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ICU/CCU, Home Health/Hospice, Cath Lab,
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patwil73 specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.

patwil73's Latest Activity

  1. patwil73

    I made a injection error... Please help me....

    A pharmacy that apparently makes injectable version: http://www.sgpharma.com/company/mainexplist.htm Also here: http://www.ncbi.nlm.nih.gov/pubmed/17720114 Which indicates it is used in England but not North America - and comes in 75mg dosage. In my micromedix the oral dose seems to have some nasty side affects, but I am not sure how that would translate to the IV form or what would constitute an overdose - everything I have read so far seems to indicate 75mg as being standard. Hope that helps Pat
  2. patwil73

    assignment due to acuity with points??

    My hospital originally used an acuity model called Quadromed to assign patient acuities. That created a number of staff to cover those patients - the higher the floor acuity the more staff you received. The problem I noticed is that people rarely assigned by acuity - they just divied up the patients so everyone had roughly the same - 6 on days, 7 on eve, 8 on nights. Since I was in charge of assigning admits to the floor I knew there would be a fight if I asked them to go beyond those numbers - even if the acuity model said they could. Most staff did not know how to accurately assign acuity numbers - often times giving less points than they should. The managers of each unit had an average acuity they were told to shoot for and if came back above that they had to try and lessen it to keep their budget in line - (note this didn't come about by changing the patients but simply by lowering their score). Also the system was not good in capturing those patients that actually took up a lot of your time - walkie/talkies who needed everything 1 at a time can be a lot more busy than the isolation total care who you only need to see twice a shift. The nurses often didn't like to walk far for their patients - so even when I assigned by acuity (a couple times I had to be the charge when we were short staffed) they asked for the assignment to be changed so they didn't have to walk so far - meaning skip 3 or so rooms to get to a patient. Acuity based staffing can work - but you got to get the nurses to buy into it, and you have to train them well so they use it correctly. Without that you might as well staff by a matrix. Hope this helps Pat
  3. patwil73

    Weekend make-up shifts?

    If I understand your post correctly - at your facility if you call in sick anytime between Fri days and Mon nights you have to make up those days, but you don't make them up on the same "day" you missed. You don't miss fri nights and then have to work another fri nights, correct? We have nothing like this, and I think our union would fall over laughing if it were ever proposed. People are entitled to use of their sick time without being made to feel guilty about it, or having to work extra to make it up. That is just plain wrong. That being said, if you abuse your sick time I feel we should be able to fire you. If you are sick every friday you should be let go. I can't really imagine how such a system would work, and I am heavily involved in staffing. What happens if they don't need you on your make up day - due to low census or such? Do you have to schedule another make up day? At our facility weekends usually have the least amount of staffing - due to low census and just the split of staff between weekends - so if you miss a weekend they get shortchanged but putting you back on a Wed would do nothing as they are usually overstaffed. What happens if you are sick and need to be out for a week - do you have to make up only the days of the weekend? Do you get sick time? I would look for work at another facility if that policy was in place here. But I like my time off. If you have a union I would fight it - heck even if you don't I would fight it. Best of luck Pat
  4. patwil73

    MRSA and patients who smoke

    We recently had this issue come up too. As the supervisor they call me and say the patient wants to go outside and smoke and is MRSA+. What do we do? Our policy states MRSA is a contact isolation and the patient should remain in their rooms. Our policy also states we are a non-smoking facility and you simply can't smoke here. However policy at some time must meet reality. Patients will continue to smoke and mobile patients will not remain bed bound for days at a time. So what I instruct our nurses to do is inform the patient of our policy and document that information. If they continue to insist we instruct them that they will have to sign an AMA form and that we will contact their doctor to see if he wishes to continue care. At this point, once either they have signed or 2 nurses have signed witnessing he is refusing to follow hospital procedure, he is free to go. We then contact the doctor who usually will say - no they will not refuse care and back he comes. After that it should never be an argument. Also depending on where the MRSA us we will take appropriate precautions such as wrapping the wound well, providing a mask, etc. Hope this helps Pat
  5. patwil73

