typoagain

I have to say it depends on the situation. I once had a patient who had pain meds ordered Q4 hours PRN for post-op pain. She would set an alarm to go off 3 hours after she got her medication and then you immediately start hitting the call button demanding her pain meds early. After 2 or 3 days the nurses went to the doctor with concerns about her abusing PRN meds. Especially since she never once said her pain was less than 10 out of 10, even two hours after being given the pain meds. She would literally wake up in the middle of the night because her alarm went off and start complaining her pain was 10 out of 10. But if we were in the room when the alarm went off we could reach over and shut it off before she woke up. And she would sleep until her next round of vital signs. One of the other nurses actually tried it. She slept nearly 7 hours. The doctor said to just give the pain medications and let him know of any adverse reactions. He also wrote in an order for Narcan. About 5:30 a.m. one morning she was on her call light demanding her pain meds. And so I pulled the meds and gave them to her, just like the doctor said to do. Then when I went around at 6:30 to check on her I found her sleeping. But I was unable to arouse her. So I got the charge nurse to come in who also could not arouse her. So she got her dose of Narcan. Needless to say she was wide awake in seconds. And she was throwing a wall-eyed fit about how much she hurt. You should have seen her face when I told her she could not have any more pain meds and why. I also explained that even if we gave her more medication it would not work until the Narcan was out of her system. Fortunately it was the end of my shift and I didn't have to deal with her anymore. When I came back that night she was giving everyone hell. She kept on demanding pain meds. But much to her disgust the doctor had DC'd all narcotics. He discharged her the next day, without any narcotic pain meds. But she did get a referral to a pain specialist. He also informed her that she would need to find another physician.

I don't know what the laws are in your state. But in my state if you don't report something like this, then you could lose your license. The nice thing is you can file a report online anonymously and it will give you a case number. If you keep the case number you have proof that you filed a report (to protect your license) and no one has any way of knowing you're the one who filed the report.

I've been an RN for a dozen years now. And I have family member with the type of hearing loss you're talking about. I hate to say it, but if I was to lose my hearing to that degree that I would be looking for another career the next day. I'm getting older and half had a very slight degree of hearing loss. Unfortunate that is good electronic stethoscope can overcome my hearing loss. You need to understand, my hearing loss is so slight that you would not notice it in normal conversation. But it is severe enough that I have to use an amplified stethoscope and pay particular attention just to do my job now. I know of way I would be able to provide patient care with a profound hearing loss. Now there are jobs nurses can do that do not require them to be able to hear at all. But the vast majority of those type of jobs require advanced nursing education along with several years of experience. And then their job is more along the lines of administration with no direct patient care.

How would love to hear some of the things coworkers have done at work that just make you mad and frustrated. For example, the other day we had a lady who was clearly terrified of needles. Now we all have patience claim they're scared of needles. But this lady was a little different. She came into the ER clearly in pain and flat refuse to let the doctors draw any blood work, or start an IV. She had abdominal pain but would not allow us to do anything that involves a needle. Try to figure out a diagnosis for abdominal pain without being able to do any kind of lab work or use any kind of IV contrast. Now I'm not the first nurse involved in taking care of this patient. In fact, I actually asked to take over care for this patient because nobody else was getting anywhere. After sitting there and talking to her for 20 minutes I finally got her to agree to let me draw blood do doing finger sticks with micro tubes just like I would have a very small child. So I went to gather up the necessary supplies. Now I am a new employee and was oriented to the ER. My preceptor took it upon himself to walk in and try to convince the lady to let him start an IV. She's already told for people know she would rather leave. She had even said she would rather go home and die then let someone stick her with a needle and she was crying when she said so. When I got back she was signing the AMA paperwork and leaving and nothing I could do to stop her. . I've been a nurse twice as long as he has I just happened to be new to the hospital. I think he was wrong and out of line. What do you think? Thanks for letting me vent. I really needed it.

I've been doing this long enough now that I think I actually know what happens. The fact is the only time anyone gets in trouble for calling themselves a nurse is it they are lying and actually working as a nurse without a license. It does happen. And people are prosecuted for that. Sadly enough, it is left up to the local district attorney to prosecute. All the all the board does is make a referral. Many times people are fired from jobs where they have been working claiming to be a nurse for several months and are never prosecuted. That is, until they've done it 2 or 3 times. I just find it very difficult to believe there are so many long-term care facilities that don't check to make sure a person has an active license when it is so easy to do!

Oh don't get me wrong, they get mailed if they use the title RN or LVN. The states mail's out a list to all nurses every quarter of people who are in trouble and being prosecuted for just that. What they let them get away with doing is saying quote "I am a nurse." As long as they don't say "I am an RN" or "I am an LVN" they let him get away with it. I don't know about you, but I never introduced myself to my patients as "I am your registered nurse" Instead I just walk in tell them my name and say "I am going to be one of the nurses caring for you tonight."

