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Pam RN

Pam RN

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Pam RN's Latest Activity

  1. Pam RN

    devices for home self-testing PT or INR

    I have the Coaguchek machine by Roche. I had a Mitral Valve Replacement 18 years ago this May and have been using the machine for about 8 years. After 10 years of needle sticks my veins were getting pretty scarred and as someone mentioned getting to a lab is not always convenient, especially when out of town. My cardiologist is in another city 90 miles from where I live so when I had my blood drawn at the hospital I worked at or at a hospital near my house it's a hassle because my doc is not on staff. The company recently recalled the strips a few months ago and the FDA won't be approving new ones until April so back I went to the lab and I hate it. The machine could be improved due to size and the amount of strips used to run the controls but it really is so much better than going to the lab. There are guidelines such as if my INR is greater than 5 or 6 I do have to have a venous draw to double check the value. Also, being a nurse, the Coumadin Clinic gave me some additional instructions to follow that they wouldn't give the average patient such as holding my dose if my INR is higher than 4.7. I check my level on the day they tell me to and then call in my result and then they call me with my instructions. It's that simple. They also told me that the patients who are able to understand how to use the machine and perform a fingerstick on themselves and get the drop of blood on the strip correctly. If the nurses at the office feel the patient can't perform this then they would not approve home use for them. The home machine is not appropriate for every patient but I am so glad it's available as an option.
  2. Pam RN

    Dealing with gossips

    How do you deal with the internal cancer of a gossip/backstabber? I have a woman at work, not an RN, who makes this destructive behavior her life. She's near retirement age, very competent at her job, knowledgeable but spreads her black-cloud of negativity to everyone she touches. She talks about everyone, acts buddy-buddy with someone new each week and then backstabs the others. She will, out of the blue during a surgical case, start blabbing on about someone to engage the doctor to get on his good side and make herself look good. She points out everyones mistakes and makes sure it gets spread around to everyone in the place. A few others egg her on and when they are together it's not pleasant. She's very sneaky about it, always making sure she comes out smelling like a rose and everyone else is at fault. It's eerliy quiet as no one mentions her behavior or complains about it. Are they afraid of her or are they professional and choose not to join her in the gossip game. I find it very stressful to work with her and have put her in her place at a few choice times, but like a cockroach she keeps coming back. The boss doesn't say anything about her. I made my feelings known to the boss but I'm not sure if anyone else has ever said anything. What's the best way to deal with this dysfuntional person?
  3. Pam RN

    Analyze this situation -I'm POed

    That just chaps my a%% that there is no respect for the patient, the surgical process or the job we need to do. Why do we need to threaten them to ensure our safety processes get done? Everything has to turn into an argument. But who's the first to complain? We know, the one's who tried to prevent us from doing the job in the first place.
  4. Pam RN

    Hostile environment

    I need to vent and get some opinions about coworker hostility. I'm in a free-standing surgicenter that a friend recruited me. I've been there for almost and year and at times it's great and other times I go home wanting to shed some tears. Gee, that's everywhere you must be saying but I know the source of the frustration is some negative, unhappy people spreading their misery on all of us. I've never seen some of the most miserable, hostile, passive-agressive, back-biting people in my life. Most of them are scrub techs in the waning years of their careers in surgery and I guess it must be the grave yard where they plan to retire from. Our RN staff in the OR is low and the boss hasn't made a move to fill a vacant position. They use scrub techs in circulating roles at times and that leaves me feeling uncomfortable being the overseer of their work, which I have verbalized to the supervisor on numerous occasions. One tech in particular is the instigator of a majority of the gossip and negativity that goes around and is very crafty at getting the doctors on her side. When she's not working the place is very different. Low key, people just go about their own business. It's tough to deal with her and I've only heard one person make mention of my above complaints to me. So, then that makes me feel paranoid that I'm "just being sensitive." What's the working environment like at your place? Do you feel the RN's get respect? Do the scrub techs rule the roost? I used to work in a hospital OR with a mostly RN staff and did not have the same treatment or uneasy feelings I do at this place.
  5. I started at a surgicenter a couple of months ago and I'm getting used to the way things are done there like the really quick turnovers and some of the cases I've not done before like epidural pain injections and eyes. I like it but it seems like no matter how hard I try I can't seem to have smooth turnovers in those really quick cases like the pain room. Either the patients IV bag is bone dry when I'm ready to take them or I take the patient back and their is some issue or the doc still needs to talk to them. The communication is horrible and I feel that people will let you sink and take the fall rather than working as a team for a smooth outcome. Any tips on how to cover my backside? There is no facilitator in the preop/PACU combo unit to oversee the turnovers and it seems haphazard. Any ideas on what to do about that as well?
  6. Pam RN

