alyca

Wow...surprised at all the petty remarks here.... My older sister has a 2 1/2 year old and a 3 1/2 month old...she was carrying the 2 1/2 year old (too feisty to put in a cart), and had the 3 1/2 month old in her car seat/carrier thing on the top of the cart , over the front part where older kids sit (there is even a groove carved into car seats so that they fit on here...they are MEANT to go there). As she pushed the cart out of the store, the cart caught a wheel and catapulted the baby in the corificeat headfirst onto the pavement. Luckily, the handle on the carrier was sticking up and it hit the ground, so the baby was not hurt at all, but it was a terrifying experience, and not really preventable, other than by not having used the cart and putting the carrier up there (even though they are intended to fit there). Not bag parenting, just really bad luck. It is obvious there is a problem here, with the statistics in that article. Maybe trying to fix it would be better than mocking it??

If it is yucky and oozy and not looking so hot (maybe infection setting in...), we have used silvadene cream covered in gauze. Works AWESOME. Only for goopy icky ones, but applying it twice a day, wrapping it in some dry gauze to let it do its thing.....cleans those things up and helps heal them in only a couple days. Otherwise.....some aquafor under dry agauze if the drainage is not so much, xeroform if it is goopy but clean/not infected. If the area is smaller and has minimal drainage, duoderm can also work really well. I love that stuff! I had a burn on my hand that was oozy, and I applied duoderm, kept it on x3 days, showered, etc with it, then took it off after 3 days and had a clean, dry healed wound that was not macerated like it would be with a bandaid sort of dressing. Wonderful stuff!! Our docs have no clue about any dressing other than wet to dry, so we end up just telling them what we want to do and getting the order to do it.

As for me, we started early. I come from a family with NO money--my mom raised 4 kids on $800 a month in child support and help from her family. Nothing. My goal in life was to have enough money for everything I need, and some of what I want. And I have that. At 28, my husband and I already have over $20K in retirement accounts, both through a voluntary investment program through work and through 401k plans. We both work for the state, and have a pension plan waiting for us (we contribute around 1.2% of our salary to it, the state double-matches it, and based on years of service, we get a pension--since we both started working in the state system in our early 20's, that is a lot of years of service!). We bought a condo 6 years ago, then sold it earlier this year for twice what we paid for it, and used the profit to buy a $400K house with lots of instant equity. We plan to pay this house off, or at the very least DOWN significantly in the next 10 years, then sell it and buy a better one. We have no debt other than our mortgage, pay off the credit cards in full each month (we have a card that earns us airline miles with every dollar we spend--we haven't paid for a plane ticket in quite a while) We own a timeshare, paid in full with cash, so vacations are somewhat set. We travel a lot, have a reliable car, season tickets to three professional sports here in town, etc. We have all that we need, and some of what we want. It really hasn't been hard to save money, to put it aside for later. My husband and I each take 10% of our paychecks to go directly into investments and retirement accounts, and send several hundred dollars each month into savings, where it is not to be touched. We don't feel like we skimp out on what we are doing--we are not missing out on fun, but we still have a ton saved for the future. No kids yet, but when they DO come, we will be ready for them both emotionally and financially. Just decide to do it. Save money, plan ahead. You don't have to give up fun now, just be smart about it.

We use rotobeds for patients that are in cervical traction or have unstable spines...they rotate to whatever degree you set them at, and have a trapdoor for bowel issues. Neat!

I thought I was pretty clear..........shoreline is my preference..........

I also went to shoreline for my ADN, then to UW-Bothell for my ADN-BSN program. So, I am a bit biased.... BUT.....I can say with all honesty that the students from Shoreline we have on our unit (we get them from just about every program in the area--Shoreline, Bellevue CC, UW, Seattle Central, etc), are much more prepared to be there. They are ready to go, have an idea of what it is that they are supposed to do, and are great to work with. My least favorite students are those from UW. They have this scared look in their eyes, and come up to you announcing that their goal for the day is to assist with a bed bath. Seriously. The shoreline students are on the ball. They are sent out in their very first quarter to nursing homes to get used to touching people and seeing people naked and doing teeny things like noticing a mouth that needs to be wiped or moving things so people can get at them. This really prepares them for coming into the hospital and seeing people with horrific injuries, and feeling like they have some clue as to what they can do to help. The UW students do a lot more reading and classroom work, and not as much clinical experience. Just my own opinion. In general, it is fun to have students to work with (assumming that we are fully staffed and I am not tearing around trying to keep up with everything). I like teaching and it is cool to show them some of the unique (grisly) things we get to do.....

