st4304

OB Nurses: Is there any condition during pregnancy in which a physician would recommend a woman not stop smoking? Pre-eclampsia? Epilepsy? Can any of you provide a link to a study or literature that shows quitting smoking cold turkey is harmful to a fetus or mother? Thanks! Sherri

I worked at CRH for 10 yrs, and many of the nurses I worked with left Seymour to work at CRH, so I guess that tells you something! LOL I feel the need to defend a few things the previous poster stated. The new NM on the PCU was left a mess by the previous NM. People were leaving, but once she adjusted to her new role and the staff adjusted to her, it is now a very pleasant floor to work on. I also feel the need to defend the NM of the CVU. She doesn't hire new hires, if she can help it. I transferred to that unit after working 3 years in ICU and 5 years in the cath lab, and I was overwhelmed at times -- and I am a very seasoned nurse! She believes, as I do, it isn't a place for a new graduate. If she hired a new grad in the past, I am sure it was because she was desperate for staff -- it happens. I have been a nurse for several years and have worked at Methodist, Wishard, and St Francis Hospitals. I keep coming back to CRH. I'm not sure why you feel they don't care about retention -- I felt they were bending over backwards to keep me there. I am currently part owner of my own infusion nurse agency and recently quit CRH to do this full-time. But if my business fails, or I decide to go back to the bedside -- I'll go back to CRH. I should mention, though -- CRH has the worst human resources dept -- they are so slow!! But once you get through the hiring process and onto your unit, the people at CRH are a great group.:cheers:

If you live in or near a large city, most of the larger hospitals will have an IV team or PICC team. You do have to have specialized training in PICC/MLC placement, but most train you on the job. I am part owner of an infusion nurse agency. We contract with smaller hospitals that don't have teams/trained RNs to place their PICCs/MLCs.

I didn't take the time to look for research (sorry!), but according to the Infusion Nursing Standards of Practice to which nurses are held in the US regarding invasive line placement, only midline, arterial, central, and PICCs are required to be placed using sterile technique. Im not sure if you are familiar with setting up a sterile field, but that requires a hat, gown, mask, sterile gloves, and sterile drapes/towels. I believe that is overkill for a simple peripheral IV start. As far as contaminating the site with a clean, gloved finger -- if the site was cleansed with alcohol, it is considered a clean site - not sterile, so touching the skin to palpate the vein 1-2 cm above the insertion site I believe is not really doing harm. I know not everyone will agree with me, but I have worked in the ER and I know first hand that sometimes you just have to get access the cleanest way possible. Many facilities have policies that all IVs started in the field or ER must be changed within the first 24 hours after admission. Just continue to place IVs the way you were taught. Check with your facility's infection control nurse to see if he/she is collecting data on phlebitis (with insertion) rates and be proactive. Sherri

Thank you all for your wonderful suggestions! In fact many of them sounded pretty darn good for gifts for old and tired nurses like me (especially the foot massage and spa.............aaaaaaah.) Anyway, again thank you and I just want to say one more thing -- I am so proud of my daughter I could just burst! And I am pretty sure I will cry during the entire ceremony -- my baby a college graduate and a nurse to boot!:cheers: Sherri

This may not be the reply you want to read and I am sure there will be other posters who will disagree with me, but if you have not adjusted to night shifts after 2 years, then I think you probably never will. Also, isn't life too short to sleep through and not spend enough time with your family? Look very closely at your finances/budget and is there nothing that you can adjust/sacrifice to make up for the loss of night shift differential? If you have high car payments, sell it and get a nice, cheaper used one. Do you have satellite/cable with premium channels? Drop the premium channels and change to the basic package. Do you or your husband smoke? Stop, save the cig money. I am sure you will be able to find something. Keep your eyes open for dayshift positions that open up, because they eventually do become available. It may not be in the unit you want or it may be out of your comfort zone, but make the sacrifice to be with your family. I worked nightshift for 3 years and never adjusted to it. I was always exhausted, crabby, and felt no energy to do anything on my days off. After 3 years, I went to my manager and requested the next available dayshift opening and was told it would be awhile before that would happen. I went to my employers website to check out open dayshift positions, and saw that a dayshift position was open in the cath lab. I was never interested in the cath lab because I had heard horror stories about the call, the docs, the stress, etc. BUT I called the cath lab manager, interviewed and ended up working there for 5 years and loving it! I took a pay cut, and had to wear a pager on my hip for 5 years but I was home every night with my husband and kids, (except for the occasional call-in for an emergency with double-time for pay), and I was awake and alert, and actually felt human again for the first time in 3 years! Look back over the last two years and how many of the people you have worked with now work days? If you are working with the same people because no dayshift position has opened up for 2 years, then you should look in another facility. If you are worried about loss of differential, pick up an extra shift every once in a while! Trust me, with the nursing shortage, you will have no trouble making up that loss of income with a dayshift position! I guess what I hope you get from my advice is that we have to make sacrifices in life, wouldn't you rather the sacrifice be monetary or material and not your family? Best of luck to you! Sherri

