exp626

I look at it this way: when I'm a bedside nurse, I work for the patient. When I'm a charge nurse, I work for my coworkers...my job is to help them take care of their patients. Obviously I have other duties as a charge nurse, but patient care and safety have to come first. I work with with a couple other charge nurses who don't share that philosophy. It is a harder day when I work with a charge nurse who doesn't help as much, so I try to lead by example. Ideally, we'd all work in an environment where this role is rotated, which helps our leadership remember what it's like to be a bedside nurse! No matter what, I never complain or say anything (except in a safe place like AN!), as I don't want to start a war. Some charge nurses or team leaders are favored or friends with management, and you have no idea until it's too late!

The other day I was taking care of a patient admitted for rectal bleeding. He had a history of chronic pain and took an opiate and a separate dose of Tylenol. I called the doctor for orders for his home pain meds, and she said he can't have the Tylenol because of the bleeding. When I was reporting off to the next shift, the oncoming nurse echoed that. I have no knowledge of this and can't find any contraindication or precautions in that setting. Can someone explain this to me? Thanks!

If they have a pacemaker or preexisting left bundle branch block the EKG won't reveal anything. Several years ago a cardiologist admonished me for ordering an EKG on a pt with a pacer, saying he wouldn't sign that order.

I work on a cardiac unit, so we don't have rapid response for CP. My manager gets annoyed when we call a rapid response for anything though, which I think is an unsupportive and unsafe culture. He doesn't say much, but he'll take it out on them by never offering to develop them professionally (relief charge duties and the like). I can see how it would be taxing on the RRT to be called for every patient with CP, but what else can you do? I wouldn't want to be the nurse who doesn't follow protocol and my pt has an MI. Do you have a charge nurse or remote tele nurse you can enlist? Maybe they can help decide if you should call the RRT. The medical floors in my hospital will call the remote tele nurse or the intervention nurse. Otherwise I'd continue to call the RRT as instructed, and if they're unhappy you can (politely!) remind them that you're not cardiac trained and there's a policy for them to evaluate CP. You could also discuss this with your manager and see if you can get some education in evaluating CP...maybe it could be unit-wide education. (Giving Ntg as part of a protocol can be dangerous, for example if the patient has aortic stenosis or are on sildenafil or tadalafil it can bottom out their blood pressure, so you'll most likely never see that happen.)

...What Earthmama said. But to give you hope, let me share this: I diverted. I was able to keep my job, thank goodness. Now I've completed a contract with IPN, and I'm working in a new and wonderful job. When I interviewed, without going into details I shared that I've completed a contract with IPN. I told her because I work in a small medical community and I didn't want her to find out from someone else. She was fine with it and I presume this earned me some level of respect. I didn't grovel and made my journey a selling point. Since you haven't practiced for a bit, you may wish to take a nurse refresher course. But keep filling out those applications, something will come along! Best of luck to you!!!

Congratulations! I believe that if we're going to disclose our story, it's important to share what we've learned and how we've changed as a result. I'm so happy for you!

Surrendering your license is a drastic move you may come to regret. I would imagine getting it back will be more difficult than keeping it, and you're making the decision based on assumptions. Why don't you cooperate and find out what happens as it transpires. You need to cooperate with the powers that be...be proactive and go to them before they come looking for you. Maybe you can pay the attorney on credit?

COC stands for "chain of custody". It's a form that you may have to take to the lab when you test. I've completed a 5-year monitoring program and never once had to use one. I know someone who went to Hawaii while she was being monitored, and it was no problem. They have testing sites, and she had no problems. (I don't think she was selected to test while she was there.)

Don't forget, each step of this journey is your choice. And congratulations on reaching this next step! Best wishes

I assume you refer to political leanings, as I don't know what else it would be! If so, it's probably more related to your location than anything else. I'm a liberal, but I live in a very red district and most of the nurses I work with are very conservative. It's not fun to be in the minority, is it?! I've figured out that getting along with my coworkers is more important than espousing my views to them, so I just don't engage. I respect our opposing views and pretty much keep politics out of our discussions. If I'm around a discussion I disagree with, sometimes I'll stick around and just listen, as I learn even from people I disagree with, and I like to hear other people's opinions. If I'm not learning anything, I just excuse myself.

I'd go to Asheville NC. Close to the Appalachian Trail and demographically they're my people...liberal hippie-types. I live in a very conservative "red" area. That, and it's not too far from my family, so visits wouldn't be too hard.

There's a saying, "Home is where your family is". Those ties are important.

My stethoscope is always either in my pocket or my bag, I don't like to wear it around my neck. No one borrows my stethoscope. No one. I don't care if it offends anyone, having my scope in someone else's ears is so gross I may as well give it to them.

