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winkiebob

winkiebob BSN, MSN, RN

Family, primary care

Content by winkiebob

  1. What would you do if you an RN, go to an emergency room with anaphylaxis. ED doc orders epic 0.3 mg IM, and the ED RN gives you the same amount of epic 0.3 mg IV...... of course your BP goes from 170/110 to 70/30... now you need fluids (5-7 bags), Troponin goes to 4.6, chest pain is severe, EKG shows lots and lots of PVCs, HR is 120-137 sustained for the next 7-8 hours. Cardiologist is called, now you have an echo, a stress test, a CT of chest, D-dimer is a bit elevated 518... Of course you are now admitted into this hospital for 3 days until luckily your heart is cleared.... When you finally feel more alert 4 hours later after the incident you ask, the nurse at this observation unit, Who gave the order for IV epi? the attending NP comes in an says: you deserve to know there was a medication error... You knew it all long but wondered why no one said a thing.... now you feel quite traumatized after feeling that Gigant Mule of EPI that kicked your chest. Your heart felt as if was going to explode together with your brain and head. You were stucked in a treadmill exercising for hours while you were lying in ahopsital bed sweating profusely and asking for ice packs and fans trough your stay.... Any ideas? By the way, they say because you aren't death there is no case, and because you are young and sustain "no physical damage" there is no case...; but what about the emotional distress and having to be off work for 10 days after while your heart rate went back to normal... and the nightmares, feelings you were going to code.... anybody?
  2. winkiebob

    Patient safety in nursing

    I would like to get your opinion on the following scenario. Please be respectful and professional. Nurse A takes patient B to the restroom after surgery (patient B is a female and had GYN procedure). Nurse A is with pt in restroom when she clearly needs a change of pad, mesh panty, gown etc. Nurse leaves pt sitting on toilet while she goes next door to grab supplies. The bathroom is not stocked with any supplies. Nurse A comes back in less than a minute, the pt is still sitting on toilet, but suddenly begins to decline and blacks out. The nurse velds patient head, tries to calm her down and keep her present, while she pulls the "emergency red cord".... a minute goes by and no one comes to help. Pt is back up, and fainting again. Nurse can't leave the pt or else she will fall. The nurse needs someone to come in and help this patient out, an extra minute goes by and no one comes... A tech opens the door, the nurse says get a nurse.... the tech closes the door quickly and leaves the nurse in the same situation. The nurse takes the mesh panties and opens the faucet on sink and tries to apply a wet compress to the patients head while she keeps waiting. A charge nurse appears on minute 2 and offers to bring nausea medicine and leaves again. At this point Nurse A is getting overwhelmed, all she wants is to get out there... another minute goes by, now we are getting closer to 4 minutes or more.... Nurse A, gets claustrophobic as the patient is now sweating profusely and she is afraid the patient will black out/faint again. The call light is still going. Nurse A decides to yell "Somebody HELP'.... that brings the attention from a nurse near by who brings a wheelchair and helps the nurse to get the patient out to her bed. While nurse A struggles to put the patients legs on wheelchair, there is a male nurse on the hallway, who sees the struggle, but dodges and let the two female nurses figure it out. The patient is back safe on her bed, BP is about 90/50, and nurse A continues to care for her. Nurse A writes an email to the nurse manager stating that she wasn't pleased with the response of the tech etc. The charge nurse complaints to nurse manager, and nurse manager brings nurse A to unit director to talk about the incident the following day. Nurse A is reprimanded because she was not supposed to use her voice to ask for help. Nurse A is glad the patient was safe. She cites some safety concerns, but management thinks nurse's A is making a big deal about it, that it 's nurse A problem and who she handles the situation. Nurse A feels like there is no real support on the unit so she gives her resignation letter as she believes that protecting her license is worth more than staying and trying to convince then that there is a serious problem in that unit. What do you think is wrong with this scenario? What would you do if you were nurse A?
  3. winkiebob

    September 2019 Caption Contest

    The regular staff is out for a Halloween party. We are the on-call team for special occasions, but don't worry your nurse will answer all of your questions once she/he is back!!!!!!!
  4. winkiebob

