DanidelionRN

Actually most hospitals I have worked at (traveled med surg to 10 states) have policies for med administration, and administering the med at the closest available port to the patient is the standard appropriate intervention. And flushing after each medication with saline. Though this does not mean that you are going to push it faster than is appropriate, administering it at a safe speed through a close port means you are ensuring that their entire dose is administered in a timely fashion, and isn't delayed due to something like an IV line running at 20ml/hr.

Sounds like time for a new specialty. Are you interested in pursuing a job where you don't have 33pts?? Inpatient nursing, pacu, pre-op,clinics, public health, etc... Almost everything but long term care/rehab is going to be an improvement

Sounds to me like you're planning ahead to fail, instead of planning ahead to succeed. The only actually appropriate options are to resign and leave, which will probably screw over your coworker's vacation altogether and be a jackass move, or to connect with your coworker now, learn about the things that you feel unequipped to deal with, and read up on the things you are lacking. If you are so useless as a manager that you can only tag along behind someone else, are unwilling or incapable of planning and learning and broadening your horizons, and are unable to do any work on your own, you should resign and find a job you are competent at. Nobody needs an incompetent manager. If having no manager is better than having you, then you should be doing a different job. And as a nurse, I loathe working with managers who are ignorant and too lazy to do anything about it. You don't have to do everything perfectly with twice your normal workload...but you do need to continue to be a professional and do your best, and find solutions for the things you cannot do. But seriously, a urostomy is something that RNs provide education about at the hospital all the time, and we do not have special qualifications to do so. You read the patient education materials, learn what you're supposed to be teaching, maybe watch a Youtube video or two, and figure it out. It's not that hard, and you should be fully capable of figuring it out if you managed to make it through nursing school. If you already know you may need to provide a patient with additional information about his urostomy, you can start figuring that out now, in advance of your colleague's departure on vacation.

I think that the nurse in the original post is not just an enabler, but she suffers from a lack of personal boundaries in her relationships. It probably exists in all her relationships,not just that one. When you allow other people's wants and desires to run over your needs and healthy boundaries, it isn't good for you. The reality is, we are all only responsible for ourselves, our choices, actions, reactions, thoughts, and feelings. We are not responsible for other people's actions, reactions, thoughts, feelings, or choices. This manipulative friend has learned that if she uses guilt as a weapon, she can control the nurse friend and get what she wants. She doesn't have to be responsible for herself, take care of her own problems and responsibilities, because if things are difficult or she needs something all she has to do is convince this nurse to give in. Every time that this nurse gives in, she only reinforces the behavior of the needy friend and does "enable" her to continue to live her life without consequences for her actions. I don't really know if this is particularly more prevalent among nurses, but I do think it is more prevalent based on people's personal experiences in childhood and relationships growing up, and how they were taught to treat people. Someone who is taught to always be compliant, and that their needs are selfish or unimportant, becomes a doormat and has more difficulty sticking up for themselves. I highly recommend your friend read the book Boundaries, by Henry Cloud and John Townsend. It is fantastic.

Depends on how precise the med is. If critically important, I would draw it up in smaller syringes. If this is something where it is less precise, I will draw it up to halfway between two lines, if I need the number in the middle.

Not every error is automatically reported to the BON. Did your employer tell you they were reporting you? If it a grievous error, like something that has seriously harmed a patient, it probably depends on why and how it happened. Was it gross negligence by the nurse? Pill in the wrong compartment of the pyxis, equipment malfunctioning? Does the nurse have a pattern of dangerous behavior? If you just accidentally gave a whole vitamin pill instead of a half, or you had an error of omission like missing a dose of something, or read the label wrong about when something was due- unless you are doing it a lot, hiding it, or falsely documenting it, I bet they don't report you at all.

HCA hospitals are some of the lousiest ones in the country, and they do DNR people for a variety of bogus reasons. It shouldn't affect you outside of their systems, but there is very little to nothing you can do about it now. I would just look elsewhere- they don't control all the hospitals in the country- and you may be pleasantly surprised by the improvements in patient ratios and quality of equipment and care that you find elsewhere.

