mjjlRN

In my current hospital, if the visitor/staff member is too unstable to transport to ER per the staff who finds the situation, then a regular CODE BLUE is called so the person can be stabilized. I did work at a hospital that had a special code to call for non-patient emergencies, but I can't remember what they called it. The code team still responded, and brought a special duffle bag (similar to what our current EET team uses) so that the actual code cart doesn't need to be broken every time. I am curious about the PP who stated that they call EMS for non-patient emergencies outside of the actual ER - isn't that an EMTALA violation?

We have one on the code cart. We do NOT have one in each room at the hospital I currently work. I have brought this up with my manager, requesting one in each room, or at least some kind of one-way valve mask resucitator in each room for mouth - to - mask breathsk and was told that it was too expensive. I was unable to reason with her, as she stated that it is on the code cart, and that should be enough. I envy those of you with one in each room!

I agree with PP. I will add, that you need to speak to your manager about this. I had this happen to me at a previous job in another city 3 times, but I was coming back from vacation or time off, say my scheduled day back was Monday, and on Sunday night at about 7:15 I would receive a call asking me why I wasn't at work. Well, I said that I wasn't scheduled until the next night, but they said I was on the schedule. The first 2 times I came in anyway, because I felt bad that my co-workers were counting on me. after the 2nd instance, though. I spoke with my manager, and told her that my schedule, once posted would NOT be changed again without my written approval. The third time it happened, I had a copy of the original posted schedule at home, (that had been posted the day before I left for my 2 weeks off), and told them that I was NOT on the schedule for that night, I would be returning the next night as previously scheduled, and that I would NOT come in, no matter how short staffed they were. (and that they needed to call my manager who had changed the schedule if they had any other questions.) Turns out, my manager had to come in and work that night. But you better believe, after standing my ground, it never happened again!

When I worked on a Heart Transplant Unit several years ago, we would give the patient frozen grapes to help with their thirst, or those oral care sponges dipped in a few ice chips (but we were careful even of these as to not give them too much.) As for allowing the patient to go over their MD ordered fluid restrictions, I am not an enabler, and will not bring patient more water/fluids than is ordered, just as I will never wheel a patient outside to smoke a cigarette. I cannot keep their family from smuggling in fluids from outside, nor can I prevent the ambulatory pt from drinking from the sink, but I will be sure not to leave any cups lying around. I don't see how one MD order is different from another. If the MD orders Lortab 10, 1 tablet q6h prn, I surely do not give my patient 2 tables q4h. I personally do not see the difference.

If the patient has CHF, then the ACE inhibitor was likely prescribed to comply with CORE measures, as it is a requirement for a CHF patient to be on an ACE or an ARB (as long as there are no contraindications such as CRI, hypotension, true allergy, etc) with a diagnosis/history of CHF and an EF of As for d/cing the iron pills, I have no idea. It is a shame that the MD was so rude to you over the phone, instead of taking a minute to explain his reasoning to you. Unfortunatly, we do have to deal with this sometimes. Do not let this deter you from calling in the future to clarify orders, though. Remember, it is YOUR license on the line! (I will add that I had a patient a few weeks ago in the hospital setting that had a chronic anemia that was being treated as iron def., but when the HEM/Onc did further testing, realized that it was NOT iron def anemia, and promptly stopped her Multi Vits and Iron pills, saying that her IRON reserves were very high, and the Iron supp was harming her rather than helping. I added this to tell you that there could have been a good reason, even if the MD wouldn't explain it to you. )

I worked in a facility just instituting a clinical ladder a few months before I moved, and what I remember, was that you needed a certain # years experience for each level, as well as the committees, certifications, degrees, etc. So it was something like you needed at least 3 years experience to move to level 2, 5 (or 7, I can't remember) to move to level 3, and like 8 (or 10) for level 4. That time limitation helped those green nurses gain experience before being pushed into precepting and charge roles.

On our computer printed out MARs, certain meds always have certain instructions/comments that print with them. Some of those are comments include, take on empty stomach, take only with meals, Do not crush, etc. So, no matter how the med is ordered, those instructions appear. The prudent nurse reads his/her MAR and follows it. I know there are many who crush them all anyway, though.

I agree with above posts. Also to say, a stroke/cva is possible in conjuction with an ami. Most AMIs are caused when a severe coronary artery blockage becomes complete, usually d/t a microclot/platelet aggregation in the blockage. If this clot is dislodged, it can travel to the brain, thus causing an iscemic episode. Whether or not this happened in this case, I don't know.

Our wound care Doc for the hospital always orderes Vit D levels on the pts he sees, so I asked him one day. He says that his personal experience has taught him that most if not all pts with chronic poorly healing wounds/ulcers are vit D deficient, and that if the Vit D is replaced (and does in pretty large amts), that it really improves wound healing in these pts.

