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JKL33

Content by JKL33

  1. JKL33

    Advice on how to study for peds nursing

    Developmental stages and milestones are something that just kind of needs to be memorized. Here's a pretty good video and you can look for more like it Do you have any exposures to children? Not really fair but having some exposures helps a lot. Take any opportunities you might have to observe children and make a guess about their age (helpful if someone can confirm age after you've had a chance to observe). Or, if you are around a child whose age you already know, observe to see what types of things are being done at that age.
  2. JKL33

    Cutting Clothes: ED SI/HI pt

    I absolutely agree with you. All I can do is take the words of the OP at face value, though, which were: I personally have had enough experiences where I did not believe the situations were proceeding in a respectful manner that I am sensitive to the whole issue. There is no excuse for unnecessary exacerbation of the situation and I would never defend that. However, at some point we go with the situation as reported by the OP. It isn't impossible; stand-offs are fairly frequent and could go on indefinitely which affects many other patients. Compromises sound great but then you have to accept that compromises sound great until dozens of different staff members are allowed to individually make compromises in many different situations based on nothing more than what they think "seems" reasonable. And those compromises are reasonable right up until they turn out to have been the wrong choice.
  3. JKL33

    Cutting Clothes: ED SI/HI pt

    What happens when remaining "calm" (or at least cooperative) only extends up to the point that it is time for the assessment to actually proceed? We can sit in "neutral" territory indefinitely (that is, no one's dignity being further violated but also no progress related to the legal obligation of evaluating the patient). In other words, when "calm" is dependent upon no one doing anything then a solution has not been reached. You need a minimum of 2:1 officers/security/etc. Are you able to duplicate those resources to dozen+ patients at the same time? Also, how do you propose to get him under control? Restrict your answer to the previously-mentioned likelihood that remaining under control may simply be a stand-off: I am calm as long as you do absolutely nothing and do not require anything of me.
  4. JKL33

    Cutting Clothes: ED SI/HI pt

    No I have never needed to do that. Do you have any specific ideas about this? I've thought about it a lot over time and haven't had any great epiphanies yet. How do you plan to ascertain this info, and what is your proposal for maintaining the safety of patient and others? I've never worked in an ED where it wasn't the policy in this situation.
  5. Not really better, just a different way of expressing the low perceived value of the work required for the position. Also not a mindset I would appreciate as a patient. FWIW I agree with a lot of your other comments, especially pointing out the practices that may be acceptable with insurances out of the picture. I'm sure that was useful to the OP. There's a lot that goes on in r/t third party payers and many RNs have no experience outside of that world. That part seems perfectly acceptable. His business revolves around selling physical beauty. Eh, your rationale doesn't support your statement tho. If we go with the idea that RN experience might not be particularly useful in this situation (which isn't a given just because it's a niche practice), that would just mean that the experienced nurse and the novice nurse would be equally desirable--which is not what the guy said. I wouldn't have been ranting if he'd said he doesn't have a particular preference or he doesn't think that RN experience is going to be crucial for this position, or that he's willing to give a new nurse a chance. But none of that is what he said.
  6. I hear you and I didn't overlook that, but there are a lot of things people aren't opposed to if/when their options are limited or they have no other choice, so their saying that they aren't opposed isn't exactly a very hearty declaration.
  7. JKL33

    Nurses don't check orders??

    Doesn't your EMR have a summary area that can be used for shift reports, though? It would be ideal if someone could look into ^ that possibility with the hope of possibly getting away from the kardex system where information has to be duplicated by hand.
  8. Good lourd. Why does anyone bother wailing over retention, then? I'm really pissed right now that any nurse would buy into this. Like no new grads have troubles?? Absolutely stellar reasoning.
  9. That's BS though. What you get with even a little bit of experience is a basic idea of how things are supposed to roll (especially in the legal and ethical realms). When people say they don't want anyone with that kind of knowledge, what they are saying they want to be able to sell you a bridge with you having absolutely zero thought of checking to see if the bridge even exists, let alone whether it's for sale.
  10. JKL33

    Nurses don't check orders??

    I understand all of that. But if the employer is going to require that information be duplicated to a second location, it has to be kept accurate or it's just a danger. What exactly is the utility of the kardex with EMR in the picture? Maybe there's something I'm not understanding but kardex seemed like its most useful situation would be paper charts in which the original information is just altogether more difficult to access.
  11. JKL33

    Nurses don't check orders??

    If keeping the kardex up-to-date isn't an expected part of appropriately taking care of orders then it is dangerous and needs to go.
  12. JKL33

    New grad on a neuro floor, need advice

    Forget feeling worse because of your L&D preceptorship. It's too bad it did not really serve your purposes very well, but it's over--time to move on. Yes neurotrauma is going to be stressful and challenging. What they didn't tell you is that it doesn't much matter; most new grads find whatever their first job is to be some degree of stressful and challenging! So tell yourself you don't have it any worse than anyone else and that will be pretty much the truth. You are a new grad like innumerable other new grads. Believe in yourself (and those who will be helping you) and put your best foot forward.
  13. JKL33

