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BluegrassRN has 14 years experience.

BluegrassRN's Latest Activity

  1. Depends on a lot of factors. In an opioid tolerant pt whose baseline is the scheduled oxy, who is in with something that increases pain, yes I would consider giving them together. It would depend on her current status, her history, her disease process, what she had previously been taking, but yes, under certain circumstances, I would give those two together.
  2. BluegrassRN

    what do you say to patients...

    Just say "No need to apologize. It's our job to help you when you're ill, and we're happy to do it." Be matter of fact and cheerful without being creepy. Move on to next topic; you can get an entire assessment completed when dealing with a code brown, or, depending upon the situation, a good amount of education (diet, disease process, side effects of meds, PT and physical strengthening, lots of topics are applicable to code brown situations).
  3. BluegrassRN

    what do you say to patients...

    Lighten up, it was a joke. It was funny.
  4. BluegrassRN

    Medication administration vs Patients wants

    In general, don't leave meds at the bedside. There are exceptions to this rule, of course. In our hospital, you can get a physician's order that the med can be left at bedside. We do this primarily with cough lozenges, inserts for nicotine inhalers, tums, etc. Even these meds can have untoward side effects, so get an order for it. If the pt wants all meds left at the bedside, just briefly explain why that can't be done. Scanning, professional responsibility, or even just "You know how the powers-that-be are; I don't want to lose my job over that, you know how it is." Most people are understanding of that. If a med is not time sensitive, there is no reason to give 10 different meds at different times between 7am and 10 am. If a pt wants them all at 9, given them all at 9. Our emar has a functionality where we just shoot a message off to pharmacy, and they change it. No physician's order needed.
  5. BluegrassRN

    Pyxis report question...being falsely accused!

    I have investigated discrepancies in my former position. Let me tell you, not wasting immediately but rather after the fact is a big red flag.
  6. BluegrassRN

    Pyxis report question...being falsely accused!

    That could mean up to an hour or more wait for the pt in my facility. The pt needs 4mg of morphing, which comes in 1' 2' and 5 mg doses in our pyxsis. So I would have to send a request to the pharmacy, they would have to draw it up, then, since it is a controlled substance, walk it over to me, hand deliver, have me sign for it, and then finally I could give the med.
  7. BluegrassRN

    Med passing question from a student

    Standard at my facility is to take meds into the pt room, scan them, and as you're opening them, to tell the pt what they are: here's your doxycycine, that's the antibiotic for your infection, here's your coreg, to strengthen and regulate your heartbeat, here's your norco, for pain...." Like an above poster recommended, I always ask if anything is new. Once you get into the habit of narrating what you're giving, it comes easily and naturally.
  8. BluegrassRN

    Would you be insulted by this?

    I don't know if "insulted" would be the word I would use. If the $10 was at or below the cost of the printing and tshirt, then I don't think that's a bad deal. If the shirts came in colors and a fit I liked, I'd buy it. I would rather have the opportunity to buy a $10 well made, well designed shirt that I could wear in place of a $20-30 scrub top (which I am required to wear and also required to supply) than have them give me some meaningless, cheaply made gift that I am going to throw away.
  9. BluegrassRN

    Peer review evaluations

    Well, we're doing them, but they aren't anonymous...we have to put our name on them. At each yearly eval, the person being evaluated fills one out, gives two to other staff to fill out (one on day shift, one on nights) and the director gives one to a person of his/her choosing. I'm honest. If someone has a problem about what I say, they can bring it up with me. I feel like I'm fair. I've only gotten three (from solid nurses) to fill out; I suspect most people know I'm not going to mince words. However, I know most people won't be honest, because they won't take ownership of it. I already know whom I will ask to complete mine; two great nurses, both of whom are secure to be honest in their criticism. Their feedback will be constructive and relevant and really will help me become a better nurse and coworker. I think these reviews can be helpful; frankly, I know how someone is doing more so than my manager. She works 8 hour days, 2 days a week on our unit. How can she possibly know who leaves a bunch of crap after every shift, who always has overdue meds, who gives a crummy report, who is completely disorganized, who has a crummy attitude, who can't seem to be found when it's time to do rounds, etc? When I fill these out, I'm very specific and honest. I'll own it, too. Most people don't, though, unfortunately.
  10. BluegrassRN

    Movies about Nursing Homes/Long-Term Care Facilities

    Are you looking for documentaries, educational resources, or fiction-yet-realistic movies? For educational, check youtube. For a documentary, I like "Young At Heart", which does not take place in a nursing home, but does center around a group of elderly folks, some of whom live in an assisted living type of situation. For a television series: Derek. It's on netflix. It's set in a small home in England, Ricky Gervais is the main character. Less realistic that some, more realistic that others. Funny, obscene, tear-jerker. If I wasn't laughing, I was crying. I'm sure there are others.
  11. BluegrassRN

    Is there something wrong with me?

