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wheeliesurfer's Latest Activity

  1. wheeliesurfer

    IVP vs Drip

    I know most NPAs cover flushing IV lines, so I would assume (bad thing, I know) that diluting 1mL IVP into a 10mL flush is well within scope of practice. However, fluids require a providers order, so without the providers consent to dilute that 1mL (let's say it is Dilaudid) into a 50mL bag of NS, I would be wary that I would be changing an order and "practicing without a license". IV orders need to have the med/fluid requested, the dosage/amount, and the rate or amount of time to infuse. If the MD doesn't know this, then the pharmacy can add what is required (let's say the MD ordered 1g Vanco IV, nothing else). When the pharmacist fills the request they can put in the dosage/VTBI (volume to be infused) and the rate (or amount of time over which to infuse). What the provider originally wrote as 1g Vanco IV, now becomes 1g Vanco/250mL NS infuse over 90 min. On the other hand, if I got an order for 1L 0.45% NS with 10mEq K+ without any other information, I would NEVER use my "nursing judgement" to figure out the rate and duration of the infusion!! This patient could have so many things going on that if I infuse it too fast, I could stop their heart, put them in fluid overload, etc. I need to clarify the order with the provider and see if they want it running wide open, if they want it over 1 or 2 hours, or if they want it on a pump for a longer duration of time. If there was an adverse event with this patient and I had used my "nursing judgement" to just let it run, I could possibly be pulled into court. I want to cover my rear first and foremost. It never hurts to ask the provider if they are okay with you adding the med to a 50mL bag of NS. If they say yes, GREAT, if they say no...you could have just stopped a potential lawsuit or board sanctions for practicing medicine without a license. Just my .02.
  2. wheeliesurfer

    Advice for going to nursing school

    My advice is to click on the "Students" tab in the main banner at the top of every page. Read through the Student forums and see what questions have already been asked and answered there. Once you have a better defined question to ask, instead of the VERY BROAD topic of "Advice for going to nursing school," feel free to ask that narrower question and someone might be able to give you a better answer. Any answers given now are unlikely to be very useful since no one can read your mind and know what aspect of nursing education you want information about. Pre-nursing (nursing school pre-requisites), nursing school applications, nursing school admission, nursing school lectures, labs or clinicals, etc. Please narrow it down so your question can elicit more appropriate answers.
  3. wheeliesurfer

    Telephone interview --> in person

    They aren't gonna want you so badly that they chase you/hunt you down for a face-to-face interview. If they hunted me down, that would scare me just as much as getting hired based solely on a phone interview! As a job applicant it is YOUR job to follow up with them if you haven't heard back about a second interview request. It is always good to follow up anyways, as it lets them know you are truly interested in a job at their facility/on their unit. I would send a thank-you card to the person who interviewed you, and also follow up by phone if you don't hear from them in a timely manner. Good luck!
  4. wheeliesurfer

    Getting a PRN job in cardiac with Parralon?

    In my opinion, any offer letter that you are required to sign as a "contract" for employment should have a few basic things covered. It should list your status (full time, part time or PRN), should cover your guaranteed base salary when you are called in to work, should detail any benefits that you are entitled to as an employee (insurance, retirement, vacation, PTO, etc...some won't apply if you are hired as PRN), if they have promised you money to keep your license current, pay for conferences or CEUs, provide an annual scrub allowance, etc. that should also be listed. Remember that this is not a one sided contract meant just to cover the employers rear. It also needs to cover you so that once you start the employer can't pull a bait and switch and completely go back on their word. Let's think about it in the terms of a lease. You want to rent a two bedroom two bathroom apartment in a newly constructed development near your favorite school district for the kids. The property management company also manages several other apartment complexes in your county. You are shown a GORGEOUS two bed two bath apartment in the new complex and told that you can rent an apartment for $850 a month, just sign on this line. You think, that sounds amazing! It is by the schools I want my kids to attend, it has everything I was looking for and is a steal price wise, so you sign. Then.....the other shoe falls. You are given a map with directions to another apartment complex in the next town that is located in a different school district. The leasing agent tells you that your new keys will be given to you in the rental office located in the other complex. You go to the complex to find out the development is about 50 years old and in need of substantial repairs. You walk to your new unit to discover that it is a one bedroom one bathroom unit, so you don't have a room for your kids. You think to yourself, how did this happen?!? They showed me an amazing, new two bed two bath and said I could rent it for $850! You think "I even signed the papers for it!" You go back to the rental agreement and read the fine print you didn't bother to read previously that says that you are not guaranteed a certain apartment, or even a certain complex, you are just guaranteed that you can rent AN apartment for $850 a month and can be sent to any complex that has a vacancy. The property management company fulfilled their end of the contract by renting AN apartment to you, but they did not give YOU any protection in the contract by guaranteeing that it would be in the new development, that it would be a two bed two bath, etc. and now you are STUCK! If you really wanna work PRN for this agency then tell them you won't sign until your hourly rate is included in the job offer. If they are unwilling to budge, it is probably because they are gonna do something shady down the line. Keep looking around for another agency that won't be so sneaky in their practices. Good luck!
  5. wheeliesurfer

