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JillR

JillR

RN
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Content by JillR

  1. JillR

    restarting prehospital IV's

    We don't restart them unless there is a need. I have heard that this is a practice others places, but I have yet to find and studies that actually states that IV inserted in the field become infected more often than those put in in the hospital.
  2. JillR

    Crazy Co-workers

    Wow. This is weird stuff. While reading this stuff I kept thinking that some people act this way because they can. They act innappropriate and when called on their actions the either admit themselves to a psych unit or do something to get admitted. Then people either feel sorry for them or are afraid to call them on their behaviors and the cycle go on and on. I have had 18-20 yr olds that frequent our facility that have never worked a day in their lives and don't have to because they are disability for depression. Well, must be nice. I wonder how the nursing shortage would be if all of the nurses that are clinically depressed quit working and went on disablity. I am sure the tax payers would not stand for that for long. I may just have a bad attitiude today, but I feel that if some people were told that their behaviors would not be accepted because they are just plain unacceptable, there would be lot less of this stuff happening. I do realize that there are people out there that truely suffer from mental illnesses, but the crap others are expected to put up with from co-workers is just too much. There has to come a time that people in administration have to say, hey you can't perform your job either take a leave of absence and get help or you will not be allowed to work here. If these people either don't understand or don't care what behavior is unacceptable, then do they really have the judment required to determine other (patient) health and adequately do care planning and intervene in unhealthy and maybe even dangerous situations for the patient? There really needs to be a serious question of competency in these cases and maybe the best place to go about this would be the Board of Nursing. Only because we all know that in many facilities, a body with a heartbeat is the requirement for employment.
  3. JillR

    feeling unsure... need input

    Delirium, I used to feel like this after every sememster. I questioned my motives, and frequently questioned if going to nursing school was the right thing for me. One time I was on break with some of the RN's that I worked with (I was a CNA and EMT) and they were talking trash about the EMT's that I worked with. Later that day the ER/EMS director called me at home and I was very upset and told her why. She said to me "Now you know the kind of nurse you do not want to be, you have the choice not to become like that. Quitting nursing school is one option, but another option is making the decision to behave in the way that you would like others to. I hope you make the right choice." She never once told me what she thought I should do, just that I had choices regarding my behavior. Now, when I work with people with bad attitudes, I just stay away from them. If they want to kiss up to the docs and wait on them, that is their choice. I choose not to act like a maid because I am not a maid and I believe that when nurses act like that, it creates an expectation. I believe that you will get as much respect and you expect to get and earn. You cannot wait on doctors and expect them to respect you for that. Same goes for your kids, would you let your children treat you this way? ( I am not talking about small children, I am talking about older children) If no, then why in the world would you let a mere aquantence treat you like that. I refuse to even respond to treatment that is not acceptable to me. I believe that all the nurses that you are observing as a student are role models. It's up to the individual student to discriminate what roles are acceptable and what are not. Use the positive and discard the negative. Just remember that not everything you will see in clinicals will be kosher. Not every nurse will do things the way that you have been taught to believe is the right way. This is where the good instructors come in to play. If you have decent instructors, you may be able to bring up these concerns and they may be able to help you to sort through your feelings and thoughts. I was lucky, we had great instructors that did not forget what it was like to be a student. Good luck in your decision. I hope you make the best decision for you. Jill
  4. JillR

    what can you say

    I remember walking rounds with the nurse and the doctor at a LTC facility I did clinicals at for school. I had worked there previously for a years as a CNA. The doctor wanted a psych consult on a lady who was acting the same way she did 5 years previous when I worked there. She had many psych consults in her time. Neither the nurse or the doctor knew this was how she had been for years. I was lucky that the nurse was nice to me and I told her that there had been no change in her behavior in 5 years. They cancelled the psych consult. But it makes you wonder. The DON used to come around and hand out their daily extra useless paparwork every day for the nurses to do on their down time. Made me sad that these nurses never got a chance to really get to know thier patients, but the DON was obsessed about this extra stuff they were supposed to do. They ran constantly and barely got the meds passed and treatments done. God forbid someone should fall or get sick. Not making any excuses for anyone here because I have had these really frustrating patients come in from the same LTC facility without report and such, but thought it was interesting to see the other side of issue while in school.
  5. JillR

