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firstinfamily RN

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firstinfamily has 33 years experience as a RN.

RN since 1981, total of 16 years in ICU, worked tele, PCU, Home health, LTC, rehab. Looking for ambulatory nurse type position

firstinfamily's Latest Activity

  1. firstinfamily

    Reporting a facility for staff ratio issues?

    Is there an admission criteria or nurse/pt ratio listed in your nursing requirements/job descriptions? If so, then the facility can be held liable for this---do a little digging, maybe see what they advertise on line etc.
  2. firstinfamily

    Please help me understand COPD!

    There was a good article eons ago in Nursing______(year?) Google the following: "Blue Bloater" and "Pink puffer" I think these articles will give you some physiology info that may help you. I agree with Granny, each COPD pt is different,(and she would know!!) You do not want to over oxygenate these folks nor do you want to under oxygenate them, their cells need O2 to function!!! Use the guidelines of your facility and if this area is lacking then bring it to the attention of your nurse educator. COPD is an umbrella term for various respiratory conditions, do a little more research and you will find your answers. This is a very complex condition and usually does require a good understanding of the specific condition and the other conditions that may contribute to someone going into respiratory distress. FYI, the winter is usually prime time for these patients to come into the hospital because of the agravation of underlying respiratory issues. You will see a lot of these type of patients this time of year. It can be a scarey situation, just remember, they need oxygen also and if you can maintain their SPO2 88-90% you are doing OK and so are they.
  3. firstinfamily

    What did I do wrong?

    Sounds like there is some family dynamic issues here that are not being addressed. Is the Ativan listed in the allergy list or as a drug that the patient is sensitive to? The son and the wife sound like they are on different pages with each their own viewpoint of what is going on. Ativan would have been the appropriate medication to give someone who is agitated unless they are sensitive to it. Ativan can make some patients worse and this could have been the case here. The son may not want his father to receive these psych type of medications because they tend to make some patients worse and affect their cognitive abilities. It is true you should not be handling medications at all unless you are certified as a CNA and a Medication Aide, the medication aide is a separate certification from the CNA. You cannot legally distribute medications of any kind, therefore, your facility needs to clarify your duties as allowed by your practice act in your state.
  4. Nurses are humans too!!! We can get sick on any day of the week and just because it may fall on a holiday does not mean it is not legitimate. If there was an established pattern then yes, perhaps extra disciplinary measures should be applied. Holiday packages should be available so staff know which holidays they will be working. One facility where I worked if you called out on your holiday, you could not use sick time, so no pay if called out; sometimes money or lack thereof can be more powerful than anything else!!
  5. firstinfamily

    Depressed about life choices

    Lots of good advice on these posts. You need to deal with your depression, part of it may be that you feel a little like a failure but it could also be from recent childbirth (post-partum depression) or this time of year (seasonal depression) When things seem so overwhelming, it is hard to find your way. You will have to focus on what you want to achieve and stick to it. You may have to develop a "hard shell" to make things happen. I truly believe determination and perseverance can help you achieve anything. You could reapply to the college for a general program and take some courses to show that you can do college level classes, or you could re-take the ones that you got the E's in to replace that grade. You can improve your GPA by retaking those classes or taking classes with the same amount of credits. I would put your earlier college experiences up to maturity and now you are ready and more focused. Not all of us know exactly what we want to do in high-school, some of us take a little longer to find our way. Good Luck!!
  6. firstinfamily

    Getting report during change of shift

    It seems our unit is always getting calls from the ER with urgency in getting a pt up "before our shift ends", meaning the very beginning of my shift. To myself I wonder, why is it always at the end of their shift?? I have just gotten my assignment and usually have just finished getting report when I am told I will be getting a patient from the ER. I feel it is important for me to do my basic assessment on the patients I already have before I get one up from the ER who may take up a lot of my time. They are stable in the ER, so why the rush?? We have not resolved the issues and are usually being told that if we take report that will be acceptable and then ask them to ship the pt up in 15 or so minutes. When I asked the evening supervisor about this, her reply was that the ER has to empty by shift change, I don't get this either!!! A thorn in my side!!
  7. firstinfamily

    Going into nursing school without any experience?