    NCLEX-RN in California

    I'm sorry to say, but the BON in California is rejecting ALL applications for ATT to sit for the NCLEX-RN where there are issues with concurrency in the RN program completed. It doesn't just cover Philipine grads, it would even affect US grads if their theory and clinical studies were not taken concurrently (part of the reason CA doesn't accept Excelsior grads). The BON will likely give you three choices: 1) Attend an accredited nursing program in California to make up your deficiencies (only a couple people have been able to find a school to accept them for this) 2) If you can't find a college willing to accept you just for your deficiencies you can repeat the whole RN program (If you really want to be an RN in CA this is likely the route to allow you to sit for NCLEX fastest, especially because after 3 years if your application is not complete, it will be discarded and you will have to apply for ATT again, have new transcripts sent, etc) OR 3) Get your ATT to test for the NCLEX-LVN under equivalent education since the CA BVNPT is not as strict about concurrency. Good of luck and welcome back to Cali!
  6. wheeliesurfer

    Dealing with drug seekers without alienating them

    Even documented "drug seekers" are prone to accidents that may cause acute pain. As professionals one must be objective in their treatment of patients. I know that as a chronic pain patient myself, if I am not on a long acting opioid and am solely relying on breakthrough pain meds, that I am more likely to need to set an alarm for my next PRN dose. This could be for one of two reasons, neither of which include the intention of "getting high". First, if I am having an acute exacerbation of my chronic pain, in order to get a "jump" on the pain to bring it down to a manageable level I might need several "scheduled/timed" PRN doses before I can start extending the length of time between doses. Second, for someone who is on a long acting med that is dc'd upon admission for faster working, shorter acting meds they might require doses at evenly spaced times to keep from having highs and lows in their pain control because of the differing half lives of the different medications, bioavailability and changes in equianalgesic dosing, etc. I know that if I were to be admitted and a nurse thought I was "seeking" and got my attending to decrease my pain management regimen, I would be way less than happy since my pain is managed by a pain specialist and I am on a set amount of medication to adequately control my pain. Mistaking me being TIRED for over sedated and thus getting my meds decreased would get you a complaint to your charge and I would go up the chain of command as needed. My attending would be paged and I would likely request for him/her to have the pain team come see me instead so that someone competent to treat chronic pain could control that part of my care.
  7. wheeliesurfer

    best nclex prep

    Is this a question? There is no "one size fits all" answer. Each prep has positives and negatives and what you use will be based on what you need help on most. If you need prioritization, delegation and assessment help it will probably be LaCharity, if you need other types of help other resources will help you. Do a search here on AN and read through the THOUSANDS of NCLEX exam resource threads. That will at least give you a starting point.
  8. wheeliesurfer

    Deciding what to give to the patient who gets everything

    GrnTea and Heather basically took the words right out of my mouth! Thanks for the great posts :)
  9. wheeliesurfer

    When to piggyback This

    From personal experience I prefer Vanco to be delivered over at least two hours if infusing into a PIV instead of a central line because it is so harsh on the veins. If a patient has Vanco running through PIV and is complaining of pain ask the consulting MD if you can infuse over a longer period of time. Also check the site frequently to insure it is still patent. I had mine infiltrate and ended up with soft tissue damage. Also, I've usually seen Zosyn dosed over four hours unless it is a pre op or renal pt.
  10. wheeliesurfer

    Pierce County, Washington nurses suing over mandatory flu shots

    There are egg free preparations of the vaccine as well as vaccines that are certified latex free. At the facility I am at there is an ancillary staff member who is required to wear a mask because of a near fatal reaction to what they assume is a preservative since they are NOT allergic to eggs. The hospital should allow for medical exemptions and religious exemptions when documented by a physician/provider or religious leader and instead enforce wearing a mask during any and all patient interactions.
  11. wheeliesurfer

    Do you clean bedpans or throw them out?