I am in the process of working with some other nurses and educators in my trauma hospital to make a pin care guideline. We are starting a study that will hopefully be published in the next year or so. Reviews of the literature available out there show that there are a huge variety of ways to do pin care, and no clear answer as to which is best at preventing pin site infections. Our old standard was the 1/2 NS and 1/2 peroxide mixture with sterile QTips, then a 4x4 gauze wrapped around as a barrier afterwards, done twice a day. Other ways to do this are to use just saline, or chlorhexidine, or to do nothing at all. Some studies indicate that doing NO pin care can actually DECREASE the risk of infection, as compared to peroxide, etc. But.....nothing is conclusive (and therefore we are starting a study). We get TONS of ex-fixes here, and mostly only have infection issues if they are the thigh pins in spanning ones or pelvic pins, especially on bigger patients. So....my answer is that there IS NO tried and true PROVEN method that is best, and it is mostly MD specific as to what you want to do. Although, our MD's generally just write "pin care BID' and let us figure out what to do with that...........

Dysplasia is actually pretty common and is usually nothing. As far as HPV, I was involved in the huge study through the UW here in Seattle that was published earlier this year. The study was the creation of a vaccine to prevent HPV, which is usually what leads to cervical cancer. Studies all vary, but as many as 80% of the population becomes infected with HPV. There is no cure for it, it does not generally even get noticed by those who have it, but it increases the risk for developing cervical cancer. Basically, if they can prevent you from getting HPV, they can greatly decrease your risk of developing cervical cancer. Now, the big debate is when to give the vaccine (must be before any sexual activity, since the virus is so prevalant), and how to market it. It will NOT be a required vaccine, but it would be really nice if everyone would get it. Having HPV is not noticeable. THe most common forms have no actual warts anywhere, just the virus in your system. THey can tell you have it buy testing your blood. There are other forms of HPV where there are actual warts, but those are not the same forms of virus that have the cervical cancer link. Sorry so rambling. In this study, I got what ended up being a placebo, and had PAPs every 3 months (I was a starving college student, and was paid and got my checkups free and birth control, etc) Anyway, a PAP came back showing ASCUS, which is abnormal small cells of unknown specification, then I had a repeat which showed mild dysplasia, then had a colposcopy and biopsy. Fairly painless, just ended up with some cramping and had to wear a lumpy bumpy bad for a couple hours. Honestly, THAT was the worst part of the whole thing. Those suck!!

Anyone else?? I am studying up, taking it October 15th. It was my new years resolution this year (I get $1 raise, yippee), and it is going fairly well so far. I work in a trauma/ortho unit, so I see all the trauma stuff that is covered, but have no experience with knee/hip replacements, etc. Non-trauma stuff. But, I can be taught (Or so I think).

I work on a trauma/ortho unit and we see lots of these. The 'turtle' brace (TLSO--thoracolumbarsacral orthotic) may be all you need if there is no canal compromise and the fractures are stable/not displaced. Generally, we put people in these for 12 weeks to protect and stabilize the injured areas, but I am sure different docs have different approaches.

I do remember my first hospital patient (as opposed to my first nursing home patient from the quarter before). Our instructor assigned patients to us on our first day, and we went in only having a brief diagnosis. We were supposed to introduce ourselves as the student nurse, then go through their chart/kardex and write down/learn all their info, then participate in their care for the 2nd half of that first shift. Well....my guy had a 'cranial defect'. What she failed to mention was that a tractor had rolled over on this late-60's age guy and he was missing his left eye, zygomatic arch and entire eye socket, and the left front quarter of his skull. THE ENTIRE QUARTER. So looking at him head on, he had a working eye, then a depression covered by skin with sutures back on his skull at ear level. Freaked me out just a bit. I need a little more warning than that about what to expect! The guy was alert, oriented, and there to have OR to put in some sort of artificial/titanium, I don't remember exactly what sort of material, but they were going to reconstruct his skull. I left the room after my initial meeting, learned about what was going on, and was fine. On a similar note, my husband is a locksmith working for the same hospital I do, and he was sent into a patient's room to change out a malfunctioning doorknob, and had been told that the patient in the room was blind. No big deal, my mother is blind and he figured he would just announce himself and that would be fine. Well, this was the rehab unit, and the guy was there because he had tried to kill himself with a gunshot through the head (vertically). He survived with a trach and feeding tube, and completely freaked out my husband. He had no eyes, no face, from the description I got. Not a great idea to send in someone unsuspecting, with absolutely NO medical knowledge/experience into a room with a patient who is going to scare them. He seriously had nightmares about this. It is different if you are prepared/have SOME clue, but he was pretty shocked. ANyway...

