sparrow

We don't isolate any MRSA patients unless they have a non-containable draining wound or are unable to maintain proper hygeine with secretions. I've adopted this stance because of the huge number of cultures that are positive for MRSA I've seen coming out of the community - usually these are patients with no recent or relevent history of hospitalization at our facility (one does wonder where else they may have been). Also, when I track down the wound site it is usually a wound incurred at home by the patient and taken care of initially there - they generally come to the hospital or ED or UrgiCare when this wound becomes infected. SOOOO, I pretty much figure that every patient in the community has the potential to be colonized with MRSA and since it is impossible for us to isolate every patient (we don't have but two private rooms) and the culturing of every admit is just not cost effective, if employees are utilizing Standard Precautions and hand washing as they should, we should be taking proper care of those patients who are colonized but not diagnosed! We must be doing something right - in the last 10 years I can count on one hand the numbers of nosocomial MRSA I've see and still have fingers left over! Also, everyone of those were highly compromised patients, who were hospitalized for a long time and on numerous antibiotics - I don't think it is so much a case as "our giving it to them" as our "causing" the stap aureus to develop selective resistance because they have been on so many different antibiotics.

Yes, the hospital pays for recert - it is done at orientation and annually at annual education. In addition, extra money per hour is paid if the employee is also certified in ACLS, NALS or PALS. And these courses are also offered to staff at the hospital and paid for by the hospital. The hospital also pays our hourly wage to take the courses and replaces us on our work unit.

I remember my white uniform being so stiffly starched that you could stand it up in the corner all by itself! Part of the appropriate uniform was a girdle to provide back support. How about metal enema buckets to which you attached rubber tubing? Milk and molasses enemas? Using sugar and orange peal on decubitus. Forceps kept in zephren and used to remove sterile 4x4's from glass jars in which they had been sterilized. The forceps were sent to CS once a week for sterilization and the zephrin was changed we now knows it grows EVERYTHING!). Putting betadine ointment around the urinary meatus as part of the Am foley care (ouch, that stuff stings!!!) Tap bells at the bedside (no electric nurse bell here - when you heard the bell you listened carefully in hope you could at least tell which direction it came from and then you walked the hall until you narrowed down the room - and then you usually had to go get something for the patient - another trip down that ever lengthing hall!). Darvocet, Darvon, Talwin, and Valium stocked in the medication room in stock bottles of several hundred tablets and no count! Headache: just take a Darvon or Darvocet. Got some aches or pains: grab a handfull for use at home! Why there were not more addicts among nurses amazes me! Drawing Demerol and Morphine out of multidose vials into glass syringes and "guestimating" how much remained at end of shift count. Dissolving codiene tablets in sterile water to give injections. All medications came in stock bottles you poured into little paper cups and placed on a tray on top of the medicine card. I remember a nurse being asked by a patient to hand something to her and she simply forgot she was holding the medicine tray and dropped the whole thing - pills and liquids ran everywhere! But I would give anything to go back to those days. You knew more about your patient than just their name and diagnosis. You got to fluff, puff and actually relieve their anxiety and pain - with out PILLS. You could really nurse, just like old Flo meant nursing to be, not just pushing buttons on a computer writing things about the patient that you really did not do or observe for yourself because you are too busy meeting the paper requirements to actually care for the patient, relieve pain with a back rub, or walk down the hall holding their hand, put their feet in warm water to soak and then give them a foot rub, in short: to care and nurse.

Depends on you state regs. If state regs say dispose of as bio-hazard waste then it must be red bagged. If state regs make no mention then OSHA regs are followed - dispose of as bio-hazard waste if visible and/or dripping blood seen with the naked eye. We do not red bag this stuff unless grossly bloody.

Perpherial heparin lock for antibiotic infusion: How many nurses use the same saline flush before and after infusion, giving 1/2 before the remainder after? Tubex is blunt plastic cannula and capped and left at the bedside for use after the med is finished.

I've not only never seen any adverse reactions, I've never even read of any. But it is individual physician preference and that is how I prefer to protect my nursing license!

As an Employee Health Nurse, I make it a practice to only give the PPD to pregnant or nursing employees only with a written order from their OB/Gyn. Most don't object but occasionaly one does. Most ICP and EH nurses differ on this and there really is not a standard.

This morning on the news I heard of an investigation by the FAA regarding airline pilots and overtime. I found it amazing that they find that airline pilots who have worked 14 hours are involved in more fatal crashes than those who have only worked 8 hours. GEE, HOW ABOUT THE NURSE WHO IS IN HER 16TH HOUR OF WORK? Isn't she unsafe too - I mean, what if she administers a fatal medication dose - and if she is that tired, she will not even realize she has done it? Or the nurse is so tired she can't recognize when a patient is crashing? Or the nurse who is so wiped out that she transcribes the doctor's crappy handwritting incorrectly and the wrong med is administered for days before the error is found? WHY ARE AIRLINE PILOTS ANY DIFFERENT THAN WE ARE - because they can kill HUNDREDS at one time and we only can wipe out one at a time. IS there a difference? When is the government, who gives lip service to being concerned over fatal medication errors, going to put 2 and 2 together and realize that med errors and tired nurses go hand in glove, and that these same nurses are putting in a lot more hours than the airline pilots?? HOW MANY DO WE HAVE TO KILL TO DRAW ATTENTION TO THE PROBLEM?

