quickkarma

Thank you for the replies. I agree with it all.

REPLY: It is coming through nursing management/nurse educator. And I've tried to tell them this isn't acceptable. We cannot spend our time reading notes and getting things ordered by paging it out and notifying the hospitalist every evening for every patient. Day shift often misses this note-to-order mis-alignment. And yes, I page things out frequently related to this situation. It is just ongoing...everyday. I imagine the NOC hospitalists are annoyed with this on-going state of affairs operation.

Thanks for replies. This sort of thing happens every day. It has been brought up to nursing management. They expect us to read notes and follow through by, basically doing the MD's job. And on evenings or nights, we then page the hospitalist and tell them... neph/cards/pulm/etc note says this but there are no orders in for it. Nurses are expected to read provider notes and make sure orders correspond to what she/he has written in their note. HERE IS HOW IT IS HANDLED: 1) Some nurses just place the order, literally. ? Again, I am not talking VO/TO. I'm referring to the note. 2) Some nurses will page it out and tell the hospitalist what they need according to what they read. This is what I do and I note it with an FYI. And 3) my favorite... some nurses are like, "This is ***ing bull-***. I don't have time to read notes and hold your ***ing hand. Order your own damn ***." ? It's truly ***ed up. But this is the honest truth. I am sorry for my language. I keep telling my co-workers that this isn't normal and that other healthcare systems, the providers place their orders according to their notes/plan. I come onto my shift all the time and read a note and see that xyz was never done because it was never ordered. Sometimes I'll ask the previous nurse and they say, "Oh yeah, I didn't have time to read notes." Totally legit response, really. When something goes down. I will not have nursing management's back. This I know. But does it hold up in court....the providers note said this and why didn't you question it? Well because I never read it, because I had no time to read it.

I am interested in learning if other organizations operate this way. Nurses where I work are expected to read the notes that MDs write and then go about getting orders entered properly. This often happens in the organization where I work. An MD writes the plan at the end of their note; but does not follow through with any orders to carry out that plan. Nurses then will read the notes, and have to decipher how to go about the plan. Often several hours later (when the next nurse comes on and has a minute to read the note), they see that "xyz" is in the plan. Again this is often never placed in any of the "orders." Examples are: Plan: stop dilt and switch to oral; stop BB and switch to X. RHC tomorrow. Angio tomorrow. Maintain electrolytes above x. As you can see, these are orders nurses cannot enter outside of say, the standard protocol orders. But I'm not referring to any orders nurse have the scope of practice to enter. Some MDs are worse than others. And some ALWAYS enter their orders that correlate with their plan. There are times when we hit the floor running and we don't read notes until 4 hours into the shift. Please be honest in your responses. I'm also curious if something happened, does a provider's note hold any weight in that the nurse is responsible if a med wasn't stopped, held, ect., when there are no actual orders. Thank you!!

Thank you for your response-this is helpful information! I just started a new job as a licensed school nurse; coming in at the peak of covid has not been fun, but I love working with the kids. (I do keep asking myself why I left my good paying job? but I know why?) I do not live in a compact state, but I know my state is considering it. It would make camp nursing out of state much easier for certain. My kids are grown but I still have so much energy.

I have seen it in home care. I sure do appreciate the perspective of our older nurses who have seen the changes in health care through the years! I would bring my own gloves for peri-care if none are provided. I live in a cold state and regularly have dry, cracked skin with small skin breaks. In no way am I going to do peri care without gloves. Protection is for both sides.

?After 18 years of experience, she has earned the right to use the word poop on Christmas Eve!? "Oh poop, I'm working another holiday away from my family." Like another said, if this manager has the time to write her up for this, the rest of the unit must be running like clockwork.

I remembered another: in mid 2020-at the heart of xxxx-show, I charted that a pt's sp cath output looked like a Tequila Sunrise in a bag. No one said anything to me. Chart what you see; chart what you hear. At least you didn't say, nasty, disgusting, poop.

I have been sick with a cold for 6 days. I am enjoying reading these posts! I was scolded once for documenting that a properly staffed shift would have prevented this fall. Oh man was the DON pissed. What was in place before the fall; what was in place after? All I could muster up back then was the terrible staffing ratios and not enough nursing assistants for the acuity. Oh well. I never did that again.

