mommybess

I am a site manager for a family medicine clinic which is part of a larger FQHC group of clinics providing pediatric, family, senior, adolescent, psychiatry, OB/GYN, dental, and vision care. I have been in this position for just over a year. I have a dual role as the RN for the clinic as well. I love my job! I love the M-F hours. It works well with my family and my online classes. What aspects of being a nurse manager do you enjoy the most? The ability to make decisions and implement ideas to better serve our patients. I enjoy being the one that the staff comes to for answers and guidance. I love being able to coach my staff (MAs and LVN) and encourage them to continue with ther own education. I've already lost one MA to nursing school and I have another strongly considering it. My LVN is also planning on bridging to RN next year. Do you feel that you are able to make a difference in regards to quality improvement/patientsafety/risk management? Yes, absolutely. However, since I am part of a larger organization a lot of the bigger decisions are made above me and out of my control. There is the ability to have more input to those above me. However, I am the one responsible for the clinic and all that it entails - TVFC program, Joint Commission readiness, budget, encounters, staffing, patient complaints, and then my RN duties (phone and walk in triage, direct patient care, etc... I wear many hats throughout the day. What are some of the positives about being a nurse manager? For me having the dual role, I still do a lot of actual patient care so I haven't lost that aspect of nursing, which is what drew me to nursing in the first place. Though there are days when I spend a lot of time in front of a computer with spreadsheets, audits, reports, and emails. For me this is the best of both worlds, patient care and a M-F desk job (even though its a M-F job I am never really "off" - cell phone texts, emails through cell phone and work lap top). The pay is better than what I made a staff nurse. That is a huge plus for me as I drive 45 minutes each way and spend many days driving several hours to and from meetings (our FQHC covers a large area). Good luck making the decision. I was a charge and staff nurse prior to this position and I just sort of fell into this position. I don't think I would want to go back to strictly staff nursing again. I'd prefer to stay in some area of management.

I'm currently working full time as the site manager/RN for a family medicine clinic and taking classes. I've applied to the Fall 2012 RN-MSN nurse educator program at Angelo State. I am hoping I can continue working full time while completing my education. It's nice to hear that others have done it.

It really depends on what state you are in and what your experience is. Nurses working in the hospital setting for a long time may be making a lot more than a new grad in the hospital setting. I made the change from hospital to clinic nursing and it wasn't a pay cut at all. In fact it was a rather large increase. I was making $23/hr + differentials at the hospital.

Has anyone taken the Maternal Newborn RNC exam? I just ordered the study guide and the 2 recommended books to prepare for the exam. I am trying to figure out how much time I will need to prepare for the exam. I am looking at taking the computer exam, so no deadlines to meet for applying. So, how long did it take you to study for the exam? and did you find it easy or difficult? In my hospital we do not have a career ladder, so no increase in pay or bonus for obtaining an RNC. However, they will reimburse me the cost of the exam. I obtained my CLC last December and they didn't reimburse me for that cert. But it's needed education towards my IBCLC. So, for me this is a matter of pride and wanting to obtain a higher level of education in my area of nursing.

I work in a very busy 61 bed postpartum unit that does about 500 births a month. We expanded last year from approx. 200 - 250 a month. We doubled our postpartum rooms and we have slowly added the RNs to the unit. Recently our patient satisfaction scores have dropped to 44% in the area of cleaniless. However, the hospital just added a 3rd housekeeper during the day (shared by other units( for daily cleaning and trash/linen removal. At night there are only 2-3 housekeepers for the whole hospital and they mostly just clean rooms after patients have been discharged. And we have 2 PCTs, one that works 7am - 3pm 5 days a week and one that works 1pm - 1am 3 days a week. They have recently been moved from doing patient care tasks such as showers, ambulation, vitals, etc... to rounding on every patient each shift to remove trash and linen, and provide water and supplies. So, now management wants the RNs to start pulling trash and linens ourselves when hampers and trash and get 1/2 full. Supposedly the complaint is that pts are smelling blood and are embarrassed. I have no problem with emptying a patients trash or hamper if it needs it but I know that many of my co-workers aren't going to do this. Our current ratio is 4 couplets to 1 RN and occassionally 5 couplets. So, my question is "How is trash and linen removal handled in your hospital?" How many PCTs or CNAs do you have pt rooms? and do you have full time housekeepers that make rounds more than once a day, and are they specifically for your unit? And what type of trash cans do you use in the bathrooms for bloody personal items?

