NancyJo

All of the above + where I'm at we can't hang TPN, access central lines, or obtain consents for surgery/blood. We also can't program PCA's but can be the verifying nurse to check with the RN.

Occasionally sputum gets to me, but that's usually when i'm already not feeling well. What really bothers me is when I see my usually edentulous pt.'s who soak their toast in coffee. Just thinking about them holding that extremely soggy piece of bread up that flops over and then they eat it, makes me want to gag. Can't handly soggy:eek:

Isolation precautions do vary from one facitlity to another. At my hopital all who are placed in Neutropenic Isolation are placed in a private room, door must remain closed and all who enter must wear gloves and a mask.

When I worked LTC our med drawers were filled twice a week. Most of the time they were stuffed full and you spent most of your time digging through the drawers. It was difficult to just pull them forward as they were so full. What i did was I would place my med cup in each pt.'s drawer and would place each pill I needed in the cup leaving them in their package/wrapper. That way in the am everything was organized and I could pull out my cup and still match my meds up to the MAR wrappers still intact without digging forever. Shaved a little time off for me. Never pre-pour or open ahead of time. We once had a nurse who would open everything and actually sign all her MAR's before her med pass, naturally she was done in lightening speed. One night got injured halfway through shift and had to go to ER. The superviser who took over for her was not amused.

Years ago I worked nights on a LTC unit. No one ever used their call lights there. We always seemed to know when we would have a death, because the nursecall system would go haywire. It would start bleeping, not even a real ring, like half bleeps. No where would it light up to a room. Just the sound. (The call system was checked several times and we were always told it was fine.)We would immediately make a round and sure enough someone would be gone. Most of our vets were DNR's, rarely had a code. It almost seemed liked someone just wanted let us that know someone had passed. It was so common it wasn't creepy after awhile. Also on a couple of occasions a coworker and myself while sitting outside on a break saw a dark figure moving across the parking lot, almost like he was floating. On both occasions he got about halfway across the lot and then would vanish. We used to hear all kinds of stories of ghosts/strange occurences from some of the staff that had been there forever. After I left there I went to work in a rehab unit that was located in what used to be an old Catholic Hospital. We were basically the only unit there other than a couple of outpt. clinics downstairs. Would often hear crying, laughing footsteps etc in the stairwells, even on holidays when we were the only ones there. There was never anyone in those stairwells. Was often told it was an old nun who roamed the halls for many years before passing on our unit many years ago. I can't believe I've forgotten her name.

No I don't. I also give a little inservice as Triage posted earlier on getting them ready for home. I also make sure to document the pt. education and that I will continue to encourage pt. to independently complete tasks/ADL's that they are able to do.

A couple of months before I graduated from high school my parents asked just what I planned on doing? I had it all figured out, I was going to take a year off and just relax and continue to work at Burger King and then I would go to school and become a teacher. I also thought I would probably get married as my husband and I were engaged. They then said they thought I should become a nurse. Just give it a try and if it wasn't for me, then pursue something else. I thought no way, since I had the weakest stomach in the history of the world, but I was a gutless wonder back then and would never have questioned their wisdom. Thinking back they must of had put some thought into this before they sat me down because they had a very impressive presentation. They listed alot of perks and pro's, some of which I have given up waiting on. Anyway I became an LPN and got married the same week I took boards. I guess they knew me better than I knew myself, been doing it for 19 years now. When I get really stressed I think I've got to do something else, but then can't seem to think of anything else that I want to do. I guess I'm destined to be a nurse. p.s. I love kids, but at this point in my life the thought of being stuck in a classroom with a bunch of kids 5 days a weeks sends chills down my spine. I guess mom and dad knew best.

:chuckle:chuckle:chuckle Read this one to my husband, who said that must be a joke. People not in nursing haven't got a clue. Says he couldn't imagine someone actually doing this. Told him this is just another day in the life of a nurse. Has a whole new respect for all of us now. Had a 32y.o man a while back who walked the halls, went down to smoke and who called to say he needed his butt wiped. Said mama did it at home, we told him he needed to do what he could for himself, but sure enough when mama came in she bathed, wiped him and waited on him hand and foot. Was on the call light constantly until she got there to remind us what we were getting paid for. In the room next to his had a 20y.o who came in for a asthma, was doing much better no signs of resp distress and was awaiting discharge that afternoon. Called wanted a bed bath and fed his breakfast. Now this kid was up moving around too, reminded that he was going home and told him he would be need to be doing these himself when he gets home. Wrong! mama came in bathed and asctually fed this young man his breakfast. Good grief:eek:

13 years on tile floors, 6 years on carpeted. Knees are terrible. I too know that I would be better off if I could lose a few lbs. My hubby works on concrete floors in a warehouse and at 38 was diagnosed athritis bilat knees. Right is worse and Doc had him fitted for a brace which helped some. Started taking glucosamine with chondroitin and says it has helped alot. I know I'm buying a lot less naproxin now days.

