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RochesterRN-BSN BSN, RN

Psych, ER, Resp/Med, LTC, Education
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RochesterRN-BSN has 6 years experience as a BSN, RN and specializes in Psych, ER, Resp/Med, LTC, Education.

RochesterRN-BSN's Latest Activity

  1. RochesterRN-BSN

    RNs- Mostly first born? Alcoholic fathers?

    I have to say it dissapoints me to see NURSES referring to someone as "crazy"......if we are ever going to stop the stigma we have to start with those in the health care business. It's really not PC. Mentally Ill....is oaky but crazy is not. It's really derogative and disrespectful to the mental health community......... sorry but that just drives me nuts and like I said if we are ever going to change the public view of the mentally ill it has to start with all of us.
  2. RochesterRN-BSN

    What floor did you first work on?

    I wanted to do OB and did....my first job was on a L& D deck. I had started nursing school when my son was just 5 months old and maybe that had something to do with my interest. I would watch shows on the Discover Health shows with L&D nurses and thought that was just what I wanted to do......I went and interviewed on a geri-med floor and in L&D and was offered a job in each and took the L&D position. I was there for 6 months. I ended up leaving as I felt like I maybe had made a bad choice and wanted to use more of what I had learned in NS...L&D was very specialized. I went and worked on a medical/respiratory floor, and then to psych once I had like 2 years under my belt. I have been in psych since but just recently took a job as the director of Education for a nursing home. Would I reccommend new nurse go straight to L&D....hard to say. As once you are there for a while you are pretty much stuck there. If you love it and want to only do OB nursing for your career that is fine but most who start in OB stay and I was told by co-workers on the OB unit that once nurses are there for more then a year they usually don't feel comfortable leaving to do medical, as they have not really used those skills in so long....... I know several nurses that I worked with in psych that started there right out of NS. Same idea...if you go straight to a specialty after a period of time there you really don't feel comfortable to do anything else. And really I used my medical in psych....since people with metal illness commonly don't take care of themselves physically there is medical to be done. And the geri psych patients can have medical needs........ Do I think all new nurses need to do med/surg.........well it is helpful. And really you will use it regardless of where you work......pregnant people can have medical complications, pts with mental illness have medical problems......etc. so maybe a year or two on a medical floor would be helpful. After this you have so many choices.....and I think you will feel more confident going into those areas......weather ER, ICU, Cath lab, OR, or whatever.......... hope this is helpful. Good luck.
  3. Liver CA? With that you can have elevated amonia levels which can cause behavioral/cognitive issues including agitation.
  4. RochesterRN-BSN

    Mixing IV Medications...Illegal??

    Nit sure on that one.....when I was on an inpatient medical unit we did mix some things, but not those. And NEVER ever potassium. If you have to do it under a hood then that is a bit odd. It is usually the cancer meds that you have to do this with. Funny I was going to say to check with your pharmacy but seems as though they are in on the practice as well...... I am not sure who you would go to for a correct answer. Maybe a pharmacy other then the one you are using?
  5. RochesterRN-BSN

    New Grad RNs in LTC?

    I know in out facility we are so short of RNs that we would likely hire a new grad if she had the strong desire to be there and was willing to work hard and learn. As far as tasks.........well I find a lot of my time is spent doing the things the LPNs can't do..........assess..........assess on admit, after a fall, wound assessment, signing MDSs, etc. Like for us the LPN will get a set of vitals and fill out a lot of the "zillion" pages that have to be done for an admit. Then I go in and do a pain and skin assessment, which I have to do. Then for me personally I do a FULL head to toe assessment........stethoscope in hand.....Cardiac, pulmonary, Abd, Vascular, Neuro, etc.....As the MD that sees the patients doens't do this...he basically goes in and asks a few questions, might look if there is an open wound, surgical or pressure. Thats it. So I feel like being more thorough will maybe catch something that the MD needs to address. And to assure that the patient is truly stable. Care plans too...........the RNs do....or at least have to have the LPN write them up then the RN reads, makes any needed changes and signs.......
  6. RochesterRN-BSN

    DON states she can't work as a nurse in LTC facility.