    Muslim Nurses Administering Haram Medications

    i know you have asked for muslim nurse response and i am not, but i hope you will take it in the spirit which it is offered. as a supervisor i have worked with a few muslims, on every floor of the hospital. i have not seen or heard of any having any problems giving any type of medication. that being said i can't tell you if the were devout or not, just that they were practicing muslims and gave medications. yes you can refuse to give a medication if you truly believe it to be harmful. for instance if my patient had q2 hr dilaudid 4mg ordered and was asleep and breathing 8 a minute when i came in and could barely arouse himself - i could refuse to give the medication based on my judegement that it would be unsafe. i would think that it would be more difficult to make the case based on a religious commandment (which probably doesn't help you to much - sorry). you could check each medication from the manufacturers website or from your pharmacy who should have the complete info - it will tell you ingredients, how it was made, what it was made in, etc. so, yes it could be done. i tried to do a search for haraam (i hope i'm using the word correctly) medications and only came up with "seldane caps and heparin". once you have the list, either through your own compilation or anothers you could then look for jobs that limited exposure to such medications. for example, working general medicine in a hospital would be difficult to avoid them, but perhaps working surgical circulating, or endo, or school nursing would allow for limited contact (and if contact did arise it might be easier to get someone else to administer.) from a very limited research it seems that the prevailing theories on giving haraam medications break down to 2 camps - 1) you can give haraam medications if they are necessary and no other alternative exists and 2) you can not give haraam medications as you don't know they will cure the disease and allah might provide a cure instead. if the muslims i have worked with are as devout as you, i would be willing to bet they fall into camp #1. hope this helps pat
  6. patwil73

    help from other night nurse mama's of young ones!

    We have two young boys (and a girl on the way - yea!) and both work nights. On our work days it goes: Sleep from 10:30 until 17:30. Up and make dinner, play, homework, kids to bed by 2030. Me - watch mariners game, her read or nap. 23:00 - off to work until 10:00 On the last day of work I come home and sleep until 17:00. Get up until 24:00. Sleep and up again in the morning. Now I am on a day schedule until I work again. I work 7 days on and 7 days off so it is easier to hold to a schedule like this. I still eat dinner around 18:30 each night, a lunch/dinner at 02:30 and breakfast at 09:00 on work days. Days off it is breakfast at 08:00 with the boys, lunch at 13:30, dinner at 18:30. It really is easier (at least for me) to work straight on nights so I don't have to switch that often. Hope this helps Pat
  7. I love this thread. It should stay around forever - so 20 years from now we can look back and go "OMG! You didn't have that when you were working. However did you survive." For me I would invent: 1) A clipboard computer that can scan your patient. It takes vocal dictation for charting. It warns you when your charting is different from prior shifts. It can record telemetry. It can connect to a bluetooth in your stethescope and record lung, heart, and bowel sounds. It automatically updates from the IV pump and foley bag. It is smart so when you ask what you can do for your confused pt - it will say "You haven't given Haldol yet. 5mg IV. Why don't you try it?". You can type in requests for the doctor and he can write orders electronically back. It will tell you what to do in a code. 2) You know those antimicrobial foams they have outside pt rooms? I want a spray dispenser for a glove product. One that molds to the hands and doesn't stick to anything. 3) A spray disinfectant at the door to each room. No more gowns to wear or stupid stethescopes you can't hear through. Just hit the button and you and all your stuff gets zapped clean. Make it mandatory everytime you enter or leave a room (for those who think isolation doesn't apply to them). 4) A spray that highlights veins and deadens the skin for 2 minutes. An alarm on picc lines that shouts - you didn't flush me or clamp me - now I will clot off Nurse "name here". So everyone who walks by knows who to blame when the picc dies. 5) This is political - but I would make every place have the same charting. Make it universal and make it follow you when you enter another facility. So you come to the ER and get registered - it automatically calls up any prior visits from anywhere - any labs, xrays, etc and they are all in the same place. 6) A drug that knocks you out anywhere from 2 mins to 1 hr and doesn't depress the respiratory drive. Usefull for NG insertions, foley insertion, MRI's, CT scans, etc. 7) Beds on tracks so you can push a button and they trundle off to radiology or the cafeteria that has a drive through. 8) Bed alarms that restrain the patient until you get there. Like a big bear hug from behind when they try and get up. Hopefully one day we will have them all Pat
  8. patwil73

