MissJoRN

I can't live without my peds scope. I don't like assessing a small child with an adult scope. As the PP said, it can cover the whole chest, also, I don't think you get good contact due to the curvature of the child's chest against a larger flat surface. I do feel I can do a quality assessment on an older child or even an adult with a small stethoscope head. I've actually sold my adult scope. A few of my co-workers have infant copes instead of peds but I think the peds is good all round. By the way ADC is a good deal- cheaper than paying for the Littmann name but same quality, IMO.

Picturing myself wheeling a guy who happens to be sitting on the commode (with his hairy butt sticking out) down the hall to store him in a closet until the fire alarm is over... Seriously, no. Not OK. We've kept pts in the treatment room, day room, etc for a couple hours until a pending DC leaves. That's only acceptable IMO since we are expanding and should only be until the new wing opens. The hospital down the street has kept pts in the dayroom for days, but they set it up relatively nicely.

Unless Mom is on bedrest there's no reason she can't work if she wants to. As I hinted, I worked on my due date (Silently grumbling everytime I heard the lullaby played on the intercom for other babies) and I worked the day before my baby was born the next week- while contracting. I don't even think school have any limitations- I went to school with some women who were "due any day" by the end of the semester. Maternity leave is so bad in the US (6 weeks, I think? I'm perdiem so I'm not sure) that working up until the first contraction is the best way to maximize your time with the new baby.

:rotfl: ... good point

I lost my first post. The summary- Maybe it was just the way my baby was positioned but I needed elastic. In the OR, I either wore a BellaBand over bigger pants or looped an elastic band around my back when I got too big for the BellaBand. (My Bella was actually an ebay knock-off) When I worked on the floor, I wore upsized elastic pants (usually from thrift shops), a white maternity T, and a regular jacket or snap front top. By the time I was a week overdue, I was tugging everyting anyway, didn't matter. Colored scrub pants look odd under white pants, IMO, since even dark ones like navy have a white panel. I looked odd enough without that.

Our meds are seperate but we keep pretty much back-up stock. Not nearly as much as Mat though where most pts get the same meds. Not only is everyone on different meds for a variety of dx, the dose is tailored to weight- so forget grabbing stock antibiotic or even tylenol and just giving it! VS and assessments/ charting q4 hrs is pretty much standard on peds- a shocker for some used to adults where it might be qshift or even BID. Daily weights are common as are daily BPs- not BP with each set of VS. Post op kids, shocky older kids, etc may get more BPs. (remember low BP is a LATE shock sign in young kids) Make sure you have the right cuff when you do do them. Also expect to see quite a few kids on CR (cardio-resp) monitors and pulse ox. Impress your instructor by not taking VS off them (I see that so often!) Expect to see the resp rate pick up burping and bouncing of the infants (and warn their parents to expect high rate false alarms) and expect to be retaping those leads! LOL

Where ever I've done private duty in PA schools they are "Health aides" or "Health room techs" Actually, even RNs cannot be called "School Nurse" unless they are cetified, here. The complete opposite is that I've had teachers refer to me as So-and-so's "aide" Hello? I'm currently suctioning the child and managing a vent... "aide"? Of course, it goes along with some insulting behavior, but that's another thread...

Ugghhh, I don't know why but I got an abusive vibe just from the way he first spoke to you. I'm sure he's hate for his wife to find out that there might be nice men in the world. I think Dayray has a pretty reasonable approach going on. By the way- I had three OB nurses caring for me in the first 2 hours of my LD admission- one was nasty and belittling towards me, one was great, and one made a mess of starting my IV and was so happy when she finally got it that she wrapped tape circumferentially and snuggly around my wrist severl times to keep it in place. (I understand that labor changes hemodynamics a bit but I've always been a good stick and was well hydrated) Of course the CRNA was not called to start my epidural until the IV was running and with contractions setting off an autoimmune response, I just sat there and watched without a protest. Who cares what gender the nurse is? Just give me someone with people and technical skills and the ability to think through a situation. I would have welcomed a good nurse of any gender on PP where I was handed a baggie of tylenol and motrin to take as needed and had 2 peri and fundal checks in 30 hours. (Has that much changed since I did PP nursing??)

Our hospital changed policy- we're not giving it any more at all. If they do want you to give a 15 min push- can they get a few bard pumps for you? Our hospital only had them for peds but I used them a couple times for adults who needed slooow pushes.

thanks, mike. and if anyone else is interested, this is the ama standard. i'm off this week so i don't have an aorn standards handy- i'll look into that when i go back. e-8.087 medical student involvement in patient care (1) patients and the public benefit from the integrated care that is provided by health care teams that include medical students. patients should be informed of the identity and training status of individuals involved in their care and all health care professionals share the responsibility for properly identifying themselves. students and their supervisors should refrain from using terms that may be confusing when describing the training status of students. (2) patients are free to choose from whom they receive treatment. when medical students are involved in the care of patients, health care professionals should relate the benefits of medical student participation to patients and should ensure that they are willing to permit such participation. generally, attending physicians are best suited to fulfill this responsibility. (3) in instances where the patient will be temporarily incapacitated (eg, anesthetized) and where student involvement is anticipated, involvement should be discussed before the procedure is undertaken whenever possible. similarly, in instances where a patient may not have the capacity to make decisions, student involvement should be discussed with the surrogate decision-maker involved in the care of the patient whenever possible. (v, vii) issued june 2001 based on the report "medical student involvement in patient care," adopted december 2000 (j clin ethics. 2001; 12 :111-15).