I just want to say that I understand, truly. I've been a nurse for 7 years. I am strangely burned out on caring. I just accepted a school nurse job & I hope it brings me more sanity. Have you considered pediatric home care? One kiddo at a time, pace is slower, but you gain a good skill set. Pay is decent. And have you actually applied to any school nurse positions? OR, are you assuming you couldn't get offered an interview because of lack of experience? I'm just curious. Mental health is important. Find a way to take care of yourself fully no matter what job you choose. I also agree that you should maintain your license. Best to you.

Hello! I'm curious how you all got started in camp nursing? Start in your own state? Part time Summer gig along side another job? Did you obtain licenses in other states? Insight into this? Is it easy to get hired for the first camp nurse job? Do you travel to various jobs year round and come home for periods of time? I had an epiphany this morning that this is what I want and should be doing while I still can! I'll spare you the details there. I'm curious on other's perspective in this field. Did you leave/come back? Been doing it for years? Opinions and thoughts are all welcome. My kids are grown, I'm very active & love the outdoors. I currently cover our insurance but can switch over to my husbands for next year if I pursue this. Thanks for your thoughts!

Please explain this further. Otherwise, No. The non-seroconversion causes the infection, or the rate of that particular person's immune response causes this. NOTE: Pertussis IgM and IgA antibodies will usually only be present a short time after vaccination or infection. Otherwise, immune response happens when the message gets sent to the lymph. The difference in people's immune system function determines infection. People are infected and show no signs of infection, but can still shed. Macrophages, neutrophils, natural killer cells, dendritic, Tcells (in lymph), Bcells (lymph). OMG, the list goes on. Our immune systems are complicated. Example: CD4+ T cells are a major T cell subset that plays a central role in immune system function when naive CD4+ T cells differentiate into effector and/or memory cells after encountering their cognate antigen via antigen-presenting cells (APCs). The phenotypes of effector CD4+ T cells differ depending on the stimulating conditions and can be categorized into various lineages. In the lungs, DCs bridge innate and adaptive immunity, and depending on context, they also induce various CD4+ T cell responses to infectious agents. During steady state, the lung contains two major subsets of CD11chi conventional ©DCs (CD103− CD11b+ cells in the lamina propria and CD103+CD11b− cells in the epithelial layer). (C&P that!) I'm writing this because parents are told, "As long as your family members have all had their DPT shot, your baby will be fine. "Cocoon affect." BS, make them cover their cough. Ask them not to cough. Ask them to wash their hands. Pertussis is extremely contagious and will continue to be contagious even if every single person-all 7billion of us were vaccinated! To all the people who are asked to re-vaccinate themselves because their titers are low, tell them your immune response still resides in your B memory cells located in your lymph. Because it does. My apology if this upsets people but this is all way more complicated than anyone realizes. And six injections is not the answer. Not at all. I will stop now.

Exactly. But the same holds true. I believe TEACHING is part of the solution. Masks should be sent home with all new borns and parents should be told to wear one or ask people to wear one if they are coughing. You can immunize all you want; your body is still going to mount an immune response and shed. Why don't people know this? Parents need to use precaution and protect and take care of their babies and themselves and taught the benefits of breast feeding or pumping. Their baby did not get pertussis because Granny didn't get her booster shot.

This is a minor rant, some facts, and mostly on topic: I think it is important to remember Biology and immune response. Memory B cells live in the lymphatic system, and live a long time. Memory B cells cannot be detected by examining your blood, i.e., blood titers. Remember, that's why tetorifice booster shots are needed every 10 years because by the time the Memory B cells got the message to make antibodies (in the blood) you'd be dead because your diaphragm muscle would lock up/contract/freeze. I don't think it's necessary to continue to vaccinate adults due to low titers for other diseases. And probably not healthy. Vaccination doesn't eradicate the disease. I know you all know this! It assists with mounting an immune response quicker. The diseases are still very present. And every person, depending on their own body, their health, their nutrition, their sleep quality/quantity, stress level affects how their body will respond to any incoming pathogen. It just seems like everyone has forgotten this. Two children with the same vaccinations will not have the same immune response when that pathogen is reintroduced. Take pertussis for example: Kid A might have congestion and minor cough for 3 days, Kid B will cough for two weeks and feel lousy. Both kids-same age-same vaccination schedule. Parents of both say, "my kid has cold." Well, they could have been exposed to pertussis. (I know this from experience BTW) In other words, pertussis is far more common than people realize/believe/think/understand. It's still out there, everywhere. We take care of ourselves and our children differently, we have different body chemistry, different lifestyles, activities, etc., that help or hinder our immune system. Last, the current plan to end federally funded school breakfast and lunch programs....Mind blowing. The government will pay to inject them, but won't pay for a basic need such as nutrition.