    Surgicenters

    What do you think about working in a surgicenter. I'm looking into a position at one. I keep hearing the docs are "more relaxed" at the center as opposed to the hospital OR's, "less pressure" they say. Are all the cases short and fast moving? What are the hours like? Which do you like better the OR or the surgicenter?
  7. Pam RN

    New grad To Dekalb, IL--Info wanted

    Hi, I'm origianlly from Rockford and there are three hospitals- two that were mentioned: Rockford Memorial and Swedish-American but there is one more, St. Anthony Medical Center. They have an excellent Neuro/Trauma and Cardiac programs. Rockford is 45 minutes north of DeKalb with a population of over 150,000 plus the surrounding areas. Others have mentioned the other hospitals in Dekalb and Sycamore and others in the immediate areas. Dekalb has certainly grown in the last 10-15 years and is expected to take on growth as Naperville did in the recent past, but perhaps not a large.
  8. Pam RN

    Have you worked outside the OR?

    I worked in the OR for 5 years right outta college. I stayed at one place for 4.5 years then made a switch to another hospital and hated it. I felt burned out and wanted to learn some "basic" nursing skills that I felt I lacked in the OR. I now work in a surgeons office but have realized that I'm better suited for the OR. I do a lot of desk work, answering the phone, triage, secretarial type of stuff along with sharing room duties with another nurse. I'm glad I've learned what I learned at the office but the type of work in the OR--set up for the case, do the case, send the patient to recovery, THE END, (maybe!) fits me better. This constantly following up, tracking down patients for blown-off appointments, etc. is not for me. I like the equipment, the tools, the instruments, the commeraderie that I found in surgery. So, I'm looking around for an OR job at the moment. Know of any places in Chicago to recommend?
  9. Pam RN

    Office nurse pay--

    Since you wrote this post in August I hope you have left that job. I just started in office nursing and so far so good. I took a pay cut from the hospital but sometimes the pay doesn't make up for the call and the abuse. Everyone in the office seems really nice and the docs are great. BTW--"Should I stay or should I go" was sung by The Clash, not the Kinks.
  10. Pam RN

    Can Circulating Nurse Sit?

    My old educator was a "miss AORN" type and for good reason. When I went to a new hospital the circulators were reading cooking magazines and copying down recipes with their backs to the field. I was so appalled. I used to make fun of the "miss AORN" types but after seeing that display of unprofessionalism I take back my jokes! The scrub would ask for a suture or something and the nurse couldn't rip her eyes from her magazine! "Sure, doc I'll get when I'm done with this article."
  11. Pam RN

    What's up with RNs who refuse to scrub?

    I love to scrub. When I worked at a community hospital I did both and taught both to new RN's and Scrub Tech's. My old manager was pro-nursing and made sure we had a mostly RN staff. But the few techs we had were excellent and had been there a long time. When I got a job a huge university hospital I only scrubbed a lunch relief maybe twice. I hated not scrubbing. I felt left out of the action. Fortunately, I left that job and if I go back to the OR I'll make sure I go to a place that will allow me to scrub.
  12. Pam RN

    want 2 work l&d

    Don't do med/surg if you hate it. Go directly to Mother/Baby. If you do post partum and if you get gyne surgicals and high risk moms you'll have plenty of opportunity to get those "basics" you get in m/s. Sure you may not take care of ostomies or amputations, but you'll get diabetics, HTN, post op, foleys, drsg changes, etc. If you happen to float to a m/s floor you'll have enough knowledge to get through. Do what you love!
  13. Pam RN

