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CampNurse1

CampNurse1

Med-Surg, Ortho, Camp
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CampNurse1 has 7 years experience and specializes in Med-Surg, Ortho, Camp.

CampNurse1's Latest Activity

  1. CampNurse1

    Oxygen at Camp

    It made sense to the pediatrician who ordered breathing treatments with O2 for his asthmatics.
  2. CampNurse1

    Camp Nurse Salary

    I worked year round for a special needs camp in AL. I got $600 a week all year, a three bedroom house, utilities, PTO, health insurance, IRA, etc. I thought it was more than fair, easy during the winter and off season, work hard during the summer. I made sure our nurses had as much time off as possible, and only one night of call a week. At $600/wk, I figured they were making plenty of sacrifices to be there, so I did my best to take care of them. I never turned my radio off. So, not much money, but a great place to work. Also, many people in the local town adopted me and my wife, and showed us hospitality whenever we were in town. So, a good deal. For those of you who know me, my wife is healthy again, so I will be camping again soon. I am a project director in a big house in Atlanta now, and every AM I look at the guy in the shirt and tie in the mirror and think, "What happened to you?"
  3. CampNurse1

    2014 camp work thread

    Congrats, Kaufer01! Full time jobs for camp nurses are as rare as hens teeth. Session one will be here before you know it.
  4. CampNurse1

    trips

    As always, Big Al, you add much to the conversation. You are one of the gurus here.
  5. CampNurse1

    trips

    Check your state's Nurse Practice Act on repackaging. Surprisingly, Alabama has a part of its Nurse Practice Act that addresses camp nursing. In our case, it specifically prohibits repackaging of any kind. We have to administer directly from a pharmacy container. Blister packs or roll (pillow) packs are best. Other states have rules for nursing homes and the like, but not for camping. Other states do not mention repackaging at all. Some camps use Camp Rx or some other pharmacy to take care of this issue, which is probably best. I am uncomfortable preparing any medication for a lay person to give. I would rather stay out of it. I understand that if a camp has been doing this for many years, it is tough for the nurse to rock the boat. This is a good conversation to have during the hiring process. It is a big gray area. I never did like the idea of lay people giving meds at camp. A one or two day course in medication administration in no way provides the training needed to safely give meds. They may learn the 7 "rights," but can never learn pharmacology, adverse reactions, non-administration principles, etc. We nurses know it takes a big skill set to safely administer medications. I do understand if only nurses were allowed to give meds most group homes and half the camps would have to close. I am not pretending to know what the rights and wrongs of this issue are. I am just saying be careful, and practice in a manner you can defend. Repackaging for lay people to administer is tempting. It is convenient, and should work about 999 times out of 1000. If anything goes wrong, it could get ugly in a hurry. Temporary or contract employees, such as nurses, will go under the bus before full time employees do. Of course, nurses make medication errors all the time. I did a metastudy on error rates when I first took this job because we are special needs here and 85% of our campers are on meds, many of them polypharmacy cases. Depending on the study one looks at, the error rate is anywhere from 2% to 22%! These errors were made by trained professionals, not lay people. You get the point. I remember the jaws dropping in the meeting room when I presented this data. This is one of the advantages of being a year round nurse. I have time during the winter to do wacky things like data gathering. No system is perfect. I had a sharp nurse find an error in a blister pack last summer. She noticed the number of pills in the pack did not jibe with the number on the MAR. Be careful, and fall back on your training. Nursing school was torture for a reason. I guess I'd better write an article on medication principles and practices at camp. Darn! Another chore!
  6. CampNurse1

    Good camp nurse nicknames?

    Better than Nurse Worse Nutmeege!
  7. CampNurse1

    Good camp nurse nicknames?

