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LadybirdRN

LadybirdRN

Content by LadybirdRN

  1. LadybirdRN

    Pre employment Physical

    There are a lot of threads about this but some are quite old, so, same general question.Im moving to another state for this job so this is weighing heavily on my mind. My pre employment physical form asks about all systems, all medications. I'm just over 50 years old, of course I have some back pain, arthritis, ( prescribed opioids) HTN, hypothyroid etc. My son committed suicide, as a result I'm taking psychiatric meds and have a couple psychiatric diagnosises. Im working in an acute care hospital on the floor, the new job is an acute care hospital on the floor and I'm fit to work. I have an excellent track record with the employer I'm leaving and have worked there for 21 years. I don't want to discuss my son's death and aftermath. I don't want to disclose all my medical history. It feels invasive and I'm also worried it will be held against me after all this upheaval of moving to a new state. I could get there and suddenly have no job.Any opinions on how this may go? Thank you.
  2. LadybirdRN

    Hospitals in Phoenix Area

    Well how sad nobody answered your question! I'm an RN who has only worked in one hospital system, Dignity Healthcare, at St. Joseph's. We have a very strong neurosurgical program, do lung transplants, recently we started liver transplants. It's a level one trauma center and because we sort of specialize in neuro, get a lot of traumas that involve head injuries. We keep our ICU beds pretty full, MICU, SICU, TICU. We have labor and delivery, plus a NICU but no peds. It's also a teaching hospital so there are residents. Ratio is pretty generic and the only hospital I can tell you about. ICU is 1-2 or 1-1. Some transplant areas are 3-1. Most floors are 4-1,with an occasional 5-1, though I have never in 7 years had more than 4. We use Cerner EHR. Banner Health is another system. They are well respected and have trauma as well. They have Psychiatry and oral surgery residents. They have a lot more hospitals than Dignity, which only has 3. They also use cerner. Maricopa Medical Center is what used to be the "county" hospital. They have an excellent burn unit. All burns go there. They have peds. All I know about them is what I saw during clinicals. Very good staff and nice equipment. Phoenix Children's Hospital. Very large, very good facility. Amazing cafeteria lol. Great food, low prices. My grandson was a patient there. If you like peds, that's where to go. These hospitals are all within maybe 10 miles or less away from each other. In Scottsdale, you have a few hospitals, Scottsdale Osborn is the closest to our lakes and they get a lot of water related traumas. There's a giant Mayo Clinic and a Mayo hospital. I liked it as a patient and they have what seems to be pretty satisfied employees. Their patients have high expectations and they strive to meet those expectations, so it's prob pretty well-staffed. So, depending on your Nursing interests and where you want to live you should be able to find a good fit. They do cost comparisons and stay fairly competitive with each other. You'd make generally a similar pay, with a similar benefit package. The current situation is lots of flu patients, lots of staff out with the flu and a strained healthcare system in the whole area. This would be a good time to apply.
  3. LadybirdRN

    Patient care question

    I'm a Med/surg tele nurse and recently had a patient who is on hospice. He was admitted for failure to thrive and having a G tube placed. Once he was at goal for the feeds he was going back to his home. He was extremely emaciated and had advanced cancer with mets. I'm not an expert in this area but I doubt he'll be alive a month from now. He needed to be turned Q2 hours, hated wearing SCD's and was uncomfortable with his heals floated. I turned him, gently and not too much, but left the SCD's off and let him keep his heels flat on the bed. I just considered it a refusal. He was oriented and capable of making decisions. He was only in the hospital overnight so I didn't really urge him to comply; I was primarily focused on keeping him comfortable; frequent pain assessments, bringing warm blankets, oral care, ice chips etc. But it made me wonder, what is the general practice with very advanced ill hospice patients? If patients don't feel well and just want to sleep, do you leave them alone or wake them up for care? Do you let them just make informed decisions that are detrimental to their health and leave it at that? A pressure ulcer would just be one more cause of pain and cause further deterioration of the health. It's also below the standard of care for nurses. How do you approach these issues, such as turning, DVT prophylaxis, leaving urinary catheters in so they don't have to get up to urinate, etc? I'm just curious and I'd also like to know in the event I ever care for a patient who will be admitted for longer than just a day or two. Thanks.
  4. LadybirdRN

