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allthesmallthings

allthesmallthings

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  1. allthesmallthings

    So I start my first home health job (travel nurse) next week...

    Hey, Poko, thank you! I hadn't thought about the car trunk organizer or the divided notebook. Sounds like things I'll be glad for! 🙂
  2. Hi, y'all. I'd like advice, please. I start Monday (October 5) in my first home health nursing job, and it will be as a travel nurse, so they'll expect me to learn quickly. What's your advice on how to succeed as home health nurse? (My background: 11 years as a nurse, 9 of them medical-surgical; 2 years as travel nurse. I haven't worked in hospital since 2018; my last year of nursing has been private duty/home care, which is mostly unskilled nursing, working with trach/quadriplegic patient in his home.) The interviewer said they do lots of wounds (PAD, PVD,, diabetic), also some post-orthopedic surgery follow-ups, some Foleys and PICC lines...so I'm reviewing those topics. Any advice along the lines of "what I wish I knew before I went into home health nursing"? How to be organized, how to work with people in their homes, time management, working with patient non-compliance or suboptimal education/home conditions, etc? Thank y'all, God bless. 🙂
  3. allthesmallthings

    Interview for a faith based hospital; advice please!!!

    That's funny!
  4. allthesmallthings

    How NOT to suck at turning a Pt, esp. w/ trach/vent??

    Thanks, orion81...you took some time w that reply! That's helpful. :)
  5. allthesmallthings

    How to do one-person turn for quadriplegic / trach/vent Pt?

    Thank you 🙂
  6. Hi, there. I need help learning best (or just good!) technique for turning my patients in their beds, especially the trach/vent patients. Of course, it's just me (one-person turn) turning them. (Yes, yes, I suck - I've been a nurse for ten years, but worked in hospital, and had second person to help with turning patients in bed for incontinence/bed baths/putting onto hoyer pads, etc. Somehow, I did not learn well the technique, back in nursing school, and it shows! I'm inefficient and awkward at turning my quadriplegic patients by myself, and I'm genuinely uncomfortable turning the quadriplegic trach/vent patients, afraid that I'm going to pull on their vent tubing and pull out their trachs. I wind up having to turn my patients multiple times to get sheets/pants/diapers/hoyer slings underneath them correctly, and I take forever to get things done with them.) Anyway, I want to not suck at it anymore. I've watched youtube videos/nursing education videos, but these don't show quadriplegic patients, or total-care trach/vent patients, or one person doing turns on these types of patients. They show two people turning a "patient" who's about 30 years old and assists in her own turn. Really?? Please help! Thanks.
  7. Hi, there. I need help learning best (or just good!) technique for turning my patients in their beds, especially the trach/vent patients. Of course, it's just me (one-person turn) turning them. (Yes, yes, I suck - I've been a nurse for a while, but worked in hospital, and had second person to help with turning patients in bed for incontinence/bed baths/putting onto hoyer pads, etc. Somehow, I did not learn well the technique, back in nursing school, and it shows! I'm inefficient and awkward at turning my quadriplegic patients by myself, and I'm genuinely uncomfortable turning the trach/vent patients, afraid that I'm going to pull on their vent tubing and pull out their trachs. I wind up having to turn my patients multiple times to get sheets/pants/diapers/hoyer slings underneath them correctly, and I take forever to get things done with them.) Anyway, I want to not suck at it anymore. I've watched youtube videos/nursing education videos, but these don't show quadriplegic patients, or trach/vent patients, or one person doing turns on these types of patients. They show two people turning a "patient" who's about 30 years old and assists in her own turn. Really?? Please help! Thanks.
  8. allthesmallthings

    How To Properly Clean Your Stethoscope

    Hee hee. A wow is a cow, w/ a politically correct name. Anyway: workstation on wheels = wow; computer on wheels = cow. (Often spelled in all caps.) One of those computers w/ a little work/desk area, rolled around on wheels. Probably not all facilities have them. They're a newer thing, probably last 5-10 years. You can google image it, probably. Used to be called COW's, until some nurse called out, "The COW is in the room already," or something like that, and some overweight patient heard it, thought that the nurse was talking about HER (not about the computer), got offended, and raised heck. Now, we have to call them WOW's. My non-nurse roommate thought that was hysterical.
  9. allthesmallthings

    How To Properly Clean Your Stethoscope

    Rather embarrassing to say, Hygiene QUeen, particularly to someone w/ your screen name and your cheery signature, but I don't think I've seen anyone at my hospital wash their stethoscope...and washing their cow/wow? Nope...have never seen it at my place. Frankly, I myself just quickly slap some alcohol gel over it when I remember. But I'll try to be better from now on. A good scrub down w/ a sani-wipe makes the world go round, and God knows those wow/cow's are probably crawling. At one of our staff meetings, they recently told us that our unit, usually sterling in press-gainey compared to our medical floor rival, scored poorly on "nurses washing hands." One of the reasons may be that the alcohol gel dispensers are kind of out of view of the Pts, so although we (maybe!) are gel-ing in, gel-ing out, the Pts might not see it over in their beds, and if they are of the old-school mentality that "washing hands" means physically washing them w/ soap and water, then, yeah, they have no idea that we're performing hand hygiene. We're supposed to inform Pts that we're performing hand hygiene, even if they don't see it. I've started saying, when I come over and touch them to do my physical assessment, "Sorry that my hands/stethoscope are/is cold - I just disinfected them." (Kills 2 birds w/ one stone, because Pts are always saying my hands are icy!) I also don't really bother w/ gloves when cutting up pills. If my hands are clean (and they are - I'm the hand hygiene queen), and my pill cutter is clean (I wipe it down), and the pills are clean, then I see no mortal sin in touching the pill w/ my clean fingers, but I only touch the pill anyway if it doesn't slip right out of the pill cutter, which is a minority of the time. (Really, since most of the immune system is in the digestive tract anyway, I don't think it's a big deal. Stomach just chomps up most of those germs while bathing them in a hydrochloric acid pool pH of 2 or 3.)
  10. allthesmallthings

