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manchmal

manchmal

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New grad, RN, Psych nurse 1st year.

manchmal's Latest Activity

  1. manchmal

    incident report documentation policy?

    Can anyone tell you NOT to file an incident report? Say a doctor or supervisor tells a nurse that something doesn't require incident report, or specifically not to fill one out. Or an RN tells an LVN not to fill one out. The incident reports require supervisor or physician signature. Should staff fill one out anyhow if in THEIR estimation it's an event worth writing about, and submit it to supervisor or physician anyhow (probably making them annoyed, if they have said it isn't an incident report event), just to cover their own butt and assure pt. safety? I feel pressure not to fill out incident reports when I think I should, but it's not an autonomous nursing action (i.e. I have to report it to someone else, who has to sign it, and they can be irritated that I filled it out to begin with, or tell me it isn't incident-worthy).
  2. manchmal

    Redlining.

    Thanks!! In this instance, it WAS signed by day shift, and they didn't catch the error. So I figured that WHATEVER my signature meant, I didn't want it to appear in 6 months time that I was the third "checker" to sign when there was a dispensing or prescribing error. Where I am there are three sigs -- LVN or RN who takes off order signs, another RN signs, then night shift signs. In this case, the pt was already gone with a mistaken quantity and dose of meds, so I couldn't "fix" it at 0300. Wasn't a serious mistake (ie the pt was fine when they got ahold of them on days). The pt was fine. In cases where there was a mistake on dosage or whatever (wrong thing in MAR) and I could fix it, I did that, but was still unsure whether to write. I know you don't mention med error report filing or incident report in the chart, but it sounds like I could write "error -- not executed" or similar. Or just "not verified." I'm glad others think I did the right thing. In my mind, the incident report is sufficient and I wanted to leave the chart with no red sig, but people were insisting "well it HAS to have a red signature on it." ok, but I want to know what the red sig means! I'm glad I stuck to my guns on this one, though it always feels bad when you're new and not super confident and someone insists you do something with the rationale "we always do it that way." They will prolly be annoyed I wrote what I did in bright red ink, but I tried very hard to just leave it alone! From now on I may write "MAR verified" or "DISCHARGE MEDS NOT VERIFIABLE" and then sign. So everyone is clear what I am saying when I sign. :) I did tell the original nurse who signed. Felt bad doing incident report as it was a confusing order but I had to, as the mistake was already made and hopefully they will fix process so it isn't made again.
  3. manchmal

    Redlining.

    I responded to a real old thread but I am not sure if it will show up and I really want info. So...who can tell me what "redlining" is, its history, etc. Nursing school trained us in a 21st century digital world and all the jobs want me to know what nursing was like before computers. There's an article topic for someone!! Anyhow...can any night shift RNs respond to what I'm going to paste here, which was a question I posted below someone who had discovered a med error redlining: "I know it's an old thread but I have a similar question about "redlining". Night shift at my facility goes through the day's written or computerized orders and signs (after the staff that pulled the orders off or acknowledged then) and "verifies" they were written into the MAR correctly, etc. Then they sign their name in red ink. I was trained in a digital charting environment and I'm a new grad, so this is new to me. Anyhow. My question is for anyone who has experience with this "redlining." Say you are redlining and you find an error -- like the original poster here. Obviously, you notify doc and fill out incident or med error report. So DO YOU STILL SIGN YOUR NAME if the order was NOT executed correctly? Say a patient was discharged with a wrong dose of a med, and you are to "redline" a printout that has an order for a different dose. I don't know what "redlining" means. I have recently said I was not going to sign my name on an order that was not executed correctly, and I was told to sign it. When I repeated I was uncomfortable with it, I was told "okay, fine, write ERROR and sign it." To me, that is vague and weird to have hanging out in a pt chart without explanation. So I wrote something like "not dispensed as written ERROR" and signed and dated. I cannot find policy on this but people seemed annoyed I wouldn't just sign it. However, I don't see the point in a red verification signature if it doesn't mean everything was executed correctly! I want to know what exactly I'm agreeing to when I sign orders after another RN has already executed them (correctly or incorrectly). HELP! :)"
  4. manchmal

    did I do the right thing????

