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Sean 91

Sean 91

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  1. Sean 91

    How do you induce passing gas post-op?

    I think you want allphysicians.com The case manager must be going nuts after 12 days, not to mention the doctors--can't believe they are "unconcerned." Insurance and/or Medicare funds must be running low. Haven't seen any mention of ambulation. Walk, walk, walk. Out of bed TID. GI docs like Reglan, as mentioned above, for GI stimulation as well as anti-nausea. Nausea at slightest PO intake? Must be on Procal and Lipids at this point if not keeping anything down--would be clear liquids still, if not NPO. What do the KUB/US/XR abd show? How's the surgical site look? Infection? Fevers? Have there been an EGD/colonoscopy in the recent past? Swallow eval by speech? TAKING NARCOTICS for pain, which is causing constipation? Stool softeners? On IV fluids and are the electroyte levels normal? Chewing gum as someone said above, but that's in the literature, haven't seen much in the hospital.
  2. Sean 91

    Starting Nursing at 52 and Nervous

    Started a little older, too, like you. The primary problem at my beginning facility was the patient load of 1:10, not people--now at a wonderful facility that is 1:5, and a great group to work with, too. Nurses are great to work with! I've got practical advice. Get a really comfortable pair of shoes; get plenty of rest on your days off and do things that you really enjoy; leave work at work; do your own work first; be helpful to others to the extent that it doesn't put your own work in jeopardy as each nurse if responsible for his/her own work first, and there are always extra hands around, including the charge nurse; triple check your work; check your own orders again before you go off shift; NEVER open your meds in the med room but take them all unopened to the room and check them again after you have the patient recite name and DOB, because they often want to know what the purple pill is--they don't take a purple pill at home, the patient will sometimes say. Annouce (your fourth med check) each med to the patient as you open so they can see, because often they'll look in the cup and ask, "What's that one/those?" And if for some reason you can give them then, the pills are still in the package. We draw our IV narcotics in the med room, label them and take them with the vials to the room (because most of the time they are PRN so the patient has just asked for it/them.) DO WALKING ROUNDS *** IN THE ROOM *** AT THE BEGINNING OF SHIFT AND END OF SHIFT--even though some nurses won't be as cooperative, some will say, "Go ahead," and stand at the door. Take the previous shift along with ou up the hallway to each door and open the door and look in--step in to make sure the patient is ABC OK. If the patient is sleeping you can at least hear/see the breathing, view the IV, check to make sure the Foley bag isn't about to burst. To see that the IV site is patent and not dripping or swollwn. DON'T TAKE REPORT AT THE DESK even if most of the other nurses do!!! INSIST on walking rounds. Walking rounds will give you a good start and ending to the day--and the patient will be more at ease and cued in (if awake). You only need ONCE to have a dead patient at shift change (oh yeah, it happens if the patient is not a telemetry patient); TABS/bed alarms not on fall risk patients and a fall occurs; maybe the previous shift hung but did not push start on the secondary IV medication at 0500 or 1700; or the IV is bad and blood is dripping down the arm; rather than discover something by going into the rooms 15 minutes after report when the previous shift is usually gone. Checks that the TABS and bed alarms are on after aides give baths for fall risk patient, as they sometimes forget. I used them even if the family is in the room because sometimes they WON'T tell you when they leave even though they said they would. If your patient has a Foley catheter be sure to check it yourself every few hours if good output because sometimes the bag is football size if the aides don't empty it. MAKE SURE YOU TURN EVERY TWO HOURS patients who are total care/can't turn themselves, and at some facilities they actually turn the patient at start of each shift to check totals for skin breakdown. Previous shifts sometimes (often) overlook. If the wherever-it's-located wound hasn't been caught before and documented, your facility owns it per Medicare. Look after your patients and you will be looking after yourself, and improve the standing of your facility. If I've assumed anything above that you have already considered as part of your work plan, then sorry for being preumptious, ignore it; but I am just trying to make your work life easiest by covering your bases.
  3. Sean 91

