sweetieann

I work 5 days per week and was hired as day/night rotation. This is a typical weekly schedule for me: Monday: 7am-3:30om Tuesday: 7am-3:30 pm Wednesday: 11pm-7:15 am Thursday: "Off" (sleeping all day though since I get home 7:15 am Thursday morning from my Wed. night shift) Friday: 7am-3:30 pm This is happening every week. I knew I'd have to rotate, but this seems a little much. It's really throwing me off. Other schedules have looked like: night, off, D,D, D, off, off, night, off, D, D, D, D, D. Thanks for any insight!

Hi all: So a tech that I work with gets the Depo provera shot as birth control. She asked if I could gie her her injection next time I see her. Am I legally able to do this? Thanks!

what id the AED is say, right beside you?

say the AED is right next to you and you witness the patient arrest....you would IMMEDIATELY apply the AED correct? you wouldn't start CPR first and then apply AED?

I have a question that, believe it or no, I have gotten various different answers to. If you witness a cardiac arrest, and an AED is immediately available to you, do you begin CPR first or use the AED first? (I always thought that if the arrest was witnessed, you defib first. If it wasn't witnessed, you start CPR first). What are your thoughts?

If I am orienting an agency nurse to the floor over the course of a few days, and she makes a med error at that time, am I liable? She is an RN with active license. Thanks!

If I apply for a new job, when in the process does the new institution begin to check references and such? I am anxious about my current job/manager finding out I am applying elsewhere. Also, what if after I interview and see the facility (not in the same health system I am currently at), I decide I want to stay at my current job? I'm afraid by the time I go in to interview, they would have already called to check references and then it will be hard NOT to quit current job and go for new job. Hope this makes sense. Any input appreciated!

Pt came in to the emergency room and brought in their meds from home (gabapentin and lithium). Pt got admitted to unit. Pt is to get discharged and asks for their meds back (they were being discharged on these meds). Nurse calls pharmacy to see if unit/admitting nurse had sent them down to pharmacy-which is what usually happens. No record. Nurse calls ER--ER staff says if they have them, they'll call right back. Never called back. Pt is anxious to leave and doctor is calling in all their prescriptions anyway. A few days later, the medications mysteriously appear in the ER (astaff called pharm/the ER again just to make sure they hadn't been found)...Now my question is: what if the pt went to get their scripts filled and the pharmacy/ their insurance wouldn't allow due to their past prescriptions (of the drugs they were on and remained on at discharge) not being due to be refilled? The unit is going to mail the pt their meds back, but what about the interim of days until they get mailed (probably 3 days?) These pills aren't controlled substances. Also, who would be at fault in this scenario? My quess is the ER as they should have sent the meds up with the pt as they are supposed to and didn't. They also didnt return call that meds were down there, even though they were. Any thoughts appreciated. Thanks!

Hi all: So I am applying for a new job. At my old job, we put in our vacation requests December of each year. So, I currently have a trip in April for a week and then a five day cruise planned in June. The cruise I purchased insurance on, so I'm sure I could probably get a refund if I had to cancel. My question is--how do I present this in an interview? When is the right time to bring it up? And how do you think this is viewed? I don't want to walk in and them think: who is this girl waltzing in here and already talking about taking vacation time? Also, where I am at now vacation time accrues; so at a new place I wouldn't have acrued any time yet? Any advice appreciated. Thanks!:)

I work at my current job 5days/week. I just applied for a new job. If the new place calls and wants to interview me, I'm really only available certain days due to my working 5 days a week. Would I just tell the new place basically--look, I can come in this or that day? I feel like if I don't come in right after they call, they'll find someone else.

whispera- could you give a standing IM med against refusal if they were danger to self? Or did you need to get one time emergency order? thanks!

thanks for your response! So, say they are on an involuntary commitment and have standing PRN meds---you could give them IM without consulting psychiatrist first or having them write one time order? Just making sure I understand. Thanks!

quick question....This is in regards to psych hospitals mostly...it is my understanding that if a patient has a standing PRN medication, say IM ativan for agitation, and they refuse it then you cannot administer it to them against their will. The doc has to write a one time order for the RN to administer it on the basis of emergent danger to self/ others. Now, let's say this patient is on an involuntary commitment. Can the medication THEN be given even if pt refuses? Or would a one time order still need to be written in this case? Also, one more example. Say a pt comes in that is catatonic and unable to take PO med to help them out of this state. The nurse administers the med IM, as the pt is unable to open their mouth to swallow the pill form. IS this ok? The pt obviously can't consent because they are catatonic and not in touch with reality...so it is ok for the nurse to give the med IM in this case? (the dosage was written for as PO OR IM in order). Of note, the pt was brought in involuntarily (obviously they couldnt seek tx themselves if they werent even in touch with reality). Thanks!

