jelnurse

I think that sort of situation calls for direct frank discussion with the patient with two clinicians present, preferably with everyone seated so no one looks extra intimidating. Of course be sure the test is correct. If it was just a "dipstick" test, get a real one using gas chromatography, then start the conversation with virtually certain confidence the test results are correct. Talk with her with a strong bias toward discovering a mental health problem that she is treating with the benzodiazepines. She might be using the benzodiazepines to relieve anxiety, and she might have been using the hydrocodone for the same reason. Maybe the benzodiazepines are just to fill in after she runs out of hydrocodone each month. Have a referral ready for a mental health evaluation from either a psychiatrist or psychiatric NP, and offer to continue pain treatment while that referral is being planned, but insist on bi-weekly urinalysis and pill counts - she shows up, or she gets no Rx. Drug abusers have a horrible problem, and I think we have a moral and clear ethical duty to help without just throwing them out. If this is her first time "caught" abusing two drugs (using benzo's and NOT using hydrocodone is TWO abuses in my opinion), then be frank but supportive. Include early in the discussion that you intend to keep treating her, and if she has a pain condition, even assure her you intend to keep using the hydrocodone with special arrangements to make sure she uses it correctly. Unless you also are a lawyer, do not give her legal advice per se, but DO remind her that selling or sharing hydrocodone is a serious crime, and so is acquiring benzodiazepines without a Rx. Make it clear you intend to help her, and actually plan to do so. In all that you do and say to her, be genuinely biased toward helping her and not just getting rid of her. Consider exotic scenarios, but those usually are not what's happening. Of course, be open to the possibility that she is being abused and forced to hand over the hydrocodone to someone. Benzodiazepines sure would make a person more cooperative with an abuser, so maybe the benzo's are being forced on her. That sort of thing certainly does happen. You might even want to start the next assessment with a focus on whether she is safe or being abused by anyone. If she is, that will sure affect how the interview continues.

I had my last exam of the semester this morning, a fairly tough one for me, and it feels great to have just one more semester left. I just wanted to encourage you to look forward to the nursing program you enter. Like I said before, I'm a "come back" student - not 18 or 19, and I could have gone a few different worthwhile directions academically. Nursing school has been hard, but well worth it. My university allows seniors to apply to nursing grad school for "early assurance" admission if our GPA is high enough. The GPA doesn't have to be amazing, just good and solid. I'm so sure I made the right decision to enter nursing that I'm going to apply for grad school and just stick around part-time while I work. That's if I did not blow today's final. All I mean by this is that I love what I'm doing even though I find it fairly difficult sometimes, and I trust you will to. You are right to be stoked about the program starting soon. Nursing papers are written in APA style. I recommend the Amazon Kindle version of the APA manual 6th edition. It's easy to search and use. Yo will have papers to write - some a couple of pages, some 10-15+ pages. If you write well and follow APA rules well, you will stand out among professors and your classmates. I know several students who write very well, and they are welcomed into any and all group projects that involve writing. Do one core thing you learned to do as a Marine - let what you do well benefit everyone around you, and be glad for everyone when things go right. Also try to catch your classmate if he or she is falling behind - certainly at least if the person asks for help and you could help. You know this already, so I'm just saying take that attitude with you to nursing school. Every student is responsible for himself or herself, so you can't do everything for a person, but help when you can. My school does not grade on a curve ever, so only a severe jerk would try to beat a classmate at anything just so the other person scores less than you do. We could all get an "A" or all blow it, half get B+ and a bunch get C+ or B- and only one genius get an "A" on an exam - like I said no grades get curved for my program. This makes it easier to work to get the whole group to succeed, since nobody benefits from anybody failing. Even if your school grades on a curve, still share your notes or a special tip you heard with others who are struggling. I didn't mean to get so preachy, just wanted to say if you help your classmates they will not care if you're male or female, young or old, funny as heck or boring as dirt. Good luck! I hope it's a great as you plan it to be!