    Patient care question

    Its ok, I appreciate the sentiment, no worries.
  5. LadybirdRN

    Patient care question

    No I don't know what he thinks. That's why I said "I think". Is this a courtroom or something? I've given facts, observations and opinions, doing my best to figure something out that will lead me to best care for any similar patient in the future. I'm KNOW that I'm not trying to offend anyone over this. But thanks for your extremely important input on this matter.
  6. LadybirdRN

    Patient care question

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  7. LadybirdRN

    Patient care question

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  8. LadybirdRN

    Patient care question

    If anyone could ever figure out who this this patient is based on the information supplied I'll eat my shoe. I was trying to give enough relevant information to nurses experienced with this type of care in order to paint an accurate and complete picture of the entire situation in order to help me, and other posters and readers, give the best care possible to hospice patients. Why someone feels the need to order me to change my post is ridiculous. This is a friendly thread with some good information being exchanged, meaningful questions being answered and insight given from experienced hospice nurses, all with the intent of helping give the best care possible to some of the most vulnerable patients at the most intense part of their lives.
  9. LadybirdRN

    I was happy once. Then I became a nurse

    Three thoughts: Are you on night shift? When I switched to days, I felt so much better physically, emotionally and spiritually. I don't know if it's possible for you but I went from full time (3 12's) to part time (2 12's). I get the same benefits; I can always pick up a third shift and get flex up pay. A lot of our staff is part time now and all the part time people are way nicer than they used to be! I feel a lot better and feel like I have a life outside of working and recovering from working. That extra day off makes a huge difference. We have to work every third weekend so in order to have a consistent schedule I work every weekend. I make an extra couple bucks an hour, no muckety-muck manager and big wigs roaming around, everything is just more laid back. It's even easy to park and the cafeteria isn't crowded. Im not sure of your age; I'm a bit older and looked into getting some type of law degree. It might be of some interest to you; the RN with law would be a great combination, career-wise, and really change up what your job is without feeling like you wasted time, effort and money on nursing school. Good of luck to you and congratulations on knowing yourself and recognizing the importance of being satisfied in your work.
  10. LadybirdRN

    Patient care question

    There's no identifying information, except his diagnosis and primary language. And gender. And who knows what his gender or primary language REALLY is, except me? There's no HIPPA issue. Unless you're a moderater, I'm not editing anything.
  11. LadybirdRN

    Patient care question

    I think this mans admission cost him at least 24 hours of pain, discomfort and emotional distress and was not in his best interest, nor in the spirit of hospice. I did my best to be a "hospice nurse" but it was not at that level; it was the wrong environment and I didn't have the tools I needed to give him the care he deserved. That sucked, for me and the patient.
  12. LadybirdRN

    Patient care question

    I'm not very senimental but he pulled at my nursing, and prob mother's, instinct. I checked on him a lot; touched him and smiled a lot, I just really wanted to help him however I could. We all want to help everyone, of course, but you all know how some patients just grab at your heart a bit.
  13. LadybirdRN

    Patient care question

    To the last two responders, this man speaks only Viatnamese, he lives in his daughters home and she works at the hospital in the pharmacy, which I personally believe is the reason the decision was made for the tube. He has nasalpharalengal cancer with mets to the lungs. He was skin and bones and is asleep or in pain, with additional pain now, due to the tube insertion. The family never brought in the advanced directives; I tried to find them somewhere on a previous hospital visit and couldn't find them. It was the weekend and he got admitted over the phone and the admitting physician didn't see him until the following afternoon. The on call doc wasn't going to change a code status on someone else's patient. The admitting orders did not include pain meds; it was change of shift but I called and got the pain meds ordered. The man normally takes one Vicodin for pain, plus oral morphine drops. The doc spoke to the NOC RN and gave IV morphine 1-3Q 4. I wanted him to have his normal meds; I pondered calling the doc from home and getting the Vicoden added. When I came in the next day, he was in pain; I called and got the Vicodin added and an increase on the morphine 1-4. I kicked myself for not making the call from home that night; the doc could have just ordered it on our EMR. I just knew this whole thing was going to be a debacle from when I got report and tried to avoid all this unnecessary nonsense for this man. He should not have been admitted.
  14. LadybirdRN

