jlmb214rn

I feel ya! This is actually a common occurance on my post-surgical floor. RIDICULOUS!!!:grn:

I'm glad to hear that other nurses are bothered by interruptions in report. Now, I am not so particular that someone can't pipe in when something is unclear. But like other people in the post have said, if I'm going to get to it, then don't interrupt. For example, at my facility we have a form that is used to report from. Most nurses give report by going down the form, filling in the blanks, and then doing a "narrative" type report on the patient after all the technical information (iv site, o2, etc) has been given. There is one nurse at my facility that is BAD about interrupting. I told her the name, the doctor, the diagnosis, then next on the form was the history. The pt had COPD. Immediately, she asked if they were on O2. Well, let me finish... I will most certainly get to that. Or another time that a patient was here for a surgical procedure and had been NPO. I tell her that the pt was scheduled for 0730 and she asks if the consent is signed and has she been NPO and.... Well, yes. If you hadn't stopped me, I would have told you that already! I feel your pain on this one. Yes, report is interactive. I don't think that anyone expects you to just sit there and take notes and never utter a word. Common courtesy does apply, though.

First of all, I wouldn't report it. (To answer the original question) But only because the patient in question didn't overhear anyone else's information, and I'm assuming that she didn't feel like someone else overheard hers. However, I do believe report at the nurses station is a no no. I don't care where you work, you should have an area, be it the breakroom, dictation room, etc. that is away from the public ear. Bedside report should be just that, bedside. You shouldn't be out in the halls around public ears. With patients in semiprivates, the verbal report should be done in a seperate (private) area, and then go to the room to look at drains/dressings/iv's. That being said, I'm suprised at some of the replies to this thread (as they seemed a little hostile to me)

An addendum to my previous entry... I can totally understand how a person who had never heard of a drug or seen it spelled out could spell it incorrectly. However, when you administer that drug on almost a daily basis, and look at it in your MAR spelled correctly, you should catch on. It's like she doesn't even care that she's spelling these things wrong!! It irks me sooooo bad!!! I just want to say, "PAY ATTENTION!!!!" I wish someone would make her go back and re-enter everything that she has spelled wrong. If she had to do that once or twice, maybe she'd start grabbing the drug book!!! Or LEARN to spell it!:hdvwl:

I have never laughed so hard in my life!!! Some of these people.... I'll share a few good lessons that my patients have taught me. Never, never, never masterbate with a raw hot dog. It will most certainly break if you try to "pinch" it to take it back out. Don't ever have sex on the floor if you have a pest control problem. Mice love the cozy warmth of a lady parts and may just "run up in there" if you aren't careful!!! If you are going to let someone put an object in your rectum, make sure it has a string or handle so that you can remove it when you are finished. And by all means, never let your drunk mistress try to remove said stuck object from your rectum with a pair of needlenose pliers. Those things pinch and tear out pieces of your rectum. And finally don't drive yourself to the ER, and expect a "quick-fix" so you can get home to "clean up the toys and blood" before your wife and 15 year old daughter get back from vacation. Always remember ladies, there is puppy formula at any veteranarians office in a case where your pet doberman cannot nurse her own puppies. Your 3 month old will not appreciate that she shared your breast with 5 puppies. And not to mention, puppies have sharp little teeth that may end up causing you a terrible case of mastitis that will forever alter the appearance of your goods. Also, never eat a whole bag of sunflower seeds (husks and all) in one sitting. You may end up with a softball-sized mass of husks and feces lodged at your orifice. Be careful before you sit down in a chair naked. You never know when there will be a wooden McIntosh apple in the EXACT area that your orifice will land. Never have someone defacate on your chest if you have a fresh incision there. It may get dirty. If you have just undergone a bowel resection, please understand that you are on a clear liquid diet for a reason. Do not expect to feel good on post op day #2 if you decided to have Domino's pizza for dinner. Never poke holes in your PCA tubing so your friends can share in the wealth. And if you do, advise your friends that taking iv morphine orally will most certainly lead to "a funny feeling in my mouth" and not to think they are having a stroke and go to ER. I'm very fortunate that these people were around so I could learn from thier mistakes.... where would I be without them????

