KneKno

Thanks, tippeny!

Does anyone have a template that they can share? I work pre/post anesthesia in a hospital based endoscopy unit, with the majority of patients being outpatients. We’re going to be starting follow up calls, and I only have an outpatient surgical script to use. A lot of that just doesn’t apply to us! Thanks for any help.

My search works. This is from someone that said she had copied it from another post: My Chicken Hez TB---Spiderman---Mrs. Wee. Its how you remember the mnemonics for isolation precautions. AIRBORNE(private room, negative pressure, DOOR CLOSED, N-95) My - Measles( Rubeola) Chicken - Chicken pox Hez - Herpes zoster (shingles) TB - Tuberculosis DROPLET - Just remember SPIDERMAN (private room or with pt with same infection, 3ft between infected person and visitors/patients, DOOR CAN BE OPEN, mask with transport) Sepsis Scarlet fever Streptococcal pharyngitis Pertussis Parvovirus B19 Pneumonia Influenza Diptheria (pharyngeal) Epiglottidis Rubella Mumps Meningitis Mycoplasma Adenovirus CONTACT - Remember MRS. WEE Multiresistant drug organisms (MRSA, etc) Respiratory infections (except those listed previously) Skin infections Wound infections Enteric infections (C. Diff., etc) Eye infections (conjunctivitis) SKIN INFECTIONS - Remember VCHIPS Varicella Cutaneous diptheria Herpes simplex Impetigo Pediculosis (lice) Scabies

We gathered ideas on about this several years ago, but none were implemented. Some ideas, based on years of service (we were talking about staff that had 20-25-30 years in the hospital and most were scheduling tweaks--no cost): Limit number of all holidays worked, have off all of Christmas/New Years (eves and days of) holidays, less week-end requirements, dedicated parking area.

pocketmod.com It's really just a fancy way to fold a sheet of paper to make a little 6 page book. I have the info I like in small font saved in my documents and just paste and copy what I want--Unit specific numbers (manager, charge, all the phones) are on the front, hospital numbers on the back (all units and the charge nurse, xray, lab, OR, PACU, phlebotomy, CRNA); my middle pages are ICU gtt and coronary artery info, and a blank page. I like that I can change things easily, and I keep a few extras in my locker for when the paper gets too shredded up.

At work, I'm paid to be nice.

One of my coworkers wants to post a notice: If you can't do it at WalMart, you can't do it here!" Must have shoes, shirts; can't eat food walking in the aisles; can't follow staff into areas where it says Staff Only....

Why don't we trust A+O people to take meds in the hospital (can't leave meds at the bedside, must watch them swallow), but we send them home and expect them to do it?

I'm a diploma graduate from about 25 years ago. Many hours of clinicals and 1 hospital taught me how to be an entry level nurse at that hospital. I think orientation would have been easier there only because of familiarity with the MDs, RNs and ancillary staff, charting, layout of the place. I would have been able to concentrate on the nursing. I went to work at a different hospital--and had to learn all of the above, and the "how to be a nurse" part. I believe longer clincial hours would help acquiring skills. 3-4 hrs a day 2 times a week seems to be the average of students where I work. 1 8 hr shift would give a much better idea of "flow," you'd have a better chance at seeing pts clinical condition change for the better or worse, and you'd have a chance to see how interventions turn out. That would almost be like an externship!

re: a pt with both a living will and MPOA--The language in most LWs says something like "in the event of a terminal illness or persistent vegatative state" I want /do not want.... In my work place, MDs still pretty much believe that terminal illness only pertains to very metastatic cancer. Also, by definition, a vegatative state takes a few weeks to months to become persistent. Because of this language, LWs are pretty much worthless in my opinion, other than serving as a limited guide on a pts thoughts about end of life care. If the terms of the LW do not apply, the MPOA gets to make any decision they want. They are supposed to be giving the directions that they believe the pt would make in this circumstance. However, many rely soley on emotions to make decisions, or may have never even discussed EOL issues with the pt. There can also be major issues when a pt has named 2 MPOAs to serve jointly--if they don't agree on a plan of care, the effort of the pt in making an advanced directive is worthless.

