qt_rn

thanks for the insights!

I am so thankful that we have a national health care plan. I really do not understand why so many Americans are against "Obamacare". He is trying to help people so that they do not lose their houses or go bankrupt due to medical bills. His policies keep getting more watered down and not satisfying what he set out to do because of opposition from the republicans. I am curious as to where you heard nothing but bad stuff about Canada and UK's system? Of course there are people out there that are not happy with the system, that would prefer a system that is more like the US, and yes, there are people who have had bad experiences. There are also people out there who only think about themselves and are just not satisfied with a system that cannot accommodate to every single need right away. But these are the consequences of having a system that does not cost anyone out of pocket. Yes, we get taxed more, but not much more than Americans. I honestly would rather have the money deducted from my pay than have to worry about finding money for health care. If I had to pay $1000 a month for health insurance, I would not have any money left to keep a house over our heads! All I have to do is watch Sicko and feel disgusted at how American's are treated by HMO's and feel so proud of my countries health system, even though it definitely has some areas it needs improvement. I have not personally heard of anyone that needed STAT treatment, life or death type of treatment having to wait and die while waiting. Yes, if you need a non urgent procedure you will have to wait. My mom just had bilateral knee replacements this past month, yes she waited a year for that surgery, yes she was in pain while she waited. But no, it was not life threatening, and it did not cost her a cent. She received great medical care in the hospital for 2 weeks, and is now at home, and receiving physio and the treatment that she needs. If she lived in the states, she would have never ever had the money to pay for her surgery, therefore she would have been severely limited in her mobility for the rest of her life! My husbands grandfather was recently in the ICU due to severe artery blockages and an arrhythmia. He had an oblation done within a week and a pacemaker in within 2 weeks of being admitted to the hospital. I am pregnant, go to the OB every week, any test or ultrasound etc that I need done is done in a timely fashion. I had bleeding during my first trimester and was able to get an appointment the same day with my doctor and got an ultrasound at the hospital within a few hours. Now, our hospitals do a pretty good job, but there are some areas that need improvement. Preventative care, wait times for being referred to specialists can be high and needs improvement. We do not have all the cutting edge technology or procedures that the US does. The governments tend to wait and see when it comes to new procedures and technology, determining the cost-benefit to things and best practices based on research. Sorry for the rant, I am very passionate about my countries publicly funded system that provides high quality care without bankrupting families. We may not get the "best" care that is available to Americans, and we may not get our MRI's or CT's, etc as fast as Americans, but we get the care that we need and that is good enough for me!

Yes, that's correct. This patient's TPN runs for 12 hours through the night so that she is able to be independent during the day for the most part. Oh and to clarify on my post about running things with TPN and disconnecting, it depends on the med whether we disconnect completely from the picc or is we y site it, as our nursing educator taught us that there is potential for meds to get past the clamp and react in the tubing. On a usual night with this patient, they are only connected and disconnected once.

Our hospital only uses single lumen piccs except for in ICU. I have only dealt with 1 TPN patient but it is the norm for us to interrupt TPN for other meds. If the med isn't compatible, then we have to pause TPN, flush, run med through, flush, and reconnect TPN. We avoid it when we can, but sometimes this patient needs antibiotics or prn meds and is NPO so we have no other choice. We always call the pharmacist when we get a new med order, especially antibiotics to see if we can adjust the med schedule so that we are interrupting the TPN the least we can.

