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scribblz BSN, CNA, LPN

Med Surg, Tele, Geriatrics, home infusion

Content by scribblz

  1. scribblz

    Coronavirus (COVID-19): We Want to Hear from You

    My hospital just created a dedicated Covid floor. I can only imagine the panic as staff try not to work that floor...
  2. scribblz

    Coronavirus (COVID-19): We Want to Hear from You

    I had my first Covid patient this weekend. It was pretty intense caring for her plus 4 other patients. Based on my feedback my manager who is very supportive is aiming for a 2:1 ratio for these patients. We're also trying to do dedicated nursing so the patient goes back and forth between the same two 12 hour nurses. We have N95 masks but only a limited supply. We are wearing them with face shield masks over them so that we can wipe them down with cavi wipes after use and each front line staff member keeps theirs in a labelled paper bag. Pt is in a negative pressure room. We glove, blue gown front and back, glove on top of that and wear a protective hair cap as well. My shoes I wipe down with cavi wipes upon leaving. Also opening the door and closing with the cavi wipes. Dedicated WOW! & VS equipment stay in the room. Poor patient's daughter is quarantined in there with her unable to leave. And this poor patient is so sick, coughing up a storm, elderly and doesn't speak English...so from my perspective I'm so grateful I have the daughter...if not I would feel my patient was unsafe being so isolated. Thank God she's A&Ox3...if she was cognitively impaired...it would be impossible. I've been doing tons of infection control and PPE teaching to ancillary staff and trying to project calm so my co workers don't panic . But definitely an intense few days...and I'm back tonight at 7 Anyone else have a Covid patient? Curious to hear about others' experiences.
  3. This is one of the most horrific things I've heard of...
  4. It sounds like your current unit needs you more than you need them. You mentioned that you have a good relationship with your manager so it seems very likely they'll keep you on per diem. Your unit's problems are not your responsibility. If you have the opportunity to further your career by branching out into dialysis, and you love caring for that population sounds like you should pursue it! Best of luck to you
  5. scribblz

    I'm a NURSE!

    Jumped all over my house yelling when I passed the NCLEX. My kids looked at me like I had lost my mind
  6. scribblz

    Giving a life-altering diagnosis

    Wish I could this post as well as like it! That had to be a devastating thing for your patient to hear. But your experience likely made you the very best person to walk her through it. We can't change the diagnosis, but we may improve the outcome by instilling hope that they will find a way to be OK. Also appreciated the ENT FAQ as I have very limited knowledge of that specialty, thank you for sharing! I have worked with a lot of oncology patients and the decision of when to get palliative involved is often so delayed. There is such intense pressure on these patients to "fight". The focus on quantity/ prolonging life generally trumps quality of life. But on their 3rd...4th admission in a year for often the same thing; they are exhausted from the endless barage of tests, procedures and treatments. The tough conversations are often us backing up their right to choose against their family members who are not ready to consider their loved one is tired of the fight.
  7. scribblz

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    I personally take my cues from the energy of the family/ patient on what "tone" they need from me. Some people are reassured by a formal, serious bullet list approach. IE good evening Mr Stevens I understand that you are here with XYZ. This is what has been done so far, and this is the plan for tonight and tomorrow. Assess and answer questions then leave them be. An elderly person might need a completely different approach where they don't want too many details, just to know the reason they feel like crap is they have PNA and that you are giving them medicine for it and will keep them comfortable. I rarely discuss my personal life with patients, but if it's a lonely elderly person I may mention my kids and a funny anecdote about them because it opens the door for them to share about their kids and grandkids which gives me insight into their needs and makes them feel connected/ safe with me. Which if they sundown later in the night I use those insights to remind them of who they are and what matters to them. Nursing is an art as well as a science. We're all just only human with unique skill sets. Some of us better listeners, some of us more comforting, some more clinical. There's no one way to be because nursing is too broad for that. At the end of the day I say be practical and kind. If they are manipulative, be firm/ set limits. If they are anxious address their concerns/ if the concerns are unreasonable/ be kind but firm in trying to readjust expectations. If they talk forever... arrange for a co-worker rescue you. If a communication goes badly learn from it, forgive yourself and move on. This expectation that nurses are expected to be all things is a harmful one. We should communicate in a way that takes into account the patient and their needs because that is therapeutic. We should not attempt to fill some void in their life... that's insane
  8. scribblz

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    Definitely inappropriate and insensitive... But not intentionally so would be my guess. Like your dad said "it's just her personality" , sometimes nurses develop "gallows humor" or dark humor as a coping mechanism for the things they see everyday. Not intended to offend, but understandable that you as a concerned family member would be put off by it.
  9. scribblz

    Coronavirus (COVID-19): 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.
  10. scribblz

    Coronavirus (COVID-19): 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.
  11. scribblz

    Outpatient infusion/transfusion vs Vascular Access Team?

    You're right they do, and I'm working my way there. I dangle that arm, apply that tourniquet and pray for a good vein. Often times I see the same clients for their weekly or monthly home infusions so I know where their good spots are. In patient if I can't get a line in our IV team has been wonderful in giving me feedback on what I can do to improve. I'm probably all things considered average at the moment, but someday I hope to be excellent.
  12. scribblz

    Home Infusion Nursing

    This is a great thread! I started home infusion nursing a couple months ago after a few years med surg (which is still my primary job). Gaining IV skills has been very challenging as my hospital prefers the IV team start the lines (with the exception of the ED, ICU, OR). I've had to basically convince my manager to allow it and then befriend the whole night shift IV team to get the limited skills I have. But you do what you have to do... I also love the 1:1 of home infusion nursing even though I still find it intimidating!
  13. scribblz

    Outpatient infusion/transfusion vs Vascular Access Team?

    Hi skydancer, If you are looking for casual per diem home infusion would be quite easy for someone with your skill set. IVIG infusions for example can be 4 or 5 hours. Once you mix the med, establish access, you could literally do homework for hours just taking a few vital signs as needed. Then just work enough hours somewhere else to provide you with insurance. Take care! Scribblz
  14. scribblz

    Infusion nurse "ish"

    *initially posted this on general not realizing there was already a specific forum. Hey fellow nurses! My background in nursing is as an LPN for 10 years in mostly LTC settings with limited IV experience. 3 years ago I bridged and got my RN and have been trying to build as much IV experience as possible. Nursing school did not provide any IV placement experience which I found very disappointing. I work on a busy med surg unit and whenever possible start all my own lines. Our hospital has an IV team so the majority of our floor nurses never start IVs. To even be allowed to start my own IVs I had to exaggerate my previous IV experience to my boss and convince him that I needed to keep my skills up. Then I watched every YouTube video on IVs I could find and befriended the IV team crew to absorb as much of their wisdom as possible. Now I'm doing home infusion nursing on the side, and that's mildly terrifying. You do an online training tutorial on the med and then you are expected to go to someone's house and mix/ reconstitute the med, train the patient about it and establish IV access. Often you don't know if they have a port that needs to be accessed, a PICC or need a peripheral until you get there. Sometimes their pharmacy doesn't even provide all the supplies you need. But, I'm sticking with it as I need the 1,600 hours of experience to qualify to test for the CRNI, and hopefully get a position in a hospital IV team. To all of you current or aspiring IV nurses what was your journey like to get there?
  15. scribblz

    LTC Center for new grads

    Nobody advertises that they are looking for a new grad. You just have to put yourself out there and emphasize the skills you acquired in nursing school. If you had a clinical instructor who thought highly of you, or any teacher from your nursing school who could vouch for you utilize them as a reference. some advice for the gen. hiring process how to get hired - Nursing for Nurses good luck

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