Patient satting 95% on 50% "vinny" mask. Patient with history of "cabbage" in '07.

We use the GOMER too!! Awwww, here comes Gomer!!! And I had a tech tell me once that our new patient had a serious case of " ****doo " (Fill in stars with the nickname for Richard) Translated to mean "his belly sticks out farther than his (insert term here). And we get patients who have FMPS (fluff my pillow syndrome)

I once overheard a nurse who was in her patients room starting an IV say "CRAP!! Missed again!!! I'm sorry, honey, I'm not a very good nurse." I couldn't believe it!

No. Not all antibiotics are compatible. Infact, most manufacturers recommend that you hang EVERYTHING (all antibiotics) completely seperately. Zosyn (piperacillin) and Vanc are compatible. You are safe there. But don't just assume. Your Pocket guide will come in handy until you get familiar. Mine still hangs around in my locker incase i run up an a med I'm not familiar with!! BTW, backflushing is just taking the piggyback bag down (still attached) and holding it for a moment below the level of the primary bag. The piggyback tube and drip chamber will fill with the primary fluid.

:yeahthat:

I am essentially the only person on my floor who cares about how people spell and pronounce medical terms and medications. I am so glad to see that I have fellow nurses who can't stand when other nurses mispronounce things. There is one nurse on my floor who is absolutely the WORST. She says stats instead of sats (I've called her on it and she still screws it up. Spells Dilaudid "dalotid"- no joke Demerol is spelled "dimeral" according to her. Our pharmacy is at a loss and when she does the medication reconcilliation sheets, the docs can't believe their eyes. I've had a doc ask me to correct it in the computer and reprint it for him. She told me in report the other day that the surgeon, during a LAH-BSO, had sliced through the patients "udder". I was like "Her ureter?" "Whatever you call it." Grrrrr She calls TURP's trips. Prostate is Prostrate. She charted that her patient was on a "Vinny" mask. She does the "Pacifically" thing. She told me my patient had a CIB going. Meaning CBI for continuous bladder irrigation. In her admission history on a patient, she charted that he had a "cabbage" in '07 . There are soooooo many more. I can't think right now.

In my facility, we use both hourly rounding and bedside report. The term "bedside report" can be confusing, so make sure what your facility expects of you. On my floor, we give a complete verbal report and then go around to each room. In the room we do the following: Introduce the oncoming nurse. Visualize the IV site, tubes, drains, or any complicated dressings. Ask if they need anything. (This is where you have to have a backbone and call in your support staff for requests that they can accomodate. If you go fill pitchers and get people to the bathroom, you'll be there all day and the next nurse will get started late) This works... really. It is beneficial in many ways. It lets your patients know that his nurses are communicating. You'd be suprised how many of them think that we don't! If you are oncoming, you can make sure you aren't left with an infiltrated IV or a bone dry bag of fluids, or any other mess, for that matter. And it gives you an opportunity to "lay eyes" on all your patients at the very beginning. We are always taught to "prioritize" care, which is important. Without the walking rounds, most nurses would just go and assess and pass meds to their patients based on their acuity. (ie: my fresh post op bowel resection before my lap chole thats gonna leave today.) With the walking rounds, I still prioritize care, but I can "see" all my patients at the very start of the shift, then go get my stuff together and start my assessments and meds. As far as hourly rounding goes, it is beneficial too. But you need support staff. You can't do it all on your own. My load consists of between 6-9 post op patients. The techs and nurses rotate hourly rounds. We aren't on an "even hour, odd hour" schedule, per say, but we communicate to make sure that someone has rounded that hour. For the most part, our patients enjoy the hourly round EXCEPT at night. I am a huge fan of letting my people rest when I can. There are some patients who can't sleep through someone "peeking" in on them. Some can. The ones who sleep heavy don't mind, obviously, but I have had complaints from those who are light sleepers and have "adjusted" my rounding to accomodate their rest. (I didn't round hourly on them, shhhh)

