wifewillis

Please e-mail me at phillipswillis.sarah at gmail dot com. Would love to see what you have to share and have someone to discuss DD nursing stuff with!

I always need ideas! I created a form for the house managers to guide them through a weekly audit of the MARs and meds, but the nursing supervisor hasn't introduced in to the company yet. She keeps planning to at our operations meetings, but it keeps getting left off the agenda. One factor that we cannot control is our pharmacy, and they've been giving us a lot of problems lately. Consumers will run out of meds, and the pharmacy will not have a correct count on prescription refills, etc. It's a mess... But we do what we can. Any suggestions you can give to me would be greatly appreciated. What kind of company/facility do you work for? I have been in contact with the admin for the DDNA Chapters, and she has suggested that I attend the conference in Orlando to attend the leadership meeting. As far as gathering interest, I have a couple of nursing students telling their classes, and I know of one instructor who will be passing the information along to hers. While I think that's fabulous, I would love to find more seasoned nurses. I thought of creating some sort of flyer to fax out to other group home companies like ours, but I don't know if that would be appropriate. There aren't any forums for DD nurses in AL that I'm aware of...

I'm looking into starting an Alabama chapter for DD Nurses through the DDNA. As I work in a company with only four nurses, I'd like to know if there is any interest outside of my company. I've never done anything like this before, aside from a community service group in high school once, and obviously that's completely different. Any suggestions?

It went well! After I applied to the ABN for my license/approval to take NCLEX, I received a call from ABN notifying me that the board would need to approve my credits, since Excelsior is not an accredited school in Alabama. I was asked to submit my LPN college transcript, by ADN college transcript, a list of my LPN work experience (like a resume), and proof from my employer that I had worked for them with my LPN license. I submitted the paperwork, and then I just had to wait for the ABN board meeting. The meeting was held on 11/14, and they notified me that very day of their approval. I received my NCLEX registration paperwork within about three days. It wasn't as horrible as I had thought it would be.

I'm a MAS (Medication Administration Supervisor) at a company that runs multiple group homes for intellectually disabled consumers. I manage the medical care of 35 consumers. This includes instructing the group home staff to give PRN medications (they administer scheduled medications also), be available to take calls from the staff in the group home in case of emergencies, etc. It's run under the Nurse Delegation Program. The biggest problem that I have come across as a MAS Nurse is trying to prevent medication errors. No matter what I do, the staff in the home just cannot get a grasp on the whole medication administration thing. Because I don't work in the homes directly, I only end up reviewing the MARs at the end of the month, unless a medication is changed. I have decided that I would like to begin directing the staff to do medication audits on 3rd shift. I was hoping to find a form online to use as an example when I present this suggestion to the administration, but I'm not coming up with any examples. What do you other nursing administrators use to detect and prevent medication errors?

Her creatinine and BUN were slightly elevated, but they became normal after fluids were replaced. I was shocked that she didn't have any renal impairment -- if not before, then secondary to this event. I have 30+ clients whose medical care I manage. I generally am not able to go to all appointments; but I'll make time for the ones that I intend to question physician's orders, etc. In this case, I didn't think it was necessary to go, because her only symptom was fatigue and her vital signs and head-to-toe were all WNL. (I assessed her myself the day before we decided to send her to urgent care.) Since then, I have decided that if the urgent care is necessary -- on the weekends and when primary physicians are out of the office -- I will either be accompanying the patient or, at least, sending a list of tests that need to be run (ie: labs, x-rays, etc.). I decided to take another patient -- also experiencing fatigue and unable to verbalize her needs -- to the urgent care center only days after this incident. This time I accompanied the house manager and the patient. Prior to deciding to take her, I was watching her eat lunch, and she coughed just slightly while she was drinking her milk. (Light bulb goes off in head. "Aha! Aspiration pneumonia!") Her primary physician's office was closed for the week, so we had to take her somewhere. I do not like sending my patients to the ER unless it is absolutely necessary. The NP at the urgent care center listened to her lungs and stated that they sounded clear. I pushed her to order a CXR any way -- "Just in case..." -- and she accommodated. The CXR showed RLL infiltrate! So, from now on, I go with my gut... In the first scenario, though, I had no idea what was going on. As we were taking her to the ER, I suspected UTI (and was correct), but I had no idea that her blood sugar was so high.

I finally addressed that question with the NP who was involved in her care, and she told me that all of her enzymes were good, and her CT scan did not show any abnormalities.

I want to know your thoughts on this scenario: A pt who is normally cognitively impaired starts having fatigue. She is taken to a walk-in clinic, where they swab her for strep (by the way:no fever, elevated pulse, or elevated blood pressure). Strep is negative. They send her home on antibiotics. She is taken to the ER a couple of days later when she is unable to stand without assistance -- at that point, it is obvious that there is something really wrong. There had been no symptoms besides the fatigue previously. (By the way, the pt is non-verbal.) At the ER, they do a CMP, and her blood glucose level is 1400. (SERIOUSLY.) She had no prior history of diabetes, and her blood sugar was last checked 6 months before this incident. It was well WNL at that time. She has a history of HTN, but it is well-controlled with medications. So... My first thoughts are: Does she have pancreatic cancer? After they began to get her blood sugar under control (this physician's idea of well-controlled BS is in the 300s, apparently), her potassium started dropping (I assume from all of the insulin). I'm a little frustrated with the fact that they are not trying to find the cause of the elevated blood sugar but just assume that she is now a diabetic. Have you known for a pt to have a blood sugar that high out of nowhere and it just be her having diabetes? I know I'm not wording this correctly, but I currently battling with a bit of frustration. I'm not working in the hospital where she is located (I have recent experience in acute hospital care, though), but I manage her medical care at her group home. I just wanted to know what other nurse's thoughts were on this issue.

Are there any Excelsior graduates who have taken their NCLEX in AL recently? I see that the most recent post on this topic was in 2009. I am attempting to finish my theory exams by the end of the month and then plan to take the FCCA Jan-March. Would like to pick up a cancelation for CPNE to take it ASAP. With all this said, I'd like to know if I should plan to look for a job in TN. :-(