I was in the same situation nearly 10 years ago, and that is exactly what I did. I called up 6 different hospitals in the city I was moving to, and left messages with HR that I would be in town between such and such dates, and would love to set up an interview. Only 1 called me back for an interview. When I got there, I went to all the hospitals, resume in hand, and got 4 interviews, the other 2 wouldn't give me the time of day, which said something about those organizations to me, that I probably didn't want to work there anyway. And I did get offers at each interview, so I say go for it!

Sorry, I would have never done what you did. The ONLY thing I have ever even heard of piggybacking into TPN is Lipids. The only thing I would ever piggyback with Blood products is NS. I'm not sure what you mean by a "carrier", though. Is is something that could have been held for the length of the blood transfusion? if not, I would have either started a peripheral line for the blood or carrier, or I would have contacted MD about declotting the TLC's other port.

I currently work in Mobile, AL. I think you will likely find RN salaries lower in AL than most other places, but take into account the cost of living is also usually lower. With 9+ years of BSN/RN experience, as well as certifications as ACLS and NRP, I make just over $23/hr, plus shift and weekend diff. Your best bet would be to call various hospitals in the area you'll move to and just ask.

With each of my 2 pregnancies, i went on bedrest at approx 32 weeks. my first son was born at 38 weeks, so that was nearly 7 weeks of bedrest prior to his birth, then I ended up staying out a total of 16 weeks, however, I was NOt a full time employee, and was NOT employed for > 12 months prior to his birth, so this pregnancy wasn't covered by FMLA anyway. I was "released' from my position at the hospital, but my nurse manager told me that I would be rehired into my same position when I was ready to come back, and that she wouldn't fill it, as she had plenty of other PRN nurses to fill in while I was out. I ended up coming back full time, since I was so impressed with how well she handled it. For my second son, i delivered him at 37 weeks, after 4 weeks of bedrest, and stayed out until he was 8 weeks old, to total 12 weeks. This one was covered by FMLA, and I stayed out the max 12 weeks covered by law. My hospital offered STD insurance, but I chose not to buy it, so I used up my Vacation time first, then my sick time, then the last several weeks were unpaid leave. When You do have STD coverage, it is NOT in addition to FMLA, but concurrent. The Law covers you for a total of 12 weeks, regardless if it is paid leave per StD or unpaid leave. After your 12 weeks in a year (does NOT have to be concurrent weeks) legally, the hospital can "release" you or fire you, and you lose all your benefits, etc. I have a close friend who happened to have 2 babies, 14 months apart. She took 12 weeks off, from March-May with the first. Then, with the second (who was of course unplanned), he was due the following May. Unfortunately, she was put on bedrest due to preterm labor, and exceeded her 12 weeks for the year 1 week prior to his birth. she received a letter in the mail stating that she was 'released" and would be eligible for rehire after a certain date. luckily for her, she was insured through her husband, but she did lose her sick time, which she was planning on using while out. Hope that helps.

I would either call the Pharmacy and ask them to reschedule the dose, or I would ask the MD to write a clarification order, with the dose due at 1800 instead of qhs. I would NEVER give the dose and then ask the next shift to sign it off for me, nor would I sign off a med given by the previous shift.

Often, as a nurse, i have patients tell me that they are "terrible sticks" and that they "always" require a picc line. some have told me that the ONLY place I will ever find an iv is on their left wrist, and don't even think about looking at their right hand, etc, etc. I always smile, nod my head, and say "well, let me just look all over before I stick you, OK." Some times, they are right, and their only vein is on their left wrist. . .usually, they are wrong, and they have several possiblities to choose from. I always try to start an IV were it will bother the patient less (not in AC if I can avoid it, and not on their dominant arm if possible.) However, usually in the ER, they are attempting to draw labs and start a largeer IV at the same time, and they probably attempted the IV in the best place to suit their needs, even if it wasn't your mom's suggested place.

What I don't understand is, if the assignment was so bad, why didn't they split it up? At least you could have kept some of your pts from the previous 2 nights then. Also, we have 1 particular nurse who "can't handle it", too. We used to try to take the harder stuff, but she seemed to always end up with an easy assignment, and was still having trouble and/or/ complaining about it, so we stopped, and decided it was time for her to pull her own weight. Anyway, it just isn't equitable for one nurse to always get the harder assignement and another to always get the easier assignment, it is bad for staff morale,and I would let your boss know if this continues to happen.

