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CDU, cardiac telemetry, med-surg
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JustAdmitToObs has 5 years experience and specializes in CDU, cardiac telemetry, med-surg.

JustAdmitToObs's Latest Activity

  1. JustAdmitToObs

    Calling BON

    BON took 3 years to contact me (via email) of an informal hearing date following a self-report submitted by the attorney I hired that whole 3 years ago. The snail-like pace at which they “protect the public” is mind boggling.
  2. JustAdmitToObs

    "My pain is about an eight and a half"

    I never understood how people could rate something a 10/10 pain until 4 months ago when I gave birth via vacuum to a posterior facing baby with a failed epidural. The handful of kidney stones I've passed were a paper cut in comparison. Had I been on top of a building I would have launched myself over the edge as I was incapable of rational thought. The thoughts that go through my head now when someone says their abdominal pain is a 10/10 while drinking a Monster and eating cheetos......
  3. JustAdmitToObs

    Help with CIWA & RASS

    May be a dumb question but can't find anything within my organization policies or even google that answers it. The paper form my organization uses to score a CIWA assessment has you total your CIWA score at the bottom and mark the RASS score below it. No further calculations of those 2 numbers are prompted. It seems that it makes some sense to subtract the RASS score from the CIWA score in determining how to medicate and making sure you don't over-medicate. For example, say your patient has a CIWA score of 5 but is drowsy and has a RASS score of -1. Would you make the total score 4 and thus not give the med ordered for CIWA score of 5-7? If this is not the case, what is the point of the RASS assessment?
  4. JustAdmitToObs

    Night shift and cognitive function

    I've been night shift (6-6) for about 2 weeks now. This is my first time ever working late PM hours as I've only ever worked jobs that required very early morning starts. I learnt very quickly that flipping sleep schedules back and forth was not going to work for me, and now I stay awake every night and sleep 6 hours from mid morning to noon-ish. Regardless of how many hours of sleep I get, the "brain fog" switch gets flipped on around midnight, peaks around 0130, and only mildly improves around 0400. This seems to occur regardless of sleep/rest, caffeine intake, diet, or pace of he shift. To those who work nights, is this normal? And does it become less severe with time? To those who are natural "night owls", do you feel this at all?
  5. The newish orientees must know what I mean. You go into a patient room with your preceptor, she overlooks you starting an infusion, you ask how to program that piggyback, and the patient has that look on their face like "OMG..." Then that patient gives you that same look every time you walk into the room for the next 12 hours! My preceptor talk through things before we go into a room, but I'm a visual/tactile learner and I find myself wanting/needing to ask questions once we are in there. I'm not sure how I can ask questions during the task without "scaring" the patient. I'm versed in going in with a confident attitude, but if I have a question...I have a question (insert shrugging emoticon that I cannot find).
  6. JustAdmitToObs

    IVP admin rates?

    In my first month of orientation, the biggest challenge I am having is with the tactile skills that nursing school either didn't allow us to do or didn't provide many opportunities to practice. I'm very tentative with IVP's because I'm unclear of how long the administration rate is. I'm not even sure how slow/fast to flush. I've asked experienced nurses but they haven't really provided any tips on how to remember the rates. So far, the IVP meds I've been doing are mainly protonix, Zofran, and dilaudid. I'm clear on pushing narcotics over 2 minutes. Code drugs and flushes are obviously getting slammed, so I've got that. Would love to hear some tips and tricks on this!
  7. JustAdmitToObs

    No specific training, total disorganization - is this normal?

    In terms of sink or swim, is it that the new hires quit or are fired?
  8. JustAdmitToObs

    No specific training, total disorganization - is this normal?

    Instead of being relieved, I'm just confused and concerned. It's such a drastic detour from the risk management efforts that operate within hospitals. But I don't see any reason why LTC would not be just as concerned with liability.
  9. Recently started my first nursing job in a LTC (3 shifts off orientation) and while I don't dislike it, I'm weirded out by the total lack of support or supervision for new hires. I had four orientation days in which I was paired with a nurse but there was no kind of structure to the training, let alone anything on paper that was geared to getting new hires familiar with the specifics of how things are done. I was shown how to log in to the charting software, but that was it. What I find equally strange is that the nurse managers haven't once checked in on my training or transition to working alone. The lack of communication and organization on the nursing side of thing astounds me. There is no hand off report between shifts, just written summaries that tend to just carry over info from the previous shifts. The nursing desk is just a deposit of papers. I have no way to tell if an x-ray order form or an abnormal lab result has been faxed and taken care of, or ignored and left for me to be responsible for. Sticky notes would pretty much solve the problem but I have yet to see this simple form of communication utilized. If I weren't running around managing med admin for every minute of my 8 hour (never under 9 hour) shift, I wouldn't have a problem having to do some investigation on the administrative side of things. But after I get the major morning meds done, I spend the rest of the day tracking down residents for various treatments and nutritional shakes that seem to be staggered every half hour. I just need to know.....is this normal? Even if it is, just knowing it is will allow me to pick my jaw up off the floor and get on with figuring out how to do my job.
  10. JustAdmitToObs

    Re-directing tips needed for Alzheimer's/behavior pts

    What about those residents who constantly scream "help me"? Sometime accompanied by more screaming about peeing in pants. How done one deal....
  11. JustAdmitToObs

    Questions for a paper on alarm fatigue

    I wish I could site your comments as references! I found one study that found that even if nurses didn't respond to alarms, hearing them prompted them to mentally "check-in" with the patient and then determine the urgency of the alarm.
  12. JustAdmitToObs

    NH Residents without ID bands

    Is this normal? Only way to identify resident is to compare them against a tiny black and white photo on their meds. This will sound bad, but I have serious difficulties in distinguishing one geriatric resident from the rest. My preceptor says to ask the aids if I'm not sure, but that doesn't make me feel any more comfortable.
  13. JustAdmitToObs

    Questions for a paper on alarm fatigue

    Doesn't admin move conversations? I'm not sure how to.
  14. JustAdmitToObs

    Questions for a paper on alarm fatigue

    Hmm all of your responses are in line with my research. I'm stumped because I have to do a literature review on the "pros and cons of alarm fatigue." I'm stumped in terms of being able to report any kind of argument in favor of it.
  15. JustAdmitToObs

    Called to interview for dream job on first day at non-dream job

    Did you tell them in person?
  16. JustAdmitToObs

    Called to interview for dream job on first day at non-dream job

    The part that I feel bad about is knowing that if I get the offer it will be just after I finish orientation and they will have had to pay my preceptor and me for no return. I almost want to cut the ties now just to avoid the guilt of being paid for orientation.