Whit2389

I would imagine that if it's one of your patients you are to go out but not all the patients will have the same nurse on call. Just my guess. And a lot of places only reimburse if the drive is over 30 miles away. Definitely ask for clarification.

Perhaps you could have an A1C results as a goal instead of accuchecks. Or ask the facility to print you a copy of the glucose levels.

You need to chart relevant information. If a patient fell but not on your shift then he/she is being followed up on r/t fall. You need to chart the specific situation going on, the relevant assessment findings, and interventions to prevent the issue from happening again. Falling is a safety issue. You could state something along the lines of "Mr. Smith fell yesterday at 7:00AM, neurochecks continue and are WNL. Patient in bed resting with no s/s of distress noted at thos his time. Bed is in low position and call bell within reach at all times" If the patient were to fracture their elbow during the fall and is having pain then instead of no s/s of distress you would chart "fall resulted in a fracture of L elbow. Pt states pain level 8/10. 3mg Dilaudid administered PO per MD orders at 1300. At 1400 pt states "pain is 3/10". If the fall results in an open wound then you either say you did whatever the doctor ordered (wound cleaned with NS, dry dressing applied per MD orders) , if it didn't fall on you to do the treatment then just chart that the bandage is intact.

I. Going through the same thing. I struggle with the 6pm-6am shift, but the only difficult part is the 8pm med pass. Like you, I am responsible for all the things you listed. I have a different "preceptor" every time I train. I only trained for 4 days before they tossed me out on my own. I told them I needed one more day of training and I requested to train with one of my favorite nurses there. I asked her if she would teach me a "real world" med pass and show me the tricks of the trade instead of going by the book so that I am not drowning. My first 8pm med pass wasn't done until after 1am. If she passes me on any great tips tomorrow then I will share them with you. Good luck and I really truly feel your pain! (By the way on the 6pm-6am shift I am the only nurse and no med techs, anywhere from 40-55 patients and about 10 scheduled mess each, plus prns, breathing tx, finger sticks, blood sugars, and gtubes).

She has type SD. It is a variant form of Sickle Cell Disease. There are several different hemoglobin variants,however they all receive the diagnosis of Sickle Cell Disease and the majority of them consist of anemia. My daughter does have the chronic anemia, her baseline hgb is 8 but has gotten as low as 3. With many of the variants you will see that some of them have more immune system issues. Sickle Cell Disease is also more severe in people with asthma.

What did they warn you about sickle cell patients?

Very true, but it's not always that simple. When I was tested for sickle cell trait I was told I did not carry it. My daughter was diagnosed at 14 days old with sickle cell disease.

Because people without sickle cell aren't rude?

It's because children with Sickle Cell are taking more serious than adults because they are not perceived as drug seekers. This came straight from both my children's hematologist, as well as our regional Sickle Cell Social Worker. They see a child in pain and they see pity, they see an adult in pain and they see a drug seeker. These children are often directly admitted to the hospital if it is after office hours, no emergency room necessary. However, at 17 they are bumped to an adult hemotologist and therefore they visit a regular hospital and not a children's hospital.

Please tell me what test there is to check for an active crisis.

Oh wow! that's, odd.. I could see if the shift ended at 7 or 8, but not at 6. You'd think they would just have you guys take on other things such as finger sticks or medicating the early risers only.

I'm still in orientation. Our night shift is 10p-6a. When we first arrive we do narc count, clear off the med cart, receive medications from the pharmacy delivery guy & do the paperwork on those and fax them to the pharmacy. We do our 11:00 med pass anywhere from 10p-12a which mostly include sleeping meds, antianxiety meds, and pain meds. We make rounds, do the midnight census, check our wanderguards for our wanderers, etc.. Make sure our pt who get O2 at night or use cpaps are all set up. We do neurochecks if a patient has fallen and chart on them, chart on our medicare patients, chart on anyone receiving antibiotics, etc.. hang IV fluids or medications. We do a 24 hour check on all new doctor's orders (get the order, compare it to the mar, mark that it was checked and correct or mark if it needs to be clarified). Trust me, the doctor does not want a 2 AM phone call about the correct dose of simvastatin on a stable patient. So then we have gtube & peg tube feedings. Sometimes an Alzheimers or behavior patient will cause a huge ruckus and wake up half the hall so we then try to meet all those patients requests. We write lab orders into the lab book, the lab lady comes at about 4am to draw blood but we have to draw if it's from a picc. A lot of times we will also be asked to draw if the pt is combative or a hard stick. We complete any incomplete admissions paperwork or duties that show up red after midnight (which means they weren't done by other shifts). Defrost the refrigerator, check equipment (glucose machines), check refrigerator temps. Begin AM med pass between 4a-5:30a. Complete trach care. Document, prep patients who have appointments in the morning (get their charts copied, showered, dressed, etc..). Get our early risers up. If the oncoming nurse is running late then we start blood sugar checks. Every once in while there will be a wound treatment but most the time we just check the bandage and reinforce as needed. And that's just off the top of my head, I'm sure I'm missing some things..