I work in an acute care setting and have worked in LTC setting in the past. Have seen both sides. When we discharge to a LTC here, we have a discharge form that we fill out. It lists the dx, physician orders for meds, activity, diet, nebs, o2, foley(reason), allergies. Most of the orders still have to be called and verified by the LTC with a physician since they seldom sign them ahead of time for us. We are required to call a verbal report to the nurse at the recieving facility. We also have to copy all labs, imaging reports, procedure reports, consultations, h&p's and that days MAR to send back with pt. We send the original copy and keep the carbons, and usually fax the orders ahead of time so that they may have time to get ahead on getting meds ordered from the pharmacy. Had a problem awhile back with LTC facilities c/o not getting report, dressings not changed etc. So we now have a discharge checklist(yes more paperwork) that we go over. It list things like calls made to notify family or poa of transfer, iv dc'd, foley emptied, report called orders faxed, pt.'s cleaned prior to discharge, dressings changed, dated, timed and initialed, etc. It only takes a few minutes to complete and it has really helped. Our problems seemed to be narrowed down to a select few who weren't doing what they were suppose to. My bigest c/o so far though has been that when we get direct admits from the LTC facilites we don't get a report, so I see where your coming from. It's very difficult to assess a demented, nonverbal, total care pt. who is a poor historian. I can usually find some info in old records, but it's nice to know things like level of activity, ambulation?, ability to feed self, inc/inv., able to swallow pills and we don't always have family to talk with. Can be very frustrating. I usually call the LTC facilty and speak with a nurse, who is usually not happy with me, as she is busy and doesn't have any more time to be on the phone then I do. On the flipside I admitted a pt. whom I had sent to the nursing home 6 weeks prior with orders to change central line dressing q week. While doing my assessment found her to still have the dressing I had applied when I discharged her 6 weeks ago.

LPN's where I work do all but IV pushes, hang blood and TPN. We do enter initial plans of care but the RN covering us has to go in behind us and enter that they concur. We also do admission assessments, all our own charting, dressings, and yes we do give baths, feed, change bed linens etc. We start our own IV's. We call our Dr.'s to get our own telephone orders. I forgot we can hang piggybacks on an existing central line, but cannot on lines without fluids already running.

Grannynurse, I work in Illinois. We have to have the script for the insulin and syringes also.

Nursing initiates diabetic teaching for new diabetics while inpatients here. What it usually amounts to here though is having the pt. return demo accuchecks, drawing up insulin and administering the insulin. Often done in a day or two, not really enough time to give adequate training. We do not have a specific education plan for diabetics, I wish we did. I would like to see a flowsheet or a checklist to keep track of what has been covered, since often our assignments may change and sometimes I will get a pt. for the first time on the day of discharge. Most do chart, but face it some are better at documeting then others and sometimes it's difficult to know just how comfortable the pt. is with the info provided. We have an excellent dietician whom I always have come to see my diabetics and she does a short class with them. She also brings a packet catered to their diet plan, sample menu, portion sizes, etc which is written in very simple terms and the diet is simple to follow. We have educational videos that I offer, but very often pt.'s decline, so usually we talk. We also have access to micromedex which has a section for discharge information for aftercare. It is written in layman terms which I print for pt.'s to read prior to discharge so that I can answer any questions they may have. I also print up the info on their particular insulin or oral hypoglycemics. I work with an RN who is a diabetic educator, and I try to get her in to answer any questions they may have, that of course depends on how busy she is, but she always makes an attempt. I try to do as much as I can before they leave, because it's difficult to get people to do any f/u after discharge. Not sure how many if any insurances cover as outpatient diabetic teaching. I went through diabetic teaching when I was a gestational diabetic years ago and it was all covered, but when a few years later I was diagnosed DM I had my doc send me to the dietician for a refresher course and this insurance(a different one than before) didn't cover it at all and it all came out of my pocket, so I think that is why so many don't follow through. We also have to have a prescription here for insulin.

