auntiedebe

Billy, Billy, are you OK? Whew!! OK, now go back to sleep!

Your BLS, AACLS training talks about futility of extending CPR. Use their standards to support stopping when M.D. calls code and pronounces. Your hospital requires certification , so you have that to protect you.

No the 5 rights, or 7 or 8depending on which source you use, of med admin need to be followed. This is your standard as a nurse. And verbal orders should only be taken in emergent situations. Stick to your guns girl!

Oops I have been known to break a few...lets see there was once that pair of really furry slippers being worn by my CCU DNR/DNI patient who wanted to see his dog one last time--of course, dogs are not allowed, thank goodness the slippers didn't bark during their visit. Or the trip to the 24 hour store so my intubated (yes I knew he couldn't taste) CCU patient could have his last hours of oral cares include a local brewery concoction--nursing involves caring for the family as well as the patient. And of course, the trip to the morgue for my patient who at 79 had needed knee surgery because she slid into third playing softball with her family: if the trip to the morgue includes a incline, the patient should get to have a last gurney ride down the incline...Wheee! She would have loved it. These rules were broken because nursing is relationship based and treats the whole person, not just their medical needs!!

My favorite similar situation was a particular CCU RN who always complained about her assignment, no matter if it was the hardest or easiest. One of the charge nurses started to just give her the worst assignment every shift. I asked him about it, and his response was, well at least this way I can feel for her when she complains! I loved it!

As a former nurse educator, I feel horrible when people have to suffer through the monthly inservices. We wouldn't teach our residents in a long boring drawn out manner, why would we teach our peers in this way. Learning can be fun!

I ask them (via email) to please be on time twice, if they are not, they I tell them I am letting our supervisor know. If they are late, I kindly point out to my supervisor, that they are paying me overtime every week because a peer is late. After that I right them up, and I show my supervisor the emails I sent previously..

And then the doctor said...

Thanks to everyone for your helpful words! I guess to a former CCU/ER RN things are certainly handled differently in LTC. I am glad that orders received but not completed are flagged. I will start there in trying to set up a procedure for handling orders so none get missed. I filled out 10 incident reports in my first couple shifts for labs or treatments that had been missed due to the mishandling of orders. Again, thanks all!

Our Resident Care Manager frequently "receives" orders, and then we are not sure what has been completed and what has not off the order sheet. In a situation like this, I was taught to note what had been done with the order, so it was clear to all that it had been completed. Receiving the order to me does not mean it has been completed. She "recevies" them as our MD is writing them. If receiving is the same as completing, then all portions of the order should be completed before the order is received. For example, order #1 is a lab draw for CBC, CMP, UA; #2 is an order for a new medication; and #3 is for a dietary texture change. It was a MD written order, and she has signed it as received. Order #1 needs to be entered into 2 different computer systems-one for us and one for the drawing lab. Order #2 needs to be hand written into the current MAR and also into our computer system as well as faxed to the pharmacy. Order #3 needs to be communicated to the dietary department, the CNAs, the MAR (dietary section), and the RNs. Upon researching, the MAR has been updated, the labs are written in a book, but not entered in any computer system, the dietary change has been communicated only via the MAR--which is frequently not looked at by the day shift until during breakfast. Our noc RN, me, has no LTC experience and was not told to complete 24 hr chart checks.

Hi, I am having difficulty adjusting to LTC and MD orders. I have 20 plus years experience in INPT, ICU, and ER; but am having difficulty understanding roles here. Is it different in LTC when you get a MD order? I was taught that you could receive an order without signing it off, e.g. a RBTO, but when you signed it off or noted it, that showed that you had taken responsiblity for putting it in all the appropriate places like the MAR, the computerized charting system (not yet using eMAR), entered the lab orders, made the appointment, or whatever the order states. In my facility, we have a Resident Care Manager who asks that we put all the pink copies of the orders in a specific place, but she feels that signing in the "orders received by" space means the order has been completed (and it is not completed.) Does this happen other places. I am trying to find a policy/procedure that states how MD orders are to be processed, but can't find one. Does anyone have a source (even from nursing school) that talks about completing MD orders? Help!

The facility I used to work at (part of the Mayo System) and the hospitals in Anchorage are only hiring BSN's or higher. If you can relocate, try IHS facilities. Sometimes you do not even need to change your state license because of IHS. You can also get loan repayments!

What types of tape and taping techniques does everyone use. We have noticed and increased incident of needle displacements during Rx and when discontinuing the other needle--due to tape residue sticking to gloves. Thanks for your help! HD RN in WI

we routinely flush with 100ml NS every 30 min. In my 10 years experience, I have found that giving the NS prime-which most places now do, and getting BFR up to 350-400 is what works best for keeping systems open. Depending on patient stability, I do also add 0.1L to TL when flushing rather than all at beginning.