I would guess that it depends on how it happened. if the patient leaves AMA or just goes AWOL, then this should have NO bearing on your license. However, if this is a regular discharge, and the nurse simply "forgets" to take out the PIV, then I can see a problem. We always must have an MD order on the chart to d/c the patient with IV access if the pt is to go home with it (a PICC line, I've never d/ced a pt with a PIV before).

as for the 10cc flush, I always use one when I start a Peripheral IV, I like to flush with a full 10cc to be extra sure that it is a good line. To the orig. question: I take a towel (folded as it is on our cart) then place my 10cc flush, my J-loop, my IV start kit, and my jelcos (usually 2 20s and an 18) on the towel, and I roll the towel up around the supplies, then, I just have to carry a towel roll into the room. . .the towel then goes under the patients arm to catch blood.

We are required to do a fall risk assessment q shift, if the patient is deemed at risk for falling, they get bright yellow gripper socks, a yellow arm band, and a "falling leaves" sign on their door. We also have signs that we put in the rooms. Green sign that says you may be up ad lib, a yellow sign that says please have a family member or staff member with you before getting oob, and a red sign says stop, do NOT get oob without your Nurse/CNA present. We also are required to do hourly rounding (the nurse, CNA take turns) and assess for the "4P's" that cause most falls: PAIN, POTTY, POSITION, and POSSESSIONS. If we have a patient who we think will not listen and will get oob without calling for help, we try to move them right in front of nursing station and leave their door open, which helps, too.

I understand the anxiety you have, and it is really hard coming into work "late" and playing catch up all day. I have worked placed where we were required to be "on-call", and as long as you are being paid on-call pay, I wouldn't be complaining too loudly. Currently where I work, they give "HR"'s which are Hospital Rquests Off for low census. We work 12 hour shifts, though, and they will only give out an HR in 4 hour increments. (ANd we do NOT get paid anything for this HR) For example, if I am scheduled 7a-7p, they will call around 0530 and give me an HR, but I have to be "by the phone until 0730 unless someone doesn't show up. Then, I have an HR until 1100. I am responsible to call the unit by 0930 to see if they need me for 1100, and if not, must stay available until 1130. then, I have an HR until 1500, but must call by 1330 to see if they need me. If not, I have to be available until 1530 before I can actually do anything. So, really, I can't do anything with my day on the chance that I get called in, and I am NOT getting any call pay because it is an "HR" even though I really only have a few hours of not being on call through the day. It is a huge bummer, and for that reason, I usually ask to be floated to another unit instead of taking an HR if they call in the morning.

In my hospital, Consents are only valid for 24 hours. Otherwise, I think is a great idea for those who have planned births (either c-sections or inductions) Not so practical for those with more complicated deliveries such as pre-term labor.

As an RN at my facilty, I am currently precepting a senior BSN student. She went through the charting class, and she charts everything (Except the Plan of Care) just as a nurse would. Then, I go behind her, read all her charting, and must co-sign everything (There is a special tab to click on to co-sign in our system). When I co-sign, I have the choise of agreeing with or modifying the student's assessment. Because I am precepting the student, I do not have to chart my own assessment, I simply co-sign hers. However, when have students with their instructor on the unit doing their clinicals, they chart, their instructor co-signs and checks their work, and I chart my own assessment as well.

I would call up the Nurse Recruiter and ask. I also work in Mobile, AL as an RN, but live in Mississippi. When I moved to the area, 2 years ago, Singing River paid nearly 2 dollars/hour more for full-time than where I finally chose to work (but the schedule where I took a job was better).

OK, here is my 2 cents. (know that this is coming from an RN, BSN) I would suggest you start the CNA route if the pay will be enough for you. It is a relatively short program before you can get started. Once you are working, you will get a good idea of the different roles of CNA, LPN, and RN in your hospital, as well as the different areas available to work in. Many hospitals have tutuion assistance for those workers who go back to school for nursing. I would suggest working as a CNA for a while, getting used to the job, and then going back to school with the hospitals assistance for your RN. Some hospitals still utilize LPNs alot, and some are phasing them out, it's a hospital-hospital thing. . .that would definately be something I would check out before deciding to do LPN school, because if you do not think you could be happy in a LTC facility, and your local hospital doesn't hire many LPNs, then you would essentially be wasting a year of school. HTH.

I was actually informed by an irritated patient (of another nurse whose call bell I was nice enough to answer) as I helped her to the bathroom the other day, that she had NOT been "waited on" like she wanted this hospitalization, and that the hospital CEO would be receiving a letter about it. I kindly said how sorry I was that her experience was not as good as she hoped, went on the do several things for her in the room (fluff the pillow, get a warm wash cloth, etc), then left the room rolling my eyes. . .you just can't please some people. However, I do try to make them happy. . .then complain about it at the nursing station.