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smk1 LPN

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mother, wife and student

smk1's Latest Activity

  1. smk1

    Non-blood products for raising hemoglobin

    Check your BON because this policy may be against the law. Blood is still and informed consent procedure and in my state requires the provider to explain the procedure and risks and obtain consent. People were getting lax about this policy in my area and we had a timely reminder about the legalities of it. In any case, the bloodless medicine centers are great resources. EPO would take time to work and if you haven't stopped the bleed anyway is not going to do a whole lot.
  2. smk1

    Visitors are OUT OF CONTROL!!!

    We have visitors who are constantly walking into the nurses station and it bugs me to no end. No one walks behind the counter at a bank or a gorcery store, it is the same principle. THere is sensitive information in the nursing station and you have no business coming in there. Also I am happy to get you (the visitor) a cup of coffee when I have the time, but constant refills, warm blankets and extra pillows with snacks starts to be a bit much. If I can only find a couple of extra folding chairs, then I am sorry that is all I have. I don't have a half an hour to run around searching high and low for that sort of thing. 20 people don't need to be holding a party in a room with a sick patient at midnight anyway. I also can't keep reheating all of your KFC and pizza hut food because you want to snack on it every 45 minutes. Enough is enough!
  3. Don't be afraid to say you don't know something. I told my manager how thankful I was to have internet access at work, because their have been quite a few times where I receive a patient who is having a procedure that I know nothing about and need to read a quick excerpt to see where I need to focus my attention, or how to explain something to the patient if they have questions.
  4. smk1

    What didn't they teach you?

    Basic understanding of how to talk to providers. We never took orders in NS so we were out of the loop in that arena. The first time I called a doc when I started my job a few months ago, I was SOOO nervous, and he just wanted me to tell him what I wanted. So always have a recommendation in mind, and then learn that with some providers you will have to be a bit assertive because they do not look over their labs or imaging results (shocking I know), and infiltrates, low potassium, etc... will be missed if you aren't very thorough. Try to look through your chart and organize your issues on a piece of paper with vitals before you call so that you aren't calling every 10 minutes. Bundle your calls to the extent possible. A blood pressure of 88/58 is not always a cause to panic! Assess your patient first, look at the trends.
  5. smk1

    Er Nurses

    I'm a clinical decision unit nurse so I kind of fall in the middle of the ER and the floors. Can kind of see both sides. From the perspective of someone who admits patients from the ER in large volumes nightly, I can say that it is a huge benefit if you can get the actual nurse who took care of the patient to give you report. It isn't always possible, but a LOT of potential problems can be nipped in the bud before they blossom into a full scale issue simply by having this communication. At the same time if I am in the middle of admitting 2-3 patients in the last hour I may not be able to take the next report when the nurse calls, and I get that she is busy and if that means that now someone else will have to give report when I call her back, then I have to deal with it and ask more questions to get the info I need for safe patient care. 99% of the patients come up with an AC iv start. I can deal with that because I understand why, what I do not get is the nurse who doesn't put and adapter on the EMS IV start so that it is compatible with our needleless luerlock devices. Yeah I can do it upstairs, and I am one who always flushes IV sites during assessment to make sure they work, but it frustrates me to no end that others do not. Not good nursing practice. Also don't question me if I say that the unit is full. I am not lying to you, feel free to come up and look if you like. (this last rant is mainly for doctors who think they are the only ones admitting patients to the unit, and can't understand why we have no available beds if they have only admitted 2 patients so far.)
  6. smk1

    Nursing Misconceptions

    Here is another example of the system setting you up by promising the world, but not providing the resources to deliver. We have one pharmacist that works in the central inpatient pharmacy at night for the whole hospital. ONE! so when I send down orders on my new admit it can take quite awhile for these orders to arrive in the pyxis and computer system for me to sign off. When I am admitting a patient I am supposed to talk about their "rights" some of which are to have their pain treated adequately and their medications delivered in a safe and timely manner. How timely is it when a patient arrived at 11 pm and the medication orders do not show up until 2 am? Now I can override certain things such as certain amounts of dilaudid/morphine or acetaminophen, but not Toradol or oral ibuprofen and other meds or many of the antiemetics (i can override zofran but not anything else). But a patient who wants to get their regularly scheduled medications that they have not taken yet today before they go to sleep could be waiting hours for that to happen, depending on how busy the pharmacy is. Now this isn't my fault but because all the other departments are the "unseen" machinery that makes a hospital run, when they aren't able to get the job done in a timely manner, be it housekeeping, dietary, pharmacy etc..., it reflects on nursing because we are the staff members that coordinate the care of the patient. It's not my fault ,but it reflects negatively on my practice. Not a fun aspect of the job.
  7. smk1

    Nursing Misconceptions

    Perhaps I have missed something, but I don't see anyone stating that they don't make an effort, are not polite and do not smile. These are things that we are in control of and probably the vast majority of us do with regularity. However if I am running interference between a patient with runs of v-tach and another with symptomatic SVT, I cannot immediately drop what I am doing to get fresh water for your flowers or grab another blanket out of the warmer because the one I got you 20 minutes ago is no longer toasty. Doesn't mean that I wouldn't like to to those things, it means that I simply don't have the extra time to do those things at the moment, now if we had a CNA or tech or "concierge" services (meaning not a nurse) then perhaps that could be done ASAP. But, we aren't staffed for that. This is the problem.
  8. smk1

