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Galendria

Galendria

registered nurse
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  1. Galendria

    Pt.s Ordering Food from Outside Hospital?

    I agree that it can be frustrating to see patients eating food that is counterproductive to their health. At the hospital I work at patients don't order delivery super often, but there is a cookie shop, Wendy's, coffee shop/bakery, gift shop with candy, etc. on site. Plus family quite often brings food in. Really all that we can do as nurses is educate, notify the doctor if the diet order isn't being followed (especially for things such as fluid restriction and renal diet), and ask diabetics to be honest about everything they are eating so that carbs can be accurately covered with insulin. As far as a patient chowing down on food while giving IV pain and nausea meds go....our doctors actually have developed some pretty good protocols for patient populations that typically exhibit those behaviors on my floor (mostly pancreatitis and crohn's flare admits). Typically if they are eating solid foods they are placed on PO pain and nausea meds. This has worked reasonably well.
  2. Galendria

    Hands break out.

    I agree with the previous poster that it could be the brand of soup/sanitizer used. If so human resources needs to provide you with an alternative if you have a documented allergy. Also, does your facility still use latex gloves? I personally have become sensitive to latex after years in healthcare and my hands broke out constantly from the gloves until I figured out what the problem was. Switching to latex-free gloves solved the problem for me :)
  3. Galendria

    Patient Nurse Ratio

    I work at a level 1 trauma/regional referral teaching hospital on a very busy med surg/telemetry floor. Our matrix calls for us to have a 1:5 nurse patient ratio, with the occasional nurse able to only take 4 patients. The charge RN typically has 1-2 patients. *If we had the staff* the nursing assistants would have 9-11 patients each. What's been killing us lately is that all our assistants are graduating and moving on, so we have less help. I feel like PCAs/techs/whatever your facility calls them are the unsung heroes that help make current nurse:patient ratios bearable. Stellar techs make days SO much better. In the past I've also worked in another hospital as a new grad on a post-op floor with epidurals, trachs, tubes coming out of every bodily orifice and a patient ratio of 6:1. That sucked big time. I also worked on a pediatric surgical floor for 7 years with a patient ratio of 1:4-5 unless we had call offs that couldn't be covered. I really enjoyed that position, and felt like we were typically adequately staffed. Now with 4 years at my current job (and often functioning as charge RN so I see the "big picture" of how each nurse on my 39 bed unit is coping with the ratios) I have a few thoughts on the 1:5 ratio that seems to be here to stay at my hospital. First, I feel bad complaining b/c so many other hospitals make their nurses manage with higher ratios. That being said, when the patients are *stable* (key word) 5 patients isn't so bad. Unfortunately, patients usually get referred here from other hospitals because they need a higher level of care which means they are pretty time intensive by med-surg standards. Insulin drips and other interventions that require RN action every hour are very unsafe with 1:5 ratio in my opinion. It's not unheard of to have 2 or even 3 rapid responses called during a 12 hour shift, and that takes up a significant amount of time for not just the primary RN, but also the charge RN and anyone else playing "gopher" or helping to cover the floor. Then if there isn't a progressive care bed available to transfer the patient to right way that also becomes an issue. I guess my point is that when managers/administrators create matrixes they seem to have an ideal work environment in mind where all the patients are "typical", and all the ancillary staff will always be available. The real world is not like that, and so we have discussions like this
  4. Galendria

    heparin drips

    A lot of great info has been brought up (and debated!) in previous posts. Back to the original question of the poster though I think several points are important to keep in mind... 1. Run heparin (along with all drips like insulin, etc.) in a dedicated line if possible (along with following any policies/procedures at your facility). 2. If you have more meds to give than IVs consult compatibility resources at your facility (like micromedix) or your pharmacist. I also suggest labeling all tubing close to the patient to avoid confusion, Y the tubing close to the patient, and avoid bolusing through a line with a drip (like another poster mentioned). Great question! :)
  5. Galendria

    Would you hire an MUSC grad over anyone else?

