KaitRN

I transferred into RIC from Umass where I took prereq's. Almost all were accepted and I still graduated in 4 yrs. RIC is an AMAZING nursing school. I highly recommend it!!!

I agree BluegrassRN, Just a little too strange/ coincidental for me!

I'm not sure if the other pt's were on corticosteroids, but I wouldn't be surprised since they're mostly all respiratory patients! I'm glad that other people have noticed this.. I guess I'll just slow the infusion next time.. Very interesting though! Thanks!

Hey everyone! Just curious, maybe this is completely coincidental, but.. In the past few months, I've taken care of about 4 patients after receiving IV Avelox. 3 of them received the IV dose in the ER. According to ER documentation and per the pts account, they started getting a red line going up the arm where their IV site was almost immediately after the Avelox started infusing. The IV site was perfectly fine, no inflammation or infiltration and it didn't appear to be phlebitis. The ER nurse stopped the infusion, flushed with NS, and after a few minutes the red line diminished, IV site was patent and working beautifully. Pts were all fine afterwards and transferred up to my floor. ER documented this occurrence each time. The 4th pt was already on my floor- I hung the IV Avelox no differently than I always do, and the exact same s/s occurred again with this pt. I stopped the infusion, flushed w/ NS and the red line diminished... So I guess my question is: Has anyone else been finding this trend when hanging IV Avelox? Its only been in the past 2 months or so! I've never had an issue with Avelox prior to this. Is it possible the company made a bad batch? Just curious! My mind is wondering...

In the chart it said "flush ct with 10 cc sterile ns. don't remove fluid too quickly" (poorly written md order). and yes, the pleuravac was to suction -20 cm.... I have since been to work and no reprocussions occurred on my end. the pt was transferred to a medsurg unit so im guessing his condition improved... i was just curious! i guess next time ill just have to call the md and clarify/verify the order (gotta love calling a surgeon on 3rd shift. haha!)

Hi all. Okay so I worked last night and had a pt with 2 posterior chest tubes pigtailed to the pleurevac with the small catheters that have the stopcock mechanism. I was told in report that we "flush the chest tube and then aspirate slowly for output." I have heard of irrigating chest tubes but I just wasn't sure so I even had the day nurse show me before she left. Sure enough there was an order to "flush chest tubes with 10 cc sterile ns qs and record output". I used a 10 cc syringe with sterile ns and utilizing the stopcock i flushed then slowly aspirated contents. i got 2 cc return out on the left and 24 cc on the right (it just kept coming! eek!). pt was stable, no complaints, breathing at ease. so this AM after report, the nurse getting my report is like, "umm is there an order to ASPIRATE?! I've never heard of that. That's scary". I'm a new nurse to this floor. I've only been working on this unit for 6 months. The day nurses are not always the nicest people. So I started to get nervous thinking that I did the wrong thing! Maybe I was just supposed to irrigate and not "record output"? But the prior nurses to me were doing this procedure as well and recording it in their nurses notes.. I just don't want to get in trouble or reported and I'm doubting myself!!! Has anyone ever heard of this type of order? I've been searching everywhere and really can't find too much on this issue. I really hope I didn't screw up Thanks.

It's so funny that I'm reading this post- I just finished my 3rd 12 in a row, which always is really 13+ hours, and recently our hospital has been understaffing us (cutting costs? I have no idea...) so that on night shift, we end up getting 6 patients at a time, on a critical care cardiac unit. We're supposed to only have max of 5! I just woke up, and, like every other day I have off, there was a voicemail from my boss asking me to work extra tonight.. I rarely ever call back because I feel that my days off are for ME, and I need ME time!!! I feel guilty about not helping out because we have been so short lately, but I know it's not my problem- They need to staff appropriately! I need to keep myself mentally and physically healthy.. So I'm not calling them back, and this post made me feel better about that :)

I would just like to add, like the others, that most of the time death is imminent in the LTC facility. the pt has been put on hospice care, families have been talked to about changing pt's status to DNR, etc. Once pt's passed I would call the family and break it to them gently, see if they'd like to come view the body, if so do post mortem care, in the meantime call the MD and notify of estimated time of death then call their funeral home choice and the funeral home always picked them up from my LTC facility. I never had to deal with a full code situation at the LTC facility I worked at.. But I would assume if the pt looked like they had been dead for quite some time, you would not send them to the ER. As one Dr. said one time, "you can't treat rigormortis!" lol morbid but true

