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allthesmallthings

allthesmallthings

Content by allthesmallthings

  1. 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.
  2. 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.
  3. 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. :)
  4. allthesmallthings

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

    Thank you
  5. allthesmallthings

    bariatric nursing a good job?

    I have an interview to work on a bariatric surgical floor (not the OR itself) on Thursday. I'd never considered bariatric - I'm trying to get back home to my home city, so I've been applying everywhere there. My dream job is ICU or stepdown or ER, maybe OR or PACU; unfortunately, it looks like most of those jobs require experience, so I'm thinking of getting a med-surg job (as my first job, I've worked 2 years on nights on a post-orthopedic surgical/med-surg floor), working it for maybe a year, and then trying to do an internal transfer to more critical care. Can anyone tell me about bariatric nursing? I've read a little about it here, and a few themes came up: 1) lots of physical work (I'm used to turning Pts and helping them ambulate after hip/knee surgery, but they're usually What kind of age group is it?? I'm thinking probably middle-aged? I do prefer younger or middle-aged. More men or women? (Middle-aged/early elderly whiny anxious neurotic women who won't lift a hand for themselves -- not saying that statement represents bari Pts, because I don't know, I'm just saying that I don't like the little sub-demographic of "Entitled Helpless usually-female aged 40-70 Pt" -- are my bane.) How do the Patients feel, emotionally? Are they glad that they're doing this, and excited about a new step in their lives? Is it emotionally satisfying? Do you see the fruits of your labor? (One of the things I like about ortho nursing is seeing the Pt work and get stronger.) Do the Pts tend to come back for surgical revisions or new surgeries, or is it a one-time deal? I'm kind of wondering if I should take the job (if they offer it) or keep searching for something "better." It is a good hospital (I went to school there) with one of the best reputations in the city, and maybe I should just take it, get some knowledge/skills out of it and appreciate it for what it is, and then try to internally transfer within a year. Hope I didn't offend anyone; thanks for any replies in advance.
  6. allthesmallthings

    Nursing: Art vs Science

    lol...
  7. 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.
  8. 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!) :)
  9. 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.
  10. 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.
  11. allthesmallthings

    The Little Things....

    I tear-ed up a little when I read this - and I'm not a tear-er upper.
  12. allthesmallthings

    HOLMES & DR. WATSON

    lol. i do love holmes and watson.
  13. allthesmallthings

    The Wisest Thing I've Ever Heard on Allnurses ...

    Disagree. Watching someone "access" a port using a Huber needle on a teddy bear on Youtube was instructive for me. (Not kidding; if it works, go w/ it.)
  14. allthesmallthings

    Who wears a nursing cap?

    kudos for going against the crowd (and the century), but dude, you're on your own. wear it with pride (yes, we will laugh at you up and down the hall, in front of your back and behind it, too). :)
  15. allthesmallthings

    What is the weirdest thing someone has been admitted to the hospital for?

    Maybe I'm ignorant, but I thought it was just men who stuff things up into their lower regions.
  16. allthesmallthings

    What is the weirdest thing someone has been admitted to the hospital for?

    Good lord. Have never heard of such a thing. Why??? You'd think the gerbil would thaw out after a while...it's fairly warm in the colon, yes?
  17. allthesmallthings

    What is the weirdest thing someone has been admitted to the hospital for?

    What kind of MD admits for constipation x 2 days?? Seriously, with the $ it requires to hospitalize someone?? On the subject of constipation, and while we're talking about weirdness, I knew an aide who "got sick" in the middle of a shift and refused to work. Her illness? COnstipation. Don't know how long she'd had it (a few days?) but apparently, the middle of shift seemed a good time to her to declare "emergency constipation" and state that she was unfit for work. (Don't ask me why your BM's are necessary to Pt care. She was an ICU aide, btw - admittedly, I don't work ICU, but maybe they have "emergency constipation" there?? jk, probably not)
  18. allthesmallthings

    Defining nursing with a single word...

    Never ending? Lol, and you're a student nurse? You haven't even started and that's what you think? Hug.
  19. allthesmallthings

    Defining nursing with a single word...

    responsibility Hmm, that was the first word I thought of upon reading your question; then "power", then "capability", then "flexibility." I'd never tried word association with my job before. It's making me reconsider things a little.
  20. allthesmallthings

    Dayshifters - do you take a breakfast break as soon as you get to work?

