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Steve123

Steve123

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  1. Steve123

    RN patient ratio in dialysis

    I am thinking about moving to dialysis but I do not know much about this field. I have 10 years of RN experience. What is RN patient ratio in outpatient dialysis? How many dialysis techs help one RN and for how many patients is one tech responsible for?
  2. Steve123

    Pain Medications

    . I've seen nurses who wouldn't give PRN valium because the pt. wasn't displaying "anxiety". I just don't have that mainframe. If it is ordered and they request it by name I will generally give it, within reason and if its safe. By other words, you are feeding addiction because they taught you in nursing school to do so.
  3. Steve123

    Pain Medications

    Yes. I read in New York Times several years ago that someone became addicted after taking few pill of Percocet after tooth extraction. If you want to know more barrow from library books "American Pain" by John Templer and "Drug Dealer, MD" written by addiction doctor Anna Lemke
  4. Steve123

    Pain Medications

    What I can say... the less opioids the better. if your friend's mother develops opioid induced constipation (it is not fun at all) neither your friend nor your friend's mother should complain... One of my patient died of opioid induced constipation. Couldn't move bowel for 2 weeks, then developed massive GI bleed...
  5. Steve123

    Pain Medications

    Thank you for your input. So called "pain scale" is criticized a lot on doctor's forums but most nurses still believe in pain scale. It is my personal observation.
  6. Steve123

    I hate the politics in nursing

    I hate politics in nursing too. But I also understand that if nursing organizations do not participate in politics, RN's wages were on the level of phlebotomist. Or may be on the level of LPN while LPNs wouldn't exist.
  7. Steve123

    Pain Medications

    That's exactly I wanted to say. it is better one patient to suffer from pain than prescribe opiates to 10 people unnecessary. You may disagree, but emergency situation has been declared and this approach is suitable for emergency situations. Also remember nursing school. Failing rate is very high. Good students who could have become good nurses sometimes fail too. Because those who make rules believe it is better sometimes to fail good students than let bad students to graduate and become a nurse who will be a danger to the patients.
  8. Steve123

    Pain Medications

    In war time someone has to die to protect the nation. Now we have opiate crisis and emergency situation has been declared. By other words, it is better to undertreat one patient than over treat many. In some cases even 1 tab of Percocet is enough to become addicted. Read book written by addiction specialist doctor Anna Lemke "Drug dealer, MD". Also I highly recommend to read book titled "American Pain" by John Temple. Of course, as a RN I do know well that very few nurses read such books and able to think out of "nursing process" box
  9. Steve123

    Pain Medications

    I am happy to notice that doctors prescribe much less pain medications now then they did even five years ago. Some nurses say that new approach makes some patients to suffer unnecessary. Well, lets compare pain medications with antibiotics. Antibiotics save tens of thousands lives but at the same time some patients die due to adverse reaction to antibiotics such as anaphylactic shock. Should we stop using antibiotics just because one out of million patients may die due to anaphylactic shock? Of course not. A lot of Americans became addicted to pain medications, hundreds of thousands already died of overdose of pain medications. Should 60 thousands Americans die every year d/t overdose just because few patients have "ligimite" pain and suffer unnecessary d/t new strict prescription guideline? My answer is "No".
  10. Steve123

    Legal elderly abuse

    Yes, I am sure, PT's WBC was normal, no fever, no puss around the lesion. No signs of infection. I have a lot of stories like that. I write a diary, it is just one story from my diary, some time I will publish them all.
  11. Steve123

    Irritated MDs: to SBAR or not to SBAR?

    You've been in the hospital for 1 year. You should know doctors and be flexible. When talking to a mean doctor, start conversation from SBAR, when talking to an adequate doctor, skip it. I once was yelled by doctor for having all 4 rails up. The doctor asked me, "Do you have doctor's order for 4 rails up??? Really you went to medical school to learn writing orders about side rails? The doc reported me to the nurse manager' but the maneger only laughed and said sarcastically? Oh, you already know Dr ///
  12. Steve123

    Legal elderly abuse

    A confused patient from a nursing home was admitted to hospital with skin lesion. According to the color and irregular form of the lesion it was obvious for doctors that it was skin cancer. The surgery was planned only in 4 days after admission. (Time was needed for pre op work-up and obtaining consent from the family. Vancomicyn IV and continuous IVF were started. Pt was pulling out saline locks all the time. Finally order for wrist restrains was obtained. Pt became even more confused because he couldn't go to restroom and couldn't understand how to use urinal d/t his baseline mental status. Then Vancomicyn through was elevated before the 4th dose. I expected the doctor to stop Vanco, instead he only reduced the dose. I asked the doctor, -Why does the pt need Vanco? - To his justify his admission to the hospital, - answered the doctor honestly. Don't you think it is abuse to restrain patients o give them iv meds they do not need. For nurses who do not work on surgical floors: standard of practice is 1 dose of antibiotics pre op, not half a week.
  13. Steve123

    rate of pay in ohio

    I quit home care a year go. At that time they paid 35$ per routine visit and 50 $ for the first visit. Ad a little bit more if a patient had a PICC line. A routine visit used o take me one hour, it included a visit itself, driving time, and documentation. So it was 35$ hr. Then they switched to computorized charting. It was terrible. To chart one visit on computer takes at last 1 hr! and still the same 35$ per visit. Since a visit takes longer now due to longer charting it is 20$ per hr. In Fact, RN's pay in home care is down to LPN pay. That's why I quit homecare
  14. I've been a bedside nurse for 6 years. It is not so bad, but I hate working nights and it is hardly possible to find straight days. So I decided to consider dialysis nurse. What is usual shift in a dialysis center? Is it 8 hrs 5 days a week or 12 hrs 3 times a week?
  15. I worked at Home Care agency prn for 3 years. I liked it and even was planning to go to home care full time. But last year I quit because our agency switched to computer charting. In fact, many nurses quit because did not want to deal with computers. It used to take me 10-15 minutes to document a routine visit on paper. Now it takes at least 1 hr. (That's what I was told by nurses who still stay in home care.) I also heard that some companies have better computer programs and charting takes less time. My question is: how much time you used to spend to document a routine visit on paper in the past and how much time you spend now? When you know computer program very well is it possible to spend on documentation of one routine visit 15 minutes or less?
  16. Steve123

    "Should Doctors Fire Their Anti-Vaccine Patients?"

    Yes, doctors should fire their antivaccine patients. I do not want to be taken care of by an idiot. If doctor fires me for refusing flu vaccine I will know he/she is an idiot. Well, in fact I am in my 40's never go to a doctor, even do not have a PCP. Several years ago I had flu with temp 39.5 -40.3 C. Did not go to a doctor, did not take meds. My job is to give meds to stupid patients. It is not my job to poison myself with such garbage as tamiflu which is no better than placebo. Temp of 40 C is not fun but it does not kill either. temp of 42 C kills but it never goes that high with infection. You can die of fever if you fever is r/t heat stroke or poisoning. In this case brain loses control over body temp and it reaches 42. Not typical scenario with flu. Sorry for too much information for RN's brain.