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scribblz BSN, CNA, LPN

Med Surg, Tele, Geriatrics, home infusion
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scribblz has 13 years experience as a BSN, CNA, LPN and specializes in Med Surg, Tele, Geriatrics, home infusion.

scribblz's Latest Activity

  1. scribblz

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    Home care makes maintaining barriers much tougher than inpatient where you have them for a shift or two rather than seeing them weekly for months. If one of my home infusion clients tries to get too involved in my personal life I usually use some variation of the following line. My company has a very strict policy on my behavior with clients such as we cannot exchange contact information, and we can't engage in social interaction unrelated to the care I'm here to provide. Now you know I enjoy being your nurse Mrs. XYZ so I can't do anything that would jepordize that. That line handles 75% of my clients, for the remaining 25% that are especially persistent, I add on the tale of woe, of my good friend "Susan" who did not take this policy seriously and was let go.
  2. scribblz

    IVIG titration rates

    I think the titration is specific to each patient based on what they've tolerated in the past. I have one client who did not tolerate her infusion with her previous home infusion nurse, and her physician got rid of her pump all together. Now I give her Privigen 4gm/450ml via gravity...6gtts/min x30 mins, 12gtts/min x 1 hr then 20gtts/min for the reminder. It takes approximately 8hrs! And I have to give her Benadryl before and half way through, also tons of water or she developed the headaches and flu like malaise. I appreciate your post as I'm fairly new to home infusion nursing, and it's nice to hear about other nurses' experiences. Outpatient nursing is so much more isolating than inpatient!
  3. scribblz

    Would this be considered abandonment?

    That sounds completely unsafe! Definitely give your resignation ASAP, run don't walk!
  4. scribblz

    What Nurses really Want to Say When They Chart

    THIS!! Every freaking time. Like do you go to a restaurant and then refuse all the food on the menu... and then throw a fit because you're still hungry??
  5. scribblz

    Wuhan Coronavirus - We Want to Hear from You

    While this outbreak is alarming, I feel statistically it's still an outlier concern for me. I'm much more concerned about the flu than anything else. For patients with respiratory symptoms you could always nursing judgement put them on contact/droplet precautions which would greatly minimize the risk of transmission as pretty much all respiratory viruses are known to transmit that way while airborne transmission I believe is not fully confirmed for Corona. Regarding the deaths on your floor, is it possible that as a hospice floor your patients have multiple terminal commorbities and are not treated as aggressively as on other floors because that is not in line with the values of hospice? Do they work them up with imaging, sputum cultures and swabbing for everything ? Or do they just treat the symptoms? Hopefully they get a swab protocol for this soon just like they do for MRSA, flu & RSV.
  6. scribblz

    Infusion nursing/ the journey to CRNI

    Hi Nursy, Thanks for replying! If you don't mind me asking how did you come by your first PICC nurse position? Curious if you bridged into it from another branch of nursing. Similar to how many hospitals now want you to have a BSN, I've noticed that the inpatient VAT positions now want you to have your CRNI within 6 months or a year of hire. This may not be the case for experienced infusion nurses who've been putting in PICCs etc. for years. In my case where I'm attempting to get into the field from med surg/ tele I'm hoping it makes me a more attractive candidate!
  7. Hi pretty nerd, First and foremost get on your own team! You got through nursing school, you passed the NCLEX and earned your nursing degree. You are not dumb. But you do sound discouraged and isolated, so kudos to you for reaching out here. Prep work: You Tube effective interview strategies and practice your answers in front of the mirror. Smile with eye contact, firm brief handshake and take your cues on level of formality from your interviewer. Try to line up a letter of recommendation and a few professional references if possible. Update your resume, as an alum you can reach out to career services at your school for help with this. Sometimes librarians at your public library may as well. Since you feel insecure about your clinical skills look for a place that will help foster the fundamentals. I would recommend looking up the survey scores and reviews for long term care facilities in your area. They often really need staff and are nowhere near as picky about lack of experience as more acute facilities. If possible pick a small family owned place if there are any near you. The patients in those facilities will all need their HTN, DM, CHF, CKD etc. managed and will teach you time management to get your med pass and treatments done. But you'll have time to learn your people and tasks because of the repetitive nature of LTC. After a year or 2 of that you're good to go, SNF/rehab or home care whatever you want to do. When I'm in a negative mental space I often look up TED talks relevant to my current issues, and I find them to be very comforting. Also cheaper than a therapist. Highly recommend walks in scenic outdoor spaces as another good way to get in a positive head space. You are enough.
  8. scribblz

    Wuhan Coronavirus - We Want to Hear from You

    Our Infectious Disease Dept. has the ED screening all people with respiratory illness for recent travel to China. People who meet that criteria are placed on airborne precautions until we can verify that they don't have the virus.
  9. scribblz

