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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

    How much info can a roommate get?

    In my opinion the immunocompromised (possibly neutropenic) cancer patient should have been placed in a private room right at admission or onset of immune system dysfunction/neutropenia. This would help place a barrier so that if a patient in a semi-private room becomes infectious after admission, the cancer patient is not accidentally exposed. I think this was a bed control issue with improper patient placement.
  7. wheeliesurfer

    Nurse Clueless

    Is THAT why my fries were so difficult to chew at lunch the other day?!?
  8. wheeliesurfer

    HELP!!! Rapidly Progressing Numbness

    Sorry, as per terms of service that you agreed to upon registration we are unable to provide medical advice. We are also not qualified to make a diagnosis and it would not be good to speculate anything with only the facts presented here. Good luck to your cousin in this trying time.
  9. wheeliesurfer

    Criminal Charge

    As well as starting to attend AA meetings ASAP, I would add that you should seek out the help of a therapist and possibly anger management. Since I don't know what began the incident I don't know if anger management would be recommended, but I'm assuming that with assault and resisting that it wouldn't hurt! Good luck! Seek legal counsel with someone who has experience working with the BON.
  10. wheeliesurfer

    Wound care at your facility

    I've seen PT do it in an outpatient setting. I believe that PTs are trained in at least basic wound care in school. After I had knee surgery previously it was PT that did the regular dressing changes. This facility treated patients who had venous stasis ulcers as a result of DM, and concurrent lymphedema. They would put them in a sterilized whirlpool bath, clean the wounds, put any prescribed ointments/wet-dry, etc on and then dress and or wrap them. Sometimes this process took the PT an extended period of time.
  11. wheeliesurfer

    Forced to resign, new grad with only 1 year of experinece.

    Newboy, I have attached Ruby Vee's first post in this thread for your convenience. I believe that this post was well thought out, nicely worded and not condescending. She explained the difference in the NM's attitude from interview to write up and why the attitude likely changed, as well as how the NM probably viewed the OP's "explanation/talkativeness" during counseling instead of just acknowledging the mistake and promising to learn from it and not repeat it. She kindly suggested that there may be cultural differences between the OP's native country and here in the states. I don't see any problem with this post. Of course when people get defensive and refuse to admit that their mistakes could have dire consequences for the patients involved, some will get assertive for the good of future patients. A nurse who makes repeated critical mistakes and does not learn from them WILL eventually harm a patient. We don't need to sugar coat and hand hold these nurses. We need to help them learn to correct the problems that led to the error so that they improve their future practice. That is the kind, compassionate thing to to. Giving virtual (((hugs))) and saying everything will be okay does not fix the root problem.
  12. wheeliesurfer

    Forced to resign, new grad with only 1 year of experinece.

    And you are full of sunshine and daisies. No snark or nastiness to be found! I would be honored to have Ruby Vee as my nurse or coworker. She is very knowledgeable and helpful, and when you are open to learning and accepting of constructive criticism, the information she is willing to share is very valuable. She may be a COB (self admitted), but is definitely NOT bitter. Her information has blessed me, and I'm sure many others. We are lucky to have her around!
  13. wheeliesurfer

    New nurse

    I fully believe that you have less face time (and code browns) than you would in a different position. The problem that I have with NOADLs posts is that he refuses to do ADLs and will "pawn off" the job to other staff or just plain hide to keep from doing them. A good leader will step in to help their team when things are hard and is not afraid to show that they have (and will) do the "icky" jobs. I think that everyone needs to work together for the good of the patients, and if that means that the charge, nurse manager or DON need to get their hands dirty or take their own patients once in a while it is alright. It also shows the regular floor nurses that they don't see themselves as "better than" a general bedside nurse. Just my .02
  14. wheeliesurfer

    New nurse

    NOADLs works in a fantasy unit where HE does not (and admittedly WILL NOT) clean up BM, ambulate patients to the restroom or do other ADL cares. The actual reality is that the majority of nurses (charge nurses included) all help patients with ADLs, to/from the restroom and clean up BMs when necessary. NOADLs will hide away somewhere and play candy crush, not my idea of a role model "charge nurse".
  15. You are not likely to receive the answer you seek here. We are more than happy to help you with your homework, but will not do it for you. I suggest you type out what information you have found so far and what you think a good sample menu is for each age group and we can help you modify your meal plan to the best answer. Good luck in your studies.
  16. wheeliesurfer

    Taking nclex in different state

    Correct. If you applied to be licensed in NJ and took the test in PA, then your license will be for NJ and NOT for PA. If you wanted to have a license in PA you would have to apply for endorsement/reciprocity there and fill out their paperwork and send whatever documents they request. You would also have to pay their application fee and pay to keep that license up to date, therefore holding two separate licenses with their own maintenance requirements (number of CME's, number of hours worked to keep licensed, etc). If you don't wish to be licensed anywhere other than NJ then at this time you don't have to do anything. Congratulations on passing the NCLEX!