kcksk

There are supposedly big differences between 6 and 7. My hospital will certify you after they hire you. You just have to get it within 6 months. You could always let them know you are in the process of getting your NRP and sitting for the practicum on xxx date.

Had a pt come up from the ED for admission. Refused all treatment-no IV, wouldn't give current med list, wouldn't allow an exam. I finally asked her why she was here if she wasn't going to allow us to do anything. She said "Dr. XYZ made me." My response? "Well I don't see him here now." She finally let me do her admission but man was she a handful.

There are a couple of different things going on here. First, were those positions posted anywhere? If they weren't posted internally they must've been posted on a company website in order for the new grads to apply. Keep you eye open for those positions and apply! If you qualify for the position it would have to go to an internal candidate before they hire someone from the outside (unless it was posted as new-grads only.) At least that is how it is in my hospital. Hourly employees would have preference over on-call though. During your probationary period you can usually be let go for any reason and the union can't help you. My advice would be to either look for another position or wait until there is another one posted in the unit and apply. At that point you would be out of your probationary period and the union could then fight on your behalf.

Maybe she means to give the meds first that are the most important. Sometimes it's difficult to get a lot of meds into some pts. I would give BP, lasix, any psych meds, etc and hold onto the colace, multivitamin, etc for last. I hate getting to the end and then they refuse to take anymore.

In some areas it isn't easy to find a medical ASL interpreter. In our state you have to go through one facility to book them; they supply interpreters to anyone who needs them. I used to work in an office and we had a horrible time trying to get an ASL interpreter to last minute appointments. Legally we had to supply someone but it was next to impossible to get one when we needed it.

I had a pt scheduled to be discharged, everything in place. All I had to do was go over paperwork with him. He didn't want to go. He called the police and told them we were killing him. Needless to say it was a very long day by the time he left, the police came to check things out and everything go straightened away. He was by far the most trying pt I ever took care of. He was so challenging, nobody got him for more than one shift.

I had a provider ask me about something that would've been done on night shift but wasn't documented and I didn't get it in report (nothing major and something she could've gotten in report from the dr who signed off to her). She kept asking me the same question. Finally I said to her "I'm sorry, it doesn't matter how many times or how many different ways you ask me that question, I don't know the answer to it." She stopped and then ended up apologizing to me five different times. LOL We never had a problem after that.

I haven't seen a child with chickenpox be hospitalized. In a pedi office you would be more likely to come in contact with chicken pox. Have actually seen a couple of adults hospitalized with it but they go in a negative pressure room so you would know. And I think you are correct, you are more apt to come in contact with it out in public. My daughter had chicken pox as a child and only AFTER 120+ other kids in her preschool got it. HAHA pretty easy diagnosis that time.

Hi! I know I had to have titers drawn even if I had proof of the immunizations. My insurance paid for the titers although not all do. I had to be revaccinated on some even though I had vaccinations previously. Call your insurance company and see if they cover it. Once you have it all done, hold onto the forms that show your immunity because you will need them again for jobs in the future.

Actually we have had this same discussion at work. If you clock out and then continue to document, technically they have proof you are working "off the clock" and it is a reason for termination among other things (like time card fraud). Also, you are technically accessing peoples charts, etc when you are off the clock--another violation. Be careful, you could loose not only your job but your license. What if something you document off the clock comes into a lawsuit? How could you have documented you did something when you weren't working? Lots of "ifs" if you work off the clock.

Ok, I know the point was the MD yelling but from what I read, wasn't the pt A&O? She would be the one that has the say in the catheter. The POA doesn't have a say unless the pt is unable to. I hate when people call and say "well I am the HCP and I want information" or " I am the HCP and if they don't do this, I will refuse that procedure". Ummm sorry, your mom is perfectly with it and she is the one to decide who gets what info and what procedures are done. That being said, I have gone head to head with a physician because I was advocating for my pt. In the end, the family appreciated it and the dr was put in his place. LOL I have also had a dr YELL at me and lecture me in the nurses station because a night nurse didn't document something. I very nicely said to her "I am sorry but no matter how many times or different ways you ask me the question, I don't know the answer to it. The nurse did not document it and she did not pass the info on to me in report." Needless to say, she apologized three different times that day and said she was sorry we "got off on the wrong foot." Her issue was actually with the night MD who took the admission-she didn't like the orders.

I won't answer each one individually but we use the Harriet Lane handbook for all peds dosing. It gives us specific instances where the general max dosing is exceeded. RE: solumedrol or prednisolone. When we calculate a dose and it is higher than the max dose, we question it with the MD. We even had a case where we "strongly" questioned a dose and asked for clarification. MD changed the dose. They explained their reasoning but we still did not feel comfortable with the dose so they changed it. As for narcotics in kids, it depends why they are being given. We have some MDs that will go bonkers that narcotics were given to kids first without trying tylenol or motrin. All depends on the reason. Try the Harriet Lane book, it is really a great tool for pedi.

Our floor does it a little different. Our holiday starts at 3pm Christmas Eve (thanksgiving and new years too) and goes until 11pm the day of. So even day shift has 4 hours on the eve and then 12 hours on the day. The way it works out, each shift has the same # of holiday hours. We have a sign up sheet and then the holes are filled in. People can "request" what holidays they want but in reality, someone isn't happy. LOL Either way, day shift works Christmas Eve until 7 (usually means 8) or Christmas Day.

