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JKL33's Latest Activity

  1. JKL33

    nursing diagnoses

    What are your thoughts and rationales specific to your patient?
  2. JKL33

    All these nurses writing articles

    I don't believe s/he is advocating for JCAHO/TJC. It's more a matter of being better informed. We only make things worse when we misdirect our dissatisfaction. It is directly within your facility's powers and capabilities to mitigate your charting burden. Just like it was never true that staff members could not have water in the nurse's station, there are a lot of other "JCAHO" things that are simply not true and don't involve JCAHO. And occasionally you can actually gain back some ground if you know what you're talking about, just like some places got their water back after pressing the issue. It's all such ridiculousness, but you definitely won't get anywhere if you accept the idea that everything is because jake-o. Of course not, and JCAHO doesn't say that you have to. Apparently someone in your facility has said that you must do it anyway. That's exactly the kind of thing the poster is talking about, and s/he gave a direct example.
  3. JKL33

    Considering ICU.... among several other options

    This sounds very similar to a situation I observed closely and was peripherally involved in. Since I have not heard anything egregious, my bet on this (diagnosis, if you will) is "Failure to reassure." Think about that. Being introverted is one thing; many people consider themselves such. But when you are new to those around you, new to the setting, new to the profession, etc., you certainly can fail from "failure to reassure." It goes like this: Someone is inexperienced. They are prone to run-of-the-mill, not-too-disturbing ignorance and misunderstandings, like I did when I was brand-spanking new on orientation and thought that medication was to be removed from an ampule with a regular needle and then pushed into the IV line through a filter needle. In my case I asked a question (is it this way, a, or this way, b?) and got the correct answer and none of this affected a patient. But when people don't talk and want to get by on this idea that "I'm thinking though things, I just don't say it out loud" - there is no way for others to know that. There are a lot of things that can act as pitfalls for new nurses, but one of the surest is a staunch, somewhat defensive determination to use introvert status as an excuse for lack of appropriate and necessary communication. Uncomfortable though it may be (for some more than others), this stage of your career requires a great deal of interaction. Secondly, given the situations described, introversion/lack of communication often also affects other areas, such as the idea of being pleasantly assertive/asserting yourself in your patients' best interests (and your own). The reason I think your lack of communication is the problem is because you haven't mentioned anything else that most new grads aren't prone to - and are usually easily coached through. On any given day they may struggle to catheterize someone, can't perfectly judge urgency vs. non-urgent vs. emergent, and might upset a nursing assistant by not immediately evaluating someone's chronic problem. In order to be coached, they simply cannot stay in their own world inside their own head. Introversion will fail as an excuse for lack of necessary communication. You can teach yourself improved interpersonal skills. Best of luck ~
  4. JKL33

    Needless ports

    Yes, upon reading the title I did think this was going to be an ethics post.
  5. JKL33

    Needless ports

    S/he isn't asking about that, but about whether or not you can stick a needle into a needleless port.
  6. JKL33

    Case Study(CSI): Stomach flu? Anxiety? What’s Going on Here?

    One 12-lead EKG please. Lots of other info I would like to know (and another diagnosis in mind), but...
  7. JKL33

    Two Jobs: Full-time night, Part-time day

    Better to try to pick up part-time work on the same shift you're already working FT.
  8. JKL33

    Quit my CNA Job ???!

    Congrats! Look for a scribe position. Don't quit the CNA position for work outside of healthcare, though, unless something else tips the balance (like the pay is significantly more).
  9. JKL33

    Gossiping Nurses

    I'm sorry but you are in for a world of misery with this attitude. You have to do your best, learn when opportunities arise and beyond that not worry about the rest of it. With your present frame of mind you can destroy your own ability to succeed just as surely as others can harm your chances with toxic gossip. Don't be the one gossiping or listening to it. Do be the one striving to do your best, learning as much as possible and having a pleasant attitude.
  10. If it could be said that you have an obligation here, you have already satisfied it. Be good at what you do, don't get tied up with this other RN (either in worrying about what she is doing or in being close enough in real or virtual proximity to get implicated along with her). Life's too short to worry about someone else's nonsense.
  11. Stay calm, convey that you are pleasant, outgoing, and a good team member. Speak well of your current position and convey that it has given you a solid foundation to build upon. Ahead of time, think through your experiences that have helped you strengthen yourself in ways that will be transferable to the ED population (there are a lot, despite what some people say--time management, interpersonal skills, developing good rapports with patients, staying calm under pressure, in addition to the specific pieces of knowledge and hands-on skills that will transfer). When talking with them, remember that the ED is not all codes/arrests/big traumas. It is very heavy on run-of-the-mill sickness and injury, including the very, very minor. If you're too much into the idea of being an adrenaline junkie, they might wonder how you will fare with all myriad stuff that is much more mundane. Good luck; let us know how it goes.
  12. JKL33