    I was hoping for "Magnificent Fighting Stud." The nickname the staff gave me was "Papa Joe." We don't get to choose them, lol.
  8. CampNurse1

    Prayer Before Surgery

    When I scrubbed, there was one surgeon who looked around the room (after client was asleep) and would say, "Everybody happy?" He would not make first cut until everyone said yes. He would then say, "Dear Lord, guide our hands." He would then begin. I always thought this was just right.
  9. CampNurse1

    Camp Nursing: 10 Camp Lessons

    Hey, Al, I'm sorry I missed your article until today! It is excellent. Your point about getting along and making friends is universal. I remember my first summer at camp. At that particular camp, I passed meds at meals and would not finish until about 20-25 minutes after the meal began. Every day for three weeks I found myself eating scraps, alone. Being 20 years older than anyone else and having a completely different job left me pretty isolated. I was not a happy camp nurse. Then one day the dietary director hollered out from the kitchen, "Hey, Nurse, back of the house!" This is restaurant-speak for come in the kitchen. The next thing I know I was eating great food, and, more importantly, had some great company. They took care of me the rest of the summer, and made my experience positive. You have brought into focus something many camp nurses know: Except for emergencies, the importance of the social and psychological parts of the camp nursing experience is universal at all camps. It may well be the most important part of being a good camp nurse. I have never been able to describe this aspect as well as you did here. I will be quoting you when I am interviewing nurses in a couple of months, lol. I wish you the best, and if you ever want to spend a summer in the south, I hope you will contact me.
  10. CampNurse1

    tylenol?

    At our place they can only bring meds in original containers. Our parents and caregivers get a medication instruction sheet that says this. It also says our nurses must follow the prescription label, e.g., "Administer at HS." Mom will sometimes say at check-in, "But I want you to give it at noon." No can do. The label says HS, and that's a doctor's order. I then offer them the option of taking the med home or getting the doctor to call or fax the change in the next 24 hours, or they have to come pick up their camper. This has caused much angst at the check-in table! In a pinch I can call the doctor (I don't tell mom that), but since they are non-compliant with our policy, I put the burden on them. This is a good example of deciding what battles to fight. My camp director is adamant about this policy! Now, I am good with administering many medications at a different time than ordered. My boss wants all doctors orders followed to the letter, which, really, is good practice. We had a couple of conversations about it. My pitch was that nurses need discretion within our scope of practice, that's why we call it practice. My CD sees it only in black and white. At the time I thought he was dangerously close to practicing nursing, which is a show-stopper for me. I decided I could live with it, since his stance is entirely defensible, my stance less so, at least from the liability point of view. This policy is etched in stone at our camp. Informal medication policy is a huge red flag. Each state has rules for non-nurse administration. These rules all involve state-approved training. So, "a retired couple from FL," or the CD or other staff have no place in medication administration. At best it is poor practice, at worst a criminal act. It amazes me how many camps do not seem to be aware of this. It is tantalizing for CDs to have informal or no policy. Nurses are expensive, if available at all. A seat-of-the-pants policy will serve for 10 or 20 years with no issues. When that rare adverse event occurs, the camp will find itself in a pretty indefensible position. Unlabeled meds in a zip lock bag? A minor making a health care decision? You googled it, it probably is Tylenol. Call the camp doctor, get an order, and administer from a properly labeled stock drug. With a formal policy, mom would have been told at check-in to take the zip lock home. To the original poster: Camp nursing is a specialty unlike any other, and I think you did the best you could. When in doubt at camp, fall back on your training. Medication policy that works in nursing school or the hospital will serve you well at camp. Right drug, right time, right dose, right route, right client, right documentation, right reason.
  11. CampNurse1

