jadespirro

Our facility is currently trying to streamline our pain cases. All patients are MAC's and go directly to phase II. Here is an example of how our cases went yesterday. 10 patients- 2 Pre-op nurses- on the 10 cases (8 ESI's and 2 discograms), those same nurses would recover the 8 ESI's and radiology nurses recovered the 2 discograms. 2 PACU nurses circulating in the OR- both working one OR, neither have ever circulated and feel they need 2 nurses to handle the cases, in case they need anything. 22 patients- 3 Pre-Op nurses- for the 22 other surgeries. Pre-op has a unit secretary and a PCA (patient care assisstant). 3 PACU nurses to come in and cover 22 other general patients to come out, all 22 to start in phase I, some would then go to Phase II and be DC'd and some to go from phase I to the floor. These 3 nurses do phase I, Phase II of recovery and Discharge. 2 PACU nures coming in at 0800 and 1 coming in at 0930. PACU has a unit secretary and NO PCA. We had a doctor who started his cases at least one hour early, so needless to say, 2 generals came out before the PACU nurses arrived at 0800, leaving one of the pre-op nurses on the pain cases to begin recovery on the 2 generals. And it only got crazier. At our facilty we do a lot of nerve blocks. Our Block nurse was one of the nurses circulating in the OR, so they had to do a block in the PACU, at the time I had 2 generals and the other PACU nurse had 2 generals, no way we could do it and had to have anesthesia wait till the 3rd nurse came in and we could monitor patient per moderate sedation protocols. Anesthesia asked me if they could just do it by thereself...WHAT!!!....not doing it on my patient without a nurse to assisst and monitor patient. By the time all the pain cases were done, PACU had recovered 14 generals. It was a crazy morning. If you work at a facility that does pain cases and regular surgeris, how do you do it? And if you do it well, tell me how, PLEASE?!?!?!?!!!!! 1. How many OR's are going? 2. How many nurse's pre-op, and recovery those patients? 3. Who gets your patients dressed (family or the nurse)? 4. Whats the average time in recovery? 5. What kind of charting paper or computer? 6. Do you have ancillary staff? 7. Who does your EKG's? 8. Do you ave a unit secretary? 9. Does it sound like were staffed adequately? We really need to get an idea of how to do this better, how to staff accordingly, and how to make it flow? More cases means more money but you can't do it without the staff. Bottom line, if you do it well, tell me how, so I can contribute some ideas. Thank you in advance....

In the past we had 2 nurses on call 7 days a week from 1930 to 0700, but due to "Consultants" coming in, we no longer have call during the week, and only one PACU nurse on Sat. and Sun. call schedule from 0700 to 1930, OR circulator is expected to stay in the PACU for the recovery period, with the house supervisor as a back up if needed. We are a physician owned hospital specializing in ortho and spinal. We have 10 OR's and only staff PACU till 1930, unfortunatly this situation leaves evening nurses to cover cases until they are done. So even though your shift ended at 1900, you are there until last case is done, this includes any "add ons" or "emergency" surgeries." With that being said there is no "call bonus" being paid, thanks "Consultants." We used to get "call bonus" if we stayed 2 hours past the end of our shift, and didn't utilize the call person. Now there really is no insentive to stay and us evening nurses are about fed up. We fought to get our shift diffs back, after they too were taken from us, "consultants" again. If the hospital had an evening emergency, and OR and PACU staff had already left, the case would be transfered out or scheduled for the morning, depending on the acuity. We have stayed as late as 0100 recovering cases, although this was rare, recovering patients till 2100 is not. I am curious how other PACU's run... How is staffing during the day and evening? Does your PACU have ancillary staff? Do PACU nurses take over pre-op patients, when pre-op nurses shift ends? Do you have to break ASPAN standards with staffing to do ancillary job (going to lab for blood, transporting patients, delivering specimens to lab, etc.)? Does your OR schedule often change (Dr. starts hours early or late)? These are just some of my questions...I know I have many more.

As a new nurse, there is a lot of information that is not known. Their is a high learning curve and we must try to slow down the process and take in what is being taught. Here are just a few of the many things I have learned in the last five weeks of my orientation. 1) Trust your gut!!!!! If it doesn't feel like the right way to do it, chances are you have a reason for feeling that way. 2) One of the absolutes to nursing has to do with NARCOTICS, always, always, always, pull narcs when you are going to give them, NEVER carry them on your person for extended periods of time, pull them, witness and waste, then give. In a peer review committe dilaudid in your pocket because "you were trying to save time from going back and forth to the pixis" will not cut it, and is one of the many excuses diverters give 3) Always be accountable for your practice including and especially mistakes...we all make them 4) Read your charts in the morning to confirm drug orders found on the MAR..... 5) If a doctors order is ambiguous and calls for "Ativan 0.5 mg q6h or Librium 25 mg q6h"......pick up on these pieces of the puzzle and put them all together. Have the ordering doctor make them clearer (D/C one med, make one PRN) Sometimes orders like these will go through pharmacy and quite a few nurses before someone rights this wrong 6) If you sign your name (RN) with an LVN, for blood administration and she says I always hang my own blood even though I am not suppose to, spikes the blood and walks out of the room- You as the RN are equally if not more accountable for this... 7) If you get in report your patient is going to get an EGD today and they already have consent signed, check and make sure it is DONE, don't just assume that nurse did it and did it right 8) If you have a patient that is in restraints make certain the reporting nurse writes the verbal order, or what have you, in the chart 9) If you have a horrible preceptor, demand for another one, if they can't provide one for you, you must ask yourself WHY?????? 10) Find someone who is a professional, ethical, and prudent nurse to get clarification from all aspects of what you learn in orientation, because believe me some people will tell you with absolute certainty what they are doing is acceptable and low and behold YOU could lose your license for it 11) Be proactive and ask questions...lots and lots of questions 12) Nurses must have stethescopes and they MUST use them If you havent guessed it by now I have had a nightmare of a so called orientation.........................Disappointed but moving on B :uhoh21::angryfire:o I trust that it will get better, better somewhere else

Congrats, I remember that feeling so awesome!!!!!! Go celebrate, then get those books and start reading......