    I am in a 120 bed LTC facility and they are right now using LPN nurse managers until they can get RNs to be the unit managers.........however until then me and the DON, and one per diem RN that works a few hours here and there are the only RNs employed there! And here in NYS we have to have an RN in the building for 8 out of every 24 hours. There are things they can't do so me and the DON do all the RN only kind of stuff. Our DON does the skin rounds which included undressing, assessing and redressing a wound. She and I do the assessment part of the admits, post fall assessments, etc. She has her hands in the dirty! I wonder if this DON you have is working on a restricted license. We have a couple of LPNs that work on restrictions by the State Licensure agengy--they can't pass any narcs, can't touch them, hold the narc keys, nothing. I wonder if she is on a restriction that allows her to only do administrative tasks. ????? I would look up her license online to see. It would say it there. Here in NYS its the Office of Professions and they list all the people who hold licenses issued by the state and also list things like restrictions, etc on the license. I would wonder about that cause my DON works her A** off!
  7. RochesterRN-BSN

    Any other new RNs still having trouble finding work?

    Not sure how you feel about moving to upstate NY but I am in Rochester and just started a new job at a LTC facility. My administrator is trying to find RNs for immediate hire........Let me know if you are interested. Send me an PM and I can give you the name of the facility, etc....
  8. RochesterRN-BSN

    New position and need some help

    I am new to my position in a LTC facility as the Inservice Coordinator/Director of Education/Infection Control RN and wondered if anyone here does this job in their facility and might be able to direct me to some resources online. I need to set up inservices for the staff--CNAs, LPNs and other staff possibly (Dietary, housekeeping, etc.) They can be longer more formal inservices or just short 10-15 min quick inservices that I can just do in small groups on each floor. I would like to do something to address the issue we seem to have with staff not complying with the policy about wearing their name badges at all times, the issue of being aware of resident privacy during toileting, bathing, etc. Handwashing.....but I need more ideas and would love to find a website with some materials I could use. Does anyone know of anything or have any good ideas of things you have covered.............. I am new to this role so I could use the expertise of you experienced LTC nurses.
  9. RochesterRN-BSN

    O2 and chest pain

    If you have a patient who is confused/disoriented and really doesn't realize what they are doing....does your hospital allow soft wrist restraints? When I have worked the older patients who are confused in both medicine and in psych and they need IV fluids or O2 and continually try to rip out the IV or take off the O2 we get an order for soft wrist restraints. They don't have to be real tight/short but just enough so they can't get their hands to their face/other hand (if trying to pull out IV)....the other thing too is I have had patients that will pullout a NC as it hurts their nose (or the tubing hurts their ears) but will be compliant with a face mask of O2...some patients prefer and find it more comfortable..... that is an idea too. Either just a plain mask or venti mask, depending on the flow rate...
  10. I would say there is a lot of good information already posted here....helping you to maybe understand that over all it's not that nurses don't want to help but are not able to......I thought I would throw in a couple things........first is that you say some are willing to help and others are not......when I was working on a medical/respiratory floor I found that this changed from day to day.......depending on the patients I had that day/shift. Some days I would be behind all day ready to scream...as soon as I would get close to being caught up something else would happen that took a lot of time, putting behind once again......other days I would luck out and get "easier" patients...maybe just more stabe, less meds, more independant--walkie/talkies we called them, etc. and was pretty much either caught up, or even having some down time. These days I was more available to help the CNAs, spend more time with my patients. Most of the techs would ask for help with changing/cleaning a vent patient as they were too scared they would knock off the tubing, etc. so they wanted a nurse in to monitor the vent with turning, etc.......many days this would take a lot of time and it was hard as it was a really bad day and I didn't have the time but had to make it....... I would also have CNAs that would expect me to stop in the middle of getting meds ready to come in and help.......this is dangerous to stop me as I am checking each med against the MAR to asure I have the right med, it's the right time for it, if I need to split a pill for the correct ordered dose, and I have to check literally 27 meds for one patient. Stopping in the middle of this is dangerous......... So I think over all most nurses help when they can, depending on how their day is going.......yes I have worked with a nurse or two who will sit and shoot the s*** totally caught up then say no to a CNA who asks for help....... As far as report.........I always thought it was important for the CNA working with my patients to get a breif report and have always tried to give one......but I have found that the majority of the CNAs seemed annoyed or disinterested. Like I was wasting their time. I like to work as a team with my CNA as much as I am able, communicating at the start of shift as well as throughout the shift and again at the end of the shift to see if they have any info to report that I may want to include in my charting.....the CNA may be the person who can tell you that the pt had 8 BMs that shift and that he /she walked the pt in the hall and how far the pt was able to ambulate,etc...things I need to report in my charting.... I have always said that a good CNA is worth their weight in gold and a bad one can be more of a hassle then a help........the ones who have an attitude, treat the patients poorly, are lazy and complain all shift. An RN or LPN and their CNA working well together, as a team is what gets the best patient care. It's kinda delicate balance! lol
  11. RochesterRN-BSN

