laurakc

Unfortunately, the first job for me was not easy either. Every day I was surrounded by people who felt overwhelmed. I think that a lot of new grads feel this. Most of the time, this is normal. I started more than 10 years ago. At that time, we had a very large turn over. It took me more than a year to feel competent, but it will come. It is a big adjustment. And it is a lot of information to know. And you will learn something new every day. Before you know it, you will have the oportunity to precept someone. So, just try to go in with a positive attitude. You can get out of something what you put into it. You did not get through nursing school and pass boards by listening to others say how hard it was and being scared away. The tougher things are, the greater the rewards when you achieve it. Hang in there. It is tough no matter what the first year. Good luck and be open minded.

never go to the ER of a not for profit hospital sign and think that means you will not recieve a bill...just because the sign says so..and then come back and argue with the nurse at triage because you did get that bill...she does have better things to do...although she may not think they are quite as funny!

woman 16 weeks pregnant had unprotected sex last night with someone who smoked pot and wanted to know if the baby would get any of it and if so could we "clean her out please"...

I have one from last night...either it was funny or I am/was tired.. A homeless guy comes in, has been living under a tree... drinks too much, lights a cigarette, falls asleep and burns his tree down.. talk about bad luck!!! Anyway, had to be treated for smoke intubation on top of all that...

The blood should just reabsorb..It should not really cause any problems after the first few days...Chances are, if he pulled the drain the next morning anyway, it would have swollen anyway.. I worked ortho for about 4 1/2 years...some docs used constavacs (I did not feel that those patients recieved any less transfusions), some used hemovacs, and some used no drains at all..many of the hips and knees were swollen anyway..many used transfusions anyway... However, you should not have to clamp the tubing from the leg to the canister when you are filtering the blood for reinfusion..just clamp the tubing to the bag once the blood is in the bag...but, I have even had nurses cut the wrong tubing once the transfusion was complete.. Hope things work out for you... Remember, the only perfect person was hung on the cross many years ago..you are going to make mistakes in your life...just learn from them..

I have a few... I accidentally drank peroxide that was on my nightstand instead of water. How much? Why the whole bottle of course. I thought it was water until I turned on the lights. and.. My heart started beating fast after I smoked crack.. and.. I can't remember if I took my sleeping pill or not, so I took another..and I think I should be checked in case I did..(of course she is not the least bit sleepy)..

Ok, this is what we were told. We were told to reheorifice. Look at the questions. It does not say, "did the nurse abuse or hurt you"? It's like..was the nurse concerned with your privacy...so you say, Let me close the door and provide you with some privacy...did the nurse introduce herself..so you say, Hi, I am ..., I will be the nurse "caring" for you today..(don't say taking care..on our survey it says did the nurse care about ....)and you must be or are ... Just read the survey, reheorifice the answers, and then, when you reheorifice it enough, you will be able to "cue your patients to answer it correctly.. Now, we do have patients that no one can ever satisfy.. But, you have still provided privacy, introduced yourself by name, etc. and they really can't deny that..then, overall care will probably not be so good, but.. Anyway, this is actually a trick, but when trials have been performed on live people, it actually worked... Now, to get people to remember your name and mention you, you have to be extremely nice, nonjudgemental, and go way out of your way...check on them frequently, look in on them and say goodbye, etc. (and candy and gum work well as bribes as well) You have to take the time to get to know what they really would like..and give it to them if possible..sometimes all they want is a smiling face..but not very often.. Good luck

thanks for all of your help guys.. will take a look at the website and look for more..

Ok, I got the arrows..can tell resp or metabolic acidosis or alkalosis...now is where I need a little help... does anyone have information on treatment.. when to vent, when to give o2, when not to...when to increase the o2.. I am just having a horrible time with this and would appreciate it if anyone has resources or will even appreciate advice..please.

