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KatieMI

KatieMI BSN, MSN

Registered User

Reputation Activity by KatieMI

Reactions Given

Like 74
Thanks 2
Haha 1
Disagree 1

Reactions Received

Like 198
Thanks 2
Haha 8
Disagree 1
Sad 4

  1. Like
    KatieMI, BSN, MSN reacted to Emergent in This is crazy. Substance abuse in 1 in 5 nurses?   
    The link goes to an ad for a recovery program. 
    Deceptive advertising to lure new customers. 
  2. Like
    KatieMI, BSN, MSN reacted to TheMoonisMyLantern, ADN, RN in This is crazy. Substance abuse in 1 in 5 nurses?   
    This website gives terrible advice, I know of no state that has a non punitive program for substance abusing nurses. And the part about "dont fight the board of nursing", are you kidding me? If people don't fight back they get steam rolled, even people with mere allegations and no proof that they were impaired.
  3. Like
    KatieMI, BSN, MSN reacted to missmollie, ADN, BSN in This is crazy. Substance abuse in 1 in 5 nurses?   
    12.5 of seroquel isn't going to do anything.  Yes, I give the nurses dose and the full 25.  No, I don't drink on the days I go into work, I don't smoke pot, I don't take medications not prescribed to me.  Sounds more of a smear campaign than anything.
  4. Thanks
    KatieMI, BSN, MSN reacted to LadysSolo in Nurses, Doctors, and Admins: Nightmare Becomes Reality   
    The "shadowing nurses" idea was done at one hospital where I worked. The hospital board wanted to cut staff, and we asked if one of the board members would follow one of us for a day before they made the decision. The board member made it for 4 hours, and said "there will be no cuts - I don't see how you do it with the staff you have!" A success in my opinion!
  5. Like
    KatieMI, BSN, MSN reacted to Here.I.Stand, BSN, RN in Nurses Are So Bossy...   
    Bossier than Florence Nightengale?  🤔
  6. Like
    KatieMI, BSN, MSN got a reaction from Serhilda, ADN, RN in Sitting down - New nurse looking for advice   
    Just to let you know - none of your ideas can be applied to nursing. 
  7. Like
    KatieMI, BSN, MSN reacted to Jory, MSN, APRN, CNM in Written Up   
    Would you have given two meds that impacted blood pressure?  No, you would not because you don't want your patient to bottom out.
    It may be "common" in long term care, but it's called crappy nursing and why so many seniors are over-medicated for staff convenience.  
    I write for scheduled pain meds and PRN meds all the time after deliveries.  I count on the nurse's critical thinking skills not to stack meds inappropriately. RNs should not need a baby sitter.  I don't mind stacking ibuprofen with an opiate for better pain control, , but you don't give them at the same time and you don't stack opiates with other sedating drugs such as Ativan, etc.  
     
  8. Like
    KatieMI, BSN, MSN got a reaction from NRSKarenRN, BSN in Written Up   
    Well, the same case I described before (without HIPAA details):
    Patient was started oral amio load while Cardizem drip was still running. Was also on IV opioid d/t NPO. Not opioid naive, but not high dose either. Liked it very much, so dose was increased. Then he was complaining on anxiety before EP lab, so was given one dose of Xanax and that pain shot plus phenergan for nausea. 
    It was his luck that he was in ICU already because at one beautiful moment he just stopped breathing, but survived. Woke up right after Narcan + Romazicon. The two possible explanations were either synergetic actions of opioid, phenergan and benzo on respiratory center, or at large suppressed CYP3A4 by high loading doses of amio and diltiazem, adding to the benzo action. 
  9. Like
    KatieMI, BSN, MSN got a reaction from Oldmahubbard in would you tell a manager how toxic her floor is?   
    Do you really think management doesn't know it? 
     
    It is only a question of you being able to afford to burn bridges with this place. Realistically, there are pretty few circumstances which would allow you to do it safely. Local nursing circles can be much tighter than one can imagine. But if you, say, move for a good distance or leave for grad school and do not plan to come back to the same level job and feel like doing it, then feel free.
    (foreseeing questions: I did just that in 2015 with the fire burning up to high heavens. A short two years later I was without any problems credentialed in the same place as an NP. Nursing administration people still try to dissolve into thin air when we bump into each other by an accident. And at least in two units the question of new grads abuse is not existing any more). 
  10. Like
    KatieMI, BSN, MSN got a reaction from Oldmahubbard in would you tell a manager how toxic her floor is?   
    Do you really think management doesn't know it? 
     
