6mostogo

At my ltc job, had an outbreak of cdiff right at survey time and we had some related infection control tags. Also had a related pt dignity tag because outside of isolation rooms we had a regular, same as what's used in the room bedside chest of drawers, in which we kept ppd to be applied before entering the room. Dignity issue because other res could pick out who was infected by who had the chest of drawers outside the room. Intervention, moving the drawers inside the room, so you have to enter the room and apply the ppd. The intervention for the infection control problem? All res in contact precautions for cdiff must apply a bright yellow ppd gown anytime they leave the room, for therapy, to the dining room, etc. Even A &O, continent, ADLs per self Residents. But not gloves. Because that would be a dignity issue. And it's not like cdiff is spread by hand to surface contact.

3.4 not a critical level, but our cardiologists like pts on monitored units to keep K+ above 4 and mag above 2, so we bolus pt with non-critical levels frequently. They do expect the on call cardiologist to be notified of a "low" level when results are available; for the most part they are all on the same page about this, and that's why the is always someone on call. Labs results start coming in prior to change of shift on our unit, so i usually will make those calls around 6-630a. But that's our unit's culture, even on other floors in the hospital I'm sure this isn't the same. It's just one of those things you pick up on after working the same unit for awhile. Now you know that doctor's preferences for the future.

Agreed. Also could have been lab, imaging, housekeeping, etc. All in scrubs and all interact with nursing, and thus may have complaints about a particular nurse.

Not discounting that the op's perception as totally inaccurate, but she did state she had AMS, feeling panic, disoriented, was getting up per self and wandering the hall, and still is fuzzy on some the the details. She may not realized that her own behavior was a threat to her own safety (walking halls per self with head injury) or that she may have been bordering on hysterical at the time, understandably. Her nurse's priority at that point would not be hand-holding and coddling, it would be ensuring her safety. Get her back to bed. Administer anti-anxiety meds. Best way to deal with any confused and upset pt? Short directive statements. Firm tone of voice. You go here. Stay here. Swallow this. A brain in panic mode can't comprehend much more information than that, let along drug information, side effects etc. A "You are safe" or "You are ok" may have added to the therapeutic relationship and kept the nurse from sounding too short, rude or offensive. Maybe in fact she did say something along those lines but the OP doesn't recall. In triage they would have assessed for hx of drug allergies/reactions, again op may not recall. Assuming this Nurse is a competent member of our profession, she would have checked this before administering an ordered anxiolytic, and we have no reason to doubt she did so. The ER doc and RN used their judgement and deemed the med safe and necessary in that moment to keep OP safe and calm, whether or not she deemed it an appropriate time for med education. OP calmed down, had no detrimental effects, remained safe while in ER, even became less fuzzy after med was given and able to give information to admitting when shortly before she was in such a state of panic she couldnt remember where she was or why she was there. Does anyone really think a little handholding and gentle redirection would have such effective results? So no, I see no reason to encourage OP to report her nurse for showing "lack of compassion." And while sharing her opinions of OP's friend may be blunt or unprofessional in that environment, many are giving op similar advice here without OP being offended. I don't see a point in encouraging OP to report her nurse just because she can. "How dare that nurse point out such a truthful thing to me in such a direct manner! She may have a point and I appreciate similar advice from strangers on the internet, but when treating me in the ER she has no right to express such an opinion, so I will file a complaint with management, for she told me things I did not want to hear!" Really? And how often do y'all have vent and rants on AN when other pts complain that they weren't handled with kid gloves and told exactly what they wanted to hear? "They said Billy needed to lose weight. They called him fat!" Or "They wouldn't let me order mom a milkshake (just because she had a BS of 385!)" I've only floated to ER a few times, but that short of thing seems magnified in that environment, because most of the pts, even (esp) the noncritical ones, are experiencing a crisis of their own and so are very focused on their own needs in that very moment. Kudos to ER nurses who routinely juggle and prioritize the needs of multiple such pts; its not my cuppa tea. In truth OP you have experienced a truly terrifying event and I hope you do find the support you need to recover from it. The ER is only the first step in that process. Hopefully you and your loved one will never experience such an event ever again, but bring with you into your nursing career the realization: there was no way that ER nurse could have dropped her pt load and held your hand and listened to you talk for 30 minutes. It would have been lovely if she could have,and you may have truly needed someone who could have done that in that moment, but in the ER there is no way she have done so and still provide safe and competent care to all her pts. It's just not the nurse's role in an emergent care environment. If this was a case of sexual or domestic abuse, in our ER anyway, a specially trained RN or counselor would be available to provide for that need - it still would not fall under the primary RN's role. Depending on what kind of position you accept as a nurse, you may find that providing that level of support is not your role either. You are the co-ordinater for all of the pts needs, not the provider. This may very well be a wake up call for you in this regard, or at least a realization that ER nursing isnt for you.