Don't think that didn't cross my mind, that's part of my reason for saying "assuming". The story is most memorable to me, the other details, not so much. I seem to remember this kid not being a frequent flyer. I'm also pretty sure parents did not stay, which makes MBP less likely. Our hospital also frequently had kids with bad cases of "Saturdayitis" where mom just needs a place to leave the kid so she can party, but actually having an ingested substance show up in bloodwork (I think one of the two was found) doesn't fit their usual pattern either.) Just a wacky situation, but no matter what the true story really is, it surely didn't involve Parent of The Year candidates.

I assume you're looking at St Chris's, too? I've had homecare pts and family at St Chris's, CHOP, and DuPont and I prefer St Chris. I ran into an aquaintance there one day and found out she works there and loves it. I has a community hospital feel- small and friendly. Staff makes pts feel at home, explains care, and gives good care. Even though it's small, they offer a wide range of services. The major downside is the neighborhood- the campus is nice and has a safe feel to it with a nice garage but you do drive through some questionable neighborhoods to get there. Nothing horrific, there are worse areas of Philly, but I wouldn't go wandering around aimlessly, either. The other downside might be that they are a Tenant hospital, if that means anything to you. I don't know much about that company. (actually, I've worked for "non-profit" hospitals that care more about money and less about pts than they seem to) If I lived within commuting distance of Philly (or had a chronic kid of my own), I'd chose Chris's, hands down. Also, I'm not sure where you are but a couple years ago I was considering working at Bristol-Myers Squibb Children's at Robert Wood Johnson. Staff there seemed great and it seemed like they would work well with new nurses. I had limited experience with them, though, and never on the patient side like with homecare. I ended up moving before I could pursue it further.

Unfortunately common courtesy may be as common as commen sense. That's why we need policy committees and I'll be bringing this issue up with ours. Typically, out of common courtesy, we do introduce and ask, but there are times that the educators bring a student after a procedure has started. Marie, does your policy make any distinction between students "belonging" to the hospital (such as a ST program), the surgeon, or outside programs? What about orientees vs students? Same thing or not? Ideally we wouldn't even change shifts without aking a pt aware- in the awake areas of nursing, don't we hurry to tell our pts who we are, we just came on duty, and how long we'll be working today? But it's not practical to tell an OR pt that, so if I'm precepting an orientee for 3-11, do I bring her in the room with me when it's time to relieve or wait until the next case starts?

We would have done it the way you did.

I'm interested to hear how everybody handles all those extra people in the OR. When a pt is in any other hospital dept they meet everybody involved in their care- students, interns, job shadowers, etc. They have the chance to be upfront and say, no- I don't want students, for whatever their reasons. What about in the OR? I know this is part of our general consent, but is that good enough? I introduce pts to everyone in the room when we go in, but how often do student nurses, interns, and orientees show up mid procedure... for instance after another room is done or after a conference? How do you handle pts who may have refused? I'll admit, we have some "VIP" tendencies- staff might pick their own team of people they are comfortable with and we don't give breaks in that room to maintain a co-workers dignity. Sure, it's more significant to some people around people you know but don't our stranger-patients still deserve half that? Anybody have policies? Thanks, Jolien

I invite your doctor to follow the trend and start his own surgi-center or private hospital. And not to hold his breath waiting for the patients to come flocking in. As far as preop paper work, I don't think that needs to be skipped. All the pts can meet seminar style, pick up the packets under their chair, see a power point on risks and benefits, sign consents, and then have a "break-out" session where they will be sorted by anesthesia. I think, if they are already in gowns, we can just give the dr a marker and he can scribble notes on their sleeve ala Ellis Island physicals?

I really like orientation grouped by specialty- yes, you still get bounced around co-workers- some say always do it like this, the next says What! Who told you that? Never do it that way. But at least you see patterns with the types or surgery, etc. Plenty of time to get bounced around the specialties leter. I am NOT a fan at all of putting new nurses on shifts by themselves or with other new staff. I hung out in one job too long as the only nurse/ new nurse and am lucky nothing bad ever happened. Soon after my OR orientation I argued about taking evenings alone with a tech (we all rotated), initially they agreed not to, then they gave me one... then two... then after a few incidents where I could just as easily done the wrong thing as the right thing, I left that OR! I kept the gown cards like Stackeyes. I organized them in a coupon file by specialty with a spot just for equipment and meds. Never kept notes on nurse preferance but probably should have! Towels. I could NOT open packs of sterile towels to save my life. I just remembered that the other day when opening with a new orientee.