Btw, I too just started my first job at a LTC facility. They told me 3 to 5 days orientation but I told them I definitely wanted 5 and would let them know if I was ready then. I spent all of 4 days taking extreme notes, asking a million questions, training with 4 different people. Tonight is my first shift on my own, and while I am SUPER nervous, I do feel prepared. I trained on 2nd shift and hated it. Third seems to much better for someone new at LTC.

If they are understaffed then odds are they will end up wanting to float you from hall to hall. If I were you I would request two days of training on each hall, then inform them of the hall you feel most comfortable on and tell them you want one more say of training on that hall. That's what I did and I found it very helpful to learn how the entire building functions as a unit. Each nurse does things differently and it was helping seeing how each nurse did each thing differently. I also ended up training on a different shift one time since there wasn't anyone to train me on my primary shift. This was helpful too, and also gave me the comfort of knowing I wouldn't freak out if I had to work a double on a shift that is not my regular shift. If you don't like passing medications then see if you can switch to 3rd shift. Most medications are scheduled during the day, so night time med passes are much smaller. Usually a few pills passed right before bed (ambien, anti anxiety, etc..), and then in the morning you may have thyroid pills and protonix (anything consumed on an empty stomach), plus prn pain meds or duonebs through the night. This leaves more time to go through patient charts and get to know your patient and learn about their disease processes. Once you become comfortable with knowing your patients, becoming more oriented to the unit, etc.. you can switch to a different shift with a heavier medication load.

I am a registered nurse and I take care of a quadriplegic. He is total care and very active. We wash his dishes, his laundry, tidy his room up, sweep, clean his toilets, etc.. as well as all of our nursing care. He was 15 when I started, he is now almost 19 years old and in college. The nurses still do these tasks. It's different being a home health nurse than it is being an acute care nurse. In the home health setting your patient is typically stable and your only patient. Especially in the situation where you have a quadriplegic patient, we are there to be their hands and medically treat them as well as keep them safe.

Try applying for jobs on Craigslist (home health & nursing homes, etc..). I've noticed that it's easier to get hired on at places that use Craigslist to hire. I've gotten on a both a.nursing home and a hh place, neither even required a resume and I was hired on the spot during the "interview". Also, apply for seasonal/immunization nurse positions. Message some of your old nursing classmates and ask them if their workplace is hiring. Sometimes it helps to have someone "on the in" to help you get on. Have someone look over your resume to make sure there is no obvious issues that you are overlooking. Also, keep in mind that a lot of new hires get hired on at this time. (Graduate in May, take NCLEX around July, get jobs around August/September). Keep trying, and spots will open up eventually.

I would think contact precautions at the least. Definitely make staff aware and either separate roommates or treat roommate prophylactically.

I think that the majority of the time you will be able to administer the medication. It is mostly just to show that the reason the patient crashed is NOT because you gave dilaudid with a respiratory rate of 9 breaths per minute.

Try keds in wide. Maybe get a half size bigger and put some inserts in them for added comfort. I believe you can also get sperries in solid white.

I'm in the same boat as you. I had a baby while in my last year of nursing school. I also had a 3 year old daughter(at the time). School was so demanding, and while I loved learning, I was so ready to be able to slow my pace a bit and focus on my children. (Did i mention they also have health issues?). I took a private duty home health case. At first it was interesting and I learned a good bit, especially as far as vent/trach experience goes. Lots of cathing, suctioning, wounds, meds, cna skills, documentation, etc.. however, I quickly became bored and unchallenged. I'd say after about 6 months, everything became monotonous. I stayed anyway. Partly because I enjoy consistency and hate being "new" and partly because it gave me freedom to focus on my family/kids. I also became great friends with my patient. However, it has now been over two years since I took on this job and I am now more than ready to branch out. I'm in this weird stage though and I keep stressing out about it I am worried that when I do get hired somewhere more demanding they are going to expect me to know a lot more than I actually do. I would like to take on a part-time med-surg job, but I want to be taught like a new grad and I don't know if this is common practice. I have been considering taking some phlebotomy courses at our local college because that is definitely one area that I did not receive any experience.