There were people I went to school with that had a similar arrangement. When they graduated, the hospital didn't have enough jobs for them so their scholarship was forgiven. Of course, then they had not job. If they offer you a job, take it and you can always move in four years. It is very difficult to get into a hospital as a new grad now let alone asking a hospital to payback loans. I don't see that happening.

We always have 2 RNs on the floor, even if there is only one or two kids. We do have another side that takes a few adults and we usually will split the floor, one stay on Pedi and one on adults but we are two pedi RNS right there. No adults and one 1 child-still two RNs. I would never be the only nurse on a pedi floor. What if you are in the middle of an emergency and there is no one to scream for to help?

We give it in the office where there is no IV access. I've given it on the floor when a pt hasn't had IV access and we couldn't wait for a PICC.

I give Rocephin all the time in a peds setting and usually we reconstitute 1g with 2.1ml sterile water. Then draw it up in equal doses and give in different sites (usually both thighs). When that is reconsituted it is 350mg/1ml concentration. I don't usually use lidocaine so I can't remember the exact dose but I thought it was the same as lidocaine. I have never seen it reconstituted with that much before. That being said, I only give 1 ml per site if using arms/legs.

We don't do block assigning. We take whoever had the pt last and they get them back. That seems to work for us. We also try to split up the precaution rooms, acuity, etc. Then we try to take the remaining pts and split them evenly. We try not to have people go from one end of the floor to another but sometimes it just happens.

ASL interpreters seem to be a little different around here. There is one place that EVERYONE goes to to get interpreters. Hospitals, drs office, etc. When we would call, they would say they had no one. If we asked what we were supposed to do, was there anyone else to try the answer was always the same--everyone goes through them. We called all local hospitals and they all gave us the same number. Tried someone I know is an interpreter and she said the same thing. She couldn't help us herself because she wasn't certified but to call that same main number. We had a nurse who knew sign language but she wasn't medically certified and it was a liability issue if we used her. So very frustrating. Our practice honestly spent days and days trying to work this out. Never happened for the family and they ended up going to a big city hospital because they have one on staff.

hmmm how about Dear Health Care Proxy, Just because you are a health care proxy does not give you the right to information or to make decisions when your loved one is A&O x 3 and making all their own decisions. Sorry, we were just having this conversation today. Needed to get it off my chest.

Ok you need to know what you have. In our office we have 1g vials and we reconstitute with 1.4ml sterile water. Not sure on the lidocaine. When we give the 1g we ALWAYS break it up into two injections because we give no more than 1ml per injection area. The reconstitution rate is 350mg/ml so if you needed to give 2 g of that you would be giving 5.7 ml if you had that 350mg/ml ratio. Not sure what you had for strength and the reconstitution. We do give consecutive days IM injections in the office we work if it is needed because there is no iv access.

hehe this thread made me giggle. First, I am a mom....three wonderful children but I definitely do my share. We had a girl we worked with who used her child ALL THE TIME as a reason she needed to be late, leave early, days off etc. You name it, it was an excuse. Even had a conversation with her one day because again she was late. She said it was just the way it was because she wanted to have breakfast with her child every morning. REALLY? Then get him up earlier. LOL We all do what we need to and I can tell you the only times I have called out have been......OOPS sorry my daughter is in the ER and they are admitting her for an unknown cardiac issue. Sorry my mom is in the ER and they are taking her into surgery and we have been here all night and yup, I think that is it. Are my kids neglected? Nope. Can we function if I am not with them for a holiday? Sure. We just work around everything. On the other side, I always volunteer to do New Years Eve and day because i don't do anything and the "younger" girls want to go out, Memorial Day and Labor Day weekend if I can please have July 4th off (family reunion every year). And to answer the topic's question? I do have a set day off to work one day a week at my other job. My manager is cool with it, it's a Tuesday so not a day that interferes with long weekends, etc.

Just got my pneumovax last week and it was horrible! The day after my arm was red, swollen and was so painful I hurt all the way down to my fingers! It was day 5 before I could even touch my arm. If anyone bumped into me I went through the roof. I have a pretty high pain tolerance too.....gave birth three times with no drugs. This vaccine was brutal. Decided when I am older, if they tell me I need a booster I wouldn't get it because I figured I had some type of reaction to it. The pnemovax shoudn't change yearly because it is the same 23 strains it is vaccinating against. Flu shot has different strains in it each year.

Well the BP med could've been held because it was due to start at 0900 and be daily and if her BP wasn't high, they wouldn't give it at night. They could've been waiting for the antibiotic to come up from the pharmacy or it, too could've been a daily drug and maybe she had already gotten it in the ED earlier in the day if they had just come up from the ED. Did you ask why they didn't give it? Honestly don't know about the vomitting. I usually run in and check my pt when they are vomitting and make sure they are ok. Sorry about your experience. When your Granny was vomitting was something else going on, maybe a code or something? Feel free to talk to the nurse about your concerns or the nurse mgr. Hope your Granny is better.

Our high risk meds need to have a co signer every time it is given. That should mean that two nurses are checking the order and actually looking at the med given. At our hospital it is for insulins, morphine gtts, cancer drugs, heparin gtts. Those are the common ones we run into on our floor. I am sure an ICU or tele floor has a lot more. In theory, having two sets of eyes verifying everything should cut down on med errors because one of you should catch it.