MarySnov

Hi, I need some help, hoping to get resources from you. I'm a nurse practitioner. My provider group has become the medical director of a group of nursing home. The staff are very nice, but communication is awful. They don't call us when they should. Or call us for situations that aren't necessary. They also don't put in progress notes in the charts. Examples: I found out today that a skilled patient left AMA this morning. There is no progress note, nothing signed. I don't know where he went or how or why. Last weekend the on call provider got a call at midnight to review labs, none were urgent, Most were WNL. There was a patient with a BP of 191/111. No phone call. They gave scheduled meds and didn't recheck. Patient with O2 % at 68%. They put him on O2 and he came up, but there wasn't a call or a note. Those are just a few examples. I end up getting note in my box about the situations later. Honestly, I feel like I'm trying to teach things that should have already been taught. The previous medical provider was only in the facilities once every 5-6 weeks, and we are going in 3-4 times per week so maybe we are seeing it more. We are going to try and put together a guide or book to keep in each facility. It's so much that it's hard to know where to start. I'm hoping that one of you has a guide or something that you'd be willing to share. That way we can adjust it for our needs. Any help would be appreciated.

Do you have a portfolio as a experienced RN? Not the kind they have you make in nursing school for your first job interviews. This would be something that you'd use for other departments, lateral moves, promotions, etc. In my case, I'm applying for jobs in the same hospital where I work.

It all depends on where you're working. The hospital I work for doesn't allow any visible tattoos. This was after allowing full sleeves for years. They changed the rules a couple years ago and one of my friends was furious. She's got 10+ experience as an RN, but could have been disciplined for showing her sleeves. Now everyone has to cover up with undershirts or whatever.

Hi, I know that every hospital/clinic is different so I'm just asking for general information. I want to know if nursing positions in ICU or ER or clinics generally pay the same as Medical-Surgical units, or to they pay more or less? Can you tell me from your own experience if you were paid more or less after a transfer? This would be after gaining experience on a med-surg unit. Thanks!!

Is that the only hospital in your area? It sounds like this place is going to burn you out very soon and is very poorly managed. I feel sorry for the patients, but you do have to take care of yourself as well. I'd suggest looking for another job, but don't quit your current position until you have one. About all these posts saying that this is the reality and you're not in nursing school anymore, etc. Seriously-that is the reality of the facility she is talking about. 6-8 patients for a new nurse on a step down unit isn't something that would happen in the hospital where I work and it isn't something that the nurses I graduated with have talked about.

Hi, I need help setting up this math problem. I'm familiar with dimensional analysis, but I get confused on starting the problems. Can someone please help me with this? I don't need you to actually work the problem, just tell me how to set it up. Mrs. H is a 56 y/o woman who is admitted w/ peritonitis. She is receiving fluids at 125 mL/hr. Her BP was 84/52 on admission. She was prescribed Drug D (400mg in 250 mL DSW) at 10 mcg/kg/min required to keep SBP higher then 90 mmHg. Mrs. H is 69kg. Calculate the ml/hr the pump will run for 10/mcg/kg/min. Thanks!!!

Hi everyone, I'm a BSN student due to graduate this upcoming May. I'm applying for a nursing fellowship position in the ED at a local hospital (my dream job). I need some advice and I've learned that asking experienced nurses is the best way to get the help I need. :) I've had my resume and cover letter reviewed by my instructors, but there is a question on the application I'm stumped with and they aren't available right now. The nursing recruiter I've been in contact with says I should put in my application ASAP, even though I won't graduate for a while. It asks "Please list any skills and abilities you wish considered. Include skills with equipment or machines you operate, special computer knowledge, laboratory techniques, etc." My skills are limited to what I've done in clinicals and lab, and my prior non-healthcare/financial experience. I don't know what to put here that doesn't sound weak. They know the position is open to new graduate nurses, so they shouldn't expect me to be an expert. But putting that I've given injections, IV medications, used Pyxis, etc does not sound that impressive. Another problem is that my critical care rotation and my capstone (which is scheduled to be in the ED of a level 1 trauma center) will be completed after I need to submit the application. They actually start next week. I mention my capstone in my cover letter. I would love some suggestions regarding how to answer this question. I appreciate any help you can give. Thanks, Mary (soon to be BSN)

Hi, This might be easy, but can you help me with these math problems. I was able to find the correct answer, but I don't think I did the set up correctly. Can you tell me how you would set up and find these answers. I want to make sure that I've got the set-up right so that if I get them on an exam I will be able to work them. Sometimes the wording on these problems gets me. 1. Dextrose 5% in water with epinephrine is infusing at a rate of 63 mL per hour. The IV solution was prepared by adding 3 mg of epinephrine to dextrose 5% in water. The final solution contained a total volume of 200 mL. How many mg are infusing per hour? How many mg are infusing per minute? I did: 3mg x 63mL divided by 200mL=0.945 mg/hr and divided by 60 to get 0.016 mg/min (rounded). 2. [COLOR=#000000]Dextrose 5% in water with lidocaine is infusing at a rate of 46 mL per hour. The IV solution was prepared by adding 2400 mg of lidocaine to dextrose 5% in water. The final solution contained a total volume of 1,000 mL. How many mg are infusing per hour? How many mg are infusing per minute? I did: 2400mg x 46 mL divided by 1000mL=110.4 mg/hr and divided by 60 = 1.84 mg/min. Am I setting those up correctly? It almost seems too easy, like I should be doing analysis or something. [/COLOR] Thanks, Mary

Hi, Thank-you all for your help. I don't have any problems yet, so I don't have one to post. We haven't actually started this portion of the class yet. I was just trying to do a little prep learing before we actually have our IV calculations class. I appreciate the website to. Mary :)

Can someone please post the formula for a Heparin IV dose calculation. I don't have any numbers for you. I'm just trying to figure out the math formulas I'll need to know when we have our IV class. FYI-I really don't like dimensional analysis. I'm better at formulas. Thanks, Mary