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Content by JKL33

  1. JKL33

    What would you do?

    I feel it isn't an isolated thing like wage, hours, customers/patients or any of the rest of that, etc., etc. I was raised below the poverty line (though never lacking for love and support) and worked plenty hard before I was even old enough to become a nurse so I feel I have at least some perspective to not complain about things like hard work or whether I should make as much as so-and-so. Rather, the overall problem with nursing is the ethical conflict; the idea of reconciling ethical practice (our Code of Ethics is a published multi-page document which declares our ethical responsibility for just about everything despite what others choose to do) + legalities + high individual responsibility + low individual autonomy, and currently we're riding a big business-driven train that has gone off the tracks. Practically every other major nursing problem someone might commonly bring up (wages, N:P ratios, toxic behaviors, workload, time constraints, resource constraints, customer service, poor treatment of nurses, significant problems with nursing education, etc.) has these underlying conflicts and/or issues as an underpinning. For this reason I think anyone who can satisfy their desire to do genuine good separately from earning their paycheck should keep it that way and not primarily try to combine altruism with earning a paycheck (arguably that latter combo isn't even technically possible). Nice to see I have at least a little company in the aforementioned survey results: I am glad I became a nurse but pretty sure I wouldn't do it again.
  2. I know what you mean and ^ that's certainly a PITA...but it doesn't become a HIPAA violation based on the fact that it was otherwise problematic. That's a situation of your employer's twisting and underhanded interpretation using a technicality in order to curb a problematic behavior. (Their [disingenuous] assertion: You can't be said to have a "need to know" when you aren't on duty. Sure...except that you are on the premises and on the unit for the express purpose of caring for patients and are in fact minutes away from being responsible for the patient whose information you are reviewing...). The fact that the employer has decided that they don't wish to pay for such preparation or the fact that the law does not allow you to perform work-related activities without being paid does not mean that you have accessed PHI for an illegitimate purpose, it means that they have you by disingenuous application of the need-to-know concept. Also, the fact that assignments might not be finalized until 06:59:30 really has nothing to do with the intent of the access or the legitimacy of it. Same reason that if you are in the middle of getting report and your assignment changes, no HIPAA violation has occurred. Same reason that salaried employees who might be working any hours depending on how they might flex their time are not violating HIPAA if they have a legitimate need to access PHI outside the 7-3, 8-4, 9-5 or whatever window of usual business hours.
  3. Agree this is potentially somewhat dependent upon the situations and the abilities of the people who are saying it. Personal preference. Nope for me; not unless the contract included a lot more detail about what I can expect from the educational process and especially from said post-graduation placement. There are no protections here, just like there are no protections for the new-grad RNs who sign longer-term contracts in return for a "residency" which could consist of just about anything. Assuming that provisions which would afford me any sort of protection whatsoever are not going to be forthcoming, I would rather pay and keep whatever small amount of freedom doing so affords me. What does this even mean? That you will pay for the credits earned/attempted up to that point, or that you will be on the hook for whatever monetary value they place on the entire program? The problem isn't that it is "unfair" that you would have to pay if you fail; that's sort of reasonable to the extent that it prevents uncommitted people from taking up space in a program and then not applying themselves in a significant effort to become a safe provider. But the big general problem with this kind of arrangement is that the school gets the money either way, the company's risk is significantly reduced without providing you any protections, and as for you, well, you either like (agree to) **everything** that happens from now til the end of your 2-year contract, or you pay; no other option--regardless of how they choose to consider their obligations satisfied. Is it an opportunity? Of course. Lots of things are potential opportunities. The question is whether or not the opportunity is worth the various risks. And we are each going to make our own decisions about that.
  4. JKL33

