PamRNC

We often have pigtail catheters (blue and other colors, 8 French and other sizes) also placed in abscesses or as nephrostomy tubes with a 3-way stopcock attached between the tube end and drainage bag. If/when ordered it is usually to flush forward only with 10ml of NS. Once you've returned the lever on the stopcock to the position that allows the drainage to go back to the bag it drains without milking.

physics & available technology... the y tubing is roller clamped directly under the blood bag and ns bag, it also cannot be used with an iv pump which may lyse the rbcs. if you do need the blood to go through a rapid infuser or warming pump, i think that may require different tubing. to my knowledge at this time there are no iv pumps or contraptions that can automatically open a roller clamp. also, if you are setting up the blood with the y tubing piggy-backed into the lowest port of a ns mainline, again that line will be roller clamped, and not running, so even if you did set it up on an iv pump the pump cannot turn itself on. the blood will back up in this kind of set-up to the point were the tubing is roller clamped, so you can't leave the roller clamp open or the iv pump running. blood and iv fluid are going to take the path of least resistance, which usually means going up the tubing vs down into the vein. nursing to do for s/p blood transfusion... check iv site, auscultate lung sounds, assess patient's vital signs, color, breathing, mental status, pain level, etc. these really need to be done in person. nursing considerations... not all patients really need to have any extra fluids infused after receiving blood, especially chf, esrd and the confused.

I've always stopped other IVfluids, and meds, because we're looking to find out if the patient is going to have a reaction to the blood. Anything else running might make it a little difficult to determine where the problem came from. Also, not as big a concern with Heparin drips which should be just a few ml/hr but with IVFluids you don't really want to put the patient into fluid overload. Depending on your policy a unit of blood should probably run over a minimum of 2 hours to a max of 4. It won't be a problem for most fluids or meds to be held off for that time.

Let's see...I've worked general med/surg so usually have adults and geriatric pts. When I used to start IV's and draw bloods...Thanks for your donation! When untangling IV lines...As a nurse you have to be part spider and part vampire. While giving dc instructions that include no strenuous activity or heavy lifting...Okay, no heavy lifting includes the vacuum cleaner, so that means you get a break from housecleaning and you're hubby will have to do. or Sorry, but you'll have to put off that triatholon, climbing Mt Everest, swimming the English Channel (or any other outrageously difficult activity I can think of) for a few weeks until you heal. When giving safety/ambulating instructions to new patients with IVs...Okay just keep in mind this is your new dancing partner [iV pole] and she/he like to spin a lot. To diabetic patients bemoaning their high fingersticks...You know, stress raises your sugar, just walking into the hospital and wearing that cheesy blue gown alone is guaranteed to raise your sugar. Anything I can say to get 'em laughing and stop worrying about the million and one things hospital/post-op/pre-op patients worry about.

Yes and matter of fact just did. Had my Dad come down from Canada in July for hernia surgery. Everything was great - he was in and out same day, had his post-op check up and then back home. If we waited for it to be done in Canada it would probably be another two years.

Our computer physician order entry system (Eclipsys) has something similar... Order sets that pull up all the general standing and prn meds for a given diagnosis/procedure. All the docs have to do is click on/activate the orders they want (Tylenol, Percocet vs Vicodin, labs, diet, allergies, etc...) and voila! If the docs use it right it will cover everything, A to Z, parameters for prn meds, notifying the docs about abnl VS, etc and so forth.