    I know of the school b/c I'm originally from South Carolina. No one where I live now would know what I meant if I said MUSC though.
  6. Galendria

    2016 salary thread

    1. Urban Ohio teaching hospital 2. 11 years experience--med surg 3. Base pay=$30.71 4. $5 shift dif from 3pm-7am. Additional $5 weekend dif. $3 charge dif. $3 over-percent dif (for hours 36-40). Double time and a half when working holidays. Cost of living varies widely depending the area of the city one lives in. My husband and I live in a "nicer" area with good schools. We pay around $925 per month for a 2 bedroom townhouse with an attached garage. This is a huge difference from my first 7 years an an RN working in the Carolinas. I got a 13% pay raise when I moved to Ohio!
  7. This is a crazy long thread, but I just wanted to add my 2 cents in. 1. I'm a gun owner. I grew up in the southeast where guns, bows, hunting, and fishing are a way of life. 2. I would never be offended if a healthcare worker asked me either at my or my child's checkup if guns were secured correctly. 3. Asking about gun safety was routine at the children's hospital I worked at during admission assessment. Right along with car safety, bike safety, water safety, prescription drug/household cleaner safety, etc. Our priority as health care providers is to provide preventive teaching to families. Education isn't always initially welcome (think the 500 lb person who is chugging Coca-Cola all day long being advised to switch to diet soda or the smoker with COPD who is advised to quit smoking, or the end stage liver failure patient who wants to go on the transplant list but needs to stop drinking to do so). Every now and then a parent might be offended that routine household screening questions are being asked....but does that mean we stop screening? I don't think so. 4. Now that I work in adult med-surg we don't routinely screen for gun access as much, but if my patient is suicidal you bet I ask. Especially in a patient with a plan. Bottom line, guns are not evil, but sometimes they are used incorrectly. Ensuring guns are secured correctly in households with children is extremely important.
  8. Galendria

    to intervene or not to intervene

    I would respond as a visitor the same way I respond if there is a car accident, someone collapsing at the gym, etc. I would offer first responder CPR/first aid until more advanced help arrived (police/EMS outside the hospital; code team inside). When I'm not clocked in I function in my role as a BLS instructor/provider, not an RN. I wouldn't say start an IV on someone in a car wreck, but I would apply pressure to bleeding wounds, do chest compressions, etc. Same thing as a visitor in the hospital. Hope this helps!
  9. Galendria

    Approriate PCA use

    Is your clinical coordinator a RN or advance practice nurse? I'm a bit confused because in your story she seems to be suggesting a plan of care/new orders to the family which isn't really in a nurse's scope of practice, especially since she wasn't collaborating with the physician when she did so. We have a clinical coordinator on the med-surg unit I work on as well (and I feel that that role has been a great addition to our unit). However, our coordinator rounds *with* physicians, works to increase communication between patients/families and the physician, coordinates care with consulting services, PT/OT/social work/case management, and makes follow-up phone calls when patients are discharged. Our coordinator definitely never acts divisively like the story you told in your post. I'm also a bit confused as to the goals of care. You mentioned that the family didn't want "comfort measures" but in an elderly patient with respiratory congestion (I would be concerned about declining respiratory function), increasing narcotics seems like it would be harmful to the patient *unless* a comfort care only approach was taken. Even then, I've never seen a PCA pump used in a confused patient. What I have done is give Q 1 hour Morphine to a DNR-comfort care patient, along with an agent to dry secretions and anti-anxiety medications. Contrary to the beliefs of some managers, families generally *do* notice when staff RNs genuinely care about their patient, perform basic comfort measures such as oral care/turning/etc., advocate for them, and work together with the physician and other disciplines. Trying to boost nurse scores on surveys by bad mouthing the physician is never a good idea and erodes any teamwork which may be occurring on the unit. Surveys are a tool, but stories like this one which portray patient satisfaction as a goal above all others make me worried for the future of nursing.
  10. Galendria

    oxygen in dying hospice patients

    Thank you *so* much for linking the medical mistakes thread. I have been solid laughing for 15 minutes now. I had no idea so many miracles happen around us, every day!
  11. Galendria

