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Tnurse24

Tnurse24 RN

Emergency
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Tnurse24 has 6 years experience as a RN and specializes in Emergency.

Tnurse24's Latest Activity

  1. Tnurse24

    Patients Viewing Nursing Notes In Real Time

    Yea, I thats what's disturbing, that is pretty reductive and doesn't give the practitioner any way to flag something as potentially sensitive for review outside a few narrow parameters. It's totally dehumanized, that can't be good for anyone. Full disclosure- my nursing education is based on a humanistic framework so others may not feel as strongly about this but it seems like a practical nightmare if your not a robot.
  2. Tnurse24

    Patients Viewing Nursing Notes In Real Time

    Don't troll on my post or I'll mark it as inappropriate. They agreed to disagree and u gotta write this nonsense? Enough. Who cares.
  3. Tnurse24

    Patients Viewing Nursing Notes In Real Time

    Agreed let's keep it civil folks.
  4. Tnurse24

    Patients Viewing Nursing Notes In Real Time

    This is a valuable perspective, I'm skeptical but this is something I'm going to try to keep in mind. Your right this could be a positive.
  5. Tnurse24

    Patients Viewing Nursing Notes In Real Time

    But who- and when and how is doing the filtering of this information? How does it work out in a real and practical way? It just seems so murky and nontransparent. Call me crazy but after this year I really don't trust our government regulations to put safety first.
  6. Tnurse24

    Patients Viewing Nursing Notes In Real Time

    That is a really good recommendation- refused is such a trigger for some ppl
  7. Tnurse24

    Patients Viewing Nursing Notes In Real Time

    For ex. a pt in a manic episode presented w. her children who were afraid of her and refused to return home. This prompted a report to cps and a police report. The children were removed from her care pending further investigation. This person knows my name, where I work, my shift and has unpredictable behavior- and every word I wrote supported the psych eval, cps, and sw consult that resulted in her losing her children. The law covers psychiatric consults, not nurse notes. The security at my hospital is non-existent. This presents all three of the issues cited by @Chickenlady
  8. Is anyone aware of a new CMS rule that all nursing progress notes are to be made available to patients in real time? This is the default at my hospital, and it is a HUGE safety risk to ER staff who are already vulnerable to erratic and unpredictable behavior as well as wide open to the public. Is anyone else aware of these requirements? What is being done to protect individuals from potential violence or security issues?
  9. Tnurse24

    What’s in your bag/what should I have as a newbie?

    Leave an extra pair of shoes and socks in your car/locker. Trust me the day you need them, you'll understand why.
  10. Tnurse24

    SNF or Hospital

    I am of the thinking that nothing beats the hospital experience. Regardless of what you decide to get your masters in it is going to be vital that you understand the hospital experience in all its gore and glory. A skilled nursing facility allows you to make an impact by being there for your residents each day but a hospital setting forces a clinical focus that will not be available in even the most state of the art SNF. Plus, recent varied work experience can only serve to strengthen your candidacy for an MSN program.
  11. Thank you so much for your words of encouragement, good luck with your writing and I look forward to seeing what you have to bring to us. Thank you for your inspiring post.
  12. Could you elaborate a bit on the role of nurse writer please? this would marry my two passions as well and I'm very curious about it. What is the role of a nurse writer and in what settings can one become employed? What does a nurse writers day consist of?
  13. Tnurse24

    We missed it

    Yes I did an abd assessment and assessed the site there was some hardness around the site but i was told "it's been like that" n that it was not really significant. She had active bowel sounds and no more ecchymosis at the site than the day before. Thanks for for all your comments I appreciate your feedback!
  14. Tnurse24

    We missed it

    I am a new nurse I just began my first nursing position this August. I am at about week 5 on the floor and just heard that a patient of mine from the previous week was sent to the ICU pretty much immediately after my preceptor and I handed her off. The story with her is that she was a big lady with chronic back pain and afib who came in with a supra therapeutic INR. she required a TEE with cardioversion and coronary stents. She was given FFP and protamine to ready her for the procedures. I had her two days post cath. She was generally a kind, patient woman who loved to talk and always treated you with a warm smile (even for meds at 5 am). But on this day I walked in and she was gray, not talkative, complaining of some nausea and pain. Her usual Percocet order had expired so I offered her the 650 Tylenol she was ordered and called out to renew her Percocet. The order came in n she said she was not having any relief from her back/abd pain so I gave her Percocet as ordered. Not long after she began to vomit yellow bile. I got her zofran, it stopped the vomiting and she slept for a little while but it didn't help the nausea. I called the PA but he was busy with a code and just gave another order for antiemetic. I was worried about my patient, I took her vital signs, did her HT assessment, there seemed to be no apparent change from the day before accept intractable nausea. Her pressure was lower since her procedures and she did not meet the parameters for her beta blockers, her heart rate which had been in the upper fifties since cardioversion was in the 70s which I attributed to dry heaving and discomfort. She was pale and nauseas but that was it. I had a bad feeling about it though and asked a few senior nurses to look at my patient bc she looked like crap. They seemed mostly unconcerned with the nausea- I asked if it was crazy to call a rapid for something like this because she looked so terrible to me and I just felt something wasnt right- they chuckled. That's the most response I got and the Pa seemed irritated with my calls by about four am. In report my preceptor and the day nurse went on and on about another patient and her heparin drip and the protocol for handoff. I could t get a word in Edgewise about my nauseous patient and my growing concerns. this is how my preceptor and I basically handed her off-Ashen, nauseous and not doing any better than when the shift started. I went home frustrated, feeling like no one listened to a word I said all night, least of all my preceptor and it took hours for me to fall asleep I couldn't stop thinking about her. I came back the next week to hear that she was a rapid response as soon As we left and went to the ICU with an internal bleed from the cath site into her abdomen. The low pressures I had been documenting and telling my preceptor all night with the raised but "normal" hr that went on all night should have tipped me/us but it didn't. I knew something was wrong but I didn't know how to properly express my concern and I felt like I had little support. I am a new nurse and lack confidence and experience and only realize that the tell tale signs were there In hindsight. I feel like my preceptor kind of let me down here and am frustrated 1. That I didn't see what was happening for myself and 2. I had no guidance in how to handle the situation properly and 3. That the day nurse new immediately something was wrong and called the rapid I asked about six hours earlier. I feel terrible. How can I prevent this from happening again and how can I advocate for my patient better in this situation? I'm feeling out of touch with my preceptor and I don't really trust her. What can I do to do better? Thanks for any advice it is very much appreciated. -newb