Congratulations on getting accepted and on having the courage to go for it! I did not start nursing school as a "traditional" student, but as a comeback, and I'm due to finish a BSN program in May. If you have any thoughts at all about being older than some of your classmates, that's one issue I think is no problem at all. Any age is a good age for school of any kind. Your discipline as a Marine is likely to serve you well, so ponder it, recognize how important it is, and plan to use it all through school and as a nurse. Your military experience will also help you deal with apparent BS in school and after. Plan to encounter a few classes, or at least some lectures, that seem useless and a waste of time. I trust you already learned how to bear that easily, and that will make a lot of things easier for you than for some of your classmates. I'm sure you also already learned that much that appears useless when you have to learn it later proves to be very important - again, you will be very good at remembering that in class. I have one specific recommendation. Put every assignment, every due date, every duty to meet a professor or clinical instructor, every task of any kind you know about in advance into a calendar on your cell phone. Put everything into your calendar with an alarm for a few days before it and again for the day before it so you remember every little detail and never lose credit for a late assignment. I do it this way, and I admit that the calendar alarms surprise me at least once a week with something I forgot about. With the calendar and advance warnings I schedule, I get everything done as needed. I've had weeks with twenty different little things due, and the calendar alarms make it all happen on time for me. I almost never leave a lecture with a question unasked. I try not to be a nuisance, but I know the professors know a heap of stuff that I want to learn, so I ask them about anything they say that is not clear to me. I never argue with faculty in class because I think that's rude and disrespectful, but if they say something I think might be mistaken, I see them later to find out. No matter what your classmates say, buy every required textbook unless you are flat broke and absolutely can not afford them. I have spent almost $300 on single books that I used only 4 or 5 times, but I'm glad I spent the cash because the few times I used them got me a letter grade better than I'd have gotten without them. Ask for advice often, and listen to any that is offered whether you asked for it or not. Figure out whether it's useful or not after you hear it, and reject any advice you think is totally junk after you think about it - including everything I just recommended! I could not be happier with my decision to become a nurse. I'll say one other thing - be open to types of nursing you might not expect to like. I'm a guy who never expected to want to do pediatrics, but I ended up going even further. I'm hooked on neonates. I volunteered in a unit with drug addicted newborns who needed a lot of extra attention as they go through NAS (Neonate Abstinence Syndrome). Those patients got me hooked on the NICU. I did a rotation in a level 3 NICU and absolutely loved it. That's what I want to do when I graduate. I'm telling you this just as an example of a student who was surprised to love a type of nursing I really had not even considered doing. Try it all if you can, at least to see it a little, Surgery, Med-surg, PACU, ICU, CCU, NICU, Orthopedics, Oncology, Pediatrics, Psychiatry, Hospice - all of it. You might be surprised like I was to find a calling you did not expect. Good luck!

It seems pretty reasonable to insist that you have proper equipment to administer all doses safely and accurately. If your superiors say the right syringes would cost too much, do a little research to find the cost of the syringes you need. Maybe another supplier can deliver them no more expensively than what you use now. If the prescribers are also researchers, you might ask them how important accurate dosing is to finding reliable results from their research. If they're researching the very low dosing, they WANT to find an effect. Maybe if you get them to think the right syringes will make it more likely that they find an effect that allows them to publish the results, they'll get you the right syringes. It's worth a try. Researchers want to find results, and accurate measurement is essential to all research. If you have any sort of regular staff meetings with superiors and coworkers all present, bring up this issue and express concern about the accuracy of the doses. Make sure you don't look or sound incompetent. Don't say you're not doing it right, but explain simply and briefly that the right syringes would make it more reliable that you give people the correct very low doses. Don't try to embarrass superiors, but let them feel a little pressure in front of others to recognize that right dosing is essential and that the right syringes are necessary to administer the right doses. Bring it up in terms of patient safety and quality of care, and maybe you'll get the syringes you need. Doing it in a staff meeting - if you have regular such meetings with superiors, might put a little more pressure on superiors to do the right thing. That might be hoping for too much, but it's worth a try. Getting the right syringes seems like a reasonable thing to expect. You're not asking for a million-dollar piece of equipment, simply the right size syringes.