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JKL33

Registered User

Reputation Activity by JKL33

Reactions Given

Like 219
Thanks 3
Haha 7
Disagree 5

Reactions Received

Like 531
Thanks 12
Haha 7
Disagree 1
Sad 1

  1. Haha
    JKL33 got a reaction from Wuzzie in How to retain nurses?   
    See I think you should've slowly raised your hand, then uber-seriously and meekly replied,
    "....more pizza, maybe...?"
    💙 🍕
    Tip: Always carry a resignation letter in your bag, just leave the date blank so you can fill it in quickly if need be, like in case you just get fed up some day and pull a stunt like that ^ 😂
     
  2. Haha
    JKL33 got a reaction from Wuzzie in How to retain nurses?   
    See I think you should've slowly raised your hand, then uber-seriously and meekly replied,
    "....more pizza, maybe...?"
    💙 🍕
    Tip: Always carry a resignation letter in your bag, just leave the date blank so you can fill it in quickly if need be, like in case you just get fed up some day and pull a stunt like that ^ 😂
     
  3. Haha
    JKL33 got a reaction from Wuzzie in How to retain nurses?   
    See I think you should've slowly raised your hand, then uber-seriously and meekly replied,
    "....more pizza, maybe...?"
    💙 🍕
    Tip: Always carry a resignation letter in your bag, just leave the date blank so you can fill it in quickly if need be, like in case you just get fed up some day and pull a stunt like that ^ 😂
     
  4. Like
    JKL33 got a reaction from brownbook in Scope Of Practice Question   
    No I would not agree to this.
    The hospital's ill-conceived policies cannot cancel out legal obligations and expectations. An RN is expected to do what a prudent RN would do.
     
  5. Like
    JKL33 got a reaction from brownbook in Scope Of Practice Question   
    No I would not agree to this.
    The hospital's ill-conceived policies cannot cancel out legal obligations and expectations. An RN is expected to do what a prudent RN would do.
     
  6. Like
    JKL33 got a reaction from Silver_Rik in I Hope This is Not the Latest Trend   
    Well, there are painfully few facts so far (and I'm not inclined to go looking for them right at the moment). So far there are allegations of yet more of those actions that nurses should absolutely never take - if those prove to be true eventually, then the nurses will have to answer for them.
    In any case, I suppose those who are worried about getting caught up in badness should maintain appropriate nursing ethics and be prepared to leave if/when these cannot be maintained due to factors beyond the nurse's control.
     
  7. Like
    JKL33 got a reaction from BarrelOfMonkeys, BSN, RN in Trigger Warning!   
    Trigger warning:
    Just say trigger warning every time you speak, to cover yourself.
  8. Like
    JKL33 reacted to Pixie.RN, MSN, RN, EMT-P in Should I try to earn my RN license or go back to college?   
    MSN programs require not only the BSN (or ASN in some cases), but also that the student has an active RN license. If you actually have a BSN that makes you eligible for the NCLEX-RN, that is your wisest move if you are going to advance your career. Comparing going back for another degree vs. taking the RN boards is apples vs. oranges. 
    If I were considering you for a position, someone who is an LPN with a BSN would raise my eyebrows. I would have questions for sure. 
    Also, it's not RN, BSN — you list the degree first because it is permanent, unlike a license. So BSN, RN. Or apparently in your case, BSN, LPN. 
    Good luck deciding on your future path! 
  9. Like
    JKL33 reacted to LilPeanut, MSN, RN, NP in Nurse Charged With Homicide   
    No, you're talking about patient profile on the ADC.  I'm talking about the MAR on the patient chart where you actually see the order of "2 mg midazolam IV"
    That would have kept it fresh in her mind that it was midazolam, not versed. (and would have led her to searching under "m" not "v" in the override menu)
  10. Like
    JKL33 reacted to LilPeanut, MSN, RN, NP in Nurse Charged With Homicide   
    I feel it would be very pertinent to the report - because had she looked at the MAR, it would have been listed under midazolam, not versed, and as the pharmacist had verified it in the MAR, there would be even more reason to believe it was in the ADC under the patient profile and not needing to be overridden. 
  11. Like
    JKL33 got a reaction from BarrelOfMonkeys, BSN, RN in Nurse Charged With Homicide   
    I think it is a plainly clear and common idea that a nurse might have every reason to believe a medication was entered as  STAT when a patient is already in a procedure area waiting for the medication.
    If you would like to talk about whether it was literally emergent or not, I agree it clearly wasn't. No way. And I can't defend her actions.
    Just the same, the topic of whether it was actually emergent or not gets around to my assertion that fake emergencies (or imposed time pressures) have become a serious problem in acute care.
    I mean, that is this situation. We have several people up in arms about a downgraded ICU patient, unattended and off monitors,  who needs something for anxiety right away in order to obtain an utterly non-urgent PET scan...
     