    Being around alot of women....Pros and Cons

    I was the only male in my RN-BSN class of 40; scared me to death at first. But most of my classmates were quite respectful, and I in turn. And usually I am the only male on my shift (although, of course, there are plenty scattered throughout the hospital), although each shift has at least one male and every once in a while there are two. But it is of no consequence. If you approach nursing with the code of ethics in mind and make it a daily self-requirement to treat all other nurses (everyone around you, actually) with respect, then all will go well. You will have your life on your nursing shift, and when you say goodbye at the end of shift and go through the front doors you will have your home life, and neither will mix. I was older, married when in nursing school so the beer and nachos weren't tempting. In nursing school allow yourself ONE night and day off from school/work if possible, and you can use that day to relax/party if you wish. But I'd start by treating your classmates as coworkers and keep the ethics-respect attitude in mind at all times (for one thing you probably will see at least several on the at the local hospital after graduation). And as a male you will quite useful for lifting help. And you will be a sevant to your fellow mankind. Mother Theresa with a mustache, so to speak. Doing a good work and something very useful and lasting.
  4. Sean 91

    I am an American.

    Maybe it's not cultural. Maybe the doctor is a paranoid personality disorder type. In nay case it is a silly request and no way can it be enforced against nursing. We owe an obligation to get clear communication from M.D.'s and that usually includes face to face as much as some doctors seem to be annoyed by communicating with nurses.
  5. Sean 91

    Benefits of being a male nurse vs Female nurse

    As a guy at our facility, you get an extra break period when they call all the guys over the intercom, by a special code designation, down to Behavioral Medicine when a patient is going off, for example, or when they need lifting help somewhere. Sometimes you can stretch it out to a half hour. I don't smoke, so it's nice to get a little extra time away from the floor--and the charge nurse takes over your patients while you're gone.
  6. Sean 91

    Do you have a system for making fair pt assignments?

    One of the hospitals in our four-hospital chain in our city assigns by blocks--a 5-6 room stretch on Med-Surg that doesn't change, regardless of acuity. It's "this is my little corner and this is where I am usually going to work." Period. I don't work there anymore I switched to a smaller, closer hospital in our chain where there is talk about assigning per acuity, but sometimes you will still get assigned three total cares, while someone else assigned "self care" type patients twiddle their fingers all day at the nurse's station. But there is some attempt to assign frequent IV pain/nausea push-type patient to RNs--but even that doesn't go most of the time, since LPNs are assigned their patients under an RN as a "team" so that the RN ends up doing the IV pushes. I much rather liked a hospital in a more progressivde state where we were all RNs as LPNs were being phases out (no offense to LPNs, but they do increase the workload for RNs).
  7. Sean 91

    RN-to-Patient Ratios Save Lives

    One other thing. Regarding the ANA position of staffing ratios, "We believe in having nurses who are the frontline workers-who know their patients best and who know their units best-develop the best staffing ratios," said Rose Gonzalez, RN, ANA director of government affairs. "Our approach doesn't treat nurses like numbers (in a ratio), but as an individual responsible for care." This statement by the ANA is utterly ridiculous (obviously made by someone who no longer works as a floor nurse). It is administration, not nurses, who set staffing ratios. We just show up for work. Perhaps in striking, such as the current one--with nurses acting as a large block via a union (as opposed to membership in the ANA, which by the ANA's statement above appears to be useless), then perhaps nurses will be able to develop--to insist on--the best staffing ratios.
  8. Sean 91

