AlexCCRN

How do you report a pattern of narcotic medication record irregularities without making it personal. A few specific nurses consistently remove narcotics NOT ordered, presumably administered under the pretense it would be what the MD would order but n...

Is anyone else just sick and tired of arrogant self-appointed straw bosses who can't seem to stop themselves from screwing with new nurses? Managers could stop this sort of ADHD behavior if they wanted to so, I'm convinced that most managers are eith...

5 day orientation - unless your a seasoned ICU nurse - it's crazy and just plain bad. As for keeping up... consider a pocket sized recorder. I use my Palm PDA with digital recording to keep voice notes if I'm not able to chart. It's just the best! On...

Tolerance used as a term denoting range of variability accepted - not requiring intervention ... yes, tolerance develops over time with experience - you knew this. Yet, you also know that experienced nurses may have developed a degree of informality ...

Assessing pain can also be accomplished without asking the patient - VS, nonverbals, trends, etc.. I've experienced that asking too often seems to train or encourage a yes or exagerated response when their level is actually tolerable. Ater admin, I f...

I once provided an inspirometer to a patient with a trach. I was just so happy to see her off the vent :)

Don't go quietly. Establish yourself as a critical thinking, caring, safe RN who's willing to argue their case without emotion. I mean, whenever something ridiculous presents itself and you are certain about your facts - represent yourself, demonstra...

Depends on the facility. ER nurses should be ACLS certified and therefore have rudimentary intubation skills and are expected to be able to accomplish intubations as part of the ACLS requirements. Yes, RNs could just as easily be as competent as an R...

What do we use? All drug doses are determined by patient weight. Unless you're caring for gerbils, the doses you mention are insufficient. Compensating by allowing more frequent dosing is a cop out. Furthermore, Demerol is bad pharmacy except for pos...

roustan jp, valette s, aubas p, rondouin g, capdevila x. department of anesthesiology and intensive care medicine, neurological explorations laboratory, lapeyronie university hospital, 295 avenue du doyen g giraud, 34000 montpellier, france. prolonge...

Not voodoo but "oh no!" is what you'll be saying if the pt is improperly anesthetized or sedated and you chose not to use the available BIS monitor. Use ALL the tools at our disposal. I've experienced good/consistent results with careful attachment a...

Topiramate label use: anti-seizure and migraine prophylaxis. Investigational use in infantile spasms, neuropathic pain, cluster HA. Teratogenic & enter breast milk. Can reduce serum HCO2 up to 67% - risk for metabolic acidosis - must be monitored...

Pinyoy, name a responsible profession in which practical experience and measured competency isn't a prerequisite for advancement. Thankfully, reputable nursing schools rarely accept candidates for NP who have little or no RN experience.

NO and as well, they shouldn't. Period the end.

Agree that open visits have downside. Training visitors takes up much time too. I wish we would have blocked off hours and a limitted visitors list including only a few family, friend or whoever. The rest can get reports from the lounge. Then I only ...

Yes, the incident should have been reported as soon as you understood something was amiss. It's our moral obligation. In the future, I strongly recommend NOT tampering with or handling medications as a CNA. Even if your intentions are good, you're go...

As with any discipline, just cuz you're a veteran or highly proficient DOES NOT justify being assigned a teaching role. Expert educators are needed to train experts. There's no value in the harsh dynamic between the preceptor and orientee. Both need ...

Finite will work just fine but if you're contemplating higher levels of involvement in say nursing research, precalc is more useful.

Skip the email. Don't act defensive either. If the manager has a problem, let her come to you unless you feel the need to report an adverse outcome or request reassignment. I see so many nurses running for cover when a patient complains. So long as y...

A new career in nursing can be life changing at the deepest level. I hope that you find what you're looking for.

Lipid solubility and partition coeficients come to mind...

Pts response to narcs is variable. Issues of tolerance and cross-tolerance may play a part. Paradoxical reactions to Versed are not uncommon. Maybe you weren't getting *all* the analgesic that was reported? Who knows. Chalk it up to learning first ha...

Our hospital employees LPNs but NOT in the ICU. Too many cooks in the kitchen. I find LPNs mostly distracting on the floors.

Nursing ignorance and prejudice when it comes to pain meds is discouraging. Once daily dosing - methadone has a long half-life - and analgesia efficacy makes methadone an excellent choice for RTC pain management. Other short-lived narcotics can be us...

HeartQueen... I'm thinking you'd intubate the right mainstem, cuffed at that level, the outer lumen would ventilate the left distal to a second cuff - must be two cuffs... just thinking out loud.