LydiaGreen

I admitted an elderly patient with a significant history and numerous meds. Not only did the son have a chronilogical list of diagnoses, tests, where the tests were performed, which doc ordered them, and the results of the tests, but a list of meds INCLUDING the ones that were discontinued, when they were discontinued and why. It was fabulous! The son kept it on his computer and updated it every month or so, keeping a copy in his car, in his mom's purse and at his father's GP's office. Isn't that incredible! The son also went above and beyond to understand everything that was going on with his father's health - he was incredibly knowledgeable. That was amazing. I guess the only time a little knowledge is dangerous, is when a person is blindly following it themselves, or the person is giving that "knowledge" out as fact to other individuals whose cases may be entirely different. If a person has gone out and gotten a little knowledge, odds are, they are more willing to not only listen to the health teaching, but adhere to it.

Our call bells ring a different tone for each type of call. If the patient initiates the call bell, it has one tone. If it is pulled in the bathroom it has a different tone. Staff members can push buttons on the call bell panel above each bed for code blue, staff assist, and talk (to talk to someone at the nurses' desk). We can also utilize the talk function from the desk. Not only do the tones ring at a panel at the nurses' desk but also on a second one just outside the medication room - this ensures that you can hear the distinctive tone from anywhere on the floor. We CAN cancel the bell at the nurses' desk and often do on nightshift. We cancel it and go down to the room, if the call bell is pushed again for that room, it means the nurse needs assistance because it is a two-person transfer but not an emergency (the staff assist button is for a patient emergency that isn't a code but requires assistance while one nurse stays with the patient or for violent situations). This set-up works well for us. Edited to add: the call-bell system does record the type of call bells from each bed and the times as well and where the call was cancelled from.

The blood is signed out from the lab and checked by one RN and one lab tech. When it reaches the floor, the blood is checked by the RN who signed it out and one other RN (for patient name, type, Rh factor, type of product, and unit number). We do vitals immediately before, at 15 minutes, then hourly until done, and then after blood is done and NS flush has started. But, we also do q15min checks for the duration. There is a spot on the form for q15 minute checks - you can just put a check mark with your initials or there is a line for comments (things like "pt. sleeping - easy, relaxed respirations" or "pt. eating - no complaints at this time" or "pt. up to BR - voided qs - refer to fluid balance sheet"). It is also policy that you must remain with the pt. for the first fifteen minutes. Not sure what all you are looking for but, we also do some assessment before and after like breath sounds on all pts. to form a baseline for assessing fluid overload. Our policy on time is that you have four hours from the time the blood is removed from the fridge in the lab until the end of the infusion. When done, the bag is sent back to the lab with the attached tag (comes that way) indicating time started, time ended, VS before and after, and any S&S of a transfusion reaction.

I doubt you will get fired for it. I am a new RN also and made a med error with insulin. Found it myself about twenty minutes later (I gave 5 units too much and it was regular insulin), followed all of the steps that I should have (q15 min checks, notifying supervisor, notifying MD, etc) and wrote MYSELf up. Felt like crap. Still get that tight feeling in my chest when I think about it. I just read the order wrong - it was a sliding scale insulin and I managed to read it backwards. We have our insulins checked by another nurse and co-signed, she read it backwards also. It happens. As for forgetting to give a med at the end of a shift - it's SO common. Out of five shifts, one of us has to phone at least one nurse once about a med that wasn't signed for - wondering if it was given or not. It's a mistake, it happens. The point of mistakes is that we learn from them. Any nurse who says they have NEVER had a med error is unfortunate in that their error was never caught for them to learn from it and learn how not to make that error again. Don't worry - you'll be okay. It will likely come up in your performance review at the end of orientation, admit the mistake, own the responsibility for it, and explain how you will avoid errors in the future.

I imagine your hospital is no different than the one I work in. The flu vaccine that the hospital has on hand is for patients and staff only and is administered on a priority basis - we start with the at-risk patients (elderly, immuno-compomised, etc.) then staff. Hospitals don't stock enough flu vaccine for the entire area - THAT'S the health department's job! And I would tell the people who phone exactly that! They are definitely trying to pass the buck.