Quick question....This is in regards to psych hospitals mostly...it is my understanding that if a patient has a standing PRN medication, say IM ativan for agitation, and they refuse it then you cannot administer it to them against their will. The doc has to write a one time order for the RN to administer it on the basis of emergent danger to self/ others. Now, let's say this patient is on an involuntary commitment. Can the medication THEN be given even if pt refuses? Or would a one time order still need to be written in this case? Thanks!

On a psych unit, medical restraints require q 2 hour documentation and behavioral q 15. Our flowsheet states that ROM should be done every 15 minutes. Many times, this is not feasible--obviously if the pt required restraints, they are likely combative. Also--what if pt is sleeping? How do your you/your hospitals handle this?

Hello all: I have had limited experience with insulin pumps. I did recently come across an order that was a little confusing to me. The pt's order sheet has al of their hour-to-hour basal rates and then for the 'correction bolus" it states: 1 unit of insulin for every 360 mg/dl over 150 mg/dl (target glucose). The insulin pump has a "wizard" that will calculate the correction coverage based on this ratio, but I still can't wrap my head around how they came up with these numbers; they just seem odd. In examples, I have seen it explained that, for instance, if someone was ordered "1 unit for every 50 mg/dl over 150 mg/dl (target glucose) then 1 unit of insulin will lower their BS 50 mg/dl. If, say, their BS was 200, they would need 1 unit coverage If their BS was 175 then they would need 0.5 units coverage. But--how in the WORLD would they come up with the ratio in the order I am wondering about??

If a pt gets a med through a nebulizer each day, how often is the nebulizer tubing disposed of at your facility? Daily?

Just a question, I know that with peripheral IVs with continuous fluid infusions, tubing is changed q 72 hours at most hospitals. Is this the same if the person has a PICC line inserted (or is the tubing for fluids changed more frequently??) Thanks!

How often should a portable humidifier be changed for a pt in the hospital? (ie-the little humidifier that connects to the oxygen tank when there isn't a wall humidifier) like the one in the link below? What's the general time interval to replace it? http://www.medicop.si/eng/content_images/Disposable_humidifier.gif

I have zero experience with this. Was wondering if a pt is in buck's traction only (say, to stabilize a broken limb--say a leg) when turning pt q 2 hours, do you turn with traction maintained? Or remove, turn, and replace? Also, do you remove the boot to do skin care and just manually hold down leg? I find conflicting info in my old textbooks. Thanks!

I haven't dealt with trach tubes in quite a while. I am trying to remember about cuffed trachs, when they should be inflated, etc. If a pt was in long term care (ie-they didn't just freshly get the trach), would their cuff likely still need to be inflated during eating? Any help with these tubes you can give me would be much appreciated :)

I see on various websites/textbooks that pneumonia is listed as "droplet precautions." However--I never see this done in the real world. Why is that? (Ps- I also looked up an old thread on here relating to the topic, and it was stated by various users that they too never saw isolation for these pts done in the real world. However, no explanation was given and I'm curious). Thanks!

no, i appreciate you honesty. i contemplated this--however, the nurse who didn't end up giving the HS dose (because it wasn't marked) is also working today and would have seen that this dose was added on by me and clearly wondered "wait--why I a giving an HS dose today and I didn't yesterday." The pt is on no other HS meds, so when the nurse goes to give her a dose tonight of a med, she's realize the error that had been made by the transcribing nurse. And this nurse coming on is VERY anal, so I didn't want thrown under the bus. Also, by my just having corrected what was written on the MAR, it could have made it seem like the nurse who didn't end up giving the HS dose (b/c none was marked) was in the wrong and forgot to give the pt their hs dose--and that's not fair, since the nurse was just following what was transcribed. Hope that makes sense. Thanks for your response!

So I caught someone's med error. I work night shift and have to check over the new orders. It was for pepcid, pt to get before each meal and at night, and the nurse who took the order off (we still use paper documentation) omitted the HS dose and therefore the next shift's nurse didn't give it, because it wasn't on the MAR to give as such. I felt like it had to e reported, because then whoever has to check the orders (me, in this case) would ultimately be held responsible for not reporting, and most importantly I had to end up fixing the order which of course couldn't be done without noticing the error. It wasn't a "big" error--no harm to pt, pepcid isn't that big of a drug, etc....but why should I put myself at risk for catching it and not reporting it. What would you have done? I just feel bad, I hate getting fellow nurses in trouble. Also, I'm afraid the nurse will find out who filled out the report (although I think they're anonymous....and the second shift's nurse could have caught it at the end of her shift and filled it out for all anyone knows) will find out I filled it out and she has been there forever and I'm pretty new and it seems the culture is "don't tell on your fellow nurses" where I work.

Just curious: if a JCAHO surveyor asks you a question and you totally flub, can you be fired for this? Do they take your individual name and report it to administration? I have no experience with them visiting but of course I am thinking of the worst case scenario and what would happen. Thanks!