    September 2019 Caption Contest

    This is a scary time to be alive. Do you guys know about the 5 rights? Or do I just get the 3 of you! God help me!!!!!!
  5. The Issue Low literacy is a complex issue that has been linked to several negative health outcomes. Poor understanding of medications and how they work can lead to errors, which can lead to delay in recovery or even death. Nurses have the professional responsibility to provide effective patient teaching to their patients. Providing information to the patient is simply not sufficient. Nurses must also know how to use health promotion and teaching methods according to the patient's level of understanding, learning needs, readiness, ability to understand, culture, and language preference. According to Scott 2016, many nurses poorly understand the concept of health literacy and its impact. The likelihood of nurse faculty that has not received proper or formal training on health literacy is a reality. Therefore, the topic of health literacy must and should be included in all basic nursing programs. At this point, it is hard to imagine the extent to which Health Literacy Education (HLE) is included within the nursing programs in the U.S. (Scott, 2016). A lot of the health literacy has focused on the skills or deficits of the patients, however; other variables can affect the patient's ability to utilize and understand health information. Those variables are the quality of the information taught, the methods used to teach, and the context of the situations, and the ability of the healthcare professional to communicate and teach effectively. Furthermore, the improvement in sharing health information requires the implementation of HLE within the academic programs and health care professionals (Scott, 2016). Solutions The question remains: what can nurses, as healthcare educators, do to make a difference in dealing with health literacy? According to Kennard (2016), it is only recently that studies have introduced the notion of health literacy education among healthcare providers. Regrettably, nurses, who comprise the largest segment of healthcare workers, reported having the highest rate of no prior health literacy knowledge. Fortunately, there are tools and techniques at the disposition of nurses such as The Quality and Safety Education for Nurses program that includes health literacy assessments. These assessments provide instructions on patient education and the importance for nursing faculty to emphasize to nursing students the potential of low health literacy in certain vulnerable populations (Kennard, 2016). Another tool designed to provide support and assist healthcare providers in removing health literacy barriers is The Health Literacy Universal Precautions Toolkit, which was developed by the Agency for Healthcare Research and Quality (AHRQ). Nursing schools should introduce these tools to assist students in their new role as patient educators. Commonly used tools to administer to patients include the Test for Functional Health Literacy (TOFHLA), which measures reading and comprehension. The Rapid Estimate of Adult Literacy in Medicine (REALM) is a pronunciation and word recognition tool that can be administered quickly. The Newest Vital Sign (NVS) measures numeracy, which is an important skill for patients to calculate medication dosage. The tools should be introduced to the nursing students prior to graduation so they can become familiar in how to appropriately administer them to patients (Kennard, 2016). Techniques to understand if the patient has been able to understand the information taught are also being developed. One case Is the "Teach Back Method" which allows the healthcare provider to identify what the patient took from the teaching and if there is any confusion or lack of clarity. A simple question such, as "How would you explain the information I just gave you to a family member when you get home?" or "What are the highlights of our conversation/teaching today?" will help the nurse to understand how well the information has been presented and/or understood. It will also give a chance for further clarification if needed (Kennard, 2016). Another way to teach our nursing students at the undergraduate level is through interactive teaching and learning modalities such as roleplaying, literacy assessment, readability testing, revision, demonstration, and practice. This can significantly enhance the undergraduate learning experience. Furthermore, this will result in well-educated and articulate nurses who are better prepared to address health literacy issues in their professional practices (Smith & Zsohar, 2011). Conclusion All in all, research evidence has shown that nursing is a discipline that needs cultural competency and skills to handle patients with low health literacy levels. The evidence also shows that the profession of nursing remains unaware of the prevalence and tools available to them to help with the issue of health literacy. It is imperative that nursing students be presented early on with the tools and means to educate their future patients with the information they will need for their health care. In short, Health Literacy Education must be provided to nursing students' curricula to ensure all new nurses can have a greater impact on their patients' health.
  6. winkiebob

    Knaves, Fools, and the Pitfalls of Micromanagement

    I so agree with you! While we work 40 hours plus, nights and on call. The department manager gets to work 9-5 PM M-F. Many of them walk around like they somehow deserve the "good treatment" and somehow the rest of us are beneath.
  7. winkiebob

