melpn

Ten patients for acute care? Amazing anyone survived, pts. or staff. I know it's supposed to be about the patients but if something happens (and it will eventually) you have your license to protect, too.

Staffing. Supplies. Real evals that mean something. Mgmt. backing up the staff when families/ pts. get really out of line and abusive. Scheduling inservices, etc. only at times that are nearly impossible for night shift to attend.

I know it's hard to be sick/injured or have a loved one who is, but man, why do we have to put up w/ this crap? I'd tell you a story or two but I'm sure everyone here would have a more unbelieveable one. That's why I work nights. Things get annoying threatening, dangerous and just plain rude. A pt's entire family came in on Thanksgiving demanding their dinner, which was provided to a limited #, first come, first serve by reservation only. Soooo, they stormed the employee cafeteria and ate all the food for the night shift. Nice, huh? Those of us that slept that day becase we worked the night before and didn't get to share the holiday w/ family had nothing to eat and nowhere to go to get any. No backup from admin that I have seen. This one is merely annoying but we all know how much worse it gets. The thinly veiled threats of lawsuits are my fave.

DRG's- cheaper than my Littman Master Classic II, lighter, have a neat little thing in the middle so it doesn't slip off your neck. Also come with anti bacterial diaphragm covers (replaceable) and they sound great. My RRT boyfriend loves his. I think the whole name is Doctor's Research Group.

I have some scrubs with slim stretch knit panels on the sides and I love them. They have a nice shape to them and you can move very comfortably. A very nice feature.

Has anyone mentioned pockets? Pants- Line the pockets with tricot so scissors, pens, etc. don't tear through them. Cargo pockets on both legs. Slash pockets on the sides too. Drawstring with elastic in the back. Tops- Forget the breast pocket because everything falls out of it when you lean over anyway. Maybe a drawstring or a little elastic in the back for a bit of shape. Offer two lengths; one that hits near the bottom of the behind and one just at the top of the hipbone. V-neck that doesn't show the goods when you put your badge on and lean over. Patch pockets. -Thanks for asking. Hope you are doing well.

Tata- She practically did you a favor by treating you badly; you are stronger and more determined for it (the ultimate revenge). You will also be a kind preceptor when it's your turn. You can learn as much from the bad nurses as from the good ones. Your attitude will take you far in life as well as in nursing. Congrats. It's nice to see a positive rant!

pulmonary toilet- clearing of sputum from the airways (via deep breathing & coughing, or more often, suctioning)

Can LPNs become ACLS, NALS and PALS certified or would we be awarded a certificate of completion?

We destroy all narcs and DACs, including Lyrica. If it's double locked, it gets destroyed.

Try Midrin (APAP, isometheptene and dichloralphenazone). Also called Duradrin. Even works on my migraines if I catch them fast enough, without that nasty chest & neck pressure I get from triptans. Also low dose Inderal and Mag-Ox prophylactically seems to keep the frequency down.

I received the vaccine when it was first approved in the US, about 10 years ago. I was aasked to get it when my titer came back low and I was going into the nursing program. I was a little hesitant to get a newly approved vaccine, so I spoke to an infectious disease doc and he said it had been used overseas for over 25 years with no problems. I got it and now I am glad I did with all the shingles pts. we get. You never find out until days later that they have it and I am thankful I am protected. I never had any problems with the vaccine itself and I haven't gotten shingles when other nurses did. It was expensive though; over $200 as I recall.

One wheezy lung COPDer, febrile, sats in the 70s. Something clearly had to be done as she could have crashed fast. But in light of her usually maintaining sats in the low 80s (history is important, too) perhaps a small increase in O2 would have been more appropriate. 6L would likely have jacked up her CO2, killed her respiratory drive and made her acidotic. Don't medics have capnometers?

Vacuum tube system (like the ones at the drive-thru at the bank where you put the papers in the box and push it up) for Pharmacy orders; so high tech at the time! Maalox and baby food to decubs and excoriated GT sites, heat lamp to sacral decubs w/ butt cheek taped to side rail if necessary. We still clean inner cannulas w/ peroxide and little brush; only now it all comes in a nice little trach care kit. Charting done in blue for 7-3, black for 3-11 and green for 11-7. Backrubs w/ lotion @ HS. Bright orange DNR stickers right next to pt's name on the door to their room- weirdly morbid.