My husband is 31, and has had a life full of injuries, culminating in a car wreck that has pretty much left him disabled from working. Unfortunately, he got to experience part of the problem with narcotics that this country has. When he had the accident, he was given 3 days of hydrocodone and methocarbamol from the ED, and told to follow up with a primary. He didn't have one, so we made him an appointment and established a primary physician. She would do nothing for him for pain other than refer to pain management. He also had chronic migraines, and she apparently thinks pain management manages those too. It was a colossal waste of money. He didn't want to be on opioids, really just wanted to know what was wrong, and fix it. He also really wanted to find non-opioid options for his pain control. The MD didn't seem to know what to do, other than refer him. The pain management MD didn't care to do anything besides handing out hydrocodone, 180/month, and ignore all input we gave on side effects, constipation issues, etc. We asked if gabapentin could help. He tried it for a month, at a very low dose. It helped but not a lot... so he didn't prescribe any more. Nobody tried to offer anything like Voltaren gel, or lidocaine patches for his back pain; just hydrocodone. Questions regarding preventative meds for reducing migraines, got nothing. After three months of the pain management MD ignoring our feedback, by husband blew up at him for not listening, and the doc offered to do some steroid injections in his back. Of course, by this time, there was no way he trusted the doc. So he never fill his last script, never went back, and lost hope in pain management in general. He pretty much just takes nothing now, and just hurts all the time instead. Some days he can't even wash dishes or do any chores around the house. He is doing much better now, almost two years since the accident, but it is really sad that everyone he tried to get help from, either seemed to not take him seriously because he is "young" and therefore can't possibly be in pain, or must be an addict, and it is really sad that primary md's aren't knowledgeable about non-opioid options.

Very well stated. I worry about a hike like this because it essentially decreases my purchase power by about 40%, and it's not like insurance companies are going to pay hospitals more, or hospitals pay nurses more, just because of it. It will probably take decades to get close to equalizing, and we already make crap in a lot of places. In AR, new hire RNs WITH experience starting at 19.50/hr when I was hired there. 4.50 above the expected minimum wage is just terrible. People in big cities in CA and NY for example are just ignorant of the way that wages work for other parts of the country where wages are lower. Sure, an RN in CA could make $55/hr, but that's really really high vs the southern states, for example. Another peeve I have: if CA hospitals can afford to pay nurses $55/hr, and stay in business......where the hell does a southern hospital in AR get off paying $19? Don't the insurance companies pay them equally?

Where are you all at, geographically? I am curious about how location affects staffing practices.

To the person saying "maybe arcane rules at schools like having to abide by manufacturers expiration dates is why homeschooling exploded in the last few decades"....... As a homeschooled graduate, I would say no. The rule males sense for liability purposes and anyone with a logical brain who has any hope of homeschooling their children successfully, can understand why the rules would be in place. Homeschooling skyrocketed because a:there is great curriculum out there now, where there wasn't as much before; b: test results confirm that homeschooled students on average score better than their public school counterparts, c: parents have a desire to individually tailor their child's education to enhance learning by focusing on their strengths and weaknesses, and individual attention rather than being 1in 30; d: you get to control what kind of experience your child has with the less savory side of the public, a bit more. No bullying, abuse by teachers or peers, intense peer pressure, pressure to be popular, etc.... because your child learns to encounter the world on his or her own terms, because they have a sense of who they are for themselves, without needing to"be like" someone else, or fit some mold. e: you get control over WHAT is taught, and how it is done. Maybe you don't like the "new" math? Teach it the"old" way. You want to go on a road trip for a month in autumn? School can go with you, and you can also schedule lesson plans to accommodate the schedule you want. Maybe you don't think your five year old needs exposure to what homosexuality or sex are, yet, or want to provide age appropriate information based on your child, and the values you want to instill in them. Homeschooling lets you do those things while providing a child with an excellent education and a love of learning that benefits them for life. It has very little to do with not liking school rules related to safety.

and you think that you have the right to demand answers from every caregiver you have, as to whether they own guns? I don't think so. You deal with people who have concealed carry weapons all the time- but because they are CONCEALED, you've got no idea. This is the way it's supposed to be. If a workplace were to allow concealed carry, there's no way you're going to get a conceal carry permit holder to just out and declare to you that they're carrying, and you sure as hell don't get to pat them down....... so you'd essentially just have to choose to go elsewhere for care, if that was the case.

homeschooling is wonderful thing. I was homeschooled, and I cannot imagine a better way to learn and explore the world, than traveling around the country and learning as you go.

