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Long term care; med-surg; critical care
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JBMmom has 6 years experience as a MSN and specializes in Long term care; med-surg; critical care.


JBMmom's Latest Activity

  1. JBMmom

    LTC to TCU/Med surg

    I went from LTC to med surg and kept my per diem LTC for about a year before I left. It's a good transition, I gained lots of experience in the LTC that helped me transition to acute care, but there was plenty more to learn. Good luck with finding your niche! It can take years, and that's the great thing about nursing, you can always move on to something else and pick up new skills.
  2. Thank you, on an upcoming day off I will try to do more specific research related to my state's laws in this area. It just hasn't been a straight forward search to this point. Thank you, I had not thought of following up with risk management, I will do so.
  3. We have recently had a few patients in our unit that have been evaluated by the psychiatrist and the psychiatric consult note states something like "Patient is not allowed to leave against medical advice because he lacks insight into his current condition. Patient has been cleared for suicidal or homicidal ideation and does not require a 1:1 sitter." These patients have generally been detoxing from alcohol, either because they presented to the ED asking for help with detox resources (rarely), or people they were admitted for acute pancreatitis (usually). My concern is when a current patient became belligerent and agitated we had to put him in four point restraints and use medications like geodon to keep him and our staff safe. At the time he appeared alert and oriented to person, place, time and situation. He was demanding to leave AMA and threatening both physical violence to staff and legal actions to sue us for unlawful detention. He has a relative who is a lawyer that called into the unit and threatened similar action. Now, as a nurse I have a progress note from a consulting physician with a line in it that says patient can't leave AMA. I don't have an order, and as it has been explained to me, a PEC is not valid for patients receiving medical treatment, only patients that have been medically cleared and are receiving inpatient psychiatric treatment. I don't feel like a line in a progress note is sufficient to protect my license if one of these patients sues us. If a hospitalist writes "patient needs lasix administration" in a progress note, I don't administer lasix, I followed the prescribed orders in the chart. When I questioned the psychiatrist about this I was dismissed with a condescending statement that "I don't know how your nursing license works, sorry, but if you read my progress note you can see he can't leave". I was told there is no order associated with that note, but system wide that is sufficient to keep a patient against their will. I've tried numerous Google searches and checked scope of practice guidelines, but I don't see anything that appears to cover this issue. Does anyone have any insight? Thanks for any feedback.
  4. JBMmom

    LVN- Central Line Via CADD Pump

    I'm not an expert on LVN scope of practice, my initial thought is that restarting should be fine. My assumption would be they cannot initiate a medication because if a patient were to have an adverse reaction, it's not within their scope to assess and respond. But, I'm not in your state, nor did we have any hospital based LVNs here anymore so I could be misinformed.
  5. JBMmom

    RN providing total care for 4-5 patients

    That does sound like an unreasonable work load, and as you mentioned it is not safe for patients. If you are using mechanical lifts that requires two people are all times itself. Which would leave you with no one on the floor while anyone is being transferred. You could always call your state board and make an anonymous complaint if you can't get anywhere with management. Godd luck.
  6. It seems to me like spending money for no reason. If you don't intend to practice as a RN, you have no need for it. And I don't think that anyone is ever practicing under a license other than the person named on the license. Students are covered by their schools, the only things preceptors could be liable for is if they use poor judgment in what they allow a student to do.
  7. JBMmom

