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not now

not now RN

LTC, med-surg, critial care
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not now has 3 years experience as a RN and specializes in LTC, med-surg, critial care.

not now's Latest Activity

  1. not now

    So is this economy hurting anyone else??????

    Go for the extra education, more education is never a loss. No problems here. My facility just took away the special pay they were giving nurses for extra shifts worked. This pay was much more than time and a half, it was supposed to last six to eight months and ended up lasting over six years. Many people took advantage of this and would work two or three extra shifts a week. The problem is that they were relying on that money for mortgages, car payments, putting in swimming pools and now it's gone. Those people were living outside their means and admit that bought bigger houses, ect because of that extra pay. Those people are suffering but that's their problem because they were counting on something that was never guaranteed to last. I never did any extra shifts because I didn't want to fall into that trap. They are blaming the economy (which is partially correct) for their poor money management. Some are threatening not to work any overtime since the pay will be normal time and a half after the first four hours of the shift. My unit also got a NM that has managed to staff appropriately. There aren't tons of open shifts like there used to be, we no longer use 3+ float pool nurses every shift, every day. People are complaining that we are now overstaffed because there was a low census a couple months back for a few days so people were docked. I was docked once and sent home early once (all my patients were downgraded to med/surg status and no ICCU admits), now the hospital is filled to the brim and were practically shoving people out the door to make room.
  2. not now

    Viagra for women...

    I thought it lowers the seizure threshold in high doses like 450 mg or more a day. So wouldn't a smaller dose (75 mg or so) not be considered a risk?
  3. not now

    Viagra for women...

    I read in one of my pharmacology texts that if a woman is having sexual problems due to SSRI's (anorgasmic, I think the term was? And/or lack of desire) the patient can be switched to Wellbutrin which will actually increase desire and the ability to have an orgasm. I need to find that book....
  4. not now

    Dementia pts refusing to eat.

    If I can't get them to eat any type of balanced meal I just give them what they want. One of my residents always had bags of cheetoes and orange fingers but she ate so family was happy. She also would refuse our food but loved any kind of fast food (she was very skinny/bony so family didn't mind) and sweets. One nurse was trying to eat her lunch (McDonald's) at the nurses station so she could chart when a patient fell. The nurse rushed to the patient and our little snacker reached over the counter, grabbed the burger and took off! Another resident would only eat food if it was drenched with honey. Everything was covered in honey. It's just a matter of finding what they want and giving it to them. When it gets to the point of not eating at all, family needs to consider comfort care. I strongly believe that not eating is natures way of letting go and it should be respected. I'm all for NG and PEG tubes when nessisary but in an 80+ year old it's sometimes just cruel.
  5. not now

    hanging cartizem

    I think IVPB is getting confused with low porting a med. With a piggyback the primary infusion stops while the PB runs. If you "low port" a med then the regular fluids (NS, 1/2NS, ect) is running on it's own pump and another med (cardizem, ativan, ect) runs on it's own pump but the med with the slower rate is hooked up to the lowest port on the fluids that is running at a faster rate. We will do this for two reasons. First, to keep the line open. If I have an ativan drip with a 1:1 ratio running at 2mL/hr I need to keep that line from becoming occluded since that rate is so slow. I run NS (or whatever the doc wants) at TKO to keep the line open because the ativan is running too slow to keep the line open on its own. Second, when we have multiple meds and two or three ports we need to combine lines to get everything in. Say you have a triple lumen. You need to run multiple meds, monitor CVP and run TPN. The CVP will take up one lumen, the TPN will take another leaving you with one lumen and multiple meds. So you have IVF with another med low ported on it. As long as any PB are compatible with all meds it'll work fine.
  6. not now

    Called Off for Low Census!!!

    Who keeps track of who's getting called off? We have a schedule book and in the front it lists those who have floated to another unit or those who have been called off and the dates. When the census is low it goes in this order: registry, PRN, OT, part-time, full-time. Full-time is always called off last. If it comes down to two or more people the team lead looks at the list to see who's turn it is to get called off or floated. The nice thing about my unit is we are step down ICU but we also take med/surg overflow so if there aren't enough step down patients we open the rooms up for med/surg. My hospital is always near full so we rarely had that problem. The only unit that gets closed on a regular basis is the "VIP" post surgery unit. I'm sorry about not getting paid for maternity leave. I'm 35 weeks and still part-time and pick up extra days. I have paid maternity leave (plus I'm taking unpaid FMLA after maternity leave is up) but I'm pretty much working until I go into labor also. I feel great and I don't want to be at home staring at my belly saying "When are you coming?"
  7. not now

    They taped the what to the WHAT!

    I hate condom caths for the reason everyone else does, they fall off or leak constantly. They do come in small sizes though. I remember and older nurse (been a nurse longer than I've been alive) that told me "Make them feel better. Show them the large, then put on a small."
  8. not now

    Beer on a patient's dinner tray?