I am originally from Wisconsin- and I really supported their anti-union legislation recently. Previously, when I was looking for jobs in WI, I did not really see ANY differences between union and non-union positions, in the way of staffing, or pay, except that the union jobs paid a tiny bit higher, and then basically the whole difference went to the union. I don't like the idea of being FORCED to give money to someone who claims they are going to make my workplace better for me, without them having to actually prove that they can/are doing it, to get my money. That's the whole idea of "Right to work"---- that if the union is crap and isn't actually improving the work environment, I don't have to pay them for their efforts. In the past, I believe unions had a purpose- particularly in the time without things like OSHA. Today, however, I really don't know of any particular things that a union has done that is worth paying them my money. To me it's essentially the same pattern as the feminism movement- right to vote and equal rights, was a wonderful accomplishment, and very important... but the people who call themselves feminists today are vastly different in values and goals than the "original" feminists who accomplished the women's right to vote. Beyond that, I REALLY loathe the democratic party, and I will not work somewhere, where a portion of my wages gets donated to them- and most unions pour money into the coffers of the democratic candidates. I care too much about vulnerable people who cannot speak for themselves, to be okay with the policies of the democratic party, in regards to abortion and euthanasia. If I want my money donated to a political cause, I'll put it there myself, thanks very much.

You know, i lived on less than 8k a year for living expenses etc, when I was in college- it wasn't all that bad, especially if you divide out the cost of rent/utilities six ways, too. The problem with that example is that kids don't result in extra rent to that same degree. If you're paying rent on a 3 bedroom apt for example, which is sufficient for a family of six- two bedrooms would even be sufficient if you happen to have all girls, or all boys- your cost is probably only going to go up a couple hundred dollars at most, unless you live in a horrendously pricey area. Here in NW AR I can get a 2 bedroom apartment that's nice and spacious for $595/month. My family growing up (not a long time ago, as I'm in my early 20s),subsisted on 35-40k a year, with 2 parents and 4 kids... so.. family of six, homeschooling and my dad being self-employed- meaning he had to pay BOTH halves of social security rather than having an employer to pick up the other half... (think, if SS/medicare deductions from your paycheck were TWICE as big). It was comfortable. You have to buy clothes at Goodwill and occasionally walmart, and buy groceries in bulk and pay attention to the prices; no name brand stuff when generic will do- and you can't have steak and pineapple and shrimp and fancy things all the time- but you can be happy. it IS tight... and I kind of want to know how my mom and dad did it- as I have 35k a year NOW, on my own, and wonder where all the money goes sometimes. But.... it's not an unfathomable amount of money to survive on.

What planet are you from? Fresh out of school I made 34k, (2011), time and a half for holidays/overtime, no weekend bonuses, no extra shift bonuses, shift differential was a dollar but I worked days so I didn't get that, and yeah, we got a raise- but a performance evaluation raise is 50 cents at max- and at $20/hr, I was already being paid less than a lot of other states- Iowa is one of the lowest paying states in the nation for nurses. Arkansas, where I just moved to, isn't much better. Getting 19.50/hr at my new job here in the Obs unit. I love it so far though. Compared to LTC/SNF, the patient load is nicer, there's a unit secretary to do a lot of the paperwork stuff I had to do at my last job, and the people and the organization is nicer. And it just about made my day to find out that I get holiday pay for holidays even if I'm not working. :) But.... I wouldn't say that it's big bucks. I think the majority of nurses in our nation do NOT make 70k a year- and the staff nurses probably make 40k as more of an average. Is this adequate? For me, yep. For me and my fiance? It doesn't cover the bills. He's job searching to relocate to me, but right now he's 400 miles away, and he can't relocate to where I am now, until he has money to be able to cover his car payment while he job hunts- because the extra $400/month doesn't fit into my budget.

Romney, all the way. Why? Because he understands how to manage money. And because he's actually got a good record at the state level, and because he actually HAS a campaign platform, other than "attack the other guy". Obama has been an incompetent moron thoughout this presidency with no clue how to actually grow the economy or advance the nation- all he's done is throw bones to his special interest groups that donated campaign money.