    Current Struggles as a New Grad

    Understand that part of remembering information has to do with things like knowing what is/isn't significant in a patient's case and just growing in other critical thinking processes. People with photographic memories remember unattached random facts, but for most other people remembering stuff like this has to do with knowing that something is relevant and how it fits together with the picture. So this will improve as you learn. I remember one of my first code as an RN--the code team stormed in and the CC PA roared, "what happened here??!" I was like..."...she stopped breathing....and she had ______ [admission diagnosis]??" That's a good start. You can also review in your mind (at the end of the day or whatever) the cases you encounter to help synthesize information. When I was new I learned a lot by carefully reading providers' notes. It's going to come together and the worst thing you can do is decide that you're off-track somehow because you don't know everything. I know the environment seems to not be very tolerant of human imperfection in general, but you just have to understand that it is irrational to place beginners into acute situations and then begrudge them for not knowing everything/enough. That just isn't your problem as long as you are doing what you can to appropriately grow in your critical thinking.
  5. JKL33

    IV Insulin and Cardizem

    ^ Yes. And unless you are y-ing at a relatively high port, it seems likely that the amount of insulin we're talking is ~ 2-3 units or so, depending on concentration of insulin gtt (usually 1:1)... so it's just a matter of how many mls of fluid is needed to prime the tubing from the port in question to the patient; 3 mls from port to patient = 3 units insulin, etc. If you y-in right at the patient/site it would be a fraction of a unit.
  6. Explain, please. Is the original purpose of the original activity retroactively changed if something else changes after the fact?
  7. JKL33

    New grad struggle

    I think you may need to take a more proactive and pleasantly assertive approach in your own best interest. At the beginning of the shift, see if it's possible to take 5 minutes to discuss goals (for you) for the day. There's nothing wrong with making a suggestion such as "I think I'd like to try taking the lead on one patient and build my way up." [For example]. It's really disappointing to read that such basic things as making a learning plan (a long range one and, separately, goals for the day) is not being done routinely. It's so basic. The alternative is that the entity believes its fine if each day is just a random experience that may or may not work toward the long-term goal. There are numerous things that can work during an orientation but one thing that doesn't seem to work well is this idea of dumping everything on someone right at the beginning--especially when "back-up" means pointing out everything they didn't do or did wrong, and criticizing it. Get this under control by being proactive. Try to have a meeting with the person in charge of new-staff orientations in order to come up with a plan. Good luck!
  8. JKL33

    Liking old posts?

    I almost PM'd another member about this but: 1) Realized it might come off as some "concerned" version of humble-brag or 2) If it were a weird situation (which I really didn't think it was...probably ) then it would also be known that I sent that PM and it would be known that "I know." (If you ever need someone to worry about things which generally don't need to be worried about, I'll be here). I've enjoyed most installments of "I wonder what I might have said about this?"
  9. JKL33

    EKG interpretation help

    What a terrible way to try to learn this at this juncture of your learning/exposure.
  10. JKL33

    Terrible experience with nursing staff

    Go a couple levels deeper. It is eventually about a payor (whichever entity that may be) wishing to save money after the care has already been rendered.
  11. JKL33

    Did we/she violate HIPAA?

    People don't need this info; they just don't. It's no guarantee anyway so it isn't as if they can make big plans based on what they're told in this unofficial manner. Secondly, you are playing with fire. I agree w/ Muno that some work places might have a culture that supports, allows, or requires the monitoring of census or bed availability elsewhere in the system by RNs in certain roles. But we've also had other people come here and report how they were terminated or in big trouble for something where "everybody does it" or that they themselves had been taught that way. The problem is half of this "we have to check some other department's activity [for x, y, z reason]" is not official system-wide policy or even an approved practice in the offending unit. And when the wrong person finds out it's going on (privacy officer, some other PTB), there's big trouble. Hope you were able to get the official word from your compliance/privacy officer about the expectations at your place.
  12. JKL33

    IV Insulin and Cardizem

    How would that work?
  13. JKL33

    Advice for new nurse? Mistake was made

    Your license isn't going to be revoked. Use this as an opportunity to review your actions and decide if you would do anything differently next time around.
  14. JKL33