    I work night shift, but when I stay over late to chart, I don't notice the dayshifters going on immediate post-report break; they work. FWIW from a night-shifter, I don't quite understand why people on any shift wouldn't be able to figure out that they should eat before they get on the clock; 9-5'ers eat breakfast before work like responsible adults.
  21. allthesmallthings

    harder to get a job with a phone interview?

    I read somewhere that it's harder to get a job with a phone interview (this interview book wasn't specifically talking about nursing, FYI), because the employer can't get a "feel" for you. My situation is that I'm in Louisiana where I've now been working 2 years as my first job, but I want to move back to Atlanta (born and bred there, went to school there, family there). I'm kind of befuddled as to the logistics of actually interviewing, though - it seems like it would be hard to get a face-to-face interview, as it's a 12-hour drive either way, which means that I need to schedule at least 2 days. (Admittedly, I haven't yet looked thoroughly into airplane fare.) I might be able to do that (I get 2 or 3 days off at a time - although my 3-days-off are Fri-Sat-Sun, and interviewers aren't interviewing on Saturday) - but it seems more practical to maybe ask for a phone interview. Btw, my work schedule is planned weeks in advance. So IS it harder to get a job with a phone interview? Do employers hire from phone interviews? I'm thinking that maybe I should even just get a travel nursing job in Atlanta so that I can be there, and be able to look at hospitals and interview more easily. Thoughts? (When I took the Louisiana job, I didn't really consider how I would ever get BACK to Atlanta. oops!)
  22. I just got a call for an interview for PACU/day surgery nursing in 3 days, and I'm not totally sure what PACU nursing consists of... I've been on night-shift on an orthopedic floor for 2 years, am rather bored/plateauing and would like to go to days. A couple of days ago, I applied for two of those rare day shift positions before they got snatched up. I figured, "Leap and a net will appear." I was hoping for the stepdown position, but I got a call back just today for a PACU/day surgery position. (FYI, my qualifications: RN, BSN, ACLS, and just got ANCC med-surg certification, plus the 2 years on an orthopedic/med-surg floor on night shift.) I do want to move into a more acute area - stepdown or ICU - so I figured PACU was something along those lines. I just did a bit of Internet research, and several posts said that you usually need critical care or ER experience BEFORE going into PACU. The job description did say it was for both "day surgery and PACU," and that position will be determined after orientation. So, does it sound more reasonable that the interviewer is focusing on me for a surgery position? Does it sound totally off the reservation that she would consider me for PACU? I know that some places will take new grads for ICU or stepdown - is PACU more difficult than ICU? 1) Am I out of my depth to interview for PACU? 2) Can anyone give me some kind of picture of what day surgery and PACU are like? Day-to-day working conditions? What does a PACU look like? I've only been in an OR once, during clinicals, for a C-section, and have never seen a PACU. I'd like to have something relevant to say for the interview! I know I sound kind of like a bumbling idiot; I want to go to days, and to more critical care; I just don't want to kill anyone or fall flat on my face or lose my license while doing it!
  23. allthesmallthings

    how do I delay an answer to one interview while waiting on a second interview?

    thank y'all :)
  24. I currently have a job on orthopedic/med-surg floor, but I have two interviews coming up. The first is in two days (PACU/day surgery), the second is 6 days after the first interview (stepdown). My question is, if I get an offer from the first interview before I take my second interview (or before a few days after the second interview, to allow the second interview people a little while to make up their minds), how do I delay an answer to the first interview until I know the results of the second interview? Is there a way to keep my options open without losing an offer from the first interview or burning any bridges? I think that I may want the PACU job with the first interview the most, but that I may have a better shot at getting the stepdown job (second interview). I'd be glad to take either job, though. (FYI: I work at a hospital system which has 4 different hospitals; my current job is within the same hospital system as the two interviews, although at a different hospital physically; and the two interviews are both at the same hospital. That is to say, the results of my interview/offer may be open-access/casual word-of-mouth to the interviewers, as well as to the higher-ups at my current hospital.)
  25. allthesmallthings

    Eek! What is PACU nursing? And do they really want to interview me?

    Thank you. :)
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