    PICC Removal

    The picc's we use here have measurement numbers on them - so you look at the end and if it says 45 and the insertion record says 45, then you are good. The numbers go all the way along the picc from 0 to (I'm not really sure the longest length) but they go in increments of 5 and have small dashes in between numbers. Pat
  9. patwil73

    hour long seizure-what was this?

    Encephalopathy should show up on a CAT scan. The brains swelling makes pretty obvious changes to the image. Also if he had encephalopathy valium and ativan should not have fixed the problem as they don't decrease swelling. You mention methadone for pain - that usually indicates chronic pain and/or drug use. If chronic pain could it be MS or spinal problems? You said labs were normal so I'm guessing no drugs other than methadone were found in his system? Had he missed any doses of his methadone - I've had pts with weird reactions who have been taken off methadone while in the hospital (even if given other pain meds methadone has a physical addictive property so it should be weaned slowly). This is one of those fun/frustrating things about nursing - getting a patient who takes a bit to figure out. Pat
  10. patwil73

    hour long seizure-what was this?

    Could it be an overdose of dopamine antagonists (haldol, reglan, amoxapine) leading to EPS (extrapyramidal symptoms). I usually see it in the face and partial body, but it does take a while after getting medication to reverse? Since the pain was relieved by valium and ativan (not normally used as pain meds) I assume that they calmed the spasms enough to decrease pain? Just a wild guess here. . . Pat
  11. i have to disagree here. as a nurse you can often apply for position from per diem (5 or 6 shifts a month) to 0.6fte (which is either 4 12 hr shifts in 2 weeks or 6 8hr shifts) to full time (which can be 6 12hr or 10 8hr). you can find positions that are weekend only (sometimes even two 16's each weekend but get paid for 40 hrs). many good hospitals will hire new grads into day and eve positions to avoid having all new people on nights. i work 7 days straight and get 7 off. nursing is very flexible. most hospitals and nursing homes will require you to work every other weekend (although a few dept at my hospital work every 3rd weekend) but there are also doctor offices, day surgery clinics, etc which are m-f. holidays are often rotated so you don't get stuck working every christmas - if they aren't find a fairer facility. also we have a dept here in my hospital which is closed every holiday. when i graduated nursing school i wanted to work in the icu - i applied and was accepted to 3 different hospitals and their icu consortium (like school but you get paid). our l&d hires new grads all the time. sure some areas require experience and more education, but not all. check with hospitals in your area to see if they hire new grads for specialty areas. where you work in nursing might be like what you described but it is not like that everywhere. just my pat
  12. 1) Nope - I started out in computer programming in college, quickly grew to hate it and moved on to teaching. Graduated with a teaching degree and worked 3+ years before I went back to college for nursing. Iwasn't getting full time work as a teacher and my sister in law said that nursing was always in demand, had good pay, and was primarily female. I didn't even know what acetaminophen was! 2) You realize that it is something you can keep doing with some success and some element of happiness. And because there are so many niches of nursing you can keep trying different areas until you are sure. 3) I cry. Hold my family. Play games. Read. Go to movies. Sometimes I can say it is for the best, but others I just have to say "life sucks". You get skilled at not holding it all in - find a relief valve and use it, often. 4) No. But many people in my class were convinced they had the latest disease of the week. You are trained in good habits to avoid getting sick - just remember to use them and not take shortcuts. It seems strange but what you learned as a kid (wash your hands) is still the best method of avoiding that bug. 5) Nursing can be very heavy and demanding. But there are niches where the heaviness is diminished. You talked about NICU which can be very fast paced but you are moving very small kids as opposed to med/surg where you might be turning a 600 pound man. However, I have found in all specialties that you have young and old, thin and overweight, disabled, sick nurses who do fantastic jobs and can keep up the pace. I would advise almost anyone to go into nursing. It is truly a wonderful profession. You can try job shadowing (although it can be hit or miss on showing you what you want), but to truly decide if it is best for you, you just have to do it. Hope this helps Pat
  13. patwil73