I work on a chronic care/transitional care unit (people that aren't quite ready for rehab). This floor recently changed from chronic care and slow stream rehab. I have to say that while more physically demanding, I find the chronic care and transitional are typically "slower" than the medical floors in my hospital as well as slower than when we had the slow stream rehab on our floor too. I am a new grad as well, been working for a year, and I have found chronic care to be a better learning experience than I thought when I took the job. Lots of trach care, feeding tubes, we do peritoneal dialysis, tpn, we do a bit of everything. We do primary care on our floor (as do most of the floors in hospitals in our area) so we are staffed 4:1 on days and 7:1 on nights. Our patients are mostly medically stable although we do have acute medical issues arise, not as frequently as on a medical floor. Medical is great experience but if your finding it to be too overwhelming maybe something like chronic care would be good for you. During a day shift, we often have a lull in the afternoon when patients are napping, there are no meds to pass and the bells slow down a lot. It gives us time to do most of our charting, start writing our report, and stock things and do the extras. On nights we often have a good 4 hours where things are quiet. So it is rare for us to leave our shift late unless something happens near the end of the shift. I am going on maternity leave soon and when I go back to work next year I plan on moving to a medical floor if I can just because I feel its time to challenge myself some more, but for a new nurse I think its a great place to start! Hope you can find something that is the right fit for you!

Sounds like some awful experiences... dthfytr you are a very strong person to go through all of that... This might be an ignorant question from a Canadian, but if the system is so awful with helping people in need, then why is everyone against Obama and his health care reform policies??? Is it just that the economy is so bad that people want him to focus on the making the economy better before addressing the health care system or are there just so many people out there that refuse to pay any more $$ for taxes so that everyone can have health care when needed? Our system is far from the best in Canada, especially when you look at cancer care and the expense of cancer drugs and different drugs being approved in different provinces for coverage but at least you can go to the dr and get diagnosed without paying = earlier diagnoses and better prognosis...

The nurses I work with have always called pharmacy to make sure the meds were compatible. For someone who is NPO and needs extra fluids, we have the lipids piggybacked to the tpn line, then a line of ns hooked up to the y using a separate pump. Our pharmacy has told us it is OK to run panto through the line with ns while still y'd to the tpn, however I would stop the pump that is running the tpn during the panto infusion. This pt has a single lumen picc and my thoughts about running a med during tpn with a single lumen was that there should be less chances of infection because you are not constantly unhooking and hooking up a line to the picc. I don't have an answer to your question about why it is OK to do the y and not the piggyback, I am interested in this as well! Someone mentioned the filter and the meds not making it through the filter, which makes sense to me!

Maybe its the difference between Canada and the US, but in Canada it is standard practice to use your nursing judgment when it comes to holding certain medications, although it is always appreciated when we have parameters! Are nurses in the USA not allowed to use your nursing judgment? That's part of our education isn't it? Or is it more related to being fearful of lawsuits that nurses are prohibited from using your own judgment? Just curious! As a new grad I would actually be relieved to be required to call the dr in these situations as my nursing judgment develops because then they couldn't get mad at us for calling them but it seems that dr's biggest pet peeve is to call them when we don't have to... If I called the dr to ask which insulin to hold they would be very upset with us "bothering" them! It is common for us to hold digoxin in hr is Does your workplace have protocols for low bs? Protocols are very helpful and help ensure that we are all following the same steps when dealing with common issues. We have very set out protocols on what to do when our pts have low bs. If you are able to correct the bs with some fast acting glucose then we write a note in the drs book for when they come in the next morning (sometimes the long acting dose needs to be decreased, or other meds adjusted), but we would never call them unless there was more going on... Anyways in this situation I would have a hard time deciding who to listen to, especially since the charge nurse is the supervisor however I would have held the short acting and given the long acting insulin for the reasons everyone else has already stated. Maybe next time when you disagree with the CN you can explain your reasoning?

I would say I do pretty well at the customer service side of care, however I have to say that am I ever glad that in Canada our hospitals are pretty well all public and making money is not the focus...our management is concerned with efficiencies and good patient outcomes, not the outcomes of patient surveys. While there are and always will be those nasty nurses that could use a lesson or two in customer service I am so happy that as a new grad I am allowed to worry more about patient care than fetching ice or whatever for my patients right away rather than worry about my patient with chest pains...