For foleys, I found that--find the privy parts-there is an upside down v just below it, and urethra is just under that---occassionally this does not work--I think twice in about hundreds, possibly thousands of people... IV's, labs--there is always a good vein in everyone between the ring finger and pinky..tap it, rub alcohol on it...up it comes.. NG tubes---I think I would rather be intubated or something...I try to get orders for Ativan if possible, Cetacine spray and use Lidocaine gel on the tube...works much better..Occassionally have used Morphine instead of Ativan and it helps also.. As for EKG's, had to take the class more than once..then one day, I got it! Difficult patients or families--just never let them know that they are getting to you! By the way, this is still the most difficult for me also. I like to send them for a therapeutic time out whenever they are just too much...Just, I am so sorry but we have a lot going on right here now, so I would like for you to wait here until I come and get you (when I am relaxed enough to handle it again, but would not tell them that)

I guess what I am trying to say is that there should be a more objective way to document the pain instead of only what the patient is saying... Quickily, I know, this is how they percieve it, so this is how it is.... However, sometimes there are noticeable improvements and the patients deny them...Sometimes, I just want to be able to say..you couldn't eat all day because you were in so much pain..now you are eating pizza, so it must be better?? Or is this just an insane approach that would be totally inappropriate?? Or you walked all hunched over and now you are walking upright, so are you sure your pain is no better?? I am not trying to say they should not ever get more medication, or even that they shouldn't get another dose now, but it seems that they may be just a little better by just observing them before and after...not vitals, just body language, affect, anxiety, etc... Just a thought...

Maybe I am opening a can of worms, but here goes: I have been reading many of the postings on pain control and management. I am pretty new to all of this, but have a theory that would be a little less subjective. Instead of having 0-10, which everyone feels is different, i.e. many people seem to think that you could not possible sleep with a 10/10 but when a patient is awakened after being given a narcotic will insist that the pain is still a 10/10... OK, does the pain keep you from: walking talking laughing breathing eating sleeping working reading and so on, depending on where the pain is...also, evaluate exactly what the limitations are..sometimes people have stated that they are a 10/10, but have no limitations to the above. So, if the pain is not interferring with normal function, I personally would not rate it a 10/10. However, I do try not to judge someone who does because this is a very subjective scale, as it is intended to be. Mine is more objective, and I think it is a little easier to measure if pain is relieved. Of course, it does not meet jacho requirements and is not approved in the facility where I work, but just food for thought. Of course, there will still be cases that it is more difficult than others to evaluate pain, but I guess I just notice many people saying, "How can she have a 10/10 pain? she is eating chips, drinking soda, and talking on the phone." So, to many people, she is still able to function, so that was the goal for her. But, importantly, could she do this before the medications?

and, by the way, we are nicer to animals than to humans. If an animal is suffering as much as some of the patients I have had, the vet would have to put them to sleep. So, why are we so hesitant to treat humans with dignity and respect? Although, I am sure it would not be easy to do such a thing to a human being, it has not been easy to do it to an animal either.

I agee. Now here is my two cents worth. I think that "drug seeking" is a bad term, judgemental, and no one should have the authority to use it. However, we do get many patients that try to manipulate us and that is when managing their pain starts to become a problem. I find it difficult whenever I go in with a pain medication, and instead of even trying it, the patient will get very anxious (which only makes the pain worse) and says "I am leaving if I can't get Demerol...dilaudid...morphine instead of _____..Or I really like you, you are the nice nurse that gave me ____ the last time I was here. Or the ones that have such severe pain they moan and cry the whole time you are in the room, and then start reading a magazine the second you leave. I do believe that they are in pain and would like to help them, but am limited in what the physician will order because it is not like I am able to prescribe the medications. But I am constantly being told "you will be hearing from my attorney" if I am not offering them the drug they are requesting. I, of course have notified the doctor of the drug requested and it has been refused, so legally am I responsible for their pain management? (if anyone knows) by the way, most of the ones that do this are of course, unknown cause of pain, like headache with neg ct, mri, which makes the physicians less likely to prescribe heavy duty narcotics in the emergency room. Sometimes, it just feels like you are so in the middle. And it is so bad when someone who takes these large doses of medications for chronic pain comes in with something acute, because some very large doses are not even beginning to help. Any advise anyone?

by saying she is sleeping, i hope that as I observe that I also notice how she is breathing..listen to the heart/lung sounds..which would be far more important than urine...what is her rhythm, other vitals..I find it hard to believe that she would be in distress with her breathing (as most are anxious, and obvious) and be sleeping...i also find it hard to believe that her bladder would be about to explode and she would be sleeping... and yes check the foley for kinks.. oh, by the way, first questions kill me..I do look, listen and feel at the same time..see the effort while listening to lungs, check perifpheral pulses, is she cold, move the foley tubing around and see if it is kinked..further actions as neccessary