    I Made A Mistake

    Just making sure we all understand that sepsis is not "the" (one and only) dx with which elevated serum lactic acid is associated. As a matter of fact in this scenario sepsis very well may not be the most likely thing, since plenty of other scenarios including pulmonary edema, respiratory failure, etc. are also associated w/ elevated lactic acid. The line about sepsis and fluids is okay...if that's high on the list of possibilities to begin with. But it isn't okay to assume that's the problem when something else is more likely and then give a treatment that is known to worsen the actual problem. We don't start with a CHF patient who is hasn't been taking his usual diuretics and has had increasing SOB and edema --> see that he has elevated serum lactic acid --> go "sepsis" crazy and --> give him a bunch of fluids because sepsis.
  13. Would never advise anyone who has significant concerns about their ability to enjoy nursing to do it anyway. That is completely irresponsible. It isn't their choice. That is their opinion and their experience. It is unlikely to be true for those who do not enjoy nursing, and even some people who do pretty much enjoy nursing might think twice if they had to make the choice again. Understand that to some extent they probably think they are advocating so that you might enjoy something they have enjoyed. They most likely want the best for you, they want you to have a good life--and nursing, to them, is a proven way to have a good life. They are having a hard time understanding that something they've enjoyed might not bring be right for you. On an even deeper level, your choosing nursing may be somewhat validating to them, and your rejection of nursing might feel (to them) as if you are rejecting/disapproving of their life choices, which just isn't the case--but it might not hurt to have a heart-to-heart with them. They need to admit to themselves that their expectations and pressure (even if subtle) have played a part in where you are right now. You need to step out and make your decisions about your life, and they need to accept them. Hopefully you all are close enough that you could sit down and let them know that this isn't just belly-aching--you seriously do not enjoy nursing itself. You can let them know things that you appreciate about your upbringing and their parenting while having the discussion. Go about this maturely and they will have reason to consider that you are not making a rash decision. Good luck!
  14. JKL33

    Rude doctors

    People behave this way when they know it will be tolerated. It's almost guaranteed that she does not treat every one of the ED nurses this way; she knows when to temper herself and when she can get away with it. She knows that you hate the idea of even a minor confrontation and will stress yourself in order to avoid having to assert yourself. This is a matter of being pleasantly assertive. Assertiveness is not: aggressiveness, sarcasm, being argumentative, mean retorts, or trying to pacify her. Not being pleasantly assertive is enabling her behavior. Pleasant/low-key assertiveness is a state of mind and emotion that recognizes that X thing (whatever little issue she has become unglued about) is not about you, and therefore you are free to proceed very neutrally; in a pleasant, matter-of-fact manner. If X is the scribe issue: In a pleasant/friendly manner state, "Oh! That number should be in your phone. I can help you find it in just a second..." This achieves the goal of being pleasantly assertive and offering a solution, but not performing her unreasonable demand and not giving any indication that you are willing to perform the unreasonable demand or are going to do it 2, 5, or 10 minutes from now--but that instead, something different is going to happen. If X is the Motrin issue: Let her belly-ache. If she was just grumbling about it into the atmosphere, pretend you didn't hear. If she approaches you and is pointedly complaining about it, keep moving and pleasantly state, "I was with another patient but it's next on my list." Don't stand there to give her an audience. Basically don't do what she wants you to do. Be calm, be neutral and pleasant, realize that X is not about you. Look around your ED. I'm certain there are people she doesn't treat this way. Learn from them--although for your own happiness I wouldn't pattern myself after the ones whom she leaves alone because they are just as inappropriate as she is...they are quite often miserable themselves, and you don't need a different kind of misery any more than you need your present problem.
  15. JKL33

    It's Driving Me Crazy

    The good news about all of this is that when you don't have time during your shift to really get a handle on how the piecemeal details you encounter here and there add up to a big picture, don't worry; chances are good the next nurse doesn't want to know the big picture anyway and is perfectly happy pretending that being able to look up a detail PRN means that they know whats going on.
  16. JKL33

    I Made A Mistake

    You're okay. I don't think you're saying you thought that a rate of 100cc/hr met the definition of bolus, but rather that you simply thought both bags were to be bolused and didn't really know that one was supposed to be 100cc/hr. So the takeaway here is to get into the habit now of conscientiously checking every order/5Rs. Yikes. It sounds like that was quite a bit of his presenting complaint. You will next time. Carry on.