In West Virginia, LPN's are allowed to do everything except give IV push drugs and take telephone orders and assess patients (these last two are just plain dumb in my opinion - they hear as well as I do and can be just as astute in assessing a patient). No doubt they can be just as compent in delivering IV push drugs when taught. As an RN, I feel they are severely under utilized. I learned more about being a real nurse when I was in nursing school from the LPN's than I did from the RN's!

I've done the same thing twice in the last 25 years. It seemed to be the only way to revive my dying feelings for nursing. It seems that I have to get back the the bedside to remind me what it is really all about! It is not about stupid rules, regulations, or standards, but about making just one person feel better for a little while, perhaps by rubbing their back or listening to their fears about surgery, or giving them a few ice chips when they are NPO, or fluffing their pillow and smoothing the wrinkles out of the sheets. All persons in management positions and positions that take them away from the bedside for long periods of time (are you listening JCAHO suveyors???) should be required to do patient care for at least 6 months every five years, just to REMEMBER what is is really all about! Good luck to you and enjoy.

Yes. I graduated in 1973 from a hospital based diploma program and there was very little I could not do. I also had many college courses as well to prepare for an advanced degree. Of course, we didn't just go during the winter: we only had the month of August off and 2 weeks at Christmas. We also lived in the dorm and classes were held right there and we were bused to the local college for many courses. But day of graduation I felt confident enought to walk into a ward of 20-30 patients and care for them in an organized, professional manner.

I agree with those who feel overworked and underpaid. I've been nursing for 25 years and most of that time I've been in a management type position (same now). I live and work in an area about 80 miles from the nations capital and still make less than $24/hr, have only 3 weeks vacation (after over 20 years in one facility), poor medical insurance, and they just (magnanomusly) started paying time and a half for holidays worked (wow, little late for me - I worked every Christmas for 15 years - where was this thank you then???). They are now in the process of killing their managers: I wear 3 caps in my position, am both the manager and sole employee of my department. I have no back up (so when I'm off sick, surgery, or vacation) no one is qualified to do my job and so things simply grind to a halt to await my return. So taking time off is difficult. The facility I work in indulges in "micro-management" - you know "swallow a camel and strangle on a gnat". They also like to keep the real power in the hands of one or two people! (You know, they tell you to be responsible but don't give you any real authority.) And then they really don't want to listen to their own people (but they will pay big bucks to bring in outside "specialists" to tell them what they have already paid you to tell them!) It has left me asking the questions: "Who am I? What is my role in life? Am I valued?" Unsatisfied, unfullfilled, depressed, frustrated, and wanting out of medicine altogether. And I felt the same when I did patient care -the one or two times I felt valued by the patient were totally eclipsed by the frustration of having to work chronically short staffed, without adequate supplies (you would think this were a 3rd world country), and never once then or now does administration every acknowledge your contribution. They just want you to keep giving until you are dried up and useless, and then they throw you away and get another young nurse to abuse!

Are you certain it is necrotizing fasciitis? This is caused by a Group A Streptococcus (Streptococcus pyogenes). These bacteria are commonly found on the skin and in the throat. This same organism is what causes "strep throat" and impetigo. Necrotizing fasciitis is caused by a specially virulent, or invasive strain of the bacteria. This is the strain that may also cause Toxic Shock Syndrome. There may be as many as 15,000 cases of invasive Group A Strep (GAS) disease each year, only 5% of these are known to be necrotizing fasciitis. The people most at risk for this are those with underlying diseases: diabetes, cancer, HIV infection, etc or those with skin breaks such as a cut, surgical wound or chickenpox. Transmission is by direct contact with the respiratory secretions of an infected carrier or direct contact with an infected lesion. Many healthy people can be carriers of the disease and not have any symptoms. Transmission by indirect contact through objects or hands is more rare but has occurred (specially with health care workers). Incubation period is between 1-3 days. Communicability is greatest whit a person is ill, but asymptomatic carriers can spread bacteria. Invasive GAS disease can have many manifestations: pneumonia, surgical wound infections, deep soft tissue infections (necrotizing fasciitis), meningitis, bone and joint infections, toxic shock syndrome, sepsis associated with skin infections such as cellulitis, erysipelas, surgical wounds, or chickenpox lesions. Invasive disease can be rapidly progressing and severe. GAS is fatal in about 10-15% of patients. Spread can be reduced by good handwashing, specially after coughing or sneezing, and after caring for persons with wounds or sore throats. If this is indeed necrotizing fasciitis, patient's should be in contact isolation, staff should be wearing gloves, masks, and gowns and practice perfect handwashing. The ICP should evaluate nursing and medical staff for asymptomatic carriage of Group Strep A, through throat cultures and treat appropriately. Handwashing procedures should be reviewed carefully as should isolation procedures. Persons with nasal or throat carriage can be treated with antibiotics and may return to work after taking antibiotics for at least 24 hours but must complete the full course. And sensitivities should be done with the initial culture and antibiotics changed as appropriate. Hope this what what you wanted! I'm an ICP and have dealt with this before and found that if appropriate measures are taken, the disease is controlled.

I have never heard of such a thing! No wonder they are so hard up for nurses. There isn't anyone on two legs who doesn't have some personality defect or quirk (some of the worst can be the "shrinks"). What is going on in that building, that they need such "psycologially perfect" nurses? I agree with the other responses: get a lawyer, maybe talk to the labor board, and do you really want to work there (PS, may be they are all crazy and you aren't and that's why you weren't hired!!!)