I am currently enrolled in the HCC ADN program and have two semesters left....You can work and go to school at the same time. Many people do it. I don't, but many of my friends do. You have to be very organized and it helps to have a job that you can study at. It is also helpful to have a back-up plan in case working does not work for you. Remember everyone is different and what might come easily for one person may not for the next. If you have any more questions just ask away.... I also wanted to comment to the OP, Pharm is a class that on average loses 1/3 to 2/3 of the students. As far as clinical, you will not lose students like that at all (I have seen one student fail clinical), as for theory, you will have to worry about PEDI, because you will lose about the same percentage as Pharm. I could list the reasons why but that is probably best in a private e-mail, but I will say that it can be done!!! So by no means let this stop you or scare you, because trust me if I can do it anyone can and if it is your dream you will make it happen, part of passing is knowing how you learn and doing what you have to do, for me that meant 8 weeks with my head in a book, for others it was something different. Don't let the numbers freak you out. The first question I asked in Pedi was the percentage of pass/fail and ofcourse the instructor declined to answer, but I think it helps to know beforehand when you are up against something challenging so you can prepare yourself in advance, by that I mean getting all your ducks in a row (babysitters, house cleaning, jobs...etc) if it wasn't for the strong support system I have I am not sure I would be where I am today, so if you can start talking to the family about what your life is going to be like and start asking for help now the better off you will be(warn them). And remember it is different from one person to the next, so what was difficult for me might not be for you....So it really is a toss-up, I just know that those two semesters Pedi and Pharm were the semesters where we lost a lot of students. Wow, did i ramble, sorry, I just remember being where you guys are and wishing someone would tell me something....Hope I helped a little....

I am currently in my 3rd semester at HCC, and I just wanted to pipe in... Any nursing program is hard work, any of them, you get what you want out of them, you have to put the work in, you have to know when to step up and give it your all, I think anywhere you go their are frustrations and disorganizations, their are GREAT teachers, and their are NOT so great teachers, their are classes that will KICK your buttocks, and some that allow you to relax...just a little though!!! (Don't get too excited), HCC graduate nurses get jobs all over Houston, so omit the comment that they don't (bitter), Nursing school is hard work but if it is your dream than make it happen and when you have to give 110% than give it.... One thing for sure is you have to learn to be FLEXIBLE, the sooner you learn to allow things to roll off your back the better, and learn to pick your battles wisely....Good Luck to all of you! I am here to say you can do it, just believe...

Psych nurses, please ponder these questions and let us all know what you think. 1) What can "we" as nurses do to better the community resources for the uninsured and dual-diagnosed client? 2) Do you treat both diagnoses simultaneously? 3) Can "we" really make a difference in regard to these issues? Thanks in advance.....

Thanks, Tom You rock!!!! After twelves this weekend and still willing to help, it means a lot to me. Appreciate the feedback....:kiss

Need a little help, Please....Pt., severe TBI, w/ depressed skull fractures, Cranioectomy, Shunt inplace, Tracheotomy w/ oxygen, PEG, Non-responsive, and pupils fixed and dilated. There is occasional eye opening and occasional arm will lift with no purpose. I am working on my careplan and I have come up with this: Risk for aspiration related to absence of protective measures as evidenced by reduced level of consciousness, tracheotomy in place, difficulty in coughing, and dysphagia Decreased intracranial adaptive capacity related to traumatic head injury as evidenced by continued fluid build up despite intracranial shunt, hemicranioectomy Am I way off here? This is my second care plan and I am still lost on these diagnosis. What would be the protective measures that are absent? Would it be the cranial nerves that control swallowing? I am feeling so overwhelmed right now. I need some direction here, am I even on the right track? What other diagnosis can you help me with? Are there any significant to the Trach and PEG? Any help would be greatly appreciated....I love this place. And I have loved going to the hospital and learning. I feel such great pride in what little I do know. I am on my way into a great profession! Thank you for your help...!!!!!:wink2:

Thank you!!! Don't I feel silly not thinking about the lack of sound...DUH! Brain overload I guess...

heres a little more info. on the scene had a gcs score of 3, depressed scull fracture, subdural hematomas, subarachnoid hemorrhage. underwent hemicraniectomy, evacuation of hematomas, shunt was placed, trach (for respiratory failure) and peg. these procedures were done approx two months ago. no bandages in place. eyes open but no tracking- pupils fixed and dilated. yawning, and coughing w/ no sound. bone flap to be replaced w/ in a week. do pts. like this get better? what do you call this state? are the meninges removed w/ the skull? is their a good internet source for information like this?

i hope someone can answer these questions. first i am not sure i have the right term but here we go. pt was in a severe mva, had part of his skull removed to help relieve the pressure, also had a shunt put in. even with these measures he is building too much fluid. (hydrocephalus) when looking at his head, it looks like the brain has fallen to the side about ear level. is this normal? when giving a bed bath, i felt the tissue around there and it is very mushy. is that normal? if any one can give me some understanding it would be much appreciated. this is my first semester of nursing school. i want to understand what these findings mean if anything.

Please Help! I am finishing up all of my prereqs this fall. I am taking micro and Pharm. I believe HCC uses Pharm as a weed out class. This is the only school I have found that requires it before the program begins. I have only heard bad things about HCC's program and I am starting to wonder if I am making the wrong choice. I could apply for Cyfair or Tomball. Please give me some information...