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Nurse, Children's Hospital

Content by Double-Helix

  1. Double-Helix

    Injection Gone Wrong: Part 2

    I'm sorry, but you're starting to lose me with the clinical inaccuracies. MRI machines do not move away” from the targeted area of the body. No visible part of the machine moves at all, and the patient in the MRI scanner would have no way of knowing what part of their body was being imaged. An MRI uses powerful magnets inside the bore of the machine to create magnetic fields and collect feedback that yields 3D images of the target area. It's up to the MRI technologist operating the machine to define the field of view and the area being targeted, but this takes place outside of the scanner. Again, other than the table that positions the patient in the center of the bore, no part of the machine can venture away” to another area of the body.
  2. Double-Helix

    Funniest, Weirdest, Most Unusual Baby Names

    No, no you didn't. With the number of people who claimed to have known twins with these names, you would think they would be easier to find. Yet no one named Lemonjello or Orangello has ever registered with the U.S. Social Security Administration. This is an urban legend- one that many people have fallen victim to- even convincing themselves that they once knew or cared for people with this name. Yet the actual people can never be produced.
  3. Double-Helix

    NRP vs PALS?

    Just curious, does the PALS certification include infant recussitation? Meaning, if I am PALS certified, does that mean I'm also qualified to do NRP? I'm getting ACLS/PALS certified through my hospital soon, and I'm just wondering is PALS includes the skills from NRP. Thanks!
  4. Double-Helix

    Angels Children's (Part 3: Hanh Tran)

    I'm sad it's over! Maybe we can have a sequel? Or a prequel to find out who the little girl is and how she got trapped in the hospital with no record of her missing?
  5. Double-Helix

    Angels Children's (Part 2: Little Miguel)

    I've been stalking too! You know, tokebi, no one would mind if you decided not to wrap up the story this time and went on to write Part IV, or Part V, or Part VI...
  6. Double-Helix

    End of the (Med) Error: or, How NOT To Bomb Your Survey

    Can you explain this? The order doesn't say to give 1.5 mg. It says to give 1.5 tabs. The tabs are 2 mg. 1 tab = 2 mg. 0.5 tab = 1mg. 1.5 tabs = 3mg. Yes, 1.5 mg on three different days would be a total of 4.5 mg in a three day period, but that's not what the order says. Recopied from the OP, emphasis mine: Warfarin 2 mg tab, 1.5 tabs PO Q PM on Mon-Wed-Fri, alternate with 4 mg on all other days." At any rate, I think we've proven that it's a poorly written order.
  7. Double-Helix

    End of the (Med) Error: or, How NOT To Bomb Your Survey

    I could read this order five times and still get it wrong... 2mg tablets of Warfarin. Give 1.5 tabs on M,W,F. That's 3 mg of Warfarin, is it not? Alternate with 4mg of Warfarin (that would be two 2mg tabs or one and a half 4mg tabs- 6mg total) on all other days. I can't for the life of me figure out how the patient is supposed to be getting 7.5mg 4 days per week and 10mg on the other three. There really should be two separate orders here. One that says Warfarin 7.5mg M-W-F. Another that says Warfarin 10mg T,Th,S,Su (using approved day abbreviations). Does it really matter that they are 2mg tablets? That just confuses things.
  8. Double-Helix

    Funny & Cute Things Our Demented Patients Say

    I definitely agree with therapeutic fibbing. One of my favorite nursing home moments came when I was working as a CNA. I had a patient who was repeatedly trying to climb out of bed, but physically unable to do so. After a few times of helping her get back into the bed, I finally asked her what was wrong. She began a long story about how she was so concerned about "John" and "my father" because they were at evening Christmas Eve mass, there was a snow storm coming, and there was no one to pick them up. She only settled down after I assured her that I would leave immediately and go bring them home. Before I left the room she smiled, squeezed my hand, thanked me, and wished me a "Merry Christmas." I knew that reality orientation would have been futile in this situation. It was, after all, the middle of July.
  9. Double-Helix

    Public Humiliation In Healthcare

    It's not just nurses who receive this kind of treatment. I've heard attendings berate residents in front of patients, family and other residents. I've heard nurses criticize CNA's in the nurses station. I've heard nurses yell at other nurses. It exists in all areas (and in all professions). The fact is that some people take advantage of their position and think it is acceptable to treat their colleagues like dirt. As long as nothing is said or done about it, it will continue. Each of us, as individuals, need to learn to stand up for ourselves and our colleagues- whether it be a CNA, a fellow nurse, or a resident. There is absolutely nothing wrong with saying to a doctor, "It's not acceptable for you to speak to me like that. On this floor, we talk to each other like adults- with respect. If you continue to behave this way, I will be notifying your supervisor." I believe that if we, collectively, took a stand in informing these people (whatever their job title) that we do not tolerate bullying, then we could change the culture of our workplace and this type of interaction would become the exception, rather than the norm.
  10. Double-Helix

