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Cosmo&Wanda's Latest Activity

  1. Cosmo&Wanda

    Best company to get malpractice insurance from?

    I use NSO also. It was recommended by my nursing school.
  2. Cosmo&Wanda

    Anatomy and Physio

    I think everyone forgets a lot of what they learned in A&P. You have to remember the basics of course, but depending on your specialty you might never use some of the more specific things you learned. The good news is you'll have the opportunity to review throughout your career. Nurses are often asking one another to refresh their memories, and many facilities will post resources in clinical areas for review. Just yesterday I referenced a chart posted in the med room so I could document an IV because I had trouble figuring out which vein I selected. I recently saw an experienced cath lab nurse pick up a reference card in the middle of a carotid stenting procedure so that she could be certain she was documenting accurately. In fact, the transcriber's area of that cath lab is filled with reference materials just for that purpose. In nursing it is always ok to admit you forgot something and take a moment to review.
  3. Cosmo&Wanda

    Help with Clinical Nursing Skills

    This is the book that got me through all my practical exams in nursing school Clinical Nursing Skills: Basic to Advanced Skills (7th Edition): Sandra F. Smith, Donna J. Duell RN MS, Barbara C. Martin: 9780132243551: Amazon.com: Books Even if your professor wants to see things slightly different from the book, if you think the procedure through logically you will internalize it better. Most important to any of the procedures you learn will be infection control. Pay careful attention to which hand is clean and which hand is dirty and you'll understand that most of the steps you are taking involve avoiding contamination. Everyone does things a little differently so your professor is not likely to follow the same steps as a book, but if you take notes during the demonstration, use the book as a guide, think things through, and practice with your classmates you are definitely on the right track.
  4. Cosmo&Wanda

    Nursing student looking for advice from RN's

    The HESI is more of a measure of how well you can speak the NCLEX language. You can know all the material but still get tricked by the questions. I recommend doing a lot of practice questions from NCLEX practice books, especially ones that have CDs so you can practice answering on the computer. I found it especially helpful to practice answering questions with a friend so that we could talk through the questions and better understand the rationales. Good luck!
  5. Cosmo&Wanda

    Does suctioning trach's ever get easier?

    I work on a vent unit so I suction all day long! It becomes like second nature, and I have to say it is satisfying to clear out a mucous plug and then see the patient finally relax and breathe. What I hate doing is wound care, especially when there is gangrene involved!
  6. That kind of thing annoys me too! When watching Nurse Jackie I'm not as annoyed by her drug abuse as I am annoyed by her wearing her scrubs EVERYWHERE! She comes from treating all those patients in the ER and then hugs her kids and lounges around her house in the same dirty uniform she was wearing all day. It's a wonder her whole family doesn't have scabies and c.diff!! Then on the show Prison Break I see the character who is supposed to be a doctor administer insulin from a 5cc syringe into the antecubital region! Or how about all these shows where they "pull the plug" of a patient's vent or even just disconnect an IV and the patient dies immediately? I could go on...
  7. Cosmo&Wanda

    Bad Day, How do you get over it?

    It is impossible to please all of your patients and their families. That being said, there are ways to approach them in order to avoid problems. When I have to make patients wait because I have had emergencies, I always make sure to get to those patients ASAP and apologize for making them wait. When patients and families demand things during change of shift I will talk to them and explain that the timing is bad logistically, and ask if there is a way we can change the routine moving forward so that everything works out better. Most importantly, I try to respond to my patients needs as quickly as possible as often as possible, this way when I have to make them wait they usually understand. I also offer extra help to my coworkers whenever I can, then in turn they offer help to me when I am overwhelmed.
  8. Cosmo&Wanda

    My nclex pn study plan, whats yours?

