Rashandap

If IV is bad take it out, it can't be used,and it may be uncomfortable or painful for patient:bugeyes:. If it is infiltrated putting something in the line could cause patient more harm. If it is occluded trying to put something in line can dislodge a clot and cause harm. I would think that you would leave a line in until you have a new line, only if it is day to rotate site (every 3 days where I work).

I think regardless of what nurse does, LOA or Impaired Nurse program I would be more watchful of her and the MAR for my patients as well as hers. For me though I wonder what nurses I work with should do? I work for a large health system and when go back to work I will be going to an entirely different hospital, and per BON the only person who will know and monitor Random drug screening is my unit manager and director of nurses. I think it is my responsibility though to ensure that I administer drugs, and waste drugs completely by the book, even if the nurse I work with does not feel it is necessary.

I have said before I am an impaired nurse. There were two instances though when I found medications (metformin and insulin on me). The metformin got d/c'd so I didn't give it, it was in my pocket. I checked my pockets before I left found nothing. However when I washed my scrubs I found metformin in my dryer, still in package. Second time with lantus I did not check pockets was in rush since husband was sitting outside waiting for me for 4 hours after my shift ended, had two of my patients code within 90 minutes. When I realized at home lantus was in there I took it back. Mistakes happen it does not suggest you are a bad nurse, had bad training, it just means you made a mistake. Its like how many nurses have accidently gone home with PCA keys? I remember my mom did when in high school, she turned right around and took them back.

Speaking as a impaired nurse myself, I can only imagine your frustration as a nurse who knows that something fishy is going on. If your management is turning a blind eye I would suggest going up the chain of command AND reporting nurse to board of nursing. If the nurse is using and stealing she clearly has a problem and needs help. Reporting to management and the Board of Nursing is important for at the very least your patients who are probably not getting percocet they may need. I don't think reporting is tattling. Although I sought help myself, I still thank God I was reported months later because programs most boards of nursing have ensure you seek out help and in my states doing this program does not ensure you will be able to work again. I hope some of this helps.

ERCP = endoscopic retrograde cholangiopancreatography EGD = Esophagogastroduodenoscopy ASA = Aspirin PCN = Penicilin RRR (think cardiac)= Regular Rate and Rhythm AST = Aspartate aminotransferase SGOT = Serum glutamic-oxaloacetic transaminase SPO2 (think respiratory)= Pulse Oximetry C/D/I (think dressing) = clean/dry/intact GERD = Gastroesphogeal Reflux Disease ETOH = Ethanol (alcohol) BID = "bis in die" (latin for twice per day) TID = "ter in die" (latin for three times per day) QID = "ter in die" (latin for four times per day) PO = per os (latin for by mouth) NPO = Nothing by mouth QHS = at bedtime AC = before meals PRN = as needed EF (cardiac) = Ejection Fraction CVP = Central Venous Pressure SvO2 = mixed venous oxygen saturation FiO2 = fraction of inspired oxygen LPM = Liter per minute BPM = Beats per Minute N/V = Nausea/Vomiting

Where I work every patient has their own chart which is located at central nurses station. In the paper chart includes area of Dr's Orders, Progress not, Daily Laboratory Results, and Dictated Reports (H&P, Discharge Summary, Radiology Results), EKG results, Printed report of Nursing Assessments and Focus Notes, Graphic Sheet (for vital signs, I&O), Medication Administration Record for 24 hour. Otherwise everything above and some additional information is all on computer. Our assessments, medications given, Registration, MD paging. All doctors orders are entered into computer. There is Retrieval guide in computer that allows anyone to access an part of patients care including orders since admission, lab results, medicIations given, patients diet. We can requests patients medications from the Pharmacy using the computer. We can request a food tray from our dietary department using the computer. Our patients accuchecks are automatically downloaded into the computer. When we remove any medication from our Pyxis it is charted automatically in the computer. Our med pyxis even allows us when giving any prn medication to chart the reason we are giving meds (like if pt asks for something for pain, when going to pyxis for meds, we chart at that time location of pain, pt's rating of pain, sedation level of pt at the time of giving meds) so we don't have to worry about charting a note later. Once the medication is giving, when we go into computer to chart assessment or focus notes their will be an automatic promp asking whether prn medication was helpful, so even if you forget as soon as you go to chart you will see the prompt and can chart. It's nice because even if someone else is using the patients chart we are still able to access patient information and record information without waiting. We are getting ready for a new system so Dr's will have to enter their own orders so we can cut down on verbal and telephone orders. The hospital system I work for is pretty technologically advanced. My hospital is only about 4yrs old.

