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Ioreth ADN, RN

Ortho-Neuro
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Ioreth has 2 years experience as a ADN, RN and specializes in Ortho-Neuro.

Ioreth's Latest Activity

  1. Ioreth

    What I Hate About Nursing In 2021

    Only once a week? I get them every day, promptly at 430 AM.
  2. Ioreth

    What I Hate About Nursing In 2021

    Unsafe staffing levels Lack of experienced nurses Exhausted PAs/NPs/Physicians that don't hear what we are telling them No/minimal vacation due to lack of staff Most CNAs pulled from floor to sit
  3. Generally yes, most breakthrough infections are still infectious. However, my understanding is the Covid vaccines are different. The viral load is much lower for Covid after vaccination and often below the threshold for transmission. I first heard this on televised news shows about a month ago, but I found a couple of websites. Halle, T. (2021, April 21). Yes, vaccines block most transmission of COVID-19. National Geographic. https://api.nationalgeographic.com/distribution/public/amp/science/article/yes-vaccines-block-most-transmission-of-covid-19 Centers for Disease Control and Prevention. (2021, June 25). What You Should Know About the Possibility of COVID-19 Illness After Vaccination. Centers for Disease Control and Prevention. https://www.CDC.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html
  4. CalicoKitty has provided some excellent information regarding the Covid vaccine. I discussed vaccine hesitancy with a hospitalist recently in small talk and he noted that because it is so standardized, most of the medical concerns in the vaccine is in effectiveness, not side effects. The biggest concern is: is the dose large enough to do what is needed while still being low enough to provide enough vaccines as possible. The other concern is choosing a part of the spike protein that will not change very much so the vaccine remains effective with variants. Honestly, this is probably one of the safest vaccines you can get. But really, just get all your vaccines. You are more likely to have health problems as a result of the disease than the vaccine. Trust me on this one. I had covid twice, likely different variants. I am still feeling the effects of the second infection from early Nov 2020 right now. You DON'T want this. I also want you to think about your patient population. They're not going anywhere, but you are only there while you work. If there is a low-key outbreak in your community and you get it and it spreads through the LTC because of lower immune response to the vaccine and hidden susceptibility... How will you feel if some of your patients die? You won't know that you gave it to them, but you won't know that you didn't. One last thought. Every person that gets the vaccine stops the spread of the virus in that person. They may still get covid, but it can't spread from them, and the illness is generally mild. But in those that don't get vaccinated... They are variation machines. In every single unvaccinated host, there is the possibility of producing a variant that can evade vaccines, and we will have 2020 all over again. Do your part and stop the spread. I have an 11-year-old who is too young to get the vaccine yet. I have never seen a kid so eager to get a shot. She is soooo tired of covid and distance learning. We live in a large city with low vaccine uptake, so we are seeing ongoing outbreaks. She's continuing to be careful, and usually of her own choosing because she hears about what it is like where I work. For the record, I got the vaccine even after having Covid. I'm not going to play roulette on getting it a 3rd time. I had a mild reaction to the first shot and the second made me sleep for a day. Then I was fine. Just don't plan on working the day after your 2nd shot.
  5. My only experience is in the hospital, so the work culture will certainly be diffierent. We all talk about staffing and retention issues all the time. Lately the upper management has started having open round tables to get direct-care nurse input on safety concerns and retention. If you are having clear staffing issues and management is unaware of the stress it is putting on you, then they're a particularly callous employer and I'd really consider if it is worth it to continue to give them my time. Staffing is horrible here too, and I'm looking at my options. Management is doing some good things such as asking for direct care RN input, but they're also completely missing the point on most of what we tell them. I think most of the time it takes an adverse patient outcome, sentinel event, or a bad state inspection to change anything, and even then the changes don't stick. They do stupid stuff here to make us feel "appreciated". This week was a fancy meal during 1 hour of lunch (nothing for night shift, sucks to be you) that we had to pay for and "free cake" that we had to leave the unit to get. Surprise, surprise that no one had time to go get it since we all worked through our lunches anyway.
  6. Ioreth

    I don't want to be Charge!