    New nurse terrified of harming pts

    If you are only 2 weeks into your orientation, then as a new grad (ideally) you should still be receiving quite a lot of support and assistance from your preceptor. Do you have a consistent preceptor that you feel comfortable talking to? Are you receiving feedback? Does your nurse educator meet with you to ask how things are going and what you are learning? I've been a nurse for 11 years, and have been precepting for about 8 of them. I want to say first of all that being nervous is completely normal. I still remember being absolutely terrified when I started my first job (on a very busy post-op unit whose patients had tubes coming out of every bodily orifice). I actually worry if my orientee has an apparent complete lack of nerves or doesn't call me with questions and/or to come check that they "set an infusion up right" before starting it. I tend to follow those orientees a bit closer, go in behind them in rooms to check their work, etc. because it is *normal* to want your preceptor to check after you for the first 2-3 weeks. Its normal to ask her questions your entire orientation (which will ideally be at least 10 weeks). It's normal to still have questions after you finish orientation (especially during the first 6 months). Being a nurse is serious business, and even now, even after 11 years, I triple check my work and bounce questions off my co-workers if I am doing something I haven't done in a while. That said, your confidence should slowly increase over the next few weeks. If, after the half way point of your orientation you are still feeling mind-numbing fear, talk to your preceptor, and/or talk to your nurse educator. In the meantime take full advantage of the safety features that are in place for med administration. Follow your 5 rights to a T, use bar code scanning, guardrails on your IV pumps, 2nd nurse verification for high risk meds, and any other best practice safety checks that your hospital uses. We are all human, and those features are in place to protect us and the patients. Best of luck!!
  12. Galendria

    How long is your commute?

    We can phone in for meetings at my hospital, and they actually still pay us for our time! Its magical :)
  13. Galendria

    How long is your commute?

    Both my nursing jobs have been at large teaching hospitals in the heart of big cities. I just love the action, learning experience, and variety that big hospitals provide over smaller community hospitals. When I worked at the first hospital my husband and I lived one county over and I had a 30 mile/45 minutish commute. When we moved to the mid-west we were lucky and found a nice townhouse in a good neighborhood about 12 miles from the hospital. We dream of owning land in the country one day though, and with that will come a much longer commute. I have co-workers who drive 2+ hours to get to work. I even have one co-worker who lives about 3 hours away, works back to back 12 hour shifts, stays in the city between with a relative, and then drives home for her 4 days off. At my previous job in North Carolina I had a co-worker who lived in Tennessee and did the same sort of thing (back to back shifts and renting a hotel in town between) because she couldn't find a NICU with the acuity and pay of our pediatric hospital's closer to home. I guess it all depends on what you like. For those of us like me who thrive in the teaching hospitals, where we work isn't an option (well not really). So it all comes down to how far from downtown we want to live, and how long a commute we can stand :)
  14. Galendria

    Charging with a patient family member

    Your post title made me *giggle*. What exactly are you and the family charging? The exit...the new snack machine...the cafeteria before all the coffee is gone?
  15. Galendria

    New grads are expensive...really?

    Like other posters have said, my hospital gives a bit longer orientation to new grads than experienced nurses (12 weeks vs. 8 weeks). However, I think the real reason (and its controversial) that hospitals think new grads are expensive is the perceived higher turnover rate that they have versus experienced nurses. Whether this is true or not I don't know, but I have seen more than a few new grads come to my floor, get 12 weeks of orientation, stick out the mandatory time to stay, and then transfer either to another floor or to travel nursing. I have a feeling that hospitals have that thought in mind when they say new grads are expensive to train :/
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