    Fired from 1st Camp job

    I've waited a few days to post, hoping to find a clear way to write about a very complicated issue. KA-THUMP! That is the sound of the nurse being thrown under the bus when things go wrong! We nurses are just hired hands, while Camp Directors, full-time employees, and Boards of Directors have a deeper investment. They are not going to let any incident threaten their jobs or their camp. Human nature being what it is, it will be the nurse, now long gone, who ends up "taking one for the team." It is complicated and simple at the same time. The complicated part is to know how to pick your battles, what to let slide. The simple part is falling back on our training, and practicing in a proper, defensible manner. I have run into CDs that loved to practice nursing, dictating medications and treatment, and wanting me to practice based on their untrained assessment. One I was able to gently educate, the other I ended up giving notice and leaving at the end of a session. I should have notified the state board about that guy. In my article "How to Choose a Camp" this area is a critical part of the interview process. "Who is the boss in the infirmary?" The only good answer to that is, "The nurses are." Anything else is a huge red flag. It is not a bad thing to read the particular state's nurse practice act. My state, much to my surprise, even had a section on camp nursing. Repackaging, always risky, is not illegal in most places. It is here. This section of our nurse practice act has been "bullets in my gun" when changing traditional, set in stone practices that no one here knew were illegal. But it took some doing! I think it is best to not fight any battle that does not have to do with nursing practice. I am often asked, sometimes at the last minute, to change the location of a med pass to help with keeping this or that programming smooth. Sure, I'll show up with my nurses in a pirate hat and tutu (don't ask) if that is what is needed. But, even in a pirate hat, I expect my nurses to pass properly, safely, and to follow the 7 rights of med administration. Then I can sit in a witness stand and defend myself if something goes south. Non-nurses giving medications while nurses are around give me a cold chill. Some people, going on a stereotype, think they know how to nurse without the bother of nursing school. Nursing without a license in any state is a criminal act; these people neither know nor care. I do not have to tell you brother and sister nurses that giving even a Tylenol or Benadryl without doing an appropriate assessment is a recipe for disaster. Lay people at camp do this all the time. When a non-nurse (forbidden at my camp) gives a med or provides other nursing care, I would document that they, not you, did it. Let them defend their practice. I would certainly not sign off on a med someone else gave, not ever. This kind of practice is tempting to lay people because, let's face it, they nearly always get away with it. They've been giving Benadryl for years and nothing bad happened. "He has a fever, I'll give him Tylenol." Did they check for allergies? How high is the supposed fever? What is the client's fluid status? Did they check the dose? Does the client have a Mic-Key they can't see? Did they check the last time the client was medicated? Did they document what they did? If anything does go wrong, the CD will say there was a nurse present. Repackaging, one nurse pulling meds and another administering (maybe not even knowing what he is giving), not using proper identifiers, etc., is all pretty risky. Would you accept a syringe that another nurse tells you is 10 units of insulin? Would you administer it? Would you accept a lay person's assessment? Bad news in the hospital, bad news at camp. What makes it tough for the camp nurse is that you may find yourself in a bad situation that has been going on for many years. It is mighty tough to fight city hall when you are a 6 week employee. Voice your concerns respectfully, and if that does not work, you must pack your bags and go. Why risk your license, your ethics, and your well-being for a summer job? I think the CD that fired the nurse did her a tremendous favor. I also think there may be more to the story. As for the camp counselor that did not bring a camper because it was only an allergy medicine, I would say nothing to the counselor. Obviously, this is not his decision to make. I would talk to the head counselor about it. Always be best friends with the head counselors! I bake for them during the summer. I am fortunate in that I am in residence at camp year 'round, so I am better able to craft the nursing culture than a temp hire. I advise summer nurses to find out during the interview about nursing practice. Ask specific questions. In short, be flexible on non-nursing matters, draw a line in the sand when it comes to how you practice. I work for a big charity, and yes, people even sue charities. KA-THUMP!
  12. CampNurse1

    Break the Silence: Report Bullying

    While her heart is in the right place, I think the original poster is living in dreamland. The "Bullying Task Force?" Zero tolerance? Never. My wife was an overhouse supervisor for years. She tells me about 2-4 hours of every shift was spent trying to find enough warm bodies to staff the next shift. So, hospitals are not going to fire any bullies, as long as they have the two things you need to be a successful nurse: a license and a pulse. Our mid-sized hospital in a mid-sized city had all the right CEUs and in-services on horizontal violence, it happened all the time, and I never saw anything done about it. One night I (male) was pushed through a doorway by a female nurse. We all know what would happen to a male nurse if he ever put his hands on a female: instant termination and maybe jail. I have seen too many bad things happen over the years after a write up, so I am very hesitant do do so. However, this nurse had been terrorizing the nurses on my shift for years, so I thought I would "take one for the team," write it up, and make a big deal out of it. I figured we could get rid of her this way. I got a phone call the next day from the DON, asking me to trust her on it. Luckily for me, the security camera caught the whole thing on tape. Two days later, I found myself giving report to this same nurse who said at the end of report, "If you ever rat on me again, you will regret it." I let it go. Let's be for real. If a male nurse shows any hint of aggression, verbal or otherwise, he is out the door. I left bedside nursing soon afterwards, for that and other reasons. Horizontal violence was a daily occurrence, and I got tired of dealing with it. Looking back on it, after the second incident, I should have charged that nurse with battery and sued the hospital for not protecting me. I should have gotten the state nursing board involved, as well as the media. I'd be smoking a cigar in my underwear in Tahiti right now if I had. As it is now, I am the DON in another field. The best way to deal with horizontal violence is to become the boss. I orient my nurses at hire to my absolute zero tolerance policy. No counseling, just termination. I've only had to do that once, about two years ago. I was sitting out of sight, doing some paperwork when I heard a nurse verbally beating up another. A little later, I stopped her in the hall, told her what I had heard, thanked her for her service, and told her I no longer had any meaningful work for her. I then watched her gather her belongings and escorted her to her car. Thank God for living in a "right to work" state. The other nurses pretty much said, "Good riddance," and took up the slack.
  13. CampNurse1