Why don't you get someone to watch him who doesn't have to go to work until after you are home?

I work night shift and have two kids. I get off at 6am, take my 6 year old daughter to school, and go to sleep immediately. I wake up to pick her up at 2:30. My 3 year old stays with my brother. I drop him off right before work and pick him up at 2:30 the next day the same trip that I pick my daughter up. We spend a few hours together then it's back to work, same routine. If I am off the next day (work Monday night but off Tuesday night) then I drop my daughter off at school and then go to sleep but only for a nap. I wake up early and pick my son up early so that I get him for more hours and I catch up on my sleep that night. Do you have someone who can watch him over night until you get off work? Then you could pick him up and take him to daycare while you sleep. You could also hire someone to come to your house and watch him from when you leave until you get home in the morning. Have them put him to bed later (like 10pm) then he will sleep later. You go to sleep as soon as you get home and wake up with him then go back to sleep with him during his nap time. I have done this as well. It is possible to work nights and have a toddler but a lot of it is trial and error and figuring out what works best for you. I would at least attempt the hours and then if it doesn't work out let her know that you need part-time hours or different nights (like maybe picking up a weekend when a family member doesn't have work. That person could watch your son from when you go to work until like 11am. Instruct that person to wake your child up at 8am that way your child is ready for a nap by noon, and you can nap with him). I have been working nights for 2 years. My son was 1 year old and my daughter was 4 when I started. I have done weekend nights and weeknights. It's complicated but once you come up with a routine it is doable.

Hey.. I am a mother of two children with sickle cell disease, they are half white and half black and have type "SD" or "Punjab". To answer your initial question of how to better care for your sickle cell patients.. That would firstly depend on why they are being admitted. They most common reason is a pain crisis, so just like a patient who is post-op or post partum, your provide round the clock pain control. You should speak with the patient about what medications and dosages work best for them, and also let them know that nausea medication is available also. You will want to keep them well hydrated, warm (maybe provide a warm blanket). Keep an eye on there H&H, bilirubin levels, iron levels, O2 sats, provide oxygen as necessary (many prefer the face mask), assess for hx of splenectomy and if there spleen feels enlarged or tender. Assess for any chest pain which can be a sign of acute chest syndrome. Assess urine color, if it is orange or brown then it is probably a sign that there hemoglobin is dropping and you will want to assure them its ok and it is not blood or there kidneys failing. Infection control is another major thing since SCD patients have low immune systems. If it seems that they have a bad attitude right from the start, well it is probably because of what you just stated in your article. You asked for help on how to care for a SC client and all you recieve were unhelpful remarks that made you develop preconcieved notions of your patient. If you would have asked tips on how to care for a diabetic then you would have been told about round the clock insulin injections, assessing for pain and decreased sensation in the lower extremities, proness to MRSA, ulcers, and other infections. That is exactly why sickle cell patients are bitter. They are often not cared for the way they should be and are looked down upon. Did you know that SCD is much more prevalent then cystic fibrosis but wayyy less funded? Because SCD is a minority illness it is seen as less important. Sad but true.Be up front with your patient. Do your duty as a nurse and care for you patient holistically. If your patient seems angry at you then tell them "I notice you seem to be in a bad mood, is there anything I can do for you or anything you would like to discuss?". Or just strike up conversation about there disease "so do you have more flare ups in the winter time?" "Is there anything you think we should know to better take care of you?" Offer to bring pain medicines as scheduled and try to do it. Empathize with your patient, and most importantly, if a nurse ever approaches you with advice on taking care of SC patients, please do not put negative preconceived notions in there head, instead provide them with a better understanding of sickle cell disease and how to hollistically care for them.

:heartbeat:heartbeatI was wondering the same thing! I am currently waiting for my acceptance letter (RCCC) and for some reason I have this gut feeling that I will be placed on the alternate list this year (due to not having all pre-reqs before Jan 1st).:heartbeat:heartbeat

:heartbeat:heartbeatTry to find a college that doesn't look at GPA! I go to Rowan-Cabarrus CC and they don't look at GPA. They are on a points system and mostly look at the grades of your pre/co-reqs, as well as work experience, and TEAS scores. There are a few more criteria but those are the main three.:heartbeat:heartbeat