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brillohead ADN, RN

Cardio-Pulmonary; Med-Surg; Private Duty
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brillohead has 5 years experience as a ADN, RN and specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

changed careers at mid-life

brillohead's Latest Activity

  1. brillohead

    Concerned

    This is a big deal and a contributing factor in a lot of cases like this. If I walk out of a patient's room and ask an aide to toilet that patient, get them fresh water, get a set of vitals, or whatever, I make a point of saying what I'm going to be doing instead that prevents me from doing the task myself -- I need to get meds for someone, I have to page the doc for an order, I have to check that beeping IV pump down the hall.... things that need to be done by an RN, so the delegation of the other task is understandable. And oftentimes it's "can you get her an ice water so I can go get that call light" -- both things that can be done by either an aide or an RN, so one of us does one and one of us does the other. Drawing attention to the collaboration helps with awareness.
  2. brillohead

    Anyone Else have to Sub in classrooms??

    I'd be interested in hearing how much they pay a substitute teacher for a day of work, and if they're going to cut you a check for that amount for the two days you've already worked as a sub. ???
  3. The initial encounter was on him and has already been handled. The OP has her own issues about being around the dude, and that's on her to fix. If she wants him to just never be near her or talk to her unless it's strictly about work related issues, then she needs to tell him that. (Send him an email if you're too scared to talk to his face.) He doesn't know that talking to you is too traumatic for you unless you tell him that -- you can't just assume that he knows to not talk to you at all, nor can you accuse him of being a sexual predator for talking to you at the nursing station. You have to actually tell him. I would also recommend more therapy, as it appears there are still issues causing the OP stress / anxiety.
  4. brillohead

    La la la la... I can't hear you

    I don't see the big problem with OTC meds and older kids. I used to self-carry OTC meds back in high school (in the 80s) all the time. I was driving a car, working a job, and I paid for them at the store with my own money. I didn't give them to anyone else, but even if I had, I would have said, "it's Tylenol" or "it's Motrin".... one would expect a high schooler with a known allergy would have known what they can and cannot take. Incidentally, Michigan doesn't have school nurses typically, and we don't have standing orders for OTC meds. It's very much a fend-for-yourself environment for school kids here. (I totally agree with not administering even an OTC without an order, though -- that's the same as at the hospital.)
  5. brillohead

    Notarization Question

    If she has a bank account (or credit union account), most financial institutions will notarize paperwork for free (provided it's not 100 pages or something -- a single sheet of paper is fine). I used to be a notary public in the state of Michigan in my pre-nursing life, and I think the state capped the fee at $6.00. It's not an expensive thing, even if you do have to pay for it (like at city hall or a courthouse).
  6. brillohead

    A nurse with a difficult name??

    My hospital will let you put your nickname on your badge (provided it's not obscene!) instead of your legal name. One coworker named Richard is Rick, another coworker named Richard is Calvin. My mother had a good friend from childhood who went by "Tootie"... I knew this woman for several decades and never did know her legal name.
  7. brillohead

    What would you do?

    There HAS to be a compliance officer somewhere in your organization. Contact Risk Management if you don't know how to contact the compliance officer. From: What are the Duties of a HIPAA Compliance Officer
  8. brillohead

    Cna incident investigation

    Here's something I haven't seen addressed yet: Is it the facility's policy that all patients are a two-person transfer? Or was this particular patient listed as requiring two people? Because the sit-to-stand lift (or whatever-you-want-to-call-it) is typically meant to be used by just one person, unless there are extenuating circumstances. It is also meant to be used only by patients who can support their weight while standing on the lift, unlike a Hoyer-type sling lift for people who aren't able to stand reliably. If the patient is normally transferred with just one person, if the patient is normally able to transfer with just one person assisting, if the facility policy is for the sit-to-stand to be operated by only one person, and if you weren't actively training/precepting the other aide, then there is no reason for you to be there, so taking your break mid-transfer would not be a problem. But if the policy states that two people must be there for all lift usage, or if you were training the person and abandoned them mid-transfer, or if the patient normally needs two people for a transfer, then that is on you for leaving mid-transfer. We weren't there, we don't know the patient, we don't know your facility, and we don't know your state's certifying authority, so we can't answer as to what is going to happen to you. But your level of "fault" in the whole thing depends on your facility's policies (two for a lift?), your patient's known history (one or two people for transfers), and your status (training/precepting?) with to the other aide.
  9. brillohead

    Do CRNAs also tangle lines!?

    I'm a lowly floor nurse (although I also float to PCU/CCU several times a year) and I have Line-OCD issues, too!
  10. brillohead

    What happens when you fail a fit test?