Try a google search - there are hundreds of reputable sites with lots of information on Fetal Alcohol Syndrome and Fetal Alcohol Effect. Many have diagrams showing each of the possible identifying characteristics.

Just got home from a 12 hour nightshift. I am entitled to two half hour meal breaks and two fifteen minute coffee breaks - get paid for 11.25 hours. What did I ACTUALLY receive? Three five minute smoke breaks (yes, I know - and to the poster that said they were written up for taking a smoke break - it's YOUR break, why do they get to dictate what you can and can't do on it?). No, I didn't sit at the desk and eat. I ran my tail off all night long. Me and two other new grad RNs and the two RPNs who were working while the experienced RNs sat at the desk and gossiped! We weren't just run off our feet with our own patients, but ended up answering bells for THEIR patients because they wouldn't get up to do it! Enjoy the breaks while you're a student because in the real world, they are few and far between. It's a combination of wanting to prove yourself and get everything done, being short-staffed because that's just the way it is, and still taking a little bit longer to do all of the care and paperwork for 7 acute patients because you aren't as experienced.

oops - thanks kaelie! know how your tongue sometimes doesn't say exactly what your brain is telling it to? apparently that can also happen with fingers on the keyboard!

Keep the tips coming guys! My 7 year old is having T&A surgery in January and I can use all of the good advice you can give! That is a bummer, Jennifer - missing out on the Thanksgiving dinner. But, you were smart to get it over and done with before the Christmas holiday!

My preceptor tried Atkins. I can't understand why anyone would purposely put themselves into ketoacidosis no matter how much weight they had to lose (and I need to lose more than a few myself). She was having increasing SOB. One night it became so severe that she had her husband take her to our ER (and you know a nurse doesn't like doing that!). Her kidneys were not happy campers. She was treated with aggressive diuretic therapy and diuresed 25 pounds worth of fluid in just three days! Shortly after, we were given an information sheet on the effects of the Atkins diet to give to any of our patients who might be doing it. She's doing her own version of a diet put together from the Canadian Diabetes Association and the G.I. Diet (Glycemic Index). She put it together with the advice of her doc and a dietician to guard against a negative impact on her kidneys. She's doing great with this - think she's lost a little over 30 pounds now and looking wonderful, but more importantly, FEELING wonderful. Wish I had that kind of self-discipline! Nothing like a little kidney failure to get you to stop a fad diet though!

Not in nursing. I did have a friend who had two foster children with fetal alcohol syndrome. What information are you looking for specifically?

Announced in my local paper and radio media today by the public health authority - anyone wanting the flu vaccine in Ontario must present valid ID to receive it. Only Ontario residents will receive the flu vaccine in Ontario. There is already a rush for the vaccination - even more so in Ontario than last year (which was a far above average year as it was). My husband and I will be attending the flu clinic at my kids' school with them. The news is also stating that Canada has a surplus so, I'm sure that shipments will start moving south soon.

No, Fiona, in Ontario it is not a perfect world. I am sorry that your experience in LTC was not a positive one. Two of my classmates LOVE working LTC in the facility I have described and would not return to hospital nursing for anything. I personally do not like LTC but not because of any abuse (verbal or physical) that I ever suffered from a resident. It's just not my cup of tea. Perhaps I should clarify that my experiences with LTC have been limited to a smaller, rural portion of Ontario where the nearest city is a four hour drive and there are towns approximately an hour and a half away in each direction with government run LTC facilities. There is ONE private LTC facility in the entire district. Perhaps government LTCs all across Ontario aren't that wonderful. Perhaps only the ones in smaller towns (less than 10,000 people) are decent enough to treat their employees as human beings. I hope that isn't true. But, why are there patients with dementia in an assisted living facility? The assisted living facilities in my area may have residents who develop dementia while living there and may continue to live there while waiting for LTC placement, but I have never heard of a "dementia wing" in an assisted living facility. Residents with dementia require a level of care that isn't "assistance" but full-time care! Maybe things are just simpler in my little corner of the world, maybe we're twenty years "behind" the way things are in the big cities.