OK. I totally disagree with this entire response. I know opinions are like buttholes, but I gotta share my on this one. First of all, a low grade temp is common in the first 24 hours post-op. It is your body's natural response to invasive procedures and stress. In my facility, we don't even treat with Tylenol until 100.5. The first temp, I don't treat at all. I monitor it. I don't want to be treating it if it's going to mask a problem. The first one should be left alone. If it creeps up over 101.5, start assessing your basics: are they using the IS, do or did they have a f/c, what does thier urine look like, have they been up yet? And for a temp of 101.5, our docs wanna know. And most of the time, they will order Blood Cultures, UA, CXR, and CBC. Cover the basics. Most post op temps are a body response. As far as the I&O comment in this post, I would hope that you strive to make your I&O accurate. Telling your patients to save their beverage containers and monitoring how many times you fill a pitcher is easy to do. I would also HOPE that you clear your pump. Fluid balance or more importantly IMBALANCE is essential to be aware of. It is a HUGE part of post op care and monitoring. If you are not keeping accurate I&O you are doing your post op patient an injustice. It may not seem all that important, but ask a surgeon. If he's a good doc, he will tell you that he looks at his patients I&O and fluid balance daily. And he would probably not appreciate it if you told him that you "don't bother" clearing your pumps. If he didn't care how much fluid went in, why would he order IVF's???? And LASTLY, there is ALWAYS time for quality care. If there's not, you MAKE it. I take care of 7-10 post op patients 3 nights a week. These are Bowel resections, joint replacements, hysterectomies, heart caths. Serious surgeries, time consuming patients. And I ALWAYS have time to clear my pumps and do an accurate fluid balance assessment.

How about "Advanced Age". No kidding. Had it more than once too. It's kind of like a cover term for "family can't take it anymore, needs NH placement" These people have no acute medical problems, just getting old. Our registration clerks type in diagnoses so we get a lot of interesting spellings and interpretations. I had a guy once whose dx read "growin abcess"- turns out he had an abcess in his "groin" Had a lady admitted with "blocked udder"- she had hydronephrosis from a kidney stone blocked in her "ureter" Had a woman admitted with "a cute lady parts" Of course she actually had acute "angina" Had to have been a type-o. Or a joke. Had a patient get angry once because his dx read "SOB". He thought we were calling him a son-of-a-*****. The diagnosis actually did fit (in more than one way).

It is totally possible (depending on the gauge, the vien, and the site) to obtain blood from a peripheral IV site. Infact, in our ER, the initial labs are usually obtained as the IV is started. Once a site has been established, you need to take several things into consideration before drawing labs from a peripheral site (or even a CVL, for that matter). What fluids are going through the site? If you have K+ in the fluids and you are drawing a metabolic panel, the potassium level can be affected. Similarly, and even more common, PPN can effect the whole metabolic panel, as it is especially notorious for sticking to the walls of the angiocath. Also to consider, what does the site look like?? If the site looks even a LITTLE pink, you could be getting false readings on a blood cluture or even WBC's. Also, consider the gauge of the IV. Smaller gauge IV's can destroy cells in the blood and effect lab values. Lab will usually call you and tell you that the sample is hemolysed. Consider also, the vien. Drawing from a good site can cause the vien to collapse from the backwards pressure and make the site go bad. If the patient has crap-for-veins, the lab may ask you to try and draw from the site. But do you really want to comprimise the IV?? Keep these things in mind... even with blood draws from a CVL!!

