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Critical Care
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MunoRN has 10 years experience as a RN and specializes in Critical Care.

MunoRN's Latest Activity

  1. MunoRN

    Feel like an incompetent nurse

    There wasn't anything inadequate about the care you provided. Any nurse who asks if being lethargic after the patient's second HD run ever is in their baseline is an absolute moron and there's no benefit in trying to answer any of their questions. Give report and tell the nurse to direct any of their questions to their nursing school instructors who had so severely failed them. Keep in mind that as a new nurse you'll frequently come across situations where you and a more experienced nurse might disagree. Which might be due to the more experienced nurse having more wisdom than you. But it might also be that the more experienced nurse is an idiot.
  2. MunoRN

    Plant-based (vegan) mandate for NY hospitals

    I don't think it's presenting vegan options as being superior, but that they should be options for hospitalized patients. This would only be a 'burden' to hospitals that weren't already providing vegan protein options, in which case they absolutely should be burdened. There are costs to the state associated with poor nutrition in hospitalized patients, so I don't think it's inappropriate for the state to place reasonable expectations when paying hospitals for their services. You can still eat 'paleo' in the hospital, since all that consists of is eating stuff already on the menu but making sure people know you're eating 'paleo'.
  3. MunoRN

    JP drain to suction?

    I'm not sure what you mean since all "JP" drains can be connected to wall suction. In general, the term "JP", short for Jackson-Pratt, is problematic since it is a brand name for a number of suction devices, all of which can be both closed suction systems and can also be connected to open suction. Regardless of type, when the drain is disconnected from suction then the suction port should be closed in some way, but none of those ways are sterile. The OR nurse was being a Jackass, don't sweat it.
  4. MunoRN

    Is Nursing a Profession?

    A difference of 60-70 credit hours in nursing education would certainly be a substantial difference, except there isn't a 60-70 credit hour difference in nursing education between ADN and BSN programs, there's actually little-to-no significant difference between the two. There is typically about 2 quarters (about 30 quarter hours) difference in non-nursing education between the two degrees. Mine consisted of sailing, skiing, Greek mythology, and geography classes. Since the various definitions of a profession all commonly refer to extensive education in the field of practice, the presence or absence of these elective credits have no bearing on whether something is a profession or not. A trade is an occupation that requires specialized training but not extensive education and training, and has little opportunity for continued growth after entry into the field. Nursing requires extensive education and training prior to entering the field as a novice, and has the potential for significant professional growth through continuing education and experience beyond that initial starting point. We also provide a service to others that goes beyond simply performing tasks, and includes far more complex thought processes than required for solely performing tasks. There are certainly some occupations that are in that trade vs profession gray area, but nursing is not one of them.
  5. MunoRN

    Is Nursing a Profession?

    There is a uniform requirement to entry into registered nursing, which is a two-year nursing-specific educational program (both ADN and BSN programs consist of 2 years of nursing specific education). Both ADN and BSN programs also requires about a year to year and-a-half of prerequisites to that program. So no, there is no substantial difference between ADN and BSN programs in terms of the educational requirements defined as components of a "profession". And increasingly, states require that the ADN and BSN nursing programs be exactly the same, so what you're saying makes no sense.
  6. MunoRN

    How often do you wash your scrubs? :)

    I don't think it's unreasonable to expect nurses to have some basic understanding of pathogen transmission, and that it has no direct relationship to the amount of time it takes the earth to make a full 360 degree revolution.
  7. MunoRN

    Is Nursing a Profession?

    There are varying definitions of "profession", and pretty much every occupation can be argued to be both a profession and not a profession based on which criteria one chooses to include or exclude, but using the criteria with the most agreement across different definitions, nursing fits the criteria better than many. Definitions commonly require that a "profession" has some sort of specialized knowledge and education. Given the spectrum of types of education and training that meets this requirement, the difference between an ASN and BSN is not significant, particularly since there is little difference in the nursing-specific education and training in ASN programs compared to BSN programs.
  8. MunoRN

    Is Nursing a Profession?

    We don't actually "take orders from doctors". While the term "order" for a physician's contribution to the overall plan of care that a nurse oversees and implements adds some confusion, we don't actually just do what doctors tell us to do, we have the professional responsibility to evaluation a physician's orders and not implement them when necessary.
  9. MunoRN

    Why bedside nursing didn't work for me....