    Am I crazy for PREFERRING the PAPR helmet/mask? Our rooms are always hot, and our isolation gowns are basically a Hefty garbage bag (not the ones with a more paper/cloth feel that breathe a bit), so I prefer the air movement that you get with wearing a PAPR -- it helps dry the sweat on my face! FWIW, my hospital did away with N95s entirely. Everyone just wears a PAPR.
  11. brillohead

    Mistake on orientation..please help

    They way our Epic is set up, if the nurse moves a single dose, other scheduled doses won't be retimed accordingly, no matter what the order says. If ALL subsequent doses need to be changed, we have to send a message to pharmacy (by clicking the message button on the associated med in the MAR) asking them to adjust the times, and telling them what we need the times adjusted to. If someone has daily/maintenance meds, we have set times that those are automatically scheduled for in our system. If I don't give someone their 0600 Protonix because they are NPO for a procedure, I can move (one time) that dose to 1100 when they'll be back from their stress test/EGD/whatever, and the next day's dose will still show as due at 0600 on the MAR. However, if the patient is a night owl like me and will never wake before 1100, I can message the pharmacy to adjust the entire dosing schedule to always have Protonix due at 1100. That's the difference between "moving" a med or "adjusting times" on a med in our Epic. Similarly, most people take their "once a day" meds in the morning, so our system automatically schedules "daily" meds to be given at 0830 (other than things like Protonix or Synthroid that they prefer to give on an empty stomach -- those are 0600 meds). Some patients take their daily meds at dinnertime or bedtime or lunchtime or whatever. If I just moved the patient's dose to from 0830 to 1200, that's only going to move today's dose. If I want them all rescheduled for noon going forward, I have to message pharmacy and let them know to adjust the time accordingly. Related but a bit different, I had a patient with Lasix ordered Q8H, and our system scheduled it for 0600, 1400, and 2200... when the heck was the patient supposed to get any sleep??? First I had to get the doctor to change the order to TID, then I had to send pharmacy a message asking them to time the med for 0600, 1200, and 1800. Pharmacy could change the times -- but not the time between doses -- because it was ordered Q8H, but with it changed to TID that gave them some leeway to do three Q6H doses and then nothing for 12 hours. This is one of those common sense things... obviously it's not reasonable to give three doses of Lasix an hour apart from each other (makes my kidneys hurt to even think of it!), but spreading them six hours apart and then letting the patient sleep overnight is totally reasonable. If it's something that has a standard/typical time it would be given (like our BID Lasix is automatically 0600 and 1800), sometimes you just need to finagle things a bit on admission day or the first day a new med is ordered to even things out (common sense-wise) until they line up with the regular dosing system the next day. I work nights and I'm a big believer in sleep hygiene, so I'll sometimes spread-out or squeeze-in some doses in order to consolidate med passes and reduce the number of times a patient is woken up. I had a patient last night with 2030 regular HS meds, 2100 Neurontin, and 2200 heparin (our normal heparin time), then 0500 Neurontin and 0600 heparin (our standard heparin time). Needless to say, she got all the evening meds together, and in the morning she got the Neurontin and heparin together. Had she not been discharging, I would have sent a message to pharmacy to change the Neurontin to the same time as the heparin for every subsequent dose -- it just makes sense. So in the future, if something needs to be totally readjusted for all future doses, make sure your preceptor shows you how to do that in your MAR. But I still don't think you need to be stressing over this, and there is NO way that you caused the other nurse to give TWO doses Q6H -- only ONE would have been off, and every dose after that one would have been Q8H already on the MAR.
  12. brillohead

    Foley Catheter Issue?

    Ditto on the "might not have been inserted far enough" comment. Getting urine return isn't enough -- insert even farther, to make sure the balloon is fully inside the bladder before inflating. After inflating, give a gentle tug to seat the balloon at the urethral opening in the bladder. When you feel that resistance on the tug, you know that the balloon is seated.
  13. brillohead

    Seizure code blue

    I'm on the cardio-pulmonary floor, and outside of Critical Care (obviously), our unit has the most Code Blue situations. When we hear a code called, one employee down each hall (we are shaped like a T with three halls) will stay on that hall to answer call lights, bed alarms, etc., and all others will descend upon the room with the code. Sometimes the aide goes to help, sometimes the nurses go to help -- it kind of depends on what's going on with the patients in that hall and who is working in that hall. I'll usually holler out something like, "Nurse Betty, you stay here and keep an eye on the hall, Aide John and I will go help!" If the code is on the same hall I'm working on, everyone reports until more help shows up -- then a nurse or aide goes back to keeping an eye on the rest of the hall while everyone else deals with the code. If the primary nurse is doing compressions when I arrive, I kick her off the chest so she can open up the chart, answer questions for the code team when they get there, call the family, etc. If the code team has arrived and there are enough people to rotate out compressions, I try to catch the primary nurse's eye and ask her what she needs me to do for her other patients. There is no excuse for the rest of your unit's staff to not have been in the room with you within seconds of the code being called overhead (and even sooner, really -- a simple "HELP!" should have brought them running). And you did everything right -- good save!
  14. brillohead

    Mistake on orientation..please help

    How did she give TWO doses Q6????
  15. brillohead

    Good Writing Skills Are Essential

    Fixed that for you.
  16. brillohead

    Prefer being up all night even when not working?

    I'm reading and responding to this at 00:54. Totally normal for me. I also recently started the first of my three loads of laundry, will be washing / drying / folding on and off all evening. Totally normal for me.
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