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PatricksRNMommy specializes in PCU/Telemetry.

PatricksRNMommy's Latest Activity

  1. PatricksRNMommy

    Fair Patient assignments

    I am a charge nurse and when I make assignments for the next shift I look at several factors: 1) Patient acuity - I try to split up "total care" patients as much as possible, as well as isolation patients, post-op patients, confused patients, and pt with cardiac drips as much as possible 2) Continuity of care - I almost always give a nurse back the same patients he/she had the night before (unless either the patient or the nurse request otherwise) 3) Nurse's Skills/Abilities/Certifications - For example giving a stroke patient to a stroke certified nurse, assigning the Spanish speaking only patient to a nurse who is fluent in Spanish, giving a critical patient to a very seasoned nurse, etc. 4) Proximity - Proximity of rooms is the absolute least important factor to me in making the assignment, but if there is a choice between assigning a nurse a patient closer to her other patients or one further away (assuming there is no good reason to assign the distal patient) I will assign the one closest to the other ones. I try to balance the needs and safety of the patient with the satisfaction of the nurses as much as possible, but I have learned that there is absolutely no way to make everyone happy...
  2. PatricksRNMommy

    Your body did what?!?

    I had a patient when I was a fairly new nurse who had gone into SVT. While we were waiting for another nurse to bring in the adenosine, the charge nurse asked the patient to bear down like she was having a bowel movement. It wasn't bringing down her heart rate the least bit, but she kept trying and then her eyes got HUGE and she pointed down between her legs. Her face was as red as a tomato. I pulled up her gown and see this huge round pinksh object sticking out of her vagina.... Turns out it was her uterus. Now I understand the concept of uterine prolapse, but at the time it certainly seemed like a medical emergency more dire than the SVT!!
  3. PatricksRNMommy

    Does anyone know...

    The MRSA patients are on isolation for a reason, to protect caregivers and visitors who go into the room. As long as you are following proper contact precautions (gown and gloves) and thouroughly washing your hands after you leave the room, you should be fine. MRSA is not just in hospitals anymore. More and more people out in the community have it and many healthcare workers are actually colonized with it. Just be mindful of basic hand hygeine along with the iso precautions and you will be fine :)
  4. PatricksRNMommy

    DNR does not mean do not treat, people!

    I can't stand that! There are quite a few doctors at my facility who get the attitude of "Why are you calling me, they are a DNR" if we call with concerns about a patient. And if you try transferring a DNR patient to the ICU, you definitely hear it from some of the ICU nurses as well. I have had many disagreements with nursing supervisors not wanting to "give up a unit bed for a DNR." DNR patients can still get aggressive treatment and ICU care, we're just not going to do CPR if their heart stops or intubate them if they stop breathing... Glad to find some others who feel the same...
  5. PatricksRNMommy

    Errors that you caught...

    I came in one morning and got report from the night shift nurse that my patient had come in in rapid afib and was on a heparin drip and a cardizem drip. The heparin drip had started at 900 units/hr (18cc/hr) and the Cardizem at 15 mg/hr (15 cc/hr) at 6 pm. She reported that at midnight (6 hours after the heparin started), the PTT came back non-therapeutic and the heparin drip had to be increased by 200 units/hr to 1100 units/hr (22cc/hr). She said that the patients heart rate had gone down quite a bit (from the 160's down to the 50's), so she had titrated the drip down and turned it off. The patient's heart rate remained high 40's/low 50's... When I got there at 0700, the PTT came back again, even lower than the previous value and telemetry called to say the patient had a 3 second pause..... What do you think happened? Right, somehow, the previous nurse had mixed up her drips and was adjusting the cardizem instead of the heparin when her PTT's came back and turned of the heparin when the heart rate went down by mistake. I figured it out before she left and she actually wrote it up herself AND called the cardiologist and primary to inform them of her mistake. I felt bad for her, the patient was fine, but she was in tears... She was a new grad, about a month off of orientation and really had been doing a great job... The cardizem was titrated down and the heparin restarted and everything turned out OK, but it could've been BAD.....
  6. PatricksRNMommy

    Is bedside report a HIPAA violation with 2-4 patients sharing a room?

    Just being devil's advocate here, but then wouldn't almost any contact with that patient be a HIPPA violation if you are discussing with them their plan of care, ordered med/treatments, diagnosis, medical history, etc....?
  7. PatricksRNMommy

    Just wondering...