    Pregnant and no experience

    Hello everyone! I have so many questions these days, so I'm a brand new nurse. I graduated last December and I went to work right away as an ER nurse, I worked for 3 months until the day I got sick and find out that I was pregnant, also I had to give my resignation letter because my husband got transferred (military) 2 states away. Hoping to get a job in the new state, I was unable to do so due to a severe case of hyperemesis, now I am 5 months pregnant and barely recovering from my first months of pregnancy. Unable to drive around yet on my own... With student loans kicking in... In a new place, where I get the "you don't have enough experience"... Response. Debating myself whether I should just wait until after I have the baby... And the go into a serious search for a job. But I wonder what if they say you have not worked in a year.. Etc and then make it even more difficult for me to get a job.... So I got my BSN and I have goals to continue with my education, certifications etc, but I noticed that experience is the main requirement...at the same time I wonder how do I get experience if I don't get a chance to prove that I am capable to do my job as a nurse. any ideas? What to do? I miss working... I don't know where to turn... Anybody? Thanks.
  8. winkiebob

    Pregnancy and work

    Yes, I am always honest up front. definitely thats what I am looking for a clinic office type of job. I still have faith that in the few weeks i may feel much better. I love nursing and I don't want to stop being current, I am afraid to lose the career I worked so hard to accomplish, meaning my degree. I am not the kind that has a degree just because it looks nice in a wall... I am a nurse by heart, and I can't wait to prove myself that I can last for a long time in a good decent job. I hope my dreams come true, all that is holding me back right now is not feeling well.
  9. winkiebob

    Pregnancy and work

    Hello everyone; so I am now getting closer to my 8 wk. I have not felt well since day one. I am not longer working because my husband got relocated and we moved to another state. In the mean time I have felt quite awful. This is my first pregnancy. I have 2 job offers, but I'm tempting not to take those because of how I feel. I am not fucntioning to my 100% I'm weak everyday, I vomit 2-3 x a day. Etc... My question is: since I only have 3 months of actual RN experience (ER), I wonder if I don't get a job at all during my pregnancy and wait until my baby is born I wonder if anyone would hire me... what should I do? Part of me says to wait a few more weeks to see if I regain myself and try to pursue a job... But the job I was offered this past week for a small urgent clinic pretty much calls me to be the only nurse in the premise and the charge nurse... I have no doubt I can do that... If I was functioning to my 100% capacity. My biggest fear is to let down my employer by me being sick everyday. Somedays I don't have the strength to get out of bed, my husband is the one who cooks the very little meals I can eat... Anyways, does anyone relate to this? I am open to any advice. Thank you so much!
  10. winkiebob

    Pregnancy and work

    Thanks for the advice. My husband is active military and I had no choice than to move with him 5 states across, it is not like I could just stay there and wait for a year, for I have no family in that town.. long story. I totally understand the 3 month thing... is hard. how do we explain ourselves? one would think that having military orders would be enough excuse for an employer to accept. Going trough a difficult time right now, I wouldn't mind to wait until I am better and give my all at my job.. In the mean time I will definitely do a lot of prayer for what it seems almost imposible for me, it is all possible for my God. Maybe I need to focus in the fact that my child should be the most important thing for me right now, and the job would take care of itself later.
  11. winkiebob

