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anonymurse's Latest Activity

  1. anonymurse

    Where to get telemetry tech training?

    I think the AHA rhythm strip class is like $50. At that price, it's worth a shot. However, I think it's way more important to work as a NA if you've never done it. Your NAs can make or break you, and working as one will teach you to be a considerate co-worker.
  2. Easy, Go to usajobs.gov and lay for a VA gig, heck, move if ya gotta, and if it turns out to be LTC, no worries--first, a RN with a BSN is a RN with a BSN so far as the VA is concerned, so you'll be paid the same as someone starting out in ICU, and second, the work load is gonna be reasonable, and it'll be the best-funded LTC you'll ever work in.
  3. anonymurse

    Do you like your job?

    An old NP told me the MOST important thing is to know your place on the continuum of order to chaos. If you're orderly, you'll hate the ER, and if you're chaotic, you'll hate working in a shot clinic. She said just get to know yourself and take any job that puts you in your comfort zone, because exact specialty of preference doesn't matter nearly as much as being able to survive. I want to add that the work culture of the places you will consider is super important. I was in an ER waiting room once and the level of fear there was so high there were 3 RNs standing at the desk blaming each other for something. That hospital was paying a nice sign-on bonus when I was applying but no thanks! Choose carefully. As Frank Zappa sang "Do ya love it, do ya hate it? There it is, the way ya made it."
  4. anonymurse

    Pressure sore classification

    Ask your wound care nurse. Local documentation conventions rule. And as everyone's been saying, make darned sure the cause was pressure before staging it.
  5. anonymurse

    Letter of Resignation

    Depends on her subjective take on how solid those 'signs' were.
  6. anonymurse

    Nurses Notes plagiarism at work such a thing?

    It's not plagiarism because we're paid to chart. That means the words belong to the hospital that paid for them. And if someone else cuts and pastes my words because it describes a situation that's unchanged to a "T," then that belongs to the hospital, too, and in addition, that person saved our employer money.
  7. anonymurse

    Top 10 Reasons Against Unions

    It's real simple. A hospital system has a permanent legal staff that can work nurses over one at a time. Nurses generally don't make enough to afford even one lawyer. But unions have legal teams to defend individual nurses. Now that's worth it right there for me, the respect that comes with having equal legal firepower. Equality, what's it worth to you? If you're a VA nurse, you belong to either of 2 unions depending on whether you're a LPN or RN. There's a no-strike clause in the contract, which I entirely support. When you hire on, you're automatically a member--and you don't have to pay dues unless you feel like it. Musicians call it 'playing for the tip jar.' They have an incentive to do their best by you. And if you live in a 'right to get fired' state, the VA is even more attractive because the Federal government carries its unions wherever it goes, so it's a tiny island of mutual respect in a sea of arrogant 'see ya later, sucka' attitudes. I can't speak for nurses in other unions elsewhere. I have no idea how they're making out. All I know is I'm super happy. If I'm called in and I have even the vaguest suspicion the meeting may result in disciplinary action, I'm entitled to have a union rep there, and the union's contract with the VA takes precedence over regulations. Haven't you ever felt uneasy when being called in? I'll never have that feeling again. Yeah, considering my personal experiences, I prefer to be a respected equal rather than a powerless peon, and I'm never going back.
  8. anonymurse

    Question about Cardizem Drip...

    One thing that's a common procedural error is paying attention to the HR number on the monitor. At our place, that's the HR of a sliding 6-second window. But when a MD asks for a HR, he's asking for BPM (beats per minute), and that's the standard, measuring HR over a 60-second period. Now if you will look for the HR graph in the pt's details, you will see the HR for a sliding 60-second window. Yeah, your tech just called you in a panic because he saw 160 for a moment on the screen, but look at the true HR--might be 110, 90, 130, whatever. So rule #1 is: don't panic. And don't tell the MD the pt's in the 160s if you want appropriate orders. If there's any way to measure BP too and have it sent to the screen, do it, especially in the first hour of initiation. Second, when you catch a new pt from the ER, always check the med admin record. Always. Sometimes you'll find they've been given a beta blocker just before they came up, and here you have a stat order for a cardizem push and drip. Again, check the HR over 60 seconds. Not too bad, say 130 or less? Wait a while to assess the effect of that beta blocker on HR/BP, especially if they're naive to cardiac meds. But really it's not a good practice to give a pt a PO beta blocker, then put them on a cardizem push/drip. Google it. If their HR is high enough to begin with, start with the cardizem and hold the blocker. Cardizem has a short half-life compared to PO beta blockers, which might hang in there 12 hours with no way to reverse the effect. Third, communicate with the MD. Compare notes. Suggest. Negotiate. Don't guess. When they wrote the orders, they didn't have as much information as you now do. Help 'em out. Sometimes, even if they aren't willing to forgo the drip, they'll d/c the push and let you start at a lower rate. And, um--we ARE talking about afib and svt, and not sinus tach, right? Saw that twice last week, cardizem drip/push for mild sinus tach. We got 'em d/c'd.
  9. anonymurse

    Magnesium for torsades

    Torsades can degenerate into vfib. Mag recommended in torsades even if mag levels normal.
  10. anonymurse

    things NOT to say in an L&D interview

    "What's a fundus?"
  11. anonymurse

    Unreasonable female 30 something p'ts

    I have no probs with them. Plus the next night they ask for a female nurse instead.
  12. anonymurse

    Restraint-free facility = FALLS GALORE

    Run away, run away!
  13. anonymurse

    1+ 2+ 3+ Edema Rating Scale?

    There are 2 schools of thought on this and never the twain shall meet: 1. Make a dent in the flesh with a finger and rate by seconds it takes for the dent to go away from nonpitting (self-explanatory), trace (it pits but it's a very shallow dent that goes away fast--exception: if the skin is too hard to dent, it's gotta be +4, actually more), then +1 to +4 (seconds dent persists). 2. Rate +1 to +4 based on how bad it looks relative to other stuff you've seen (I hate this but there are more folks who use this than the first method).
  14. anonymurse

    Ever Refuse a MD order?

    Yes, but not for fun, for survival. It was definitely license threatening. I can't go into the details, but here are the generalities: 1. When your license is threatened by an order, choose the nuclear option, unless you don't care if your family eats. 2. When you choose the nuclear option, don't mess around and don't hold back. 3. Tell everyone, and tell everyone else who you told, not just to keep everyone in the loop, which is wise, but because knowledge creates a duty to act when others know the knower knows. 4. Do the research before you say a word. You might be dead wrong or gloriously right. 5. Don't do squat if you think you'll chicken out or lose. You want an unassailable position, because you're betting the bank.
  15. anonymurse

    A worn out topic

    I try to show everyone little kindnesses, aides, docs, everyone. It's not something you can turn on and off like a light switch. I'd rather default to on than off.
  16. anonymurse

    What is this Press-Ganey business?

    It's an attempt by management to get in touch with patients. They could accomplish the same thing much more cheaply by going into the rooms, but--ya know.