tamadrummer

I just went through the Bard Sherloc/3CG course and I can attest to the professionalism they bring to the table with their course! The training rep is an RN that has been doing PICC since they were being used in the 90's and she is flipping excellent in the field! As far as the didactic portion, I could take it or leave it. You need to study the anatomy of the veins in the arms and chest!!!!! That will aid you immensely when they are teaching you how to approach the arm and understanding the bundles of veins/arteries and where you are. The best part of the didactic class was the ultrasound lesson and how to use the Sherlock/3CG system. Also be familiar with the numbers of crbsi and be ready to become a pro at full sterile barrier prep! I think that is the most difficult part of the entire procedure! If you can contact Bard and get them to sell their product to your hospital, they will give you the best training you can receive! (IMHO)

I'm a new PICC RN using the Bard system and when we are done with our insertion and getting ready to print/save our strip, the actual number of cm out of the site is documented on the strip and is also documented on the EMR in lines/devices category. (We use Cerner for EMR) Maybe for an active person, the PICC should be sutured in place vs just using a Stat-lock although the Stat-lock should help prevent migration in a perfect world. Isn't there a place that you can research the amount of line left out of the site?

Is it possible to get the company to purchase a small cheaper ultrasound? It's not a sure hit every time but you know when you are in before you even see the flash.

Anything else seems kind of alien to me. All 3 of the facilities I have worked in have operated in the same fashion. Call the answering service and tell them whether you need, "orders, results, or condition" and stat or routine call. One physician, actually an intensivist/pulmonologist has given out his cell number so it is really fast to get him on the phone and get orders. If not careful it can be abused but he is not the kind of doctor that screams and shouts at people. If I were ever to be sick, he is the doctor I would want on my case!

Not one human being was harmed in this! You have to keep that in perspective! Risk management wants a statement because they always want a statement. It gives them a record so if heaven forbid this situation is brought up, they can mitigate the situation before escalation. Relax and enjoy being an RN. If you gave the wrong med and injured said child, I could see you totally freaking out but making a call to the wrong person and correcting it before any action could be taken by the wrong parent does not under any circumstance warrant having your license revoked.

Its a legal document that is reported to the risk management department of the hospital. It is used when any medication error is made, any violent interaction with patients, ect. It is also used to report unsafe situations of any kind, up to and including lazy doctors that are sitting in front of the computer refusing to put in their own orders and telling the RN to do it for them. It is really a system documentation to keep your license safe while working. If you work in a hospital, it may be called something just ask your risk management department about it.

Risk-master is your friend in these situations. Complaining families can become like a terminal cancer to your position in the hospital. If you defend yourself and keep your charting square and treat each patient like law and order you will feel more comfortable. Our new director of the ICU/PCU has taken the locks off the ICU doors and has pts families all over the place. We stop report and tell families from 6-8pm is report time either get in the room or in the waiting room but standing in the nurse servers listening to report is OUT of the question! Just be your own advocate when it comes to beligerant family members and like Nick7225 says, increase your assessments and make your presence known, you are legally responsible for the proper care of that patient. Your lisence doesn't say blah blah hospital on it, it says your name on it and that is yours alone!

I think that patients family member who demands you keep the lights off should be risk mastered, the supervisor as well. You have to be able to see everything happening with that patient and when you put them all on notice that this will not be tolerated and that you are responsible for all condition changes and that you are the one that has been tasked with caring for that patient, you will then be protected. At a minimum the risk master will make sure they know you are serious about patient care and will not be bullied by some sniveling family member or some non-compliant supervisor that left bedside care however many years ago. Keep up the good work and keep patient safety and care #1 at all times!

Have you ever called out for a consult? The doctor being consulted in an expert in their said field. Cardiology in this case would be the required expert. You don't decide if they are an expert of anything. The hospital already made that decision by hiring the expert consulting service that physician brings to the table. So in essence, if you had a cardiologist on the phone and they said to you, push xxx over xxx time and it was opposed to current 2010 ACLS guidelines, he/she would supersede those guidelines and as long as those orders are charted and cosigned by that physician, the case if closed. If you are questioning those orders and do not trust that doctor to cosign their orders, have a second RN obtain the order before initiation of said orders.

The dept of health will always be the cheapest place. Sent from my iPhone using allnurses.com

I had 3 job offers right out of school. I just graduated in April 12 and passed my nclex on June 13. I work in a pcu now and will be in the icu starting December 2nd. There will be work when you graduate. Just worry about school right now. None of you have any clue what you are in for. This is going to be the toughest time of your lives, just keep your nose in the books and don't get easily discouraged. All the games and convoluted crap is but a mere drop in the bucket. Sent from my iPhone using allnurses.com

Shoot I put 3 foleys in females just today. Just be professional and if they refuse, so what. Get a female and be done with it. My career isn't worth some woman being modest. In my experience, by the time these ladies need a foley, they are ready for the "son of sam" or whomever to instill it! They have not been able to pee, or they are peeing all over themselves and don't want to be woken up q30m for potty checks and baths so they don't get ulcers. Nope no prob here but if there is I will be the first to get out and get help.

I have 2 excellent stethoscopes. The master cardiology and MDF ER premiere, the master cardiology is >$200 the MDF cost about $160 or something like that. I like the Littman because it weighs less but the MDF gives me better auscultation IMHO. If you can go to a medical supply store and try them out. In school you don't need to have the best of the best but it will help to start out with the best you can afford. Personally I would buy apps for my phone before tangible equipment. You will also want to see what books they give you and then supplement from there. I know I used a ton of the drug guide apps, lab apps, and other things all the time except in the actual hospital. We were not allowed to touch our phones when in the hospital setting for clinicals.

I am not sure many understand what it means to have 49 people to pass Meds on and educate. Day shift and management really need to be involved. The DON and case manager along with poa and MD. The nightshift nurse has to pass Meds and fly around like a maniac with little to no help. Here in fl we have " med techs" that pass Meds but do not administer them. They use a MOR (medication observation record) vs MAR and help keep the LPN on time but only the LPN can administer insulin. The facility I worked in only had 2 RN's come in to draw up the insulin for the Lpn's. It's crazy to think Brandon has in any way sherked his duty. This resident is not an inmate, they are living in their home but their home happens to be in LTC. If admin and the doc along with the family/poa cant fix it, how can the nightshift LPN? Brandon if the guy says he wants 7u and you happen to administer the ordered dose, so be it. You are following orders and not lying as long as you don't say to the resident, "I am giving you the 7u you asked for" Sent from my iPhone using allnurses.com