Indiana Nurses Rock BTW! Sherri

philly22-- I'm sorry! My question about starting an infusion team was referring back to the original poster - ART96. I was just thinking back in the day when I was a new PICC nurse how daunting it would have been for ME to start a new infusion team/company with only 3 successful insertions under my belt. . .talk about sweaty armpits! -- I should have added that I also precept nurses in hospitals where they only place PICCs once every 3-4 months, and I have been called to assist in every placement even after a year or more.My experience as an independent preceptor is quite frequently with nurses from small, rural hospitals that have been sent to a large facility to learn, they get their 2-3 successful insertions, and they leave the larger hospital with a great learning experience, all excited to poke someone and show off their newly learned skills. BUT when they return to their own facility, it may be a month or longer before they get a chance to stick someone again and by then they have forgotten what they learned, lost their confidence, or the equipment they have to work with is nothing like what they learned with and they are not successful. I recently signed a contract with a small hospital to precept their 2 new PICC nurses in their facility -- it had been 6 MONTHS since their training at a larger hospital. Their ultrasound machine was a huge monster with 10 different probes and no one had trained them on how to use it. But we got that first PICC in and had a great time doing it! May all your PICCs go SVC! Sherri

"The criteria is that you come for 2-3 days and have a minimum of 3 successful insertions prior to finishing your training." I precept nurses in hospitals where 10-15 PICCs are ordered per day and we get to do as many as we can without killing ourselves (maybe only 3-4 the first few days) and it is still at the very least a couple of weeks before the student and I feel they can go solo. . .so starting an infusion team with only 3 successful insertions? Wow. From your original post, I am a little confused: are you starting an independent infusion company/agency or are you starting an infusion team within a hospital? If you would like to PM me, I can give you sooooooo much advice since I have experience doing both! Check out these websites: http://www.infusionknowledge.com and http://www.vascularaccessspecialists.com Good luck! Sherri

I know that most of the hospitals in the larger cities have their own infusion/PICC teams, but what about the smaller hospitals in the rural areas? Do you use infusion agencies, or are all IR placed? Are the patient's sent to larger facilities for PICCs? Does your facility have a few trained nurses that place your PICCs? Or maybe your facility doesn't ever use PICCs? If your facility does not place PICCs/midlines, what do you do with patients' on vanc or TPN? Please take the time to respond to this as I am trying to find out if there is a need for independent PICC nurses in your area (especially in southern IN). Thank you so much for responding, Sherri

My daughter is graduating from nursing school next month. Any unique ideas for a gift? She has requested a PDA, and I will probably get her one, but other family members keep asking me for ideas and I have run out. Thanks, Sherri

Thank you! I have been wondering what happened to those nurses and the physician accused. My heart went out to them and everyone involved (accept the prosecutor, of course). I guess the charges being dropped is not "newsworthy" or juicy enough to make it to the national media. Sad. Sherri

When you write LTC Facility do you mean nursing home? Just curious. I use to work in a staffing pool for an LTAC and floated between three LTACs. For those who don't know, an LTAC is a 'long-term acute care' facility. I would take care of patients on ventilators, critical drips, etc. Actually, there were three levels of care there, but because I was an RN with critical care experience, I was always sent to care for the sickest patients. Most of the patients there are trached and are being weaned off of ventilators, or getting intensive physical therapy before going to a nursing home or to home. The rewarding part of LTAC nursing is that the patients are there for at least a month or longer and you get to see their progress, plus get to know the families as well (of course, sometimes this isn't a plus!). Sherri

Early in my nursing career, my husband would tease me for watching ER. He worked in road construction and would say "You don't see me watching shows about pouring concrete or laying asphalt!" Of course, my response was, "If it was a show of Pamela Anderson pouring concrete, you would definitely be watching it!" Anyway, I guess I did get burned out on those shows. Haven't watched them for years, but just recently started watching ER reruns on TNT. I do have to laugh sometimes, though. The one doc from Bosnia the other day ordered a "Stat 12-lead ABG". It gave me a chuckle. Has anyone seen the movie "Children of Men"? The delivery of the baby does look pretty realistic. But then I am not a L/D nurse, it may look fake to you experts, but looked pretty real to me. Sherri

Right on, Tazzi. Make sure his doc knows about this behavior -- this patient is going to be noncompliant post-surgery and post-discharge too. AND he'll be the first one to sue for malpractice when his leg never heals, so document everything and CYB.

Congrats! You will soon become addicted (if you are not already) to the challenge of finding that perfect vein! May all your PICCs go to SVC, Sherri

I am part owner of an infusion company and after our PICC class, we will travel to the facilities of our students and precept them (at a fee of course) until they feel comfortable going solo, providing back-up and telephone troubleshooting for as long as they need us. I don't know what state you are in, but I believe Methodist Hospital in Indianapolis and one of the catholic hospitals in Cincinnati (I'm sorry - the name eludes me at the moment) provide training with precepting in those facilities. And I do believe one of my partners will be in Orlando for INS. Sherri