I am the admission RN for my unit. We recently decided to try something different, everybody took a turn trying out the role for a day or two, but I'm the only one who has stuck with it. (my idea-go figure:trout: ) I work 4 days 12pm - 10pm, try to get discharge paperwork and admissions done. Since we have computerized charting, when I get information about our pending admissions, I can set up the charts before they even get to the floor, and print out orders/medexes to have on hand when they arrive, order/collect any special equipment needed, etc. Our floor is a busy general surgery unit, so we get direct admits, ER admits and post-ops, as well as a few transfers from the ICUs/step-down units. One of the reasons I'm working the odd hours - we call it 'swing shift' - is so that I'll be available on the floor during change of shift report - that lovely time when the other floors feel it's safe to send a patient, or someone who wasn't having any pain when the district RN was available is suddenly in agony, now that he/she is in report. The patient's like it because for a few minutes they have my undivided attention, and the other RNs like it because I handle all the assessment and paperwork, troubleshoot any immediate problems or issues and basically when I hand over the patient to the district RN all they should need to do is say hi and here's your meds/tx/whatever. I won't kid you - it can be a rough gig, Monday we got 12 admits that showed up almost 3-4 pts at a time, after discharging nearly as many people. I can't handle so many in a timely fashion, so the district RNs still need to assess some of their new arrivals, but not all. Even though I may not get to see all of them, I can usually set up the charts, and get the RNs the paperwork saving them a few minutes, here and there. Being a more experienced/technologically saavy RN I'm also available to help troubleshoot/problem solve and cover lunch breaks. I'd love to hear what other places are doing and how they are using this kind of a role.

Have you checked out IHI.org? http://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/ImprovementStories/AccuracyatEveryStep.htm

oh yes!!! i want a stress ball - make that twenty, gotta pass 'em out to my co-workers!:biggringi you got questions? we have answers... http://www.allnurses.com or http://www.allnurses.com bringing all nurses together... all around the world i haven't quite finished reading the posts, so please forgive me if someone else had these ideas.

I joined in '96. I was probably searching the web for something on nurses or nursing - couldn't tell you what or why. Probably just passing time. Have to say though, I've had a grand time coming back here and reading or posting to the different threads.

Depends on how many credits of your RN program and other prior education/experience will be counted towards the program in the school you decide to go to. Many colleges will offer you credits for life experience if you complete some kind of portfolio for them. The length of time it takes depends entirely on you, and how many classes you are willing/able to handle at a time. Other considerations may be if the school gives you the opportunity to test out of certain classes. Run a search for RN to BSN programs, and check out the student boards here. Good luck and congrats for planning on going for your BSN.

I love computer physician order entry. Orders go in whether they are picked up or not. That said I've worked in other hospitals where we had to pick up our own orders or had unit clerks to pick up the orders. Relying solely on the unit clerks (except for the truly organized and exceptional ones) was just not always a smart thing to do. When I worked nights as a manager I basically spent a good portion of busy nights being the unit clerk, everything from picking up face sheets from admitting, putting together and stuffing charts, to re-writing MARs, and picking up new orders as well as 12/24hr chart checks. DIY order pick-up is the only way to be sure nothing gets missed, mis-spelled, and picked up correctly and completely. Besides even if the clerk picks it up, I still had to look at the chart before signing the MAR/Careplan.

If you are using a PDA with a recording function that should work as well. Check out the PDAs and Nursing forum, do a search and see if it has been discussed. https://allnurses.com/forums/f234/

In the meanwhile, this may be the closest we get. Maybe some of our other computer savvy nurses can create and produce their own online shows? http://www.nursetv.com/ :icon_wink