    Prejudice Against Overweight Patients: An Issue To Ponder

    Here's an example from work today that fits this issue perfectly: The patient was a seven year old female with a diagnosis unrelated to weight. She weighed 70 kgs (155 pounds). As a reference, the 98th percentile for a 7 year old girl is 70 pounds. The patient refused to do simple things for herself- such as help reposition herself in bed, feed herself, and wipe herself after she had a bowel movement. If I told her she had to help or had to do something for herself, she would whine and complain that she "can't do it" or she "didn't know how." Instead, her mother would do these things for her. Her mother also brought her extra snacks and juices (mom reported the child drinks up to 64 ounces of juice per day). When the child refused to eat the meals that dietary had prescribed for her, the mother would bring her bacon and sausage, grits covered in butter, McDonald's cheeseburgers and french fries, cookies, etc. I don't think she ate a vegetable all day. It was extremely frustrating for me to take care of the patient when the child was acting so helpless and the mother was enabling her laziness and poor eating habits. I'll freely admit that I had more than a few judgmental thoughts about the family. But what really irritated me was not that the child was morbidly obese, but the attitude that accompanied it. The weight wasn't the issue- it was the fact that the patient (in this case, the patient's mother) refused to acknowledge there was a problem or invoke change, despite education from our nutritionists. I realize that this situation is not the child's fault. Seven year olds cannot go out and buy McDonalds themselves. They can't drink a gallon of juice per day unless someone is bringing it home for them. They don't get away with doing nothing for themselves unless someone is willing to do everything for them. So my bigger issue was with the mother, not with the child. While the child wasn't admitted for a condition directly related to her weight (but she did have a history of hypertension and obstructive sleep apnea) a good diet is very important in the management of her condition. And even though she wasn't in the hospital for a weight issue, there was no doubt that her weight was directly affecting her medical care and her recovery. I suppose my point in all of this was that, for many people in the healthcare field, it's not the patient's weight that causes them to have prejudice or be judemental- it's the attitude of the person who is overweight. Or, it's the health care worker's repeated exposure to the attitudes that I described above that cause them to have negative associations. Finally, even if you don't have a medical problem that's caused by being overweight, the weight can still be a factor in the management of that condition and the overall health and recovery time. A hysterectomy may not be related to weight, but a morbidly obese patient who can't get up and walk after surgery is at much greater risk for complications and much more likely to end up staying in the hospital longer or going to a SNF. So if it wrong of the gynecologist to bring up weight, even though it isn't directly related to the issue at hand?
  11. Double-Helix

    Long-Term Care Nursing: A Specialty In Its Own Right

    Thank you for writing a great article about the truth of LTC nursing. It truly is a specialty area that requires a unique skill set. Unfortunately, LTC has a very poor reputation as one of the least desirable places to work- a reputation that is undeserved. LTC nursing requires just as many skills as any other area of nursing and can be a very rewarding place to work.
  12. Double-Helix

    Prejudice Against Overweight Patients: An Issue To Ponder

    Phrasing is everything. You can address a weight issue without saying, "You're fat." Addressing the reasons for the increased weight is different and more effective then just addressing the weight itself. It's the difference between: Patient: "My back has been hurting me." Doctor: "I think you would feel better if you exercised and didn't weigh so much." And: Patient: "My back has been hurting me." Doctor: "Lets talk about your daily routine and exercise habits. Maybe we can identify a few lifestyle changes that might help with this pain." In the first example, the doctor is making the patient's weight the issue. It comes across are more judgmental, because it doesn't really offer any practical help for the problem. It also doesn't involve the patient in the discussion, but is simply the doctor giving their opinion. In the second example, the doctor involves the patient in the discussion and makes the focus about lifestyle factors that an be adjusted in order to help with the problem and make the patient healthier overall. It's much less likely to come across as judgmental and biased. I think this philosophy of phrasing can be applied to many situations when discussing weight, such as when discussing health with teenagers. Many teenage girls feel an obligation to be skinny, like the magazine models and are afraid of gaining weight. When our educational sessions with these girls, focusing on weight, BMI and obesity can further reinforce the idea that gaining weight is bad and they need to be skinny. If we focused on the lifestyle choices that result in better health (balanced diet, regular exercise) instead of on the weight, I think our teaching could be more effective.
  13. Double-Helix

    4th Nursing Caption Contest - Win $100

    "That'll be the last time he asks any nurse for a sponge bath..."
  14. Double-Helix

    Coffee Addiction

    I went through phases in nursing school where I would drink coffee/iced coffee every day. Had to have it or I got really bad headaches. I didn't like being dependent on it. I got really sick with a bug and the idea of coffee sounded horrible. So when I recovered I pretty much stayed away from it. I might have had a small cup once every other week or even once a month, but it didn't taste as good anymore. Then I got pregnant and cut it out completely, although I do still have a caffeinated soda or hot chocolate occasionally. No more coffee for me though.
  15. Double-Helix

    Advice on position offered

    If it is a big hospital then it there might be a lot of offers/applications/paperwork for HR to process. It's not unusual for this process to take several weeks. I would suggest calling HR directly if you have not heard anything in another week. At least ask when you should expect to hear.
  16. Double-Helix

    New grad survey! Bsn over adn!!??