Here's how it works in my state: If you're being monitored for drugs, you're being monitored for anything that can be mood altering. This includes alcohol, Benadryl, NyQuil, the kind of antihistamines that come from behind the counter such as Claritin-DS, etc.

Addiction among nurses is a quiet epidemic. Very little attention is paid to this by nursing schools, so stigmas flourish. Our culture is to abandon addicted nurses. Not so many know about the mental health and addiction assistance programs available to nurses, so when nurses find themselves addicted they don't really know where to turn. And then there's the addiction itself, terrifying, horrible, secret, and shameful. Addiction isn't fun, it's all-consuming, and promises "I'll get this under control, next time". We can start changing our culture by supporting those around us. The addiction must not be tolerated, but the nurse should be given hope while recovery efforts are supported.

...and if all the comments from the previous posters didn't make you feel better, then think of this: the needle you touched the skin with was probably sterile, or at worse had the baby's own flora on it. I wouldn't worry!

That's a sweet and sad story. I'm sorry you have to move on. Sometimes it makes us feel better to help others, and maybe the comfort your patient provided you at that moment also gave her something she needed. You reminded me of something that once happened to me: I worked night shift in a busy ER. I was called to the phone to talk to a physician, and even though I was able to go almost immediately to the phone, he had already hung up and called back again. The ER doc met me as I entered the nurses station and loudly reamed me out for making the doctor on the phone wait. I was so surprised and confused that I didn't say anything as he stood there yelling at me (making the doc on the phone wait even longer). When he eventually stopped yelling at me, I was able to take the call. (I found out later the HUC had first gone looking for the wrong nurse.) This happened very near one of my rooms where parents had their baby daughter on her first birthday. The father came out after hearing all the yelling to check on me and make sure I was okay. Years later, to this day, I'm touched when I recall that. Good luck with your next job!

The ECC was the most stressful place I've ever worked. I prefer a more controlled environment. All the drama, drama, drama...Yeeeccchhhhh! (It didn't help that it was weekend nights!)

Besides the tubing being kinked or a clogged catheter, more specifically, if it's a male with bleeding, it could be a clot and may need flushing. If the catheter has been there for a while, there could be mucous or something clogging the tip and may also need flushing. If it's newer, it could also be bladder spasms...is there pain?

I've read the statement linked above. Are you licensed by the NY Dept of Education? In my state, RN's by licensed by the Dept of Health. Besides that, it's a crazy regulation. Among other confusions, I can see blood sugars getting missed under this new rule. I'd rather just do all of my own.

Congratulations on graduating with your MSN, and best of luck with your NP! That sounds like terrific advice from twoyearnurse, I'm sure everything will go great!

I traveled an hour for school and clinicals, and it wasn't bad at all. We had to be at clinicals at 0630, so I'd leave the house at 0515 or so to get there on time. I'd do it again.

The one question that I can answer is that while you're being monitored and undergoing any type of random urine drug screen (UDS) you cannot drink alcohol. I even avoid things that are made with alcohol, such as sauces, and I avoid things with poppy seeds in them. Also, unless you're told otherwise by the body who is monitoring you, don't take meds such a Benadryl, Nyquil, or any other cough and cold medication as it can result in a positive UDS. Make sure you report any prescription medications to them as well. If you come up positive, you risk being referred to more stringent monitoring, which I'm sure you don't want! Just to be safe, besides Tylenol and Motrin, don't take anything without first clearing it with them...it'll make your life much easier in the long run. The UDS process that we go through in my state is very sensitive, and some people's UDS results can be affected by caffeine (it makes mine dilute, which comes up suspicious to them). I try to go first thing in the morning when the lab opens before I've had anything but a few sips of water, and I try to make it the first void of the day. I don't say these things to scare you, but to share with you my experience of what works so you'll get out fast and without problems! Congratulations on overcoming your past and going to nursing school! Best of luck to you.

AHA doesn't teach it as part of the ACLS curriculum. Trendelenberg is an old sacred cow that's not supported by evidence, and aside from fooling the baroreceptors, it only succeeds in making patients very uncomfortable. Subee is right: it's voodoo.

Given the information you've provided, I doubt you'll be arrested for anything. This is what I think will happen: your license will be suspended and/or have conditions. If the state(s) in which you're licensed have a nurse assistance program, you'll be referred to that and enter into a contract with them in order to keep your license. Being licensed in two states complicates things. Most likely both BONs will find out things you don't want them to know. Call your malpractice insurance and/or an attorney who specializes in licensing issues STAT. Don't worry about losing this job as much as your license(s). You may be advised to refrain from practice until this gets straightened out. Best of luck to you.