We use Eclipsys for our RN and ancillary documentation, labs are imported to it from the Cerner system, Physician order entry is in it and communicates to other departments including Pharmacy, lab, radiology, etc. The system is great for paperless charting, and we have access to old charts from previous admits in the system, which means if the nsg hx was completed on the last admit it can be copied and then updated for the current admit. We can also print specific notes or sections as needed. The docs should be charting in Eclipsys, but only a few services are. There is still a paper chart for that and some really ancient paper flow sheets we had to use during an unanticipated downtime. The charting follows the idea of the sections in a paper chart. For instance under the tab flowsheets you have: Vital Signs, I&O, Respiratory, Neuro, Treatments, Patient Education, and a couple of others. Each flowsheet can be modified for your patients' needs, either by adding or removing individual parameters or by using a macro. The macros are templates which place parameters on each of the relevant flowsheets without having to go back and forth from sheet to sheet. So for a med/surg admit with a few keystrokes you could set up the flowsheets to include fingersticks, POx, foley output, peripheral IV, safety and braden risk assessments, etc. The care plan is comprised of including standards of care or protocols on the assessment flowsheet, and in one section of the flowsheet we detail the plan of care for that shift. Most of the charting can be done by selecting items from drop down lists and clicking on it. If those things don't apply then you can type in what you want. The items in the system get updated on a regular basis, and for progress notes there are templates for some of the more common notes. The only problem is there doesn't seem to be any way for me as a staff nurse to have input into some of the changes going into the system. For instance I think there should be a template for a blood transfusion note to make them more uniform - we got pegged by CMMS on a visit recently for discrepancies on blood transfusion notes. From what I understand Eclipsys is based on an older computer system called UNIX. My floor has about 20 computers around the entire unit (and somedays it still doesn't seem like enough). Most of the computers are at stationary, there are a few on carts throughout the unit, but only one has a wireless connection to the system and the battery which should make it a mobile unit has been long since fried. The oncology unit does have computers built onto their medication carts (I wonder if they'd notice if I traded one of theirs for one of ours?).

It depends on the clinical reason for the Heparin. Heparin 5,000 units subcutaneous injection q12hr or q8hr are typically for deep vein thrombosis (DVT) prevention. A Heparin drip is used for several reasons: DVT treatment - the patient is started on this and it is titrated until their Ptt is therapeutic (60-80), then they are started on Coumadin and that dose is titrated until the INR is therapeutic (2-3). When the INR is therapeutic the Heparin drip is d/c'd. Pulmonary Embolism (PE) - VQ scans with a high probability result will usually mean that you'll need to start a Heparin drip. I think spiral CTs are replacing the VQ scan as the diagnostic tool of choice. Pre-op patient who was previously on Coumadin. Heparin has a shorter half-life than Coumadin. It is possible and sometimes necessary to have a patient admitted prior to surgery and on a Heparin drip so as to continue anti-coagulating without the Coumadin on board. This way the Heparin drip can be stopped for about 4hrs prior to surgery and the risk of developing new clots or excessive post-op bleeding is decreased. Understanding half-life, onset and duration of your meds is important when determining/anticipating what med to give or hold. Your drug guide should also give you a list of routine dosages and indications/usage for this and other meds. Congratulations and welcome to nursing.:balloons:

They are. Z track is to avoid the subcutaneous tissue and keep the med locked in. With Lovenox and Heparin we want to get the med into the subcutaneous tissue and avoid the muscle. That's why we bunch up the skin "pinch an inch" and use a 25gauge, 5/8ths inch needle before giving the subcutaneous shot.

Hey there SheriLynnRN, General surgical units are the other half of general medicine units and many nurses or new grads figure that they'll do a year in med/surg before going to whatever specialty they really want to do, be it the ED or ICU, etc. While I don't know how it is in your area, it can be a very busy place with an interesting mix of cases depending on how many different types of surgery services you have in your facility. My floor takes care of orthopedic, vascular, urology, gyn, gyn oncology, trauma and a few other surgery services, as well as occasional boarders from specialty services with their own floor like neuro. When I was hired 2yrs ago I also received a warm welcome because of my experience in med/surg. The fact that you have worked someplace similar and want to come and work on their surgery floor is a huge plus for them. Having someone who already has an idea of what surgical patient will require in terms of pain management and other issues is going to make part of your transition to their facility easier. The fact that you already know how to use the computer documentation is probably taking a huge concern off of the shoulders of your preceptor who may or may not be comfortable with teaching the computer system even though she/he uses it on a daily basis. You are a valuable commodity - a RN with experience! :biggringi Be proud, confident and assured that you will do well. All you need is a little time to get used to the unit routine and get to know your new co-workers as well as the hospital policies. Best of luck!

http://www.nyp.org/careers/ Check this site for jobs. New York Presbyterian has housing (read apartments) available for some staff. If you want a place in Manhattan. Check other hospital websites as some may have positions posted. For general tourist info - which might give you an idea of how some areas compare to yuir bonnie Scotland, take a look at http://iloveny.com/ Best of luck with your search and your plans.