    I also did not have any healthcare experience when I attended nursing college. I graduated in 1981 with my ADN and found work in a hospital about 2 weeks after graduation. However, times are different now. Your $600 would most likely be well spent, as you would be able to get that in return from your earnings, and you would have some experience that would look good on a resume. The skills as far as providing basic patient care would benefit you in nursing school, but really is not required to be successful in nursing school. Most BSN programs try to gear their students into higher positions that may move them away from the bedside, usually most new nurses start at the bedside. I agree with the above posts, the experience as a CNA would benefit you but is not required to be successful in nursing college, having any position with a healthcare organization will make you more eligible for future positions. It is difficult to work while going to nursing college and it would benefit you to concentrate on your studies and clinical experiences instead of combining work and college. Good Luck!!!
  8. firstinfamily

    Priorities Can Kill: When Passing the Buck Gets Dangerous

    RN2B123: The pt had not coded, he still was breathing and had a pulse, therefore a Code Blue would not have been appropriate. Rapid Response was the proper call. The lack of follow-through with critical labs shows in this case, and I have to ask, Why?? Is it that we are so busy with the tasks needed that we get overwhelmed and perphaps do not pay attention to the current lab values? The heart will not work in an acidic environment, and it was most likely the fact that the ph level was not corrected for 3 days that led to this pts demise. Great catch and great article. I bet all of us will be paying much more attention to those lab values after this!! Sometimes I think because our plates are so full we just do not stop long enough to pay attention to the whole picture the pt is presenting and then sometimes something gets lost and we forget to follow through. Jacquie stated that a few changes had occurred at her facility based on this case, so sometimes it takes something this drastic for change to occur. Good exercise!!
  9. firstinfamily

    New Nurse Proverbs.

    Tools to always have in your pockets, alcohol preps, tape, scissors, will help to keep you on task without trying to find them!! And I always go by Murphy's Law---if anything can go wrong, it usually does!!
  10. firstinfamily

    New Grad RN Needs Help

    The reason they say to start in a hospital is because you can get the 'best" training there. Hospitals have become more picky about hiring new grads and do not have the educational monies they use to for training. You should start where ever you can find work. If a clinic setting is better for you then go for it!!!
  11. firstinfamily

    Opinion on using the word "retarded"?

    I have also heard of mental retardation referred to as "metally challenged", which really can mean a number of different things, mentally challenged such as psych issues, mentally challenged such as dementia etc. So as everyone here has already said, the bus keeps rolling!!
  12. firstinfamily

    Social Skills in Nursing (Part I): The Art of Validation

    I kind of wonder if we are connected better at work, does that affect how we are connected at home? If we are being a team at work, and learn little idiosyncrasies of each other does that make us work better together, what about in a crisis situation? During a code for instance, if we connect with each other in a more personal way do we connect better when functioning as a code team? Those nurses who communicate better function together better even in crisis mode??
  13. firstinfamily

    Too Tired to Care: Fatigue in Nursing Has Ugly Outcomes

    Having just returned to night shift I am learning how to attempt to get adequate sleep. I have worked nights in the past, but being older, I have found this time to be more difficult. I know the sleep I get during the day is not the same quality that I would get at night. Daytime sleep must not be as deep and as far as I know the deep or REM sleep is when our body rejuvenates. Therefore, I am feeling the drain of working nights and working 12 hours is impossible!!! I truly do not understand the national wave of forcing hospitals to work nurses these very long shifts. Was it to eliminate the middle 3-11 shift? It certainly was not to create better patient outcomes with more consistent nurse-patient relationships!! And, if the nurses are working 12 hours, what about the rest of the ancillary staff, like respiratory or diagnostic staff? If we are truly operating on a 24 hour day then why cannot certain testing be done during the night etc?? Wouldn't that shorten the amount of time patients are in the hospital? Do the larger medical centers have 24 hour care including diagnostic testing available for patients?? Why is nursing the only ones to work 12 hours??
  14. firstinfamily

    What is the draw to nursing these days

    I believe the actual nursing shortage is happening as those of us who are baby boomers are approaching retirement age. What is not mentioned is that we will have to work longer because the benefits of being retired are being taken away on a daily basis!! Therefore, the potential of a nursing shortage is there, but it may not actually happen because us old bats are having to work longer!!! There is shortages in specialty nursing fields and most likely that will dissipate over time and the younger nurses move into those specialties.
  15. firstinfamily

    Lippincott vs Mosby

    Nursing magazine put out a "Skill series" which is published by Mosby, you might be able to google this. I found their skillbooks extremely helpful---there is one Total Assessment in 3 minutes---which really narrows it down to the nitty gritty. Also, the "dummy" series may have something on assessments. There are also books just on Physical Assessment that have diagrams of the systems being assessed and stethoscope skills etc.
  16. firstinfamily

    Death bed visions

    It seems to me just about every patient whom I have been with in the dying process has reached upwards towards the sky or said they see a bright light coming towards them. Some are talking a conversation that only they seem to hear. I do ask patients if they are seeing angels and some admit that they are. I usually make sure I notify the family, after checking vitals, of course, because I have found that when they say they are seeing angels it is not long before they pass.

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