I haven't read the rest of the thread yet, but I'm sure I'm not the first to say this: I would jump at the chance to learn from Ruby Vee for a day.

We've just had one of those families leave our SNF. Brought mother to our facility for PT/OT after a hospitalization, and there was a family member at the bedside 24/7, always taking notes. For a while they didnt cause too much trouble and actually helped with mother's care, ambulating her to the BR and so on. But then they would start finding things to fixate on and worry about excessively. To the point that they brought in her home glucose monitoring supplies to take BS at randomn intervals, and requested prn neb tx exactly 4 hours apart day and night whether or not mother wanted them or if lung assessment warrented them. Finally they raised a stink that the nurses weren't providing enough of mother's care, and if they weren't there, why nothing might get done at all! They might as well take her home! So they did.

Agree with everyone else. You were out of line. Furthermore, a NURSING supervisor has no authority over dietary matters. A cursing member of the nursing staff calling a nursing supervisor demanding information neither party has a right to? Sounds pretty intimidating to whoever this gets passed along to. Definitely demonstrates a lack of professionalism on your part. And if later you were to mention that Suzie Nursing Supervisor said such-and-such, she would also be out of line. She has her own butt to cover. Think about what you did, and sincerely apologize for your behavior. Make no rationalizations. Just apologize, state you understand why you were out of line, and that it will never happen again.

In my years as a CNA I've never come across a resident on Airborne Precautions - not droplet precautions, but airborne - until recently. Pt tested positive for a active drug-resistant infection and definitely is on airborne precautions. From school, I know that this normally requires a special mask which staff should be fitted for, use of negative pressure rooms, etc. My concern: I've seen two boxes on N-95 disposable masks. Once those were gone, these were replaced by boxes of regular procedure masks. Once the facilities store of masks were exhausted, we went the weekend without. Pt is is a regular room, with the door shut AAT. Without proper equipment, most staff avoid the room as much as possible, and address pt by standing at the open doorway. Pt is able to complete ADLs independently, but after several weeks on isolation is incredibly lonely, call light happy, and eager to engage in lengthy conversations - can't blame the poor guy. questions: Is the disposable N95 adequate protection without proper fitting and education of the staff? My unlicensed coworkers mistakenly believed these "duck masks" were cheaper due to the uncomfortable fit and preferred the regular masks. I've advised several on how to ensure the mask formed a good seal to the face. Since this pt isn't dx w/ active Tb, but a drug-resistant organism, are regular face masks adequate protection? A regular unpressurized room? (Standing with the doorway open to address the resident in lieu of mask??? ) A couple of the nurses must have seen how this was going to go, wise prescient beings that nurses are, and have labelled and saved their disposable n95 mask for repeated use, keeping them in plastic bags in the isolation cart outside the pt's door. I know that airborne precautions are specified for organisms that must be inhaled to cause infection, so theoretically, is this practice ok? Cause for me it still carries an ick factor. But if disposable masks can be used by the same nurse for the same pt, then if those "duck bill masks" make a reappearance, I may do the same. Is this better than a regular mask, or no mask? And on a personal rant, why isn't the activity department required to provide one-on-one time with residents on isolation precautions? Shockingly, for me, this facility is one of the nicest I've worked in. It is evident that price wasn't a concern in the design of the building or when it comes to satisfaction scores. Employee satisfaction and safety, sadly, are not as important concerns. No reason why the weekend manager couldn't pick up some masks for the staff at the pharmacy down the street!