The difference is though, between patients refusing treatment or interventions... is that they have to be competent and alert/oriented to do so... and at times, that can mean choosing not to remain in a facility, if the things they want to refuse are significant enough. The same family members who refuse alarms, tend to be the ones who play pharmacist and doctor and want to dictate for the nurse exactly how to care for their family member, and having them around is not always worth the liability.

I think that alarms should be a condition of staying at the facility, if indicated by the resident's condition. If the family wants to refuse, they should be told to kindly find their relative a new place to live, or provide 1:1 monitoring, themselves. We can't be everywhere at once, and if a client has dementia enough to be non-compliant with waiting for assistance at times, a wheelchair or bed alarm could have saved them from falling, because they go off when the person starts to TRY to get up, giving staff time to RUN down the hallway and go rescue them. I have had countless times in our facility when I was working in LTC/SNF that a little lady would be sitting at the table and decides to take off without her wheelchair, or her walker- sure, people should be watching, but you only have eyes on one side of your head, and the alarm alerts you to look and see what's going on. If a family wants to refuse an alarm, because they don't think it's necessary, they can do 1:1 with that patient, thanks, because we don't have the staff to 1:1 every single patient -and they aren't the ones there 24/7 to see that their elder gets disoriented at night, or is only half as alert and oriented whenever they aren't present.

the link given by a previous commenter mentioned that tryptophan, building up in the body, could cause blue urine- particularly if one were constipated... often it seems that hospice patients do suffer of constipation at times.... is she eating lots of turkey?

I have a Littmann Master Classic II... I love it. I haven't had any issues with people stealing it, but then, I DON'T let it out of my sight. The idea of the store being too loud is not a very good reason to not hear well... remember- patient rooms are not always going to be quiet places!

Yes, it's LTC- but Rehab usually means there's a rehab unit- short term rehabilitation patients, rather than all long-term. They may stay a week to a few months, for anything from IV antibiotics and wound care, to therapy after having a knee replacement, to therapy for strengthening after a bout of pneumonia, and then go home. That's what makes it different than just a long-term care home- but most rehab facilities tend to have a LTC unit or LTC beds in their facility, for those who are admitted as LTC, because they do not recover adequately for being discharged home.

I don't get any differentials, personally- but i do work days. I did not hear about there being differentials for the night shift though. Our facility does though, have problems with some of the night shift nurses in some ways- several nurses I've known have had to go to work in the middle of the night to start an IV because the facility didn't schedule an RN for the shift (I'm not sure how that's legal, honestly), to find all the night shift nurses sitting around the nursing station playing cards... or taking turns taking naps on the job!.... while they fuss at the day shift if they haven't managed to process all the dr's. faxes and lab results that came pouring in an hour before the end of the day shift (during the 4pm med pass). I'm pretty sure there'd be an uproar from days if nights got paid more, unless they started doing more too. I do get alright benefits I suppose- though I'm seriously contemplating skipping the insurance and just getting pay in lieu of benefits (they do that here) and putting money in a health savings account- since I don't really spend $150 a month on healthcare stuff, and that's what I"m losing through deductions.

Thanks. I couldn't find a page like that one for some reason- I had only found a long complicated PDF document of rules that only talked about the IV stuff. That was helpful. I still think my facility is messing things up though, from reading that- in that- "Initial assessment" is required to be done by an RN... and at my facility, that doesn't happen. If an LPN is working a hall that gets an admission, they typically do all of it. I've definitely met a couple of LPNs at this facility who kind of have me wondering how and why the hell did they ever becomes nurses at all- but overall most of them are pretty excellent. I definitely have learned a lot from some of them.

This doesn't always work. My facility does not provide much in the way of equipment. When I was hired, I was a bit shocked to discover that every nurse had her own thermometer and blood pressure cuff- the facility has a basket of ear probe covers, and a thermometer or two kicking around somewhere, but not always able to be found- and the manual BP cuffs are in such sad disrepair that on one occasion I had a resident who was experiencing some odd symptoms, and whom I was trying to check BP on; the wrist cuff I borrowed from another nurse didn't work on this lady accurately, the first manual BP cuff I grabbed literally POPPED as I was inflating it, the second one had a leak in its tubing- and it took me rummaging around to find a third cuff that was in working order, to be able to take this poor woman's blood pressure! (which turned out to be WNL). I now have my own temporal thermometer and wrist BP cuff- as it's the only way to guarantee I will be able to find them when I need them.