    It is only a question of you being able to afford to burn bridges with this place. Realistically, there are pretty few circumstances which would allow you to do it safely. Local nursing circles can be much tighter than one can imagine. But if you, say, move for a good distance or leave for grad school and do not plan to come back to the same level job and feel like doing it, then feel free.
    (foreseeing questions: I did just that in 2015 with the fire burning up to high heavens. A short two years later I was without any problems credentialed in the same place as an NP. Nursing administration people still try to dissolve into thin air when we bump into each other by an accident. And at least in two units the question of new grads abuse is not existing any more). 
  11. Like
    KatieMI, BSN, MSN got a reaction from Oldmahubbard in would you tell a manager how toxic her floor is?   
    Do you really think management doesn't know it? 
     
    It is only a question of you being able to afford to burn bridges with this place. Realistically, there are pretty few circumstances which would allow you to do it safely. Local nursing circles can be much tighter than one can imagine. But if you, say, move for a good distance or leave for grad school and do not plan to come back to the same level job and feel like doing it, then feel free.
    (foreseeing questions: I did just that in 2015 with the fire burning up to high heavens. A short two years later I was without any problems credentialed in the same place as an NP. Nursing administration people still try to dissolve into thin air when we bump into each other by an accident. And at least in two units the question of new grads abuse is not existing any more). 
  12. Like
    KatieMI, BSN, MSN got a reaction from Oldmahubbard in would you tell a manager how toxic her floor is?   
    Do you really think management doesn't know it? 
     
    It is only a question of you being able to afford to burn bridges with this place. Realistically, there are pretty few circumstances which would allow you to do it safely. Local nursing circles can be much tighter than one can imagine. But if you, say, move for a good distance or leave for grad school and do not plan to come back to the same level job and feel like doing it, then feel free.
    (foreseeing questions: I did just that in 2015 with the fire burning up to high heavens. A short two years later I was without any problems credentialed in the same place as an NP. Nursing administration people still try to dissolve into thin air when we bump into each other by an accident. And at least in two units the question of new grads abuse is not existing any more). 
  13. Like
    KatieMI, BSN, MSN got a reaction from caliotter3 in Written Up   
    I would do whatever I can to use non-pharmacologic methods to comfort the patient and help him sleep
    I would explain him that what he was taking home may or may not be safe for him right now. He is in hospital because he is sick, isn't he? He takes many other meds now for that reason. Now, ALL meds are working in the same human body at once. Some of them work together, and it can be good or not. Some counteract each other, same story. I am a nurse, I cannot determine if that 1 mg of Xanax safe right now. Doctor can, would you like me to call? 
    If I call, I will start from fresh set of vitals taken by me personally. And I will tell the whole story, not only "hi, this is KatieMI from X, about your patient ftom 1234, can he get something for sleep?". In the case I described sbove, I would sure mention loading amio, drip and quickly escalating opioids. 
    I would not tell about "home dose Xanax for sleep" at all, unless it was verified or I can verify the dose. Most conscientious providers would not order it "for sleep" anyway. 
    If a provider will indeed order Xanax or something equally borderline (say, Versed - I had such orders in ICU), I would politely doubt it right then and there. I would mention my discomfort re. possibility of respiratory depression and then "just suggest" Valium, low dose Restoril, eszopiclone, Remeron or Benadryl. 
    If the provider still wants Xanax, I would call to whoever manages the amiodarone and cardizem and ask that person directly if they think it would be okay. Cardiologists are usually better verced in complicated pharmacology of their own drugs.
    I have strong pharmacology background, so doctors usually listened to what I said.
    About "1 hour apart" rule: 
    For example, you work with IV dilaudid to be given q2h. 
    1) check renal and liver functions.
    2) if they are more or less normal, proceed on your own; if clearly not, call pharmacy and speak with PharmD, not tech
    3) go Google and search for "dilaudid half life". Or use free app like Epocrates or drugbook. 
    You do not need a peer-reviewed article. The first link Goodle has is from something named "therecoveryvillage.com". It is good enough, as the number will be the same everywhere. 
    Dilaudid half life is about 2 hours. So, if you gave dose at 10 AM and the next at 12, your dose #2 will be "catching tail" of the first one as 1/2 of #1 will still be there. After #3 at 2 PM, you will have 1/4 of #1, 1/2 of #2 and whole #3. After #4, you will be close to "doubling" (draw it if it is difficult to understand). Which can be fine if you treat acute postop pain or cancer pain, but not for chronic.
    Usually showing Higher Ups that you understand that works. But I must tell you - it sucks to be more than average intelligent person in general, and especially if you are a nurse. 
  14. Like
    KatieMI, BSN, MSN got a reaction from Here.I.Stand, BSN, RN in Written Up   
    Write up? Probably not. 
    Stern talk about poor clinical judgement and critical thinking? Oh, yes. 
    BTW, this is what happens when we providers are bombarded with calls about something for this symptom and something for that complain and nobody consciously reviewing the already existing orders. And BOTH sides need to do that every day for every patient. 
    And, yes, 0.5 of Xanax doesn't seem to be a lot, but if patient also was on Norco 10 q4h PRN, dilaudid 1 q2h PRN, on loading Amio PO and new Cardizem drip for afib/RVR (both inhibitors of CYP3A4, which metabolizes benzos), then the benzos-naive patient could experience respiratory depression. 
  15. Like
    KatieMI, BSN, MSN got a reaction from Oldmahubbard in would you tell a manager how toxic her floor is?   
    Do you really think management doesn't know it? 
     