1 milligram every 6 hours. I would never question it. In fact I'm wondering why so far between doses? Is it an elderly patient or do they have some disease that will keep them from metabolising the drug. Do they even stock vials of 1 milligram dilaudid? The smallest I've ever seen was 2 mg.

I begin my career with seven years in pediatrics. Then I transferred over to the ER at the ER directors request. Lo and behold we got a new er director shortly after that. A year and a half later I did what many of us do, I quit my boss and went to work at another hospital. The new hospital has an extremely busy er that handles a large number of trauma cases. It's a nice facility that's only 10 years old. And it has a great team of nurses. But the local economy has been booming and the bottom line is they just do not have the resources to handle the volume they need to. Then last week we had an incident where I had three patients, all of whom were ESI level 2. I had one patient going in and out of a fib. Another in afib who had just had a stroke. And another with an altered mental state that we could not figure out what was causing. I was fine until the 3rd one got sent to the ER and they brought me in and auto accident victim with a head injury. My teammates stepped in and gave me a ton of help but we very nearly had an error made that could have been fatal to one of my patients. Even though I had a lot of help it was still my patient in my responsibility. After several days I've decided that was it two years in the ER was enough for me. I liked having a license. I met with my boss and turned in my notice. 2 hours later I was interviewing and offered a telephone nurse triage job at the same facility. I think it will be a very good career move due to other things going on with my family. Plus it is something I have actually considered doing before I ever went into the ER. Now my question: what do I need to do to get ready for this new job that starts in 3 weeks to make myself the best at doing the job?

In my state, Texas, you can call yourself a nurse if you work in a doctors office. You can do this with even wirhout getting a high school education much less any further training. It is an old old loophole the doctors used to use to get inexpensive help in their office. Legally the doctor is responsible for everything they do. And they are working under the doctor's license not their own. I run into it all the time and I hate it. I generally respond by asking them for some quote advice on a topic that I am sure they know nothing about. I do this using the biggest most technical terms I can find. I love the look of utter confusion and stupidity they get on their face. My favorite is "I have a patient with cholecystolithiasis and they're asking for dietary recommendations. And an embarrassingly enough, I am drawing a total blank. Can you think of any?"

if you don't want to work nights, holidays and weekends, then basically you need to get out of nursing. You are going to need a lot of experiance before you get anywhere close to the hours you want. As for the money, if I quite working nights, weekends and holidays withthe same exact job I currently have (like they would ever allow that) I would ben up taking about a $250 a week pay cut.

I have a co-worker that went the D Ramsey route big time. She went on a working rampage for 3 months and pain off $48K of her mortgage in three months. For the next 6 months her husband worked 2 jobs. They not only paid off their house-along with ever other bill they had. They ended it by taking their 2 kids and all four grandparents to 3 days at Disneyworld and then 5 more days on a Florida beach.

If I ever have a fear about meds, I toss theright away and start over. Noone has ever faulted me for that.

My first time was one of the first nights I ever charged. It was a slow night on pedi-only 3 pts on the floor. One of them just did not look right and I had no idea why. Pt was in for RSV. Had both the house-super look at her and the RT. No one could ever find anything wrong. Finally at 03:00 I called the MD. I said I needed her to come in and look at pt. I had no idea what was wrong but something was not right. All she said was that she would be there in 15 minutes. She went into the pts room, came back 30 minutes later and ordered a bunch of tests. By noon the next day we had transported the pt 350 miles and the pts was having open heart surgery for a congenital defect. Now I always LISTEN to that nagging little voice. I have gotten griped out a few times, but I still listen! It has been right often enough that I will always listen.

The triage nurses in my ED are supposed to always ask about travel. it has been part of our normal triage process for years. I personally always ask if they have traveled outside the US and if they have travel out of my state. You would be shocked the number of people who say they have not traveled outside the US and then turn right around and say they have recently been to Mexico. I even had a pt argue with me and tell me that Juarez is the same as being in the US. She knows this because she grew up in a border town!

I had a pt call from the ER waiting room. An ambulance picked her up, took her around to the ambulance door, through triage and then sat her down in the exact same chair! The said good night and then walked off.

Maybe it has to do with the fact that he knew that if he had said that, then he would also be admitting that he broke the law and deliberately exposed hundreds of people for personal gain.

I had a 65% increase in insurance cost last year. Now I have changed my wife and son to the policies offered from her job. I had to change my son's doctor. I have increased my major medical deductibles from $500 to $2,000 for my wife and son. Then to top it all off i STILL have to pay 16% more than I did the previous year. As for work, we are seeing even more people in our ER. Sadly, most of the increase are people with no insurance or Medicaid. Plus most of the Medicaid pts are still people who should been seen in the PCP’s office. We are also seeing an increase in pts who are coming in less than 24 hours after being seen in their PCP’s office.