    Team Huddle: The Right Way to Start Your Day

    I find a "huddle" to be a great meeting of the minds/ team work/ brainstorming session when done right. I work 7p-7a on a 25 bed med surg unit and myself and several others rotate being "charge". When I'm charge I like to chat with each of the night nurses about their assignment around 0430. Hopefully this has given everyone enough time to read up on their people and get a feel for their needs/ plan for the day for that patient/ predict issues that may came up with them. After that comes the hardest part of my night, creating a fair assignment for the oncoming shift and designating one of them to be charge. I then "huddle" and report off with a quick run down on the floor to the charge nurse and the ANM. This saves the day nurses from all losing precious time between 7am and 8am but gives a good heads up into the day ahead. I like the system, but it is very time consuming to be charge with a full assignment. Curious to hear about "huddle" Dynamics and communication wins/fails on other units.
  10. scribblz

    Help me choose a shift please! Time sensitive..

    I have been working night shift my children's entire lives. Yes, I've been available for appointments and anything/ everything on any given day, but the exhaustion of swapping your sleep schedule back and forth is unreal. There is also a significant difference between 12hr nights and 8s. 12s you miss family dinner 3+ nights a week. If you can afford childcare take the 8-5 and enjoy dinners and bedtime baths and weekends together. As long as you can survive on the Epi position $ the stability is probably worth the pay cut. I like the idea another poster mentioned of finding childcare near your work. Often times preschools put on little plays or have special events that it would be nice to be able to attend if they were close to your job and you could slip away on your lunch break.
  11. scribblz

    New grad need help, afraid I’m failing

    Hi LMS, Based on everything you've said it sounds like you are doing as well as you should be for your first year in nursing. What it sounds like is a communication problem. All the feedback you mentioned came from the same person, and seemed pretty generalized. What is the culture like on your floor? Every nurse for themself? High turnover? Do you have a mentor or someone you trust that can provide you with feedback on how you're doing? I suspect that your ANM may be actually trapping you to keep you. People who work hard and keep their head down are not that easy to find. I personally would be pretty put out to always have heavy assignments, minimal ancillary support and instead of a thank you get "you are doing so badly at this". Her paper trail of criticism of you could make it difficult to transfer to a different unit. I would start lining up alternative references ie. Charge nurse or nurse educator who is willing to vouch for your clinical skills and work ethic. I would be very careful with your interactions with this ANM, you might want to establish a paper trail of how she speaks to you. IE. She pulls you into her office to criticize you, try to remain calm and ask what you should have done differently in XYZ situation rather than defending what you did. In the example you gave applying oxygen and stabilizing a patient's O2 sats prior to grabbing the diuretic is perfectly sound nursing judgement. If she wants to explain otherwise invite her to. Document time, day and specifics of everything she says in case you need it down the road. Don't stop doing your best and look for a way out of this unit is my advice! You're almost at your one year, and then you can go almost anywhere.
  12. scribblz

    9 Types of Manipulative Patients

    I think the OP's article was pretty spot on for common, manipulative behaviors that we nurses have to navigate in practice. To all those who feel we are stereotyping our patients and that this is an unethical way to talk about them... you are making an excellent observation that we need to keep in mind. That being said these are real behaviors which like "non compliance" or "aggressive" behaviors can harm us and do the patient no favors. So we would be wise to focus on recognition of these behaviors and how to manage them rather than how we feel about the patient. Because these patients are tough, especially if they roll through your unit every few months. They should be rotated through nurses, and the team needs to set fair limits and provide a united front. These patients are utilizing maladaptive coping mechanisms, and it's unlikely you can change that. But you can be kind and fair without being used if you can set boundaries and ground rules if you people demonstrate these red flag behaviors that the OP mentioned.
  13. scribblz

    Alarm Fatigue Design Feedback

    We are generally assigned to a unit and then within that unit we have a group of assigned patients. It's important that equipment be easily programmable to the patients assigned to that RN so we don't get overwhelmed by all the alarms on the unit.
  14. scribblz

    Alarm Fatigue Design Feedback

    This is a great idea! I love the idea of a vibrating wrist band which will notify me to refer to the monitor to check my patient rather than my ascom phone going nuts beeping. This beeping disrupts so many conversations and aggravates both patients and myself.
  15. scribblz

    Wound vac question

    Hey Kristin, As long as the black foam covers the entire surface of the wound bed without over lapping to the surrounding skin I believe you should be good. If there is such a difference in depth that the wound vac dressing is caving in on itself then you may need a thicker layer of foam. If it's nicely flat and even with the surrounding skin once the suction is turned on that is a good indicator that the correct amount of foam is in there. As to keeping incontinence away from my beautiful dressings... one of my favorite products is the thin duoderms if I have them, cut to "window" my dressing to protect the edges so nothing gets under there. They're much more water proof than most dressings. If you don't have those, wide paper tape works too! (Plus it's cheap so if they stool all the time, just change the soiled tape).
  16. scribblz

    Just Say “NO” to Nurse Staffing Laws

    Huge fan of his also!

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