    Night shifters- try a weighted blanket

    hoiboy, I got mine after August and I have turned on my room fan a few days. I do wonder whether it will be too much next summer. I've searched cooling weighted blankets, which supposedly exist in case mine gets to be too much. I have woken up one night overheated, but only once to far and I usually tend to get too warm. (I think I couldn't get my thermometer foot out because of the combination of my blanket, dog and cat. ) thanksforthedonuts, I have wondered about dementia units and whether it would be considered safe and appropriate. I think it would be up to the facility, although if I had a loved one there as a patient, I might try supplying one to see if it helps them. As long as it was the kind with a washable cover.
  8. What an awful situation for the patient and the nurse. I can only imagine how difficult this has been for everyone. If the CEO's first response was to actually ask how they could have such an incompetent nurse working in the emergency department, without having all the information, that's the sign of an administrator that really has no understanding of their own staffing, and no compassion for staff. Unfortunately, there would be so many scapegoats at every level that this will never get up to the people responsible for setting up such an awful system. It's all about those stupid survey scores, not providing the best medical treatment.
  9. Just my personal experience, obviously not medical advice since we don't give that here. I was wandering through Walmart recently and saw a weighted blanket for around $40. I've heard all about them and while I don't have sensory disorders (that I know of), I know that since I went to night shift over two years ago I have had trouble sleeping during the day. I have no trouble falling asleep, (anywhere, any time) but I would wake up every hour or two and sometimes be up for hours in between short naps. I have not been willing to invest $100+ dollars for the ones on the internet, but $40 seemed worth a try. Life changing! I've read some articles that say it's because the weight is making my body produce more serotonin or melatonin-like chemicals. Whatever it is, I am now getting a solid 5-6 hours some days which is awesome. I don't know whether I'll be able to use it when summer comes back around because it will for sure be a little warm, but sometimes I'm okay with my "thermometer foot" hanging out from under the covers. I have no personal gain in posting, not really meant as an advertisement, but from one night shifter trying to get through life, to any others that are struggling, I hope this might help you. I've recommended it to all my coworkers and a couple have had similar positive results, but another one didn't really care for it. People that sleep with dogs seem to like it better, maybe since we're used to be smothered by our dogs. Hope this might help someone else.
  10. JBMmom

    Feeling lost in my nursing career

    I transferred from med-surg to ICU, I can understand your feelings. My ideal job would be split between the two units, because they are different but each has drawbacks and advantages. As for the personalities, I think that many ICUs attract some pretty strong ones, and that can make or break someone's experience there. You shouldn't be disappointed to realize that something you thought you wanted didn't turn out as planned. You couldn't really know what ICU was like before you got there. If you can give it some more time, maybe some of your disappointment is related to still feeling pretty new. But if you decide to leave, I think that there's nothing wrong with realizing after six months that something isn't a good fit. I hope you can find something that works best for you. No real advice, since I wouldn't be the one to tell you what your next steps should be, just wishing you the best.
  11. JBMmom

    Does L&D experience count for NP school?

    I agree that all experience counts, however, you might want to consider your NP goals as well. If you want to go into women's health or CNM you will have great experience working in L&D. However, if you're considering acute care or primary care of adults, your nursing experience may not give you as much experience with assessments of other populations, which will impact your ability to be successful even if you get into the school. Hope you find a path that works for you.
  12. JBMmom

    Is my career over already???

    That's an awesome update, so glad that things worked out for you!
  13. JBMmom

    Improving critical thinking

    First, don't expect too much of yourself as a new nurse. It's awesome that you recognize this is something you want to work on and mostly it will come with time. Do you have coworkers that are readily available to talk things over when you find something you think needs to be addressed? Having someone else, in real time, that can confirm your findings and be a sounding board for the next step will be your best resource. As far as when to call the docs, consider what the assessment change means for your patient? Is it something that you think will rapidly need a higher level of care or an intervention? Then you need to call. Things like an acute change in mentation, a sudden onset of new chest pain, sudden severe shortness of breath, etc. Most subtle changes will mean it's something to make note of and monitor, but not necessarily call a doc. Good luck with your practice, sounds like you're doing your best and you will be successful!
  14. JBMmom

    going back into med surg

    I work in the ICU and I pick up per diem shifts whenever I can on my old med-surg floor. I love the difference in the two work environments, and if I decided ICU wasn't for me anymore I would go back to med-surg in a minute. I don't think anyone will think anything about it, unless you make an issue of it. I don't think that by going to the ICU I "moved up", so going back to med-surg wouldn't be a step back. They are very different work environments and there are benefits and drawbacks to both. I think your coworkers will be thrilled to have someone with a critical care background on the unit, especially if patients have a change in status and might need a higher level of care. Good luck with your plans!
  15. JBMmom

    The Vehicle Has Not Come Yet To Take Me!

    A beautiful recount of such a personal time. It sounds like your family had a good experience with the care your uncle experienced at the time of his passing. I hope that happy memories bring all of you peace in difficult days.
  16. JBMmom

    Night shift to day shift interview

    Didn't you have an interview to get your night shift position already? I would think a schedule transfer within the department wouldn't be an actual interview, just confirming your interest in changing shifts. In my facility if you're the most senior person applying for a shift change, they just confirm when you want to switch. Good luck.

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