amber1142

My initial response to SBE was a simple disagreement. Go back and read it. (Edit: In fact, read my first two posts in response to her. I was not rude in any way. She thought I was accusing other people of being not being morally defensible. She was the one who became defensive and accused ME of being rude.) She took it further because she didn't like my response. We are allowed to disagree with her, aren't we? (though when we do that we're accuse of being "rude" and "inexperienced" and told how "we'll see what it's really like" That sure sounds like being patronizing to me) Apparently when you're a moderator you're allowed to lecture and accuse people of "tilting at windmills" any time you want. The original question was about tips on charting, which a few people gave. OF COURSE one has to check professional standards and institutional policies. What kind of dummy wouldn't know that? I suppose some people think they need to point out the obvious because they think it makes them look really smart. BTW, she couldn't resist a private message to me telling me to stop addressing her. She obviously can't stand dissent of any kind. I've been on email lists and discussion boards for many years, and I know how they work. I understand that boards have "favorites" who are allowed to get away with **** with impunity. I have no interest in listening to lectures and walking on eggshells when I disagree with someone.

How about if I agree to work on my style if you agree to work on yours. I'll stop being "rude" if you stop being patronizing; I'll stop tilting at windmills if you stop lecturing.

My post was the equivalent of asking for tips on starting IVs, and you answered with the equivalent of a lecture on infection control. I am aware of legal issues; I was asking for charting tips. This is pompous. I'm sorry, but people who believe differently than you do should not be dismissed simply because they are inexperienced. I happen to be 40 years old and on my third career. Different ways of thinking of litigation and risk isn't a matter of experience (ask any midwife). No, you don't. Some people are comfortable playing games like writing "decel occuring late in time" rather than "late decel" while cranking up the pit on a vbac patient. I'll save my fear and concern for where I think it matters.

I don't assume a "lack of morality" on anyone's part, but I refuse to live in fear (and it's not because I'm new; it's because it's what I believe). (Ever wonder why the csection rate in this country is 25%? why people think hospitals are safe? why EFM is used routinely when there is absolutely no evidence that it affects outcomes? What if people took a stand? What if people said, "I will not be a part of this?). Feel free to practice nursing any way you want; I will not be afraid and I will not contribute to the culture of fear and litigation that led away from evidence-based practice in the first place.

Believe it or not, I know this. You may not remember what it's like to be starting out, but when people are learning how to chart they start with small steps. As far as "legally defensible", I like my idea better. I practice morally defensible nursing; I provide good care, and I will document the care that I give. I am not afraid.

Ok, thanks. I wish there was some practical way of practicing on myself. I'm going to run out of patient (not inpatient) volunteers.

I was told *not* to advance the needle at all, rather push the hub and advance the catheter into the vein because that way you won't re-puncture the vein. (Eeek, so many different ways to do it wrong! :rotfl: )

I have four kids, and sometimes I think about having another. I'm appalled by the number of friends (people who would not be impacted in any way) who say, "No, don't; you shouldn't have any more." I can't figure out where they're coming from. What difference could it possibly make to them?

ok, i've been practicing. I've managed to get the needle into the vein a few times (progress!). Once the needle is in, how hard or easy should it be to advance the hub and thread the catheter in? It seemed like it didn't want to go in. Should it be very smooth and easy if it's in the right place?, or will it always take a little bit of pushing and manipulating to get it in?

I dream about checking the fetal heart rate strip! (OMG, it's been 15 minutes!)

I posted a question a while ago asking for documentation tips for new OB nurses. I've learned a few things that I thought I'd pass on: When someone comes in for triage (we serve as ER for all pregnant women), on the nursing note I usually say something like: "Pt reports contractions started at 8 pm; occurring q 15 minutes. Pt reports no fluid leak or blood per lady parts or odor. Pt reports positive fetal movement. " If the patient's BP is up I will write something like: "Patient denies headache, RUQ pain, and blurry vision. Urine dip reveals ________." When a patient is leaving I have been taught to write: "Patient is discharged to home. Patient verbalizes understanding of discharge instructions; written instructions given." I think these things are so automatic for experienced nurses that they don't even thing about them, but learning which phrases to use in our documentation is very useful for us newbies.

