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vicarious

vicarious

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  1. Does your facility require a physician order to double concentrate an IV drip? In my facility, we mix some of our own drips, e.g. 40 mg Neo in 1000 ml NSS (or 20 mg in 500 ml). We have no hard and fast policy on mixing drips or double concentrating them (or even quadruple concentrating them if we are really trying to limit fluid intake). I did not think we needed an order to double concentrate a drip. Another nurse told me that we had to get an order before we did so. When I asked her why, she said "just because that's the way we've always done it." When I said, ok, putting that aside, why do I need an order to double concentrate a drip, she replied, "You are altering the dose of medication." I disagree. I feel like it's 6 of one and half a dozen of the other..I feel as though I can compare it to this, even though the situations aren't exactly the same...if a 1 L bolus is ordered and I use 2 500 ml bags versus 1 1L bag, what is the difference? If 0.5 mg Ativan is ordered and I split a 1 mg tab in half rather than use a 0.5 mg tablet, what is the difference? Thoughts?
  2. vicarious

    keeping glucometers clean

    If you do a finger stick correctly, if the patient never comes into direct contact with the glucometer itself, and if you aren't placing the glucometer on the patient's bed or sheets, I see no reason to clean the glucometer after every patient use. The last thing I am thinking about is how clean a glucometer (esp. one my patient is never going to touch) is. I'm more worried about my hands and the things I have with/on me, like my scrubs. The people that think the glucometers on the typical med/surg unit are getting cleaned after every patient live in a fantasy land. I'm starting to wonder if maybe they think we just haphazardly prick fingers and wipe the blood all over the machines until it spits a number out at us.
  3. vicarious

    keeping glucometers clean

    It has been my experience that the policy is to clean the glucometer between every patient use. In reality, I have never, ever seen this done. Just curious--how many of us sanitize our pens/ penlights/ watches between every patient? I cannot rationalize that, nor can I rationalize sanitizing a glucometer between EVERY patient use. I understand if the glucometer is dirty. I understand q24h. Further, I understand sanitizing stethoscopes--they come into contact with the pt. but I don't understand why nobody makes a big deal about why we do NOT sanitize blood pressure cuffs between every use. Think about it. What makes any of these things different? But I digress. I don't see a point in sanitizing glucometers unless they come into direct contact with the patient (which they do not). I don't wash my scrubs between patients.. Can somebody enlighten me on why it is recommended that the glucometers are sanitized between every patient use? Are there any randomized control trials not sponsored by the Clorox Wipe corporation :lol2:to show that there are any effects??
  4. vicarious

    Licensure in PA but live in OH

    Update- PA does require background checks in the state in which you reside if you reside out-of-state. I haven't been able to get a hold of anybody at the PA BON, but I've decided to apply for original licensure in Ohio, apply for Graduate Nurse TPP in PA, take NCLEX for Ohio, and apply for licensure by endorsement in PA. For anybody wondering what the cost differences are, it isn't much of a difference either way..my decision was based primarily on the fact that I reside in Ohio, my school is in ohio and is sort of guiding us through Ohio's application process, and it seems it will be less difficult if my original licensure is in Ohio. Original licensure in OH, PA TPP, NCLEX, and endorsement in PA came out to $440. GN TPP in PA, Original licensure in PA, NCLEX, and endorsement in OH came out to $485.
  5. vicarious

    Licensure in PA but live in OH

    But I am not licensed in Ohio and will not be when I apply to be a graduate nurse in PA. Thanks all. I am calling the PA BON about this one. I'll let you know what happens
  6. vicarious

