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  1. LibraNurse27

    Hospitals paying for your stay?

    I was hired over the phone when I was a new grad at a hospital in Arkansas and givena $2,500 relocation bonus which actually went pretty far because things were so cheap there. But I would say beware of being hired and accommodated so easily because once I got to the job it was absolutely awful... super high ratios, burned out staff, “preceptor” who worked 30 12 hour shifts in a row too tired to train me, etc. I lasted 7 months, got a job back home and had to pay back the bonus at that point would have emptied my bank account to get out of there!
  2. I used to work in a community health clinic doing a mix of phone triage and walk-in patient triage as well as quick scheduled "nurse visits" like for injections, TB tests/reads, newborn weight/bili checks, INR checks and coumadin adjustments, etc... there was lots to do! I loved it but unfortunately the pay in community clinics is usually much lower than hospitals. What area do you live in? Where I live there are many clinics serving lower income/vulnerable patients like the one I used to work in and they are almost always looking for nurses! Public health might also be a good option.
  3. Won't say real name I became a nurse because my dad wouldn't let me major in Latin American Literature due to no job prospects with this major... for which I am eternally grateful. 5 years as a nurse: 3 in community clinic, 3 inpatient Med/Surg and Stepdown (some overlap) Most satisfying aspect: camaraderie with coworkers, relationships with patients, ability to help people at their worst and see them progress, sense of contribution to your community, physical work (no desk!) Least satisfying: short staffing, unrealistic expectations from admin, culture of blame and little recognition, poop/pee/blood/guts, burnout, injuries, seeing REALLY sad and horrible things Most memorable experience: Etoh withdrawal patient with altered mental status with his hand in his diaper stroking his genitals. Asked him what he was doing and he said "I'm petting my little kitty it's so soft and fluffy", then later picked apart the white fluffy part of the inside of the diaper and was throwing the fluff all over the room yelling "It's snowing! Come play in the snow!" Also just yesterday meth withdrawal patient told me "I will die soon and when I do I will leave you all my money". However when doc asked him who the president is he said "Abraham Lincoln" so I'm not counting on him to remember his promise =(
  4. LibraNurse27

    Nurse Charged With Homicide

    I agree she most likely did not know that midazolam was the generic name for Versed and also did not know much about the effects of Versed or monitoring usually associated with it. However since it was not emergent or even urgent to give this medication she should have taken the time to ask someone about the medication or ask for help when she couldn't find it rather than overriding it. And she DEFINITELY should have looked at the vial, after she pulled it, while she was drawing from it, before she administered the med... at all the times when nurses are supposed to look at what they are doing. I understand nursing is super stressful and there is pressure to get things done quickly and it is difficult to find someone who is available to consult with. However it is much better to be reprimanded for being too slow because you insisted on doing things safely than to cause injury or death. I am afraid to ask this but I have a safety question regarding a practice at my facility: We do not have a monitor that we are able to bring into the MRI room (poor community hospital!) so if a patient cannot be off monitor we have to wait for them to be stable to do MRI. If the patient is claustrophobic sometimes the doctor will order PO ativan 30 mins to one hour before (usually 0.5mg for patients with no benzo tolerance and 1-2 mg for those chronically using benzos) and in some cases they order IV (with same dosing as the PO but 5 to 15 mins before or to be given during the MRI if patient gets anxious during the test). In this case we are expected to wait for order and pharmacy verification, pull the med (not override) and scan, etc. but we ARE expected to go to MRI and give it and then go back to the floor to care for our other patients. I usually stay for a few minutes or ask someone to stay if I am truly worried about the patient. Also the MRI techs talk to the patient continuously and can see the patient during the entire scan. They call us immediately if any concerns. I know ativan is different than versend and 0.5mg is not much but after reading this I am so nervous about this practice. Would it be best to advocate that a nurse needs to stay in MRI if a patient gets any type of possibly sedating med? We are always short staffed so will be difficult to implement but I don't want to compromise patient safety. Thanks all!
  5. LibraNurse27

    In and Out Privileges

    Wow, Daisy4RN, that sounds crazy! I'm glad you got a new job! Thanks for sharing.
  6. LibraNurse27

    IMCU (Intermediate Care Unit) Tech/CNA; What exactly is it??

