joyla163

I wrote that in regards to the OP mentioning that the patient was refusing all vitals/labs/assessments. Patients can only refuse if they have the capacity to do so. If psych deems the patient incompetent to make medical decisions (at least for the time being while he is experiencing delirium), than he would no longer be able to refuse assessment/treatment. Once he is becomes more oriented, which should happen faster if he is getting appropriate medical treatment, than they can re-evaluate competence and allow him to have a more active role in the plan of care. I understand that withdrawal and seizures are a medical issue. But you cannot just have a patient that is admitted to the unit lay there without being assessed or treated for these problems. The most important thing psych would be able to establish is if the patient has capacity to refuse at this point in time.

If his CIWA score was 23 he should have already been getting PRN ativan along with a librium taper. Usually facility policy is to notify the MD for 2 consecutive CIWA scores greater than __ (we use 8). So the MD should have been notified prior to the seizure activity that there was an issue. Also, seizure activity while admitted warrants MD notification. Even if they aren't ordering anything new, they should be aware of changes in the patients status. Detoxing patients can go south quickly, it's important to get ahead of the withdrawal so that you can anticipate/manage potential complications. All of that being said, your co-workers share much of this blame. "Patient refusing assessment" works if the patient is A&O and competent to make medical decisions. Obviously this guy has some issues going on and could benefit from a psych eval. Your co-workers could have used a little team work (1 distract while 1 assesses) to help avoid this episode.

I am going to answer this question, give some advice, and vent a little... My answer: By definition med/surg should consist of patients that are stable but require IV antibiotics, IVP pain meds, continuous pulse ox monitoring, dressing changes post procedure, and general nursing care. Telemetry floors have patients that require cardiac monitoring and more frequent vitals/assessment than a med/surg patient. You can also push different IV drugs if the patient is on the monitor. Some places have techs that watch the rhythms and others place that responsibility on the nurses. Step down units have more critical patients that are on cardiac monitoring and may even be on a ventilator, but they do not meet the criteria for a critical care bed (or the micu is full and bed placement and administration is playing who can we kick out to open beds). They may require gtts to maintain normal pressures or heart rates. These patients require much more frequent assessment and have greater care needs than a med/surg patient. My advice: When you interview for a position, ask the nurse manager to define the unit and explain the types of care the patients require. Also ask about ratios. The more complex care each patient needs, the less patients each nurse should have. My vent: I work on a "med/surg" unit. We have a 1:6 ratio on a good day and a 1:7 ratio typically. I call it a med/surg unit because that is what my facility calls it. We have no step-down/progressive-care unit in the hospital. We do have two other units that that have tele monitors. Every bed in my unit has bedside cardiac monitoring (that also shows up on a central monitor at the desk, although there is no tech to watch them). Every bed is also vent ready. And we are the only unit outside of the micu/sicu/cvicu that has this. Out of 40 beds about 25-30 require tele and we have anywhere from 4-12 ventilators at a time depending on admissions. So out of my 6-7 patients, at least 5 are tele monitored and you get a vent patient (who always have a ton of care needs besides the vent care). We push lots of IV cardiac drugs that other units can't. However, we cannot titrate cardiac drips because there is no way to assess a patient frequently enough to titrate when you have 6 other patients. It is unsafe. We end up having a lot of rapids, falls, and even codes because of this arrangement. I have been in a vent room doing dressings and had another nurse come in to tell me that my CIWA patient down in the other hall was found on the floor with a systolic BP I the 200's. Sometimes a patient in fluid over load with giant pleural effusions that desperately needs a chest tube placed goes south and takes up your time and you can hear a vent alarm ringing and have to wonder if it is your vent and hope a team member jumps in a suctions them while you work on getting your CHFers sats up. We are told by administration that it is all about time management, but it is completely unsafe. Time managing tasks in med/surg (real med/surg) is one thing, but when your patients are very sick time goes out the window, you need to keep them alive! I'm thinking of applying to ICU's and step down units in other hospitals at this point. I have learned a lot at my current job but I would like to take excellent care of a few very sick people without having to basically ignore the 4 or 5 patients that appear to be more stable (the guilt is getting to me, they are admitted to the hospital because they are sick but are neglected because they are placed on a unit that has patients MUCH sicker than they are).

I am a graduate of Suffolks RN/ADN program but was never an LPN. What I have learned through some of my co-workers is that although both Suffolk and BOCES offer an LPN program, when you are ready to do a bridge program to get your RN you will need ALL of those pre-req's that Suffolk requires anyway plus more. If you are serious about bridging to an RN in the future, the question is do you want to take all of those extra classes now or later? You will inevitably end up taking them at some point though. Suffolk is much cheaper, if that is a deciding factor. However, BOCES can probably get you working in the field faster. Weigh all of these factors before you choose. Good luck!

I am just over here trying to figure out where LTC pays more than ICU...

On long island it has been a nightmare. I am currently a nursing student but have worked in a local hospital in billing for the past 6 years. I was laid off, along with about 320 other employees at the end of 2013. I was told flat out that because of the ACA, the hospital is losing reimbursement and struggling financially and has to let go of staff to make up the loss. For those currently receiving care at that hospital, the are being treated by nurses and support staff that is stretched entirely too thin and that are being asked to preform tasks beyond their scope of practice to make up for the lack of employees. More people may be able to afford care, but the quality of care that the receive is not up to par due to under-staffing. It is a safety issue!! Be very careful with private jobs right now. Depending on your area, layoffs may not be uncommon during this time.

Is anyone else feeling defeated and and nervous after yesterdays orientation? I am looking forward to the program itself but I have no idea how this is going to financially happen. Between ATI and all the other fees, even though I work full time (and will continue to through the program) we are struggling to pay our bills as it is. And I'm sure a lot of you are going through similar situations. How do you plan on handling the extra financial stress that comes along with this program?

All that were accepted have until the 26th to accept their seat and put a deposit down on their tuition. You had to be right on the borderline with your gpa, you still have a chance.

I would call the campus that you are waitlisted for and ask. Find out how many people on the wait list and how many seats in the program

Anyone else going to Grant Day program?

Congrats to all of you. Which campus will you all be attending?

I just got my acceptance letter also!!

At Suffolk, A&PI is a lecture/lab combo class that is worth 4 credits, you get 1 grade. Same with A&PII, Micro and all other sciences

I just finished a CNA course. I was employed at a local hospital in the business office for the past 6 years but I was recently layed off. I am now looking for CNA jobs and I am very disappointed at the salary I will be looking at for now. . It is definitely a step down from what I made in patient accounts but I truly hope the experience in patient care benefits me in the long run. I guess we are all in a similar boat, good luck to all of you.

I personally felt A&PI was easier but the majority of my classmates disagreed with me. I think that the summer sessions are a blessing. It is an intense few weeks but it is very possible to get it done and get an A. I do not like taking my science courses during the full semesters because it draws out the information over TOO MUCH time and becomes hard for me to stay focused, even if I have no problem with the material.