What should you check? * Does the medication match the order? * Does the patient's name/ID band match the name on the MAR/label for the antibiotic (Abx) (assuming your IVPB bags are delivered pre-mixed and labeled with the patient's info)? * Allergy history of course * Did the patient receive any other doses of antibiotics, before this one? (It happened recently that pt was on standing Abx q6hr and also ordered for the same med as a pre-op)

Short version: Get report; give report; check orders and lab/test results; assess patients; teach patients; give out drugs; reassess patients; chart assessment and drugs given; work with doctors and social workers to discharge patients safely to either home, rehabilitation facility, or nursing home; call doctors/nurse practitioners/physician assistants to get orders changed/fixed or to see the patient; teach patients/family members; send patients to the OR, receive patients from the PACU; send/receive patients from testing areas; Give report; finish charting. There are so many little things and big things to do during the day that any nurse would be hard pressed to tell you all the details. Long version: Keep in mind there is a lot of repetition, and depending an who needs what when, the activities of the day are fluid. I may start giving meds and going from room to room, but have to skip rooms, or stay at one room until I fix a problem, or because there are no problems. Hmm, let's see. I receive report starting about 7:30am from the night nurse, on 6-8 patients depending on how many nurses are working on our 32bed unit. We have computer charting which includes physician order entry, and lab/test result data. So, after I get report, I check the computer for any new orders, any lab results that are back from the early morning blood draws, and then go out and take a look at my patients. Any orders that need to be fixed or clarified means a page to the intern/resident doctors in charge in the particular patient. I need to check the computer for new orders at least every 2 hours, but the doctors do their rounds early in the morning and often make the most order changes during the morning up until about 10am or 11am, so I'll be checking the computer more frequently at this time. By 8:30am I go to each room, say hello, introduce myself, check to make sure everyone is safe, pain free, and without any urgent problems (difficulty breathing, etc). The nursing assistant has been taking vital signs, so she'll give me the vitals while I give her report on what is expected or needs to be done for our patients. The things discussed in report are usually: who's going home; who needs help with eating/getting out of bed/getting washed up; who's expected to go to the operating room, or testing area; what diet each patient is supposed to be on; how frequent vital signs need to be done for each patient (fresh post-operative patients need to be checked more frequently); if we need to keep track of intake and output (how much the patient drinks and how much they pee); and any special considerations for each patient (drainage tubes, wound dressings, equipment, religious/cultural/language issues). I work in a teaching hospital - so if we also have nursing students I may repeat some of this report to the nursing students depending on which of my patients he/she has. 8:30-11am: I begin by giving out medications to each patient and as I go along, I check their IV sites, pain level, incision sites, listen to lung, heart and bowel sounds, feel for pulses in wrists and ankles, ask about how they slept, what concerns they have, what their doctors told them. Giving out medications means looking at the medication record (medex), taking the meds out of the draw on the medcart (each patient has a draw with only their own meds in it), doing a safety check to compare what the medex says is ordered with what I have in hand, then I take meds and medex to the patient and check the patient's ID band against the patient info on the medex. (It takes longer to write than to do). If there were any medications I didn't have I'd have to contact pharmacy for them to be sent. If there were any medications I didn't know about (new medications), then I would check my drug guide in my PDA to find out about the medication, what it does, side effects to look out for, and potential interactions with other medications. Most of my patients medications are pills, somtimes I have to give injections or medications through the IV. I repeat the process of giving medications for each patient, and assess them as I go along. Often I get called to see a patient sooner rather than later, to answer the phone for a call related to one of my patients (family calling, testing area that's ready to see my patient, doctor looking to check on something). Medications are regularly due at 9am, 12pm, 1pm, 2pm, 5pm, and 6pm. Not everybody has meds due at all these times and most meds can be given up to an hour before or an hour after the due time. 12pm - fingerstick blood glucose checks, more meds, set patients up for lunch. 5pm - fingerstick blood glucose checks, more meds, set patients up for dinner. As I go through the day I spend a lot of time teaching my patients, usually with each encounter. As I give medications out I tell them what each pills is, what it does and how much it is. If they have other questions about their meds I answer them. If they have pain, I ask them where, to rate it on a 0-10 scale, describe how it feels (burning, aching, etc), and then offer/give pain medication. Often patients are concerned about receiving pain meds because they worry about becoming addicts. This is when I have to do more teaching about pain, and pain medicine. Since most of my patients are surgery patients and just had some kind of surgery pain is expected and we need to treat it so that the patients will be able to get up and walk around as well as do breathing exercises. Many times I will teach the patient the safe way to get out of bed (depending on their surgery site), and how to do the breathing exercises (this includes watching them do it). Patients who have tests scheduled get prepared (if anything special needs to be done) and taught about what to expect during the test. I spend some time providing emotional support to my patients usually by reassuring them, sometimes by joking and talking with them. I also discuss plans for the patient with the doctors and social workers so that I keep up to date with their discharge plans. Patients who are being discharged - I have to write up their discharge papers, print medication or treatment information sheets from the computer, sit down and discuss with the patient what they need to be aware of and do when they leave the hospital. I also work with others who come and go depending on patient needs and sometimes if I call them. For instance, the patient may be ordered for physical therapy - the Physical Therapist (PT) will come to me, ask about the patient, and if it's okay to work with the patient (I have to let them know if there were any problems that might prevent them from working with PT). If when I checked their IV site it was bad/needed to be changed - then I would call the IV nurse to place a new IV site, after I removed the old one. If the doctors wrote new orders for blood work, then I would call the phlebotomist to come and draw the blood from the patient. If the patient needed to go off the floor for a test of be discharged then I or the secretary could page the escort service to come an transport the patient to where he/she needed to go. At the end of the day, I check orders one last time and chart that I've done a 12hr check (looked at and acknowledged all orders during my shift). I give report to the night nurse who is taking over from me beginning at 7:30pm, then finish my charting and go home.