    I work in IMCU and Davey Do described it perfectly! Some conditions I commonly see are severe asthma and COPD exacerbations and pneumonia. Sepsis from many different causes, CHF exacerbations, alcohol and drug withdrawal, more complex post-op patients who need closer monitoring due to having many comorbidities, pneumothoraxes, pancreatitis, diverticulitis, cancer patients not currently getting chemo, etc. I think it will be great experience for you and as a CNA you may transport patients to get imaging done and be in the room when doctors, specialists, etc are visiting the patient. Best of luck to you I hope you enjoy it!
  7. LibraNurse27

    Any facilities actually using an AccuVein? Any thoughts?

    I agree with above sometimes the light shows small superficial veins not really suitable for access that needs to last a few days. Sometimes I'll find a good vein but often I've used it in a pinch (example patient needs amiodarone drip and IV push diltiazem urgently and IV team busy) to put in a short term small size 24 or 22G until someone who can do US can put in a bigger/better/longer-lasting. It has also caused me to attempt access on a small, fragile vein which sometimes works but sometimes the vein blows. Time to learn ultrasound!
  8. LibraNurse27

    In and Out Privileges

    sleepingquietly that sounds like exactly what we need!
  9. LibraNurse27

    In and Out Privileges

    The Med/Surg floors do tend to have a high turnover but surprisingly there are many nurses who have been there for years. The staff is wonderful and I think that is why people stay, as well as the fact that some of our patients are really wonderful as well and we have the opportunity to help vulnerable patients. But we are definitely getting tired of the constant violence. I considered all the thoughtful advice and decided to call The joint commission to make a safety complaint. Hopefully they can help! Never thought I’d actually WANT them to come to my hospital! Thanks everyone
  10. LibraNurse27

    In and Out Privileges

    We have had a patient overdose by injecting heroin into her PICC. Her consequence was removal of the picc (because it also got infected) but our consequence was a CLABSI counted against our unit and having to try to get peripheral IVs on her. We are not empowered to set limits with our patients due to fear of poor satisfaction scores. Thank you all very much for your input I really appreciate it!
  11. LibraNurse27

    You must watch me!

    It is! If you don’t watch and someone is diverting narcotics and you signed a waste for them you can be liable as well.
  12. LibraNurse27

    In and Out Privileges

    Oh gosh I didn’t realize that these things are not happening frequently at other hospitals... maybe time to look for a new job, haha. Well many of our upper admin have never worked as floor nurses so maybe they don’t know what is acceptable and what is not... I’m really not sure what’s going on!
  13. LibraNurse27

    In and Out Privileges

    Sometimes they are admitted for actual medical diagnoses and then when those have been treated they become a placement issue if they came from the streets or if their families say they are no longer able to care for them, they are deemed gravely disabled, etc. Some are brought in by police after calls from neighbors. The diagnosis is usually dementia with behavior disturbance, grave disability or sometimes it literally just says “discharge planning issues”. I really feel for these people who have nothing and no one, it’s very sad. But housing them in an acute hospital is not safe. We don’t have subacute or long term beds, supposed to be acute care facility
  14. LibraNurse27

    In and Out Privileges

    Thanks for the replies! I will definitely document when patients do things that go against medical advice... for example shooting meth into a picc line! I will document that I educated them and they chose not to follow advice, etc. I had not thought about contacting law enforcement or regulating agencies but I think that will be the next step if things don’t improve.
  15. LibraNurse27

    In and Out Privileges

    Hi all, Just wondering what the policy is at other facilities about admitted patients leaving the hospital and coming back in. Because I work at a county hospital, in addition to our acute patients we also house about 40 long-term stay patients who we are unable to place in nursing homes, group homes, and shelters because of their behavioral issues. Some of these patients have dementia with severe behavior disturbances and others are alert and oriented but are homeless and either ineligible for shelters due to behaviors. These patients have caused our hospital many issues, including acute patients spending multiple nights in the ER hallways and acute patients being disturbed and even in some instances attacked by long-term patients. Staff are often attacked as well. It is difficult to contain people in a hospital room long-term and some of the patients stay for months or even years (record so far is 3 years, 7 months for extremely violent TBI patient). Sometimes staff take confused patients out for fresh air or at least walk around the unit with them to prevent agitation. Alert patients are allowed to leave the unit unsupervised as long as they sign out and return within 30 minutes (although this is often not enforced). When they leave they often use drugs, sell drugs, drink, go to Wendy's while NPO with an NG tube... so many other examples. We have had patients fall and also get their belongings stolen or get beat up in a drug deal. Then we become liable for the injuries sustained because they were still "under our care". Does this exist anywhere else and does anyone have any suggestions? We are trying to enforce the policy that patients who don't return within 30 mins or who commit extreme violence against staff (nurse got STABBED by a placement patient last week and he is still living in our hospital). Thanks and sorry for long post!