suzi0612

Thanks for everyones comments! The provider just made me feel so bad about it and that I was dumb.. Glad I used the pump ... Made me feel comfortable !

I'm at a clinic ... forgot to mention that!

I actually used a printed out guideline from the clinic beside us that I used the pump. I told my manager she told me to document everything he told me to do ... I was just so upset because I was trying to follow guidelines for me and the pt and ge made me feel bad about... I'm currently trying to find a new job... I am not going to do things that the dr tells me that makes me uncomfortable ... Not risking my license!

Hey Everyone, I recently started a job in a clinic and only have been a RN for almost a year and had a question. I have not worked in the hospital and only start IV's in the clinic a few times... but today we had a patient that was getting vanco IV. In the past the provider made us give the vanco via gravity, so today I went and borrowed a pump from a different department because I read that you HAVE to give vanco via infusion pump for patient safety. I also talked to another nurse that I borrowed the pump from about certain standards of giving vanco she said we usually have a primary line going and piggy back the vanco 1 gram in 250mL of normal saline and infuse at 167mL hour (1.5 hours). So I got the pump ready and the provider ordering the Vanco was mad I got the pump and said "you should just be able to look at it and know how fast it is going, if you have any problems with that pump don't ask me for help because I do not use them." He also wanted me to mixed that 1 gram of vanco in only 50ml normal saline? And I had a protocol for our facility that said it has to be mixed in 250mL of normal saline. I told the provider I did not feel comfortable giving the vanco without the pump because "i cannot judge how fast it is going." and that the standard was suppose to be 250 mL. He said okay whatever mix it in 250mL of saline. So the dr had me start the primary line by gravity and once I got the vanco mixed he told me to stop the primary infusion and just infuse the 1 gram vanco(in 250mL) over at least 1 hour. After 1 hour it was not infused all the way because the pump was set at 167mL an hour he said please disconnect from pump and I want the rest ran through gravity and he set drip factor (which was wide open because he said it was not going fast enough) 1st question- was it wrong telling him I wanted to use pump because I did not feel comfortable, it felt safer for me and the patient 2nd- can you give vanco just through a primary line without piggy backing? (because he told me to stop it and just do the vanco) This just made me feel very uncomfortable today and need some advice because I am not around this stuff everyday. I am also looking for another job because I believe I should not be treated this way when I am trying to keep my patient safe and my license. I also documented everything he told me to do step by step, to cover me. Please be kind :)

Pearsonvue trick worked for me!! :) I passed! :):):)

Hey everyone, I just took NCLEX RN this am. I just looked on Pearsonvue and tried to do that trick and reschedule. This is my 2nd time taking NCLEX and last time it let me pay for a new test. This time I got the pop up saying " The candidate has previously passed this exam. A new appointment cannot be rescheduled." It shut me of at 75 questions. Is this a good sign that I passed?? I remember my PN BOARDS I did the trick the pop up was different & I still passed. Is this a new thing? Comments would be greatly appreciated! :)

Hey everyone. I have been a LPN for about a year now... working at a long term care facility currently. I have been a CNA for 2 years and a nurse for 1 year. I take my RN boards again and after I pass them I want to find a new job. I really am not interested in hospital nursing or what I am doing right now.... because it seems these types of places are understaffed and very fast paced and I just want a job I can work decent hours. Right now I work a lot of 3-11 shifts and a lot of weekends and holidays and do not see my husband at all... Any suggestions of what types of jobs I qualify for only have one year experience as a LPN and being a new grad RN?