This is an issue that every nurse runs into. We all want to be able to spend time with our patients and provide them with the company and conversation that they need. It's part of caring for them wholistically. In a long term care setting, there are so many people who just CRAVE attention and love to talk. It's the same in the hospital setting. BUT, we also know that we have a job to do. I run into this all the time. I have assessments, med passes and treatements on 6 other patients to do, and Mr. B wants to tell you all about his doggies and then his kids and then his cars he likes to work on and then..... The way that I handle this is to get to everyone else first. I still prioritize my care, but I keep in mind the people who will inevitably want to chit-chat and I get to them near the end. If there is something that I absolutely have to get in and do quickly, I enter the room and say something like "I need to hang this antibiotic real quick and then I'll be back to check you over!" That lets them know that I am in a hurry and sometimes (not all the time) they won't get into a big story. They are also aware that I will be back and if I save them until close to last, then I can afford a little extra time. If you have med pass and then treatments, maybe save the "talkers" for last meds and do their treatments with their med pass. ?? I don't know how your facility works but that could be a possibility. Prioritizing care is DRILLED into every nurse's head in school. As long as one of your "talkers" doesn't have something crucial going on, saving them for last will be better for them, you, AND your other patients.

Dr. B, who direct admitted a patient to us and (because we were slammed) offered to bring the patient to the floor herself! Got off the elevator grinning, wheeling the patient to her room. Dr. W, gyn surgeon who calls twice in my shift to check on her patients and make sure we don't need any new orders (I work nights)!!! Always thanks me for taking care of her ladies! Dr. S, also a gyn surgeon who calls to check on her patients in the middle of the night. Every night. Always a thanks and a smile. Dr. SV, who is never impatient, extremely thorough, and is a great teacher to the nurses taking care of her patients. Dr. T, the funny cardiologist who never leaves the floor without trying to make you laugh! (Last week he said he was starting a petition to require nurses to wear hats again! HAHA) Dr. S, who used to be one of the "difficult" ones. Still has his moments, but makes a sincere effort now! Brings bagels to the nurses every Sunday morning!! And finally, Dr. MK, who is TRULY a nurses advocate. He never hesitates to help other docs off their pedestals when they need it! Give the good ones a round of applause!!

I've worked nights for a little over 2 1/2 years as a charge nurse and I can honestly say that I have never caught a nap on my shift. And no one on my floor sleeps either. Unless it's on their break. If they are clocked out, they can do whatever they want! But can you imagine a patient or family member walking up the hall to find snoring nurses and techs at the nurses station? I'd be embarrassed!! A hospital is 24 hours. There is ALWAYS something to do! Clean some equipment, count the pixus, peek in at your patients again, review a chart or two! And if everyone is alseep and your patients are covered, see if another floor needs you to start an IV or do an admit!!

