not now

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.

My son will get all vaccinations except for varicella and HepB. If he doesn't get chicken pox by the time he's four then I'll vaccinate him. As far as HepB goes, my four month old isn't having sex or doing IV drugs, the vaccine can wait. Many non-vaxers will argue that vaccines can trigger immune responces causing such things as Autism, Type 1 diabetes and Guillan-Barre because it effects and already weak immune system. They will frequently link the flu vaccine to neurological damage (incluing paralysis) and adults with Gullan-Barre. Some also argue that there is evidence supporting the theory that childhood diseases were on their way out before vaccinations were introduced. They also believe that the diseases aren't as scary and fatal as the medical community make them out to be. Also they see themselves as more educated about vaccinations and diseases than the average parent. They research vaccinations extensively and feel the facts prove that vaccinations are a greater risk than the chance of contracting the disease itself. As for non-vaxing parents suing doctors after their child is harmed by one of these diseases, many of them wil flatly refuse to sign the AAP waiver for refusing vaccinations. They will either request to use their own waiver or cross out parts of the AAP waiver. They believe that the AAP waiver takes all the blame off the MD and places it directly on them. I believe it's the line "I know the failure to follow recomendations about vaccination may endanger the health or life of my child and others with whom my child may come into contact" that they don't like. I'm part of the Mothering message boards and their views regarding vaxing/delayed vaxing are interesting. There is actually a thread going now about what the most impressive arguments from pro vaccination parents which sucked up about ten minutes of my life as I had to read all 21 pages of it.

Pros: -A daily routine -Becoming familiar with your residents which actually makes your job easier (i.e. I can Mattie to take her pills if I do this, Ted can usually be found next to the roses, ect) -If you are a LVN/LPN it pays more than the hospital -Getting close to residents and their families -Being there for a resident who is passing -Big hugs from the residents who see you more than they see their family -Geriatric people are just plain awesome Cons: -Chasing people out doors, down hallways and through parking lots -I was hit, kicked, slapped, punched and bit. Oh, and I had a wet brief thrown at me. -When an emergency happens you have little to no help (no RT, code team, or doc available) -Guilty family members taking it out on staff -Tons of paperwork -Overworked CNA's (I was one of them) I loved working LTC.

I wear a long sleeved shirt under my scrubs and a black or dark blue hoodie. My old NM forbid them but my new NM is her polar opposite and doesn't care. The only time I wore a lab coat was in school.

I've seen one nurse wear her white cap. She was younger too, only in her early 40's. She wouldn't wear all white though, she'd wear regular colored/printed scrubs with her cap. I have two caps, one from LVN school and one from RN school, we didn't wear them in clinic, just for graduation. They are both in clear plastic boxes displayed in my sewing room.

I hate reading charts and not knowing what the writer is saying because it's messy or full of abbreviations that I don't understand. For that reason alone I don't abbreviate in my charting. Ever. When I worked in LTC I wrote everything out. Now I'm in critical care and we are the only department that doesn't chart on the computer. I still write everything out. I also write in large clear letters so no one (not even me) has any doubt what I'm describing. Find out what is approved at your facility and go by that.

That's what I was gonna suggest. I don't remember the name of them either.

Got the flu shot once, years ago when I was a phlebotomist, and didn't get the flu. Haven't had a flu shot since and came down with the flu once, the same year I didn't work in a health care setting. Actually, I wasn't working at all that year. Last year I missed it because I was tied up in a patient's room when the house supervisor came around to give them (night shift). This year I'm missing them because I'll still be on maternity leave when the employee health nurse goes floor to floor to administer them.

I don't have some huge sense of pride because I'm an RN but my mom sure is proud that I am. I don't hide the fact but I don't shout it from the rooftops either. I am VERY grateful to be an RN because it's a profession that I really enjoy, I earn a very good living, I have a truly flexible schedule and it's a stable job.

Our pharmacists are so fast to arrive that we hardly ever use the meds in the crash cart. The just show up with a big bag of meds, needles, syringes and start drawing up what the doc orders except bags of meds/fluids. It's great because it leaves nurses free to do other things.