    Your title and article are a bit confusing because you seem to be saying you no longer work at the bedside because you still do direct patient care in another department, which is still "bedside nursing".
  10. MunoRN

    California Nurse: Ratio Laws and Rest Periods

    Break coverage is not an exception to the mandated ratios, it is illegal in California for a nurse to be required to be responsible for more than the maximum ratio even when covering for another nurse on break. A charge nurse can take responsibility for another nurse's patients while they go on break, but if that assignment is already at the maximum number of patients for one nurse then they cannot legally be required to take on other patients as well to break other nurses at the same time.
  11. MunoRN

    Medication order correct or no

    That's not a requirement or an appropriate prescribing practice. The point in the process where the determination of the number of tablets to take and communication of that to the patient occurs in either the administration or dispensing, where it's determined by the stock on hand or preferred form. If the prescriber for some reason has a specific preference as to the tablet size, it should be written as "acetaminophen PO 1000mg q6hrs. Dispense as 500mg tablets". An order or prescription written as "500mg take 2 tablets" does not include the correct dose of 1000mg anywhere in the order, and instead includes an incorrect dosage distractor, which is a poorly written order. Where I see this most commonly is where a prescriber thinks they're being helpful by writing a script for 25mg metoprolol as 50mg, take one-half tab, to try and save their insurance-less patient money, not realizing they are most likely going to use the commonly available $4-for-a-month supply options, in which case the prescriber is going to fill the script as 25mg tabs, but the prescriber jumped ahead in the process and already told the patient to take a half-tab, so now they are taking half a 25mg tab. And then when the patient comes into the hospital, med recs often format the PTA orders as an initial section for dose, which would in this case be 50mg, and then somewhat obscured in the comments section it says "take one half tab", these orders will be frequently misread and the patient will have their home med ordered as 50mg while in the hospital. There's no reason to not write the initial order with the correct dose prominently included, and no reason to jump ahead and try and do the administering or dispensing step of the process at the same time as the prescribing or ordering step.
  12. MunoRN

    Medication order correct or no

    You're describing a dispensing label, which is different from a medication order or prescription. The prescriber writes the order or prescription, then someone licensed to administer (nurse) or dispense (pharmacist) interprets the order and directs the patient how many tablets to take. It may seem benign and I know the current trends in EMRs have blurred this distinction, but it's actually pretty important that the prescriber stay in their lane in terms of how they write the order or prescription. A large portion of the medication errors I come across share this common root cause.
  13. MunoRN

    It's Driving Me Crazy

    It's a popular myth, but it's not actually a HIPAA violation to look up your patients prior the start of your shift, so long as the information your accessing are for the purpose of preparing to provide care to the patient, it makes no difference if that access occurred at 6:45 or 7:15 since the purpose of accessing the information isn't different based on the time. There are potential labor law issues, as well as insurance coverage issues (in the event you were to injure yourself while looking up patients), but it is not a HIPAA violation.
  14. MunoRN

    Tired and burnt out from the abuse

    They are under no obligation to sign a behavior contract. The only reason to tolerate an abusive patient is that there are legal obligations to continuing to care for the patient (EMTALA), in which case the facility is obligated to continue to provide treatment regardless of whether the patient agrees to a behavior contract. Outside of IV drug users seeking new valves, the only patient I've had who 'signed' one just wrote "*** you" on it.
  15. MunoRN

    Tired and burnt out from the abuse

    There's certainly nothing acceptable or appropriate about the patient's behavior, but how personally you choose to take their comments is also largely up to your control. People who, at their best, are generally unpleasant get far more intolerable when they're not feeling their best, so their behavior is largely a symptom of their underlying reason for hospitalization, and just as it's not a good use of your energy to take a person's acute heart failure on existing chronic heart failure as being your fault, it also makes no sense to take personal ownership of a patient's lack of coping skills. Set boundaries, make the patient aware of those boundaries, and move on to your next priorities and don't allow a manipulative patient to alter those priorities.
  16. MunoRN

    It's Driving Me Crazy

    If getting report on / looking up patients is part of your shift, why are you doing it before your shift starts?