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  1. missjennmb

    How to refer to self when writing a nursing note

    I work in a clinic setting, so I'm sure its a bit different, but my docs hate to read drawn out entries, so I stick to the absolute minimum necessary. I was taught in nursing school to just write the facts, and the less I add to that the better. The only thing I am very careful about is writing "patient stated" entirely too much, just to be clear that I am not saying the pt has done x, y, z, just that the patient has said it, so I'm not held liable. "Pt called stating Ambien was giving nightmares. Per Linda Skewn, MD, called Diphenhydramine in to Walmart Pharmacy 555-5555, pt aware. Jenn MyrtleBeach, LPN" (of course giving strengths and dosages as well) I figure since I'm putting my name at the end, I dont need to say my name inside the note, I only say the names of others involved in the care if necessary so that I am not speaking of something that someone else did, that I cannot speak for personally for liability. CYA all over the place. We have one nurse who says "this nurse" and it sounds funny to me, but perhaps its just because I only see it with her (out of 50 or so nurses we have)
  2. missjennmb

    Dialysis, HIV and terminal Pts. Abuse?

    There is a difference between dialysis and transplants. If there were people standing in line waiting for dialysis and unable to get it because of abusers, it obviously makes sense to have a criteria of the perosn who most likely gets the benefit of it, but to be honest, there are times when the transplant issue really breaks my heart as well...and I wish we had enough to go around so even those who you dont feel "deserves it" would have that opportunity. A very beautiful and sweet patient that I grew to know very well at our clinic died a few weeks ago because she did not get a transplant before her body shut down. She had a history of alcohol abuse, but that didnt stop me from crying at her loss, and wishing there were a way we could have saved her, feeling the world were less for her not being in it. Perhaps seeing drug addicts, HIV patients, alcoholics, and psychiatrically challenged patients every day, the same ones repeatedly, and watching them struggle with those, growing to love many of them in my own way, makes it hard for me to understand the idea that they are an acceptable loss. They are people, they live, breathe, love and smile just like everyone else, and they have every right to it. Back to the original issue though... if dialysis is not a way to 'bridge' towards better health, if it will just prolong the inevitable, maybe that should be ok too. More time to say good bye is still more time. I dont even Kevorkian would deny a patient that, if that was their choice...
  3. missjennmb

    Who is responsible for paying for an ambulance?

    I dont know about the charge, but at my clinic, we always call 911 if we feel the patient needs it, regardless of if they want it. We dont even mention that on the phone, because for liability reasons we need to cover our tails. If we call, they come, pt doesnt want it, they and EMS make that decision and we can say we did all we could for them. We call an ambulance for the homeless quite often, sometimes twice in one day, and sometimes patients are just too drunk/high/afraid to go even if they should. Clinically speaking, some bp meds seem to make bp go higher the first hour and then drop after that. We are a clinic so the situation is different of course, but we treat bp's that high at times. It amazes me how high pt bp can be and them walk around like its no big deal.
  4. missjennmb

    Dialysis, HIV and terminal Pts. Abuse?

    "I am not spending my tax dollars on..." OMG ugh!!!!! I think its horrendous that we can discuss life and death using money as a reason to let people die. It truly makes me sick to my stomach. Now I am not saying that there are not situations where people should be allowed to die with dignity and as little pain as possible. I've cared for some people who should have been allowed to die long long before they finally passed. But to judge someone's right to live based on their addictions or compliance? How cold and judgemental. It saddens me to see such judgement. We can pay $23.4 MILLION dollars on a space toilet but cannot afford to care for people lives??? Drug and alcohol addiction is not like being addicted to chocolate. If you have not walked a mile in the shoes of a drug addict, there is simply no way you can possibly understand how immensely difficult it is for them to get that monkey off of their back. They need our compassion and understanding, and they are people too. HIV as well. HIV is not a death sentence like it used to be. People can live long active lives with HIV status, and they have every right to come to terms with their own deaths however they wish, even if it means they want to be a full code. For myself, I don't ever want a doctor to decide my fate, EVER. I would not want to let my fate rest in the hands of someone who may have their own agenda and beliefs different from my own. I want to die with dignity, but if my family is not ready to let me go, and I am beyond repair, I pray that I feel no pain at that point, but I would sacrifice myself to let my husband and children come to terms with my death before letting me go. It is MY choice, and I choose to let my family decide for me, in the event a situation arises that I am unable to choose for myself. Who are you to say otherwise?
  5. missjennmb

    Back to Traditional Nursing Uniforms?

