DManAZRN

I refuse to pay another insurance company that prolly won't honor their word anyway! Know what you are responsible for, respond to it, notify MD's and document, they can't touch you. If they know you have it, the prosecuting party is MORE LIKELY to go after YOU personally. If you do not, they are more likely to go after the hospital/Dr. because they are required to have it. If you are not confident in your abilities, go for it, and buy more than average. Have your OWN lawyer subpoena the staffing records for that shift. I dont think any jury of my peers would say my hospitals staffing is "Reasonable and Prudent" Failure to listen to your own medical professionals is NEGLIGENCE!!!!!!!!

Self-governance is a FARCE. If you really want to study it, look for a Magnet hospital, usually it's one of the conditions of becoming a Magnet facility. The Farce part is that they set up committees of "floor nurses" that are carefully groomed and surveyed by management prior to being put on the committee. Then when the committee comes up with a bright Idea like "we're going to have more nurses for the patients" it gets rejected by management because "we're out of money". BS, you are not out of money! You get money from the state, the fed, non-profit tax breaks etc.... The hospital does not just implement what they decide on, if they ever do decide. TOTAL FARCE. (But it does sound nice, like most PR stuff)

I would have to advise avoiding ortho. Dependent on the facility and ratios of course. Lots of heavy equipment, anyone here enjoy moving CPM's all night? More likely to pull something and ortho docs think they're really special, well, they are. "Don't wake me up for that nurse" and then the next day, "Why didn't you call me with this?" etc... Go to TELE get ACLS work a year or two, get EKG down and THEN go to ICU or stay put. The ratios are the only thing I will consider anymore PERIOD.

Wow, sounds like you need to report you manager. Don't you have a union or are you not in California? Report it to them. You made the right call. I tell oversedated patients that it is too dangerous and they could OD, but only if they are exactly that sedated. Was your manager there to assess the patient? Nope. So it's your call. She has NO IDEA PERIOD. As long as you document the s/s of the patient i.e. severely slurred speech, inability to rouse the patient for more than a few minutes etc... VS, O2 sats. Inability to swallow effectively. I would have even dialed back the PCA a notch. Sorry, but I didn't become a nurse to euthanize people manager! What are you managing exactly, outcomes or press/gainey scores? I am the bedside nurse, it is my job to manage the patients condition. Where were you? At home asleep *****!

Wow, someone missed some data here! Sure would like to know if Tamiflu/Antivirals were given? Duh. Some article. Typical media. Guy was prolly having an ALL Rxn to something they gave him he'd never had before..... hmmmm My Immune system is so strong it kills the cockroaches in the backyard! Adapt or die (Darwin) This goes for our careers too.....

OK, you need some more advice on this...... Really you do, Do not let anyone else know they exist, if they flub and someone spills beans like, to a lawyer, they can subpoena your notes..... just 2c. A tactic I used recently was simply to say, "The patient was stable on my shift", "The patient became unstable on the next nurses shift and that is his/her responsibility to address". Managers/Day Rn's always seem to be trying to blame the prior shift for their problems. Sorry, NO DICE!

At every charge meeting I go to after the start of the shift, the ER talks allot about they're BH patients. They are always filling up beds. Maybe we should start a suicide hotline or something... As far as saying "I want to kill myself", wow, that works huh? I'll remember that for myself later. Anyway, I would prolly be tempted to ask them "Do you mean today?", but never would. I think allot of them are either looking for meds, looking for a place to eat/sleep and are casualties of our economy/healthcare system. And yes, they know the key things to say because they are in there so often.... Maybe if we just stick them in a real mental institution with REAL crazy people they will get better.... hahahaha, make'em a ward of the state and suggest ECT. OH GOD! I've become NURSE RATCHET!!!

Of course they are valuable. I am not implying anything like that. The RN just cannot take on two high ratio assignments worth of pain shots (IVP), central lines, all other IVP meds, "oversee" the LPN (most LPN's don't need much oversight) and still not burn out when people are constantly complaining they aren't getting their IV heroin to management because it's 5 minutes late. Those RN's will burn out and leave. This hurts the hospital more (financially) then just dumping the LPN's and hiring a few new grad RN's and then cutting back the CNA ratio as well. Wow they just saved allot of money! Money that won't be put back into the staffing, the unit, or even the hospital! It goes in managerial bonuses to Administartion! Wow, some "non-profit" I'm workin for huh? PS THERE IS NO SHORTAGE! duh. That is a media/hospital scam to get more nurses graduated in order to begin wage fixing and dropping all wages down to 1980's levels again. Wake up and smell the ...oh forget it.

