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staff / charge RN in a teaching hospital - I work

Content by Altra

  1. Altra

    New Charge Nurse

    Childish, at the very least. If you ask me to change an assignment, the reason better be related to the patient and/or family.
  2. Altra


    Health care is a highly regulated industry, and its administration is highly political. HouTx has excellent suggestions above about the nitty gritty actual work of the political process. Some homework for you: do legislatively-mandated staffing ratios necessarily have to be state-by-state, or are there proposed federal bills that aim to do just that?
  3. Altra

    Nurse Creates The Mother Lode of All Advance Directives.

    Great satire ... if only!
  4. Altra

    "My Nurses"

    Too much being made of nothing. I thought about this for a minute, and can name people in all roles up and down the payscale in my department who use this phrasing: when the unit clerk calls us "my nurses" ... when we refer to "our residents" ... etc. It speaks to the underlying team culture.
  5. Proud 21st century diploma grad here. I have since completed my BSN.
  6. Altra

    Best one sentence handoff report

    Awesome. Thanks for reviving a great thread.
  7. Altra

    Dedicated Trauma Nurses in the ED

    I have followed this thread with interest. The 2 Level I trauma centers where I have worked both have a dedicated trauma assignment every shift ... but this assignment is rotated among all department RNs who have been in the dept. > 1 year. I believe that setting up the trauma RN as a separate job title would cause significant animosity where I work. Non-trauma ED staff may well resent that they too maintain all competencies, but are designated as the "B team". I would also foresee jockeying for the "better" of 2 simultaneous traumas: "you take the routine unrestrained MVA with questionable loss of consciousness ... I'll take the GSW to the chest". And if I am reading the proposal correctly, these trauma RNs will float throughout the dept. when possible, but will not ever slog their way through 12 hours of abdominal pain or vag bleeding. Pretty sweet!
  8. Altra

    New Rule: No work bags allowed in ER

    It's totally not for me to dictate what size bag someone brings to/from work ... but I'm having a hard time picturing "educational resources" that I would be responsible to lug back & forth with me every day. References on gtts & IV meds? Should be easily, quickly accessible in either binder or electronic form. Educational materials? If there are references that are considered the "gold standard" in line with your policies ... shouldn't they be accessible to all? Eye charts?? Is this ED not equipped with a Snellen chart? Leaving personal belongings in a group work environment is a recipe for a mishap.
  9. Altra

    Reason for IV fluids

    Are these fluids being ordered after labs have been resulted? The above responses have given a variety of reasons why fluids might be given during a work up, until we have lab evidence of a lack of anything actually clinically wrong with the patient. But if fluids are being ordered after lab results ... I'm inclined to think this is more about a customer-service driven desire to appear to have "done something". And apparently your management is ok with the resulting drag on throughput times.
  10. Altra

    Why white shoes?

    Ruby Vee makes an important point above - the standing for long periods of time is what will dictate your shoe choice in the long run. The floors of hospitals and other care facilities are typically some kind of tile over a concrete subfloor - it's just the way large buildings are constructed, and it can be very hard on the body over time. White is simply traditional in the US. Some schools require it, some do not. I would bet money that whatever shoes you wear while in nursing school are unlikely to be worn for more than a few months into your nursing career anyway.
  11. Altra

    leaving clinic with Patients still in exam rooms?

    OP has given some indication that some of her clinic's patients have been at the hospital for other appointments by the time they arrive at her particular clinic to be seen. I also work at a large tertiary care hospital with virtually every specialty and subspecialty represented in our attached professional office buildings. Overall, the patient population trends toward the elderly and those with multiple comorbidities. During the week -- daily, yes, daily, we get ER patients who initially arrived somewhere on the hospital campus but are now in the ER with syncope, near syncope, generalized weakness ... etc. Not to mention those wheeled down from whatever outpatient office because they "arrived looking like s**t and will probably need to be admitted". So I can definitely visualize the issue that the OP raises. Many patients have transportation issues as well. I can easily picture a scenario in which patient goes to Internal Med clinic but mentions that they have not followed up with Opthamology Surgeon clinic since their procedure and Internal Med staff try to facilitate the patient seeing Opthamology "while they're here in the building" ... and Opthamology agreeing to squeeze the patient in later in the afternoon. Nothing like 4+ hours of shuttling around different clinic offices and diagnostic departments to tax an elderly, infirm patient ... Just saying -- many patients receiving care in outpatient settings do not exactly resemble those smiling, energetic folks pictured in my hospital system's advertising ... But back to the OP ... you've gotten some great info here which hopefully helps alleviate your concerns about responsibility for your patients once they leave your clinic. To improve further discussion, please help us understand exactly what is occurring, and steps you and others have taken / are taking. Thank you.
  12. Altra