    I won't ever regret getting my BSN. I was told specifically when I interviewed for a job that one of the reasons my application was chosen for further review was because I had a BSN. I ended up getting the job.
  17. Double-Helix

    Where are all the jobs????

    Definately apply to long term care, skilled rehab, doctor's offices, schools and summer camps. Anything to get your started and making money. Jobs are highly competitive right now, as many hospitals are not in great financial shape and are not hiring. Many nurses already employed are working extra hours or not retiring due to the economy. There are also way more nursing graduates than there are jobs to fill. Having an ADN, depending on your area, may but you at a disadvantage, but there is no guarantee a BSN will help.
  18. Double-Helix

    Supervision of a Registered Nurse

    Does it matter if the telephone schedulers ask the patient questions? Aren't you still going to get to talk to the patient and ask them the same questions yourself? Maybe the schedulers ask the patients questions to make sure they are calling for the right reasons- i.e to schedule an appointment. Have they been trained to recognize the symptoms of an emergecy and tell the patient to call 911? For example, a patient calls to talk to an advice nurse. The scheduler asks them their symptoms. The patient replies "I'm 35 weeks and started gushing blood and have really bad cramps." The scheduler tells the patient to call 911. This takes about 20-30 seconds. On the other hand, scheduler does not ask the patient any questions, just says "I'll put you through to the nurse." The nurse is on the phone with another patient and takes 4 minutes to answer the call. The nurse asks the patients her symptoms and tells the patient to call 911. This takes about 5 minutes and the patient might very well bleed to death. Perhaps you should speak to your supervisor about the reasoning behind these policies and see if you can get some clarification. As far as this unlicensed woman being your supervisor- she does not seem to be supervising you clinically, but administratively. i.e. professionalism, punctuality, attendance, attitude, etc.
  19. Double-Helix

    Kind of fed up with things...possibly nursing in general

    Maybe nursing in a doctor's office would suit you for awhile. Or a walk in care center that has 8 hour shifts? Outpatient surgery? With your experience, you have lot of options that can give you the schedule you want.
  20. Double-Helix

    dementia pt/wants out

    Alert the nurse or other staff as soon as possible. Attempt to get the resident's attention and divert him to another activity- snack, drink, phone call, etc. Bring a wheelchair and try to get the resident to sit down. Do not try to grab him or restrain him from going outside. The resident could get hurt, fall, or hurt you. The biggest thing is you need to get some other staff to help.
  21. Double-Helix

    Lpn to Rn or BEN

    The benefits to having a BSN are: 1. You might be more hireable in some areas in a hospital setting 2. You can work your way up to management 3. You can more easily gain a higher degree (MS, NP, CRNA) 4. You might get paid more in some states Cons: 1. Takes longer 2. More expensive The reverse applies if you go for the LPN-RN program.
  22. Double-Helix

    An ER "First" for Me...

    Haha. My friend had an ER clinical rotation and said that a patient came in complaining of pain. When he saw the doctor he said, "You know, oxycodone 5/500 works for me. That's what they always give me." Oh dear...
  23. Double-Helix

    I messed up my ppd site

    A positive PPD is a raised area of 15mm or more, (unless you have HIV, and then it's 7mm). So with a 2mm raised area, I don't think you have anything to worry about. Edit: I just read the "quarter sized" comment, so I'm thinking the 2mm was typo? 2cm maybe? Try applying ice, and then moist heat, like a warm washcloth.
  24. Double-Helix

    How long can a recommendation letter be used?

    You should definately have a letter of recommendation in hand (and an electronic copy as well) in case you are asked for it. You might not use it, but many job applications may ask you for one. You can use that letter as long as it makes sense to do so- since it's from an instructor, as long as you are a new grad. Once you have been working at a hospital for a year, you would want a letter from that facility, not your school. For most hospitals, you can find information about their nurse residency programs on the facility's website. I'd check there before emailing a recruiter. Why are you waiting to apply for jobs? You can apply now, while you are waiting to take youe NCLEX. Chances are you will have taken the test before you start getting many calls for interviews. I started applying months before graduation and I have a job waiting for me as soon as I pass my test. It's a competitive market and starting early is never a bad thing.
  25. Double-Helix

    How to become a maternal newborn nurse

    You need to get an RN, and probably a BSN for best chances. Do well in school, especially your OB clinical rotation and make friends with your instructor and the nurses on the floor. If possible, do your capstone or partnership in OB. I'll also add that you should only pursue this route if you want to do other types of nursing as well. You might not like OB once you start school and there is no guarantee you'll get a job in OB right away, as they are very competitive. You may have to work in another specialty for a few years. As far as your CNA license, it depends on your state. You can probably just pay a fee and renew it, but depending on how long it has been since it expired, you might need to retest. Call your state board of nursing for more information.