Exactly!, natural birth is so inconvenient these days... Maybe they're medicating with THC for the morning sickness, since their HMO won't cover the meds? (Natural medicine?) hahaha, JK I saw a true natural childbirth once, in Africa. Woman just squatted, out comes baby, not even a grimace! Oh oh, time to cook dinner. Just like nothing happened! Look ma, no bills! Makes you want to bring back birthing chairs! No, wait too inconvenient, need to lay down in a bed so the doctor doesn't have to bend over. Amazing what gravity can do to help ladies, that's why they're up walking in circles before the birth, duh.

401K is better than a company pension. If the company goes belly up, no pension. Did'nt we see this somewhere recently? What's the street with the big wall? I thought the new retirement age is now like 72 or something.... My plan is to die right as I run out of money, or just burn out and fade away into poverty and become a patient who lives in the hospital! Look ma, free food, drugs and housing, complements of the taxpayers! I'm finally getting out what I paid in!

Go with AHA guidelines for the intervals, the push rate of administration you have is 2min small dose, 5min larger dose of 5mg, That is standard for us. If the hospital P&P even mentions it, go with your hospital guidelines always, so they can never say you "deviated" from policy.

Well, making less than they're current experienced RN's helps... it motivates them to hire you OVER someone WITH experience. Pretty good advantage I'd say. So much for that fake nursing "shortage".

Speaking of coats.... I had a ratty lookin' family member steal my leather jacket once. At least he will be warm I thought. Warn out anyway, matched what he was wearing. As for a cynicism... how can you not be? Of course nurses are cynical. We watch doctors turn a blind eye to this all the time. We know it's drug abuse but hey, who am I too judge? It is the doctors liability to treat the drug abuse, period. Unfortunately they know the system too, and are too cynical to bother. Oh well, just say no to drugs right?, just not in a hospital. Those patients make sure to be "problems" if they don't get it. Just hookem' up to a PCA and send them home with home health!~(not really) The doctors comment is really reflecting his attitude all too well. How he looks in a mirror every morning, I don't know. That's between him and whoever pieced him together from leftovers when he was created.

As far as the salary I would put "negotiable". Take a look at new grad RN pay in your area and you will have an idea where to start.

Buy an NCLEX study guide. Read it. Remember it. Is the Hesi like a Pre-SAT for nurses? Silliness. Why do we demand such smart and good people just to burn out and throw away? This society throws away it's best people and then wonders why it is so sick! IMHO our system deserves to fail. Too bad people on both sides are all caught in the middle.

You take a "mental health day" and call in sick. You talk to your doctor. You go slower at work on purpose. Don't rush. Save yourself for the real battles, like coding somebody. If they're not coding, it can wait. Take your 30 minute federally mandated UNINTERRUPTED lunch break! And when they interrupt you put "no lunch" and get paid. Yes, there are federal laws regarding this. Get a new job every 2 years, change of setting coworkers can help, just something new, plus your wages will be up-to-date to boot. Stay anywhere too long and before you know it, new grads are making more than you!

A surgical tech just sets up equipment, cleans the rooms etc... Like a CNA/Houskeeper for the OR. Cheaper than a nurse too... Probably got Hep C from prior theft of syringes too. How poetic. So much for that medical career eh? Yeah, the Media is just out of control sometimes... must have saved that story for last, and made you wait the whole program right? Must not have had time before they cut to commercial to tell the whole story! Every time they slander nurses that aren't even nurses the ANA should stand up for nurses and sue the stupid media! That might give them a real nursing story. Why don't they report on our working conditions?