    So far I've seen the following orders in acute care: "Wine with all meals." "One can of (insert beer brand here) with all meals." "One can of (insert beer brand here) QHS PRN." These all came up on meal trays or dietary would stock the fridge with whatever was ordered. It was odd to open the fridge for a apple juice and have two cans of Miller Lite. And my favorite, this was what was written on the MAR: "Vodka 30mL PO TID with meals. RN to mix with one glass of orange juice" I also had to go to pharmacy and sign out the shot of vodka like I was taking out an Ativan drip or something along those lines. This lady was a heavy drinker who had broken her arm falling at home. I honestly don't think it was enough for her. In LTC one of our cute, tiny, 98 y/o ladies was allowed to have fried chicken and Bud when her family came in for special occasions (birthdays and whatnot). The family would bring it in and they'd all sit on the patio and have a good time. My favorite thing about it was she always said "Bud only no Bud Lite. Bud Lite is for p****s!" :chuckle Gah, I miss her.
  9. not now

    Nurses on Antidepressants?

    If I don't take my med I can't function at work. My concentration is shot, my head is all over the place, I can't keep my priorities in line, I can't hustle like I should and I crumble under stress. I stopped my med when I got pregnant and had to go back on because being off my med and pregnant was too much for me to handle. I have no problem with lack of concentration or feeling sleepy (aside from being 8 months pregnant!). But I take wellbutrin which is known for increasing alertness and making people a little on the hyper side.
  10. not now

    Bumex drip and lab draw

    I had a patient today on a continuous bumex drip at 2mg/hr. The hypokalemia and lab draw protocols were in place so I was able to order a K+ level whenever I wanted. Thing is, I'm not sure how often I should have had it drawn. The protocol states when a K+ level should be drawn after a dose of K+ has been given but if the K+ is within normal limits how long would you go before having another K+ drawn? The only other fluids were NS at KVO and some antibiotics. No routine K+. I kept getting different answers from different nurses and the MD just answered "You have the protocol ordered..."
  11. not now

    For Those of You Who Have Press-Ganey At Your Hospital

    On my last unit the NM would post all the comments (good, bad and "neutral") in the break room for all the staff to see. We were also one of the worst scoring floors in the hospital. If you were mentioned by name everyone knew unless it was a negative comment, then she would omit the name. My new unit just got a better score than the "VIP" unit at the same hospital. My NM does not post any of the comments but will post a unit wide e-mail if someone gets named by a patient/family thanking them for making an impression on patient/family.
  12. I saw it once on a physical assessment video in class but have never used it. I pretty much forgot about it to be perfectly honest. My preceptor in ICCU never brought it up. The video that I watched in school and some of the things that we were taught I never see an RN perform outside of my instructors. Ever. Ha!
  13. not now

    Appearance at work

    Because I have blotchy skin that has been plagued with acne (hello red spots) since I became pregnant.
  14. not now

    Floor Nurses: When medicating your new admission....

    I always look at the ED record to see what was given no matter how busy I am. The ED only charts on the computer so everything is in the report. I ask patient or family member when the last time they took all their home meds and what the "regular" time is to take those meds, then explain that times might get changed while in the hospital. If a patient can't talk I just start them at the next appropriate time. The only meds I worry about giving right at admit are the ones that are gonna treat what's going on right then. I'm not gonna worry about routine meds like Lipitor when their BP sucks. With tubing I try to use it and label it if they came to the ED within the last 12 hours. Normally I have to switch all the IV cannulas to connect to j-loops or add extensions or the meds all get changed and I have to low port meds appropriately so I just change it all out. I really have no problem with patients from the ED, I know they are busy and have different priorities. Everything can be fixed/adjusted so it's not a big deal. The few things I find mildly annoying are: 1. A Pt with a central line and blood was never cleaned up. I consistently get patients with dried blood all over the peri area so I'm down their scrubbing dried blood or off their neck/shoulder. 2. An IV cannula connected directly to tubing. When the infusion stops I can't just SL the thing, I need to add on a J-loop myself. 3. A Pt that's older than time who was waiting on a gurney for a bed for God knows how long and was never turned or had their heels floated. I've admitted patient who had large deep tissue injury's on their backside and family was MAD (understandably). But like it said, ED is busy and have a whole other set of problems to worry about.
  15. not now

    So how many pts do you have?????

    When I worked med/surg we had 36 beds and seven nurses. We all took patients on nights (even the lead) but days had a free team lead. We had five patients but one person had to take six because of the number of beds. I always took lunch and my breaks no matter how busy it was. There was no teamwork. Not because we didn't want to help but because we couldn't. We had a unit clerk until 10PM and three aids until 2:30AM (unless it was crazy busy and the house supervisor had to approve). I hated the aide situation because they were struggling every shift. Now on ICCU it depends on the patient. If I have a vent I'll have two or a vent and a BIPAP or some other complex patient. If not I'll have three patients tops. I never go over my ratio. We have one unit clerk, one monitor tech and three aids. The aide situation still sucks but at least I have time to help them. The teamwork is outstanding. I always have plenty of help and plenty of time to help. I always take lunch.
  16. not now

    RN's that used to be LPN's

    I'm updating my post. Ha! After six months on med/surg I went over to ICCU. At my interview the NM asked me "How long have you been a nurse? Count the LVN experience, I used to be an LVN." When I got on the floor my preceptor let me go as far as I was comfortable. I needed a few skills and to get comfortable with the level autonomy. I had the shortest orientations in the last few months. They trusted me and were confident in my abilities. If it wasn't for my NM I probably wouldn't have had a chance.