Five minutes. Maybe ten if I hit all the red lights.

I used to work nights on a med-surg floor. If there were multiple open beds on the floor the team lead based it on acuity. If you didn't like it, tough. If you were swamped at the moment it would come into consideration but with multiple empty beds everyone is bound to get at least one admit and on med-surg every nurse is busy. Usually team lead would say something along the lines of "I'll assign this patient to another nurse but try to catch up for the next admit." I would usually ask for the first admit and try to fill up my rooms quickly because I didn't want an admit rolling in 10 minutes before my shift ended and days giving me grief because nothing was done. Technically it was a 5:1 ratio but with seven nurses and 36 beds "someone has to take a sixth patient..." that was usually me since the majority of the time I was the one who was the most caught up. Team lead couldn't take it because on nights they always had their own patient load.

My facility is odd. They have stopped hiring LVN's in all acute care except ED and urgent care. Urgent care only staffs LVN's and the LVN's in ED are regulated to the "fast track" area of the ED. All LVN's left in other departments were either encouraged to bridge over to RN or continue working until they retired. I only know of one LVN who will stay on until she retires but she's pretty close to it already. As for long term care, the facility I work for has off site buildings that hire LVN's. There is a sub-acute facility that I worked at for a short time as an LVN that is mostly LVN's. It shares a building with a "transitional care" unit that staffs LVN's. There is also a assisted living/nursing home owned by the hospital that staffs LVN's. I did LTC when I was an LVN and there is still no shortage of positions if one chooses to work LTC.

I was in the same boat as the OP. I loved what I learned on my ortho/med-surg floor but I was drowning every night. I loved my co-workers but I hated going to work. I wanted to go to ICU but didn't have enough experience so the director of critical care suggested step down ICU. The floor is mostly ICCU with some med-surg overflow beds that open up when the hospital is full (uh, pretty much every day). We take turns doing med-surg so not to get burned out. I love my floor. The ratio is 2-3 patients max and med-surg is 5 to 1. I get to learn critical care and keep up my med-surg skills. Plus, it's nice to have patients who are well enough to carry on conversations every once and a while. Try ICU or a step down unit if your hosptial has one.

I totally agree with the PP that getting patients up and walking is the ideal but sometimes it's not gonna happen. Thigh highs make patients sweaty, so do knee highs. I find that to be the biggest complaint from all my patients next to "It's just annoying". In ICCU we use them for our bed bound patients (sometimes) but I often worry about breakdown from sweating and getting the tubes just right. They are also a pain to get on when your patient can't lift their leg to help you as you put them on. What I love are the foot SCD's that the ortho docs use. I don't know why only the ortho docs in my hospital use them. I used to work on the ortho floor and that's all I saw, when I moved over to ICCU I never saw them again unless it was a transfer from my old floor. They are so easy to put on and the patients usually say they feel like a foot massage. Granted there are some patients who will complain no matter what you do. I read a study that proved they are as efficient as the thigh high and knee high SCD's. I wish I could link it but it was on the online database at work. Boo. Here are the foot pumps:

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?

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....

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.

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.

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?"

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."

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.

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.

After today I totally could have written that OP. I was losing my mind this afternoon and all I get is "This order was written two hours ago and you didn't get it done?" Um...no, I was trying to keep the other guy from hurting himself, then he went to CT and just got back. So no, the vamp isn't up and the drip isn't hung.

In my last semester of clinical we were not assigned patients until that morning. The thought being that in the real world you don't know before hand what patients you are going to get so you'll never have time to do a careplan or look up meds before your shift starts. They were trying to prep us for being on our own. So, yeah, I was standing at the nurses station looking up meds and trying to write a careplan before the day was over because it was never homework. We had to get up if a chair was needed by a nurse or a doctor. Also, is the semester almost over? Some instructors back off a week or two before the semester ends. I'm not saying it's right or wrong but it's happened to me both in LVN and RN school. I've also had students assigned to me on their last day(s) and I totally give them a break. I remember being them, I was tired, stressed, so over it and just wanted it to end. I give them little things to do and help out more.