    RN-to-Patient Ratios Save Lives

    Prof of Nursing, Peter Bruehaus, Vanderbilt Univ., is against legislation mandating staffing ratios. Two articles on Medscape currently (June 2010): "What is the Harm in Mandatory Staffing Regulations?: Concluding Comments," by Bruehaus in which he states vehemently his opposition to mandated staffing ratios, but he is rather vague about solutions to improving patient safety. And in "Nurses Rally Renews Debate Over Mandatory Staffing Ratios," by Robert Lowes, in which Bruehaus states: "Give these institutions [hospitals] a sufficient financial incentive to improve patient safety, and they will figure out a way to do. Some hospitals would be forced to address nurse-patient ratios, some would not." "Not all patient safety problems have to do with staffing," Dr. Buerhaus said. He worries that by failing to deliver what it promises in terms of patient care and lower costs, mandatory staffing ratios could hurt the reputation of his profession. The public, he said, might suspect such regulations were designed only to keep nurses off the unemployment line, says the author. Again, Bruehaus is rather long on suggestions but vague on details. As a hospital RN, I feel that educators/administrators like Bruehaus live in another world far removed from the acutal machinations of nursing. "It will get done somehow," they say or assume. All I know in MY world, is that patient safety is far better now with five patients daily on average compared to 10 patients when I started out as a nurse. Bruehaus argues that the public (patients) will have an impression, through mandated ratios, that they are somehow not safe. But with a 1:5 ratio patients, even then, patients often ask, "Are you short staffed?" In reality, staffing is far shorter when ratios go to 1:8 or 1:10. Bruehaus also suggests that hospitals will employ FEWER nurses if staffing ratios go to 1:5. I'm scratching my head about that one. That would require hospitals to take fewer patients--keep some beds empty on purpose.
  9. When the full law comes into affect, then maybe patients like the woman who had to leave my hospital med-surg floor two days into her hospital stay--two days after the insurance company cancelled her health insurance for a pre-exisiting condition (obesity) without telling her (she found out on the third morning of her stay)--will be able to get the complete care that she needs. And maybe the patients who are "self pay" won't have to worry about sudden illness (or suddenly diagnosed illness), and have to worry about the Business Office and physicians (worried about their ability to pay) shunting them out.
  10. Sean 91

    Patient to Nurse Ratio

    Started off my nursing career as an RN with 1:8-1:10 nights (4-5 times 1:12) and started getting neuropathy and swollen ankles (Our older charge nurse with history of long term illness would call just before shift half the time, leaving us in the lurch). But now several years later at a different hospital/city, have 1:5 most days, and end shift somtimes with 1:4 maybe after a discharge, which is nice. Except for those days with two discharges and two admits.
  11. Sean 91

    Your thoughts on the nursing jurisprudence examination?

    Many of the answers require common sense, within the scope of nursing practice, so to speak. And a few are just blatantly common sense (right vs. wrong). But to be prepared for those questions referencing a specific section of the nursing regulations, or about the Board of Nursing (BON) authority and responsibilites, just download, from the Texas Board of Nursing (as the BON instructs you to do on their website) the following: - TEXAS BOARD OF NURSING RULES AND REGULATIONS relating to NURSE EDUCATION, LICENSURE AND PRACTICE - Nursing Practice Act, Nursing Peer Review, Nurse Licensure Compact, & Advanced Practice Registered Nurse Compact And then bring each of the two documents up in reduced windows and start the test. You can then right click within those windows to search for certain terms, or just click up or down to find a certain section or subsection/subparagraph referred to in the question.
  12. Sean 91

    texting at work

    Texting??!! What really bothers me are employees who are chatting on their phones!! Especially some aides, who if you are looking for them, just go to the staff room and there they are. But, I mean, walking around the hall as they get linens talking on their phones! And I'm working my butt off as a nurse. (But the administrators say that for evey 10 interviews they can only offer a job to two people because the other eight don't pass the background check, so it's impossible to be fired once they get hired because the administrators are more afraid of not having someone than the phone use.)
  13. I just finished T.R. Reid's (2009) book, "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care." An excellent read, giving a good overview of the fractured American health care system...Well, one really can't call the U.S. version of health care a system, as all the other industrialized nations have A SYSTEM. We have bits and pieces from 1) the Bismark health care system of Germany (private insurance w/ premiums paid for by enrollee/employer); 2) the Beveridge plan of the U.K. (and adopted by the Veteran's Admin for the VA system); 3) National Health Insurance as in Canada (and as adopted for Medicare and Medicaid); and 4) Out-of-pocket in most of the world (nonindustrialized)--or NO insurance if out-of-pocket is took expensive. I highly recommend the read. (You can get it at your library.) - Sean, RN-BSN (P.S. I go by SeanSean because I can never remember the number I usually have to use after my name.)
  14. Sean 91