    It is only a question of you being able to afford to burn bridges with this place. Realistically, there are pretty few circumstances which would allow you to do it safely. Local nursing circles can be much tighter than one can imagine. But if you, say, move for a good distance or leave for grad school and do not plan to come back to the same level job and feel like doing it, then feel free.
    (foreseeing questions: I did just that in 2015 with the fire burning up to high heavens. A short two years later I was without any problems credentialed in the same place as an NP. Nursing administration people still try to dissolve into thin air when we bump into each other by an accident. And at least in two units the question of new grads abuse is not existing any more). 
  16. Like
    KatieMI, BSN, MSN got a reaction from brownbook in Written Up   
    That was likely about me. As I said, there are lots of people who just cannot stand anyone who is smart and openly proud of it. 
  17. Like
    KatieMI, BSN, MSN got a reaction from caliotter3 in Written Up   
    I would do whatever I can to use non-pharmacologic methods to comfort the patient and help him sleep
    I would explain him that what he was taking home may or may not be safe for him right now. He is in hospital because he is sick, isn't he? He takes many other meds now for that reason. Now, ALL meds are working in the same human body at once. Some of them work together, and it can be good or not. Some counteract each other, same story. I am a nurse, I cannot determine if that 1 mg of Xanax safe right now. Doctor can, would you like me to call? 
    If I call, I will start from fresh set of vitals taken by me personally. And I will tell the whole story, not only "hi, this is KatieMI from X, about your patient ftom 1234, can he get something for sleep?". In the case I described sbove, I would sure mention loading amio, drip and quickly escalating opioids. 
    I would not tell about "home dose Xanax for sleep" at all, unless it was verified or I can verify the dose. Most conscientious providers would not order it "for sleep" anyway. 
    If a provider will indeed order Xanax or something equally borderline (say, Versed - I had such orders in ICU), I would politely doubt it right then and there. I would mention my discomfort re. possibility of respiratory depression and then "just suggest" Valium, low dose Restoril, eszopiclone, Remeron or Benadryl. 
    If the provider still wants Xanax, I would call to whoever manages the amiodarone and cardizem and ask that person directly if they think it would be okay. Cardiologists are usually better verced in complicated pharmacology of their own drugs.
    I have strong pharmacology background, so doctors usually listened to what I said.
    About "1 hour apart" rule: 
    For example, you work with IV dilaudid to be given q2h. 
    1) check renal and liver functions.
    2) if they are more or less normal, proceed on your own; if clearly not, call pharmacy and speak with PharmD, not tech
    3) go Google and search for "dilaudid half life". Or use free app like Epocrates or drugbook. 
    You do not need a peer-reviewed article. The first link Goodle has is from something named "therecoveryvillage.com". It is good enough, as the number will be the same everywhere. 
    Dilaudid half life is about 2 hours. So, if you gave dose at 10 AM and the next at 12, your dose #2 will be "catching tail" of the first one as 1/2 of #1 will still be there. After #3 at 2 PM, you will have 1/4 of #1, 1/2 of #2 and whole #3. After #4, you will be close to "doubling" (draw it if it is difficult to understand). Which can be fine if you treat acute postop pain or cancer pain, but not for chronic.
    Usually showing Higher Ups that you understand that works. But I must tell you - it sucks to be more than average intelligent person in general, and especially if you are a nurse. 
  18. Like
    KatieMI, BSN, MSN got a reaction from Here.I.Stand, BSN, RN in Written Up   
    Write up? Probably not. 
    Stern talk about poor clinical judgement and critical thinking? Oh, yes. 
    BTW, this is what happens when we providers are bombarded with calls about something for this symptom and something for that complain and nobody consciously reviewing the already existing orders. And BOTH sides need to do that every day for every patient. 
    And, yes, 0.5 of Xanax doesn't seem to be a lot, but if patient also was on Norco 10 q4h PRN, dilaudid 1 q2h PRN, on loading Amio PO and new Cardizem drip for afib/RVR (both inhibitors of CYP3A4, which metabolizes benzos), then the benzos-naive patient could experience respiratory depression. 
  19. Like
    KatieMI, BSN, MSN got a reaction from caliotter3 in Written Up   
    I do too. But, what I went through before that got clear enough to others, including the management...