Our exams, tests, etc., came from the main school - with multiple satellite sites spread across hundreds of miles, they didn't want the each site's instructors writing different tests. Those exams were RIDDLED with errors. We would point them out - our instructors would agree, support us 100% and collect our documentation to prove it (we would submit the correct answer as direct quotations from three seperate references to PROVE our answer was correct). Mid-terms and finals for each semester are one thing. But, when it came to our nursing school exam (the cumulative one of all of the preceding years that you need to pass to graduate from nursing school), we expected that they would have it together, you know? Nope! We found errors galore, submitted our evidence as we always did. The head of the program said that she would look into it. Three of my classmates had to rewrite the exam (8 hours!) a month later because the school counted the CORRECTLY answered questions as incorrect because THEY couldn't make sure the answer key was right BEFORE they sent out the exam! One failed the first time by 0.3% when if the error questions had been corrected would have given her an additional 4%!!!!! We wrote the CNE (Canadian Nurses' Examination) and every single one of my classmates passed on their first attempt. Once in a long while, I can see one error in the answer key (scored by computers) but not on a continuous basis throughout nursing school. As far as the NClex, I would imagine that it is graded in the same manner as the CNE. If there is one answer that is incorrect by a vast majority of the people who took the exam, they review the question and answer key to determine whether or not an error was made in the preparation of either.

I'm a newbie RN but I don't think that calculation sounds right at all! If you are one nurse caring for 12 patients then the ratio is 12:1. Those other nurses aren't there when you are - you ALONE have the responsibility for those patients while you are on shift. Did the person who gave you the other ratio number perhaps work in management?

Not so funny - it's already happening! I live in Ontario and U.S. residents in the nearby border towns are trying to make appointments to have their flu shots in Ontario clinics - willing to pay almost anything for them. There is now the fear that Ontario may run out of flu vaccine if the Ontario clinics do this on a large scale. Ontario clinics are now being encouraged to refuse all but Ontario residents.

I'm almost afraid to post my opinions. Let me start off with this - I graduated in May of this year and will be the FIRST to admit that my experience is limited. I have seen patients in severe pain whose pain was discounted only to discover later on that their pain was real and the delay in diagnosis was detrimental. I have also seen patients who became addicts having never touched an illegal drug but from developing a dependance after receiving pain meds for a legitimate medical complaint. I dislike oxycontin intensely. When a patient's oxycontin is discontinued, they suffer withdrawal symptoms including abdominal and bone pain. It isn't pleasant. Oxycontin used for terminal illness or chronic, unrelieved pain I can understand. Oxycontin for the treatment of more transient or temporary pain, I cannot. When the med is discontinued, the withdrawal pain is real - the patient doesn't know it is withdrawal, they just know that they are in pain and return to their PCP or the ER for something to stop the pain. Follow the doctor's order? That's all well and good but, sometimes my conscience nags me to consider the toll it is taking on the patients' lives. There are many cases of patients who became addicted to oxycontin and whose lives were ruined by it. There is a campaign to ban oxycontin in some of the Canadian maritime provinces - even some MD's are pushing for the ban. Yes, pain is what the patient says it is - but, we need to ask ourselves (as one poster has already stated), what is CAUSING the pain? If the cause cannot be cured, then by all means, continue long-term pain medication at a maintenance dose that allows for life to be lived. But, if the pain is actually due to a physical dependance on pain medication, then gentle withdrawal is necesssary and should be assisted and the patient should be counselled about the withdrawal. Individuals addicted to street drugs will seek assistance with their addictions when THEY are ready. But, if the addiction is to a prescription medication and there is no longer a physical need for the med, then the medical system has CREATED the problem and should take the responsibility for it and the steps necessary to correct it.

