Darknights

This is for every patient, including those with heart failure. The rationale is that there is no reason not to administer the packed cells over one hour. However, when the pt has been admitted with heart failure and were overloaded we are reluctant to give a unit so quickly.

Hi, We frequently have extremely elderly patients with heart failure and multiple co-morbidities who require blood transfusions. The physician wants the 350ml Packed Cells administered over an hour and doesn't provide an order for frusemide. Is this volume enough to overload an already compromised patient? IF so, what is your standard over in the U.S for duration of transfusion of Packed Cells for such patients. And, I'd be extremely grateful if someone could tell me why vaccines, heparin, Enoxaparin etc are given via DEEP subcutaneous injection. I can't find the rationale for it to be deep, less pain receptors in the deep tissue????

She said it was to decrease errors. As most safety experts talk about having less steps in a process, to lessen the risk of errors....I can't see how administering from a trolley out in the corridor will decrease errors. And it would be less productive, heaps more walking.

My worst scripting experience was dealing with a telecommunications company lately. The call centre personnel were totally unable to deviate from their script and actually stumbled if I tried to divert them straight to my issue. It took me 5 1/2 hours of going through the same series of questions and answers with every person I was put through to, until I finally got someone who had no script and within five minutes she had identified my issue and promised to correct it herself personally. I will not forget her because she was such a welcome contrast to all those robot voices I'd been unable to get any sense from previously. Some of their scripted responses to what I'd say were so ridiculous and completely out of context that I felt like I was trapped in some sort of call centre hell.

We have med lockers on the wall next to each patient's bed. Nurses are responsible for restocking them or initially stocking them from meds stocked in cupboards in the treatment room. Our DON has suddenly dictated that we must now purchase a medication trolley for each end of the ward and administer meds from that. It's drawers will contain a box for each patient's meds. She said this will reduce the number of med errors. As it would take one nurse three hours to administer meds to an end we would have two nurses sharing each trolley so it is supposed to be put in the middle of the corridor with the nurses doing laps between it and the patients. To me this will increase the possibility for errors. I can also see the potential for med charts to not be put back on the right beds etc. How can a dedicated locker next to each patient result in more errors? I just can't see it, but it is the only system I know.

You care. From what you said I don't think you sound like a bad nurse. Try to remember that New Grads aren't considered able to work confidently and independently until they have at least 12 months experience. You have a lot of knowledge to connect with the benefit of the experience you are getting so it all can slowly come together for you. Unfortunately ward work is hectic most of the time now. You do what you can, when you can. Make the minutes count. Here, we RN's shower patients too. That's where most of my deep and meaningful conversations with patients happen. Just remember to look after yourself. Do what you can in your time off to replenish your care bank. Then you always have something to give and those minutes you can enjoy with your patients will be enough to keep you going. You are like an apprentice RN. It is hard for everyone.

"Keep your chin up matey and at least you know ur not alone :)" ..................................... I can tell you're an Aussie. :)

What programs are in place for New Grads in the U.S? Are they just given a couple of days supernumerary like here, or are there extended programs? When staff are run off their feet it is ridiculous to expect them to hold a New Grads hand. Last week when we had two New Grads on day shift it was like being two staff short. So we ran around doing the extra work, while the New Grads did very little, then complained about our lack of support. I'm also wondering what the nurse educators are doing and why they aren't helping the New Grads......

Thanks for all your responses. I think I can let this incident go now.

When a patient died a couple of months ago I had an audience of new nurses who all wanted to see a dead body and learn what to do before taking the body to the morgue. When I showed them how to get the body into the body bag one of them said, 'This is so sad. A life has passed and this is it. We put them in a plastic bag and they no longer exist.' I can see what he means. But he forgot the person does still exist in the hearts and minds of their loved ones. The death of a person is a very significant event. Perhaps there should be trumpets and angels carrying the body off towards the light. Morning tea that day was very funny as everyone tried to outdo each other with their ideas about what should happen to mark the end of a life.

We don't. I have some friends who work as nurses in the U.S so I know what our equivalents are. The minimum qualification for RN's here as been the equivalent to your BSN, and has been like that for many years. LPN's here are called EN's, Enrolled Nurses. CNA's are AIN's, Assistants in Nursing. These mainly staff nursing homes. Our nursing homes aren't like yours. Anyone needing IV's etc is sent back to the acute care facility. Our best New Grads tend to be those who have worked as AIN's to fund their degree. They have mastered time management BEFORE they start with us. Our EN's did a medication course a few years ago that enabled them to become Endorsed Enrolled Nurses. This allows them to give out all the same meds as we RN's, including IV's and narcotics. However, they can't NIM medications. In my hospital we RN's have to do without respiratory techs or therapists, IV teams etc. We do the lot, and this includes ADL's and bedmaking. If there is already a crisis happening in the hospital we have to deal with our own too. We also frequently do bed moves and transport patients through the hospital ourselves, take bodies to the morgue etc. We're also amateur social workers and counsellors. You name it, we do it.

Paracetamol, Coloxyl and Senna, pantoprazole, frusemide, clarithromycin, ceftriaxone, metformin, coated aspirin, perindopril, atenolol.

And I always thought the pillow cases faced away from the door so all the departing spirits didn't get trapped in the pillowcases on their way out the windows. :-) I read some of the original nursing texts last year and I am sure that old Flo didn't mention the way a pillow opening should face. Nor do I believe did texts until at least the 1920's. I didn't read after that so I don't know where the tradition came in . The early texts advised on how to stuff pillows with straw or horsehair and not to leave them lumpy. They also sometimes mentioned that beds and wards should look clean and uniform to improve the patient's sense of wellbeing. Those original texts also advised on colours of walls, how to tend the fire for temperatures in accordance with patient's conditions etc. As an RN working in a hospital without assistants, and being an ex-Naval officer, I'd actually forgotten there was any way to make a bed without hospital corners. It wouldn't take me any longer to do this than any other method for pulling up a bed. Now you have to explain to me what you all do with those Chux. I've never heard of using Chux on beds before. We just have a bottom sheet. Incontinent patients wear pads. We move patients in the bed using a Slippery Sam (slide sheet).

Thanks everyone. I expected feedback on what I'd done wrong. I hadn't anticipated your positive comments. I really thought there was some answer on what I should do in such a situation and I just couldn't see what it was.

I am working in a very remote hospital in outback Australia. It is a 5 1/2 hour drive to the next town. We have to fly critically ill patients interstate for care as we are too far from city hospitals in our state. My ward is general Medical/Rehab. Our patient population is acute stroke and MI patients, chronic care patients, oncology, psychiatry, palliative care, dementia pts with behavioural issues who the one local nursing home refuses to take, detox, rehab. The union doesn't get involved because we are so remote that nurses don't want to work here. However, I always say that if they looked after the nurses here they would actually stay. 4:1 ratios have just been approved for this state but we've heard our hospital will be 5:1. That seems a stupid move as it isn't going to encourage anyone to go remote. We've also been told that our ratios will depend on staffing and they can't enforce mandated ratios out here if there are no nurses. We are a 70 bed hospital. Last year we were short 30 RN's -FTE. It became a news story when it was discovered that the hospital had never even advertised for more nurses.