I don't have a problem with a dr not being able to read a strip or some other skill he rarely uses. It's OK, that's why we have specialists and hospitalists. I do have a problem with him not being able to admit that to himself an others. "Hey, that looks like sinus to me, what do you think? Well EKGs aren't a big part of my practice so let's run that by the cardiologist on consult before we make any changes."

Ooop, thanks JWK! If I'm going to nit-pick, I need to nit-pick my own post, too! Thanks for pointing that out. One of those things I "know" but wasn't attentive enough. (And you are an AA, correct?) We use LPN anesthesia techs and OJT techs. None are certified. Both can do accuchecks etc since "point of care testing" is within the scope of a nurse's aide, here. Only LPN techs may start IVs. Since we do use OJT techs, the pay scale is brought down. Likewise our LPNs who scrub don't make much more than CST pay, which is pitiful here.

Not to be nit-picky but you would be an "anesthesia tech"- assist the CRNAs and MDAs by setting up equipement, go-for ing, changing circuits, cleaning equipment, doing accu checks, hemocues, provide extra hands during intubation, sometimes start PIVs, etc. An "Anesthesia Assistant" is an advanced provider- the anesthesia equivalent of an PA. Some hospitals do use anesthesia techs, some don't. You may take a paycut from bedside nursing.

Hey, what about the things the patients are saying? I treasure my OB because he suspecialized in endocrinology. A co-worker once questioned why I would go out of network and pay my office pills out of pocket. Just change Drs, see Dr Smith. I said, Dr Jones has seen me for years, he's managing my issues just fine, and when I want a family, Dr Jones is the only one I trust to get me pregnant. Ooops! We just looked at each other and started laughing.

I'm skimming this post and had a few thoughts- I started in a smaller/midsize hospital- it can be stressfull too. There a fewer procedures but being prepared to be on my own meant being prepared to take call independantly and some of the most important cases to get comfy with aren't done too often. I was expected to be ready to take call with a tech for "my" holiday, which happened to be 9 months after starting. Sounds like a long time, but... Everyone says it will take 1 or even 2 years to really feel comfortable. That's full time. I was really into orientation for the first 2 months, then hit a wall. My brain couldn't take any more new info and I was tired of always being ignorant. "dumb". Everyime I figured something out (or almost figured something out) it was on to the next new thing. Sometimes I was actually complimented- that's how my preceptor knew I was in that area too long, LOL A great day was when our OR was short staffed one day. They asked if I would mind "working" instead of "orienting" that day. I was assigned to scrub a podiatry room. Easy peasy stuff but I really felt good after that. I knew something! For one shift I was an OR nurse, not a student. I felt human again. Likewise covering an extra shift on my old unit was good for my spirit. Somewhere in this world you are an expert on something. Remember that! This will come too! The wacky thing is that OR appeals to perfectionists, which makes orientation that much harder on ourselves. We don't forgive our mistakes as newbies, and as we get comfortable we find it hard to forgive others- residents, anesthesiologists, rad techs, co-workers of all levels, and new nurses. Sorry! of course, some of us do mean it more personally than others but that's another thread... :deadhorse

You have ever been taped snuggly to a kids IV because your friend was so eager to secure it before the wailing toddler dislodged it or because he was thrashing so hard she couldn't even see where she was taping. Either way, frget the armboard. You are attached to him now and you're considering just staying that way until he goes home because it would be easier than risking a restart! :)

Just Google and price shop. I couln't believe how expensive they have gotten in the last few years though! Ebay sometimes has overstock deals or gently used peds scopes. I ended up buying an ADC Adscope that is the same quality for much less money. With a little coaxing the Littman eartips fit since I only like those! Or, you can add an ADC head to Littmann tubing and earpieces, if you were going to get rid of the adult scope anyway, I know someone who did that. I got me ADC through Amazon for the best price I saw, you may want to check Littmann prices for their affiliates, too. My personal opinion is that you can do a much better assessment on an adult or big kid with a pedi steth than you can do on an infant or toddler (or even cachexic adult) with an adult steth. Plus, it hurts less when you bend to pick something off the floor and it hits you in the teeth :)

hmmm... I'm pretty sure they are latex free but wouldn't assume that with out the OK from the manufacturer. They should have a rep on call, but I wouldn't know how to reach him- your purchaser should. I don't think we were ever prepared on peds to deal with a latex allergy properly but in the OR we keep binders with all of our latex free items listed, latex containing items listed, and contact info from suppliers, we have been able to reach them on weekends. I know this doesn't help now but make sure you have that contact info in the future!