nursing04

One of my coworkers had a patient on telemetry. During a crazy day shift her beepers starts going off- I glance at the screen and it reads "leads off". We both head to the room where we found this pleasantly confused older gentleman with the tele leads all on his member. We just looked at him and laughed hysterically.

I too have never had an IV program or certification. I didn't learn it in nursing school and when I was hired it was mentioned for like 5 minutes.

That is ridiculous! Did she forget that if you wear gloves you are ok? And that's selfish. She won't do it because she worries for herself but she's not worried about the other nurses being exposed. I would tell her to do it herself.

Starting IV's is much more of a practiced skill then cleaning up poop. Anyone can clean a patient. IV's are harder. It's all teamwork. I happen to be good with starting IV's but when I can't feel a vein, or aren't confident, I don't stick my patient. It's not fair to cause harm for no reason. If that is the only thing they won't do, there is nothing wrong with helping. In helping this nurse it's more important to find out the root of the problem. This nurse might have put in a bad IV where the med extravasated and caused serious problems. I wouldn't blame her for not wanting to do it anymore. As good nurses when we have patients that are anxious or angry we talk to them to find out the root of their anxiety or anger. This nurse deserves the same.

Hello. I am thinking of switching from Med/Surg oncology to HH. How far are your patients from each other? How are you reimbursed for mileage and/or expenses? What are the big differences from hospital nursing? Anything you can tell me would be great! I used to be in outside sales so the driving part is fine with me. Thanks!

Can you also tell me the differences between Home Health and hospital nursing? How do you get orders? How are you trained? What different things do you have to do? How are you reimbursed for travel? I've read most of the blurbs but don't have a full grasp. I'm looking to switch to HH within my city hospital system. I want to switch into a field where I can still help patients but am not on a hospital floor. Thanks in advance!

Hello. I am a med/surg/oncology/ everything RN at a city hospital and have been thinking on HH nursing. My concern is safety. Have you every been sent to very unsafe places where you were scared/concerned?? Thanks.

Hello. I feel very bad for you and your fiancee. Your concern is legitamit and this is not the way her nursing career should be. I work on a very busy oncology floor which a lot of times seems like a critical care/hospice unit. We have pts with trachs (arificial airway in the neck), feeding tubes, pts with severe sepsis etc... which we have to manage. But, I am a charge nurse on night shift and I do have one to two less pts then everyone else. This correlates to 4-6 pts each. It is just unsafe to only have three nurses on a floor unless it is a very small unit- like 15 beds. If someone is coding there is no one there to immediately help. And, believe me I've seen it. It never fails that when we are short staffed or at change of shift a patient is found in a life-threatening situation.Each manager does have nursing budgets and they need to figure out how to stay within that and still run "safely". I have never heard of a manager getting a comission off the money saved. And, no I also don't think this "friend" should get preferential treatment. These are both conflicts of interest. I don't know what the laws are in your state or the status of the shortage there but she should definitely look into a place where the ratios are fair. When interviewing I highly recommend her touring the floor she's considerring and talk the RN's there. I hope things get better for you both. Best of luck and happy holidays!!

Calling docs as a new nurse was also one of those things I was fearful of. But, then I realized right away that they are interns and they are learning too. I found it amazing when they ask me which medicine to prescribe. It's very intimidating but also great that they respect our opinion. But, when calling the doc make sure you are calling the right person in the chain of command, also have pertinent info available. For example if you are calling b/c the pt has a fever, also have a full set of vital signs ready. If a pt is c/o nausea, ask the pt if anything imparticular worked before, then request this med- otherwise the MD may prescribe a med that the pt may not want. Also trust your instincts, if something doesn't feel right then go to a colleague or tell the doctor. Ex. on orientation, the MD ordered an antipsychotic med with pretty severe side effects and withdrawal symptoms if they stop it suddenly, the pt had not had a psych consult nor were they aware of this med- so I talked to my charge nurse about it then called the MD to ask why they were putting her on it- and he said that the renal MD had requested it and he wasn't sure why- well, that was sufficient so I told the MD that I wasn't going to give it and if he wants her to take it he needed to explain it to the pt and give it. Remember that your the pts advocate- they trust you. And, if you don't know why something is being done then you need to f/o why for your pts safety. Also, your ultimately responcible. As far as tasks- foley insertions- take another nurse with you. I am not good at female foley insertions- grab another nurse so they can hold the labia open while you insert- it's so much easier. Anymore questions let me know. Good luck!

Welcome and congrats in deciding to enter the rewarding field of nursing. Here's some tips: 1. Know why the pt is taking each medicine, if you don't know feel free to ask the pt- they will teach you so much. 2. Practice doing history's!- we didn't do any admission assessments or history's in nursing school but now I do them all the time- it will help you learn to be thorough and obtain very impt info. on your pts and provide teaching along the way. 3. Look for opportunities to learn- ask the nurse to let you know if there's anything going on that you can help with or learn but also give them example's- "any foley's, trach care, even priming tubing" etc.. Experienced nurses forget that everything is new and and exciting and even doing an enema is good experience. 4. Ask questions- no question is dumb. 5. After moving pts, make sure to put the bed back down and bed rails up- I can't tell you how many times I have found bed rails down and pts way high up 6. Be prepared- if you go the hospital to prep the day before, go in and introduce yourself to the pt, and do a history- it's much easier then trying to read the MD's handwriting, and/or ask the nurse caring for them. Track the history/events since their admission. 7. Most importantly- try and have fun!! Nursing school is challenging and difficult, but, your impact on your pts is life-changing, they will tell you things and trust you in ways they wouldn't with their own family/friends. Best of luck

Well said. I work in the city on a medical floor. I chose this because I knew I would get a lot of experience I wouldn't get on a specialized floor or in the suburbs. I have all kinds of patients. Patients with trachs, feeding tubes, isolations, ureter catheters, ng tubes, chest tubes etc.. I've also learned to do periotineal dialysis. We take care of everyone, asthma pts, renal failure, transplant, oncology, COPD, etc.. It is very stressful most of the time but I am learning a lot. I don't plan on staying on this type of unit for much more then a year or two though. I think I would get burned out and my back can't take it. Question for everyone out there...by the time we get the majority of our patients they are actively dying, how do you all deal with that? Recently I have been taking care of a pt for the last 2 weeks who is terminal- prognosis 6mths to live max, 40 yo, 2 young kids. It breaks my heart, I find myself tearing up in front of him when we talk about it, and then crying on the way home. How do you cope??

Thank you very much everyone. I get nervous w/ these temps and its such a pain to keep calling the doc- can't wait till I have some experience under me.

Hello. At the hospital I work for they do not do blood draws through the pts central line whether it be a Picc, portacath, whatever. This is to reduce the risk of infection. To me I would think a pt is more at risk for an infection by being stuck 2-3x a day for blood draws. What is your hospital policy on this? Thanks

Thanks a lot! Makes sence.

Hello. I'm new to practice and have a question on blood transfusions. My pt last night had a temp of 100.8- the doc still wanted her to get the blood- so I gave her tylenol, her temp went too 100.4 and then back to 100.8 within a half hour, I ordered the blood and started the transfusion as the doc ordered. Is this ok? Her temp obviously wasn't dangerously high but isn't it just going to get higher during the transfusion? I don't know what the final outcome was if her temp went up and if they needed to stop the transfusion b/c my shift was over. Does anyone know what the protocol is for pts temp? Also, what does the temp need to be to halt a transfusion? I just felt like I kept asking the MD every 5 min. Thanks!