    ED Acuity Systems

    Good luck though on your project. If I come across any information about this I will pass it on.
  6. JillR

    ED Acuity Systems

    I am sorry if I offend you here SueBe40, but I just can't help thinking that is a very risky way of staffing an ER. Hope that the hospitals that impliment staffing based on an acuity system for ER has very good insurance. Hope the nurses and doctors do too. WOW! One more question I am going to have to remember for future job interviews. I say the people that think up these "trends" have way too much time to think up all these inovative ideas and really need a dose of reality if they are going to staff safely.
  7. JillR

    ED Acuity Systems

    How can you possibly use an acuity system for staffing in the ER? You never know what is going to poll through the doors. The only thing you could possibly do is project what might happened by using what usually has happened in the past, and that is many time inadequate. Is that kind of what you mean?
  8. JillR

    Tell the truth

    Was nursing school hard? For me it was not as hard as I expected it to be. I had heard many horror stories, so I was convinced it would be the hardest thing I would accomplish in my life and it was not even close. The hardest thing about nursing school for me was not the difficulty of the work, but the amount of the work. The amount of time required to complete the work, cut into my time with my children and that bothered me. No it was not difficult to pass. I never thought I would fail. I sometimes thought I would not do as good as I wanted and/or expected to do and somtimes I thought I would not have time to complete eveything. It all got done and I did very good in the end. It was not difficult to grasp the medical terminology, but I had been exposed to it already. I think I would have had a harder time if I had not taken a medical terminology class earlier, but I know I would have made it with or without. I suggest a good medical dictionary. I think you have to consider your motivations when it comes to nursing school. I was very motivated and I don't think I would have stuck it out when I was 18 years old, or even my early 20's.
  9. JillR

    What could be the ramifications?

    CEN, You are probably right about the delegation thing, but I was thinking not just in legal terms, but in the terms of this techs reputation at work. Not that the work was not done due to laziness, but the tech was actually told not to hook the patient up to the monitor because the nurse did not believe the patients complaints. This whole situation is just down right scarey, and I think she should cover her action with this one. Either way, I would still suggest being really careful around anyone you are not sure you can trust to be honest. I guess I am not a very trusting person, but I have seen people lie in order to hurt others reputation just because they don't like them or were too lazy to do their own work. I could see her and possibly management trying to use you as a scapegoat. I also agree with writing the event down, it helps not only to recall the situation later if needed but also to allow you to vent some frustrations about the situation.
  10. JillR

    What could be the ramifications?

    When I have a person come in complaining of chest pain, they are hooked up to a monitor, VS taken frequently, pulse oxemetry done continuously, oxygen on, IV inserted,ect until MI or any other life threatening cause is ruled out. I don't really care how many times they have been in for drugs or any other reason. Tests that will be ordered are called for usually before the doc even sees the patient. At the very least the doc would order an ECG and cardiac enzymes. The only thing I can think of that you may have been responsible for is if the RN would have stated that she told you to put the person on the monitor and other stuff and then it would have been her word against yours. Luckily, the patient had a significant other in the room with him, this might have helped your case. The techs that worked with me in the ER did not have to ask permission to put someone on the monitor, they just went ahead and did it and it was expected from them. I guess what I am saying is to be real careful and cover your butt. If this nurse did not have a problem lying about putting the patient on a monitor, I doubt she would have a problem saying she delegated a task to you and that you did not follow through. Another thing we do is take a strip as soon as the person is hooked up to the monitor, so you can see what time that happened. I would tend to agree with CEN, that the RN may be negligent, but that you are in the clear.
  11. JillR

    interesting--emts in the ER?