Umm....if it looks like a grenade, it's a JP (Jackson Pratt). If it is round and flat with springs inside, it is a HemoVac (HV). Not sure about the blake.

Well, I work both 8 and 12 hour day shifts at an extremely busy level 1 trauma center on the trauma/orthopedics unit. My day~~~ 0700-0730- get report on the 3-4 patients that I will be responsible for. We do total care, so the RN is responsible for everything for their patient. There are 1 or 2 aides for the entire floor (27 patients), and they do VS and assist with bathing, etc, but we have to share them. 0730- I always look into our computer charts for each patient and write down what times they have meds, noting any abx or really time-sensitive meds, pertinent lab values, and read over the past few nursing notes to be sure I didn't miss anything in report. Next, I go meet my patients, assess their pain, etc, make sure that they don't have any new numbness or loss of movement, etc in their injured limb(s), invariably I end up also giving out juice and morning snack stuff because no one wants to wait for breakfast 0830- start giving my 0900 medications, usually including blood thinner shots, stool softeners, long acting pain pills, and a wide variety of BP, psych, etc meds. I try to get started on these at 0830 so that I am sure to get everything done in time--if you wait until 0900 to start, something always comes up and you will end up being late with some meds. 0930 or so- give out comfort baths to patients who are able to clean themselves, discuss bathing with the patients who need to be bathed, especially those with spinal braces. I am pretty flexible, and let them tell me when a good time for bathing is. Our PT/OT are always around, and do not have set times to see each patient, so we are always flexible with what a patient wants. So, until around 1130 or so I am involved in bathing patients, charting my morning assessments for each patient, doing dressing changes, helping people get up to chaire, etc and I take my 15 minute break and have some breakfast. at 1130, I start preparing my 1200 meds, if I have any. Lunch comes around 1230 or so, so the time until 1300 is spent getting people prepared for that--sitting up in bed or premedicated for nausea, etc. I also start getting out my 1300 meds (usually abx or iron pills or tums, things like that) around 1300, I like to go to lunch . Sometimes I have a 'buddy' who will hold my phone and watch my patients for my break, other times I hold my own phone. It is pretty easy most days to work out when is a good time to go, when my patients will not be needing much from me. We carry cell phones so the secretary can get ahold of us when our patients call, and I don't mind interrupting my lunch to go see them (it really doesn't happen that much). After lunch, there is usually a lull. My patients have either been seen by PT at some point in the morning, or they are being seen now. At this point, I know the patients fairly well and can sorta expect what their needs are. So until 1500 or so, during shift change for the 8 hour people, I can finish up on my charting and do any dressing changes that are left and just give out any prn meds that are needed. If I am picking up a patient at 1500, I go to get report on them and meet them, but pretty much I am not busy until around 1630, when I start getting my 1700 meds ready. The nice thing about being a 12 hour person is that you really have a good understanding of your patients towards the end of the day--which one goes through ice water quickly, which one will call at 3 hours on the dot to get their prn pain meds, etc, so you can anticipate what people need, and go in and ask about their pain just at the 3 hour mark, etc. After the 1700 meds, it is about preparing for dinner around 1730, and getting 1800 meds together. I try to write my case note on each patient after 1800, so that I can be sure to get in what happened all day with that patient. I finish up these, then give report from 1900 to 1930 and head off for the evening. So, that is what I do in a 12 hour day. This doesn't include if a patient is going to OR or needs to be sent down for Xrays or to the cast room or if I get an admission during the day or if there is a pt with horrible pain issues or a patient on Q1 hour assessments for a reattached limb or if they are on a PCA and need syringe changes or if there is a code somewhere or lab draws are needed, etc. Lots of other little things come up, but this is basically what I end up doing.

I work at Harborview in orthopedics and went through the new grad program here. It is tailored to you. generally, it is about 12 weeks long, you spend the first 8 weeks or so(depending on your progress) working with a precepting nurse on the day shift, after that, you are rotated to whatever shift you were hired to work (days, eves, NOC, etc), and have a few more weeks there being oriented. There are 4 or 5 full days of just classes to go to on different procedures, etc, you always have someone there for you, and when YOU are ready, you are advanced to being on your own. It can go quicker/shorter or it can go longer if you need a few extra weeks. Very good. You are totally prepared by the time you are on your own.

