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Med Surg
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belgarion specializes in Med Surg.

belgarion's Latest Activity

  1. belgarion

    Will there ever be a surplus of nursing jobs again?!

    And not just in the Hill Country. We had an opening for a night LVN for over 4 months. We are finally getting a new grad from a nearby CC class that graduates next week. All occupations have up and down cycles unless they are jobs that are becoming extinct, like a typewriter repairman or long distance operator.
  2. belgarion

    stethoscope for nursing student

    You're right, my bad. That's what happens when I try to type in my sleep.
  3. belgarion

    stethoscope for nursing student

    AllNurses.com has a nice selection at decent prices. I used a Littman 3000 because I spent too many years working in noisy environments.
  4. belgarion

    Small Hospitals

    Exactly how do you define "rural?" If a 75 bed hospital were located in a urban area I don't see how you could call it rural. And yes, I can think of several small acute care facilities in the middle of "civilization." I work in a hospital that has 35 official beds and we can expand to 45 in an emergengy. It is in a town that is as rural as they get. As far as facilities we have a 6 bed ER, our radiology dept. has everything you find at a big facility except an MRI which shows up every Tuesday on a truck. Our lab can handle all the usual tests but some are sent into the city. We have a very nice but under utilized surgery suite. Babies are no longer delivered here except in an extreme emergency. Dietary, ummmmm, less said the better. As far as staffing goes we have more LVNs than RNs. This works because there are very few functions we are not allowed to perform. Save the "LVNs can't do this" rants. This is Texas where we have much more freedom than most states. We usually have an RN or two on the floor and one in the ER but sometimes the floor RN is downstairs as well. We don't have unit clerks so nurses are responsible for entering all orders. Respiratory therapy is only here during the day so the nurses are responsible for breathing treatments at night and on weekends. The lab isn't here 24 hours so if we need labs drawn at an oddball time or in the ER one of the techs has to wake up and come in. If the sample needs to go to the big hospital, the tech takes it before going back home. As far as patients the ER may see anywhere from none to 25 in a shift. Acuity can range from "haven't been able to poop since yesterday afternoon" to acute MIs. We have a "rent-a-doc" in the ER and four locals on staff. Specilaists can come over from the city or do on-line consults. On the floor we may have 1 or 2 pts one night and 20 the next. The most popular dx is AECOPD with AMS and "general weakness and debility" close seconds. The overwhelming majotity of our pts are over the age of 70. We do a lot of swingbeds so sometimes the place feels like an LTC. I've talked to nurses at similar facilities in a hundred mile radius and this seems typical. I probably didn't answer all of your questions but maybe this helps.
  5. belgarion

    Forced canceling/calling off question!

    You need to check with your state's employment commission about unemployment. The rules vary from state to state but I do know in some you can receive UI for excessive numbers of call offs or send homes. That's one reason most facilities rotate the call offs or pay employees a token wage for being on call when they are told not to come in.
  6. belgarion

    Those Darn Diabetics

    I picked up my wife's diabetic supplies for the month today. Lantus Flex Pens - $60 co-pay Novalog Flex Pens - $60 co-pay Flex Pen Needles - $60 co-pay Test Strips - $60 co-pay This is every month and with insurance. We are fortunate in that we can afford this. But imagine what a person would feel after receiving a diagnoses of DMII and then being told they must go to the pharmacy and immediately spend hundreds of dollars and that expense will be every month forever. Not to mention that eating a diabetic friendly diet will usually cost more than than the meat and potatoes heart attack diet. Non-compliance is not always a matter of caring or not caring. Part of teaching someone a new lifestyle is finding out what kind of limitations they have and finding ways to deal with those limitations instead of pushing them away with an "we know what's best for you now go forth and obey" attitude. I believe the original point of this was that maybe if we work WITH newly diagnosed diabetics instead of dictating that they immediately retool their lives them we might be able to increase compliance. (GAWD, I hate that word. Sounds like 1984 or Brave New World) While I agree that expecting someone who has failed to take care of themselves for years is probably a lost cause, changing our approach in dealing with the new patients and making them partners in their care rather than the old "just do what we say and shut up" approach might just give them the idea that they actually have a voice.
  7. belgarion

