tommycher

Most often lumbar punctures and bone aspirations/biopsies are done with local anethestics, yet we still have to make these pt.'s NPO, due to the possibility of nausea/vomiting, and we still have to do the same recovery/vitals once they return to the floor. And, most often, in the case of hypotension, the docs do like for them to have fluids infusing.

Have you ever seen a code run on a pt that a nurse forgot to put the DNR bracelet on? I have, and the hospital is still in litigation over this. A doctor's order says DNR, and two nurses sign the order and the bracelet, unless the nurse is negligent. This is very sad, and happens all the time.

Was it an order to begin IV fluids at 0600? Often that is an order for a cardiac cath or a procedure using conscious sedation. It would seem to me, that if you are giving report at 0700, and it is noticed the fluids have not been started, it would be no big deal to just go ahead and start them. I cannot see how a lack of 125ml or whatever the order was for, would cause such a problem. However, if the order was written on the previous shift for fluids, and they were not started all night, then certainly it was neglectful to not complete the 12 hr or 24 hr chart check and catch that yourself. But, no harm done, and we all learn from our mistakes, and trust me, there will be mistakes. Graduating from nursing school does not ensure infallability in a human being, so do not beat yourself up, this is how we learn to become more diligent. Good luck!

When and if a pt goes bad, there often is not the time to discern color codes, you absolutely have to know, without a doubt, what this pt's wishes are. We do use a blue bracelet, with DNR or No Code written on it, with two nurse's signatures next to it, in order to ascertain without a doubt what the Dr.'s order, and the pt and or family's wishes were. I have attended many codes, and they happen quickly, and not all staff are that well versed in the meaning of bracelet colors, and when a code is called, many people come quickly. This is not a HIPPA violation as far as I am concerned, it is ensuring the pt will not suffer undo trauma in the event of death. What would be more tragic, and I have seen this, is the uncertainty of the pt's code status, and the family is devastated when their family member has broken ribs, and brain damage, due to people with adrenaline rushes NOT checking what the bracelets had written on them. In that event, the family is left to make choices they did not want to have to deal with.

I am sorry you dread giving report, I recall feeling that way as a new nurse, only because of my own fears of having missed something that a more seasoned nurse might question me on. But, being a day shift nurse, I have another point of view. We get along very well with night shift, only occassionally do we have a problem. Like the critical lab value called to the floor at 0545 that the nurse did not call to the doctor, and admits from 2100 that had NO admit work done, because, "they wanted to sleep", that is difficult for us to swallow. The biggest problem we have is that when we hit the floor at 0700, so do the doctors, x-ray techs, family members, etc. And the patients are trying to eat breakfast while we are trying to do assessments, IV restarts, meds (of which there are many more than at night), check the AM labs, and it never fails that the minute we walk into a pt's room, we hear our name called because we have a doctor at the desk, family member on the phone, pharmacy on the phone with plenty of questions about the med orders on the PM admit, etc. etc. etc. It is a VERY hectic time. So, when I heard a PM nurse yesterday morning telling the AM nurse in report, " You need to do this, You need to do that, You need to address this with the doctor, ....." I just knew I was glad I was not the one receiving that report! Being the nurse on the floor at the time when most of the docs are also present, we are the ones who have to answer to them why such and such was not done, why they were not called, why it took so long for the transfusion to be started, etc. Very stressful. So, please understand that if the day shift nurse seems to be giving you the grand inquisition, it is most likely not personal, just searching for answers to questions they will most likely have to answer within the next hour. Hang in there, before long you will be able to anticipate exactly what they need to know in shift report, aside from the basic details. This is why it is called, "Nursing Practice"! We are all still practicing!

Certainly, if the student gave the meds without the instructor present, did not follow instructors instructions, then it was a med error. Students were kicked out of our program for such a thing.

And by the way, the instructor is ultimately responsible for a student giving meds in clinicals. The instructor should have asked the student all of the appropriate questions before the meds were given, such as, what did the physician order say regarding dose, route and times. If the student did not know one of those answers, she needed to find out the answer before the meds were given, but that is why they have instructors. This instructor blew it.

Dusktildawn, I am sorry if I appeared to be sarcastic, you are very thorough, and I meant my compliment sincerely. Our pharmacy has meds timed on our MAR, and designated as such, when they are to be given on an empty stomach, which are compatible and which are not. This is a secondary safety measure to compliment that which we should already know on our own. I do crush together compatible meds, and am aware of the route, etc. And of course, if it is an NGT to suction, the stomach is void of food anyway. I never give crushed and dissolved meds via Dobhoff, too much chance of a clog, and now we have these new peg tubes that are enteral and have feeding going along with suction, these are impossible to give meds through unless the meds are liquid. Anyway, I agree with the above postings, did not mean to be sarcastic, and we use drinking water to flush with.

Oh my dusktildawn, you are extremely meticulous, must be a great nurse. Do you by any chance work in ICU, that is the only place I can imagine working and having the time to be this meticulous. Otherwise, giving meds via NGT while staying within your window of correct med times when you have 7 patients to assess and medicate would be impossible. But, kudos to you for being so precise and perfect. Practicing the 5 rights of med administration and being without a history med errors, I have yet to see anyone on the floor give meds via NGT, when ordered that way, not crush the meds together and dissolve enough to not clog the tube, and clamp if on suction.

I did not know "what nurses do" until I was almost out of nursing school, and was "doing it" without even thinking about it! I get frustrated at times on the floor and think to myself that a patient's family just does not "know what nurses do" when they get mad that I did not arrive in a family member's room within 15 seconds of an overhead page. I, of course, was tending to another patient who needed me, and knew I had very recently medicated that pt to whose room I was being called, had already spent entirely too much time talking to different family members regarding this patient who was stable with no immediate problems. Then, to my dismay, family member goes room to room to hunt me down while I was charting the just completed procedure on the patient who needed me, and this family member wants to know why I was not coming when called!!!!!!!!!!!!!!! DO THEY THINK THIS IS THE HILTON AND I AM A WAITRESS?

Bless your heart, keep your chin up! I have a feeling this will go nowhere, but I know that does not ease the anxiety much. Thank you for sharing, reminds us all to be extra diligent, once again.

As a staff nurse, the other nurses with whom I work, and I, know which docs are prone to rudeness, therefore we do not take it personally. We know them as Equal Opportunity Offenders. You carry on, keep your chin up, know it is Them, Not You, and just wish their mammas had spanked them more often!

The amount of sodium bicarb in an amp is inconsequential, the doctor who orders it is also aware of the pt.'s labs, thus the purpose for ordering the potassium in the first place.

As far as an LPN not having nearly as much training as an RN, when it comes to bedside care, that is hogwash. LPN's go through intensive training in this arena, as this is their primary job. Many RN's will tell you that without LPN's to help them when they were GN's, they would have been in deep doo-doo.

When doing a manual blood pressure, the stethoscope actually should be placed on the little finger side of the antecubital area.