    Can't deal with rude, unfair colleagues

    There is some personal bias involved here. How can I tell? Because staff nurses don't have the corner on rudeness and unfairness; in dealing with a wide variety of patients some degree of impoliteness/rudeness (and sometimes unfairness too) is simply not rare. It is frequent. I haven't had much difficulty with physicians personally but difficult types are out there. So you are at least occasionally dealing with rudeness and unfairness from people besides staff nurses. How are you doing that? I can promise you that it has at least some small part to do with how you are viewing the situations. Introspection required. Good luck!
  14. JKL33

    New overwhelmed nurse on the block

    This is not appropriate. I would probably handle it one of two ways: 1) Go to your manager pleasantly and professionally and explain that you are not able to provide a full experience for the students and that doing so is not a goal of yours at this time. That your goals are continuing to solidify your routine and continuing to grow in your role, taking excellent care of your patients and continuing to improve your patient management and time management. 2) Don't make a big deal of it but when the occasion arises let the students each have a turn at administering a medication and call it good. If they ask or expect to do more (like administering all the meds due their patients, etc) say, "I need to have you work that out with your instructor. I'm sorry but it isn't something I can personally prioritize right now." Be very kind and professional--but don't say it any other way; don't act guilty about it. ** I guess the million dollar question is whether or not your hospital expects staff nurses to facilitate the majority of the clinical experiences for students. And don't make the mistake of thinking it's just a lazy clinical instructor or some problem solely with the school. It's very possible that your hospital has various policies that make it pretty hard for CIs to do the role the way it used to be done.
  15. Aw, he's so original, too! When people don't take personal offense they know they've found exactly who they want to hire.
  16. JKL33

    I feel so alone

    That alone is bound to have you feeling a little bit like an outsider and more prone to believing people have formed cliques fast. It's more likely they have tried to quickly become familiar with others because they actually didn't know that many more people in that particular nursing cohort than you do. Just be friendly with people and get down to focusing on your class requirements above all else. Your (or their) friend count is not what is going to take you/them forward for the most part. good luck!
  17. JKL33

    Need Advice with Encouraging Staff to Precept New Hires!

    I'm very curious when anyone looks at a situation like this and draws some of the conclusions you are drawing. Here is what you have said: No that is not the main reason for the difficulty you are having. The main reason is that your facility treats people like crap and then tries to blame the fall-out on those same people. Resorting to ever-more desperate means of staffing in lieu of treating employees well enough to have employees who want to work there is making this problem worse. It is not nurses' fault that when faced with difficulty over their own choices, employers choose to double-down. Why doesn't the employer have any staff on the shift and on the same floor who can orient the new people they hire? That is not a problem with the nurses, it is a problem with the employer.
  18. Disappointed. And surprised at the end to see this was written by a nurse. If they have the aforementioned overly-simplified legal obligation then this assertion is immediately problematic: The questions of "futile"/medically-inappropriate care, autonomy, beneficence/nonmaleficence are complicated matters (beginning right at the start with how terms are defined) with very few (if any) easy answers and engaging them with such lack of nuance is irresponsible.
  19. JKL33

    Liking old posts?

    Yes, of course it was a bit of a dramatization--for comic effect. Supposed to be a little bit of humor, not an accusation. I won't quit my day job, I guess.
  20. JKL33

    IV Insulin and Cardizem

    ^ WADR, part of all of that is understanding the "why" in what you are or aren't doing and this entire discussion is not belaboring anything, it is a discussion of the whys or why nots. For example, yes, we should follow our employers' policies if not contraindicated but at the same time understand why they might have written the policy the way they did. Hypothetically, you could find out that there isn't anything inherently dangerous with running these medications with other medications but the policy was written that way in attempt to (for example) decrease the chances of a nurse picking the wrong pump on which to program a bolus, and bolusing insulin instead of saline. Hypothetically you could also find out that the instruction to "never never ever" do something is simply because it's against the policy, which is not an adequate explanation.
  21. JKL33

    Chewing Gum

    I personally enjoy making a tiny little pop with each turn. I like to see how long I can go without missing. So satisfying.
  22. JKL33

    Frustrating Nurse Family Members

    I would like to add "" to the kind of likes/reactions we can give. And you get an award for not kicking and for not saying, "Ah! So you skipped skills lab!"
  23. JKL33

    Frustrating Nurse Family Members

    Ditto. There are lots of little things I try to do/not do (make sure to say pleases/thank yous, refrain from random convo--with nurse or family member--while nurse administering medications or needs to concentrate, don't speak when my FM can speak for him/herself, move completely out of the way if the nurse needs to be on my side of the bed, etc., etc., etc). I have even endured discomfort in my attempts to not be "that nurse," like one time I watched a few IV attempts (on myself) involving super bad technique like burying the needle all the way to the hub before trying to slide the catheter off (ow). The nurse was getting a little exasperated so I said, "You can do this. Would it be okay if I helped a little?" He agreed and I coached the next attempt and it went right in. He was newer and had never noticed the little tab on angiocaths for pushing the catheter off the stylet...and apparently thought the proper sequence of events was 'bury the whole thing in the patient's arm then pull the stylet out.' (Again...ouch.) So. I think I have proven I am not that nurse.
  24. JKL33

    Liking old posts?

    Overall this is stinking hilarious. A bunch of people privately fretting over "what to do about Joe."
  25. JKL33

    Chewing Gum

    There are a lot of ways to be rude and display terrible manners.
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