JessicRN

lets see honey to vulvectomy pt's wounds glass needle syringes and metal needle that were resterilized glass iv bottles moms stayed 3 days after lady partsl delivery and 5 days for C section babies always slept in the nursery during the night and came out only to breastfeed having to remain flat on back 24 hrs after Lumbar puncture or cataract surgery Intraperitoneal dialysis manually Gastric lavage for overdoses with ewalds and not a closed system iced normal saline lavages for GI bleeds. obtaining sputum culture by using your mouth as the suction (stills makes me gag when i think of it) giving every patient a back rub at bedtime usually with alcohol. 12:1 pt load on days 20;1 on nights did not matter if getting dialysis or chemo. NO paperwork except about 4 lines in the ED paperwork with vital signs. SOAP charting med cards for every medication. multidose vials and containers for every medication no single doses. medications outside pts rooms in unlocked drawers preparing your own chemo 45 minute tubing changes on central lines as no extension tubing NO IMED PUMPS only interns and residents and students started IV's pts always being connected to IV 's and being KVO. Manually calculating drips on all IV fluids you used buretrols for critical meds. RNA's CNA's ???? no such thing. PRIMARY CARE NURSING (you were assigned to 20 patients, if they were admitted you were totally responsible for their care every time (you did their care plan)) lady partsl fungal suppositories to be sucked on for stomatitis from chemo.

I took the CEN after I took a critical care course without even steping in an ER yet and passed. I would not have passed if I had not have taken the course in my opinion. I recommend you take the CEN review course first. TNCC was pretty easy and even if you fail the test they let you take it again

To the OP, please listen to those who have worked in the prison system or at least a nurse. Some of my best friends were the officers we would work out together in the morning and go skiing together it was like one big family, they watched your back. The ED I work at now has more seedy nasty people then there were in the prison. Inmates never once tryed to kick or spit on me. If they so much as made a derogatory remark to me they would lose priviledges.

I worked Corrections for 7 years before I came back to ED nursing and the one thing I became was very adept at my assessments. I had decide if that inmates pain was real enough to warrant a trip to the hospital or if I could manage him inhouse. Unescessary transports put the officers at risk. I did sick call in the AM and had to decide if I could treat the patient or if I needed to make an MD appt. I did alot of other things but I think that is what made me a better ED nurse as I could recognize a patient was going sour before he crumped and sometimes prevent it. I still drew blood and did IVs just like an ER. I did procedures like EKGS and dressing changes,suture removal cathertizations etc., and managed Trauma pts or acutely ill patients until an ambulance arrived. I also gave out pills and managed pts who were psych and suicidal. Sound like what you do in an ER, about 75%

No I have been a nurse 31 years and the way it worked is you write the Exam then in 4 years you do the CEN RO then in 4 years you had to rewite the exam and so on and so on The last time I let I lapse by a year. And NO I PASSED EVERYTIME I do not think it has changed except I think if you do not let your CEN lapse, you can take the test from home (at least that is what one of my cohorts said the other day)

I just took the exam yesterday and passed. This is my third time taking it but this time I swear was so much harder then the past in my opinion. I did very well but I truthfully think I guesed at more questions then ever before. ( I could narrow most to 50/50 but then I was stuck as there was not enough info to go on. ) I was so glad that there was no nursing diagnosis and only one calculation though. I did have Laura tapes but many things she says although they may be right in the real world they were wrong for this test so it was confusing. IE give LR for liver injuries. Go with the old standbyes the CEN test review book and the CEN emergency curriculum review book. And know your pharmacology well as they were alot of questions on it and they were not easy.

Maternity does not mean an job opening, it means a nurse is going to be off for 12 weeks. Not many experienced nurses are going to apply for a job that is only 3 months long and no Nursing director will hire a new grad for that short period either. I know in MA there are little to no full time jobs anywhere for new grads and there are few jobs for experienced nurses either.