I never initial and time the depend. In my experience, it's always been a nurse or member of administration bent on catching a slothful CNA who sneaks into rooms to do this, not other CNAs. I also *love* when little notes are left under the resident's rear end: "Please return this note to the charge nurse as soon as possible" to see how soon the aide goes in to turn someone. People with that much time on their hands should just turn or change the resident while in the room and give the CNA a break.

Foreign terms drilled into my head when I was in CNA training: patient = resident diapers = briefs or Depends bib = clothing protector toileting is a verb poop = BM I'm not sure they still teach this in my area, or if they do, its not as emphasized as I remember. These just roll off my tongue without having to think about it anymore. Some of these new aide look at me like have two heads when I report Ms. So-and-so was last toileted at such-and-such time. For the most part, residents have always looked at me like I have two heads the first time they hear "BM" and I usually have to break down after a few rounds of "Can I assist you with your clothing protector" and just say bib. But I still cringe when hear it. It's better to show an attempt to maintain the pt dignity than to show total disregard. And it's much easier for an A&O resident s/p CVA to accept the use of a clothing protector than a bib - good for his dignity, good for me, one less shirt to change. Just saying.

Depends on your state. I was certified as a CNA after a 2 week course - one week in class, one week on the floor. Then I was able to work for 3 months before taking the certification exam. Also, if you have completed one semester of nursing school, you can apply to take the certification exam. That's how it is in my state. A PCT (patient Care Tech) in a hospital does the same thing a CNA can, usually the same training is required to be hired. The hospital, depending, may train you for other very specific tasks, such as inserting a Foley Cath, d/cing an IV, very simple dressing changes, etc. Nothing invasive (IV starts) and no med administration. I have found my CNA experience to be both very rewarding and very enriching to my education. I have found nurses with CNA experience are better prepared for the workload, the general environment, etc - they are used to juggling a lot of very needy

Not in Indiana. I took a CNA course the summer I turned 17 and worked LTC through my senior year of high school.

I've been a CNA for several years, but never in the hospital setting. Since I know where I want to work when I graduate from nursing school, I've been keeping an eye out for any CNA/PCT openings at this hospital, thinking it would give me a foot in the door when the time comes. Unfortunately, it's been several months of watching and waiting for a position to open - the recession even affects UAP! Never thought I'd see that happen. Anyways, a listing finally opened this week and I immediately applied. It's for a 3-11 CNA position in the OR department. Now what exactly does a CNA in the OR department do? I wouldn't be surprised in any of the inpatient departments, but I will be going into an interview with no idea what to expect as far as job responsibilities. Some vital signs, some moving of people from one stretcher to another, some paperwork (what kind of paperwork???) is the most I can come up with. The job description just stated must be able to lift up to 50 lbs and have computer skills. Cross-posting to the CNA board.

I'm a certified nursing assistant and home health aide.

Infection Control Mnemonics - Nursing for Nurses I've used this for tests before and found it helpful. :)

I'm going into nursing because it's all rainbows and moonbeams.

Druggies and "out of wedlock" mothers? Really? And on a 4 year college campus, no nursing students ever partake of of the wacky tobaccy or overindulge in alcohol. And in this day and age, really, how dare those unmarried mothers be responsible, earn a degree, and enter a well paying profession. They should stay home on welfare or hope for their 18 year old boyfriends to step up and "do the right thing." In my area, the local community college's ASN program is highly respected, has a 90% NCLEX-RN and nearly 100% NCLEX-PN pass rate, and in the facilities I've worked in and had clinicals in, I've been told these graduates are better prepared and preferred over the local state college's BSN graduates. Which is why when I decided to go back to school, I CHOSE an ASN program to enter the profession. In my entering class of 40 students, only 2 were under the age of 21 and entering straight out of high school. Most of us have been in the workforce for years, have families, been laid off, etc. The state college is where most straight out of high school nurse students apply. Your generalizations are very insulting. And rude. You wouldn't like it if I based all my assumptions of BSNs on some of my shared clinical experiences with the BSN students from this state school. For the OP, it seems to depend on your area. Where I'm from, the ASN is in high demand. Few positions outside of management state BSN preferred. Even in critical care areas such as ER and ICU they are still hiring new ASN grads.