You're on the right track. I have one comment regarding your first dx's goal of GOAL: client’s skin will remain intact. It is more realistic for the goal to be: no further breakdown of client's skin Others that you could use: Risk of imbalanced nutrition: less than body requirements Imbalanced nutrition: less than body requirements Risk for aspiration Risk for infection Risk for falls Risk for injury Feeding self care deficit Toileting self care deficit Impared transfer ability Impaired physical ability Impaired verbal communication Risk for loneliness Powerlessness Impaired swallowing Disturbed sensory perception Risk for imbalanced fluid volume

For mom: Since she is a first time mom you could go a psychosocial route such as: Caregiver Role Strain r/t care of newborn Social Isolation r/t care of newborn or Sleep Deprivation r/t breastfeeding newborn Fatigue r/t care of newborn Risk of constipation r/t narcotic pain medications Impaired comfort r/t lady partsl laceration Risk for deficient fluid volume r/t postpartum bleeding Deficient knowlege r/t birth of newborn Readiness for enhanced knowledge care of newborn Acute Pain r/t lady partsl laceration Impaired tissue integrity r/t lady partsl laceration Risk for infection r/t lady partsl birth For infant: Risk for imbalanced body temperature r/t immature thermoregulation Risk for imbalanced nutrition: less than body requirements r/t breastfeeding Impaired Tissue integrity r/t removal of foreskin (if this is a male baby being circumcised) Risk for ineffective infant feeding patterns r/t breastfeeding Hope these help. There really are a lot more.

As for ther abx... The reason that I would not answer this as the 1st thing you will do as abx generally do not stop an infection with a dose, it takes several doses generally. But in the "real world" you would give tylenol and hang IV abx at the same time (taking it for granted that a dose is due). Give a dose that isn't due is a med error. And again in the real world if the pt spiked a temp while already in iv abx... then it's warranted to discuss this with the MD, as there may need to be a change in abx or an addition of another abx. The spike in temp tells me that either the abx isn't working or there is another issue causing the fever. Which is why in the real world you'd be doing a while lot more assessment first, and without that just giving a dose of abx isn't doing the pt a whole lot of good. The greatest danger to the patient at this time (what's going to kill him first) is the fever and the risks involved due to other conditions (diabetes). The fever needs to be treated now, and we need to continue the abx for it's duration to ultimately treat the infection. As for a cool bath... I really don't like this answer and if I had to do it, as I stated in previous post, it would be after I provided wound care. You don't want to spread a draining wound to others areas of the body and start another infection.

referring to our postpartum pts with BP issues. We can do one dose of IVP Labetalol and Hydrazaline, if this does not reduce BP, they go back to L&D where they can be more closely monitored (still no tele).

There are a few reasons for it. Increased maternal blood volume during pgy = body shifts extra volume to tissues where they are safe, pt diuresis and or sweats extra volume out over a few days. IV fluids increase vascular volume... which increases the above. Pitocin causes fluid retention. Many pts receive Pit during labor.

If answering this for a nursing exam here is how I'd place these in order. Remember with nursing exams you always have an order for the options given and remember Maslow's Heirarchy. Tylenol - fever needs to be treated asap. An increased temp and draining wound in a diabetic increases the risk of dehydration which increases the risk of DKA. As well as many other issues related to fluid imbalance and electrolyte imbalance. Start Abx - we must assume that a dose is due Wound care - pus draining wound - you would want this area free of drainage before applying a cool bath and you need to assess the wound for changes and a draining wound increases the risk of skin breakdown in diabetic. Cool bath -but with 104 temp it would be more like not too cool bath In the real world: What is pt's LOC like? Full assessment for any other changes. Is there a foley? is it draining? (kidney fuction impared?) Medicate pt with Tylenol, culture wound, order labs if it is protocol in hospital, get accucheck for sugar levels - and give insulin if needed, run LR IV fluids to replace fluid loss through fever and draining wound, start IV abx if due, apply cool wash clothes to areas of warmth (arm pits, groin, forehead to help cool pt). Call MD with findings and for further orders.