I work on a cardiac unit where BP's are all over the place. And it's true, especially in the geriatric population it can be very difficult to hear diastolic. We never have an issue when alerting the MD to a low or irregular BP and stating just the systolic, diastolic unable to hear. If you go very slow sometimes you are able to get a reading but if you can't I think at least verifying an SBP is better than nothing!! I may be wrong but I believe that sometimes you cannot hear the diastolic due to low perfusion? I think you did a very smart thing by documenting it that way. It does concern me that the ADON "fixed" your charting, but I also started out in LTC as a new grad and I totally understand how it works there. There's a lot of "fixing" that happens which is scary hence why I left as soon as I could land a hospital job! Good luck to you and I would support your documentation fully.

In the hospital I work for in Massachusetts, CNA's are able to insert foleys and straight catheterize, but I believe they need to be trained first. I think it just depends on the facility. I worked as a student nurse intern in R.I. during nursing school and the CNA's were able to insert IV's, which I was surprised about... So I think it depends on the training provided in the specific facility.

I worked in LTC for a year and did a few night shifts there. Now working at a hospital and am doing exclusively nights. I really enjoy nights. It can be crazy at times and there's not as many people there, but that can be a benefit as well. I find that most of the time, you are able to give yourself more time to assess your pts., etc. Sleep with an eye mask and ear plugs- it helps! As for med passing, in the hospital its not too bad, but I know from passing meds in LTC, it can take well over the alotted amt of time. I'm not saying that you should do this, its a big no-no BUT i know at my old LTC facility, most of the night nurses would pre-pour their 6am meds, write the room # on a seperate med cup and place that med cup on top of the pre poured meds, and hide them in their med carts. Also start right at 5 am passing meds. I was always nervous about pre-pouring my meds although the older nurses swore "everyone did it", so instead of pre pouring, I would arrange my meds in the med cart according to when you need to give them. If you use the big square med packs where you just pop out the meds, just arrange each pts meds in order in your cart. That way you can just go down the list in your MAR and pop each med out in order. Makes it a lot faster than filing through all the meds. (you'll have time to organize your med cart at night- a plus!) I hope this helps!! In regards to calling families at night, I would say wait until the end of your shift to call, if its not an emergency.. Good luck! I hope you like it! I find that people on night shift are more helpful than ppl during days sometimes!

I am a newer nurse as well so don't take my advice to heart, but I think you have the right idea to possibly get OR certified. This would enable you to expand your credentials in the OR nursing world.. If you want you could move out to the northeast! Most of the RN's that I work with are ASN graduates and I work in a small community hospital. I am a BSN and in the minority. Getting your MSN would be unneccesary if you want to continue working in patient care. If you go for your Master's I would not settle for just a general MSN and go for NP, if you want to go in that direction. But for the time being, get OR certified. It will make you more marketable :) Just my opinion though! Good luck

Sounds exactly like my unit! I'm still very new, just off orientation and I find that this is quite a hassle and most nurses on my floor will agree. The nurses are always held responsible, the MD's are not. It's a rather unfair standard...

Hello all! So I just finished my orientation on a busy cardiac critical care floor yesterday at 7:30 am I got a great review from my supervisor and the director of nursing so I am very excited, just had to put that out there! YAY! haha. Anyways- I did most of my orientation on days then switched to nights 7p-7a about 2 weeks ago and will remain on nights. I actually don't mind it at all. My body has adjusted fairly well to the sleeping schedule and I try to stay within that sleeping schedule even if I'm not working (it just helps my body to stay in sync). However- I'm wondering for all those night nurses out there- how do you find time to schedule dr.'s appts, hair appt's, food shopping, all those "day activities"? I find that I sleep until 4pm and most of those places are 9-5 schedules! I'm especially wondering because I just moved to a new area for this job this summer and have yet to find a new dr., dentist, etc. so I'd like to get it out of the way. I'm thinking probably an early morning appt would be better.. Just wondering what other night people do! Thanks

I took the Kaplan course and thought it was well worth the money! The questions teach you HOW to THINK.. It's all about reading into the question and finding the best answer, which is the same strategy that the NCLEX uses. Kaplan taught me an entirely new way to think and read into a question... It's not so much about facts and diseases and such on the NCLEX- they know we know that, we've been through years of nursing school!- It's all about APPLYING that knowledge and prioritization techniques.. Kaplan definitely showed me how to do that. Even if you can't take the class, buy the book!