    Not sure about any other state, but here EMT's and Paramedics are liscenced for pre-hospital and transport care NOT for working in hospitals, and even in pre-hosp and transport, they are working under the MD's liscence. When they are hired in ER's they are legally UAP's and are working under the supervision of the RN, they are delegated to by the RN. Now some ER's give them more resposibilities than others, but they are still not liscenced for ER, so they are not liscenced prefessional in this setting. Be very careful what you delegate and to who. Like someone else previously said, it is very important to know the EMT or Paramedic. Don't let anyone tell you that they are not working under your liscense, be very careful. We used them in the ER I worked at and they were great, but they are not educated to work independantly of the RN. They are great assistants in the ER.
  12. JillR

    unique

    Nursing is the only profession that I know of that is accountable for providing, not only nursing care, but is expected to do the jobs of all other areas in the hospital. We are expected to perform dietary, housekeeping, physical therepy, occupational therepy, respiratory therepy, pharmancy, social work, spiritual care, emotional support, security, safety, maintenence, and depeding on the protocols of the facility medical care for the patients at the hospital. We are accountable for all of the this for each and every patient and then treated and if we are maids because we provide these services. We are expected to be experts in our fields, but not given credit for being experts in our field. We are expected to also be able to competantly work in other fields of nursing that we do not have experience, but other professions are not. I would like to see a physical therapist make sandwiches for a hungry patient, it would never happen. We are expected to get hit, sworn at, treated like maids, and say nothing and just take it. We are expected to give up weekends, holidays, birthdays, and our days off, all without adequate compensation. If we say no, then we are not "team workers". Personally I am sick of being a team member, when we don't even get a measly thanks for it. I work the baylor program at our hospital and then volunteer one or two days during the week to help fill staffing voids, so what does my employer do, they let the weekday people have that day off because I am there as a volunteer. This has happened to me the last 4 weeks I have worked, so I am not doing it anymore. The weekday people don't ever offer to work even 1/2 a shift on the weekend and I know there would be hell to pay if a weekend person was allowed to take a day off on the weekend because there is a volunteer on. It has come to the point that I am not going to volunteer for anymore weekdays because of this. From now on they can call me the day they need me and pay me the two hour call in pay for it too.
  13. JillR

    prohibiting employees from discussing wages

    If the employers were to compensate employees farely, with consideration to longevity and such, across the board, there would not have to be fear of "hard feelings among employees." The hard feelings come from unfair labor practices, and hiring new employees and new grads at a high rate and not compensating employees for longevity.
  14. JillR

    Are you ready?

    If there is a disaster and the facility calls us to come in, we cannot refuse, that would be grounds for dismissal. If they cannot reach us by telephone, and we don't show up, they cannot fire us. I have worked at this facility for six years and they have never declared an emergency, I know they did this once about a year before I started working there, for a tornado touch down. I tell the single parents, that if they are home alone with their children, do not answer the phone, but I don't think that will be a problem, because no one ever answers their phones during non-emergent times anyway.
  15. JillR