     
  12. Like
    JKL33 got a reaction from TriciaJ, RN in Nurse Charged With Homicide   
    Too bad they're stuck on the same boogeyman they've always been focused on: The Evil Physician. They act like there's nothing to watch out for on behalf of the patient except what those uncaring, greedy doctors might do. I think they missed the memo that, for the most part, doctors aren't the ones running the show now...
  13. Like
    JKL33 got a reaction from thoughtful21, BSN, RN in Nursing school has pushed me to the edge. Anyone else?   
    Well, since I have been called upon (@thoughtful21)....
    I do think the OP's background as described (including the perfectionist aspect) is ripe for extreme nursing school frustration.
    I didn't experience it necessarily in my original program which I felt prepared me very well. Years later I still feel I couldn't have asked for better preparation. These people had a wealth of knowledge and expected dedication and accountability. I had no problem learning what they wanted or doing what they asked because I wanted to become like them.
    I am aware, though, of situations were the instruction is lower-caliber and the people instructing can not possibly have ever been excellent at patient care. In those situations everything becomes about head games - which, although easy enough to overcome, are a colossal waste of life, breath, brain power - everything. Weak people resort to games and tactics that can allow them to feel superior when they otherwise wouldn't.
    One such individual wandered into a resus room where I was involved in a resuscitation ("Code") that two of her students were observing. This idiot had no clue what was going on, but that didn't stop her from wrongly reporting me for a medication administration "error" that was so far off base it became immediately evident that she didn't even know what she was observing - and it was fairly straightforward. She was officially invited not to step foot back in our department and the school informed that someone else would need to supervise the clinical rotation.
    Other instructors play head games by twisting and contorting things, criticizing at the wrong juncture or in an improper manner, and generally faulting people no matter what they do. These are merely symptoms of personal and intellectual weakness.
    To the OP I have two comments:
    First, nursing itself is an adjustment for perfectionists. Humanity and life is complicated and there isn't a formula for it and you can't do something correctly and be done with it. It isn't very amenable to checking boxes and feeling like things are perfectly done. Ever. That's because it's life. So to some extent you will have to grow in this area and learn to do what you can do and let the rest go (might seem like an abomination, I know - but it's true).
    Secondly, good lourd, to the extent that you are frustrated by silly game players (which is what I suspect) don't let them determine how your nursing career is going to go. Just get it done and get out of there. By not showing up on time and and not doing things according to your own standards that you know are right, you're just throwing the whole thing! You're better than that. Why choose to lose at something solely because of goofballs?! 😱 I am sure you have been taught to be determined enough to keep that from happening.
    Nursing school is a period of adjustment and uncertainty and broadening your view of the world. It sounds like that got you down for a moment, but now you have to make a choice. You can succeed here. Pay attention and give them what they want, which isn't difficult to figure out. If they want the care plan to meet 45 persnickety little requirements? No problem - sit right down and pound it out and let them know what an awesome assignment it was!! 😂. Seriously. Let them mess with someone else. Let's get some enthusiasm going and get.it.done. 🔥
     
  14. Like
    JKL33 got a reaction from Silver_Rik in I Hope This is Not the Latest Trend   
    Well, there are painfully few facts so far (and I'm not inclined to go looking for them right at the moment). So far there are allegations of yet more of those actions that nurses should absolutely never take - if those prove to be true eventually, then the nurses will have to answer for them.
    In any case, I suppose those who are worried about getting caught up in badness should maintain appropriate nursing ethics and be prepared to leave if/when these cannot be maintained due to factors beyond the nurse's control.
     
