect information. I think most people will appreciate your honesty. Todd
  13. twarlik

    Is Joint Commission more hindrance than help?

    The Joint Commission no longer announces its visits. Hospitals are given a window of time in which they could be visited (usually several months). This is suppose to keep hospitals in a state of "continual readiness". Not sure how effective it will be. Todd
  14. twarlik

    Single patient use BP cuffs

    Have you done a literature search? There was a recent article in Nursing Management regarding a hospital which was able to drastically reduce the spread of MRSA through a new infection control program. I don't think that the use of disposable blood pressure cuffs was one of their interventions. I've heard that our local VA hospital uses individual cuffs for each patient and also swabs every patient for MRSA on admission. They have been able to almost eliminate the spread of MRSA (or so I've been told). Todd
  15. twarlik

    My family is getting tired...

    As someone who is responsible for putting together my unit's schedule, I can certainly sympathize with the position your manager is in. I know at my hospital, it is quite a lengthy process even getting new positions posted, not to mention actually finding someone to hire. If you signed a contract saying you were available to work up to 72 hours in a pay period, then your manager should be allowed to schedule you for those hours. However, there needs to be some middle ground here since you're obviously unhappy and thinking of leaving. You should talk with your manager and try to come to an agreement. Lay it on the table and let her know your thoughts. Any smart manager will try to make a good employee happy. Perhaps you could work 3 days one week, and 4 the next. Good luck. I hope everything works out for you. Todd