Violence against nurses by patients and family is well documented but truthfully little is done by the Upper staff to stop it. In MA, there is a bill that will allow nurses to charge people for assault and the fines will be the same as law enforcement it was signed by Govenor Duvall and now goes to the senate so hopefully things will change with it. At this time if the patient or visitor is A&ox3 and hits a nurse or other staff member, they are arrested. It is up to the staff member to do the charging not th hospital though. It does not matter whether it is in a nursing home or not, it is your right if you are physically hurt why people don't is still a mystery to me. People who are "not of sound mind" however the story is very different still and we seriously need to do something about it but the laws have yet to change. Except if a place is truly unsafe for nurses do to dangerous patients where the brass is not doing anything a little call to OSHA will change there tune but someone needs to make the call. As for nurse to nurse or MD to nurse or any employee disrespecting or harassing each other. In our facility sexual harassment is not tolerated at all and 3 nurses including the Nurse manager have been fired for it. Now Disrespect is not tolerated and we have a policy saying it and it is being enforced. Case in point, I had a doctor who in front of everyone including patients, said who charge nurse knowing full well I was charging when I answered he said "your not a very good one" He is one who is known to punish anyone who stands up to him by ignoring them to a point that it threatens patient care so instead of confronting him I reported the incident to my boss who in turn contacted his boss, I He is now having to answer himself in front of the Director. Not sure what will happen but my boss is Livid. So you see not every nurse sits back and takes it. But it is true I have seen Dr's snap at nurses and they do nothing. I have interceded for them though to let them know there behavior in unacceptable and they owe the nurse an apoligy and yes they have done just that. I also know that at least in our hospital is the our duty to report sexual harassment even if it was only witnessed. Many people it is not in their nature to speak up for fear of reprisal. those of us who have no such fear should stand up as they witness the harassment. Bullys Bully as long as they can but Bullys stop when they are confronted, sometimes it only takes a few well placed comments other times it takes going up the chain of command. My question is this, please tell me you are not witnessing sexual harrassment of staff or violence against staff by other staff members and doing nothing about. If you are then you are part of the problem.

Been a nurse 32 years 20 in the ED, are there horrible days yes, Lots are there great days, lots,would I trade it for anything? nope. The hours are long and you miss alot of holidays ,on some days you want to kill your fellow nurses, doctors,interns,residents and students and on other days you want to kiss them. Nothing different in a family. Some patients may drive you crazy and really try your patience but the best thing about ED nursing, they are not there too long. If you get in it for the money you won't make it. (in MA the pay is great) . The best thing about nursing is there are so many fields to choose from. If you don't like one, try another. Getting into nursing schools is extremely difficult and the program is also very tough.

We still do narcotics count 2x/week even with pixis Any body remember retrieving sterile sputum specimens without suction machines. It is a small bottle with 2 tubes (still have the same collection receptacle to this day) one tube goes in the patients nose or mouth the other in your mouth. You are the suction. As you suck in the sputum goes into the comtainer. Nothing better then collecting a sputum sample this way one day only to find that the pateint has been placed on TB precautions the nextday. To this day I still gag when dealing with sputum.

Sorry I agree, you have an hour leeway with meds. Also If you get report which you should, and they say the patient is on O2 then prepare to have the extender in advance if they are on IV meds needing IMEDS have them available as well. Not sure where the patient came from or how many patients you had but a patient coming from the ED who needs immediate breathing treatment and pain medication that is inexcusable at least in our place? Also when a patient is admitted in our place the aide does the vitals and such and settles the pt. The nurse comes in says hi does a quick assessment then leaves. When she/he has time, then she does the admission. If you are crazy busy and can't do the complete admission inform the charge nurse she will have to assess the situation and maybe leave it to the night shift (do not make a habit of this but no night person will fault you if you truly are stuck).

People wonder how we treat our frequent flyer patients. Tonight for example 4 patients all return customers in under 14 hours one 3 times in 12 hours. If they are violent which the patient who returned 3 times we put them in restraints. When they behave for 30 minutes we take them out. They get food and juices If they have anything medical we treat for the last patient who is violent we did a CT of the head for change in mental status (he has come 2 times a day for 10 days and has had 8 CT's so far one 2 times in a day.) The ones who live in a wet shelter, they get rides back to the shelter using one of the shelter vans ( they usually the others are on their own. We used to be able to section 35 them ( involuntary detox for up to 30 days but usually 2-3 days of late even for the most violent) if they came too often but the court now says they won't the last one is a violent pt who kicked 2 CNA's in the face and sprained this reporter's wrist when he grabbed on and squeezed all in under 3 months. He comes a minimum of daily but mostly twice a day and stays out maybe 11/2 hours between visits. If we call to have them sent to jail if they are violent and too drunk to leave the cops who are supposed to keep them for 4 hours minimum, literally pick them up then let them go a couple of blocks away only to have them return not 2 hours later after they have had a few more drinks. Because of EMTALA WE CAN REFUSE NO ONE. if they cannot walk steady we have to keep them. By the way none of these pateitns pay a dime they have no insurance even though they are supposed to have it here but who do you send the bill to?