Orders for us are NPO until tolerating clears, and then advanced to full liquids, and then advanced to regular once passing gas, and no N/V. I usually do chips and sips for several hours first, then if all goes well, offer apple juice and encourage more water, if the patient is passing gas and I hear good active bowel sounds then I offer chicken broth and saltines. For most of my c/s patient their first regualr meal is breakfast (I work nights) and I really encourage a light breakfast. I have not yet seen an ileus on our floor.

Most of our c/s get Duramorph. Depending on doc c/s pts either get Toradol 30mg q 6 X4 doses or 800mg Motrin q 8 for 1st 24 hrs. Then they switch to 400mg Motrin q 4 PRN and/or Norco 5, or 10 q 4 PRN. lady partsl pts get ice packs, Tucks, Dermaplast for the tearing and hemorrhoids. And for pain pain meds they can have Motrin 400mg q 4 PRN and/or Norco 5 or 10 q 4 PRN. Occassionally we have a c/s with Diluadid or Morphine PCA, but it's rare. Usually it's a pt with some sort of chronic pain issue. And for patients who can't tolerate or think they are allergic to Norco (some swear the nausea it can cause is an allergy) we can give Darvocet i to ii tabs q 4 PRN (watching closely the amounts of acetominophen) and sometimes we have pts taking Percocet. We also have standing orders for acetominophen 650mg for headache or fever >100.4 and if fever resolved after 2 doses requires call to OB. I agree with the others that those that get up and OOB sooner do the best!

i am a staff rn/charge nurse unit the postpartum unit in a hospital that recently went from delivering approximately 3000 babies a year to 6000 babies a year! we have 61 postpartum beds, 8 antepartum beds, and about 30 ldr beds. we do couplet care with rooming in. we generally have a ratio of 8:1 patients. that mix can be 4 mommas and 4 babies, or it can include a few moms only (nicu moms) or babies only (moms dc'd but babies staying for bili therapy or weight loss, etc...) i work nights 7p - 7a. a typical night for me as a staff nurse is: 1845 - report 1900 - initial rounds on all patients and then start q shift momma assessments, pain meds due 2100 - 2300 hs meds, and routine meds, pain meds, q4 vitals/fundal assessments for post c-sections, dc teaching for pts going home next day 2300 - 0100 baby assessments and daily weights 0100 - 0300 meds, more vitals and fundal assessments for my q4 pts 0300 - 0700 dc foleys, pain meds, vitals, fundal assessments, pre-circ meds, report off to day shift generally leave between 0730 and 0830 for home add in there admit patients, assist with breastfeeding, assiting pts oob to void for the 1st time, showering c-section pts @ 1st 24 hrs post c-section, linen changes, momma and baby accuchecks, im meds, admin insulin, starting ivs, bladder scanning on pts unable to void, cathing pts unable to void, admin iv abx, medicating the post c-section pt with issues from duramorph (puritis, emesis, etc...), drawing baby labs, starting phototherapy on jaundice babies, calling docs, an occassional hemorrhage emergency, answering the non stop calls to my cell phone from pts, and tons of teaching! :bby: etc... night shift is just as busy as day shift. at out hospital there are no set visiting hours. some patients do have visitors that stay late, like 0200 or later!! esp if they delivered late. the difference is that there are less docs on the floor. when i am charge nurse it's a totally different experience. making assigments for 100+ patients (mommas and babies), and planning on admissions and discharges can drive you insane! but i love it! :redbeathe

me me me... I am working on getting mine and will hopefully sit for the exam in 2010.