    How To Properly Clean Your Stethoscope

    Do you pay for those wipes personally, or does your hospital supply them? My hospital has "purple wipes" (I'm sure there's a name for them, but we just call them that because of the color of the lid on the cannister).
  11. allthesmallthings

    How To Properly Clean Your Stethoscope

    I just use the alcohol swabs. Sometimes I dump on a glug of alcohol gel from the dispensers that we use for hand hygiene. Plus, I just use disposable stethescopes (after multiple stethescopes that I'd bought for myself disappeared), so every few weeks or months, I move onto a new stethescope. Makes me feel better that not too many germs can be setting up camp. The other day, a Pt actually laughed at my "OCD" ("I saw you wiping down your stethescope w/ those little swabs, now you're doing it w/ your business phone!") Yeah, dude, and I wash my hands, too. (This guy was 46 years old and had actually never spent time in a hospital in his life, other than being born, I guess, so maybe he really was ignorant of hospital germs.)
  12. allthesmallthings

    Nursing: Art vs Science

    lol...
  13. allthesmallthings

    Losing respect for nursing students

    I'm glad to have students w/ us. At my hospital, we're having last-semester ADN students. They're very polite, respectful, eager, earnest students; most of them are probably 20's or 30's in age, some maybe in their 40's, and I think a lot are either second-degree or second-career. One of them was noticing things that I myself didn't, and helped the Pt that day, and helped me learn, too. I've never seen any unprofessional behavior from any of them.
  14. allthesmallthings

    Nursing: Art vs Science

    My managers have had a similar discussion with me. I guess they'd say that I'm good at the science...need to work on the art. Thanks for the article. That's good deductive thinking, by the way - those examples of figuring out the link between a Pt's life and their symptoms. I'm not sure of the correct way to say this without offending anyone, but it sounds as though you're thinking like an MD (I mean that as a compliment!) :)
  15. allthesmallthings

    Reflecting on the Above and Beyond

    This article helped me re-evaluate my perspective on "little things" and the attitude with which I perform them. You know, "Argh, they're asking for ice chips while I'm trying to do x-y-z important stuff, don't they know I'm BUSY?" Yeah, sure, I'm busy, but as long as I'm (quickly) passing ice chips, I can do it w/ a smile rather than a chip on my shoulder.
  16. allthesmallthings

    Pain Med Administration

    You may want to check w/ your pharmacy, the MD, or your charge nurse, or the other nurses, to see what the hospital rule is, or the "floor culture" is, to make sure you're not flying rogue unknowingly - but, personally 1) if a Pt has been having trouble w/ pain, I use what I have to steady out his pain. So if pain is 8/10, I'll go w/ dilaudid, and then in an hour, when the dilaudid has brought the pain to a more manageable level, I may give the oxycodone or percocet to keep the pain from shooting back up again. This can lower the number of times that he may need IV dilaudid. **Of course, you want to make sure to assess the Pt's LOC, how well he's breathing, possibly O2 sat, etc., to make sure it's safe to give another pain med after the first one** although if it's been an hour, the dilaudid has peaked 2) sometimes I'll give an oral med (oxycodone or percocet) when the pain is moderate to try to keep it from going high to the point that the Pt needs IV med. But if the oral med doesn't work, and the pain is climbing, then I may follow with IV narcotic - again, after checking LOC, responsiveness, etc. **Caution: the oral med takes longer to kick in and also longer to get out of the Pt's system, so if you follow it w/ an IV med (as opposed to giving an IV med and then thirty minutes/sixty minutes later an oral med), you do risk the IV med hitting the Pt at the same time that the oral med is becoming effective. So I warn the Pt of this, make sure that they don't get up w/out calling for help after taking narcotics, and monitor him. I take baby steps w/ giving 2 meds in succession if I haven't had the Pt before and don't know his ability to tolerate narcotics and/or if other shifts haven't been giving meds this way w/ the Pt tolerating it. That is to say, go w/ a smaller dose at first and monitor the Pt! Explaining what you're doing and the different time frames for effectiveness/peak/duration of IV vs PO meds also helps the Pt understand, and participate in the plan of care, and to help you make things safe. And don't forget that you can contact the MD - either to get an order (at least a "Yeah, that's okay" which I can chart) that meds can be given successively (this covers your butt), or to let him know pain meds aren't working, so he can dose pain meds appropriately.