Sounds like my floor! There are always going to be those that come in to work their hardest and go the extra mile and there will always be those that come in to work so that they can make $ and do the minimal amount of work as possible. I am the new grad on my floor and its hard to fit in with the staff. If I work work work all night long and don't join in on the relaxing it seems like I a making myself an outsider to the rest of the group that is relaxing... I bring in a book and read on a night shift, but only after everything else is done, including extras. Our night shifts are pretty quiet...everyone is generally in bed by 2300 and then we have charting and med checks to do. That takes until about 1am depending on how many call bells ring during that process. We do hourly rounds and t+r as indicated by skin integrity and patient preferences, and bum changes and toileting depending on the patient. If they are the patient that has not had a good day and has finally settled for the night then we check up on them and lightly reposition them without waking them up. 5am comes and its time to do another set of rounds, change and reposition everyone, do 0600 meds and lab work and then report. This is when I tidy up trays and bring fresh water for the day, although some mornings are hectic and occasionally this does not get done. Usually between 1-5am, most nurses on my floor will read a book, surf the internet, watch a movie or nap as long as everything else is taken care of. The ones who nap take one of those phones with them and check to make sure with other staff that its ok for them to go into the quiet room for a quick snooze. Generally the complaints that arise between shifts involve the dishes in the break room, the table in the break room, and things not being stocked or charts not being stuffed. I do think that some of the night staff come in believing that they are there to make sure nothing goes wrong and do minimal pt care or other work, but generally most of them are great and make sure to get all work done before they move onto their movies or knitting etc. Keep in mind I work on a sub acute unit so the patients are stable and some are independent and I do work both shifts

I like that idea!! A good reminder, 2 hours can fly by so fast without realizing it! Then there are lazy ones who just don't want to be bothered with it...to those I try to offer a hand with turning their patient hoping that by mentioning it they will get the hint...

People give me a crazy look at my workplace too when I ask for a hand turning a pt q2...which is weird because on another floor in the same hospital my preceptor was all over the q2 repositioning. A lot of nurses tell me at night time to let them sleep because we are a rehab floor and they need to sleep to function well with pt/ot or that they are a poor sleeper and if you wake them up while turning them they will never get back to sleep...then there is the one who refuses to be turned until he starts getting a coccyx sore, will allow a pillow to be placed under his hip to remove pressure and once the sore disappears he again refuses to have that pillow there... I try my best to turn the dependent pts q2, although we do have quite a few pts that would prefer to sleep no matter how much information you provide about pressure ulcers. I feel like I just don't know what to do sometimes! To turn or not to turn! What if a pt can only breath comfortably in a certain position, or just prefers not to be repositioned overnight? Do you just document and leave it at that or do you continue to encourage or just do it?

I like your outlook! Focusing on the positive and the things that you can do to better a situation beats complaining about every single thing you dislike. Focusing on the negative only makes things seem worse and its just a downder.

You know, I never even though about that probably because we don't have the CNA's but that does make an awful lot of sense now doesn't it! So by the time they get to you they are ready for the medications and assessments and such. I am glad there are nurses out there like you who will explain the why about things. Its so important! I have been constantly learning since starting my first job and I'm lucky there are a few nurses I can go to with questions when I don't know where to find the answer that are nice about it and don't give me the eye roll because I am inexperienced...but everyone is right so far, there are just some cranky nurses out there.

You do bring up some very good points and boy would I have loved nurses showing me how to deal with many of those things. At the same time, toileting, feeding, adl's, general patient interactions, health teaching are important things for students to do and depending on where they are in the program, the focus on clinical skills and critical thinking is different. If these are first semester students that have absolutely no experience with basic interactions, teaching them about the things you mentioned is great and very useful but that doesn't mean the basics aren't important as well. I think balance between the hands on knitty-gritty part of pt care and the critical thinking/assessment is important and the balance is determined by the care area and where the students are in their learning and experience. From your post I have the understanding that you do the medical part of patient care and CNA's do the other part of care that involves adl's? If these students are on your unit to only do the medical aspect of care because they will not be responsible for the tasks that CNA's do then I definiately see your point about them not being there to help with ADL's and toileting, however that part of care is still a learning experience. A day with you as a student would be wonderful as from the sounds of it the students that are with you for the day learn very valuable information and skills.