    Socialized medicine and nurses pay...

    OP here....WOW this thread has gone on for a lot longer then I expected when I first posted my questions.......a large number of posts were so political and detailed I honestly got lost! lol But thanks for all the posts.......I really was just wondering how nurses pay really is effected by these systems.....
  12. RochesterRN-BSN

    I am watching Michael Moore's "Sicko" for the first time....

    I watched that movie for the first time just a few weeks ago........actually I posted a thread afterwards curious as to how social medicine would affect me as a nurse.......got some interesting feedback! The movie does get ya thinkin though doesn't it?!!?!?
  13. RochesterRN-BSN

    What can I do about sister with hoarding OCD

    I think you could be right but a full evaluation by a psychiatrist would be a good idea, and if she does indeed have OCD there are meds that can help a lot......however unless her behavior is unsafe its not like you could call and get her MHA'd to a hospital for an eval and even if you did if she is not a safety risk they would discharge her, despite maybe diagnosing her with something like OCD.....however the other part of the problem is if she doesn't feel this behavior is a problem she won't continue with outpatient treatment and certainly would not be med compliant so its a catch 22. She needs to want help and needs to want to take meds and you can't force her to get that help unless she is a danger to herself or others......if there is danger in a sense of living conditions, etc...that could be an argument but hard to say...... There would need to be a full eval as well to be sure the hoarding is not related to any kind of paranoia, which I have seen or if it's more of an anxiety d/o like OCD. It's a lot more involved to do a full eval.....trust me, that is what I do for my job.......the nurses do 95% of the eval in our psych ER, then then the doc gives the dx. Hope this helps.......and like a pp said if she doesn't want help and is not a danger you may just have to live with her the way she is.....
  14. RochesterRN-BSN