    I know it's an old thread but I have a similar question about "redlining". Night shift at my facility goes through the day's written or computerized orders and signs (after the staff that pulled the orders off or acknowledged then) and "verifies" they were written into the MAR correctly, etc. Then they sign their name in red ink. I was trained in a digital charting environment and I'm a new grad, so this is new to me. Anyhow. My question is for anyone who has experience with this "redlining." Say you are redlining and you find an error -- like the original poster here. Obviously, you notify doc and fill out incident or med error report. So DO YOU STILL SIGN YOUR NAME if the order was NOT executed correctly? Say a patient was discharged with a wrong dose of a med, and you are to "redline" a printout that has an order for a different dose. I don't know what "redlining" means. I have recently said I was not going to sign my name on an order that was not executed correctly, and I was told to sign it. When I repeated I was uncomfortable with it, I was told "okay, fine, write ERROR and sign it." To me, that is vague and weird to have hanging out in a pt chart without explanation. So I wrote something like "not dispensed as written ERROR" and signed and dated. I cannot find policy on this but people seemed annoyed I wouldn't just sign it. However, I don't see the point in a red verification signature if it doesn't mean everything was executed correctly! I want to know what exactly I'm agreeing to when I sign orders after another RN has already executed them (correctly or incorrectly). HELP! :)
  5. manchmal

    I feel so bad

    You did the right thing by trying to talk to her first. You probably wouldn't have gone to the manager if she had been more receptive to your talking to her. So she seems pretty much to have chosen her own destiny. It would have been acceptable, but maybe not effective or considerate, to go to the manager first -- but you didn't do that; you tried to talk to her, and she was defensive. I have similar problems, and have had them my whole working life (in my non-nursing career), with feeling bad about asking someone I'm working with to do something if there was any way I could possibly have done it myself. But I wind up growing resentful as I continuously do the other person's job and they do less and less and I do more and more. And I don't like being resentful, so when I finish school and get a nursing job, it will be a top priority NOT to be the one who everyone knows will "just do it all" (I know where this road leads...). She's lucky to have someone who talked to her first, and she's stupid to have been nasty and defensive when you were taking time to talk to her.
  6. OK, I'm probably dense, but... what do you do with 2 different colored pens and a highlighter?? Like, specifically...cross off stuff when you're done, or... Also: Is there a thread on here about what people's "organizational sheets" look like. I have one, but I'd love to see someone else's. My pockets... Hmm, a little less predictable. On a good day, 1 or 2 alcohol prep pads, bandage scissors, tape, my iPhone with drug guide, lab guide, diseases/diagnoses handbook, IV compatibility book, etc. all on it (!), my cool LED pen light that looks like a tire gauge, 1 black pen, a tiny sheet of scrap paper, and a couple 3mL flushes. Sometimes those blue cap things for the IV tubing. Stethoscope there, or around neck. Usually around neck. I also carry a black clipboard with a cover on the front for privacy, but I try not to take that in and out of pt. rooms very often for infection control purposes. That clipboard has a pad of paper, the report sheet, a blank assessment sheet from before we went computerized, a sheet with my 'to do' list for that shift, a laminated quick reference to lab values I made, some referral/info cards for domestic violence shelters and escape plans, and a one-page quick-reference sheet for psych behavior terminology definitions.
  7. manchmal

    Does nursing school teach you anything?

    Yes. Nursing school teaches you: to be diligent, to do your homework/research, to work very hard, to learn to sift out good info from the crap, to be resilient and brave, to put up with crappy supervisors, to admire and respect talent, to make good friends, and to put your own problems in perspective.
  8. manchmal

    Spouses/Visitors In Patient's Beds

    Oooh, here's an interesting one (to me): what about long-term inpatient psych? There are both voluntary and involuntary admissions, some forensic and some not at state hospitals, and I was thinking just the other day about sexuality, sexual frustration, and 20-somethings (and all ages, really) being hospitalized for months or years. I'm not saying they should have sex in their rooms (the issue of competency/incompetency comes to mind here), but I am saying that there's no way that not having sex for months doesn't impact their moods and their behaviors. I think it should be discussed more, and I'm not sure how I feel about it aside from agreeing that sex is a physiological component of well-being for many, many people. So ignoring it sort-of does away with nursing's goal to look at the "whole patient," etc. PS: this is an example that disproves whomever said "if you're well enough to be having sex, you are well enough to go home." That's very short-sighted and applies only to a limited area of the medical/nursing world.
  9. manchmal

    Spouses/Visitors In Patient's Beds

    Hey, in nursing school they teach us that sexuality is a physiological need according to ole' Maslow... :) Not that I totally agree with the whole Maslow thing, but I do think it's interesting how rarely sexuality is considered in patient care.
  10. manchmal

    Mental health nursing easier than Med-Surg?