    1) Seek out a counselor who specializes in interpersonal skills. This can be hit or miss, you may have to try a couple of therapists before you hit the jackpot, but once you do, you'll learn so much. 2) Do you have a trusted friend or family member, with whom you can confide? If so, ask them about this. They may give you some insight into specific behaviors or instances where you come across as rude, uncaring, whatever. If this is a person you are around a lot, ask them to work out a signal with you; when you say something or do something that would be off-putting or rude to others, they give you the signal, and it gives you the opportunity to examine the situation while still in the moment. My husband has used this technique successfully many times in his classroom, with students who are typically on the autism spectrum and lack social skills, the ability to read social cues, and/or have repetitive, unhelpful behaviors. He gives the student very specific feedback as to what the behavior is, why it is not acceptable, and what he (and society, ultimately) expect. For example, he had a student who would interrupt and comment at EVERY OPPORTUNITY. As in, hundreds of comments and questions in a 50 minute class period. Whenever the student had a question or comment, he was to raise his hand. When my husband looked at him and raised his eyebrows, the student was to think if he what he was going to say really and truly was applicable and necessary to the class. It dropped him down to only asking questions or making comments about 20-50 x an hour, which was a vast improvement. The point is, find someone (or someones) who can help you recognize the situations AS YOU ARE IN THEM, so that you can evaluate what you are doing and how it is being perceived while you are in the moment. It can be helpful to later ask them for their input as to that situation, and how you should have handled it differently. Good luck.
  12. BluegrassRN

    AIDS during the 80s

    We had a nurse the other day who seemed out of sorts that her admit had HIV. Everyone was a little incredulous that it was an issue for her, and there were several comments such as "This isn't the 80s, you don't need to be ignorant about taking care of an HIV pt," and "well, don't have unprotected sex with him and you'll be fine." Nice to see that even in small town Midwest, that attitude and level of ignorance isn't acceptable.
  13. BluegrassRN

    Transgender Nurses - experiences/opinions

    You will probably get some unfortunate responses, but for the most part, if your work environment isn't incredibly toxic, I think you'll find that most people won't be phased. Even here in the midwest, we are getting more and more transgender pts. My child is trans; once we went public with this, I of course discussed it at work (in my hospital, pretty much everyone is friends and very open about their lives. It's a small community). I have fielded very honest questions, but not one person has said anything negative to my face. Several people (some of whom I would not necessarily have expected, given their religion and politics) have gone out of their way to show their support. I work in a small community hospital, in a smaller town that is flanked by two cities. This is probably a more liberal part of the state, but it's still a midwestern town. It's actually made me realize how good people are at heart. I think today's trans/gender fluid is the previous generation's gay. The more people have a face, personality, and personal connection to put with something "strange" "weird" or "unnatural", the more they realize that those adjectives are inaccurate and unnecessary, and a trans person becomes just like any other person. If you are the only trans person in your workplace, you will be spokesperson and educator for the community at large, whether you want to wear that hat or not. I think that is simply the reality of the situation. I hope you don't shrink from that, because the next time they encounter someone who is trans, it will be a simple shrug of the shoulders and a an "Oh, like Kaley". Also, people *want* to be helpful and do the right thing by you. You will need to be very specific when you transition: "Because I am a man, I will now go by the name Kevin, and when you refer to me, it should be by male pronouns. I will be using the male bathrooms/locker rooms. I welcome any honest questions, in the appropriate time and place. This has been a rough road for me, and I thank you all for the support." You give as much info as you feel comfortable with, and you politely decline to provide any more. Or you can transition and live stealth, which is of course fine, too. It's completely up to you, but if you wish to live stealth you will need to transition before you get your job. I know this is a long road, but please do the right thing for yourself. And know that you will have support and acceptance. This is, luckily, 2014, and people are honestly more open minded than we sometimes give them credit for. While it may take a few people a while to wrap their brains around it, it is only a very small, minute percentage who will actually be rude or hold it against you.
  14. BluegrassRN

