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Nellie Nurse

Nellie Nurse

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  1. Nellie Nurse

    Got myself stuck out west

    That's surprising. Prior to moving out here I was working just south of the MI border, in Indiana and I figured their wages would be similar. Hoping to someday go to possibly the GR area.
  2. Our hospital just switched to Cerner. We had started out with using computerized MAR but we just went back to the paper MAR because pharmacy was totally unprepared for the change and a lot of scary things were happening- meds were being put in twice, insulin was listed under PRN section and was being missed. One of our patients didn't get their coumadin for 5 days because the nomogram orders were being overlooked. I'm really glad we went back to the paper MARs. I do like the computerized assessments but it also seems as though the paper work has doubled. For instance when a patient is admitted you have to not only document all of their home meds in the computer but also write is out on paper for the chart. Also the aides have to chart blood sugars on a paper flow sheet, on their assignment sheets, and in the computer. There is too much double and triple charting involved at this time. Management has also not told us which paper forms we are no longer using and which ones are still to be used so every other day they change their minds about how to chart. One example of this is there is a place to chart restraints in the computer but the paper form is still on the unit so some people are using the computer and others are using the paper because it is still available. There is still a lot of confusion. We have had this system for a month now.
  3. Nellie Nurse

    Considered Mandatory Overtime?

    The unit that I work on signs us up for 1-2 extra 8 hour 3-11pm shifts per schedule. I normally work 7am-7pm. They don't let us pick which days to be signed up for and they are mandatory. If you can't work those days too bad, find someone to switch with. I am very pregnant and 2 weeks ago I was scheduled to work 3 twelve hour shifts and an 8 hour second shift all in a row! When I pointed out to my boss that this is a little much her reply to me was, "Well, at least you get to sleep in on your fourth day because it's a 3-11 shift." She made no attempt to accommodate me at all. I work with a single mom with 3 boys. She usually has to call in on her scheduled extra day because there is no one available to watch her kids on these hours. In addition we have mandation which is not used very often but does happen. So worse case scenario: I could be forced to work 7am-11pm one day and in addition have to come in an extra day that week for an extra 8 hour shift. This is on top of the regularly scheduled hours. I really HATE working extra. If I wanted to work extra I would sign up on my own. That is the worst part about this job and frankly a lot of nurses are getting frustrated and leaving which adds to the problem because then we are signed up for even more extra shifts!
  4. Nellie Nurse

    Pain Management

    I work on an Ortho/Neuro surgical unit and pain control is a huge issue. For total joint surgeries our patients usually have either a PCA or epidural with PO meds for breakthrough pain. If these methods are not controlling the pain and I have tried all breakthrough pain relivers I contact Doctor. If I let a patient stay in agony just because the next dose is 2 hours away I would be in so much trouble. It amazes me though how some of our docs seem to have no concept of pain control. One of the doctors will only let his patients have T-3s and Demerol & Vistaril IM injections. If you call him for further meds he usually will not prescribe them. So frustrating. We do have a pain team that I utilize quite frequently and they routinely follow patient with epidurals. Another frustrating issue is when the patient recieves an epidural with only a -caine in the bag and no narcotic for pain control. It is so hard to try to get their pain under control even when the anesthesiologist is notified for pain meds. When pain is controlled I always make it a point to routinely ask the patient if they would like more meds and to educate about why it is better for them to take pain medications instead of just "biting the bullet." Education for patients is another way to help them to get good pain control for themselves, especially since they will be discharged with PO pain meds.
  5. Nellie Nurse

    I'm going to in charge for the first time.

    Well I was lucky, this weekend we were wonderfully staffed and not too many admits. We discharged a bunch of people and so my shifts ended up being fairly slow. I never realized though how many little issues would pop up that I would need to take care of. For example I had to call our medical equipment supplier to get some equipment out to a discharged patient who had not yet received her supplies. I also had to figure out how to juggle the staffing so we didn't have too many people working but we wouldn't be drowning if we got slammed. It wasn't as bad as I thought it would be. Thanks for the great advice. I am going to try to make a worksheet up for myself.
  6. Tommorrow I will be charge nurse for the first time. I'm nervous but excited at the same time. Anyone have any words of wisdom to help me through my shift. Thanks.
  7. Nellie Nurse

    Reality Shock

    Do you work at my old hospital? I used to work on a neuro med/surg unit as a new nurse. Absolutely hated it because I would have 7-10 patients on nights with maybe 2 -3 nursing assistants for a 47 bed unit. I totally felt overwhelmed and awful because I felt like I was neglecting my patients because I couldn't get into their rooms as often as I wanted to. Not to mention having 2-3 trached patients, several confused patients crawling out of bed, q 1 hour neuro checks, etc, etc. Well I lasted 10 months at that job. I am now working on an ortho/neuro unit in another hospital where the staffing is good 1 nurse to 1 aide. I don't feel nearly as overwhelmed as I was at my last job. Talk with your manager about your concerns. If there is not a real push to hire new people then get out and find a job that has more support staff and less patients per assignment. You will get burnt out fast if you try to stick with something like this for too long, not to mention putting your license at risk. Best of luck to you.
  8. Nellie Nurse

    Total Hip restrictions

    Our docs say no more than 90 degrees of flexion, but when you sit in a chair it is better to recline than to sit in an upright position.
  9. Nellie Nurse

    need to vent (duplicate posts merged)

    Honestly, I don't know how anyone passes that ridiculous test. I can remember feeling totally unsure of all of the questions that I received. My friend took the test the first time and failed. The second time that she took the test she passed with seventy five questions. She told me that the second time around she wasn't nearly as stressed and thought that it was actually easier. Hang in there. Go to a review course, do practice questions every day (at least 50), and also do some things for yourself to decrease your stress level- go out to dinner, get a manicure, etc. If you continue to dwell on your failure you will never succeed, except to make yourself more stressed. Best of luck to you. Don't give up now! You've graduated nursing school which is a feat in and of itself. Now all you have is one little hurdle left to jump.
  10. Nellie Nurse

    I have some questions about charting...