hair loss = APEC ERCP EGD ASA PCN RRR (think cardiac) AST SGOT SPO2 (think respiratory) C/D/I (think dressing) GERD ETOH BID TID QID PO NPO QHS AC PRN EF (cardiac) CVP SvO2 FiO2 LPM BPM N/V

I am totally in favor of the Hospitals Policy to try to get patients up to the floor within 60 minutes if a bed is ready. That being said, getting the patient up to room in 60 minutes is not more important that patient safety. I feel it is my duty to make sure any patient in hospital is provided safe, adequate care. To do that I need to get a basic report from the nurse before the patient arrives on the floor, so if anything I can start getting things together that I may need to care for patient. What if a patient coming up to floor had C. Diff or MRSA that is something I need to know before I go into patients room. ED nurses are not the only ones who hold on to patients until change of shift so they don't get a new admit. This particular day it was rush, rush get that patient up to floor. Yet later on that same day @ 130p I was told I was getting another admit from ED. @ 200p I called ED for report, and to get fax since it had not been sent, the nurse was at lunch so they took my number. I again had to call nurse around 5p because patient still had not been brought to floor nor had I got fax. At 6p I finally got fax but it was completely inadequate, the last vital signs time on patient was from noon, it is now 6p. An even those vital signs were incomplete, with no temperature or O2 sats. Why was getting the patient up to the floor in AM a rush, but later that same day the next patient can wait six hours, to right before my change of shift. When these patients come on to the floor in addition to a head to toe assessment, I have to make sure orders are put in, I have to enter patients clinical pathway, as well as appropriate care plans. I usually have to call MD for orders, because at my hospital MD's are not required to write orders for patient before they get up to floor.

The hospital I work for has a goal for admitting patients from the ED. All patients admitted via the ED, the hospital wants these patients to be on floor, in the bed within 60 minutes of informing ED and my med/surg unit that this patient was being admitted. This is a great goal, because so many times patients have to linger in the ED for hours, and most of time may not be very comfortable on stretcher as they would be in a bed on the floor. Here is the problem: about 2 weeks ago, I came into work, my nurse:patient ratio is 1:6. I was sitting at the nurses station with night shift nurse receiving report. The unit clerk this hands me a index card to inform me of a new admit from the ED. I took card a set it aside and continued receiving report and reviewing the last 24 hrs of orders. When we were on the last patient, the other day time nurse took answered phone from ED. The nurse told the ED nurse that the nurse who would be getting patient was in report, she was about to say could you hold on when the ED nurse started screaming at her, yelling saying getting the patient up to floor in 60 minutes was a priority over getting report for patients already on floor. I took the phone from the nurse I would be working with, and I talked to the ED nurse. He proceeded to tell me how he needed to get that patient up to floor now, and how getting patient up in 60 minutes were more important. He said if somebody doesn't take report I will just be bringing patient up. I told him I would be receiving patient and I needed him to hold on as I was in middle of report and I had not even gotten the fax they are required to send for me to review and ask any questions. He just continued to be very rude so I told him again to hold on, he just wouldn't he said what ever I was doing could be postponed and I could look at sheet after taking report. Finally I just told him that NOTHING is more important that patient safety and that unless I was given oppurtunity now to review patient data I would not take patient right now, I told him if has a problem he could call my charge nurse, and I gave him the extension and hung up. This scenario keeps happening at the hospital I work for. Most times when the ED is not busy, they take their time bringing the patient up and I usually have to chase down the nurse to get report. When it is busy they want everyone up to floor immediately. My problem is I feel like I am being rushed to take patients and I end up having more questions about patient from nurse in ED, but for the most part after they fax transport/report sheet you will see ED techs bringing the new patient. The techs of course can not really answer any questions I have for the previous nurse. So since I have not gotten adequate report I don't except responsibility for patient, I tell the ED tech and my charge nurse (well charge nurse in training) that I cannot safely take care of patient. The reason I did this was patient safety. On a previous occassion around change of shift, I got a patient from ED, I got the info as I was going for lunch. When I came back there was no transport/report sheet, no chart, and I couldn't find the index card, so I went back to taken care of the patients I had before. Around 630p light goes off in room at end of hall, which is were the new patient. I went in to room and the patient and her husband were in the room, I asked how long they had been and he said an hour. Apparently when ED tech brought patient up they just left her in her room, and her paperwork so nobody new she was there. So I had to hurry somewhat to at least get her vitals well that patient O2 Sats were 80% on room air. So I had to get some O2 on her. The girl was in severe pain (sickle cell crisis) and was ordered a dilaudid PCA. So I had to call IV team to get a line in her. IV nurse start a new IV Lock only to then find out patient has a mediport. I think sometimes that as nurses so much is put on our shoulder in terms of giving patient care, providing support for patient and family, that things like being in a rush to get patient up to floor or anything else should trump patient safety.