Pt c/o my delay in returning w/ her meds promptly as I had stated I would after doing her VS. It's true; I was delayed because another pt coded. When I told her I had an emergency, she said "Then why didn't you come back and tell me you'd be a while?".

A turkey. Literally. A frozen turkey.

You lost your cool w/ a drunk selfish jerk who has no regard for anyone's life, even those who are trying to take care of his sorry @#%. You put up w/ way more than I would have. The doc should have tubed him a long time before it got to that. Why is it that we have to put up with this abuse and assault just because we are nurses? Don't admit to punching him; you pushed him away in self-defense. Try not to beat yourself up; there is only so much anyone can take. The fact that you feel bad about it speaks volumes about the type of caring person you are.

I understand, Lizz. But no matter how many pts. you have it is extra effort to train because you can't just do the job, you have to stop and explain what you are doing and why; it slows you down. This is an explanation of frustration, not an excuse! None of us were born nurses; we all had to go to school and be precepted by someone else. That's why I said it's no excuse and newbies should be treated kindly no matter what. I remember the resentful attitudes I encountered 10+ yrs. ago from my preceptors and I vowed I'd be the exact opposite. Teaching is unfortunately not something everyone does well or willingly and I am truly sorry you had a bad experience. Please don't let it sour you on nursing. Again, you learn just as much from the bad preceptors as from the good ones- the message you take away is that you know what you'll do better when you are the preceptor. As a result, you will be a great teacher when it is your turn even though it was a crappy way to learn that lesson. I wasn't trying to defend the nasty attitude you received- I hate it and when I see a newbie getting it I pull them aside and give them a bit of encouragement. No offense intended.

OK, to all of you students and new grads out there, here it is in a nutshell. It sucks in the beginning. We are short-staffed and precepting takes more time and effort, yet mgmt. throws exta pts. on the preceptor because "you have help today". It makes for resentment among the old staff. That is no excuse to treat the newbies that way so don't flame me. If you don't treat the newbies kindly, then they'll never stay. And it fosters that weird cycle of "that's how I was treated so I'm going to do the same when I become the preceptor" attitude. I make the time and try to really teach them. I've had nothing but positive feedback from my students. I love their enthusiasm and utilize them to refresh my memory for the stuff like drip rates that I forgot 10 years ago because we all use pumps now. Remember, you can learn as much from the bad preceptors as you can from the good ones, if for nothing else than how not to do it when it's your turn. Hang in there! M

I regularly chart +BBSH CTA (positive B/L breath sounds heard, clear to auscultation) RRR (regular rate & rhythm). In court they ask for interpretation of med terms all the time, so as long as you're not making up your own, it's OK. But now that I see other posts, I do agree w/ "unable to" and "unwilling to" instead of "non-compliant" or "non-adherent" or at least as an explanation of why. Some very good points made here. M

-diaper=briefs or underwear -refused= declined (w/ a brief explanation of why pt declined and noting that teaching was given re: importance of tx and possible consecquences; not to scare them into something they don't want, just to allow for informed consent and to explore alternatives) -non-compliant= never did know what to do w/ this one but I like "non-adherent" better M

While I am highly offended by her attitudes, ignorance and total lack of professionalism and understanding, I do not believe she should have been fired. Yes, switch the assignment of that pt. to another nurse for that shift. But cultural sensitivity training and a reminder of what her job responsibilities are would have been a better idea; otherwise she will just take her ignorance and bigotry elsewhere. If she can't manage to change her attitude after that then there is no choice but to fire her. Education, in my book, is always the way to go first. Perhaps a better understanding of Muslim culture would have changed her outlook, though I doubt it. Bigotry is pretty deeply ingrained but she should have been given the chance. A pretty sad situation. But you are to be congratulated for taking action on her behavior instead of letting it slide. M

Management (if they are not already aware) needs to be involved. Maybe HR as well. Help this poor woman. I know the repeated nastiness tends to diminish one's compassion, but she needs help, medical and maybe psych. If she appears this way to you, how must she impress the pts.?

Sorry this happened to you. Keep good notes on your pts., using a form is best w/ spaces to fill in, then you are less likely to forget. If the facility doesn't provide one, make one up on the computer. Remember, it's okay to smile and say "let me consult my sheet". After being questioned so many times, I'm sure you looked a bit flustered and that can translate into " I can't keep up" or something similar in her mind. You'll be fine. You're new. You will find your rhythm and become a smoother, more efficient worker. Give yourself a chance even if they didn't. Good luck to you in your career!

Untuck your shirt?