    I'm a last-semester RN student who started this program specifically to do psych nursing. I was open to being interested in other things, though. Last semester, I was in ICU...and while 90% of my class was LOVING their long-awaited ICU experience, I realized I never, ever, ever could do ICU nursing. How I dreaded ICU...most of the patients were on vents and didn't talk! Everything was so focused on the acutely physical problems and so much of the acutely psychological problems were (understandably) on the back burner, and it felt like I was monitoring machines more than people that...I was...BORED, even. :) I like the patient interaction, sometimes longer-term stays, socially/behaviorally hectic unit, interesting and underserved population, and unique clinical skills I need to know to do a good job as a mental health nurse. I guess if you weren't interested in that stuff, it might seem easier, but only because you'd kind-of not really be taking the job to be good at it and good for the patients. Anyhow. Psych isn't by default easier than any other unit. It's different, for sure, but in the same way as a cardiac unit is different from a hospice unit -- different priorities, different illnesses, different needs, different skill sets emphasized. And like others have said, there often is med surg going on on a psych floor, and there oughta be more psych interventions going on on general med surg floors, too. I happen to be really interested in mental health nursing, and that's because I find it more challenging and rewarding (for me) than med surg or critical care. Good thing there are some of us interested in most areas. I've spent 2 years of nursing school fighting off any and all faculty members who tried to convince me I don't want to do mental health nursing. :) I wanted to do psych nursing when I started, and I want to even more now that I'm almost done.
  11. Oh man, we had to do the McDonalds drive thru style flu clinic, too -- the whole school did it, with first semester students drawing up vaccines, and students who have taken pharm and passed skills tests in pharm giving injections. I totally agree that students need to learn to pass meds. I have the same theory about that as I have of prisoners who have 2 year sentences: they're not gonna be students or prisoners forever, so it is wise to teach them how to function once they get out. :) Edit: we precept over 130 hours our last quarter, too, and the expectation is that we will take 80% of the RN's patient assignments and do everything the RN would do, so long as it is in the scope of what we have been trained to do. They mostly expect by that time we should be trained to do almost everything for basic patient care. This is, of course, supervised precepting but students are supposed to delegate to UAPs, do assessments, meds, etc.
  12. manchmal

    What was the lowest diastolic bp you have seen?

    78/44 during c-section of mom with twins with 900 or so ccs of blood lost. They got it up pretty fast. Listening manual, I've heard 102/40 and patient had a hx of heart disease of HTN -- I was a student, wasn't sure whether to give the calcium channel blocker that is due in such cases but doc wanted it given (based on history and that typically it is held for systolic Have had 88/68 myself, no symptoms. Have seen those numbers on a patient who was dizzy and puking, so it does depend on the person.
  13. Did anyone else's school not tell them anything about this sort of thing? I mean, I got a student handbook that told me that I was to do x, y, and z, and most of it was somewhere along the lines of "if you don't follow your instructor's instructions, you can get dismissed from the program. ask your instructor if you have any questions. this is subject to change at any time. be nice. don't mess up." Maybe my school is disjointed, but in my experience, every clinical instructor is different and has different preferences and rules about what students can and can't do. And the guiding principle seems to be what the hospital system dictates is acceptable, which I assume is in accord with state nurse practice laws, else they'd probably be in trouble come JC certification time, right? Like if student nurses were systematically running around on every shift and every floor callously passing meds unsupervised, and with overconfident reckless abandon, in direct insubordination to what nurse practice laws say? I think what a student can do varies by state, like several people have said. Nursing education programs have their own section in the state legal code, separate from what an RN can delegate to a UAP (at least in my state), so I think it's different. Personally/not from a legal point of view, I don't see any problem whatsoever with nursing students executing some independence as they are trained to do tasks. There's no magic *thing* that happens inside you once you are licensed as an RN, and since that is the case, I'd prefer nurses who are caring for me to have practiced (hands-on) skills they are performing. Part of being an RN is learning to make independent (informed) decisions, and so I feel comfortable with nursing students learning this as they go along (with practiced skills, such as reading a MAR and pulling meds, IV placement, or walking into a room to give an IM vaccine), rather than granting them 0 independence, and then thinking they should be magically totally independent once they have a piece of paper/license.
  14. Also: as an RN you can refuse a task and go to a supervisor or a different job if it's a frequent thing that you are asked to do something questionable. It's considerably more scary for a student who doesn't yet know nursing scope (we are in school to learn that) and refusing to do what an instructor says is sort of saying "I'm a student and I know better than you." Students get yelled at and intimidated for that, at best. Maybe a good lesson in pt advocacy and thick skin but I'm not an expert in nursing yet so it would make me nervous. I've done it, but it ain't pretty.
  15. It's very presumptuous to assume student nurses are demanding to pass meds and are overconfident. That's not been my experience. If anything, for better or worse I am often pushed out of my comfort zone by classroom and clinical instructors. A first semester student may not even know what state nurse practice acts are, so instructors should know what their students should and shouldn't do. And students should inform themselves, also. But it is wrong to assume overconfidence is why students are passing meds. Some states and facilities seem to allow it, and in other situations it's likely often the case that they're doing what their supervisor tells them to do without knowing the legal stuff.
  16. Yeah, same with us on the heparin subqs or vaccine IMs. We can give insulin without RN in room but she has to inspect and sign off on the flexpen after it is dialed or the drawn up insulin (she observes us drawing it up also).