When I was in nursing school, they were filming for the show "Birth Day", and one of my patients was having a C-section and I was filmed in that one. Didn't do much but stand next to the docs as they did all the work. He was great in telling all the details of what they were doing and why--it was a pretty good experience. I had to sign a release to be able to be there. I have never seen the show, though (dont get that channel)

We are a trauma/ortho unit, so no total joints or little ligament repairs, etc. Our planned foot surgery pts lately have come in with peripheral nerve caths of bupivicaine for 1-2 days post-op, especially for calc fractures. They also may or may not get a fem/sci block. In addition, they have a PCA of either MSO4 or dilaudid hooked up, which most don't need until the PNC is turned off. With the PCA, we give a long acting med, usually MSContin. Works great. For our trauma patients, when they are post-op, they generally get a PCA of dilaudid 0.2mg/8 min/ 6 mg 4 hour limit or MSO4 1mg/8mins with a 30mg 4 hour limit once their pain is stable in PACU, along with MS Contin or methadone as a long acting pain med. Used to give a ton of oxycontin, but insurances have changed and no one covers it, so now we see a lot of MSContin instead. We have a specific pain relief team that is consulted as needed, which is great. They can get pretty creative with their med orders.

my point exactly lets not just throw out stereotypes and try to pigeonhole people.

so if your friends decide to jump off a bridge, I guess I know where to look for you Just because a bunch of people do something a certain way doesn't automatically mean that every other way is wrong And, as of 2003, per the www.census.gov website, there were 33.5million foreign-born people living in the US (not including any who are institutionalized). That is a big chunk of people. And, by 2050, the white/non-hispanic community will make up only 50% of the population, and will no longer be in the majority. Its called a melting pot.

oh my god you people scare me. i work in an extremely diverse environment, with nurses from portugal, new zealand, ethiopia, eritrea, [color=#0f0b7f]côte d'ivoire, canada, nigeria, china, vietnam, korea, the philippines, england, denmark, and many more that i can't think of off the top of my head. they all have native languages, cultures, etc. it is great! we serve a very diverse patient population, and it is wonderful having nurses who may speak the language of a non-english speaking patient, it is great to learn about other parts of the world. [color=#0f0b7f] [color=#0f0b7f]i love learning words in different languages. every year in early november, i go to every single staff member i can find, and ask what languages they speak, then write out and put up a mammoth collage that covers a wall of the phrases merry christmas, happy holidays, happy hannukah, happy new years and seasons greetings in each of the languages i get. every year we are all amazed at the huge number of languages present. patients and visitors get excited when they are wheeled past the nurses station and see their native lanugage on the wall. we put the language's name below the messages, so people can learn the phrases and know what language they are seeing. it is awesome, and it brings people together in some small way. [color=#0f0b7f] [color=#0f0b7f]face it----the population of this country is continually changing. there will very soon be more brown faces than white ones. (i, for one, am thrilled. although i am a blue-eyed blonde haired caucasian, my children will be biracial. they are the wave of the future). we occasionally have patients request a 'white' nurse or a nurse who is not a 'foreigner'. they get to have a talk with our nurse manager, they don't get to pick and choose their nurses, either by race, nationality or gender. stupid, stupid, stupid. we have nurses and staff speaking in a multitude of languages, which is fine. for those of you who have no clue, there is no official language in this country!!! you may think it is english, but that is just what you get for thinking. this country was founded for people from other countries to come to as a religious and societal refuge where they would be free to live their lives. so when did it become a requirement that they lose their culture the moment they step ashore and speak only english and eat only hot dogs and apple pie? "give me your tired, your poor, your huddled masses yearning to breathe free, the wretched refuse of your teeming shore. send these, the homeless, tempest-tost to me, i lift my lamp beside the golden door!" this is the poem on the statue of liberty. thnk about it. there will always be immigrants coming to the us. your family immigrated here, why do you think you can draw a line and say no, these are immigrants, i am an american, i deserve more. stop blaming immigrants for your issues. if you happen to have these huge issues with people in the us from other countries, perhaps it is not a good idea to live in one of the us states with the highest numbers of foreign born people. namely, texas, california, new york, etc. move. and, lets just stop stereotyping. not all filipino/filipina nurses are pushovers or bossy or meek, etc. and saying or assumming they are is just plain ignorant.