    What to do

    My story feels like to large to tell. I graduated on December 12 and got a job at a community hospital in the ER on dec 15. Everything was going well until they brought me from the 7 am -7pm shift to the 3pm-3am shift. To beging with I never felt welcome in there. After working 9 hours straight on my feet I asked for a lunch, I was told: "we don't ever go eat here when we want, we eat when we can". I got visibly upset, because I asked the charge nurse, I begged her for some time to eat something before I would drop in the floor. So I got like 3 minutes to eat. So from that I learned not to ask for a break, or lunch. I would just try to snack until my shift was over at 3 am and the eat. The nurses on that shift seemed to be uncaring and careless. They were quite unapproachable, so I tried to never ask anything or stay on their way. One day like 3 weeks ago, I got sick while on the job, I actually almost had a syncope, and the attending doctor said: put her in a room. My BP was sky high, and the it drop so sudden, they gave me phenergan IV for the nausea and sent me home, the next day I went to see my doctor, and I just couldn't work. The supervisor called me upset asking me what happened the night before, because I went back to work, but I felt bad again and I had to go home. Later on I came back to work, and I continued to work just fine, until a week ago I gave my resignation letter to be effective at the end of the month because my husband got orders from the army to move. They accepted that I continued to work. This past Tuesday night I was working and pushing it as hard as I could, it was around 10pm when I couldn't no more, my head was spinning, I had nausea and started trowing up, I let the charge nurse know and she sent me home. The next two days were my days off. On Thursday morning I got a message from the director saying: "I heard you were sick, would be able to work this weekend". At that point I was honest and I told her I was feeling bad, by the way I had gone to another ER the night before to get IV fluids because I had had watery diarrhea all night and had not eaten a solid meal in 24 hours. So I thought I would be nice to let them know I had viral gastroenteritis ahead in case they needed to have someone to work for me. I was honestly afraid to go in to work and have diarrhea while there. I really though they cared for their employees being sick. Well, I got a voicemail on my day off from the director to call her back. She asked how I was doing, I was honest I told her not so good. She said: did they doctor told you not to work this weekend, I said not she didn't say that because I never even asked for an excuse. So the boss said: well I'm just going to take your resignation effective as of today, and wish you a good life, and she hanged up on me. That was the most unprofessional thing I have ever seen, but at this point I wouldn't expect anything less from them. To work for a place where there was so little caring for the employees If none is very rough. There so many things I wish I would of have said, but at the same time, there never seemed to be any time to talk to no one. I never had a chance to be heard, I guess there isn't such a thing. All I can think of is I have so much to learn. I don't what to say or what not to say, as a brand new nurse I honestly don't have much confidence in being heard. That's the only placed I have ever worked, and they weren't very friendly or caring. I felt like they took advantage of the fact that people need a job and they could just use and abuse anyone, the survivors in that game are the tough ones who feed of each other. They have set up ways and I was some how a treat to them. How? I was new, and even though I tried my earnest best, never complain of anything, I put up with so much, their words, their mistreatment, they would be really really mean I would just act like I didn't hear it, I would smile back. At one point the charge nurse treated me like I was a dumb ass because I lose an IV line on a two year old, and because I didn't have the time to make coffee for the family of patient that asked me for some... They would get upset if went to have a lunch even when my rooms where empty... I could feel their love, not really. They didn't said they hated me probably because they weren't allowed to say that at loud. So that's just a synopsis of my story. I just wanted to share it. Now I have to figure out how to chose a better place to work, surely I know I don't want to work night shift and I feel like I'm done working at a ER.
  12. winkiebob

    What to do

    Found out I am pregnant. :) that solves the hunger, nausea, and fainting mistery :) extremely happy!
  13. winkiebob

    What to do

    Well... The Fainting at work and all that not feeling well wasn't in my head. I found out that I am pregnant! What an exciting moment for our lives. My morale was down because I felt bad for having to leave in the middle of the shift and getting sick at work. But now, I don't feel guilty anymore. What I felt wasn't something I made up. :) Glad to have these days so I can have more time for the move and also to spend with my hubby.
  14. winkiebob

    What to do

    Thanks so much for the reply. Luckily for me, I am moving out of state, and I just wish to have learned something good from this experience. I will definitely know what to look in for a job. I just got married and I definitely don't want to work nights, even working a small job in a doctor's office with a lower salary would be ok for me. I did remember feeling like walking into a lion's den when going to work everyday. What is interesting is the patient load or the job responsabilities were never a problem to me, what I couldn't deal with was the hatred from the other nurses, their demeanor, their ugliness, their lives seemed to be so bitter, there was no joy, mostly the ones with the bad attitudes were the charge nurses, even the doctors and the mid level providers always had a bad attitude. There was only one doctor that was always nice no matter what, the rest were honestly pure jerks, it was so hard to ask them anything. I saw so many nurses that had been there longer go inside the med room and cry. As far as bad reviews goes, I don't have to give any because it all speaks by itself, nurses and other employees leave there on a weekly, monthly basis. They can't keep no one in there. I heard so many complains daily from other workers, and Me.. I smiled, went home feeling like a truck load just went over me. Never said anything, but that one time when I was visibly upset because I wasn't allowed to take a break to grab a bite. That is why there is a nursing shortage, somebody has to do something, you can't work 9-10 hrs straight with an empty stomach, I'm not talking about sitting down in a desk, I'm talking on your feet... Constant work... It is simply awful. We are humans too, and yes we do get sick as well. Anyways, I know I will be better, I will make sure to have a much better lifestyle after this, I will have time to exercise and eat right. I know that, after all no money can compensate ones health. :)
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