"snowing " patients with Bronfman cocktail Glass chest tubes Sterilizing your own equipment -#13 ewald NG for every OD (a tube the width of a quarter shoved down your throat and 2-4 liters of NS inserted and removed manually (no closed system) -Honey applied for vulvectomy incisions daily -Sucking on miconizole suppositories for thrush of the mouth for all cancer patients -No LPN only RNA and they only worked in convalesent hospitals RN's only in hospitals -Patient load 12 pts on days 20 patient on nights nothing automated all manual -peritoneal dialysis manually (bag in left in 40 minutes bag dropped to ground to remove fluid only to repeat over and over manually -Patients with MI's spent 6 weeks in the hospital minimum the first week on strict bed rest even had to had bed baths. The 2nd week they were allowed to dangle their legs. Etc -Dressing sets were rationed only 6 sets per floor you had to share sets between all your patients including sterile gloves (one glove for one patient one for another the third patient got forceps only no gloves -IV metal intracaths were rationed (6 of each size per floor ) it was nothing to start an IV on a patient using a #14 intracath. -Only interns started IV's nurses were not allowed - banana bag we still use often : 1 liter NS with 1 mg folic acid,100 mg thiamine, multivitamin and magnesium sulfate if needed. -pneumovac system for everything as no computer. -Hoyer lift no way you lifted 2 person manually when you were alone which was most of the time I remember how excited we got when someone invented the belt for lifting a pt. -rinsing out your draw sheets before putting them in the laundry -primary care nursing on an oncology floor (you were responsible for 20 patients's care even when you were not there the nurses followed your plan.) - peritoneal lavage as no ultrasound -rapid volume infuser consisted of a plastic tube that slid over a normal IV widening the entrance so turned an 18 cath into a 12 gauge so fluid could flow faster. -changing the a central line dressing easily took 45 minutes due to strict sterile technique.

The abuse is rampant where I work and will never change 911 is a joke here. Ambulance cannot refuse anyone, we have people who are discharged from one hospital who walk across the street to came to another hospital only to walk out and do it a third time , we have pts who come in by ambulance with ear aches who when arrive get off the stretcher say thanks then leave as they needed to get to a store or an appt or to a restaurant and they are any age and an ambulance is cheaper then taxi. We have had one pt come to the ED 5 times a day every day for a month for several years we sectioned her only to have the courts let her go only to have her return again and again COPD we have had people come in every night with anxiety because they are lonely and need company. All call 911 many don't pay a dime as they are illegal and we are a safe haven for illegals. MY favorite is the "good samaritans" (they are people who do not like stepping over drunks"who call 911 because they saw a drunk stumbling in the square ( a popular watering hole) when the police arrive, they are given a choice jail or hospital, they always chose ambulance and hospital as they give you food and drink and warm blankets. If the person cannot walk we are the drunk tank so they come to us until they can walk. During the holidays the good samitans increase exponentially not to mention the police empty out a popular tourist spot every 4 hours for the tourists so we get about 4-5 drunks every 4 hours. We have about 15 a shift like that none have anything but gov't insurance if at all. Many of our doctors are new so they work these patients for "change in mental status (lab banana bag CT head etc all at least 5-$10000 workups) some get 2 CT's in a day. We also have a large group of drunks who use us as a shelter as they were kicked out of one because they were violent. All come by ambulance, all have chest pain. We have one pt who comes in everyday as a walkin with chest pain SOB for 10 years (if you refuse her she sues and wins she has won 3 times.) . 70% of our patients in our hospital is either illegal or indigent. They have a PCP but do not use them they are on medicaid medicare etc all gov't insurances. We are their PCP . We have a kind of universal insurance for the indigent or people who are not middle class and above but still they won't get it. The only people who do not use the ambulance service are the people who truly need it. Parents use our ED as clinics for there children and relatives as then they can come on their own time rather then take time off work for an appt many come by ambulance as they have no car many because there is a $2.00 copay to see a PCP and to come to the ED is free choose the ED. Many want precriptions for OTC meds as the government lets them buy it for $1.00 or free in many cases. The only people who do not abuse the ED are people with real insurances not government ones. The ambulance also abuses the system they bring patients from a chronic rehab for "stabalization" knowing that the patient belongs at a different hospital and will be transfered there. (it is funny trauma pts no matter how critical are never stabilezd here before going to a trauma one hospital even though we are a trauma 2 hospital. The longer I work here the more the abuse I see I know in Canada it is sooooooo different as I lived there although it was awhile ago. You call 911 and they decide if they will send an ambulance. if it is not critical you are on your own ED waits are 8 hours and more so no one abuses it as they are so many CLSC (urgent care clinics run by the government) that are much faster. If it is deemed that your reason for coming to the ED is non urgent the triage nurse just keeps putting you at the bottom of the pile and no one cares about press ganey scores as there is no competition in hospitals they are mostly goverment owned. Patients who are admitted get directly admitted to a floor you do not have to go through the emergency dept for a complete workup first like here.