    bladder spasms and foleys

    B&O suppositories are appropriate, and work well for bladder spasms. If the patient does have a hx of drug seeking, does that mean that we hold appropriate intervention because it happens to have a narcotic in it? That would be cruel.
  16. I had a 15 year old girl come in tonight with shoulder pain that radiated to her elbow and numbness and tingling below the elbow. She had been having problems with pain, numbness and tingling intermittently for three weeks now. She is a catcher on the high school softball team. She had been seeing the sports trainer for the local HS who told her that she may have a torn muscle and to apply ice and see her again before the next game. She went back to see the trainer and the trainer told her she would be okay to play ball. She had a game on Thursday night and after the game, her whole arm was numb from the shoulder to the finger tips. She reported this to her mother. Tonight her mother asked the coach to not put her in the game. The coach stated that the trainer said she was okay and she would like her to play her in the game because "after all the trainer is just like a nurse." Mom agreed, because she thought that this person had medical training, so her daughter would be okay. The daughters pain was so bad that the daughter asked to be taken out of the game. The coach refused and instead put her in center field. Ball was hit to CF and girl caught the ball and threw it to second base and immediately felt severe pain to shoulder and numbness and tingling from elbow down. Coach took her out of the game, but did not want her to seek treatment until after the game. Mom brought her right to the ER. I have seen this girl in our ER before and she is no wimp when it comes to pain. The girl arrives with tears in her eyes. Mom tells me that she felt so bad for letting her play, but she was taking the advise of someone who is "just like a nurse". I told her that I don't think any nurse would advise anyone to play with these problems until they were cleared by a doc. Xray was good, but we do not have MRI available, so she will need to wait a few days for that. Until then she is out of softball probably for the rest of the season and maybe forever. This seems to be a common thing with the kids in sports in this area. They are encouraged to play with injuries and NEVER advised to seek medical attention, they are actually told they don't have to seek medical attention because they have this questionable sports trainer. I am getting very concerned about this as I have seen this before. I was livid. I just wanted to get this off my chest. But do you guys think I am making a mountain out of a mole hill or am I right and is something really wrong here? I am considering making a call to the local newspaper about this practice, but I need to know what you all think. I am very concerned about the wellness of our local athletes. :angryfire
  17. JillR

    Sports injuries/would like input

    I got an update on this girl today. Her arm is still very painful and numb. She saw one of our orthos who told her that she is young and it will heal, he released her back to sports/gym. Her mom is not letting her play though, she made an appointment with the other ortho, and hopefully he will take this a little more seriously. This jerk ortho never even ordered a MRI, just told her she will heal. The mom is very upset that they are blowing this off and is determined not to give up and let her daughter suffer further injury, so that is good. I will keep you all posted. Thanks to everyone for the replies, keep em coming. One more thing, the gym teacher told mom that if the girl was not participating in gym, even with the docs recomendation that she not participate, she would fail. I told her to fight that. Can they really do that? Even when they have a doctors excuse?
  18. JillR

    Practical jokes at work

    One April fools day, the people on med/surg decided to fill the work sheets with all sorts of patients that had weird problems, one was there for a penile implant. When I came to work, one of the nurses in ER inadvertently let it slip that the floor nurses did that. So when I came to the floor and there were suposedly 35 patients for two RN's and no LPN's and CNA's, I made the comment that unless we get some help right now I would not be taking report. They told me that they tried to get help and no one would come in or stay. I told them that I was going home that minute. The look on thier faces were priceless when I faked that I punched out and came back and said April fools! The NTG thing, I would not recommend it. I have had NTG before and it puts me into the worst Migraines possible, ( not just a HA, but on my knees puking for hours HA) you would loose a nurse for the shift with that little joke.
  19. JillR

    Is it like this everywhere???

    I have worked as a Waitress, Bartender, Cook, Laundry, housekeeping and even worked in a gas station once and this backbiting stuff is just universal, it is not only females either, men can be just as bad as women. Doctors are not above it, have had docs come to me to talk about others. The one response I give is I ask if they have discussed this with the other person. The response I get is usually no, and I inform them that I would rather not talk about someone who is not there to defend themselves. I will let people vent, but don't like getting caught up in the gossip.
  20. JillR

    healthcare experience prior to nursing

    Started out as a CNA, then EMT, then EMT-Intermediate, then ER Tech and now RN. What is next, who knows!
  21. JillR

    Duties not related to nursing.

    I work ER, and I do believe that it is my resposibility to check the crash cart daily. The meds are checked by pharmacy for outdates. We also check the accu check machine daily. I also make sure that the ER is adequately stocked when I come in. There is nothing worse than not having something on hand when needed, expecially in the ER. I have a belief that I am not housekeeping and I will clean only if needed, or I am bored. I am usually to busy to worry about doing everyone elses job for them. I wonder if teachers are expected to clean the classrooms? The expectation that nurses do the cleaning is outdated and unreasonable. It again comes down to the fact that I may be able to do their job, but they can't do mine. The paperwork comes with the territory, and no I do not shred papers. I am expected to do the ordering for the ER on sunday nights, and I would rather do it than have a tech do it, because I have found that many times the techs don't really know what to order and how much. If I don't have time then the day shift will have to do it, but I usually find the time to do it. When it comes down to it, all else will wait untill patient care is done.
  22. JillR