    Patient care question

    It was extremely ridiculous that he was even admitted. The tube was placed by IR while he was in the ED. Being admitted mean multiple lab draws, IV, Wien up for vitals, not mention being away from home- pretty much the reason most people choose hospice. My charge nurse and I tried to get him discharged from the ED. The admitting physicians response was "I already admitted him so he has to stay overnight." I felt pretty bad about it, I thought it was inappropriate. And, I could never get his code status changed either.
  15. LadybirdRN

    Considering MSN in Education

    I'm a late bloomer! I got my ADN RN at 42. A few years later I got my BSN so I could have more options, which has done nothing for me except for added a few more letters after my name and a great big bunch of dept. I've been working on a Med/Surg/Tele/Post-op Gyn/psych hold floor for over six years now. I'll be fifty soon; I'm so tired and often have back, knee, hip pain after my shifts. I lost my son to PTSD (post Iraq) when he committed suicide two years ago. I have really changed, including my stress tolerance. We are always short staffed and for physical and emotional reasons, I simply can only do so much anymore. I'm currently going through a divorce after 23 years of marriage, so financially I'm on my own. I only work 2 days per week because I just can't do more. I wanted to continue to my MSN in education after my BSN but heard the pay is lowsy and it's difficult to find work. But, I've now been employed at the same hospital since 2003 so I'm hoping that I could get a job as an educator there, which would actually be a pay increase. I'm also thinking that if I didn't have an insane job, I'd be able to work full time again and even if I make less per hour, I'd still net more money. I love my patients, I also love my students. I always take students doing their clinicals and work hard to give them a good experience, lots of teaching but keeping them feeling safe and confident. They often try to get me back, tell me it was their best clinical day ever and usually hug me! I'm curious what those of you in the field think; I don't want to regret getting this degree. Though I must say I'd be very happy to have a Master's just to have it. Thoughts/opinions? Thank you.
  16. LadybirdRN

    Considering MSN in Education

    Thank you everyone for your kindness and candor, as well as the resources. My insurance changed and I lost my counselor in June. I will call my EAP today, just saying it here so I feel accountable and will follow through. Having such strong responses all saying the same thing, I'm going to put my MSN on hold until I feel more confidant. I'm a perfectionist who stressed about every test and am upset it I get a 98%, cause I might need those points down the road. So you guys are right, I'm not ready. Thank you so very much.
  17. LadybirdRN