    They absolutely can and they should, IMHO. At my facility the PharmD calls the doctor for order clarifications UNLESS the original order was a telephone order written by the nurse, in which case it is the nurse's responsibilty to call and speak with the doc to clarify. Speech therapy, case management, PT, OT, and RT are able to call doctors and write orders related to their specialties as well, however not all will do so....
  8. PatricksRNMommy

    Chief Complaints

    I always find it funny when someone presents to the ER at 2 am on a Saturday with "headache x 6 months" or "foot pain x 2 years"....
  9. PatricksRNMommy

    Funniest real orders you have seen in a chart?

    "Help the patient to poop" (yes he really wrote POOP in the chart lol) And this was not an order, but something written in the MD progress notes in the chart of a patient who had been having very high blood pressures (think 220's/110's) that nursing was calling the doc about frequently (that he had been refusing to treat): "Will order Clonidine prn to treat the patient and nurses."
  10. PatricksRNMommy

    Pulse oximeter

    The end-tidal co2/pulse ox machines have an adapter that we plug into the call light system and then we set the alarms for whatever parameters we want to be notified of. It's very helpful, except when you have a patient on the end tifal co2 monitor who keeps removing their oxygen ("because it's annoying me") and their call bell is going off every 2 seconds...
  11. PatricksRNMommy

    Pulse oximeter

    On our post-ops, we wire the O2 sat and end tidal co2 monitor to the call light system and if the numbers drop too low the call light alerts us.
  12. PatricksRNMommy

    scared about to quit ...

    Talk to your manager, be honest, tell her your concerns and issues, and see what your options are.... Sometimes when you talk things out, a solution will present itself. Bottom line is that you have to do what is right for yourself as well as your child. Maybe you should start looking for another job before you quit, though (if you need to work, that is). Good luck, hope everything works out for you.
  13. PatricksRNMommy

    ER handoff report to floor

    Agreed, both are very different... Busy in their own ways, though. We have had ER nurses float to the floor and could not stand it d/t all the charting, the constant phone calls from family, doctors, cat scan, pt, ot, speech, pharmacy, lab, etc. And floor nurses that have floated to the ER that hated it because they felt like it was so fast-paced that they constantly thought they might be "missing something" with a patient. Maybe all floor nurses should have to spend a day floating to the ER and vice versa so we can better understand eachother....
  14. PatricksRNMommy

    ER handoff report to floor

    There are some fabulous ER nurses out there that I know do their best to make sure the patient is taken care of and that important information is passed on to the floor nurse, and I appreciate those nurses tremendously. I understand the push from administration to move the patients up to the floor within a certain timeframe (usually 15 or 30 minutes) which is why if the receiving nurse isn't available because she's tied up with another patient, the ER nurses know they can call my extension (I'm the charge nurse) to give a quick verbal report before the patient comes up. My problem arises when they don't do this and the patient just comes up, the room isn't ready because we didn't get report and therefore don't know what the patients needs are (suction, O2, etc.). There just needs to be more understanding both ways.... The nurse isn't always going to be ready to talk when you call, because if she is in the middle of something with a patient or doctor she can't just walk away from it. If you absolutely must get the patient up there, maybe you could ask to give report to another nurse on the floor or the charge nurse. Housekeeping can also be a big issue... As soon as a patient leaves, we put the room number in the system to be cleaned. The room is usually assigned to a new patient right away as well. Sometimes it is an hour or more before that room actually gets cleaned even if we put it in as a "STAT" clean because there is one housekeeper per floor and we often have multiple discharges at the same time... Maybe more housekeepers would help, too. Actually since I posted the original post, things have gotten alot better between my floor and the ER. Their charge nurse and I had a talk and agreed to call eachother to discuss any issues between the floors when they happen so we can come up with better ways to manage these issues. As soon as a bed is assigned, I try to look at all their labs and vitals and notes and if I feel that the admission is not appropriate for our floor, I let their charge know and if he agrees, he gets the appropriate order from the doc for a higher level of care.... As I said before, I had just had a hellacious week and was venting in the original post, not meaning to insult ER nurses in any way...:heartbeat:nurse:
  15. PatricksRNMommy

    How much IV fluid to give?

    Shouldn't this be based on a doctor's order or a writtin policy or protocol? What if the patient had an adverse reaction from being overhydrated that was unexpected and you were not covered by a policy or a doctor's order. Wouldn't this be considered practicing medicine without a license?
  16. PatricksRNMommy

    Things you'd LOVE to be able to tell patients, and get away with it.

    To the PIA VIP patients: "I don't care if you know the CEO, the President, or the Pope, I care for all my patients the same, so you need to sit down, shut up, and I will get you a newspaper when I am done taking care of the patients who treat me like a nurse and not their servant."