    Camp Nursing: Choosing a Camp

    You sound very wise, SnowShoe, and a good nurse. I was mostly speaking from my own experience; I have made my share of mistakes over the years. I do my best to only make them once, lol. Thanks for the compliment. This board is a great place for us to share our experiences and become better nurses.
  14. CampNurse1

    Camp Nursing: Choosing a Camp

    SnowShoeRN, I am glad you are enjoying your summer. Camp nursing is pretty amazing, to say the least. Come and work for me next year, lol. I want to respectfully bring up an important point. I go to great lengths during orientation and during the summer to keep my nurses from getting outside their scope of practice. As nurses, we are getting onto dangerous ground when we diagnose and treat. Diagnosing is fine until the nurse is wrong; we've all been there. If you are wrong, no one will hesitate to throw you under the bus. Not the camp, not the staff, not the parents, not the patient. If a nursing diagnosis or standing orders won't serve, I at least consult our medical director. Stick to reporting signs and syms. As we used to say in the army, "Stay in your lane." Lay people tend to think we nurses are "mini doctors." That's why they come into the health center and say things like, "I need an antibiotic!" I spend time every off-season gently educating our staff about the difference between medicine and nursing. And while I am at it, don't give in to the wacky treatment suggestions the staff or Camp Director might give you. I remember setting up an Albuterol breathing treatment from an O2 tank, per standing order, on a wheezing camper with a sat of 97%. The counselor kept insisting I give the camper his rescue inhaler. I'm thinking I'll have this set up in about 30 seconds, and I did. The counselor, during the breathing treatment, pulled out his cell phone, called the camper's mother (his cousin), and shouted into the phone, "The nurse ain't doing right!" I took the phone, and listened to the mother screaming at me until I managed to explain what I was doing. The camper stabilized quickly and left. The scene between the counselor, the Camp Director, and me was not pretty.
  15. CampNurse1

    How's the Summer going?

    When do you guys find time to write, lol? Busy here. I guess the worst thing was bringing in a Lifeflight for a malfunctioning shunt with ICP problems (had surgery the next day). It took me a couple of years, but the camp culture here is now a strong wellness culture. This means that accidents and illness are getting rare, down to one or two per day. My day, as Head Nurse, is full, with administrative work, calling parents (a must!), getting ready for the next session, meetings, arranging care outside of camp, wrangling my nurses, etc. I am strongly aware, from my experience at other camps, how exhausting this job can be. I craft my nurses' days accordingly. Each has a four hour health center shift, and it takes them about four more hours to do their other duties, mostly pulling and passing meds, or doing treatments. That's it. I find myself shooing off-duty nurses out of the infirmary. "Go shooting! Go swimming! Go ride a horse! Go read a trashy novel!" My summer staff is full of passion and heart, and I am proud of them. Passion and heart run out when you are worn out. I do my best to take care of my nurses. Luckily, no nurse drama this year. The adventures listed in your posts remind me of why I chose camp nursing as a full time career. I got tired of working with volunteer and temporary staff, having to re-invent the wheel every summer. About the time I really got good at it, it was time to leave! I am blessed to work with a team of professional staff year round. We plan, and plan, then plan some more. All in all, a great summer. I am looking forward to some down time, like the rest of you. All my best!
  16. CampNurse1

    Camp Nursing: Choosing a Camp

    I wish you the very best of luck. You might get hooked! Let us know how your adventure turns out.