I've worked nights since for 20+ years, the first 2 were 11-7, 7-7 since then. My "schedule" has changed greatly over the years, it really depends on your life. I've gone from single and living with parents to married, to 1 kid, to 2 kids. Every change in my life resulted in a change in my sleep patterns! With kids (I was a late bloomer, they're 11 and 7) I believe I see more of them now than if I worked 12 hr days. My dad was a coal miner, as was all the men that lived around my parents. They took night shift and allowing the men to get their sleep seriously--as a kid, I knew what neighbor was sleeping and knew not to be yelling near their yard! That respect for sleep made a huge difference in how I adjusted to this schedule. It amazes me that coworkers get phone calls all during the day while they're trying to sleep from their families, who are amazed that they're sleeping! Over really stupid stuff! Be willing to try nights--you might like it. And, we have cookies.....

When do the nurses get a chance to "fill out a survey" about the patients? Did they smile, did they show interest in learning about their meds, did they volunteer to walk 3 times on post op day 1 or did the nurse have to "encourage" them, did they use the inspirometer without reminders? And, I'd also like to give my opinion about the visitors..... think they will they "Strive for 5?"

Self scheduling--as long as you schedule a combination of 3 Fri and/or Sat and 1 Mon and 1 Thu. That's 5 of 12 shifts. I guess the "self" part comes in cause you get to pick which Mon you want to work!

There was recently some information in my local newspapers about the use of pictures with dementia patients. I can't find any references about it right now, though.

FMLA? For your own mental health if not covered by "primary caregiver of family member."

Another poster already mentioned POST/POLST forms. Can also see if your state recognizes DNR cards (provides for out of hospital DNR order). Living Wills are very general forms, are usually written to apply only if "unable to make my own decisions and in a persistent vegetative state or terminally ill." Doesn't usually apply to acute situations. MPOAs are better suited for day-to-day decsions, especially when the appointed decision-maker has discusssed end of life situations with the person they are making decsions for. In my experience with MPOAs--naming more than 1 person as decision maker is about the same as naming no one. AND, name a person willing to make the decision you would make for yourself if able; a spouse or child is not always able to make the decison you would want. A good resource site: http://wvethics.org/advance_directives_forms_laws

expressive aphasia?

See if you have access to MicroMedex at your hospital. They have a tab on the site that checks IV compatibility. List all the IV meds someone is on (gtts, piggybacks and pushes), it'll spit out what is, what isn't and what is unknown re: IV line compatibility. I found that insulin and propofol are compatible. If you don't have MicroMedex, become great friends with the pharmacist! Good Luck!

I frequently refer orientees to this site: http://www.icufaqs.org/ Lots of information about various subjects. Good Luck!

I'm 45, an RN for 23 yrs (1/2 my life!). I plan to be working for another 25 years, because of the need for health insurance. I 've been a the bedside for that entire time, and my body is feeling it! I'm imagining myself hobbling down a hallway with my walker, Foley hooked to the side, serving glasses of soda to my patients visitors.... I really don't think I'll physically be able to retire from my current job (community hospital ICU). I'm trying to figure out my options, hopefully decide what to do in the next 5 years.

I rarely have patients that complain about night shift care activities. However, I do not understand the fmaily member that stays with an ill patient overnight and sleeps for 8 hrs. I work in ICU. I've had lights on, done complicated dressing changes, given 2 or 3 complete bed baths to an incontinent pt--and the visitor doesn't stir. I'm pretty sure we could code the pt without the visitor waking up. Why are they there? If they don't get those 8 hrs of sleep, they c/o how much their family member was disturbed (even if the pt was heavily sedated and vented....).

http://www.wpxi.com/news/25591637/detail.html A little more information from a local TV station web site.

I think team nursing requires a lot and almost constant collaboration between the team leader and the other staff members. I'd think that would be difficult if all the team members are charting in their pt rooms. What's the hospitals goals? What are they trying to accomplish with the change in care delivery mode? Are there not enough staff? Too many nurses staying too late? Pt complaints about care? What's the hospital trying to fix?

My workplace has a "Short Stay Unit." It's a max 24 hr stay (although some insurance will go to 48hrs), billed at a per hr of stay rate (would cost the same as a regular room if the pt stayed the full 24 hrs). Most of the pts seem to be r/o chest pains, they stay until cleared by cardiac enzymes and stress test or admitted as a regular pt. Other pts are post ops that would generally have been discharged; but, these ones have some sort of issue--uncontrolled nausea, need for IV fluids, uncontrolled pain, not waking up well enough, etc. Pt's may or may not be on telemetry. Lots of insurance/regulatory hoops to jump through. It's a busy place, nurse pt ratio is 1:4-5, with an assistant for every 10 pts.

FMLA?