I'm having real trouble with blood draws and IV starts. The patients aren't generally very gracious about being used as pin cushions, and I can't say I blame them, though it makes it harder when they say things like, "You don't know what you're doing". (Actually it does annoy me; *everyone* was new at IV starts at some point; how do they think people learn?) Anyway, I'm very frustrated because I can't seem to do it.

Hell, I gave birth at a birth center, and I wore my own damn panties! :rotfl:

I think most schools offering nurse midwife programs require experience in L&D, though I'm not sure that they require it as an R.N. or if experience as a doula might count. A few phone calls to CNM programs would clear up that question. As an aside, most direct entry midwives do not suddenly one day decide to deliver babies. They apprentice themselves to a master midwife and assist at hundreds of births, gaining their experience that way.

Do you see a gynecologist regularly? You should go yearly and ask for reassurance at that time. That said, women have a lot of glands in the vulva; sometimes it looks like goosebumps. Inoffensive, non-odorous discharge is normal at different times of the month. When you're ovulating it might be very thick and clear and stretchy; at other times it might be thicker and pasty. See your doctor if it smells really bad or if it is itchy or if it burns when you pee.

I loved nursing school (and I miss it). It was difficult but in a very different way than A&P and chemistry. I didn't find the content in nursing school difficult (except maybe when it came to learning about electrolytes and fluid balance which was a little bit challenging). What nursing school is about, though, is absorbing content while learning to think like a nurse in the application of it. It's a dual-pronged approach, and I think the sooner you realize that the more successful you will be (and you will avoid spending the first semester or two complaining, "Where did they get these stupid exam questions? I didn't study *that* stuff!")

Hi there, yup, I'm one. I started on July 18. It's more than a little overwhelming, but I really love it. Good luck on your first day. :)

I would avoid grilling people with a lot of predetermined questions. If you catch people unawares they may stammer and end up looking foolish, and that's unfortunate. I'd say ask one or two open-ended questions like "why do you want to work here?" or "why do you want to work L&D?", and then let them take it from there. People who are enthusiastic will show it by the questions they ask. My own interview ended up being an hour-long conversation about all kinds of things; I think we both enjoyed it.

The way I see it, if you invest 2-3 years of your life in becoming a nurse, you will never be out of a job, never not be able to support yourself, and you can spend the rest of your life doing whatever you want with that safety net in place. Deciding to become a nurse is not a life sentence. You bet I'd encourage my children to become nurses if that's what they wanted to do.

Thanks; this is very helpful. Some of the nurses on my unit were debating the other day about whether to call decels as variables or lates, or whether to simply describe what you see (e.g. FHR delines 15 beats from baseline over 10 seconds with gradual return to baseline over 30 seconds after peak of contraction) because to actually call it a variable or a late is akin to diagnosis. The redundancy of the charting is irritating because what I just described is shown on the monitor strip and we have to mark it electronically to acknowledge it, but then I guess we have to describe it in the flow sheet as well. We also have to note that the patient is up to pee, that a sterile speculum exam was done, a lady partsl exam, the patient's comfort level, etc. It really is a skill to be able to document what you're doing and seeing while you are doing and seeing it. What would you call that? Running narrative, concurrent documentation? It's quite different from the other paperwork: admission, triage, plan of care, etc., that you can do at any stage.)

The experienced nurses on my unit encouraged us new nurses to pull up a chair, get comfortable and to take our time. It's less scary for me to be sitting next to the patient than to be looming over. Somehow standing implies efficiency and experience which is hard to live up to.

I disagree. My question isn't about the charting system, it's about what makes a good nurse's note and about whar routines are useful for charting. *Of course* I am paying attention to what is required at my facility. Thanks for trying to help.

Someone posted a question in the new nurses forum about guidebooks for charting, but I thought I'd ask here. Knowing what to chart (and where to chart since we have a lot of redundant documentation going on) is an unexpected challenge for me. Does anyone have any thoughts, advice, references on how to chart on antepartum/intrapartum flow sheets, on monitor strips, etc. What kinds of things are essential to document? What habits do you have for charting that make it automatic/second nature rather than a set-up for writer's block?

Say, "Mom, you are you. I am me. You are not me." Then take out a couple of student loans or apply for a pell grant and go to your local community college which is probably dirt cheap and become the nurse that you want to be.

If a BSN is paid more for her bachelor's, I want to be paid even more for my two master's degrees. I believe you should be paid according to what you are required to do.