    leaving clinic with Patients still in exam rooms?

    OP, it has been hard to follow some of your posts. Are you saying that: 1. You have been the staff member to raise concern about medically fragile patients in your clinic? 2. Clinic management is re-evaluating the practice of providers continuing to see patients late in the day without nurses present? 3. This re-evaluation has been ongoing for the last month but no formal decisions have yet been made? We don't work where you do, OP. Help us out - fill in the blanks. It will make for better discussion.
  13. So, this means that you have read detailed case studies of these nurses, including their social histories and been able to conclude that on the job exposure, of which they do not have a clear memory, is the most likely source of their infection? Some reading for you: http://www.cdc.gov/hiv/resources/factsheets/pdf/hcw.pdf Of note -- no cases of HIV transmission to healthcare workers have been documented in the US since 1999.
  14. Altra

    leaving clinic with Patients still in exam rooms?

    We must be reading the OP differently, because I am not sensing this kind of self-aggrandizement in the OP's posts. What I am reading, is a disproportionate worry about leaving the clinic at the end of the workday when there are still patients being seen. IMO, in an effort to explain her discomfort with this practice, OP has offered up a number of increasingly unlikely "what if" scenarios to justify her worry. Bottom line OP -- you now work in an outpatient setting. If you believe a patient is at risk of a medical emergency, you, one of your providers, or anyone else in the outpatient setting bears the same one responsibility -- to activate emergency response. That's it. I suggest the following: 1. OP should clarify expectations of her work schedule 2. OP should ask for clarification of the clinic's operations regarding division of duties for nurses and providers 3. OP should ask a preceptor, charge nurse, manager, etc. for some advice and perspective on outpatient care vs. inpatient care, and the differences between them.
  15. Altra

    leaving clinic with Patients still in exam rooms?

    Understood. You are correct that medical response to those occurrences is the responsibility of the hospital, if the individuals are on hospital property at the time. However, do not infer that to mean that the clinic, or you personally, are responsible. The medical response team will do their job and respond and obtain the appropriate continuing care for the patient. I sense some worry on your posts that it will be judged that you personally somehow failed to rescue a patient ... and I think that is a big, big stretch for an outpatient opthamology clinic that may not even obtain vitals in the course of a typical office visit.
  16. Altra

    Psychiatric emergency nursing

    I have worked in hospitals that had a separate "psych ER". In one, it was organizationally a sub-unit of the emergency department. In the other, it was a program operating under the psychiatry service. So I don't necessarily see a bait & switch, although it is something to consider. Both of these were staffed with RNs who assessed and reported findings to a psych provider, provided ongoing monitoring and reassessment, and implemented orders as needed. In one, insurance auths/bed searches were also completed by the RN ... in the other, there was a social worker who handled those functions.
  17. Altra

    leaving clinic with Patients still in exam rooms?

    Agree ... and I also suspect it is a metaphor for the frail condition/restricted mobility of many of the patients in OP's clinic.
  18. Altra

    leaving clinic with Patients still in exam rooms?

    Though the OP may not have articulated her concerns well ... I suspect she is referring to the hospital/healthcare organization as a whole.
  19. Altra

    leaving clinic with Patients still in exam rooms?

