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Ayvah RN

Med Surg, Specialty
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Ayvah's Latest Activity

  1. Ayvah

    An open letter to the #NursesUnite movement

    Sounds like you've got a great floor! Med surg nurses over here always have 6 patients on days, rarely 7 (during the interview I was told 4-5, rarely 6, hahahaha) and 7-8 on nights. 95% of my experience with charge nurses have been phenomenal. Most CNA/techs I've worked with have been great. I've experienced no nurse-nurse bullying. But everyone is overwhelmed. Lack of breaks is very common. People clocking out and staying late to chart is common (writeups if people stay over too much). When I would ask very experienced nurses how they do it, they tell me they are unable to sleep the night before a shift because of anxiety and they've just mastered how to look calm on the outside. People don't leave because they don't feel they can get the same salary elsewhere and they are the breadwinner of the family, husband laid off, etc. That's why it gets me so angry when certain people automatically say someone has bad time management skills or can't hack nursing without even asking the circumstances. When you have bad ratios its all about just getting through the day hoping there are no emergencies, and feeling patients are getting the bare minimum care. Med surg has been my passion but the ratios destroy the job, especially without good support (availability of an admit nurse is really big, good CNA ratios are also helpful). Getting a ratio law in place would be a huge first step.
  2. Ayvah

    An open letter to the #NursesUnite movement

    To the person who said clocking in is humiliating, being 'exempt' is not a position you want in floor nursing. That's all the more incentive for management to overburden nurses into unpaid overtime. Ruby, while I agree with a lot of your post, I am sure you aren't oblivious to the fact that there are poorly staffed floors/hospitals which make providing good or even safe care difficult, and that this is a widespread issue in part due to lack of ratio laws. (For some reason it seems Florida always comes up as really bad nurse-patient ratios, like 7-8 day shift med surg patients bad). The vast majority of nurses don't have near the experience you do, so of course you should be handling shifts better than them. Blanket statements that nurses who stay late (the price they pay for wanting to do the best they can for their patients... especially in the conditions I mentioned) just can't make it in nursing is simply not logical. Lack of mandated ratios is absolutely a nursing profession issue.
  3. As I mentioned earlier, general recommendation now is that you don't need to aspirate for insulin and heparin, but I've not seen any evidence that all other subcutaneous injections shouldn't be aspirated. edit: Here's evidence per Lippincott that other subcutaneous injections should be aspirated (pg 306): http://books.google.com/books?id=fhYoKc0bg-QC&pg=PA306v=onepage&q&f=false
  4. Here's an example of a sub-q injection that you must aspirate on, per manufacturer's protocol (step 10) "Step 10 Release the skin pinch, keeping the syringe in position. Pull back slowly on the plunger. If blood enters the syringe, this means you have entered a blood vessel. Do not inject CIMZIA. Pull the needle out and throw away the prefilled syringe and needle in a puncture-proof container. Repeat the steps to prepare for an injection using a new prefilled syringe. Do not use the same prefilled syringe. " Everyone's anatomy is different, don't assume you won't enter a blood vessel simply because its sub-q - or please show evidence to the contrary. More info: https://www.cimzia.com/at-home
  5. No you don't have to aspirate for a flu shot anymore. I would guess that in the unlikely event of it being administered IV it wouldn't really harm a person? However, this recommendation is specific towards vaccines (and for SQ I've read not to aspirate for heparin/insulin). I have aspirated blood before, from an IM injection and from a SQ injection shockingly enough(an allergy shot so I was very glad I aspirated), so will continue to aspirate non vaccines/insulin/heparin unless I see evidence otherwise.
  6. Ayvah

    My dad was a 'throw-away'

    Of course judgement is not something anyone(not just nurses) should be doing, but education is a critical part of nursing. Educating on the benefit of discussing between the patient and family on whether they would like to complete end of life papers/POA/DNR/living will/whatever is important. We discuss that with every single patient who is admitted into my hospital. The honest truth is you can die from a routine gallbladder surgery so these forms are important to discuss with patients. Educating honestly on the pathophysiology of the conditions the patient has is something nurses do every day. Educating in a straightforward manner that a patient has risk factors for x/y/z and that is why they are getting this medication or that treatment, etc. If there is something we don't know we should be honest about that too, and yes, stick with facts. When my family member was unexpectedly hospitalized as a young adult with TIAs and a heart condition which needed OHS, one doctor came in and told my family she was at risk of heart attack or stroke at any time. My family hated this doctor at first - he scared them with how he talked, and they thought him cruel because of it. However, they came to realize they liked the doctor the best because he was honest and was trying to prepare them for what may happen. Its not easy to say that a patient is very sick, but its unethical to lie or omit information to give false hope. A lot of it is in how you word it. Its one thing to say 'your family member has no chance', and its another thing to say "Your family member is very ill which is why we are closely monitoring him in the ICU. He has X condition which means Y, you have opted for treatment option Z which has potential complications ABC from that which we are monitoring for. Has the patient discussed with you his thoughts about what he would want if he should ever be in a situation like this?" Just the facts, ma'am. I've had to make the call that a family should come in to be with a patient who was tanking. Again, wording is key. You don't word it "Your family member is going to die, you need to come in now", you word it that "Your family member is not doing well, we are not sure what the outcome will be, you should come in now to be with them." Were I to wait for the doctor the patient may have been unconscious or dead before the family got there. There's no easy way to do a lot of this, but its part of our job as nurses.
  7. Ayvah

    Patient falls: What works to prevent them?