I recently had an amazing experience with a palliative care patient... I am orienting a new nurse to the floor who at this point is ready to be on her own. It was her second to last day so she was doing her thing and I was there for support. She took the entire load of patients so when the ICU wanted to send me a palliative care patient, I took her as my "only patient". I love end of life care and was glad to have the opportunity to be able to devote all of my attention to this patient and her family. It was an 89 year old woman who had come in for an pleural effusion in the rt lung. Her condition on arrival was grave enough that she recieved a chest tube and was sent to the ICU. She was placed on BIPAP where she stayed stable for a week, but with no improvement. On the lady's 90th birthday, the family decided to remove her from the BIPAP. The ICU staff took her off with the family gathered around, but to everyones surprise, she kept breathing on her own... effectively. She required oxygenation but only with a nasal cannula. She was still unresponsive at this point. The decision was made to transfer her to the floor and put her on palliative care. Her transfer orders were for diet as tolerated, (she was unresponsive), NS @ 10cc/hr to KVO for Morphine 2mg hourly as needed, 02@2liters, and q2 turns. The chest tube was put to waterseal and that was that. When they brought her up, I took one look at her and just knew that the transfer from the ICU bed to our bed would be it. Transfers on patients that looked that bad were always it. But she survived the transfer. During our fourth turn of the night, she opened her eyes. I stayed in and did a neurological eval on her. She was not verbally responding to me but she would follow me with her eyes, and could nod her head. The Hospice nurse had already been in to discuss with the family expectations at the end of life so they understood that there is often slight improvement before the final decline. But something felt different to me about this one. I let the rest of the night ride out just taking care of her but not pursuing anything aggressive. When I came back the next night, the nurse reporting to me said "I just don't think this is it for her." I had had that same feeling the night before. I took her as my only one again that night and when I went in to do my assessment, she was in a semi fowlers position and alert, looking around the room. I asked her how her day had been and to my suprise she said "I feel terrible, honey." !!! Granted her speech was VERY garbled and difficult to understand (she had been lying for 10 days with her mouth open and didnt have her teeth in) but I could make it out. I proceeded to talk with her and ask her some neuro check questions and she was oriented. She was a little confused about the dates obviously and a little foggy on EXACTLY what hospital she was in, but was easily oriented!! She told me that it was 2008 and Bush was in office and asked me if she had had a stroke!! I was flabberghasted at this level of improvement. The family had no idea what to think. They couldn't understand her speech so I had to interpret. Everything she said was so appropriate and she even joked around and told me stories about her late husband and their gardens and her baking pies... just 100% oriented and I was amazed! I sat in there all night. She was stiff so I exercised her legs and she expressed an interest in her daughters ice cream. She ate a half cup of that. Drank some water. Then wanted some Pepsi. I just couldn't believe what I was seeing. We tried to get her teeth in so we could understand her better but her mouth was so dried out and they wouldnt stay in place. She was able to voice things that made her uncomfortable, tell us that she didn't want so much Morphine. I was so excited to be able to pamper her that night and spend so much time with her and the family. Closer to morning, she told me to go to her house and get her tan shoes ("they are the only ones that fit right") and her rolling walker because she wanted to walk!!! Keep in mind, ALL we are doing for this woman is 10cc of saline per hour and iv morphine. Better bet after that night I was on the phone with the docs getting her fluids increased, getting the surgeon who put the chest tube in back on her case, getting things ordered to support her if she was gonna turn her bus around and head back our way! As I left that morning, she was sitting up in bed eating cream of wheat and thickened OJ. I told her that I was going to be off a few days (going on a weekend trip) and she squeezed my hand tight and said "Thank you, precious, for taking such good care of me." I teared up like a baby, but I had spent a LOT of time with her. And I figured that when I got back to work that case management would have already had her home. She teared up, the daughter teared up... It was so touching... When I got back from my trip I dropped in to see if she was still there. She was. I walked back in the room and she had her little rolling walker and was sitting in the chair in her tan shoes eatin oatmeal. Her face lit up like Christmas. She had her teeth in and talked as plain as you or me. Chest tube was gone, she was on po pain meds and she was headed home that day!!!! To me, that situation was miraculous. To be a part of it and have a hand in it was just amazing. Things like this are unforgettable and they make you realize why you do what you do.:redbeathe

thanks for correcting me. i know that in kentucky, an lpn cannot administer a blood transfusion. but you are right, i didn't think about it varying from state to state. thanks again!

Wow. I take care of a lot of abdominal surgeries and this sounds awful. You can remove staples as a nurse, but you best believe on something like that, I would have done the same thing! Don't you love these "Godly" physicians and thier attitude problems!?! Must've felt good to know that when he got the call that his pt dehisced, he thought "she was right" somewhere in his subconcious??

I've never seen one in a Carotid either... Makes you wonder if he even looked at the fluids as he hooked em up. And how could he not know that it was in the artery??? It had to spurt blood! I hate assisting with those things cause sometimes I just wanna reach in and do it myself!