    To be perfectly honest, I think the white nursing uniform is beautiful and incredibly symbolic of what a nurse is. (female only of course, lol) I would love to wear a white scrub dress, cute little nurse hat, shoes with a little bit of a heel..... But seriously, I would be so uncomfortable and so preoccupied with keeping it clean that I would be totally ineffective. I cant drink a single can of soda without wearing some of it, and pretty much all of my food bounces off my boobs otw to my mouth lol. It would be a failed attempt at best, and a full scale adventure in humiliation at its worst. I'd have to keep spare scrubs in my desk just to make it through the day.
  6. missjennmb

    Do your hospitals have bed bug problems?

    I dont personally have a problem with bed bugs, but I can tell you its going around the east coast and its in SC.
  7. missjennmb

    Fluid restrictions vs Patient rights

    I skipped the 500 pages of this thread... but since this was a response to my post... When I am a patient I AM NOT A CHILD!!! If a woman goes in to labor and goes into the hospital, the doc wants an epidural, pitocin, NPO. So would you say that if I chose not to go NPO or to refuse the epidural and/or pitocin I should go have my baby in the alley? Thats pretty much what you're saying. Drink water and go have your heart attack elsewhere. The reason people hate hospitals so much is because they feel like they loose all control of themselves and their lives when they walk in there. How is a patient taking responsibility for themselves when you treat them like a CHILD??? It is a proven fact that bringing patients into the process of taking care of themselves improves compliance. Wetting their lips, bringing them a sip of water, talking to them about the reason for the restriction (and I dont mean quoting 'education' I am really listening to them) goes a lot further. It doesnt take all day to make a patient feel like a person, but treating them like a child with no control over the decisions of their care and their life can bring a feeling of hospital-phobia and helplessness that will last for a LIFETIME.
  8. missjennmb

    Office Nurses!!!

    I work for a medical clinic, the only difference perhaps being that we get grants to care for the homeless at one of our clinics (but not all 4 for the most part) so that may factor in to the sheer amount of paperwork. Each doctor generally has 2 nurses - 1 for paperwork, 1 for intake. Our intake nurses put patients into the room, take bp/weight/temp/height/hr and o2 sat and peak flow if they're having breathing issues. They also do a lot of breathing treatments, finger stick blood sugar/HIV/hemoglobin, urinalysis, setting up rooms for paps and procedures, ear flushes, and more. We also do some med related things, collecting and distributing meds from sample closet and med assistance programs (all overseen/ordered by the provider) Our paperwork nurse does referrals, calls in meds, does pre-auths for meds, radiology referrals, getting back/entering reports, taking calls, doing a lot of triage and "nurse visits". We also do paperwork for a few things that are processed through grants, which is a pretty drawn out process. Because I'm at our homeless clinic now, we see a lot of knife wounds, random assault and alcohol related accidents etc, but I'm sure you get your share of drug seekers, chest pain, etc at private clinics as well. I love what I do and where I work, and I can't imagine working in any but this kind of setting. Hopefully I will never have to. :)
  9. missjennmb

    Lvn's who became Rn's... how did you do it?