    Considering MSN in Education

    I got the darn BSN so I'd have more options. I've really been disappointed because I've been trying to get off the floor for a while but every position I've applied for I've been passed over for someone with experience in that field, i.e. physician office, endoscopy, interventional radiology. I could get hired in our ER, I worked there as a tech for 6 years. I think ER experience would position me better for a lot of jobs. But, I just feel like it would be too stressful. Im totally fine and on point at work and then after I finish my last shift, I fall to pieces, I think because I have to push everything out of my mind, then it comes back like a sledge hammer. It's better; I used to not even make out of the parking garage before just breaking down and sobbing in my car for awhile before I could drive. So I don't think a higher stress position would be a realistic or smart move. I think I might just totally lose it. I'm afraid that I won't be safe for my patients because my cognition will be compromised by trying so hard to keep things together. Other jobs I've looked at, such as case management, utilization review etc require experience in those fields. I feel totally boxed in and am pretty frustrated that the BSN hasn't been of any realistic use. Unless of course, I continue my education. I really think that a nurse practitioner of any type would be too stressful; I just don't want that massive responsibility. In all honesty, I'm just at a loss. I want to try to rebuild my life. I worked so hard to get my degrees; it took me 7 years for the Associates with prerequisites, working full time, kids at home. Since 2008 both my parents and all my (4) sisters died. Jeepers, the night before my first shift as an RN, my house burned down. But I stayed working hard, pushed through, was at clinicals the day after my mother died. And I worked hard on my BSN, I was able to join Sigma Theta Tau, got on the Dean's list and graduated with honors. I'm just confounded that I can't seem to make anything work. I'm sort of just subsiting because I don't work enough. It makes me so sad to think all that was for nothing now if I can't do anything but work at a job that's getting hard to stomach. I feel like my son killed me too sometimes. I guess, I feel sort of ruined and am trying to remake myself despite this quagmire of endless loss. Yes, I'm in counseling and on medication. Sorry this is so long. It's just kind of a complex situation. There's actually more stuff that's happened but I'm trying not to write a book; I'm just trying to explain where my head is at and get some light shed on how to proceed. Thanks.
  18. I'm on a Med Surg Tele floor. We are almost always short staffed. Short CNA's, short nurses, which means our clinical lead has patients. It's stressful, tiring, and no one has time to have anyone's "back". I never get my 2 allotted breaks. I often have no time for lunch and just cram crackers and pudding down my throat to stave off hunger. If I take a lunch I go to the cafeteria, eat on my way back and get back to work. God forbid someone falls or anything happens that sucks up my time; it's a disaster and utterly destroys my day. As everything is so difficult, nobody wants to work extra. I doubt I would pick up an extra shift even if I got double-time. It's nothing but working my *** off 14 hours straight and I go home feeling bad half the time because I didn't give the type of patient care I'd like to give. I'm pretty well organized and rarely, maybe five times, stay after report to chart. It's just the way our floor is. I've been there five years and am trying desperately to get out but feel like a new grad; no experience doing utilization review etc. etc. I think I'm "burned out". I got my BSN so I'd have more options but it doesn't seem to do anything for me; it just put me $32,000 in debt.
  19. LadybirdRN

    why do many MAs and CNAs call themselves nurses?

    I've had a lot of patients who state that they used to be a nurse. IMO about 80% are lying, based on other behavior and statements. I never call anyone in it but it's in my mind.
  20. Similar question as above. I'm 49 a med/surg tele nurse where we are often understaffed and frankly, it's hard on my body. I get off work and my back and left hip hurt. How physically demanding is the job?
  21. LadybirdRN

    Do RNs get extra pay for working with students?

    Me, never. I hated mean nurses during clinicals so I vowed never to be that way. About 90% of the time we have students I get one and they always say how much they liked working with me. About half of them hug me. If they come back, they try to work with me again. It did make a difference on my evaluation. But it really can make my job harder. I have a system to stay on track and it slows me down.
  22. LadybirdRN

    Would You Report Me for This?

    The thing is, it's not correct policy. It's just something you NEVER do. Like, leaving the baby by the pool for just a second.. You just don't do that. Also, I assumed you charted that the med was taken but you don't really know. That's another problem. Third, what if a patient who already has loose stools would have taken it and fell while rushing to the bathroom? It could have caused a sentinel event. So it seems silly, you were busy, real world vs policy...I don't know if I wod have written you up but as there was a complaint it might have been rather unavoidable. Perhaps if we spoke and you realized the issue/possible consequences, I might have let it go with a strong verbal. Not being an administrator, I don't know, but maybe the administrator was obligated to write you up. Just take it as a lesson learned and move on. I guess you could have attempted to give the pill later or just not given it, charting refused. Do that next time.
  23. LadybirdRN

    CRAZY / GROSS / NASTY

    After working six years in ER/level 1 trauma I learned never to conclude that I'd seen it all. But, the guy who cut off and ate his penis (so it couldn't be reattached) is still the most, I don't even know what word to use, extreme perhaps, thing that I'd ever seen. Very sad. 20 years old. Was just released from another facility after trying to cut off his arm; he couldn't get through the bone. Someone hopefully took some responsibility for that as he was clearly a danger to himself. Prior to heading to surgery the anesthesiologist asked him the last time he ate or drank anything...everyone just kinda stared at him, that one goes on the "stupid question" thread though.
  24. LadybirdRN

    CRAZY / GROSS / NASTY

    No matter what, there always has to be someone to complain about the post. Can't you just keep scrolling?
  25. LadybirdRN

    The Nursing Licensing Cartel

    Ha-ha, true that about itimized hospital charges.
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