    Transfer into ED

    Good luck! If people are really curious about it or definitely interested, I always say go for it.
  15. JKL33

    Transfer into ED

    One of the bigger adjustments might be the episodic/focused nature of ED work and the nurse's lack of ability to plan the next 12 hours. You've probably heard the interdepartmental complaints about us over the years (we haven't taken off everyone's clothes to examine them head to toe, may or may not know if they "use a walker" or even if they ambulate, period. No idea what their bowel sounds are, etc., etc). We do have a lot of patients with multiple chronic issues and multifactorial problems, but we're there to 1) figure out what is causing the main problem today, 2) temporize/stabilize it and 3) get things done to figure out what needs to be done about it in the very short term, aka where they're going today, ASAP. The other main thing is just needing to know a little bit about a lot of different things. If you're in a general ED that means patients of all ages. Any problem humanity can come up with. It's a lot, even though other specialties may have a greater depth of knowledge about any of the specific problems we deal with. Your background is going to give you a great knowledge base to work from as you add on new information. It will mainly be whether or not you enjoy the atmosphere (loosely organized chaos a lot of the time) and can hone in enough to provide episodic care quickly. This isn't (usually) the place for those who carry a brain sheet; their planning and concern for all manner of details is awesome but often better off somewhere else [a generalization not always true but generally true in my observation]. The ED is about just rolling for 12 hours with whatever next thing comes up. I say try it. Shadow and see what you think.
  16. JKL33

    Do you consider an infiltrated IV a medical emergency

    I prefer silence "," since there are really no useful words for this kind of behavior. But, "Clearly you haven't worked in an ED" or "I will pretend you didn't really just say that" and a lot of other fun rolling in the mud comes to mind.
  17. These are people who are simply accustomed to having the time to get a better handle on patient information than what there is usually time to obtain. I never arrived very early (now I don't have to worry about it anyway d/t working in an area where it wouldn't be useful). But I did used to have time to read charts during my shift when I worked the floors - probably an hour of time all put together during night shift. And it was useful. As a new grad I was on a floor where patients might stay for awhile and I really learned a lot about their diseases and treatment processes by understanding the bigger picture of the course of their hospital stay. Times are different now. That kind of thing isn't expected, it isn't as relevant and there wouldn't be time for even if it were. There was a time (maybe it's regional, I have no idea) when people didn't worry as much about ^ that; they weren't nitpicked and treated with the kind of begrudging disdain that has become common. Employer-nurse relationships were completely different. In some places there weren't even restrictions about punching in 7, 3, or 1 minutes before the shift, either, so some nurses could actually punch in if they arrived early and wanted to get prepared. A historical view is useful: Arriving 15-20 early might have been common and yes, at one time might have been a way to go above and beyond. Now it is considered low-value and stupid, but people are willing to go above and beyond by sitting on committees where they have very little say in anything and doing projects that may or may not ever help a patient. . You don't need to compete. No, although that might be a result of actually knowing the basic information before-hand and not having to blindly rely on whatever someone else chooses to share. No. If anything it's more a reflection of individuals' personalities. Some people it just makes them feel like they have a better handle on the information. I fully expect the reverse of this will be argued in this thread, but I will tell you right now: Both views are going to be somewhat correct because they'll be talking about what they find useful or not useful. Some people feel more prepared with the kind of practice you're reporting. I don't think you really need to worry about it much, but if it seems to be fairly common practice where you are, I would avoid the scoffing of your professors and focus on learning all you need to learn and upon creating a routine that makes you feel comfortable.
  18. JKL33


    You have my condolences, very sorry to hear of your losses. Allow yourself to grieve and be easy on yourself as you acclimate to these difficult changes.
  19. JKL33

    Did we/she violate HIPAA?