I was scared to death. I didn't even want to be a nurse, wanted to be a teacher, but my mom and dad talked me in to it my sr. year in high school. I was a gutless wonder then. Never thought I would make it through, but they knew me better than I knew myself. It's been 19 years now and I can't imagine doing anything else. The nervousness goes away. I had one of the weakest stomachs ever as a kid, but that to went away pretty quick. Can handle about anything now. Hang in there.:)

1. The nurse doesn't know what she's doing when she doesn't get the iv first time on my morbidly obese, dehydrated 97y.o. great-grandmother.(happened today) 2. The only reason anyone becomes a nurse is to land a Doctor 3. The nurse has a secret magic communication device to summon my Dr. immediately. Because there is no way my Dr. would ignore numerous pages. 4. The nurses spend too much time "playing" on the computers.(never mind I'm already an hour overtime and doing my documenting because I just spent the last 8 hours busting my butt to keep everyone happy) 5. It's the nurses fault when case management and your insurance company decide you no longer meet criteria for hospitilization and need to be discharged. 6. There's really no need to close the door or pull the curtain while I'm on the bsc facing into the hall. I'm claustrophobic. and my all time favorite 7. How dare you ask me and my 19y.o. girlfriend to quit making out in my hospital bed because the poor little 88y.o man in bed 2 is getting a little embarrassed.

As many have said there are good and bad no matter what initials follow their names. The first thing my charge nurse told me when I started many years ago, listen to your cna's, they can teach you more than you can imagine and she was right. They are you extra eyes and ears. That was 19 years ago and I couldn't agree more. I find myself telling our new grads when we are training the same thing. I love our Cna's and they know it. They know they are appreciated and put an extra foot forward when they work those of us who don't treat them like pack mules. They do get their breaks and lunch, but I don't fault them, understand much of their duties aren't as time-sensitive as meds, treatments, doc orders etc., however if they notice that I have been swamped, they try to do what they can to get me a break. Have even got me a snack or juice because they know I'm diabetic and worry. Right now we have about 5 nurses who feel they are above what they feel is "cna work". They are working them to death. I fear we may start losing them and have voiced concerns. With staffing being what it is today I shudder to think what it would be like without them.

We have a high census right now- had 5 to start and then 6 with a new admit at midnight. 5 is almost ok if you don't have back to back piggy backs. 19 Pt 3 rn's a 1 cna Thank god for the cna she moves them, gets VS and I&O's. Still be at work getting all that stuff. What part of IL? Danville. East central Illinois, about 85 miles west of Indianapolis.

Hello from Danville!:)

Med-Surg/Illinois Dayshift-I average 7-8 pts.'s/day. On a good day 6 and on very rare occasions(low census, which we haven't had in months) 5. We have 2-3 Cna's to cover 38 pt.'s.

All of the above are very important to me. We still have taped report and often I get "no change" , I have to remind a select few that we may have never had this pt. or may not have been here the day before. I also want to know if anything pertinent happened on the shift prior to the ones reporting. The other day came in to find a pt. I had had the day before with a laceration on his head and multiple bruises, with no mention how they had occured. His roomate told me he had falled on the pm shift. Actually got a better report from the roomie than my coworker.

:yeahthat: Amen!! So true, so true. I like #1. I have an eleven year old who screams "that's not fair" about every other sentence. I told him today that phrase has officially became a bad word in our house. His response "that's not fair!" He got pretty bored with no tv this evening. I'm not real popular around here tonight.:chuckle

We have access to intranet, and departmental email. Also have micromedex that I use alot for pt. eduacation and to look up drug info. Definately comes in handy.

I have been in med-surg for 4 years now and do like it for the most part. As many have said the down side is inadequate staffing for the amount of work we are expected to do. I did my first 12 years in LTC and loved that too, enjoyed that too, but decided to leave when my back started bothering me and I was only 32-too many years to go. Then did 3 years in acute rehab but the unit closed so a friend talked me in to giving med-surg a try. I never had any desire to work in an acute setting and was scared to death, never thought I could do it. It was like starting all over, but it came to me quickly and I really enjoy it now.:rotfl:

Cruel, sad and true. I've seen this happen to many times before also.