spitfire

We also use a insulin drip protocol, if the pt has a cell saver -vamp- I'll use that. if not I often use the ear lobe for a drop of blood - almost all say it is less painful.

My experience is that the abd skin varies between patients, some pts have very tough skin and it seems you almost have to really push to get the needle in, I feel bad for the pt. but there is nothing that can be done about the density of the skin, usually younger pt are the harder stick and some of the very older folks. spitfire

I am interested in hearing if the hospital or you the nurse were held responsible for this patients outcome. Are we held responsible if our patient has an OK from the docs to smoke and then falls?Or would we not be responsible if the patients does go out without permission if we document that. This is the original question that I was posting.I do not want my licence brought into question because my patient had an injury or worse while they are out of the hospital smoking.

Soon we will be going to all computer generated orders-that will be interesting to see some of the older docs manage a computer- so the docs will all be entering their orders. You know it's bad when the doc can't read his own handwriting! Ask them to clarify the order if you can not read it.

The NM just wanted the patient to stay and be TX or he was going to lose his arm. Personally I don't thing patients should smoke while in the hospital ( I am not going to stop them) but they always seem to let some and then not others.I do not have time to step out with a patient or want to. My concern is at a prior staff meeting this same NM stated that if we were medicating a pt for pain and let them go ouside to smoke and that pt. fell then it was our licence and he was not going to stand behind us......This week, it was ok to send a medicated patient outside. So where did that leave me if the patient did fall or was doing heroin while he was unsupervised?

What is the legal aspect of a pt going out to smoke and falling- or using drugs - this pt had IV access and was not asking staff to go out with him, he is a know IV drug user and is being treated for a raging infection. I feel set up by the nursing manager in that the staffs safety was not considered and if something did happen my licence would be brought in to question.

We had an issue tonight and was interested in how others deal with patients being allowed to go out to smoke cigarettes, usually patients are offered a nicotine patch and are told our hospital is a non- smoking facility,I believe here it is a state law also. Today a patient was permitted(by the nurse manager) to go outside-with a staff member to smoke every 4 hours, he is being treated(antibiotics-I&D-dressing changes) for an infected AC from using needles. Well 4 hours turned into when ever he wanted and then he was outside in someones car smoking, when I went out to ask him to come back into the building he went off on me. Now I realize- after he elaborated on his drug abuse - that he is going through heroin/ oxycontin withdrawl and the issue for now is resolved.Does anyone here permit patients to go out to smoke with a staff member or how do you deal with these issues. There was not a written order for him to go out but I was told the MD said it was ok and to leave his nicotine patch on too.

Please I must defend some of the docs where I work,they often give credit to the nurses, I have had a few experiences where the doc has said to the pt, " thanks to your nurse for alerting me to a problem" or the doc leaving a patients room ( new admit) telling the nurse -its more important that you are in here right now, and leaving until I am finished starting an IV, antibiotics etc. before he does his assessment.Most of our docs are pretty grateful and value nursing observations-judgement, lets face it we are the ones that spend the most time with the patients. Most depend on us.

I also work med-surg 3-11 and often a patient is ready to come to the floor at change of shift- we have a policy that PACU waits until we are done getting/giving report before we accept the patient.No patiet is ever brought to the floor and dropped off until the floor nurse has taken/given report or is ready to except the patient. Same is true for ER admits,they have to wait until we are done taking or giving report before we take a new patient. Unless it is truely an emergency ( trauma coming in to the ER) and then the patient is brought out to the floor sooner.

We are experiencing a decrease in patients this summer, but this happens yearly,we make up for it in the winter. We are offered low census but do not have to take it one weekend we had only 3 patients per nurse(med - surg) they offer staff low census or on call first before per-diems, they do not want to keep calling off per-diems for fear of losing them and like to offer staff a break first. We have earned time / vacation time-we can use to make up our pay,this amounts to about 6 hours a week that can be accumulated and used for vacation-low census- or a cash out at the end of the year. So even if I take low census I am still paid the same, if I am on call I recieve my regular pay plus extra for being on call. If we do have extra staff, some float to other depts- by choice or we spent time restocking, or taking competency tests. During my time off there is always plenty to do,garden,exercise,or nothing at all. spitfire

HI EVERYONE,I NEED ADVICE.I STARTED MY CAREER NURSING IN SEPT.ON A MED-SURG-BUT WE REALLY HAVE EVERYTHING-FLOOR.LAST NIGHT I WORK 3-11,I CAME IN TO 7 PATIENTS AND THEN WAS TOLD-NOT ASKED THAT I WAS TO PICK UP ANOTHER PT.I TOLD THE MANAGER THAT I WAS NOT COMFORTABLE AND DID NOT WANT ANOTHER PT.WELL SHE SAID EVERYONE ELSE HAS 8-9.I SAID WELL MAYBE THEY FEEL COMFORTABLE WITH THAT,BUT I DO NOT.I WAS FORCED TO TAKE THIS PT.LATER THAT NIGHT I HAD A PT.FALL OUT OF BED-(MY FIRST ONE)WHAT ARE MY LEGAL RIGHTS IN REFUSING PT THAT I DO NOT FEEL I CAN TAKE CARE OF?MOST OF THESE PT. ARE VERY SICK AND BED BOUND.PLEASE HELP.spitfire

