Beaches10

Xanax aerosol q 6 hours. Advised MD that all the nurses would be happy, but perhaps Xopenex would work better for the patient's lung function.

If you all don't work for the same company (CNA and RN's), you really have no right to supervise the CNA's as they are private contractors. Nor are you responsible for what they do. Yes, I agree you guys should all be on the same page and coordinating care, but just as in a hospital setting not everyone wants to work as a team and some resent being delegated to perform certain duties. It is then up to the family to "coordinate" care with guidance from a knowledgeable source or find one agency (there comes that recommendation-tho I doubt it is law) where care can be coordinated and everyone is responsible for carrying out a standard of care and accountable to a higher level of authority.

Of course it is everyone's responsibility to answer call lights, but I've seen some obviously deaf people who stand around the unit and act like it isn't beeping. I have also seen staff who purposely sit on the other side of the desk far away from the call system just to avoid answering the light. Duh, it is still beeping! My only gripe is patient's who always ask "for my nurse" and all they want is a box of tissue and yet the one who answered the call will state "so and so needs to see her nurse". I usually advise the patient (nicely) that they don't have to wait for that type of thing, anyone is willing to help, but if they need medication or any medical need ask for me by name. A couple of good questions to ask when answering the call light "Can your nurse bring you something when she/he comes in?" or "Your nurse is with another patient at the moment, can I help you?"

This sounds like a bit of hoo-ha to me, but I am no expert. If the family is paying for the services directly out of their pocket they have the choice of whom they hire. If the state is paying, there may indeed be some restrictions under "managed care" programs. Consider the source of funding and therein you may find some definitive rules.

In Baton Rouge and thankfully the weather part is mostly past with just a few high gusts and some rain. It was a wild day here with trees crashing through over 400 homes in Baton Rouge alone. Lost power around 10AM this am and expected to be out up to two weeks. My neighborhood is pretty much a diasaster with trees and power lines down. Neighbors have a tree thru their house, trees down in my backyard and the fence is gone. But thankfully, no loss of life in my immediate area.I have only heard of about 5 deaths related to the storm in south LA and that is such a blessing with all the destruction. Thanks for the thoughts and prayers. Clean up begins tomorrow, but it will be awhile before people will be able to move out of the shelters simply because there is no power grid to speak of at this time. There is a wind outside, but rather warm inside. We are one of the lucky ones with a last minute buy on a generator and a breeze from a box fan. Bought an aircard just two days ago in preparation for travel nursing - so atleast I can connect to the outside world.

Kudos to you that you are there to make sure your nurses get breaks. Not all hospitals have that nurse to back them up. Potty breaks are hard enough, not to mention the lunch break. When it is really busy it matters that the lone nurse on the unit doesn't get swamped with the "to do" list. Even in our hospital, and as charge nurse, I find certan nurses that routinely delay report from the PACU for transport to floor and then simply go off to lunch leaving the LPN (who can't accept report for a patient coming back in our state). ArgHhh! Again I say consideration of your fellow nurse is one of the most important aspects of having a well run unit with team work an optimal goal.

I am not going to dis my hospital, but yeah, the breaks are non existant and the lunch is usually grabbed behind the nursing station. Most of our nurses are pretty supportive of one another and stay in the back room in case there is a problem. Can't remember the last time I had an uninterrupted lunch. I could walk off to the lounge, but appreciate the other nurses when they are there for a quick question when a doc shows up or things go bad. What I do object to is a nurse leaving the unit for longer than the allotted time and strolling back in asking did you do that check, what about the accu check, etc. Consideration of others goes a long way in my book.

Ok, so just what meds are required for double check? We of course still do Insulin and chemo drugs - what other common drugs is everyone else double checking. BTW can you tell me about that Dilantin situation. Moving into a new unit and see you can push it (peds are different) but tell me the restrictions other than max of 50mg/min in the adult population.

Tim Porter O'Grady tends to run at the mouth a bit. Because he is a "former" nurse (I don't personally consider him one anymore), he tends to run off at the mouth spouting quite a bit of rhetoric about nursing. Gets paid big bucks by hospitals needing magnet or simply a transformation. If administration would simply listen to the nurses who work for them, they could save alot of money. Case in point is hospitals scheduling inservices for nurses, yet the nurses who would most benefit are working on the unit and can't get away for the inservice. Anybody else have this complaint!!! EBP is the "new generation" word as it should be. Nurse managers and policy makers still are not listening when you ask "why do we do this?", or "I read this and I think we need to look further into it." Yep, still sizzling on the back burner.... Give Tim a port-a-potty because he certainly has a lot to put in it.

Drug Addiction units where people are there just to get out of jail. You have patients in there that are really trying - mixed with those that are really lying. It's the last ones that simply monopolize the program with their "reformation", tears and embellished stories that just make you want to find the nearest barf bag. These type of actors wouldn't know the meaning of "get real" if it was written on the front of a mack truck grill as it hit them.

We gave our patients the choice of xylocaine vs nothing, both peripheral and via port. About 4% chose not to use Xylocaine while 96% state it makes the experience better. Only 2% felt the topical was worth the trouble of remembering to apply. I'm torn - topical would be worth it with a port if it were me, unpredicatable as far as a peripheral site access. Infection at the port site is rare, so can't say the extra stick with Xylocaine use would be a true factor.

Yep, agree with Theresa. All it takes is a shift in position of the arm to hear the base of lung air exchange and if there is a problem. Find on my AM shift that the patient is generally in their most comfortable position, many having not moved spontaneously all night and discover that I have to be the "bad" nurse once again with the move, move, move routine and yes incentive spirometry doesn't work unless you use it every hour or two. More acute, unresponsive patients you find the pool of fluid in lower positioned lung and flanks-a key to fluid overload or third spacing, not always preventable/curable in the end of life stage and renal patients.

silver888stein, Not sure if you are asking about chemo unit in the doctors office/vs hospital outpatient/vs. chemo unit inpatient. Do you also have surgical oncology, medical oncology and end of life oncology? Clarify and be happy to give you a brief overview - but warning, not two days are the same.

It is a wonderful and rewarding career option, but you have to be the type of person who accepts that not everyone will be cured. As you see the same patients weekly, biweekly or monthly, you can become attached to them, know them, know their families, and know how cancer is affecting their lives. We hug and rejoice with them when the scans come back clear and they move on to live the rest of their lives. When it is time for them to die, you have to let them go knowing you provided the best compassionate care that you could. Do we cry? Yes. Do we obsess over death - no, it is simply a part of living. I don't personally go to a former patient's funeral as that is a drain on my own emotional well being. I have to believe that I made a difference in the quality of that patient's life and therein is the reward for being an Oncology Nurse.

I work Oncology Surgical/medical/end of life care inpatient with in patient and outpatient chemo on the same unit. We have 9 patient beds plus a 4 chair chemo room. Will do up to 6 or so chemos daily. It is a 2 nurse/2 CNAs unit and on lucky days get some float help. Can be hectic, but the thing to remember is never rush chemo patients in and out - that's where mistakes are made. We have tried scheduling the chemos and is working better, but invariably our chemo patients think of us as family and drop by early as "they know we wouldn't mind". As we are "family" they also want to chat alot. Can be a killer day. Worked 3 hours after shift was over on Tuesday just finishing the paper work. I still hate computer charting, I can write 3 times faster.