lalorac

Sky, I'm not sure what type of information you are looking for, regarding scavenger hunts. I take students onto an inpatient, pediatric floor. As part of the orientation, I include a scavenger hunt. I have found this to be a useful excercize for the students so they can locate the supplies and equipment they need to care for their patients. I also include the items of emergency exits, fire alarms, code carts, etc., that the hospitals require us to review with the students prior to giving patient care. The hospitals do not provide me a list. I have developed the list depending on what is available on the unit and what the students would need to complete care tasks and course objectives. Before the orientation, I inform the nurse manager and floor staff what the students will be doing. I also try to arrange the "hunt" to begin when the floor is not so busy, for example, not during MD rounds. On occasion, I've gotten those "disapproving looks" from students as if they think it is a juvenile exercize. However, the majority of the feedback is that it was helpful for them to be able to locate supplies and equipement before being responsible for patient care. They feel more confident and prepared to give patient care. I hope this info is helpful. Lalorac

WoW! I don't know about a "time line". Based on my experience, I would not administer a neb treatment without a doctor assessing the patient first and giving me an order. What would a nurse do in this situation that is within the scope of practice? I would anticipate the order and have it ready to go, but I would wait for, at least a verbal order. I might even initiate filling in the cxr form, but I would not send it or the patient until the doctor or NP signed it. I would set up O2 and get the doctor but if the child was in severe respiratory distress, and I couldn't get someone, I would call a code. IMHO, unless you have exact, detailed protocols (to cover the range of patient ages and symptoms), you are not, as a RN, covered to order treatments and tests. Fortunately, for me, I work in a small clinic and I know the doctors well, and they know my skills well. If they are with a patient and I interrupt them to tell them a patient is in distress, they stop what they are doing and come. That, in part, is because they know I would not interrupt them unless it was critical. If they are in another emergent situation, they will at least give me an order for what they want done. I think it would be difficult to work in a situation where the doctor did not "trust" or believe that my assessment of "respiratory distress" is really resp distress! I know how frustrating it is to deal with families who are impatient with waiting. We have some families who get impatient with waiting 15 minutes! But, we still can't let that feeling lead us to cross the line of our scope of practice. Also, even though we are great at anticipating what the doctor will order, we should not carry them out unless the MD/NP gives the order. I hope there can be a positive outcome to your situation.

That is discouraging. Does anyone know if there is a web site for JCAHO? I'm thinking that it depends on how administration interprets its guidelines. I was wondering about ACLS too. It seems to me that if we are trained then our scope of practice is extended, and we would be neglent if we fail to carry out those interventions because we were waiting for a doctor's order. (Our administration is telling us we cannot even take verbal orders because the MD's are right there. The exception is during a code, when there is a recorder writing down the verbal orders.)

I'm working in a hospital-based, outpatient, pediatric clinic with urgent care. The pediatricians and I are trying to establish standing orders for some of our sick patients. We are meeting resistance from nursing administration. Administration is insisting on a separate order sheet for each patient that comes into the clinic (as opposed to our system of writing the treatments and medications on our urgent care forms). I am trying to show that standing orders are an acceptable practice. Do you know of any resources for establishing protocols and standing orders? [email protected]

Teaching was always an interest of mine. However, when it came to making career choices, nursing seemed to be more flexible. (Which I have not regreted). I've worked in Pediatrics (floor nursing, pedi rehab, nurse manager, Emergency Room, Clinic and Urgent Care settings) since I got out of my BSN program, many, many years ago. Several years ago, a co-worker and I convinced each other to go back and get our masters. Soon after graduation, my co-worker received a desparate call from a faculty member at the university, needing to find a clinical instructor for pediatrics. The faculty member was my co-worker's advisor and did not know of any other graduating students who specialized in pediatrics. (We were the only 2 in our class). My co-worker hates the stress of teaching and refused the offer, but told her that she knew someone who could do it. She put the faculty member on hold and ran down the hall to get me. She warned me that she would not speak to me again if I did not take this job offer! :) So, I couldn't have one of my dearest friends not speaking to me, could I? Seriously, it was a position I only dreamed about and it hadn't occured to me to actually seek out opportunities. So, I took the job. My first semester was terrible. The students were disrespectful, and, not completely their fault, not prepared to handle pediatrics. I almost left and gave up on teaching. However, the course coordinator (who started with the university when I did) convinced me to stay. We had some input to the curriculuum and made some significant changes in coordination with the other faculty. Now, the students are more prepared and teaching is a joy. Carol

Hi, everyone. I just found this board. I've been teaching clinical pediatrics in a BSN program for 4 years. Recently, I have been appointed a full-time clinical position. I look forward to the sharing on this board!