I also had an amazing experience recently. I am orienting a new nurse to the floor who at this point is ready to be on her own. It was her second to last day so she was doing her thing and I was there for support. She took the entire load of patients so when the ICU wanted to send me a palliative care patient, I took her as my "only patient". I love end of life care and was glad to have the opportunity to be able to devote all of my attention to this patient and her family. It was an 89 year old woman who had come in for an pleural effusion in the rt lung. Her condition on arrival was grave enough that she recieved a chest tube and was sent to the ICU. She was placed on BIPAP where she stayed stable for a week, but with no improvement. On the lady's 90th birthday, the family decided to remove her from the BIPAP. The ICU staff took her off with the family gathered around, but to everyones surprise, she kept breathing on her own... effectively. She required oxygenation but only with a nasal cannula. She was still unresponsive at this point. The decision was made to transfer her to the floor and put her on palliative care. Her transfer orders were for diet as tolerated, (she was unresponsive), NS @ 10cc/hr to KVO for Morphine 2mg hourly as needed, 02@2liters, and q2 turns. The chest tube was put to waterseal and that was that. When they brought her up, I took one look at her and just knew that the transfer from the ICU bed to our bed would be it. Transfers on patients that looked that bad were always it. But she survived the transfer. During our fourth turn of the night, she opened her eyes. I stayed in and did a neurological eval on her. She was not verbally responding to me but she would follow me with her eyes, and could nod her head. The Hospice nurse had already been in to discuss with the family expectations at the end of life so they understood that there is often slight improvement before the final decline. But something felt different to me about this one. I let the rest of the night ride out just taking care of her but not pursuing anything aggressive. When I came back the next night, the nurse reporting to me said "I just don't think this is it for her." I had had that same feeling the night before. I took her as my only one again that night and when I went in to do my assessment, she was in a semi fowlers position and alert, looking around the room. I asked her how her day had been and to my suprise she said "I feel terrible, honey." !!! Granted her speech was VERY garbled and difficult to understand (she had been lying for 10 days with her mouth open and didnt have her teeth in) but I could make it out. I proceeded to talk with her and ask her some neuro check questions and she was oriented. She was a little confused about the dates obviously and a little foggy on EXACTLY what hospital she was in, but was easily oriented!! She told me that it was 2008 and Bush was in office and asked me if she had had a stroke!! I was flabberghasted at this level of improvement. The family had no idea what to think. They couldn't understand her speech so I had to interpret. Everything she said was so appropriate and she even joked around and told me stories about her late husband and their gardens and her baking pies... just 100% oriented and I was amazed! I sat in there all night. She was stiff so I exercised her legs and she expressed an interest in her daughters ice cream. She ate a half cup of that. Drank some water. Then wanted some Pepsi. I just couldn't believe what I was seeing. We tried to get her teeth in so we could understand her better but her mouth was so dried out and they wouldnt stay in place. She was able to voice things that made her uncomfortable, tell us that she didn't want so much Morphine. I was so excited to be able to pamper her that night and spend so much time with her and the family. Closer to morning, she told me to go to her house and get her tan shoes ("they are the only ones that fit right") and her rolling walker because she wanted to walk!!! Keep in mind, ALL we are doind for this woman is 10cc of saline per hour and iv morphine. Better bet after that night I was on the phone with the docs getting her fluids increased, getting the surgeon who put the chest tube in back on her case, getting things ordered to support her if she was gonna turn her bus around and head back our way! As I left that morning, she was sitting up in bed eating cream of wheat and thickened OJ. I told her that I was going to be off a few days (going on a weekend trip) and she squeezed my hand tight and said "Thank you, precious, for taking such good care of me." I teared up like a baby, but I had spent a LOT of time with her. And I figured that when I got back to work that case management would have already had her home. She teared up, the daughter teared up... It was so touching... When I got back from my trip I dropped in to see if she was still there. She was. I walked back in the room and she had her little rolling walker and was sitting in the chair in her tan shoes eatin oatmeal. Her face lit up like Christmas. She had her teeth in and talked as plain as you or me. Chest tube was gone, she was on po pain meds and she was headed home that day!!!! To me, that situation was miraculous. To be a part of it and have a hand in it was just amazing. Things like this are unforgettable and they make you realize why you do what you do.:redbeathe

Your profile information says that you are an RN. As an LPN, I know you are not authorized to handle blood transfusions, so I can see why you wouldn't be able to obtain a consent for one. But unless is it just a facility policy wherever you work, an RN is legally authorized (at least in my state) to obtain and witness consents for most all procedures. As an RN in my facility, we are responsible for obtaining consents for blood transfusions. That includes educating the patient on the procedure and obtaining a signature. As far as surgical consents, we are responsible for obtaining the signature, but the MD initiates the education and explanation beforehand.