    Nursing Misconceptions

    The problem is when they promise the moon and create a phony sense of what the patient can expect and fail to pay for the staff to deliver on those promises. What good is a beautiful rose garden on a terrace if the patient in room 2 requires someone to take her in a wheelchair out to see it and no one is ever available to do it? What good is "telling" someone they have round the clock room service when the staff aren't provided to actually accomodate these promises? I have excellent customer service skills, I am new, bright eyed and busy tailed and gung ho, ready to make a difference... and even I can tell that the promises made are pretty empty.
  9. smk1

    Nursing Misconceptions

    The biggest misconception seems to be the ones that the hospitals themselves promote. The hospital decorates the place like a hotel, we have valet parking, everything is about customer service, we are supposed to write down patient requests and wishes for their care and follow it etc... Now the hospital does not staff for this in any way. so if I have a 5 patient load and the pampered lady down in room 1 is on the call light for someone to adjust her pillows and get her coffee and find a way to take away any scrap of discomfort she is having while in the hospital, I don't have time to deal with her requests when room 2 is having pain, room 3 is have runs of SVT, and room 4 is nauseated.
  10. smk1

    Do Nurses Eat Their Young?

    What I have found is that when you are "eaten" you knw it for sure. There are no doubts because the behavior is that astoundingly inappropriate. For me at least these experiences (to this point) have been few and far between. There was a CNA who did it when I was a first quarter nursing student, a labor and delivery nurse when I was a 3rd quarter student, and a nurse who did it when I was a 4th quarter student. Now there have been others who were sarcastic or testy at times but they didn't "eat me". The ones who were truly disgusting in word and action are ones I can remember clearly, I remember their faces and their voices. Everyone has a bad day, can get irritable and be less than helpful at times. This is not "eating the young". Eating the young is someone who goes out of their way to purposefully degrade you or make you look bad, or try to get you booted from a program or fired from a job, or takes pleasure in planning an assignment for you in which they know you are doomed to fail in from the start.
  11. smk1

    Do Nurses Eat Their Young?

    Some people are also overly sensitive. I have been nitpicked about stuff as ridiculous as what side of the bed I put an extra chair on or the side table etc... Yeah it s annoying, but it is not exactly "eating the young". If all you get is nonsense like that then yeah, it will wear you down, but some stuff has to be able to slide off of your back.
  12. smk1

    Washington/Oregon Wages vs California

    Depends on your experience. I am a new grad and started at 27.50 plus night shift differential. I live and work in a suburb of Portland. Cost of living is much lower than in California, so all things considered you might be fine even with what seems like a steep pay cut.
  13. smk1

    Interviewer asked about my GPA

    no one asked about my GPA, but I am sure that they knew it because it was on my resume. I had two interviews and was offered both jobs a couple of days after passing NCLEX. GPA means something otherwise every class would just be pass/fail, but it is not "everything". But the lesson should be not to have the C=RN mentality if you can avoid it. If you can do better, then strive to do so, if not, then you know you have done the best that you can and most people will not fault you for that.
  14. smk1

    Tough time with senior co-worker

    Even if there are two sides to a story, this story is the OP's to tell and she has a right to vent. There are numerous threads about inexperienced nurses that have a negative tone just as there are threads about experienced nurses.
  15. smk1

    Do nurses get mad when..

    When it negatively impacts my ability to care for the patient then yes! Loud talking! Different people coming out to the nurses station to ask me questions every 10 minutes. Demanding juice and food for the little ones. Not being willing to find their way back downstairs to their cars so I have to walk numerous people out to the elevators multiple times when I am trying to work. Making me go and fetch 10 folding chairs so the whole brood can get comfy is ridiculous too. Not moving when they are in the way of my beeping IV pumps. Keeping screaming children on the unit way past their bedtime and expecting me to find something to occupy them with. In short, family members/friends/ significant others etc... are welcome when they conduct themselves in a manner that shows they have common sense. If the room can barely fit the patient and the bedside table, the whole family shouldn't try to squeeze in there. Keep the visit brief and utilize the telephone.
  16. smk1

    Do Nurses Eat Their Young?

    Give them a gentle nudge in the right direction as to where they can find simple information that they are looking for (phone numbers, codes, forms etc...) suggest that they keep a notebook and write these things down in so they remember for the next time that it comes up. I'm not sure what "CRN" is. Is it the designated preceptor? If so then perhaps that person is not the right person to be precepting new grads if no one feels comfortable "bothering" them. If you (and probably other nurses) are picking up the teaching slack when someone is specifically designated to that role then this should be brought up to the manager. As a new grad myself I have to say that most of the nurses I have interacted with so far have been at least tolerant and many have been extremely helpful and did not try to "eat" me. There definitely are a couple however...