    surgery fear PLEASE ANSWER ME

    As an OR nurse I can tell you that not all patients receiving a general have a foley put in. If you're having a hysterectomy they will, if you're having a lap chole they may or may not, doctor's preference. Don't worry if you don't, you won't pee the bed. If you're having a gyne laparoscopic surgery for say an oophorectomy or an ovarian cystectomy you'll get a foley after you're asleep and will be removed before you wakeup. When you get your pre-op "cocktail" you should feel very relaxed, thanks to the versed. The induction agent used is propofol and it looks like milk in your IV. It may burn going in but they usually put some Lidocaine in with it to take the burning sensation away. We don't tell people to count back from 100 anymore because the induction goes quick. We tell people to pick out a good dream. It's better to drift off to sleep thinking of Paris or laying on a beach with an umbrella drink! My brother had his deviated septum repaired last year and he said going off to sleep was really nice. I agree. The anesthesia gases they use cause you to get that feeling that time is shorter than it is. So when you wake up and feel that you've only been asleep for 5 minutes or less its the gases. I had open heart surgery for a valve replacement and I went into surgery at 7a.m. and when my memory returned it was after 3p.m. but it only felt like 10 minutes. Very strange. I won't tell you not to worry because it's not an easy thing. But, hopefully this information will help you plan in your rational mind what to expect. We also tell people to go ahead an worry so we don't have to!! Good Luck!
  14. I think you either love the OR or you don't. I was planning on going into tele and eventually ICU when I was in nursing school and switched the day I observed in the OR. When I did a 6 week role transition class my senior year most everyone was nice and helpful. Now, four years later I'm in the OR and I love it. I just had a nursing student in one case today and it was her first time she had been in the OR and it was fun to explain things to her. It's different than training a new employee because of their questions and reactions to things. I made her put down her clip board, put on a pair of gloves and stand next to anesthesia for intubation. Even though she didn't actually do anything I thought it woud make her feel a part of the action and increase her interest. Plus it kept her busy while attended to a few things before I could talk with her. I haven't actually worked with any flat out mean nurses in the OR. I ran into some mighty mean ones on the floors though. Some were actually psycho. The nurses I work with seem to be supportive, but as in any place there is a certain amount of cattyness. But, sometimes it can be the morale or management that supports that behavior.
  15. Pam RN

    What qualities are most needed for an OR RN?

    The OR is most definitely a more structured environment then a MS floor. The autonomy is less since you are part of a team to get the surgery done. Each member has their role, but each part is essential. We start our day getting the room ready for our first surgery by laying all the supplies, instruments, medications, etc out in the room. Just basically preparting what we need. Once the patient is in the room you want to leave the room as little as possible. Surgeons are a different breed and you have to be able to do what needs to get done and shyness or being timid is not a trait that will last long in the OR. Not all the doctors are jerks, but some are. Once you are part of a team they all know you and it can be fun. You have to like to work with equipment because you will need to know how to trouble shoot in certain situations. For example, during laparoscopic surgery you have to move towers of video equipment, plug in cords, take pictures, print pictures, etc. You have to not mind that your patient is aleep most of the time in the room. Some nurses don't like that they don't have interaction with their patients. The patients are awake for a short time before anesthesia and it is a very important time for comforting them. You have to be able to lift heavy trays of instruments, be able to bend down and crawl on the floor to move (surprize!) more equiment like foot pedals, passing cords, etc. If you like that there is a beginning, a middle and an end, then that's the OR. It's definitely a different environment and work pace then the floor or unit. Either you like it or you don't.
  16. Pam RN

    Orientation: How long is enough?

    KC chick--I remember when I first scrubbed a breast biopsy bymyself I was so nervous. My hands were shaking when I handed the light handles to the doctor! I always try to remember those feelings so I can relate to the orientee's anxiety. I had a dream when I was on orientation in general surgery that the doctor asked for a Kelley or something and I turned to get one from my instrument tray on the back table and it was filled with forks, spoons and knives!! Good luck with your orientation and remember that this should be fun as well as a challenge! Tracey--Actually a doc did complain to me when I releived the orientee for lunch one day. The doctor said the orientee didn't seem to know his way around the tray of instruments very well and he had poor anticipatory skills. (Clamp-Cut-Tie). But, if management is unwilling to deal with it, I guess they get what they deserve. Poor attitude I know, but it's their choice.