    Question about Anti-Social Personality Disorder

    Unfortunately there is not a treatment for ASPD, even if he does have it. The most you could do is if he is unsafe again call 911 and tell them you want him mental hygiene arrested and they will have to bring him in for an eval...... Here is some interesting info I got on an a-mail--I am part of a group on Facebook called stop the mental health stigma and they send out info on different dx each month.......this e-mail was about ASPD Hope it helps Diagnostic Features: Antisocial Personality Disorder is a condition characterized by persistent disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. Deceit and manipulation are central features of this disorder. For this diagnosis to be given, the individual must be at least 18, and must have had some symptoms of Conduct Disorder (i.e., delinquency) before age 15. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. Complications: Individuals with this disorder have an increased risk of dying prematurely by violent means (e.g., suicide, accidents, and homicide). Prolonged unemployment, interrupted education, broken marriages, irresponsible parenting, homelessness, and frequent incarceration are common with this disorder. Comorbidity: Anxiety Disorders, Depressive Disorders, Substance-Related Disorders, Somatization Disorder, Pathological Gambling (and other impulse control disorders), and other Personality Disorders (especially Borderline, Histrionic, and Narcissistic) frequently co-occur with this disorder. Associated Laboratory Findings: No laboratory test has been found to be diagnostic of this disorder. Prevalence: The prevalence of Antisocial Personality Disorder in the general population is about 3% in males and 1% in females. It is seen in 3% to 30% of psychiatric outpatients. Course: The course of this disorder is chronic. This disorder is usually worse in young adulthood and often improves in middle age. A common misconception is that antisocial personality disorder refers to people who have poor social skills. The opposite is often the case. Instead, antisocial personality disorder is characterized by a lack of conscience. People with this disorder are prone to criminal behavior, believing that their victims are weak and deserving of being taken advantage of. Antisocials tend to lie and steal. Often, they are careless with money and take action without thinking about consequences. They are often agressive and are much more concerned with their own needs than the needs of others. Symptoms of Antisocial Personality Disorder: * Disregard for the feelings of others * Impulsive and irresponsible decision-making * Lack of remorse for harm done to others * Lying, stealing, other criminal behaviors * Disregard for the safety of self and others What are the treatments for antisocial personality disorder? Another very common question asked is, can antisocial personality disorder be cured? While it can be quite resistant to change, research shows there are a number of effective treatments for this disorder. For example, teenagers who receive therapy that helps them change the thinking that leads to their maladaptive behavior (cognitive behavioral therapy) has been found to significantly decrease the incidence of repeat antisocial behaviors. On the other hand, attempting to treat antisocial personality disorder like other conditions is not often effective. For example, programs that have tried to use a purely reflective (insight-oriented) approach to treating depression or eating disorders in persons with antisocial personality disorder often worsen rather than improve outcomes in those individuals. In those cases, a combination of firm but fair programming that emphasizes teaching the antisocial personality disorder individuals skills that can be used to live independently and productively within the rules and limits of society has been more effective. While medications do not directly treat the behaviors that characterize antisocial personality disorder, they can be useful in addressing conditions that co-occur with this condition. Specifically, depressed or anxious individuals who also have antisocial personality disorder may benefit from antidepressants, and those who exhibit impulsive anger may improve when given mood stabilizers.
  15. RochesterRN-BSN

    my first poop/ nasty experience... just wanna share

    Funny story for ya...think you will appreciate....... one of my peers in nursing school had a fun experience with poop! lol We were in our first clinical at a long term care facility and she had a patient with diarrhea....she had a pan of water and wash clothes cleaning him up and with the diarrhea the water was getting pretty gross pretty fast so she bent over to pick up the very soiled bin of water with lots of poop in it to go and get a clean bin of water and keep going.....and well she had made the mistake of putting her keys in the pocket of her scrub tob, the chest pocket! and yeah you might know what I'm gonna say.....the keys fell out and into the poopy water!!! Mind you these were her keys, personal keys--house, car, etc-- she pulled them out with a gloved hand and carried them to the sink and put them on a paper towel-- I think she did tryto rinse them quick--finished up with the patient and then came out with the keys in paper towels with her gloved hands looking like she was gonna either puke or cry, and sort of laughing too...to the instrutor and says....ummmm I have a little problem........how do I clean these!!?!?! My instructor and she went into the dirty utility room and I could here the giggling from the hall! lol She never lived that one down!!! Well that is until she passed out in a patients room and the little old man (the Pt) is leaning over the bed (bedbound) saying "oh honey, are you okay down there???" she awoke to hear him saying this! she was fine--was over heated and had not eaten...........but between the fainting in a patients room and the keys we teased her all year!! lol
  16. RochesterRN-BSN

    Need Help

    There is a lot of evidence (and proof!lol) that both exercise and doing things like crossword puzzles, word scrambles, sudoku, using your non-dominant hand to do things that you usually use your dominant hand for, all those kinds of things decrease the risk of alzheimers and well generally "losing your marbles" with old age........lol..... Likey you could find things on that on the web.... look at http://www.memory-key.com/Seniors/senior_research_exercise.htm http://www.mwsearch.com/anti-aginggame.html one on the benefits of exercise to cognitive function in the aged and one on how stimulating the brain can slow down aging........ Hope this helps.....good luck