    There is nothing that is preventing me from charting in real time. This is just the way that I was instructed to chart at this particular institution and I am wondering if this is acceptable or if I should continue with what I was doing before.
  11. Nellie Nurse

    Has anyone ever seen a prolapsed rectum?

    I'm laughing so hard tears are rolling down my eyes. Who knew that after 14 hours of work kitty 'rrhoid issues could be so funny.:rotfl:
  12. Nellie Nurse

    HIPAA help

    This is a fabulous idea however our facility does not have this policy so I don't think it will work if I am the only one doing this. It's a good idea to plug to management for future consideration. Thanks
  13. Nellie Nurse

    I have some questions about charting...

    I started my nursing career in a facility with computerized charting and I was very diligent at charting. I charted often and very detailed. Now I work at a unit where there is paper charting. The way that the charting is done is the there is a complete beginning of shift assessment that is charted, along with goals for the shift (maintain safety, pain control, etc.) Then at the end of the shift there is an evaluation charting stating what the patient did during the day such as ambulated in hall, dressing change, pain control measures and if the goals were met. This style of charting is more recap of what happened rather than the previous method of charting at the precise moment that the events occured. One example of the difference is neuro checks- previously I would chart every two hours as ordered about my findings regardless if there were changes. Now we are taught to chart at the end of the shift that the neuro checks were completed every two hours with no changes. The same for IV checks. Is this an acceptable way to chart? Is it wrong to be too detailed with charting... I have heard arguments for this. I have a real desire to perfect my charting and to make it detailed and at the same time not overwhelm my shift and prevent me from giving quality care. Thanks for your advice.
  14. Nellie Nurse

    HIPAA help

    I've been searching for some specific HIPAA rules and all I seem to find is vague guidelines on how to deal with privacy issues. Basically I am wondering how to handle family members who ask questions about my patient's condition. Some nurses that I have talked to about this tell me 1. Have family talk directly to the patient- preferred approach but what if the patient is unable to do this? 2. Ask the patient if it is okay to discuss care- works if family member is physically there but I don't know if that is okay if the person calls. 3. Direct the inquiring person to call designated family member- What if there is no clear spokesperson or POA to refer the person to? The list goes on... What is the best thing to do in this situation? Also does a HIPAA resource exist that in plain english spells out what can and cannot be done related to privacy? I want to protect my patient's privacy and also keep family informed. Is there a way to do both without breaking rules? Thankyou for your advice.
  15. Nellie Nurse

    I've left the OR

    This is an update to my previous post. So I was orienting in the outpatient surgery center before I was to go to my permanent home, major OR, when I had an epiphany- I don't want to work in the OR. Now don't get me wrong. I love surgery. It's the coolest thing in the world, but I was disappointed with the responsibilities of the nurse. Don't get me wrong I am not downgrading the OR nurse or anything but I just really missed the hands on approach to nursing- passing medications, giving basic care, doing physical assessments etc. I also realized that I do not have the personality that it takes to be a good circulator. I don't feel that I am assertive enough to tell someone that they have broken sterile technique. To insist to an irate doctor that the policies must be enforced, etc. I was also very disappointed with the working dynamic of the group (hostility towards one another. Doctor screaming if the procedure took 10 seconds longer than he expected it to, No patience with people who are learning). In addition, I thought that I would like the structure and order of the surgical environment but I actually found it to be hindering to my learning. I felt as if I could not touch anything- including nonsterile equipment, and I was very frustrated because I couldn't even do the simplest things, such a putting a blanket on a patient without someone telling me that I did it wrong. I was having all of these feelings coupled with the fact that there was a wrong side surgery performed during my stint as an OR nurse (I was not present in the room when it happened). Right site was marked, time out completed, Wrong limb operated on. This is the second time that this has happened in less than two years so you can imagine the level of stress and hostility present. I really had this strong feeling that this is not where I was meant to be. I was very disappointed about leaving because I really wanted it to work out but at the same time I was very relieved to go. In the month that I had been there I felt very lonely. The management was very supportive and said that I could come back at any time. I found a job on an ortho/neuro unit so that I can still be involved in some aspect of surgery, and I'm hoping to find a doctor who will let me shadow every now and then down to the OR. You guys do an awesome work in OR. I was daily in awe at how advanced medicine has become. Who knows maybe someday I will have the qualities it takes to make it in OR.
  16. Nellie Nurse

    Yelled at by NA for shaving pt.

    I really appreciate all of the input that I have received. One of my goals for my growth as a nurse is to develop more assertiveness when dealing with confrontation. I am going to keep my ears open and my mouth shut for a while and just observe how other people interact with her and what works. So far it seems that the nurses just let her do her thing.