    Sports injuries/would like input

    Thanks for your replies. This mom did want to get medical treatment for her daughter, but was discouraged because this althletic trainer was "just like a nurse". She trusted suposedly intellegent, educated people, who did not look out for the welfare of this child, but played with an injury even though mom asked them not too. This is the exact reason why I go to all of my daughters games, I don't care if they have to forfeit, I will not allow them to play her hurt, with numbness and tingling down an extremity.
  23. JillR

    Help! The "Life" of a Nursing Manager?

    Layna, I guess there is always the chance that some people might be put off if you hire agency, but I know that the people I worked with were happy to have the help. We are a union hospital and there really was no problem with it. Another thing they did was get together a retention and recruitment commitee. The members were voted for by the RN's and LPN's. The five (I think) highest voted for nurses were asked to be on the commitee (sp?). This helps keep the staff and management on the same page. It also gave other staff memebers someone to go to with ideas for solving the problems. Also, have you considered hiring LPN's to take care of some of the more stable patients on your med/surg? We have a few and they are great. Do your nurses work 8 or 12 hour shifts? If they work 8, are they willing to work 12's? This may help take some pressure off, if they work less days but more hours. The only down fall we have had with 12's on the weekend staff is when ther is a call in, it is really hard to find someone willing to cover a whole 12 hour shift because the people who work during the week all work 8's. One other things, you and administration may not like to hear this but, I have found that rural hospitals, in order to compete with teritiary care centers, must offer wages and benefits that are competative with those larger hospitals. I know that many of the hospitals in the northern part of WI do not offer wages that even come close to what we get here and they are always advertising for help. Just because people live in a very rural area does not mean that they do not expect to get competitive compensation. Many people may be willing to relocate, but may not be willing to take a pay cut to do it. Just FYI. I don't know, just throwing some things out there.
  24. JillR

    Why you love/hate ER

    I don't mind the drunks as much as most people. I don't even mind the drug seekers all that much, they are so transparant, it's not even worth getting worked up over. I do mind the people who come in for sore throats, stubbed toes, ect and expect to get back right away, and throw a fit if they have to wait. I mean stand in the middle of the waiting room and yell like there is not tomorrow. I just walk away, but geez, get a life. Had a lady bring in her sig other the other day, we were full with people waiting. He had not been feeling well for a couple of days, but was stable and such. A few minutes later she tells the xray tech that he was having chect pain. So, we kicked someone out of a bed, got him back only to find out he was not, nor had he ever had chest pain. She comes back and starts throwing names around..give me a break. I personally don't care if you met DR.Soandso eight years ago, I will not treat your loved one any differently than any other patient. Well, I got him settled and went back to work on my REAL chest pain patients. I don't even mind the frequent flyers that much anymore. I have found out that all the patient teaching in the world does not make a difference with these people, they will come here if they want to anyway. So, I do the teaching and do not even expect them to take my advice. They obviously have some unmet needs that are way beyond my control. I have never had more fun at work than I do in the ER sometimes. You must have a good sense of humor and the ability to accept that sometimes things are just out of your control and there is nothing you can do about it. I do mind parents that want us to give them tylenol, motrin or whatever OTC med, because they can't afford it, but they have money for cigarettes. I have and will tell them that they may have to skip that next pack of cigs in order to buy that Tylenol. I smoke, but give me a break. I do mind the people who call the ambulance for a sore throat, to the waiting room they go to wait their turn like all the others. Agree with CEN about the prisoners though. I love it when they think they have found a get out of jail free card, only to be sent back when we find out they were just faking. Even though I can say there are things about the ER that really irritate me, I can still honestly say that there is no place I would rather be. I have never dreaded going to work in the ER as I had going to work on med/surg. I love it. There is always a new experience to be had.
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