I am torn on this issue. On the one hand, I know that wanting carstration is a gut reaction and a human one but, I know it wouldn't work. When one means of sexual assault is removed from the offender, they turn to other means. Would I feel differently if it happened to one of my loved ones? Definitely. Despite being a nurse, despite considering myself to be a good person, I would resort to more permanent means. Having seen offender after offender repeat, receive a slap on the wrist, rerepeat, and receive another slap on the wrist - I am all for vigilante justice on this issue. If it happened to one of my loved ones, I would find a permanent resolution to the problem. I believe in the law, but I also believe that the law fails us on this issue. Would I go to jail to ensure that my loved one would know that the offender could NEVER harm them again? You bet. On the other hand, how many people have been falsely convicted of such crimes and suffered for it, both in prison and at home? There have been several men in Canada released from prison after serving DECADES for crimes they didn't commit after DNA evidence proved that someone else had done it. Would I resort to extreme measures if I was sure? Yes. But, have you ever seen that movie with Sean Penn and Kevin Bacon? It was just released in the last year or so? Sean Penn was sure - and he killed the wrong man. I'm not saying that in the OP's experience the man was innocent (obviously the DNA evidence from the victim will prove it beyond any reasonable doubt). I'm just saying, can we be certain enough to castrate someone who may be proven innocent at a later time?

I am also an Ontarian and I concur with the opinion that you should "run", Worthy. It isn't worth it. Can your morning job offer you any more hours? If not, think about a non-healthcare job for evenings. One of my classmates put herself through school working the evening shift as the desk clerk in a hotel. It was her job to STAY at the desk and once all of her paperwork was done, she had nothing to do but study and do homework for nursing school and get paid for doing it! Even if it's less money than working in that private facility, it's worth it NOT to end up on the wrong end of a lawsuit. Even a PSW can be sued and it sounds like that facility could care less if that happens - they are setting you up to fail (residents spread out over THREE floors! - that's insane!).

Our facility provides flu shots to all employees but, I live in Ontario and ALL Ontario residents can receive the flu shot free of charge. The public health system sets up flu shot clinics at every school, Walmart, Safeway, etc. It's on a rotating schedule. I won't be getting mine at work just because I'll be getting mine at my kids' school when they receive theirs. Can't make them do anything I wouldn't do first right?

Med/surg - you could have between 6 and 8 patients on days (provided no one calls in sick) OR you could be CCA (CCU) and have four patients on med/surg OR you could be OB and have four patients on med/surg. And, we have NO aides period. On nights, I have had as many as 12 patients and I just graduated in May. Shocked? Imagine how I feel!

Patient admitted with a diagnosis of chemical burn to the esophagus - caused by Fosamax and her not following the directions at home (on the box, in the package insert and reinforced by BOTH her doctor and her pharmacist - she figured it was "just a pill, not a bullet" and that everyone was being overly cautious. Exceedingly painful experience for her and a glaring caution to the nurses of how NOT to administer fosamax.

But - are they using the title of "Basic Care Nurse". That is the concern. In the advertisement in Georgia, the "school" is implying that at their school in Alberta, they have graduated "Basic Care Nurses" who are working in hospitals as "Basic Care Nurses" and that the school has secured the title of "Basic Care Nurse". The problem with all of this advertising is A) they are attempting to attract students (and therefore $$$$) by implying that you can become a "nurse" through their school - the average lay person has no idea what the difference is between an RPN, RN, and nurse practitioner - it is doubtful that they will question the title "Basic Care Nurse" and may fork over all of those dollars to NOT become a nurse B) again, the average lay person does not know the difference in types of nurses, regulation of nurses etc... seeing advertisements like that, the average person may have the wrong impression of the nursing profession - ie. "They only have to go to school for 6 months! How much could they learn in only six months? And they're making a fortune!"

But - are they using the title of "Basic Care Nurse". That is the concern. In the advertisement in Georgia, the "school" is implying that at their school in Alberta, they have graduated "Basic Care Nurses" who are working in hospitals as "Basic Care Nurses" and that the school has secured the title of "Basic Care Nurse". The problem with all of this advertising is A) they are attempting to attract students (and therefore $$$$) by implying that you can become a "nurse" through their school - the average lay person has no idea what the difference is between an RPN, RN, and nurse practitioner - it is doubtful that they will question the title "Basic Care Nurse" and may fork over all of those dollars to NOT become a nurse B) again, the average lay person does not know the difference in types of nurses, regulation of nurses etc... seeing advertisements like that, the average person may have the wrong impression of the nursing profession - ie. "They only have to go to school for 6 months! How much could they learn in only six months? And they're making a fortune!"