    I doubt that kind of activity is approved by your employer's policies; I wouldn't do it even if it isn't strictly prohibited. People who are on-call should address their inquiries to the supervisor; you should not look up this type of information for them or use your system for any of the other activities you mentioned. The charge nurse is responsible for her own activity and may be asked to answer for it at some point if she is using the system for unauthorized purposes. Make good habits for yourself whether that is what everyone else does or not; be especially cautious with stuff that relates to privacy practices and/or HIPAA.
  20. JKL33

    Blood pressure in peds patients

    I can only tell you what I've heard: - Some places have policies for their own reasons that demand blood pressures on all patients, including all peds. - Because of ^ this, some nurses put blood pressure cuffs on every peds patient, whether squirming, clenching, flailing or screaming bloody murder, and will enter the resulting value into the chart. - Some nurses assess patients by other means, including those you have mentioned, and make an attempt at blood pressure; if it is clear that an accurate value cannot be obtained in a low-acuity patient at that time, the attempt is abandoned. There's no arguing that in general children should be screened and monitored for hypertension. I haven't yet read any widespread standards about how a blood pressure on a frightened, crying/screaming, active or resistant patient has anything to do with appropriate screening. The referenced article was interesting, but due to innumerable observations, I don't think that their definition of calm is sufficient and I also doubt the accuracy of the determination that a child was calm. My experience is that it's fairly rare for a generally healthy infant/young child at a lower-acuity ED visit to tolerate a blood pressure without the fine movements they usually do in response to it: the fine clenching, twisting and intermittent muscle movements--even when they otherwise could generally be said to be calm (even cooperative). There are other factors (anecdotally) that would also suggest that a triage b/p is particularly worthless even if a b/p was absolutely mandatory sometime during the visit. They come into the triage area and, whether in pain or particularly fearful or not, they are encountering stranger, they're very curious about their surroundings, they are uncertain about what's going to happen to them or if it's going to be painful or scary. I would make the argument that in the absence of conditions (whether congenital, chronic/acute, etc) that place them at high risk, this is a very low-value activity in the ED.
  21. JKL33

    What would you do?

    Well, you will get along better in nursing than some people do IF you maintain your current financial status and trajectory. Financial security helps one navigate that a little easier (if things are unsafe or otherwise unsatisfactory you have options besides staying there and putting yourself at legal, physical or emotional risk). That is important. But, I advise parsing it out a little further. What about these roles would bring you the sense of happiness/purpose? I understand how it can seem like an obvious difference from retail but you owe it to yourself to go a little deeper than the idea of "helping people" vs. doing a different kind of work. If you just want to help people there are tons of people who need help and you can start helping them immediately, KWIM? If you have an independent interest in health care and nursing specifically, that's a different matter. ** I would be interested to hear what your FIRE community thinks of proposals like yours, too.
  22. JKL33

    Disrespect & Profanity

    Agree in general. Even in settings known for being a little more wild things are generally better if you just don't go there. ** I will respectfully disagree, Emergent. It isn't the cussing, per se, but the fact that it's often part of a generally rodeo attitude/atmosphere. Patients can and do readily observe this and they know what to make of it = Free-for-all. That's not good, especially given the number of complaints we have about patient behaviors.
  23. JKL33

    Patient face-down ok?

    Ignorance on my part: Can you clarify whether you're referring to additional restraint (manually by another person or via device) or are you referring to the prone positioning itself as the restraint? Thanks.
  24. JKL33

    Airway Maintenance During Seizure w/Trach

    I asked the question so as to possibly get some critical thinking going regarding why the situation of suctioning a trach is not the same as sticking something into the mouth of a seizing patient. But it occurs to me that the OP was possibly referring to oral suctioning of secretions. The answer there would still be that in active seizure the suctioning would be limited to the cheek pocket/outside the teeth and not to put a yankauer between the teeth during a seizure, if that were even possible.
  25. JKL33

    Did we/she violate HIPAA?

    Why would you need to?

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