BluegrassRN

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.

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).

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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!

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!

Musical taste is so individualized; whatever gets you energized or inspired is what you need. My workout playlist has everything from music from the 80s through the present, in 4 languages (only two of which I speak), everything from pop, rock, punk, emo, rap, and even some older country (ah, Willie, I just love you). Every song puts a spring in my step and a smile on my face. Here's what I do: every time I hear a song (on the radio, in a movie, on TV) that makes me feel better, that makes me want to dance, sing at the top of my lungs, start a riot, or puts a huge smile on my face, I run to the computer and download it to my iTunes account (or write it down and save it for later). I then put it on my running mix, and the mix stays permanently on shuffle. This is why I have Prince, A-ha, Los Fabulous Cadillacs, Stiff Little Fingers, Run DMC, the Get Up Kids, Grouplove, Flogging Molly, Bob Mould, Willie Nelson, AWOL Nation, Die Toten Hosen, and over 70 other artists on a 200 song playlist. Very few have more than 1 song on there; it keeps everything fresh.

We don't do self scheduling, but our schedules and timeclock are in Kronos. I have never worked with any other software. I don't know how horrible or awesome it is. I feel like I wasn't well trained in it, so there were a few things I didn't understand. I felt like there were some dual designations that I had to enter, particularly with employees who worked in more than one area or filled more than one position (for example, a staff RN who charged, or an aide who worked as a sitter for a shift). Overall, it got the job done. I don't know how much individualization each organization receives. I think a lot of our issues were issues between accounting and clinical staff. For example, accounting wanted us to enter on call hours in the schedule in one manner; but this led to nursing supervisors not knowing the exact hours that someone was on call, and the on call staff not getting paid for hours if they didn't get called in. Those of us entering the schedule finally just entered it the way the supervisors liked it, and then had to go through and change it to the way the accountants liked it when we were double checking time cards for payroll. What a waste of man hours. However, was this an issue with Kronos, or how we implemented it? I have no clue.

I left the floor for a while for an administrative position. Went from walking 12k plus steps a day to barely clearing 3K. My stress level was through the roof. Went back to to the floor. Lost 5 pounds, have more energy, and am happier than I've been in a while. anything can cause stress. Any job. You don't always have a lot of control over your job, but you control what you do about it. Regular exercise, meditation, healthy eating habits, a schedule that breaks up your work days (or if you prefer more time off, chunks them together), changing jobs, medication, therapy, changing your lifestyle outside of work (developing healthy habits and hobbies that bring you joy and lower your stress levels), all these positive activities are within your power.

Cotton balls come in a large container that is open for weeks/months. They are typically stored in smaller containers where they are exposed repeatedly to different hands and therefore germs. 2x2s are individually wrapped, and remain sterile until opened immediately prior to use. See where I'm going with this?

First, I always make sure the pt is actually aware of the smoking policy. Second, I explain the reasons why they aren't allowed to smkoe, including the fact that we have a lot of critically ill respiratory pts for whom even a scant amount of second hand smoke would be very harmful to them and can trigger a coughing attack with decreased oxygenation. Third, I inform them that if I suspect them of smoking again, we will discuss the need to discharge them. Fourth, if I suspect illegal drug use, I'll tell them we'll turn it over to the police. Finally, if they are just smoking cigarettes, I offer to obtain some sort of replacement nicotine, as well as ativan or Xanax if appropriate. It's difficult to not be able to smoke, particularly if the habit is a heavy one, and I'll do anything I can to keep their discomfort to a minimum. no one needs to be smoking pot in their rooms. That's idiotic. They can cut it out, have the cops called (if it's a banned substance), or they can leave.

The flip side of this is that, when you have a. Fellow coworker whose pt has coded, you should touch base with them and ask what you can do to help. If your charge doesn't take pts, they absolutely should be stepping in to take over some of your pt care.

We had this issue with our students, and a lot of us complained. There was no guidance as to what the students were capable of, expected to already be a proficient at, etc. Our ed department met wih the local nursing schools and now each clinical day, the instructor leaves a little form at the desk, which has 3 sections: tasks that the students can do, tasks that they are not yet allowed to do, and then a section for the objectives and expectations of the clinical day. Under that 3rd section, the instructor usually puts how many patients they expect the student to have, or if they want them to follow the nurse, etc. We survey our nursing students, and one complaint they routinely have is that they are not included in the nursing process, that they do a lot of clinical activities but don't get enough practice of critical thinking and of the whole picture. So now I try to "narrate" what and why I'm doing something. I used to not ask students questions, as I didn't want to put them on the spot or make them uncomfortable, but now I say something like, "Our pt is C/o abdominal pain, why do you think that is and what should we do about it?" And then after I get their answer, I try to talk them through what we are, in fact, going to do about it and why. i feel like this means I'm doing a lot of talking (particularly when I'm narrating what I'm doing), and I worry this decreases their attention. I'm trying to find a happy medium. Also, I don't think the realize that critical thinking skills are difficult to teach; on the other hand, I think their complaints that they do too many skills and not enough of the planning and evaluating is a valid complaint.

Our hospital rarely worries about the color of the clear liquids. If I'm concerned about a bleed, I'll limit it myself, but if there isn't any concern for an active bleed, it shouldn't make any difference. I would have given the potassium.

We give IVPB all the time without accompanying fluids. Just depends on the physician's orders and the pt's status. Some antibiotics are hard on the kidneys, for example, and until the physician has a day or so of oral intake data on the pt, we keep them on iv fluids as well as iv antibiotics. Or the pt has electrolyte imbalances, or their lab work indicates dehydration. Lots of reasons to run fluids and iv antibiotics together, but not all those reasons apply to all pts, and some pts simply don't need fluids, so they don't get them (pts with chf, for example). Does that answer your question, OP? and yes, I know IVPB technically means piggyback, but in our facility it simply means an intermittent infusion, and I assume it means that in most. When you piggyback the other fluids aren't running concurrently, anyhow.