    Med Surg Staffing Ratios

    At Valley Medical in Renton the staffing is 4 or 5 on days, 5 or 6 on eve, and 6 or 7 on nights. They have 1 pca for up to the first 15 pts, and after that they get another pca every 12 (so 1-15 = 1 pca, 16-24 = 2 pca, 25-36 = 3 pca) they get extra pca's for suicide watch. Hope this helps Pat
  14. patwil73

    MOVING to Seattle from NOR CA, NEED HELP

    Hello, I'll try to answer as many as I can. 1) Yes, but they are usually LTC or office work. Most hospitals around here are almost all RN. 2) Contact http://www.doh.wa.gov/hsqa/Professions/Nursing/forms.htm and see what they say. Your state might have reciprocity (meaning your license will transfer to washington with only a small fee) 3) Yes, lots of community colleges in the area. Some online learning process. Some hospitals also provide money for the education if you can get hired on. Very competitive in the BSN programs. Moderately to highly competitive in the ADN programs (just shop around and find their wait list) 4) Unsure maybe $15-$20+ depending on experience. 5) Seattle is expensive to live in. Most of the closely surrounding area is also expensive to live in (Bellevue, Redmond, etc). I would suggest moving to Pierce County. It is located just south of seattle and is generally less expensive to live in. The biggest city is Tacoma. From their you have St. Peters Hospital in Olympia (30 miles south), Good Sam in Puyallup (10 miles east), St Claire in Lakewood, St Joseph in Tacoma, Tacoma General, Allenmore, Auburn, Valley, St Francis, Swedish (first hill, cherry, and ballard), Madigan, the VA, Highline, Harborview, Virginia all within 30 minutes or so from Tacoma. Of course there are a whole load of LTC facilities to choose from also. 5a) Puyallup generally is rated as having good schools and a lot of new suburbs on the south end. 6) Yes. The area is very pretty, people are generally nice, a lot to do both indoors and out. It is a pretty good place to live. Hope this helps Pat
  15. Technically it works out to $350 for 2 weeks since my wife and I work one week on and one week off. It is a bit high for the typical school year since mostly she watches them at night. But during the summer, spring break, and all those half days that the school loves to have she has to watch them while we sleep, so those times it is a bit low. We figure it evens out over the long run. Pat
  16. patwil73

    Can You Refuse A Patient Assignment

    My first instinct on reading this is that you could certainly try to refuse the assignment but i doubt you would get very far. As a med-Surg nurse you should be able to deal with a patient with a recurrent headache. Also you should have had at least some pysch training (it is mandated that you ask about thoughts of suicide or self-harm here at our hospital). So essentially you are treating his pain, monitoring his detox, and assessing for underlying symptoms that could cause headache - stroke, meningitis, etc. If such a patient had been admitted at my facility I would have had a quick talk at the start with him - essentially emphasizing the fact that if he threatened anyone here I would call the police. If he threatened to hurt anyone here because I call the police i will restrain him and then call the police. You can't let crazy dictate your treatment or limit your options - it never works out. Finally I am betting, since my ER has tried this a time or two, that since no beds were available in surrounding psych units that the ER did not want to be stuck with this patient they came up with a handy medical diagnosis to get him admitted - I have had them say we want to admit with hypokalemia (K is 3.2) simply because they don't want to watch him themselves. Hope this helps Pat