    Research Questionnaire - Reducing Patient Falls

    Oh yeah, we have "skid proof" footwear which does make a difference over the bare feet or athletic socks many pts come in with. Gait belts are unavailable exc to PT--probably a $ matter. We do dead lifts (pivots), for some pts.
  15. Sean 91

    Research Questionnaire - Reducing Patient Falls

    1.have you ever witnessed a patient fall? yes. several times, been near. have heard the thud. in most instances, the bed and/or other alarm(s) are not in place--but some people are just quick and are over the rails and out of bed before you can respond in time. 2.where, and during what activity, do patients fall most often? trying to go to the bathroom. 3.what procedures or protocols does your hospital have in place to help reduce patient falls? bed alarms and tabs (string attached to pt's gown and pulls away from wall alarm to sound loud alarm) for pts with high fall risk which is >49. trouble is some nurses, aides, pts, others do not not replace these alarms. there are four rails. supposed to be frequent checking of pt for bathroom, food, drink needs. some staff do not respond quickly to the alarms--or may be tied up in other pt matters. 4.what problems do you experience with your hospital's current fall prevention procedures? the procedures are not consistently adhered to. 5.what tools does your hospital use to assess patients' fall risk? total points from: fall risk if ordered by md, previous falls, multiple diagnoses, ability to ambulate without aide, iv site present, narcotic meds being administered. 6.is there any specialized equipment that your facility uses to prevent falls? (floor mats, bedside commodes, bed alarms, etc.) bed alarms as above. 7.what problems do you experience with your hospital's current fall prevention equipment? as above, not adhered to al of the time. pt's who are a&ox3 but who shouldn't be getting up on their own do not call for help--think they can do it on their own--at least the first time before they fall. 8.what equipment to you use to assist with patient transfers, re-positioning, or moving? (patient lifts, transfer belts, turning discs, etc.) gait belts not available. pivot to chair or bsc, usually after assessment by pt, if ordered by md. but often people who seem be able to walk to bathroom with minimal assist/guarding can fall, if for instance, they rely for support on moveable objects such as bedside tables. 9.what is the most common reason for a patient falling? as above, lack of alarms being engaged. poor response time by some staff. 10.what do you think your hospital could change to help reduce patient falls? at one hospital i worked at there were mobile coputers and also a computer outside each room which made it easy to keep an eye on high riskers. unfortunately, my current hospital (built in the mid 1990s) has only a central nursing station. have to put high risk pts in beds by the nurses' station--but that is not always possible when rooms have filled up, then it seems inconvenient to transfer pts around. put younger no-fall risk or lower fall risk pts further out from the nurse's station and save rooms by the station for fall risks. charge nurse should check high fall risk pts for alarms every two hours--or at least twice a shift--can't depend on staff nursing and aides in all cases. at our hospital you get a black mark (your name on a list on the bathroom wall) if you miss charting a pt's bath and linen change--but no demerits if one of your pts falls--if the alarms weren't on. (incident reports are filled out, of course.) we have gone from rugs to a floor covering that has a rubber liner that is softer and absorbs impact. but not all units or hospitals in the city chain have it.
  16. Sean 91

    Fired all the LPN's

    A hospital I worked for a few years ago did the same partly in an attempt to move toward magnet status. It gave the ultimate to te LPNs to go for LPN to RN or find another job. Most LPNs left as most were older. Also, there was only one LPN tech school in the area and the local school board was thinking about closing down the program. 90% of the state schools, including all communiy colleges, were turning out RNs. And the local university was RN-BSN and, together with the community college RNs, supplied plenty of RNs to the local city hospitals. A few students in those RN-ASN programs starting as nurse techs at the hospital took the LPN test and became LPNs at the hospital while in school, as they were in the process of moving toward RN within the year. Also on the administrators minds was the report several years ago that hospital morbidity-mortality was lower with RNs than LPNs. And with all RNs we didn't have to worry about interrupting our own work to push IV meds--as we were all RNs throughout the hospital. LPNs cont to work in the clinics.