Time-and-a-half is the standard rate for overtime. So they are only offering you what you should already be getting when you work past 40 hours or your regularly assigned schedule. Now if they were offering double time I might consider it something special. Are you salaried or paid hourly? That might be the difference. Most places I've worked management was supposed to be salaried (meaning they could not get paid OT), but in order to attract some of the RNs into management position they allowed OT pay for working extra shifts to fill in shifts on the floor staffing.

Let's see where I work now: overnight on a 32 bed surgical unit is 4 RNs and 2 NAs, and that's a good night. It could be 3 RNs with 2 NAs (or 1), depending on what the census is before the shift begins. Where I used to work: 43 bed unit med/surg 4 RNs, 3 PCAs, and 1 SCA (provided they weren't pulled to sit a 1:1). The last time I worked with an LPN who had her own assignment was my very first nsg job - then I think it was a 30 bed med/surg unit: 2 or 3 RNs, 1 LPN, 2 NAs.

Tuesday, being the extra shift should be the only one you get paid time-and-a-half for, the only problem I see is if the pay the overtime only for your hours past 40. Then you first 4 hours on Tuesday will be straight time. Don't they already pay time-and-a-half whenever you go over 40 hours? What makes this a special deal?

Do you mean cultural nursing? Could you be refering to Madeleine Leininger's Theory of Culture Care Diversity and Universality? Three parts of this are culture care maintenance/preservation; accommodation/negotiation; and repatterning/restructuring. The point is to provide care to patients while being mindful of their cultural practices, values, beliefs and needs. If we can incorporate their cultural needs into our careplan, then we may be able to provide more effective care gaining their trust and cooperation/compliance.