    I got my LPN and graduated last August. My plan was to go right into a LPN-RN bridge program from there, and get a job that worked around that. I ended up taking the first job I could, 8:30-5:30 m-f which pretty much nixed it for me. I figured I'd work until my pre-reqs were done and then figure something else out, but now that I'm working, and really enjoying my job, going back to school is harder and harder. If you have a choice to go straight through your RN or do the bridge program, please take my advice and do your RN up front. It means struggling for a few more semesters, but it is SO much easier to go straight through than to stop and go back.
  10. missjennmb

    Public Health and birth control

    I work in community health, which is similar to public health. Our services are free to the majority of our patients, we do free paps, mammograms, general care, STD/HIV testing/counseling, along with general care. I cant imagine being here, with the patients I have (and love!) and being judgemental. People won't trust you, if you judge them, regardless of their backgrounds/beliefs/choices. Those that walk through our doors are very distrustful of healthcare providers, because of how they are judged, and nothing less than open minded acceptance of them, continuously, changes that. Think of it this way: given your beliefs, if patients know that you have them, they would likely be less open about their thoughts/concerns regarding pregnancy. That would undermine everything you are trying to do, as a public health nurse.
  11. missjennmb

    Not smart enough to be a doctor?

    delivering a healthy baby is cake... Its more about staying out of the way. The human body is amazing that way. Thats a big difference from taking care of very sick babies in the NICU with wires and resuscitation and meds and random crashes. IMO the biggest difference between nursing school and MD school is time. I could do it. I wouldn't love the classes but I've no doubt that I could get through. However, the idea of that much school straight and being moved all over the country before being let loose to actually get a 'real' job, not to mention the debt incurred, almost makes me break out in hives.
  12. missjennmb

    Fluid restrictions vs Patient rights

    "not interested in helping themselves" Nice way to think about patients. sigh This is why I don't work in a hospital, and am terrified of being there. Patient rights are trampled, and to not agree with or abide by one choice means you are "not interested in helping yourself". I'm sorry but patients have a right to make their own choices in life, even if its to their detriment. It is THEIR lives, and when they are unable to walk to the sink, they are completely at our mercy for every thing. We may not like it, or agree with them, but throwing the baby out with the bath water and assuming they dont care about themselves and should just go home has a lot to do with the total non-compliance of patients. Think of it this way: if you have a patient with a fluid restriction that is insisting on a drink regardless, and they get their own, they are probably going to get a tanker full of water. If you get it for them, you can give them a dixie cup full, and that might be enough to get them through. The idea of being the patient in this situation practically has me breaking out in hives.
  13. missjennmb

    Tennessee Mothers Choosing Home Births

    I've had 3 children... the first in a hospital where I was terrified, my terror encouraged (i.e. do x y z because you dont want to be in pain or hurt your baby) I gotta tell ya, I was in a lot of pain, fear, and have had a huge issue with the idea of being pregnant again, so much that it was 9 years before I ventured down that path again. I had my second and third child at home, in water. My second was 2 min 30 seconds from a hospital with a NICU. They were born at home, in water, in an amazingly soothing environment, and believe it or not, right into my very own hands. It was an amazing experience for me, and I cannot tell you how incredible the bond we shared, or how safe we felt. I did about 8 months of research on home birth, birth complications, things to look for, etc etc (and I mean obsessively over 8 months). I've gotten off my soapbox about my children's home births because so many wont understand it no matter how great the stats and are pretty nasty about it.
  14. missjennmb

    Dating someone from within ???

    I've dated in the workplace often, before I became a nurse. Its complicated, and it becomes way more complicated if it doesn't work out between you. If you are far enough away that you don't have to deal with eachother if the situation goes south its not bad, but when you have to see that person all the time when they screwed you over and broke your heart... very tough. All that said, the heart wants what the heart wants, and I've found not following my heart to be a very bad idea. You don't want to wake up 10 years from now and think "what if..." There will always be another job, there will not always be another "the one"
  15. missjennmb

    Just sign for it

    This is a really scary concept. So what happens when suddenly someone is accused of stealing the meds? they were signed for, but there is no proof they were given to a patient and nobody can find them.... Would be very hard to protect yourself from nefarious allegations after the fact.