Melina

This case didn't even involve a central line or drawing blood for lab tests, and no medical professionals were found to be culpable.

If you want to try out a Prophecy test, Mightynurse.com offers access to a free exam. You can take any of the competencies. Melina

This is already being implemented as part of the APRN Consensus model. The move is to a population-focus instead of setting-focus. For instance, the acute/critical care CNS program I am in is now an adult-gero CNS program, and we are expected to manage that population from wellness to critical care.

I love this thread! The LTACH where I work has a lot of the issues you all speak of. I am planning on taking on this issue for my master's comps. I was inspired by the reports by the ACCN (Relevant Research) about reducing medical errors by speaking up when another professional is acting inappropriately or dangerously.

I was wondering the same thing on my last shift! It wasn't covered in our policy, so I looked it up. Depending on the manufacturer, some end caps do not require clamping to function. Clamping between uses is recommended, though, because the end caps could loosen, making patients vulnerable to air embolism,etc. http://www.carefusion.com/pdf/Infusion/clinical_documentation/white_papers/Clamping_WP_MX2923.pdf

Have you tried Cymed? They have a novel, appliance that adheres to the skin with a tegaderm-type material. Because it is so thin, stool cant easily leak underneath. You can see them at http://www.cymedostomy.com/what.html. The company is very generous with samples. The ulcer can be protected with Arglaes powder. Brush off excess with dry gauze before attaching appliance.

I found this: ECMOjo Simulator and Trainer - Home by searching "ECMO simulator." Not sure if it is the one you are looking for, but it's kinda cool.

There are many anti-chafing lotions on the market. I've never tried the lanacane brand, but a lot of althetes use Bodyglide. There is also a product called Luvees (http://www.luvees.com) that might be worth trying. Good luck.

A calf BP can be significantly higher due to calcification of the lower extremity arteries. We see this all the time when taking ABIs for wound assessment. I would be hesitant to to use this to take a patient off pressors. I'm interested as well to hear why there was no a-line.

I'm currently enrolled in University of Cincinnati's online CNS program, but I am transferring to CU Denver this Fall. Nice to connect with you all.

Have you tried switching brands? Cymed makes an excellent product that uses a transparent film instead of a hydrocolloid wafer. I've used it with great success on several occasions.

I have worked intake, and I can tell you that we would often not get d/c notices until after 5pm the evening of discharge, especially on the weekend. There would be know way to let you know by Friday. As for whether you get paid for cancelled shifts, that would depend on your contract with the agency.

As long as the infection is being treated a wound vac is appropriate. Silver foam seems more reasonable than sterile technique. You can always call and ask the doc for his or her rationale. Melina

No caseload? How many nurses will see a single pt? I've never heard of this either. Is there any issue with continuity of care? Mel

I chart vitals and make notes of anything exceptional with a pen (a fine tipped TUL gel pen, in fact) in the pt's home then bubble everything after the visit, usually in my car before I leave for the next pt. That's where I write a visit note as well. It was tedious at first, and it's really tedious now that computer charting is on the horizon, but I wouldn't call it doing everything twice.

Our agency uses them. We are currently transitioning to their electronic version, but right now it's "bubble, bubble!!" Raven

My agency researched what an "appropriate" patient load should be for a full time HH nurse. They came up with 5-6 visits a day, with SOC counting as two and other oasis visits as 1.5 I don't have the sources they used by if you PM me I'll get the info to you next week. I have had days where I have seen as many as 10 in a day, but not every day. The important fact is that YOU feel overwhelmed, and for your sake and the sake of your patients, you need to back off. Mel

Can she wear some sort of girdle that extends down the thigh a way? Something snug enough to hold a dressing in place without tape. Mel

I wouldn't call it relaxed, but I definitely feel like I am giving better care than I was ever able to in the hospital. I have 15-20 pts, but for the hour or three I spend with each every week, I can totally focus. You have to be pretty autonomous, and comfortable working with doctors, therapists and especially family. I really feel it's much more patient goal-oriented and less task-focused in the field, so if you are someone that prefers the structure of specific tasks to complete, you may want to look elsewhere.

We get $45 a visit; $75 to admit. Meetings, case conferences, CE classes, and other non-billable hours are paid hourly @ $36. We don't get mileage, tho, so I definitely keep track for tax purposes. HR says they are not the highest paying in the Denver area, but we are competitive.

Oops, sorry. You did mention the vac. Is it only because they are shallow that you are ruling it out? There are dressings for shallow wounds available.

Have you ever considered a wound vac? I didn't see it in your list. You can even instill lidocaine into the dressing prior to removal to ease the pain of dressing changes. Mel

What's the opposite of nursing?

I think you nailed it when you said staff doesn't understand your role. How can you change that? What can you do to show staff that QI is about improving quality for everyone, patients and staff, and fixing system errors, not about blaming and punishing individuals?

Do you have social workers at your agency you can bring in? What about Protective Services? If you suspect abuse, not only physical but financial or emotional (and stealing pain meds is abusive) you need to do something. APS doesn't always do much, but if something does happen with your pt, and you and your LPN have had suspicions but didn't take any action, what then? A social worker could also help set your pt up with money to get to the doctor.