    I also use chux to line a wash basin for patients with emesis (since we all know actual emesis basins are useless!). That way if they get sick again before the basin is emptied, washed, dried and back at bedside it doesn't take as long to deal with. You just empty and dispose of the chux and place a new chux inside. I learned that from a nurse who worked in acute rehab with SCI patients.
  12. wheeliesurfer

    Med error during a code

    Correct me if I am wrong, but in this type of a code situation in the ED wouldn't scanning the med be kind of pointless since this is not a med that was previously ordered for the patient? Sure, you could scan the med, but if all you looked at again was the first two letters you still wouldn't notice the error, and the computer wouldn't alert you to the error because it was not a previously ordered drug for the patient (and the patient likely doesn't have an EMR profile yet?)?
  13. wheeliesurfer

    Choosing the RIGHT Malpractice Ins

    Per the TOS we are not able to give legal advice, and telling you which insurance is the best fit for you would be a breach of TOS. Also, you agreed not to ASK for legal advice. It sounds like you have done a good amount of research into what you want/need out of an insurance plan, so why not call the carriers people have mentioned and ask them the questions you have posed here. Only YOU know what is going to be a good fit for YOU. Good luck and Congratulations nurse!
  14. wheeliesurfer

    Any Psych NP's with advice???

    NP's often DO have the ability/knowledge to do psychotherapy, but their ability to do so on a regular basis is hindered by the setting and reimbursement requirements of where they work. If you work in the OP setting, the Psychiatrist you work for wants you to see as many patients as possible in as short a time as possible because they make money based on the number of patients they see (aka how many times they can bill insurance). If you work in the inpatient setting, you have a certain number of patients that are assigned to you, and you are required to round on them daily plus do admits and discharges. Admits are when you are most likely to form a relationship with your patient, get to know their background, health history, etc. Sure, you will have a small amount of time to get to know your patients when you visit them daily, but you are only reimbursed for a hospital follow up visit, not for doing psychotherapy (there are other inpatient providers whose job that is). Your goal of owning your own practice one day, I'm sorry to say is a pipe dream, unless you are not in it for the money (read, you are willing to possibly take a loss). When you bill insurance, you bill based on ICD-9 (or ICD-10) codes (diagnosis codes) as well as CPT codes (procedural/billing codes). A CPT code might allow you say, a 30-45 minute (60 min max usually) consultation and a 15-30 minute follow up based on the complexity of the case. Granted, I am not a PMHNP, but I doubt that you are able to bill for a follow up and psychotherapy. Also, it makes very little sense for you to go through a PMHNP program as well as a PhD. program in psychology when you could just as easily refer your patients to psychotherapy and do a small amount of "talk therapy" with the patient while you are doing a follow up/med check/med refill. You would be spending A LOT of money on schooling, with not a lot of return on your investment. But then again, thats just my .02
  15. wheeliesurfer

    Moving to california

    Be prepared to work "any" job for a LONG time!! In that area there are several world class magnet hospitals that REQUIRE BSNs and the area is COMPLETELY saturated!! You would be lucky to find a LTC/SNF that was hiring, but even that is doubtful. Be prepared to apply for HUNDREDS of positions and be granted few, if any interviews. Not to be mean, but I hope that you have A LOT of money saved up for living expenses while you look for work (any work, as the employment market around there is very crummy right now) and/or have a spouse/significant other with a well paying job lined up already that you can fall back on while you look for work. I live approx. an hour from "the city" and even out here it is hard to find a job!
  16. wheeliesurfer

    Translator for patients

    As long as the LPN or CNA is proficient at the language in question (more than knowing how to ask where the bathroom is and ask to order food, etc) then there should be no problem with that. I would not ask a janitor or someone to translate however. If there is no one on your floor that speaks the needed language your hospital is probably contracted with a medical translation service who should be able to supply a translator for the language needed and possibly even American Sign Language if you have access to a video relay system such as Skype. Anyways, I see no problem with another care provider (LPN/CNA) translating bc they are bound by HIPAA. The language translation services are also bound by privacy laws. Main thing is to supply the necessary teaching in a way your patient understands and to protect their privacy in the meantime.