after a long day working trauma/orthopedics in Seattle.......... It was day shift on Ortho, and all along the floor, patients were yelling 'knock before opening my door!'; Armed with my 'brain' and my alcohol swabs, I looked 'round the breakroom and thought, 'man, we're slobs!'; As I stepped on the floor, the call lights were ringing, 5-1, I don't know--let me see who I'm getting!; A trach, tropicana, med seeker and psych-- At least I am working with nurses I like!' To 13 to 10-1 to 5-1 I run, feels like this day will never be done; As for that trach, things couldn't be badder, The aide helped me turn him, then I heard a splatter; Never have I seen someone move quite that fast, as I did when the aide jumped aside and phlegm shot past; Phlegm, I know is my achilles heel, the sight of it makes me start to reel; So we turned the patient back, and I got out the suction, So glad the yankaur wasn't too clogged to function; My tropicana was another story, slightly less goo, but slightly more gory; Now gore is a thing with which I have no issues, unlike phlegm and things caught up in tissues; The room was so hot, I started to sweat, as did my patient-now his bed was wet, So up to the chair, I settled him in, Then stripped down the bed and tucked him back in; We microwave Comfort baths, generally speaking, but for this poor guy whose sweat glands were leaking; Into the fridge went that pack of moist cloths, Later, his back with cool cloths I washed, Back to that psych patient-you think I've forgotten?! Her attitude stinks, she also smells rotten; But short of tying her down (thats obscene!) there was no way of getting her clean. An air freshener from stores, to minimize this nasty, but three hours later, no word from the UST Heaven forbid, don't call 8-3-8-4, A reprimand from them, you'll be in store for Pain issues seem to be the theme of the day, "I swear it's contagious", I was heard to say. Starting in one room then down to the others, Someone should warn PRS docs to take cover Bolus then bolus then bolus some more, Oops, my PCA key is now stuck in the door, Must have turned it a bit to quick, hurry, all these pain meds are making him sick! The debate between Reglan and Zofran is easy, Zofran always makes patients less queasy. With Reglan I have had not as much luck, but it's great when somebody's bowels are stuck! Which happens too often when taking these narcs, stool inside decides to just park Have you ever debated with an 18-year-old, the merits of mag citrate-those bottles are gold! And who in their right mind named 'Go-litely' so-- In my experience the right name is just 'GO'!! Off of the bowels, my mind must not linger, now there's no cap refill on my tropicana's finger! Lets get some dextran and leeches Q 2, In comes the order, but the finger is blue. So off to the OR he heads in a rush, oh good, we'll give his room to someone hit by a bus. It's all never-ending, or at least thats how it seems, Patients keep coming--were splitting at the seams! Not one but two hallway patients parked at the desk, Give them some screens, and hope for the best. 'Cause Harborview's full but we keep on admitting, No one else gives the care our patients are getting. If ever I'm picked up at an accident scene, 'Take me to Harborview' is what I will scream.

My sister called me on the phone in tears, saying that she was having horrible abdominal pain and thought it was maybe horrible PMS cramps or her appendix. After asking a few questions (pain was on the right side and radiated to her back, pain was a severe cramp that lasted 30-45 seconds, then let up for 5 minutes or so before repeating), I told her I thought it was a kidney stone. She went to an urgent care center, they played around hemming and hawing until she told them that her sister thought it might be kidney stones. They ran a few tests, and lo and behold, it was. A whole handful of them.

Are you kidding??!?? I have never heard/seen any of this. Our docs don't yell at us, they respect us. On occasion someone will get snooty (generally if it is an off-service pt and the doc is not as familiar with our floor), but that is absolutely not tolerated. Our nurse manager goes to bat for us and we have them all trained nicely. Respect and respect. THat is it. They throw us a fancy nurses breakfast each year, cater a wonderful formal Christmas party, and are great to work with. It is absolutely unacceptable to work in a situation where you are demeaned and have even a threat of violence like that.

Washington has a law against mandatory overtime in nursing. It is their responsibility to find someone to cover the shifts, not the individual nurse's. If they absolutely can't find someone, we have had our assistant nurse managers take over shifts (happens extremely rarely), but nurses are not in any way forced to work overtime.

For our patients, if it is a stable, nondisplaced fracture that is not in danger of becoming displaced, they get a Miami J cervical collar for 12 weeks with limited physical activity. Surgery is not always required, especially for just a hairline fracture.

We totally still use kardex's. Each pt has a kardex that has their diagnosis, diet, allergies, precautions, medical history, IVF ordered, weightbearing restrictions, lab orders, therapy instructions, etc on it. Each order that comes in for a pt is added to the kardex in pencil, except for meds, which are just entered into the computer chart. These are constantly being updated, and double checked on every order by 2 people to make sure that each order is added to the kardex. Old or outdated orders, especially on people who have been admitted for awhile, get erased, and sometimes we fill out a whole new kardex once one gets totally trashed by lots of erasing and rewriting of orders. When a pt goes to OR, they get a new kardex when they return with new orders. For report each shift, the nurse coming in gets the kardex for each of their patients and writes down the info on their 'brain', then goes out for verbal report from the nurse on the previous shift.