EarthwormRN

Wondering what you all would do in this scenario. A patient came from an outside hospital on ceftriaxone for "suspected UTI", as well as urinary retention and acute kidney injury. He had been on it for about a week. I couldn't find any old culture results at the prior hospital. Most often UTIs are caused by e.coli so ceftriaxone would normally be adequate. We redid a UA and culture anyway and the culture ended up being positive for an enterococcus species. I was training a new nurse and instructed her to let the doctor know that the culture came back and ask if she would like to change the antibiotic. The doctor responded dismissively and said something along the lines of "thanks, I can take care of my own patient". The new nurse was embarassed to have been spoken to that way. I questioned whether or not my instructions for her to notify the doctor were necessary. My thought was, it was kind of late in the evening (1530ish) and sometimes the docs finish up and go home between 1600 and 1700, then stay on call until 1900 if needed. I figured it would be better for the patient to get the proper antibiotics as soon as possible instead of waiting until morning in the event the doctor didn't see the new result until the next day. What are your thoughts? Did we do the right thing or overstep?

I have moved from one facility to another and I am being trained differently than what I have been doing with wounds the last 4 years. I'm not clear on whether or not the nurse I am orienting with is just extra cautious or I too should be assessing sites the same way she does. I assess the site when the dressing is due to be changed, PRN (strikethrough, pt c/o increased pain, got wet in the shower, erythema noted around dressing, etc) and on admission. My orienting nurse peels a dressing up and looks at the wound Qshift, and sticks it back down if its not due to be changed. If anything I would assess Qshift, but I'd be more inclined to clean and re-dress because of infection risk. If a doctor or wound specialist says change Q3days, why expose it to infection every shift? Or change it early when it wasn't needed? I understand an infection could get missed on day two without visually seeing it, but if it does become infected it would start to ooze or the pt will have increased pain. Both of which should be assessed Qshift. Thanks in advance for any of your input.

Thank you for your answers. I feel better now. I'm always always learning new things. Even when i feel like I'm pretty comfortable with my knowledge i get challenged with a question i am totally unequipped to answer.

My stance has not changed. I have been hearing more and more people complain that its all just a trend to be anti gmo right now. Which is irritating, these are the same people who believe the reports that "prove" global warming is not happening. I wish that websites posting "research studies" had to be screened for efficacy. Anyone can say they did research and write a really good study on it. But if its just some joe shmoe making it all up..people will still buy it.

A family member of my patient asked if his grandma could have the fluid drained through a tube. First i told him i wasn't sure if we could do that procedure here. Its a small rural hospital. Then i said since she was elderly and her progression of chf is severe the fluid may reaccumulate and the risks involved wouldn't be worth the procedure. This patient also had pneumonia but the chest xray didn't show a pleural effusion. My question is can you even drain the fluid from inside the lung rather than in the pleural space with a thoracentesis or does that only work for pleural effusions. After going home i kept wondering if i had misinformed the family. I did however explain that we were dieuresing her with lots of lasix and that was a safer alternative to pull the fluid off.

I have been a nurse for 2 years. My experience consists of primarily assisted living and long term care. Just after graduation I breifly worked on a swing bed unit on night shift with 20 patients by myself. Due to lack of traing and no one to help me with questions I quit because I didnt feel like it was safe to stay. Now I have transferred from LTC to the acute/swing bed wing in the same hospital and I really feel like a rookie. I am having no problem with medications and treatments, that is the easy stuff. But I am brushing up on my head to toe assessment skills, knowing when to alert the doctor, admits/discharged/transfers, and giving good thorough reports. Its been about 2 or 3 weeks since i have started and Im doing okay. I have not harmed anyone. But being the only rookie in the department I feel like my every move is being judged and monitored by the other staff and Ive always ben the worrier of what everyone thinks of me and my work. Please any advice to help me feel more comfortable or share your own stories of when you were new, would be greatly appreciated. Thanks.

Love it!

I do it! I love my job and although the drive gets tiring and I often think I should get a job closer, I end up staying because its a good place to work.

"I'll get you a Snickers, you act like Frankenstein when you're hungry."

1. State you work in ----------------------------------------------------------WA 2. Years of experience --------------------------------------------------------2 years 3. Specialty/unit and work setting (clinic, hospital, prison, etc)------------LTC 4. Hourly Pay (base rate) or salary-------------------------------------------$25.66/hr + 10% per diem 5. Differentials (if any) --------------------------------------------------------$2 evenings, $4 nights 6. Union? -----------------------------------------------------------------------i think so

I know how you feel. I have been a nurse for 2 years and even with that under my belt, I feel like I won't even have a chance at an interview. If I had my bachelors I'd have an easier time, but right now I only have an associates. I have been looking into getting my BSN through on online school but I'm not sure yet if I want to start now or wait a bit longer. I have looked at midwifery schools as well and I did find one that has an ADN to MS Midwife bridge, buuuut of course in the application process it strongly recommends some sort of experience in pregnancy, labor/delivery or something to do with newborns. I have though about asking our local midwife about volunteering in their clinic and I have found some classes to be a childbirth class instructor or lactation consultant. I haven't committed to anything yet, because there are so many options, I'm not sure which one would give me the best outcome. Volunteering would really up your chances, especially if you volunteer at the hospital you want to eventually work at. Once they know you, they might overlook your experience and let you right in. Wish you best. :)

Hello, I am a nurse working per diem in a hospital in a small town in washington state. Many are hired right out of nursing school (I was). This hospital has a clinic, LTC, Assisted living, Swing beds (basically rehab), acute beds, and ER. Unfortunately, there is no labor and delivery In this hospital LPNs are able to do IVs with certification (which many hospitals seem do not allow anymore) It is rural healthcare if that is something that you are intersted in. For now, we are in desperate need of a nurse on the long term care wing and I can honestly tell you that its the best long term care I have ever worked in. The turnover is low, the CNAs are great, and my boss is very very nice, not the kind who hovers over your every move, but offers constructive critisism when needed. As much as I love it, I prefer not to work full time and my boss really wants me to take this position. I offerred to fill in until we find someone else. So far its been about a month. We don't get a lot of applicants due to the small area, but if you are willing to move, this is a nice small town and a great place to raise a family. Also note, if you eventually want to work in acute care, many of the LTC nurses move to acute care or another department within a year or two of employment. Info: LTC wing has 25 residents and only 1 nurse is on duty per shift, but they are pretty low maintainance. Evening shift 5 days a week, 8 hour shifts, every other weekend. Pay is really good for a long term care position, I won't say exactly a number but I was pleasantly surprised. the name of the facility is Columbia Basin Hospital, in Ephrata, WA. Please apply, you won't be dissappointed.

Honey I shrunk the nurses.

I have this patient who asks for ativan every day at 7pm. I was told by my supervisor that I need to offer alternative ways to calm her down before giving her the ativan, such as offering food, water, one on one, back rub, visualization etc. Well this patient refuses to take part in the other methods and sternly says I wouldn't ask for it if I didn't need it. But at 5 oclock, she will say bring me an ativan at 7, and I think how does she know she will be anxious at 7 o'clock? The only time she doesn't end up getting the medication is if she doesn't ask for it, if she does, she bullies me until I cave and I cave pretty easy. I talked with a fellow nurse on a different shift about how "pain is what the patient says it is" but is anxiety what the patient says it is as well? I think yes, but i wonder what my supervisor thinks. How should I go about this situation?

Oh and what exactly do you mean "Likely get slammed for this"?