    The title says it all, but I'll unpack. I've worked at my first job in nursing for just shy of 2 years, 1 year nights and most of the past year days. It has been a ROUGH past year, as I'm seeing everyone is experiencing. I made it through my first year of nursing constantly feeling like I wasn't keeping up, but I've found my groove. I'm still running ragged, but now I recognize that our hospital-wide acuity has increased, folks are delaying hospital services and coming in much sicker than before. Our unit has increased in physical size with a move to a different floor, but we have not increased staffing to match and we can't retain the staff we have. I don't know any different, but generally floating to other floors is a relief, and float pool says our floor is particularly rough due to patient population being minimally mobile and prone to falls, and little to no CNAs. We are severely understaffed with nurses too, but who isn't? However when I go to other floors and have the same number of patients, I don't feel as exhausted at the end of the day. I know my manager is trying to hire nurses and CNAs, but there's not been enough applicants, and we still bleed staff faster than we can get more. Few people are trained to be charge nurse, and most often a nurse will be thrown into the charge rotation because the scheduled charge called off and someone had to cover. Well, you survived once, so now you're it. The worst case of this was with a new grad RN with only 3 weeks off orientation (back when we were a much smaller unit). She did OK, but she eventually left because she was stressed all the time from being charge most of the time while still learning to be an effective and efficient RN. Recently I had to be charge on a day without CNA coverage and I had a more than full load myself with all other nurses having a 1.75 load. It was pretty awful, but fortunately one of the regular charges (a nurse that has been a nurse a little shorter time than me) came in for the last few hours to help me wrap up paperwork and set assignments. My manager took some time to train me for charge and the plan was that I would be ready if that happened again. Now one of our full-time day shift charges just quit and I'm terrified that I'm going to be charge every time I work. My manager knows I don't want to be charge, but I don't know who else can do it. For the day shift, there is only one other RN with more experience than me (but less time on this unit and hospital), and the rest are all less experienced and frankly ill-suited for this role. There's a few PRN nurses with more experience, but being PRN means they can't be charge under our pay structure. The experienced full-time RN has charge experience, but doesn't want it any more than I do. I know I'm a competent RN, but the situation of our staffing and the accuity has made everything so much harder. I frequently have trouble keeping up with charting because I'm doing all the CNA work for total care patients and my load is usually 1.5 to 1.75 of the staffing ratio on our staffing grid. But I'm not ready to be charge. I don't have the breadth of experience to be charge. I generally know what to do or who to call in an emergency, but that is according to my experience of 2 years. For more complicated things that aren't a clear emergency, I really don't know that I can be a resource for the rest of the nurses. I'm also worried about the patients I have as charge. Generally we give charge the "easy" patients, but I've seen those go downhill fast too, and sometimes there's just no "easy" patients. Our charges also consistently take a full load, while everyone else takes a more than full load. I'm not done with my BSN (took the COVID year off and had some delays getting back into the program due to the long break), and I wanted to finish that before moving on to a new job. I do like my work, but I know that it isn't what I want to do forever. The unit I want to go, Oncology, is occasionally hiring, but not as often and not the ideal shifts/FTE for me. My manager is fully aware that this unit is not my forever home and supports my growth towards my preferred nursing goals. I think she even knows that I may leave if she overextends me as charge. And in truth, I am already looking. We had an open round table with upper management yesterday and I attended after a particularly difficult day. I brought up my concerns of new grads being charge and all the other nurses at the table from various units chimed in about how dangerous this is and how much faster these new nurses burn out and leave the hospital or nursing all together. The upper management rep reworded the suggestion to "consider not putting new grads in charge position until they are several weeks off orientation". I stopped her and said "No, my suggestion is to not put new nurses in the charge position until they have years of experience, not weeks or months. Ideally these nurses should have 3 years of experience." The suit pursed her lips and didn't amend her notes. This really bothers me. I don't care if this is the way it is done. It isn't safe. I don't care that they don't have the staff. It isn't safe. They should work more on retaining our experienced nurses, not burning out the new nurses, and providing fair pay all around. Finding nurses is their job, not mine, but I am tired of being put into unsafe situations and being told it is normal. Ugh. I wrote another book, and as usual I'm not looking for any specific answers. Mostly I just want reactions from those that have been there.
  7. Ioreth

    What to do when patient refuses wearing a name band?