Corpus cristie Tx great beaches not great pay but low cost of living You have to like it hot though but nothing like tanning in feb

I have been the wife of a carreer military officer for 20 years then I joined the military myself. There are no exceptions for nurses. If he is posted you either go with him or stay. If he goes to another state you must apply for licensure, you do not have to rewrite the Nclex as most states have reciprocity. If he is shipped to another country then you do have to rewrite the boards and get licensure. ( I have had 12 licenses in 3 countries have written my canadian boards and my rnclex and german boards.. Your husband will spend much time on ship so you will be alone alot you go to different states where you know noone and have no family you have to face crisis on your own (thank god for SKYPE) His carreer will trump yours, you constantly asked in interviews why you have left so many jobs.

Med errors should be reported but near misses in my opinion should not. In the case of the unit manager she should not be penalized. It sounds more like a systems problems then the Unit Managers problem. I have never heard of anyone doing month to month transcribing without a 2nd person rechecking. In our acute care facility when I worked on a very busy chemotherapy unit, the charge nurse checked all patient charts for orders written in the past 8 hours to make sure if there were any errors they would be caught early. In the non acute facilty the Nurse double checked all new orders. It was also a policy in both places all new orders needed to be cosigned by the first person giving it. If you have not done that much transcribiing you would not understand how very very easily it is to make a mistake. When that person is transcribing is she allowed to do it without ANY interuptions? If this is not happening what do you expect, she is only human. Instead of complaining be proactive suggest 2 people do the transcribing one to write and the other to verify, your patients will thank you as will the boss.

Oh how I agree it was a total culture shock when I left the military and came to work as a civilian. It seems civilian nurses make tattling a science. I personally believe if you have to tattletail for every little thing then you need a life.

What good would it do the unit manager already knows why I am the one choosen her answer is "we have a lot wrong with the unit "

It is so frustration when you have 5 patients and you see that each put that they had pain they stay in the ED for up to 5 hours and no one addresses pain. You go to talk with them and the next thing you know you are giving 5 pain meds then reassess every 15 minutes which is JACOH policy after giving a narcotic (v/s q15 minutes then hourly for 4 hours ) Of course if the pain does not go away by 1 hour or if the patient c/o of increased pain I again seek out the MD. Rarely do my patients get admitted with pain and if they are it is documented as to why. Does every nurse do that absolutely not therefore I get auditted one more time. Trust me my documentation has changed it says c/o of pain pain scale (1-10) md notified med given. Then there is reassessments why I want my audits to go smoothly and trust me there have been 5 more since. My Boss jokes at least I know when your name comes up It will go smoothly. It is so frustrating that the nurses who do not care about the patients pain don't have to document and no one notices because their name never comes up for an audit.