Well I am not a CNA, but there are several clinical days when if it wasn't for the CNAs helping me I would have gone nuts. Many times the CNA was more of resource than the nurses on the floor. So to all CNAs (or care partners, or nurse aides) keep up the good work, most units would fall apart without you.

Well said Debby, I agree.

I think sometimes, especially at night when you get whoever is just covering, the dr. (especially residents) want you just to tell them what you want, like you tell what is wrong and say "do you want to get blood cx" or do you "want to give the compazine". But I think you did the right thing, if you hadn't have called if your patient coded then they would have been saying why didn't you call. I know what you mean about being nervous, but you did good, and you should be commended on calling back even after you had called before and this doc was kinda rude. Cause when it all comes down your first priority is your pts well being. Also you have to follow policy cause if it comes to it, you following protocol could be what saves your job, or your license. So keep up the good work

I think it depends on where you are and what people ask you to call them. I am from PA and up there the a lot of the time you called the young residents by their first name, and alot of the attendings by DR. so and so and they called you by your first name. I just moved to VA and here everybody seems to address every one by Ms., Miss, Mrs. or Mr. and Dr. when they want to be informal they say Ms. and the first name. Even the doctors address people that way, I think it is part of the culture down here. I think some Drs want to be called Dr. not because they have some sort of superiority thing just because they are so excited to be a real dr.

My mom was nurse when I was growing up, a single mother. She would take us to a family members house before school, and we went to an after school program at the boys and girls club. She would then pick us up. She would cook in advance an either put it in fridge or freezer so it only had to be heated up when we got home. On weekends whether she worked or not we spent time with our grandparents or aunts and uncles. I think it helped her that we had family near by, and she had lots of friends. Even in high school where she worked a lot of double shifts (me and my sister went to college at same time - she had to save) dinner was still ready she called in the morning to make sure we got up for school. We had to leave homework out for if she got home after 11p so she would know we were doing it. I often wonder how she did it. I think it was a matter of priority for her, she had to support her family but she sacrificed a personal life so she could spend as much time as possible with her kids. I think you need to have a support network to help you.

I'm sorry this is just pitiful. In no way is it responsible to sleep on the job. If you are your break that is fine, do what you want. But to be asleep when you should be on the floor, what if something happens is a few extra minutes of sleep worth possibly someones life, and your license.

I worked on a unit in PA and actually there were several male nurses and for the most part they were great, caring, and great advocates for their patients and for nurses. One nurse in particular always had patients and their families sending him thank you gifts and bringing him food. I think male nurses, just like female nurses have the capacity to be great nurses. I think it is societies general role bias that makes it seem strange to have male nurses. The only thing that irritates me is that on the unit I worked on The doctors treated male nurses differently, not that they were all jerks to female nurses, they would just talk to the male nurses as though they were the best of friends and very rarily did they question their assessments. Now this is not the male nurses fault however, they can not be held responsible how other people view and treat female nurses. I think the best way to handle it is to stop pointing out that there is a male nurse, like he is some sort of exhibit in a museum.

They would tell you if you had results, as long as the PA board of nursing tells you that your results are still pending that means they don't have any results for you. The bon said right now they are really busy because of the LPN renewal, all the LPN in the state have to renew their license by the end of June. All you can do it keep checking everyday, the website is supposed to updated every morning at 7a, it is only updated once a day. Hang in there:innerconf

I just got my result this morning, I passed yipee !!! I guess there is not set time you will get your results, no matter the waiting sucks

I called the bon and they told me it could take anywhere from 2-30 days for the license info to post on website, it just depends on how busy they are. Apparently they are pretty busy right now with PN license renewal so there is no telling how long it will be. I took my test this monday and it is thursday and they still have no results yet....I know the waiting sucks:uhoh3:

As an african american myself, looking someone in the eye is not considered rude, but be too close and articulating with your hands in a persons face is rude. In my experience not looking someone in the eye when speaking makes you seem as though you are not being honest or you are trying to hide something.

IT is not the degree a person has that makes them arrogant but the person. I think that for uniformity there should me a minimum level of education that every nurse should meet. I am a BSN student and I do feel I have some advantages because of my education, but I have some deficiencies as well. What makes a nurse a bad nurse is not level of education but how they use it and not recognizing their limitations.

I agree that there are a lot of people going into nursing now because of the money. It's not just new nurses, but nurses who haven't worked in awhile also. I don't think these nurses should be there if they are all about the money because there is something that is going to be missing from the care they give to the patients. Nursing is not the easiest profession in the world and if your heart isn't in it, if you don't want to be there to help people you shouldn't be there.