    In my hospital unit, we have an advanced dementia patient who is periodically violent and is sadly fairly young and very strong. Due to her unique situation, she has been here for a long time and will continue to be here for a long time. We cannot put a bracelet on her and we certainly cannot approach her with a scanner. We have had to put her bracelet label on a card and leave it in the hands of the sitter who will hand it to us when scanning meds, but we used to leave it at the in-room computer. We expect state inspections very soon, so we are tightening up our practice. This is the only compromise we have found between staff safety and HIPAA.
  8. Ioreth

    Things I wish my patients understood

    Countless times I have been screamed at by patients or family when they wanted a med the physician specifically said no to. Alternatives were offered each time, but they wanted that one thing. Gentle education went nowhere with any of these people because they knew best and I'm just a "dumb nurse". Some examples: Ambien while on an epidural, Aspirin with a GI bleed, Marijuana formularies when constipated (can't have MJ products at this hospital anyway), that one narcotic that made them loopy, a routine med one of their outpatient specialists ordered but is contraindicated right now. "This is a hospital, so I know you have it so just go get it." "I take it at home, so I have orders for you to give it to me." "Just ask the doctor again, he'll say yes this time." It is always satisfying when they tattle on me to my manager or the physician when rounding and are told once again that they can't have those meds, often in the exact same language I used.
  9. Ioreth