iNTERESTING YOU ASKED THAT i TOOK OVER AS CHIEF NURSING OFFICER IN A FACILITY THAT JUST GOT RID OF CMS. ALTHOUGH I NEVER WORKED WHEN THEY WERE THERE I SAW THE AFTERMATH AND IT WAS NOT PRETTY. APPARENTLY AT NIGHT YOU WERE EXPECTED TO FAX THEM NOT PHONE IF ANY INMATE NEEDED TO GO TO AN OUTSIDE HOSPITAL FOR SOMETHIING YOU COULD NOT HANDLE IN HOUSE. THE ONLY THING WAS THEY DID NOT GET BACK TO YOU FOR HOURS. I WAS IN A BAD POSITION BECAUSE I WAS SHARING THE POSITION WITH THE OLD DON WHO WAS HIRED BY CMS AND WHOSE CONTRACT WOULD END A YEAR FROM MY DATE OF HIRE AND IT WAS WRITTEN IN HER CONTRACT THAT SHE COULD NOT BE SUED. AS A RESULT I ATTENDED 7 LAWSUITS AS A REPRESENTATIVE OF THE STATE OF INMATES WHO HAD A MI AND WERE NOT TREATED IN A TIMELY MANNER, A PERSON WHO STROKED AND DID NOT GET TO THE HOSPITAL IN UNDER 3 HOURS SO THEY WERE LEFT WITH A SEVERE DEFICIT. PATIENTS IN SEVERE DT'S, A PT WITH A HEAD BLEED WHO WAS BEATEN BY THE POLICE PTA AND A PT WHO HAD A SUBARACHNOID BLEED LEFT IN A VEGETATIVE STATE, THE CHARGES WERE ENDLESS NEEDLESS TO SAY i LASTED ONE YEAR. THIS DON WAS SCARY, I SAW HER THROW WATER ON A INMATE AND SLAP HIS FACE BECAUSE SHE THOUGHT HE WAS FAKING A SEIZURE ( HE WAS NOT HE WAS CYANOTIC AND IN STATUS EPILEPTICUS AND ENDED UP BEING INTUBATED BY EMS), SHE ALSO INSTEAD OF APPLYING PRESSURE AND ELEVATING THE ARMS OF A PT WHO SLICED HIS ARTERY OF BOTH HIS WRISTS PLACE THEM IN ICE WATER THINKING THEY WOULD CONSTRICT (NOTTTTTT). SHE REFUSED TO GIVE A PATIENT WHO WAS HAVING ALL THE CLASSIC SIGNS OF AN MI (CHESTPAIN DIAPHORESIS AND SOB) UNTIL SHE GOT A DOCTORS ORDER EVEN THOUGH WE HAD STANDING ORDERS TO GIVE IT. THE STRAW THAT BROKE THE CAMELS BACK WAS SHE DECIDED EVERY INMATE WHO CAME IN WOULD BE IMMEDIATELY REMOVED FROM ALL PSYCH MEDICATION AND NARCOTICS AND WOULD HAVE AN APPT WITH THE MEDICAL DOCTOR WHETHER THE INMATE NEEDED IT TO BE REINSTATED ( THE PROBLEM WAS SOME APPT WERE NOT FOR SEVERAL DAYS). WHEN I CALLED THE BON AND ASKED IF I WAS ACCOUNTABLE FOR THE DOCTOR AND DON'S BAD JUDGEMENT I WAS TOLD BECAUSE SHE COULD NOT BE SUED THEN YES I WOULD BE. I CANNOT TELL HOW FAST I WAS OUT OF THERE.

Promethazine is buffered with acetic acid-sodium acetate and has a pH between 4.0 and 5.5. That is stronger then some chemotherapy medication. Because of this too many accidents just like shooting acid into a vein. This drug has been banned by ours and every facity I know of due to the danger.

No idea the security officers just swear out a c/o and it is done we are not so lucky. Hmmm and they get hazard duty pay to work with the same patients we work with. Get this they cancelled the meeting for the write up due to the holidays but it is in my file and I am still being punished by not being allowed to do charge. (Not that I care so much except when a new employee is being made charge over me or they bring in a 4th nurse to do charge OT.) In truth I hate charging here all the nurse take one PT and say they are too busy to take more yet have no problem giving me several critical pt's at once

Tell me about it I needed an EKG on a pt with chest pain and was told that I would have to do it myself as the tech was with a patient. I Did the EKG not to mention drew the lab started the IV and gave the meds. When my pt was settled I went to the room where the Tech still was to find he was suturing a patient with the doctor watching. I was in shock I told the Doctor that suturing was not in his scope of practice and she said it is ok he is doing it under my licence. I wanted to say maybe I should notify the medical board and see what they say. Another time we have a code and the Nurse is doing CPR while the tech was getting a lesson on intubation. Then after the pt was declared the doctor then proceeded to give the tech a lesson on Defibrillators while we went on to the patients that came in during the code. I know it is truly the doctors fault for doing this but it is also the techs fault he knows that it is wrong but hey if someone is willing why not and if the charge nurse condones it as well what can we do.

If you do make sure you go to another state and a totally different type of Job. Sorry you are in a situation where there is a surplus of nurses now not a shortage as people keep saying. Nurses are a dime a dozen or just bodies to fill a position if you don't like it quit there will be twenty clamoring to fill your job. If you quit a job the chances of getting another job are not good especially as a new nurse. Don't worry in another decade the tables will turn again like it did in Canada and then you will be in the drivers seat again. There is usally a turn around every 7-10 years.