Of course there's a demand for surgical nurses. (OR nurse) As far as being gender specific, what's with that? Male/Female/Not sure, still a nurse right? Men work in L&D sometimes too, not my cup of tea, too many patients don't want you to assess them for "cultural reasons", but they apparently don't mind the male physician doing it.... whats with that? Trust your doctor but not the nurse who's been by your side the whole shift? I think I would trust the doctor less... wash your hands doctor gloveless! That is definitely a double standard... Any discrimination is still discrimination ladies. Now wear the shoe on the other foot eh? EEOC protects you from gender bias/discrimination on hire, period. If you feel your gender was a factor, sue. I am a male, and have never had a problem getting a job, taking care of patients, or with anything else. I simply choose not to work in a GYN type setting due to liability from the patient or child. Too many lawyers with commercials about suing for something that happened 17 years ago, and probably would have happened anyway. Doctors are even barring people from video taping their childbirth because these lawyers have scared them so much! My children will be on video, your not going to take away our memories Dr. X! If you can do it right then you won't mind the camera will you? Pluswhich, I want a record of it too, it's our right!

OK, it's your notes.... as long as you DO NOT allow the information to be comprimised and it's in your personal residence AND you don't talk about it you are pretty much untouchable. And if for some unknown reason somebody is in your house that you don't trust and sees them in your lockbox..... All you have to say is "I keep them for legal reasons" in case I'm ever called to testify on a case. Do not duplicate them, fax them into your computer etc... They are your "Original notes" from that date, only for your own review and learning experience. Those are gonna add up though. Better get a big gun safe to stuff them in.... Or, just chart everything like you're a camcorder right?

Any response? I wrote my representative.... not even a form letter in return. Of course, I thought nurses could only make progress like management does... By making vague sugar coated threats.... like..... Ahem..... If you don't do something to regulate staffing ratios... all the nurses will organize and take our taxable incomes elsewhere. For example a state that believes in adequate health-care, education, child-care, pay for on call time etc.... Oh God, there's no state like that!

I love caring for my elders. I love not being the "typical" man. I love values from 200 years ago. How about a society where health and happiness are more important than greed and how much stuff I can fit in my big garage? I can't recommend social work. My father majored in liberal arts at first, the only job he could get was "would you like fries with that?"

Sorry to post twice but I have to say..... Litigation will only cost you more than it's worth. Blow it off and find something else, do you really want to go back to the same? You have a better chance of getting money falling down in a store on a wet floor than from getting fired for bad reasons....

Hey, a warning is just that.... (your bad, be gooder) If your manager can add, which is quite unlikely, as they are always "over budget", maybe they'll begin counting them and figure out they need to talk again.... Just to hear themselves. If they want you gone in a "right to work" state, you're gone..... Federal law protects against discrimination (gender, race, religion etc..) being fired for that is still "wrongful termination" even in right to work states. That's EEOC stuff. What if my concern is staffing? And that I don't feel comfortable or capable of caring for X number of patients? Where X=ridiculous? I send my concern up the chain.... and probably get fired for "not meeting expectations" right.... ? Our CNO is crazy about administration for some reason (pays her mortgage). She will not address our concerns. They already laid off all the LPN's due to the X ratio. Lost several RN's to resignation and transfer..... doesn't that illustrate my point? Could it be clearer? Nurses sicking out allot... me too please! Let me get behind everyone else in the warning line! No, wait, I'll get in front on the way out, come on! it's a parade! Seriously, can I voice my concern to the State? The Managers? Will it really be "Considered"? I feel that only state or federal governmental reg's can put our hospitals back in line with modern top notch medicine. Who's delivering it? Nurse X!:heartbeat

I think the first answer you got would be the best, and yes the trough is first for that exact reason. The equipment is pretty specific. Ask for information on your particular PICC brand. Our PICC lines are now larger and some are "power picc's" that they can run a high volume at high rate, which tells me it's an even larger lumen. We now use "autoflush" caps that supposedly eliminate the need for heparin flushing entirely. We simply flush with 20cc of saline after blood draws, 10cc after med infusions or pushes. They cited a study about heparin flushing not being neccessary anymore even for peripheral IV sites. So we only use saline flush for peripherals too now. It will just depend on the PICC itself, and the type of cap placed on it. As far as the peak, we draw one hour after the infusion completes, your P&P for peak and trough (should be called trough and peak really...) should be there somewhere, but to save time, I would ask the laboratory manager or other knowledgable individual.

Sounds like they all went to high school together and never grew up. Suck it up, keep working, and all you can do is make the manager aware of the behavior. Hopefully you have a manager that didn't go to their high school too. As for being torn a new one...... Just say "Thanks for the input" period. No smile, no frown just pretend it doesn't even matter. Because it doesn't unless the manager is giving the input.