THANKS EVERYONE,MY PRECEPTOR IS GIVING ME ROOM NOW AND ALSO FEED BACK SINCE I ASKED FOR IT.WE ALSO SAT DOWN WITH ONE OF THE SUPERVISORS AND TALKED ABOUT WHAT IS GOING GOOD-WHAT NEEDED TO BE WORKED ON AND WHEN DID I THINK I COULD GO ON UN-OFFICIALLY BY MYSELF....I TOLD THEM I NEEDED AT LEAST A FEW MORE WEEKS(IT'D ONLY BEEN-3-4)THEY SAID I CAN WHEN I FELT COMFORTABLE.THEY NEEDED TO HEAR THAT I WAS NOT GOING TO LEAVE-AS A FEW HAD ALREADY.SO I DID SPEAK WITH MY PRECEPTOR AND THINGS ARE GOING MUCH BETTER.peace

TAHANK YOU EVERYONE FOR ALL THE ADVICE AND COMMENTS-I LOVE THIS SITE!I DID APPROACH MY PRECEPTOR AND ASKED HER HOW SHE THOUGHT I WAS DOING AND IF SHE HAD ANY RECOMMENDATIONS FOR THIINGS I NEEDED TO FOCUS ON IMPROVING.SHE SAID SHE THOUGHT I WAS DOING WELL AND JUST NEEDED TO FOCUS ON TIME MANAGENENT.AFTER 4 DAYS WITH ALMOST THE SAME PATIENTS I FOUND MYSELF WITH ENOUGH FREE TIME TO ACTUALLY OFFER HELP TO THE OTHER NURSES AND HELP THEM WITH A FEEDING -BATH AND PASSED SOME PAIN MEDICATION.I ALMOST FELT GUILTY BECAUSE I HAD MY PAPER WORK DONE EARLY.I FEEL MY STRESS WAS RELATED TO HAVING POST-OP PATIENTS SOMETIMES 2 COME UP AS SOON AS I CAME ON.THIS MEANS DEALING WITH N/V AND PAIN.MY PRECEPTOR IS GIVING ME ALL THE ROOM I NEED NOW AND IS JUST CHECKING TO MAKE SURE ALL MEDS WERE PASSED AND PAPER WORK IS ALL SIGNED OFF AND ANYTHING ELSE I MISS.SHE ASKS IF I'M OK OR NEED ANY HELP.THINGS HAVE IMPROVED SINCE I HAVE SIGHTLY MORE CONFIDENCE IN THE FLOW.MY EXPERIENCES HAVE BEEN MANY THIS WEEK- A 15 YEAR OLD WITH A DRUG OVERDOSE-A 28 YO WITH A SPONTANIOUS PNEMO(CHEST-TUBES) AND A 91 YO WITH A NEW HIP AND A LAP-CHOLI.SO MUCH IN A WEEK.I AM GLAD I AM HAVING THIS EXPERIENCE.PEACE AND LOVE...SPITFIRE

THANK YOU FOR THE INPUT.TUESDAY I WILL SIT DOWN WITH MY PRECEPT. AND ASK HER HOW DOES SHE FEELS I AM DOING AND FOR ANY SUGGESTIONS.MY HUSBANDS INPUT WAS - YOUR NOT THERE TO WIN A PERSONALITY CONTEST BUT TO GET USED TO THE FLOOR AND NURSING.SOMETIMES I THINK EXPERIENCED NURSES FORGET JUST HOW FRIGHTENING AND OVERWHELMING A NEW NURSE CAN FEEL.SPITFIRE

HI EVERYONE,I AM IN NEED OF SOME INPUT.I HAVE STARTED ON MED-SURG AT A SMALL HOSPITAL,AND MY PRECEPTOR WAS VERY FRIENDLY TO ME THE FIRST FEW DAYS AND NOW OUR RELATIONSHIP IS STRAINED.I HAVE NO IDEA WHY.EVERYTIME I MAKE A MISTAKE I FEEL LIKE A TOTAL IDIOT(I AM OLDER THEN HER).I DO NOT GET ANY FEED BACK FROM HER UNLESS I ASK.I AM FEELING VERY INTIMIDATED.SHOULD I SPEAK WITH HER OR ASK TO HAVE ANOTHER PRECEPTOR??THANKS FOR YOUR HELP,MY EXPERIENCE THERE IS NOT TURNING OUT POSITIVE OR SUPPORTIVE.