    Those Darn Diabetics

    Families need time to adjust as well. You can't expect an entire familiy to make drastic changes to their lives because one member walks in the door and announces "I have diabetes and things have to change around here starting now!" Ever made an annoucement like that to YOUR family? Let me know how it worked out. Another consideration is cost. Anybody tried to pay for test strips, insulin, or medications lately? Not everyone has insurance, medicare, or medicaid. Most insurance requires a copay, some of them are pretty stiff. How would you like for some doctor making a couple of hundred large per year to tell you that starting today, you have to cough up maybe 300 dollars a more each month and if you don't your insurance will no longer cover you? Some people are seeing this as a black and white, do it or suffer the consequences type of issue. I for one don't see how you can expect to dictate to a person that they must make drastic changes in their lifestyle, their family's life, their finances, and expect them to be a good little robot, go forth and obey without question.
  8. belgarion

    Which states do LPNS push IV meds?

    I wouldn't be too sure. On the TX BON website under the FAQs they specifically state there is no master list of what an LVN can't do. About the only thing I found the BON restricts to RNs only is triage and initial assesment. Like you said about IN, it's up to your facility's comfort level.
  9. belgarion

    "Alphabet Soup" After Nurses' Name?

    In my previous career I could have put the following after my name - BSME, MSMM, EIT, CMfgE, CQE, and Six Sigma Black Belt. First, why would I want all of that following me around and second, who the HE!! would have cared? My cards and e-mail signature said Belgarion, Senior Project Engineer.
  10. belgarion

    Insulin tips for no bubbles in syringe

    I was giving my wife insulin for twenty-five years before I became a nurse. I agree with those who say inject the air, draw a little insulin into the syringe and shove it back in hard. Then draw a little more than called for and push the extra along with the bubble back into the vial. As others have pointed out, this doesn't work when mixing but I have noticed over the years that the bubbles don't seem to be as prevalent on the second draw as on the first. At least that's been my experience.
  11. belgarion

    Those Darn Diabetics

    So we use financial blackmail to coerce pts into doing exactly what we say, how we say, when we say, and where we say? Given the cost of healthcare that isn't giving the patient freedom of choice. Sounds more like bullying than anything else. What is wrong with giving a person who has just been given a life changing diagnosis a little time to come to grips with the situation, do a little research, maybe get a second opinion, and maybe accept things rather than expecting them to make immediate on the spot changes that not only affect thier lives but their family's as well.
  12. belgarion

    How does the study of sociology relate to Nursing?

    Had a engineering prof some years back who gave us individual assignments for our capstone project. Turned out he was doing some consulting on the side and we were his unpaid research assistants. Sounds like this instructor is running an experimental study and the students are the guinea pigs.
  13. belgarion

    Are 12 hour shifts going extinct?

    No way my hospital would do this. It would mean adding a couple of more shifts. While the total amount of pay would be close to the same it would mean the hospital paying for more employee benefits. Guess who would end up paying for that. Our benefits are practically non-existant now, they'd get even worse with more employees added into the mix.
  14. belgarion

    Duct tape anyone?

    I got a nastygram in my mail slot for agreeing with a patient who was complaining the cable sucked. Why not? The system is a bargain basement, watered down basic package with 18 channels of which only Animal Planet, two shopping channels, ESPN, and Encore come in clearly. I was supposed to try and convice the guy what a great cable package we have? My point when I was talking to the guy was that yeah, the cable is lousy but if that was the biggest complaint he had we must be doing pretty good.
  15. belgarion

    How to deal with mean old men

    That's pretty much my tecnique and one well seasoned nurse I know calls this her "come to Jesus" talk. The secret is to let the person in charge know what is going on and document, document, document. A dog keeps barking at the mailman everyday because the mailman always goes away. The dog wins. If you validate bad behavior by sympathizing with unreasonble demands and complaints, the patient sees no reason to modify his behavior. The dog wins.
  16. belgarion

    Top three patient complaints?

    "The TV channel selection sucks." Yep. Be grateful for what you have. It some members of the board had their way we'd be picking up television via a coat hanger on the roof. "The TVs get lousy reception." Thats because they're about twenty-five years old. While don't you see if your very rich uncle would like to donate about 25 60" LED 3-D flatscreens? One of my all-time favorites - "Would you ask the doctor for a pass so I can go home to watch the Tech game?" Even better, the doctor not only gave him the pass he came and picked him up and took him to HIS house for the game and brought him back about 2100 with both of them singing the Tech fight song. Gotta love small towns!