    AIDS during the 80s

    I am too young to have been a nurse back in the 80's, but have two stories from family with personal involvement. My great uncle died of the disease in a larger town in the Midwest,sometime in the 80's (I'm guessing earlier than later, because I don't remember this event, and I graduated from high school in 90). He was in isolation the entire time he was in the hospital, and no visitors under age 18 were allowed. My parents did not ever tell me about it, I didn't know this until I saw Dallas Buyers Club, was commenting to a family member about how the AIDS pts were treated, and they filled me in. my great aunt (other side of the family), was an ER nurse when the AIDS epidemic started to hit. She retired at that time (and since I think she would have been in her 70's, it was probably about time!). While the AIDS epidemic is why she retired, it's not the reason you would suspect. As previously mentioned, AIDS brought us gloves. My aunt was horrified by the thought that she had to wear gloves when touching someone. She considered it cold and uncaring. She did not want to abide by Universal Precautions, and therefore left rather than wear gloves. When I visited her in the nursing home and told her I wanted to be a nurse, she came alive, and ranted for a decent amount of time about how the profession has changed for the worse, now that we nurses have to wear gloves! She just could not wrap her mind around how you could really care for someone and wear gloves.
  15. Jeez, that was long! The "too long, didn't read" version is: Omega 3, multivit with C, and D3 supplements. Food, activity, and mood journal. Avoid processed foods. Avoid meat. Make own meals. Take meals to work. Tea, water, sparkling water. Daily exercise. Monitor steps with fitbit. I feel great!
  16. I recently read "The Depression Cure" for a friend of mine (he was going through the classes and needed some support). It was a surprisingly reasonable and research based book, despite the title, and I have incorporated some of its recommendations into my lifestyle: namely, supplements: multivit with C, Omega-3s, and D3; mood journaling (added to my regular journal), and more regular exercise. He also teaches you how to recognize, be aware of, and avoid "ruminating" on negative thoughts. Because of this, I've started listening to more things that require my attention when doing housework: news, podcasts, books on tape. It really has lifted much of my negativity. Other things I do: Journaling, which consists of a checklist of items I want to accomplish each day (made the night before), the foods I've eaten (not amounts of calories, just everything I've consumed), my mood (on a scale of 0-10), and any notes I want to make. This takes less than 5 minutes of my time before bed, but really helps center my thoughts and goals for the next day. Make everything from scratch, whenever possible. I try to avoid overly processed foods, and I try to avoid meats most meals. My husband is highly carnivorous, so this is a balance, but he cooks on the days I work, so he can get all his meat in then. Sometimes when I cook I make something that has meat on the side, or a small amount of meat in it. My formative cooking years were spent as a vegetarian, so I don't really even know how to cook meat well, and it honestly grosses me out, so I avoid it. I bring my own meals to work, which almost always consists of a fruit, a green salad with home made dressing, and some sort of plant based, high protein item (soup, tofu tikka masala with brown rice, whatever leftovers I portioned out and froze). For a snack I have homemade granola. Ordering out or eating from the cafeteria (or worse, the vending machines) is really horrible, overall. Portions are huge, food is hyper-processed, and it's very expensive. I drink only tea, water, or sparkling water (or beer or wine when the occasion is celebratory). I used to drink wine or beer every evening with dinner, and then most nights a drink in the evening with my book, but I've cut that out in an effort to consume fewer calories and just in general be healthier. I exercise every day. I'm working on getting back into running, so I run 3-4 times a week (with a couch to 5K app). Almost every day I take the dogs on a walk. I do yoga at least once a week (I'd like to increase this to 2x a week, but I'm rehabbing from an injury and am limited to the "old lady gentle yoga" class offered just once a week at my gym). Once my physical therapy is over and I'm cleared for it, I'd like to start a kickboxing class 1-2x a week. I have a fitbit, and I monitor my steps daily. I aim for 10K or more. On days I work, I don't even have to worry about this. It's on my days off that I sometimes find myself out for a walk with the dogs at bedtime, trying to get my last 2-3K steps in. I am not the picture of fitness. I have about 45 more pounds to lose. I feel really great, though. My energy level is greatly improved. I don't have a constant sour stomach. I don't have a ball of stress in my gut. And my house is cleaner!