Hello, rnwayne! I, too, was at one time one of two RNs who placed PICCs (by feel) in a 325-bed hospital. I also worked in a busy cardiac cath lab. If it was a slow day in the lab, it was no problem, but more often than not, we were very busy and I couldn't get to the PICC until the late afternoon/evening. If we were not available and the patient needed the PICC sooner than late afternoon, they were sent to Radiology and a radiologist would put it in (at greater expense, of course). So I feel your pain and frustration. Keep the faith! Sherri

I have been a "camp nurse" in the past. I am an RN and this is Indiana, BUT I can't imagine summer camps are all that different (except special needs kids camps...). All I did was pass meds and inhalers. Each parent filled out a form with their child's list of meds and directions of each, with the meds in their original bottles. I was not allowed to give a Tylenol to a child if their parent did not send some with them. The year before I did this the first time, a child's parent was the 'camp nurse' and I believe she was a stay at home mom (no nursing degree). And this past year, the camp could not find a nurse, and the camp staff did it themselves. I cleaned scrapes, put on bandaids. I did have malpractice insurance of my own, but never signed a contract. Are you perhaps looking into this too deep? Maybe Missouri is different. . . Sherri

Along the lines of the same subject (however, I may be reaching here. . .) I get very irritated when I call a physician's office for a telephone order and the medical assistant takes the message to give to the MD 'between his office patient's'. Then the MEDICAL ASSISTANT calls me back to give me the MD's order. I know I am not allowed to take orders from a medical assistant by my state's practice act, but for some reason the docs just don't get it. This was never a problem when I worked in the ICU, but now that I am working med/surg again, I am constantly battling these PCPs. The other nurses on the floor have no problem with taking orders from non-nurses. They state they would have to wait too long for the doc to ever call back, which is exactly what happens to me. And if their not calling me back delays a patient's discharge, I let the patient know exactly why their going home is delayed -- their physician is not returning my phone call. Just my two cents.

I recently enrolled my daughter into a pre-med program. Her advisor told us this: Getting into med school is all about the MCAT and GPA. Med schools today don't care what your undergrad degree is in as long as you ace the MCAT and your GPA is at the very least a 3.5. She recommended majoring in something you enjoy so you make awesome grades. If you love biology, major in biology. If you love chemistry, major in chemistry. If you love the history of romance language in Russian, then go for that. The MCAT is physics, biology, and organic/inorganic chemistry. My daughter will take one year each of those and then she will take the MCAT at the end of her junior year. Her advisor told her she didn't even need to take anatomy/physiology because IT'S NOT ON THE MCAT. She stated she will get enough anat/phys her first year in med school. Another thing to note: in our area only 50% who apply get into the area med schools. So whatever you major in, make sure it's a degree you can do something with in case you don't get in. Good luck. Sherri

Last month in the town where I live, an popular urologist and his wife were arrested for growing 33 marijuana plants in the basement of their home. They were caught by the Postmaster General in Chicago -- he intercepted seeds they had purchased on the internet and informed the police in our town. The police found growing behind locked doors in their basement 33 plants - many over 3 ft tall, a sophisticated plant-growing lighting system, and a large amount of cash in a safe. Since his arrest, the urologist has been fired from his practice, his privileges to practice at the hospital revoked, and his medical license has been suspended pending the outcome of this mess. His wife is claiming that she is totally responsible, but they are both in BIG trouble. Since they were using the US Mail to purchase seeds, they are being charged with federal offenses too. We, meaning the nurses/staff at the hospital, are all so shocked and so disappointed. He is a very nice man, one of the docs you could sit and chat with. The question being asked over and over is why would he put his license at risk like that? Was it greed? Was it the excitement of doing something illegal? We'll probaby never know. If he doesn't lose his license, he'll have to move away and start over. I'm sure he'll never be able to practice in this area again. So sad. Sherri

If you are driving from Spencer, I would also watch the road from Bloomington to Nashville! I always seem to get behind the dump truck who, although only driving 30 mph, slows down to 10 mph for every freakin' curve and hill and can never be passed by us more speedy drivers. It's very frustrating, especially after working a night shift and you just want to get home!!!! I use to work in the ED at Columbus and here is a word of advice. . .they are an awsome group of nurses, night shift is great, BUT they don't tolerate timid nurses. Just be willing to jump into the mix and you'll do great. If you have any ER experience at all, you'll do fine. I only left the ER because the registry let me be in control of my schedule, otherwise I'd still be there. Good luck! Sherri

Dear Nursejennie76: Welcome to Columbus Regional Hospital! I have worked here for 10 yrs and it is a pretty nice place to work. What floor will you be working on? I am an RN in the hospital's registry so I float everywhere. I probably will meet you somewhere along the way. Are you new to the Columbus area? I look forward to meeting you and hope you like it here! Sherri

My teenage daughter and I were sitting in a drive-thru waiting for our order when a good-looking male employee in tight jeans came out the back door and bent over to cut boxes. "Man! That guy has the best veins!" I thought and proceeded to daydream about starting an IV in those awesome veins. Next thing I know, my daughter is hitting me in the arm, saying "Mom! Quit checking out that guy's butt!" When I told her that I wasn't looking at his butt (which she was right by the way, very nice.) but at his veins, she could only reply "That's so pathetic." Sigh. Sherri