    I used all of the resources that you used with a very similar schedule and I passed on the first try. Sounds like you have a great plan! One thing I did that you didn't mention was to study with a friend a couple of times per week. It was really helpful to have someone to discuss the questions with. Also, my friend had a Mosby book and I had Saunders so we practiced questions from each. We always made sure to have a glass of wine and some good food too toward the end of our study session in order to relax a little.
  9. Definitely buy the textbooks and read them. Most of my professors would select test questions based on that particular book, and often ask about specific details that the study guides do not address. Be careful not to load up on too many study guides. I did that at first and was overwhelmed. I recommend getting the supplemental study guide to your particular textbook, if it is offered, as something to look at on the go. I also recommend getting an NCLEX book for practice questions. Otherwise stick to the textbook and read it carefully.
  10. You're lucky to be out of that place. People are ignoring the patients and covering up narcotics errors, and preceptors are hanging their orientees out to dry! The lesson to be learned from all that is you should trust your instincts. If there is a change in condition of a patient and you are not sure what to do, and a senior nurse brushes it off, still follow up with the supervisor or doctor and document your interventions carefully. Also, don't ever let anyone rush you through a med pass. Take your time and make sure you check everything carefully before administering. You will be very slow in the beginning, but you'll get the hang of it and catch up. You might be bullied by other nurses but stay focused and keep doing things the way you were taught in school. You worked way too hard to get your license, don't let anyone pressure you into putting that license at risk.
  11. Cosmo&Wanda

    Injury to patient. New nurse questions.

    One more thing, you might want to write out a statement to make sure your thoughts are straight. Email it to yourself so you don't lose it and you have a time stamp. If you can, keep a copy of the progress note you wrote on that day as well. The investigation will likely take some time and you will start to forget the exact sequence of events. If you are interviewed you will want to be able to reiterate the occurrence in the same way you reported it initially.
  12. Cosmo&Wanda

    Injury to patient. New nurse questions.

    What does doing "everything you were supposed to do" entail? If you followed your facility's protocol precisely then you have a firm leg to stand on. If you documented carefully then you can be confident that you can be confident if you are interviewed by the state. Especially if you notified the supervisor upon observing the skin tear. I've been interviewed by the state (NY) before in response to reportable incidents, and I've seen this sort of thing happen with other nurses as well. Have confidence that that you made a nursing assessment and reported accordingly. If you allow the supervisor to make you nervous and start questioning yourself then you are going to appear guilty and uncertain. If you stand by your initial statement with confidence then you are likely ok. It sounds like you care about the resident and are taking your job seriously. Perhaps the fracture was there at the time you assessed her, but if she wasn't complaining of pain and didn't have apparent signs of injury then how would you know?
  13. Cosmo&Wanda

    Foley cath

    In my facility we never cath without a doctor's order. I assume by your question that you facility has a protocol in place that allows nurses to decide when to cath based on urine output. If your protocol does not specifically account for a hospice patient then I'm thinking you should contact the doctor for guidance in the individual circumstance. What you are saying makes a lot of sense, but its important to stick to stick to the orders and/or protocols.
  14. Cosmo&Wanda

    Giving Morphine

    You didn't mention if the order was standing or PRN. Sometimes you might hold a standing medication because your patients don't meet criteria, but in the case of hospice you would not. It is ok to give the medication even if your patient is a 0 on the Wong-Baker scale because you are giving it as prophylaxis. If the order was PRN then yes, it is your call. In this case though I would recommend talking to the doctor and asking if he/she wanted to change it to a standing order since your supervisor seems intent on making sure your hospice patients are well medicated. Ultimately the physician has the final say on the amount and frequency of your patient's medications.
  15. Cosmo&Wanda

    Giving Morphine

    I care for hospice patients in a nursing home and I am directed to administer morphine as ordered regardless of their presentation because the most important thing is to keep them comfortable. A hospice patient shouldn't be allowed to reach a state of distress. When we are inspected by the state that is one of the things they look at, whether or not we are adequately providing pain management. I'm thinking that your supervisor is probably under scrutiny regarding pain management. She was likely undergoing, or about to undergo an audit and wanted to make sure all of the hospice patients were being adequately medicated for pain. It was weird for her to demand that they all be medicated at once, but I think she was essentially giving you correct guidance.
  16. Cosmo&Wanda

    Overthinking on tests! HELP!

    Here are some things to consider when answering test questions: 1) what is the question asking? Eliminate any answers that don't address the topic of the question. 2) Is the question addressing a physical or a psychosocial concern? If it is a physical concern you can eliminate all of the psychosocial answers. Sure, offering reassurance is important, but probably not the most important. 3) Is the question asking you to triage (what would you do first)? Follow the ABCs - Airway, Breathing, Circulation. You are going to put a patient in fowler's in order to open the airway before you would obtain a blood pressure. Some questions will really trick you, but at least if you keep these steps in mind you can eliminate one or two answers.