    Agreed! I have had 2 patient falls specifically because of those mats. Got to be careful with those.
  8. Faith most often connotes with religion/spirituality. Not everyone has religious or spiritual faith. The issue was that the original poster (orangepink) said, that she feels that staff who do not openly show faith are different compared to those who do. See the below quote from the OP in which she clarifies this difference as negative. __________________________ Many people feel it would compromise their faith to openly pray to a god other than the one they believe in[if they do]. If it doesn't bother you that's fine, but respect that others shouldn't have to do what they feel compromise themselves to do the job. For example, a nurse may believe that abortion goes against her religion, therefore she should not be forced to participate in it for a patient. If you would agree with that nurse's right to opt out of something that goes against her religion, why would you feel that a nurse is bad for not participating in prayer which is not of his/her religion, especially when an alternative is available? Chaplains are the experts educated in anticipating and attending to the spiritual/religious needs of the patients in a sensitive manner. Why do you feel that a nurse is 'passing the buck' by getting an expert involved to give more thorough spiritual care? Why is that not a therapeutic thing to do? See the above clarified quote by the OP as she does specifically mention that she thinks it is a bad thing. It would have been a far, far different thread if the original poster had simply asked "How do you incorporate faith into your nursing practice?" Just as you are saying that the original poster can have their views, so too can the respondents have their dissenting views. You are yelling at someone else for their opinion too you know -- just because you don't like it doesn't mean you have to hate . It is good to talk about and challenge other's perceptions.
  9. Ayvah

    The Worst Its Ever Been

    I thought that if a hospital could not meet its legally mandated nurse patient ratios(including during breaks), they were required to close beds. OP can you clarify if you are in Ca and if so, if your hospital is breaking the law?
  10. Ayvah

    The Worst Its Ever Been

    The California Nurses Association/National Nurses United has succeeded in getting state laws passed which limit the amount of patients a hospital nurse can have at one time in California. http://www.nationalnursesunited.org/issues/entry/ratios
  11. I've got a lot of respect for vets. Many of my family members are also currently serving or past vets, and that is by far not an easy job. I think military and police share a close bond with nurses. Thank you for your service, TheCareerStudent.
  12. I'm going to go out on a limb and disagree with the numerous posts of people who say that (floor)nursing is just like every other profession. I've held a half dozen other jobs besides nursing and no other job had the extremes that floor nursing has. In no other job have I gone home shaking, knowing that the lack of staffing almost killed one of my patients. And in no other job have I gone home after saving a life. Politics are, yes, in every job, but there are extreme highs and extreme lows in hospital nursing which few other jobs come close. Its not all merely venting either -- floor nursing has serious issues threatening patient health and safety which one would be foolish to pretend doesn't exist.
  13. Ayvah

    New to nursing leadership and having some difficulty

    I come from a med surg perspective so this may not all apply to the ED. It makes a big difference to morale when a person in management will occasionally work as a 'regular' nurse on the unit, especially when staffing is very bad. That way you keep 'in the know' and hold a partial status as one of the nurses, and not only just 'management'. I agree to try to tone down the "you need to do more work of xyz", and instead reword it as "you're all working hard under difficult circumstances, does anyone have any suggestions on how I can help remove obstacles in your practice so you can have more time for the patient?" That puts the focus more on the issue rather than the person. Remove the obstacles to patient care and the customer service part will naturally come with that freed up time the nurses now have. Common time waster obstacles to patient care include bogged down or double documentation and broken/missing/inadequate supplies or meds. Can any of these be streamlined by working with SPD/Informatics? Can the volunteer department be utilized to do things like stock clean rooms and keep the refrigerator for patient food stocked? If the RN staff is low, can there be extra float techs or secretaries allotted to help relieve nurses of call lights/order entry? Can the unit secretary be crossed trained as a tech to help with patient care as needed? Good luck! It sounds like your heart is in the right place.
  14. Ayvah

    I hate what's happening to nursing...

    alaine, I am curious, are you management or do you actually work on the floor, and how long? As Jan mentioned, there are many reasons that people are upset at scripting. A big reason is that a common script pushed onto staff is "I have time", which is a lie the majority of the time. I'd like to know your rationale as to why being asked to lie to my patients shouldn't be insulting? The other reason is because many times, more emphasis seems to be placed on hourly rounding, scripting, and other customer service "fluff" than on the patient's actual health. You don't have to travel far on this form to find the examples. I don't need to round on a 25 year old walkie talkie appy and ask him if he has all his P's taken care of every single hour. That's time away from my unstable patients who really need me at the bedside. I also shouldn't have to be fearful of a write up because I'm coding someone and miss my hourly round on that appy. Making cookies or toast for patients takes me away from contacting the doctor about lab results that are trending towards dangerous, keeping tight control on my patient's pain, or a myriad of other interventions that actually mean something to the patient's health and well being which there's barely time to do in the first place. Another example is that my hospital stopped paying for ACLS for med-surg and instead started paying for staff to go to a customer service retreat. When you have customer service meaning more to management than actual patient health, that's when the nurses get up in arms.
  15. Ayvah

    To strike or not to strike?

    CNA(NNU) HAS made huge change in places like California. Don't discount the possibilities.