    I hesitated before replying, thinking that my reply was coming from my own assumptions. But truth be told, many other responders have also interjected a whole host of assumptions here as well. Don't most of us see patients, in any setting, who are frail, with multiple comorbidities, often accompanied by a spouse who doesn't seem to be in much better shape? Who make us wonder, how in the heck are these people managing at home? Who raise our BP every time they attempt to transfer or ambulate? Who, although they do ambulate independently in their smaller home setting, are overwhelmed by navigating a larger environment like a giant parking lot/garage -- hospital layout -- clinic location? I doubt I'm the only one who works on a hospital campus that can take 15 solid minutes to navigate, even walking at a good clip that qualifies as a cardio workout warmup. OP's references to diabetic patients and surgical patients leave me picturing an older, higher-acuity patient population. Not the family visiting for their annual eye exam and picking out cool new frames. Having said all that ... OP, I am aware of clinic providers who see patients without support staff. They check patients in, obtain vitals, update histories, etc. Some nurses with clinic experience have responded here that their workplaces operate like this, at least for the later part of some workdays. Hopefully this gives you some reassurance. I am aware that the chain of command in clinic settings can be a bit muddy, with nonclinical administrative management mixed in with clinical leadership. But I'm confident you can ask your question of a charge nurse/provider/etc. ... and get some clarification on expectations. I would suggest making your question as specific as possible: "Provider X has appointments through 7pm on Wednesdays. Are you looking for me to stay until those appointments are completed on Wednesdays? If so, I can plan on that for scheduling purposes." If you get clarification that the clinic providers are fine operating without nursing or support staff for the later part of their day and that is the way the clinic operates ... I would not worry that that there is any risk to you as a nurse.
  20. Altra

    Heat stroke & DIC????

    Dehydration & rhabdomyolysis --> multi-organ failure.
  21. Altra

    Possible attendance write-up

    OP had apparently accumulated enough prior points for calling out/being late that the points for the "no call no show" on the class day triggered some corrective action.
  22. Altra

    Blue hair

    Agree with the others - check your dress code policy first. But if the policy does not prohibit any colors ... inexpensive clip on hair pieces or extensions would be a good way to try it out before committing. Temporary hair washes can be OK for a costume kind of thing or to try at home on a weekend, but they tend to bleed onto clothing and skin and probably would not be workable for "real life". If you currently dye your hair to cover gray, etc. ... the transition to a bright color becomes more complicated, as the current dye must be stripped out of the hair, and then the desired color applied. I really wanted some pink streaks in my hair, but my hairdresser steered me away from the process. I love, LOVE those pictures from BuzzFeed!
  23. Altra

    Mr.Pubes the excessive hair patient

    I work prn in a MICU - land of c.diff, tube-feed and liver-failure related diarrhea, and never-ending secretions around ETTs and trachs. For brevity, I will side-step all the ethical reasons not to alter a patient's appearance and focus on the nursing practices and skills involved here. Even dried secretions or fecal matter can be dealt with by use of sufficient water. Saturate the area, then change the linen. Ridiculous "wipe" products encouraged by some facilities do not clean. If you are tugging on hair to clean - you're not using enough water to soak the area. And while it is sometimes a good idea to consider hair clipping in the context of tape adherence and eventual removal -- if you can't feel a vein because of a hairy arm, you're not nearly as skilled as you may think you are.
  24. Altra

    Army medic to RN

    I have worked with several people who were military medics and transitioned to civilian nursing. Some suggestions: Research schools in your desired area, and apply to several. Many have wait lists, so the path may take longer than you originally hope for. Have a plan for employment until you are in nursing school full-time ... and maybe even something that you can continue on a very part-time or casual basis once you start school. Do you plan to explore the possibility of continuing to work in EMS as a civilian? Find out what the requirements would be in your state - if your military experience would allow certification, or if you would have to complete an educational program. Good luck to you, and thank you for your service. :)
  25. Altra

    Will I become a bad nurse? How should I change?

    First, a general comment. Life is too short to go through it being pissed off much of the time. You only have a finite amount of energy - if it's all negative, this narrows and limits your perspective tremendously. You might consider how this impacts your life, regardless of your career choice. Secondly, what draws you to nursing? You have enough self-awareness to recognize that interpersonal skills and managing stress are not currently strengths of yours, and yet you intend to pursue a high-stress field that requires both emotional maturity and above-average people skills. Seems like there is a disconnect there ...