  15. Like
    JKL33 got a reaction from BarrelOfMonkeys, BSN, RN in Nurse Charged With Homicide   
    I think it is a plainly clear and common idea that a nurse might have every reason to believe a medication was entered as  STAT when a patient is already in a procedure area waiting for the medication.
    If you would like to talk about whether it was literally emergent or not, I agree it clearly wasn't. No way. And I can't defend her actions.
    Just the same, the topic of whether it was actually emergent or not gets around to my assertion that fake emergencies (or imposed time pressures) have become a serious problem in acute care.
    I mean, that is this situation. We have several people up in arms about a downgraded ICU patient, unattended and off monitors,  who needs something for anxiety right away in order to obtain an utterly non-urgent PET scan...
     
     
  16. Like
    JKL33 got a reaction from juan de la cruz, MSN, RN, NP in Nurse Charged With Homicide   
    I don't know what to say. The whole quote regarding this is an ambiguous sentence or two from someone who may or may not ever touch patients or these machines, whose team performed an analysis.
    Okay. I'll just quote the report (quote is from the MAPST, Manager of Adult Patient Safety Team, p.22):
    My point is that we do not know the status under which the medication was ordered (STAT, NOW, Routine, PRN, etc). I have not been able to find that. She may have had reason to believe that it was entered as a STAT order since the patient was already down in radiology waiting for the med. But what we can't assume is that it wasn't entered STAT just because the situation was not in fact a dire emergency. It may indeed have been ordered STAT. She may have had reason to know that in such situations where the med is wanted sooner rather than later, it would be entered as STAT.
    You see what I mean? So the wrong med pops up, somewhere on the screen is the override button, which has a warning saying it is for STAT orders. Given the perversion of the use of STAT/NOW order status, she very well may have believed that it was a STAT order.
    Or she may have overlooked the 'red box' (whatever it was) like she overlooked everything else. 🙄
    The thing is, aside from RV, if you (we all) are interested in keeping patients safe, it does matter how override is commonly used, off the record, in that facility. Not how I use it or how some other nurse uses it, but what the tenor of its use is in that facility. This could be a situation that was utterly out of the ordinary with regard to the use of override, or it may be that she was doing a very common action and it went wrong only because of other serious mistakes she made.
    From a strictly patient safety standpoint, the minute details of this do matter. That's why it's a second, or third or fourth freaking crime that such things seem like they aren't even being looked into. You know - that, and well, the whole cover-up thingy.
     
  17. Like
    JKL33 got a reaction from TriciaJ, RN in Nurse Charged With Homicide   
    Agree that if she believed the med simply had not been profiled yet (which is what I assume she thought but have no way of knowing, the correct thing would have been to either call pharmacy and request that it be profiled right away, or else simply wait. I'd pick the former.
    But STAT, NOW, and Routine are order types whose meanings have become perverted by processes and systems. There are places where you actually do need to enter an order as STAT if you must have it in under an hour or so. It most certainly isn't an order status that is strictly limited to some hair-on-fire emergency.
    I didn't see the order status (STAT/NOW/Routine) in the report. I just went and specifically looked for it but perhaps I am overlooking it.
    You are incorrect about the verbal order thing, though. The order was in fact already profiled when she went to the cabinet. She didn't think the order was profiled because she was searching under generic names while trying to find Versed.
  18. Like
    JKL33 got a reaction from juan de la cruz, MSN, RN, NP in Nurse Charged With Homicide   
    I don't know what to say. The whole quote regarding this is an ambiguous sentence or two from someone who may or may not ever touch patients or these machines, whose team performed an analysis.
    Okay. I'll just quote the report (quote is from the MAPST, Manager of Adult Patient Safety Team, p.22):
    My point is that we do not know the status under which the medication was ordered (STAT, NOW, Routine, PRN, etc). I have not been able to find that. She may have had reason to believe that it was entered as a STAT order since the patient was already down in radiology waiting for the med. But what we can't assume is that it wasn't entered STAT just because the situation was not in fact a dire emergency. It may indeed have been ordered STAT. She may have had reason to know that in such situations where the med is wanted sooner rather than later, it would be entered as STAT.
    You see what I mean? So the wrong med pops up, somewhere on the screen is the override button, which has a warning saying it is for STAT orders. Given the perversion of the use of STAT/NOW order status, she very well may have believed that it was a STAT order.
    Or she may have overlooked the 'red box' (whatever it was) like she overlooked everything else. 🙄
    The thing is, aside from RV, if you (we all) are interested in keeping patients safe, it does matter how override is commonly used, off the record, in that facility. Not how I use it or how some other nurse uses it, but what the tenor of its use is in that facility. This could be a situation that was utterly out of the ordinary with regard to the use of override, or it may be that she was doing a very common action and it went wrong only because of other serious mistakes she made.
    From a strictly patient safety standpoint, the minute details of this do matter. That's why it's a second, or third or fourth freaking crime that such things seem like they aren't even being looked into. You know - that, and well, the whole cover-up thingy.
     