  20. Like
    KatieMI, BSN, MSN got a reaction from caliotter3 in Written Up   
    I do too. But, what I went through before that got clear enough to others, including the management...
  21. Like
    KatieMI, BSN, MSN got a reaction from caliotter3 in Written Up   
    I would do whatever I can to use non-pharmacologic methods to comfort the patient and help him sleep
    I would explain him that what he was taking home may or may not be safe for him right now. He is in hospital because he is sick, isn't he? He takes many other meds now for that reason. Now, ALL meds are working in the same human body at once. Some of them work together, and it can be good or not. Some counteract each other, same story. I am a nurse, I cannot determine if that 1 mg of Xanax safe right now. Doctor can, would you like me to call? 
    If I call, I will start from fresh set of vitals taken by me personally. And I will tell the whole story, not only "hi, this is KatieMI from X, about your patient ftom 1234, can he get something for sleep?". In the case I described sbove, I would sure mention loading amio, drip and quickly escalating opioids. 
    I would not tell about "home dose Xanax for sleep" at all, unless it was verified or I can verify the dose. Most conscientious providers would not order it "for sleep" anyway. 
    If a provider will indeed order Xanax or something equally borderline (say, Versed - I had such orders in ICU), I would politely doubt it right then and there. I would mention my discomfort re. possibility of respiratory depression and then "just suggest" Valium, low dose Restoril, eszopiclone, Remeron or Benadryl. 
    If the provider still wants Xanax, I would call to whoever manages the amiodarone and cardizem and ask that person directly if they think it would be okay. Cardiologists are usually better verced in complicated pharmacology of their own drugs.
    I have strong pharmacology background, so doctors usually listened to what I said.
    About "1 hour apart" rule: 
    For example, you work with IV dilaudid to be given q2h. 
    1) check renal and liver functions.
    2) if they are more or less normal, proceed on your own; if clearly not, call pharmacy and speak with PharmD, not tech
    3) go Google and search for "dilaudid half life". Or use free app like Epocrates or drugbook. 
    You do not need a peer-reviewed article. The first link Goodle has is from something named "therecoveryvillage.com". It is good enough, as the number will be the same everywhere. 
    Dilaudid half life is about 2 hours. So, if you gave dose at 10 AM and the next at 12, your dose #2 will be "catching tail" of the first one as 1/2 of #1 will still be there. After #3 at 2 PM, you will have 1/4 of #1, 1/2 of #2 and whole #3. After #4, you will be close to "doubling" (draw it if it is difficult to understand). Which can be fine if you treat acute postop pain or cancer pain, but not for chronic.
    Usually showing Higher Ups that you understand that works. But I must tell you - it sucks to be more than average intelligent person in general, and especially if you are a nurse. 
  22. Like
    KatieMI, BSN, MSN reacted to hherrn in Written Up   
    I think the dose may not have been a big deal, but the rationale was less than sound.
    Using that rationale, you could have also given some ativan for vertigo and some valium for a muscle spasm along with both doses of xanax if they were ordered PRN.
    Then after they stopped breathing, you could have given some romazicon, but given the likely benzo dependence,they would seize with no effective med available.  
  23. Like
    KatieMI, BSN, MSN got a reaction from brownbook in Written Up   
    That was likely about me. As I said, there are lots of people who just cannot stand anyone who is smart and openly proud of it. 
  24. Like
    KatieMI, BSN, MSN got a reaction from Here.I.Stand, BSN, RN in Written Up   
    Write up? Probably not. 
    Stern talk about poor clinical judgement and critical thinking? Oh, yes. 
    BTW, this is what happens when we providers are bombarded with calls about something for this symptom and something for that complain and nobody consciously reviewing the already existing orders. And BOTH sides need to do that every day for every patient. 
    And, yes, 0.5 of Xanax doesn't seem to be a lot, but if patient also was on Norco 10 q4h PRN, dilaudid 1 q2h PRN, on loading Amio PO and new Cardizem drip for afib/RVR (both inhibitors of CYP3A4, which metabolizes benzos), then the benzos-naive patient could experience respiratory depression. 
  25. Like
    KatieMI, BSN, MSN got a reaction from brownbook in Written Up   
    That was likely about me. As I said, there are lots of people who just cannot stand anyone who is smart and openly proud of it. 
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