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traumaRUs MSN, APRN

Asst Community Manager

Welcome to allnurses.com. I'm the Asst Community Manager. Please let me know what I can do to make your experience more enjoyable.

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  1. Hmmm...full time is 40 hours but we all work more than that.
  2. traumaRUs

    Maternity leave

    Our practice has a policy of using 7 days of PTO then if you have paid for STD (approx $32/pay period) you can use that for up to 12 weeks.
  3. traumaRUs

    Question of legality

    You have received solid advice -please report it. Take care.
  4. In 2013, the Society of Critical Care Medicine (SCCM) recommended the following as basic to ICU patient care: routinely monitor all intensive care unit (ICU) patients for pain, depth of sedation, and delirium, using valid and reliable PAD assessment tools;(2) assess and treat pain first, before sedating patients; (3) avoid deeply sedating patients; (4) use nonpharmacological delirium management strategies over medications to prevent and treat ICU delirium; and (5) link PAD management to ventilator weaning and early mobility efforts. These recommendations have been incorporated into a single bundle of best practices, known as the ABCDEF bundle: A - Assess, prevent, and manage pain B - Both spontaneous awakening and spontaneous breathing trials [SATs/SBTs]; C - Choice of analgesic and sedation D - Delirium: assess, prevent, and manage E - Early mobility and exercise F - Family engagement and empowerment; Integrating pain, sedation, and delirium management allnurses.com staff recently interviewed Joanna Stollings, PharmD, a clinical pharmacist in the department of pharmaceutical services at Vanderbilt University Medical Center (VUMC), Nashville, Tennessee. Here is what we discussed: Q: This is a multi-disciplinary assessment. How are institutions initiating this aspect? Daily meetings/huddles or is each discipline responsible for their own part of it? Institutions are using many different methods to implement the ABCDEF Bundle. One of the best has each of the team members to present a separate component of the bundle during interdisciplinary rounds. Another approach is to include documentation of the entire bundle in one area of the medical record. Our group is actively working with Epic and Cerner to help with this documentation process. We want to avoid having practitioners practicing in silos and to promote the interdisciplinary aspects of this bundle to promote the best care of the patient. Q: Regarding family engagement in ICU care of their loved one, does the introduction of a formal palliative care program fit into this objective? Does open (24/7) visitation of family members help to achieve family engagement? In many pediatric ICUs, there is open visitation. Could adult ICUs take this as an example? A formal palliative care program can be part of the objective of family engagement. The Family element of the ABCDEF Bundle promotes involving the family in all decisions about patient care. Adult ICUs definitely could use the open visitation policies that are commonly found in pediatric ICUs. Open visitation by family members definitely helps with family engagement. It allows the family members to be present during interprofessional rounds and to assist in the implementation of other parts of the ABCDEF Bundle such as assistance with physical therapy. Q: Regarding mobility assessment - does implementing early physical therapy referral assist with this goal? Implementing a referral for early physical therapy can help with obtaining appropriate mobility assessments. However, nurses, physicians, advanced practice nurses and physician assistants, etc. also need to be able to do an appropriate mobility assessment to better triage the utilization of physical and occupational therapists to the most complicated patients. Q: With the opioid overuse crisis, utilizing a range for dosing of opioids for pain control is often ordered for ICU patients. Of course, this must be regulated by hospital/facility policy. What educational material would be utilized to provide this education and best practice for the bedside ICU nurse? We would recommend utilizing resources from the Joint Commission and/or the American Pain Society to educate nurses about range dosing of opioids. Q: How do you get "buy-in" from the bedside nurse who can already be overwhelmed with documentation and care of the patient? Seeing their patients have better outcomes and other results from implementing the ABCDEF Bundle help secure buy-in from bedside nurses. While it is important to introduce the concept of the ABCDEF Bundle as a whole when implementing it, the team can focus on the various elements individually over time. This allows the unit to keep the big picture in mind while fine-tuning the details along the way. It always helps the whole team to remember that these elements are interrelated. When ICUs start to use the ABCDEF Bundle, we recommend they start with one letter and to start with only a couple of patients. As nurses start to see the results of each of the different components of the bundle in a few patients, they will want to implement the Bundle in more patients. Resources Utilized by Joanna Stollings: Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ABCDEF Bundle Improvement Collaboration AACN news release: Practical Advice for Implementing the ABCDEF Bundle Society of Critical Care Medicine
  5. traumaRUs

    56 and considering NP school

    What is your MSN in now? If a clinical focus, what classes would you need? Just the three Ps and clinicals? Do you have experience with housecalls in the NP role?
  6. I moved this to the student NP forum for more current answers....
  7. traumaRUs

    Blast from the past...

    Lol - I can relate. I watched an old Bonanza episode recently (in B&W no less) and while mindless...it left me with a smile.
  8. traumaRUs

    Conflict of Interest

    Can I ask what country you are in? "Patron" is not used in the US, neither is a "town council" utilized for personal problems. Perhaps this is a cultural issue.
  9. traumaRUs

    PAs Do Not Like Us

    I work with PAs also. While Mary Doe, PA might not "like me" its not because I'm an APRN but rather a personality conflict. Too frequently we generalize
  10. MOved to Nursing Student Assistance forum
  11. traumaRUs

    Tips or resources for managing an addiction group?

    Moved to Addictions Nursing forum
  12. traumaRUs

    when should i tell my manager i'm pregnant?

    If you have told others at work, I would be telling my manager ASAP. If not, I would let it ride - its up to you.
  13. traumaRUs

    Commute to your job?

    I work in multiple places throughout the day and travel is figured into my day. I have very flexible hours and as long as I work at least 40 hours and my pts get seen, no hassles.
  14. traumaRUs

    NP Schedule

    Have you had a sit-down with the manager? If not, this needs to be done. This is a business and you need to address these issues. All places of employment have issues - some can be resolved, some (like your 1 hour commute) can't. If THAT is the main reason, I would say start looking. However, the other issues are resolvable: 1. Noncompliant pts require careful documentation. All practices have these pts. You can't care for them more than they care for themselves. Your documentation will cover you. 2. If multiple co-morbidities are concerning you, since you are a primary care practice, you take care of the complaint of the day and turf the other stuff to specialists. Leukemia care to the oncologist, HIV to the ID folks, etc.. Again, if you need dosing assistance or drug interaction info, ask the pharmacist, call the other care providers. 3. We currently have 3 pregnant providers - I've gained another 40 pts to see weekly - however, I am compensated. 4. MA - document and fire them if they don't want to work. In order to be thought as an equal provider, you have to look at this as a business. The manager does, I assure you. Either make changes that you can make or leave. However, be very aware that every practice has issues. Best wishes - let us know what you do....
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