YAY! Just passed my final Med-Surg exam today! Getting an A in the class, woo-hoo! This fall is my final semester of the ASN program, graduating in December. I'm ready! Good Luck in your classes this term.

Never been in this situation, but want to reaffirm what some others are saying. The interviewer has no right to ask if you are pregnant, planning to become pregnant, etc. It is a discriminatory against women - if a man were interviewing for the job, they would not ask if he and his wife/partner were expecting or planning to concieve, even though he may opt to claim FMLA leave after the birth as well. It is within your rights to politely point out that such a question is irrelevant to your ability to perform the duties of your job, leave the questioned unanswered, and move on with the interview. Do not intentially be misleading (say no, then mysteriously deliver a full-term baby 5 months later ) but again, it is within your rights to NOT answer. If you choose to be upfront before accepting an offer, unfortunately, its unlikely you would be offered a position. If you accept a position, even if they choose not to hold your position for 4-6 wks after delivery, you would still have 5 months maternity experience when you rejoin the workforce - and have 5 months worth of additional income. Just my

I understand the trepidation, but if you don't feel like you are able to prevent an injury if the person were to be unstable, then please, please don't ambulate this person by yourself. I am just a nursing student now, but I have been a CNA for 9 years, and I've held Restorative aide positions during this time as well. I have had to execute "unplanned relocations to the ground," but never had a pt fall during a transfer or while ambulating. Neither I nor a pt has ever been injured due to a need to lower them to the floor. You don't "catch" a falling person. Catching implies a sudden wrenching movement to stop a fall, which of course opens you to injury. Neither should you act as a human bean bag to break a fall. When I am walking with somebody, I stay one step back and slightly to one side of them. I have a hand on them at all times, preferably on a gait belt. This alerts me quickly if the pt is having balance issues - I feel that they are off balance before they appear to be visually. It also has me properly positioned in case they do become unsteady. If they pull forward, I can pull back, if they fall back, I can guide them forward. If they are majorly unsteady, I don't attempt to hold them upright - a controlled lowering to the ground is much better than a quick stuggle resulting in the both of us on the ground. If the pt is small, i can slide them down my leg to the floor on my own. For a larger pt, I have someone else walking with me pushing a wheelchair or also behind the pt on the opposite side to assist me in lowering to the ground. Im still upset over work this weekend, so if I seem lecturing, please forgive me. I go to school full time during the week and work every weekend. A resident who has been at my facility for several months had been steadily making improvement the past month or so. This weekend I went in and she had been given the ok by therapy to walk with nursing staff. She was excited by her progress, and as I walked her to and from meals, activities, the bathroom, etc, all she could talk about was how she hadn't been able to walk this well in over two years, that her therapist were talking about home visits to plan for discharge, etc, she greeted all the residents she passed with huge smiles and in general was over the moon about her progress. I walked her to the afternoon activity shortly before the end of my shift. Passed on to the next shift where she was and when the activity would be over so they could walk her back to her unit. Left. Came back the next morning to learn that shortly after I clocked out, this resident wanted to return to her room, ask the help of the activity volunteer. Who, instead of alerting an aide, took it upon herself to walk this person back to the unit. She didn't even make it to through the doorway of the activity room... broken hip. I'm just sick about it. Since Sunday I can't keep the picture out of my mind of this poor woman lying on the ground, crying "I was doing so well. I was so close. I was going to go home!"

Using this, the CEO of the hospital in my area make 314,000 n 2008. Not bad money, but far from millions of dollars. He's not even the highest paid member of the hospital, several doctors make significantly more. Is this normal?

Check my work too please =)

Thanks for sharing this. I wasn't trying to contradict that the apical pulse is most accurate, just thought that this wasn't what the OP was asking. Again thanks for sharing your rationale for us students. :)

Under the age of two, a brachial pulse should be taken to assess peripheral pulses.

I haven't worked in the hospital setting, but some of the LPNs in my class work the Ortho unit, and it is HARD work. Very physically demanding unit. They are going back for their RNs to try to get off this unit, as they have had no luck in transferring. Something to consider.