    Licensure in PA but live in OH

    Thanks elk. http://www.dos.state.pa.us/bpoa/lib/bpoa/nurseboard/tpp-exam.pdf It states, "You may apply for a Graduate TPP if you have completed an approved nursing education program in Pennsylvania or any other state of the U.S. less than one year ago and you have not taken the licensure exam. The TPP fee is the same for both PA and Out-of-State Graduates." It goes on to say.."A Pennsylvania TPP holder who takes the licensure exam in another state and wants to obtain PA licensure, must complete an Endorsement Application for Pennsylvania and submit it upon notification of licensure in the other state." It's my personal opinion that it seems a bit easier to get an initial license in PA just from looking at how both states handle application for licensure. For example, I do not think that PA requires fingerprint or background checks whereas Ohio requires BCI and FBI as well as passport photos and a notarized signature. I am not entirely sure, but I'm guessing that getting endorsed for licensure in Ohio with an existing PA license may require all of the above. Also, I have heard that Ohio is one of the more difficult states to get licensed in from a few different people. I guess that is why I wanted to get licensed in OH, which is questionably more difficult when it comes to handing out licenses. At this point, since I plan to get licensed in both states, I don't think it matters that PA charges $100 for out-of-state inital licensure applicants to take the NCLEX, because I'm sure there are fees for endorsement from OH to PA and vice versa. The bottom line is that it is going to cost some money regardless. I see that this is definitely something I will need to call the PA and maybe OH BONs about. Now who thinks that either will answer their phones and be able to answer me? :)
  7. vicarious

    Licensure in PA but live in OH

    Thanks for your response! It is my understanding that PA issues temporary practice permits to graduates of nursing programs before they take their boards as well. I have seen them refer to them as Graduate TPP or Graduate RN permit.
  8. vicarious

    Licensure in PA but live in OH

    Hi all, I am graduating this spring from a nursing program (RN) in Ohio. However, I plan to work in Pennsylvania. I am weighing my options and I would appreciate if anyone can give me any information I might not already know! I do plan to get BOTH Ohio and PA nursing licenses at some point. I am currently debating which one I should get first. I have heard that some people find it difficult to obtain licensure by endorsement in Ohio, so I am thinking about just getting Ohio's first and get that out of the way. I am not too upset about doing that because in PA, you can work as a graduate nurse with a temporary practice permit. So to sum up my conundrum...I am thinking about applying for Ohio licensure, and then applying for ONLY a temp. practice permit for PA (NOT licensure by exam). So then I will be a graduate nurse and able to work in PA. Then I will take the boards in Ohio. Hopefully I will pass the boards, so I will be an RN in ohio. I will apply for endorsement (or is it reciprocity?) in PA, and while I wait for the PA board to endorse, I will be permitted to work as a graduate nurse in PA. Is that allowed??? Any suggestions?? :yeah:I applaud anybody who read that whole message and understands it!
  9. vicarious

    Prescriptive Authority

    In Ohio, there has been some confusion on whether or not a CRNA can prescribe medications for patients..awhile ago I remember reading that in the nurse practice act, there was no mention of a CRNA being able to prescribe any medications, even intraoperatively, even if the prescribing CRNA was the administering CRNA. I believe that has since been clarified, and I believe it goes on further to say that the CRNA may prescribe pre, intra, and post operatively for a patient so long as he or she is the one administering the medication. However, there appears to be a bill (forgive me, I am not familiar with legislative terms) that proposes the CRNAs be allowed to prescribe medications for patients in the pre, intra, and post operative setting and allow for RNs, RTs, and other health care team members to administer per their practice acts. I'm not sure how this bill has been received. If anybody has any input I'd be glad to hear it http://osana.org/osana-highlights/senator-morano-introduces-sb200
  10. vicarious

    BSN Research Proposal Ideas

    Hello, I'm looking for a few simple--albeit good--ideas for a baccalaureate level research proposal. It has to be clinically significant (e.g. not whether or not nursing students are more stressed than other students). It also has to be quantitative in nature. I am interested in the critical care setting, but I would have no problems with med surg or even perioperative proposal suggestions. Medical rehab (hips, knees, etc.) would be okay but more as a last resort. I'd like to stay way from ideas regarding skilled nursing, OB nursing, and pediatrics. My original idea was a study comparing the effectiveness of foot pumps and knee-high SCDs in preventing DVTs, but there were too many variables to control for (different patients on different anticoagulants--too much for BSN level). What I'm thinking now is more along the lines of a study that compares the healing rate of patients in private rooms, or a study that compares healing on a unit with strict visiting hours versus a unit with more flexible visiting hours. Or does a Foley anchoring device contribute to UTI. I would really appreciate some ideas--I have been trying to brainstorm but with little to no success. Please help!
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