You did everything you possibly could....the patient was sent the out and the hospital sent them right back.... they seem to do that over and over with LTC patients. They obviously missed something at the hospital. I have experienced this over and over when I send LTC residents to the hospital! With you quotes saying "follow up with MD" heard this order from ER doctors/oncall physcians over and over! Do not blame yourself, you did everything you possibly could. I would have done the same thing in the situation and you followed all the orders you were suppose to with monitoring the wound. Hope this makes you feel better. :)

I work in LTC! you definitely hit all of them on the head! I give all of those drugs you just said! :):)

I have been a LPN for about a year now... I have worked in LTC as a CNA for a total of 2 years and a year as a nurse. Taking RN boards again at the end of September. Hoping I'll pass this time! :) I believe LTC is hard work. When I started working on the floor as a nurse I was overwhelmed... thankfully I worked at the facility before as a CNA so I knew all the residents. Sometimes with all the behaviors, alarms, falls, calling oncall because your attending physcian is n/a on the weekend, pharmacy and lab closed on the weekend, the amount of residents you are assigned to, helping your CNA's, I get no breaks and always on the run! I love geratrics but I feel sometimes I have to pass my medications to one resident and move on to next resident because its always so busy! I feel I need to do more with my degree when I get my RN and learn new experiences- sometimes I feel I lose my skills working as a nurse in LTC because its the same thing every day. It seems I just pass medications to 20+ people a shift, do treatments, orders, and paper charting. The skills I learned in school that I have used the most in my job are putting caths in, nursing care with a wound vac, and Gtube nursing care. I just hope me working in a nursing home for a year is enough experience to get a RN job somewhere. To your comment about going from LTC to psych... in the elderly there are so many behaviors due to dementia. If you look at all of the medications you give. In our facility I see a lot of zoloft, cymbalta, seroquel, ativan, xanax, and haldol. So I believe you have the experience with depression, anxiety, and mood disorders! :):) I also believe nurses at the hospital do not understand how hard LTC nursing is! Caring for 20+ residents is very hard... I know sometimes it not complex nursing problems and complex nursing interventions( like IV, PICC lines, TPN, and different procedures) but its hard managing care for all the residents especially when the whole facility gets sick! I do believe that LTC nursing gives you a different kind of experience with nursing :):)

Thank you! :) I think i about passed it on my first attempt, I just need to not freak out if it doesn't shut off at 75 questions and stay positive! That's what my problem was I think the first time I took it. I will study study study and hope for the best !

Thanks everyone for your comments. I am a new graduate and this was my first hospice patient experience. Basically I have learned there is no high limit with morphine with the dying because some people have different tolerances. Basically keep the patient comfortable as you can, I just was doing research on morphine and "safe dosages" and wasn't seeing a standard order that matched the order we received for this patient. I guess every patient is different and you treat the pain as "real" and listen to your patient and know what signs/symptoms your patient expresses if they can not tell you. Thanks everyone!!

Yes, and the patient isn't getting it every hour. Just like six-seven (20mg) doses in a 24 hour period prn. I was reading blogs about that too about how in a facility we should not have to judge with parameters like 10-20mg prn for pain. I know that hospice was the ones to get this order for the patient and had it signed by the physician. I know the patient was on routine oxycontin and oxycodone when not in the dying phase and taking PO medications. I was just curious because it was my first time working with a hospice patient and made me nervous.

I am a LPN currently and graduated with my Associate RN in December 2010. I took RN boards in April and failed with 265 questions. I got my results and all areas were "close to the passing standard" or "above the passing standard". I didn't get any "below the passing standard." I am taking RN boards again at the end of September for the 2nd time. Any suggestions to make sure I pass on my 2nd attempt? I have been putting off boards because I am scared to take them after I failed. But I decided to schedule them and hope for the best! Any suggestions/tips would be greatly appreciated! :)

Hello, I am a new nurse and I recently graduated with my RN and taking RN boards soon but working as a LPN at a long-term care facility. I got to take care of a patient that is dying and is hospice. We have a morphine order that reads like this in our mar: 10-20mg morphine sulfate sublingual every hour as needed for pain/dyspnea. I was doing some research online and I see a lot of orders every 4 hours not every hour. What are normal morphine orders in dying patients, is this dose to high? Any input would be greatly appreciated. I was just curious! Thank you.