Just a few thoughts that come to mind; 1. Know what sites to use for waht ages. 2. What meds cam be mixed with lidocaine and when to do so. (ex. Rocephen) 3. Personally, after drawing meds I always change to a new/sharp needle just before I inject any med. 4. You have a job to do, so go and do it. Stalling while you work up your nerve will NOT make it any better and can make it worse. 5. NEVER mislead a child. If it is going to hurt I will tell them. If it is not going to hurt, I tell them. I want them to truxst me. 6 Finally, I will never let a parent use a shot as a threat. (i.e. - you had better behave or he will give you a shot) I have made more tham one parent mad, but I always tell them to not do that. The last thing we need is for a parent to feed what fear the child already has. That will just make it harder on all of us-including the pt.

Pt is a 34 month old male that has been potty trained for about 5 months. Mother states the pt went to bed the previous evening c/o severely upset stomach. During the night he supposedly had a large, fowl smelling, incontinent diarrhea stool at about 1:00. This was followed by another that was discovered at about 07:00. When mother removed the pts underclothes she says she saw large blisters, some of which had burst and had the covering skin peeling off. The pt was admitted to my unit at about 18:00 on the weekend. The affected area ran from the base of the scrotum up to the coccyx. It was about 11cm wide at the buttocks and narrowed at it went up the gluetal fold to about 4-5cm. Only the very lower tip of the scrotum was affected and had a Here is the catch: the area right around the orifice and inside the gluetal fold was only slightly red to normal in color. In fact, the center area of the buttocks (where most of the pt's weight would rest) was basically normal. But the blistered area had blisters as big as 1cm by 3 cm. One of the areas where a blister had burst and the skin pealed was an oval area of 2cm x 4 cm. (Boy, I wish I could post pictures of this.) Judging by the shape of the affected area and the severity of the burned skin, I believe the child was laying in a caustic fluid for a long period of time. At this time CPS have removed the pt and a sibling and placed them in foster care. I was told that they were even looking into criminal charges against the mother. Now I am normally the one on the unit that is first to bring up the topic of calling CPS. I have even ****** off a couple of MDs by doing this myself when they felt it was not necessary. BUT I do not think this is abuse! Not this time. I think it was not a deliberate injury because of the shape of the affected area and what parts of the area show the most injury. Have any of you ever had to deal with a case where a child had large blisters on the bottom when it was NOT abuse and what causes it? What, if any action do you think I should take? Do any of you know of a source where I can get pictures of burns in the same area where you would expect a bad diaper rash?

It has been my experience that students can, and most often do, drastically INCREASE your work load. But I do love having them around. it helps to keep you reminded just why we choose to do this.

In my state there is no co-pay for medicaid. I do often ask about insurance -and for a good reason. If you have no insurance I know of a few ways to help keep your costs down. We have a local businessman who offers FREE Courtesy Health Screening, (a.k.a. lab testing) to anyone who walks in the door. No co-pay or cost of any kind. All they ask for is your name and a phone number where you can be reached. For the owner it is a huge tax write off and a public relations gimmick. For people without insurance it is a godsend. You get a CBC, CMP, A1C, PSA along with all your vital signs checked. You can pick up the results in 3-4 hours or they will mail them to you. A MD comes in once a week and checks all the labs. If you have something to be concerned about her will call you. The lab in located in a quiet, low traffic area of our large mall and is open Monday thru Friday, 9:00-6:00. My hospital also offers pregnancy testing and help getting free and low-cost prenatal care at the same clinic. WE also offer different services for seniors that are free-if you know about them. Sadly, this clinic only gets about 300 people a month. I recommend ANYONE with no insurance goes there, and then gets a check-up. You can get one of them at WalMart clinic for $45. Knowledge of a pts insurance situation will go a long ways towards helping you to guiding them to the best place to get help-and keep non-emergency pts out of your ER. When I work the ER I can also tell you if your MD is taking call that weekend and if not who is covering for him. I also know what pedi MDs can be contacted over the weekend and how to get them.

There is no co-pay with Medicare! As for the rest-hold out 2 hands, wish in one, and . . .

I was filling in at an after-hours pedi clinic and took care of a baby that the mother complained that no one could figure out what was wrong with her child. He had a rare, non-productive cough, no nasal congestion or discharge, and his chest sounds were text-book perfect. He had been seen by seven different doctors before coming to us. Mom was 16 and the baby was 8 weeks old. She was the MOM and she KNEW that something was wrong. The doctor had her change formula and come back in 10 days. When she came back she was so glad that the doctor had listened to her, (unlike all those others who had not idea what they were doing) Her baby ". . . was cured!

ANY kid that says (as you make your 3rd attempt at starting an IV) "Please don't, I promise I'll be good." I have cried more than once with this-and I am a gray headed old man! We recently lost a 6 year old who had been severely beaten by mom's drugged out boyfriend when she was just 3 months old. She was left with severe neurological damage. Thankfully she was adopted by her foster parents who were nothing less than God's special gift just for her. I also will be going to court soon with a co-worker who lost a grandchild to shaken baby syndrome. That is one babysitter I personally would not mind pulling the plug on myself. Now if they would just arrest the mother . . .

try listening just under and forward ot the ear. if it is UAC it often is a lot louder.