  19. Like
    JKL33 got a reaction from mtnNurse., BSN in Nurse Charged With Homicide   
    She was in an ICU....she may have been accustomed to the leeway of which you speak, Jory. I'm not saying she used the privilege appropriately - - just that it takes on a different shape than this wacko idea that she got into some "dangerous medication vault" to purposely access a more dangerous "death row" medication. (And I know those aren't your words, but they represent the belief of various news outlets and various nurses participating in these discussions) 🙂
  20. Like
    JKL33 reacted to Jory, MSN, APRN, CNM in Nurse Charged With Homicide   
    ...but that is at my hospital. Vanderbilt may be different. I have never worked there, so I have no idea.  But it is a dangerous practice overall if you don't truly need it right then.  
    Even the ER and ICU doesn't get a complete free pass.
    Example: Let's say you have someone coming in with intractable vomiting.  I think we can all agree nobody is going to die in the next 15 minutes with intractable vomiting, especially after an IV is started and flowing.  The ER doc may tell you to pull some IV Zofran to get it going...patient absolutely needs it now because while not emergent...it is urgent. Everyone saves the bottles and scans it after-the-fact.  
    But if that same patient is just very nauseous...you need to wait until that drug is loaded so you can pull it.  
    Drugs pulled on override not verified with pharmacy also runs the risk of drug interactions with something else the patient is on.
  21. Like
    JKL33 got a reaction from Silver_Rik in I Hope This is Not the Latest Trend   
    Well, there are painfully few facts so far (and I'm not inclined to go looking for them right at the moment). So far there are allegations of yet more of those actions that nurses should absolutely never take - if those prove to be true eventually, then the nurses will have to answer for them.
    In any case, I suppose those who are worried about getting caught up in badness should maintain appropriate nursing ethics and be prepared to leave if/when these cannot be maintained due to factors beyond the nurse's control.
     
  22. Like
    JKL33 reacted to Wuzzie in Nurse Charged With Homicide   
    I highly doubt it. I would imagine he thought she was being transported like every other ICU patient he’d seen...on a monitor with a nurse in attendance. No reason for him to think otherwise. 
  23. Like
    JKL33 got a reaction from brownbook in Scope Of Practice Question   
    No I would not agree to this.
    The hospital's ill-conceived policies cannot cancel out legal obligations and expectations. An RN is expected to do what a prudent RN would do.
     
  24. Like
    JKL33 got a reaction from Julius Seizure in Nurse Charged With Homicide   
    That is a problem.
    Using multiple hard stops and pop-ups and messages to meet billing and regulatory goals and having them all mixed in with the safety messages we are supposed to be receiving is a major issue.
    In this case the messaging on the ADC when she went to take the vecuronium said something like [it] was only to be used for a STAT order. That use of "warnings" is as good as no message at all. It requires no interaction (I'm familiar with having to answer a question about whether the patient is ventilated when removing such meds) - and what kind of messaging is that, anyway? Used with a STAT order? Right up until auto-profiling, anything you wanted sometime today had to be entered as either "NOW" or "STAT." It's just like the override issue - used so often that is disingenuous to suddenly act like it was supposed to be a safety measure. 
    And why create a message like "only for STAT order" when you could use that space tosay "CAUSES RESPIRATORY ARREST."  Better yet, make it interactive. "CAUSES RESPIRATORY ARREST. Is this patient's ventilation being supported? Y/N"
  25. Like
    JKL33 got a reaction from brownbook in Scope Of Practice Question   
    No I would not agree to this.
    The hospital's ill-conceived policies cannot cancel out legal obligations and expectations. An RN is expected to do what a prudent RN would do.
     
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