I'm curious how many facilities out there have the nurses carry the cordless land-line phone and answer calls coming in during their entire shift through med pass, cares, etc. One can imagine how many calls come in in a day. It is however split between several of us, it seems only a few will actually answer it. Thoughts please. Just wondering if this is common.

Well, interestingly, I logged in to ask a similar question. I think this job of yours sounds exhausting and sounds like a heavy load to me. I've got day shift 1:15 ratio, sub acute TCU where the cart nurses handle all incoming phone calls during their med pass, along with all other nursing cares. After reading your post, mine doesn't seem so bad.

I graduated 2 years ago and a fellow nursing peer was 57. She is working and making a nice salary with an ADN! She is only a few years younger than you-then by the time you would graduate. Yes, it might depend on how quickly you get into your program. But I say, go for it! And I have to say I believe it helps to be extra healthy. Body, mind, soul. You're only as old as you feel. Jobs are out there.

Hello all: I am in the process of switching jobs to a Transitional care Unit after a couple of years working in private duty nursing. I have had non-nursing, fast paced jobs within facilities in recent years, so am not too concerned about the pace. I am, however, concerned about this particular facility after just one "shadowing" of the RN. I am being offered three "shadow" days and then I'm on my own. Ratio is 1:16 with 2 NARs and 1 TMA. I think this is reasonable, but training is poor from where I am coming from. And lack of "protocols" and reasonable "systems" in place has me majorly concerned. It appears that, well, they are not defined very well. My gut is saying not to move on this job switch because of what I saw after just one shift. (I haven't had much in the way of job offers from other facilities with just RN-PDN experience) Questions if anyone has some insight please: 1) Is this 3 shadow days the norm? 2) Is sloppy, late charting more common than I realize? 3) Am I unreasonable with expectations on protocols and follow up? 4) Is it common for the nurse to leave the unit for breaks (and I mean leave-go 3 floors down) leaving no other nurse whatsoever on that floor/ unit? She would need to be called back up from break should a nurse be needed. 5) What does training look like for a new job like this? I understand it is probably different everywhere, but even a baseline of some sort would help me decide. Thanks!

I am curious of others opinions on private duty nursing and the extensive boundary crossing that is seen in this type of setting. I've seen it all, gifts, vacationing together, planned lunches, visiting while on maternity leave. Both sides-family and nurse. Sometimes nurse is on duty, sometimes not. Just bizarre. I do understand the need to share phone numbers because communication is more accurate without a middle-man. But Ive heard of nurses bringing in loads of baby gifts after a minor disagreement between client's family and nurse. Yikes. I just try to follow the rules, but some of these families seem offended that I'm simply cordial and don't become their close friend. And then it becomes awkward. I'm not in this job to expand my friend list! The latest family, which I thought were the most "normal" yet, have insisted it's impossible to not be close with the nurse. I just don't agree. I am, however, hoping and planning on switching out of this type of nursing soon. At any rate, looking for thoughts and opinions here. Am I too conservative? Is this as common as it appears to be?? Thanks...

I think/believe this is the lymphatic system moving through and clearing debris. A good sweaty work out would probably resolve these strange vibrations. I practice yoga regularly-twists, compressions, breath work, etc., and the only time I've felt this was while in nursing school when I had no time for myself! I was so out of shape, never worked out, and felt these strange vibrations quite frequently. Otherwise, it was caused by anxiety?!

Thank you for this post. I usually just read, but I needed to thank you. I'm dealing with some situations right now and this article posted to my email at exactly when I needed to see it.

"There are a few glitches. Apparently it doesn't understand homophones. Could you explain the difference between ilium and ileum?"

"Unfortunately, they haven't perfected critical thinking. But, WOW, they are fast on the EHR! Would you like a demonstration?"

"And I think the best part is, she (it) cannot roll her eyes or frown, like you are doing right now. Body language is so over-rated."

"I'm sorry Rachel. This is what our staffing agency sent! You will have to do your best with GoogleNurse14! I'm not even sure what she knows. Good luck."