    Things I wish my patients understood

    I don't know what your hospital stay will cost, but refusing necessary cares and medications will prolong it. The activity and movement restrictions are for your safety, and ignoring them will cost you a revision surgery. If you ask for pain medication and I say it will be 30 minutes before it is available, asking again in 10 minutes won't make time pass faster. This is especially true if you are reporting 3/10 pain. I cannot give you a benzo and a narc at the same time. I don't care what you do at home, but here you are under my watch and I won't risk my license for your high. If it isn't on your MAR, I can't give it to you, even if it is over the counter. Relaying your request to the physician doesn't mean it will be granted. It is a bad idea to let your grandbaby under 5 visit you. I can't tell you what is wrong with the other patients. Yes you really need to be turned Yes your Foley needs to come out. We don't have Netflix. I have other patients sicker than you. PT/lab techs/x-ray can't come back later. You will not get rest in the hospital. I can't take out the IV, telemetry, or wristband until you are walking out the door. ***Family edition!*** Yelling at me won't change the hospital policies. I can't give you an update without patient permission. It isn't my fault you sat on the chair alarm. Unit fridge is for patients. I can't bring you snacks. The patient can't have the food you brought if it isn't in their diet order. Eating your greasy food in front of the nauseated or NPO patient is mean. It is really hard to get an Ortho patient in a lifted truck. Meds are for patients only. ***Doctor edition!*** I don't call in the middle of the night unless I need something that I need orders for or a changing condition that you really need to look at. I am not allowed to reconcile your discharge meds. Yes I have already tried all the non-pharm methods. At this hospital, I need orders for what was policy at your old hospital. I cannot discharge the patient instantly after you said he can go home now. I will not relay a devastating diagnosis to the patient. That is your job. The mask policy applies to you too.
  10. Exactly my thought! I don't break out the IV stuff unless that pain is at least 7/10. The manager is an RN and generally someone whose judgement I trust, but wasn't the management RN that came to the bedside to help settle this patient. She was kept in the loop and probably did talk to the patient that day, but wasn't physically there for the worst of it. She thought I should have broken out the IV stuff when the patient couldn't take orals. *shrug* Maybe the patient's pain did creep up before end of shift above a 3/10. To be clear, we're not talking about a huge length of time. 1400-1430 Patient to floor, Charge and management RN in room 1430-1500 Charge and Management RN leave, I stay in room 1500-1700 I tend to my other patients while checking this patient at least q15m. 1700-1730 Patient STARTS to be more interactive and able to converse, finish assessment, get patient to toilet, 3/10 pain 1730-1900 Race around trying to finish shift like a crazy woman
  11. TLDR (cause I can't edit): Patient loopy and sedated arrived to unit, requiring lots of work to keep safe. Came more awake shortly before shift change, safe, pain acceptable, respiratory status stable. Patient fired me as an RN for the next day saying I was incompassionate and didn't manage pain. Management says I should have given more pain meds. Long version (story time!): I work on a post-surgical floor that also gets a fair bit of non-surgical patients. Hospital was at capacity and we were being pressured to take more patients while the charge RN was trying hard to keep beds open for our surgicals. Meanwhile, PACU was being slammed and out of room. It was a mess waiting to happen. I already had a full load and took report on a patient coming up to us from PACU. Report was unremarkable. They mentioned that they had trouble meeting pain needs and keeping the patient breathing, but the patient was having itchiness from the narcotics given in PACU. Again, not unusual. I live in a marijuana-legal state, and recreational MJ use really messes up narcotics effectiveness, and most of our patients won't admit to MJ use (and most of our surgeons don't screen for it). I mentally prepared to use non-pharm methods of pain control and set up my room. Patient arrived writhing in pain, screaming, and clawing up her bed. She also was completely unresponsive to me and the PACU RNs. She was doing all this essentially in her sleep. If I could, I would rate her RASS a +2 and a -2 at the same time. Her husband was in the corner constantly asking "Is this normal?" No sir, it is NOT. The PACU nurses that brought her in had already fled, and I was trying my best to both get her to respond to me and improve her comfort. The CNA came in (probably because of the screaming) and asked if I needed help. I told her "Yes, go get the charge". Charge came in with one of the management RNs and we spent the next 30 minutes trying to settle this patient, who was still not responding to us and intermittently crying in her sleep. Remember that I had a full load before this patient showed up, so I was essentially neglecting my other patients until I got this one safe enough for me to leave her. We finally got her a little more comfortable with ice packs on the surgical site and warm blankets on non-surgical sites. The consensus was that she came to the floor way too quickly from PACU and we just needed to wait out the anesthesia. I checked the charting while I was staying in her room to make sure she didn't claw off her oxygen (which she did frequently) or try to flop out of bed (slightly less frequently). PACU had her RASS at -2 when she left them. I had never seen that, at most (least?) a -1. I don't know what their criteria for transfer are, but this was odd from my end. I was finally able to step away from this patient and check on my other patients, who all needed something, some anxious, some grumpy, some cheerfully waiting for something they should have asked for instead of silently waiting. I ran my tail off filling needs and darting back to this patient's room to ensure safety and check for improved rousal. Needless to say I did NOT get a lunch. Hell, I didn't even get to pee. Sometime after 3 hours of checking this patient every 15 minutes or so, she started to mentally clear and was able to converse with me. Fortunately, she didn't remember much of anything of the last 4 hours. It was not a good time for teaching, but I expect to repeat teaching anyway, so I oriented her to the room, discussed medications, and filled in the gaps of my assessment now that she could talk to me. Pain wasn't bad, a 3/10 and I told her this is a good place to be as long as she can sleep and isn't afraid of movement. She got up and peed. She was wobbly, so we didn't go far. I talked about pain medication as part of my standard orientation to floor. She said she doesn't like morphine because it makes her feel weird. That wasn't the drug she had available IV, but I shrugged it off as a refusal. She was still dry heaving often, which cut out oral pain meds. Besides, her pain was manageable through non-pharm methods, so I didn't dwell on it. At this point I mostly left her alone. CNA walked her to the toilet and into the hall, but again didn't get far. I raced time to finish the tasks my other patients needed done before the end of the shift. I continued to pop in occasionally, and she was much more stable. I was even able to titrate down the oxygen a bit. Patient was still pretty nauseated, for which I gave PRN antiemetics. I honestly don't remember discussing pain again. Before end of shift, I felt pretty proud about keeping my patient safe, getting her non-formulary home med checked by pharmacy so it was ready for next shift, checking in with the husband before he left, getting this patient ambulatory, and using all my tricks for combating nausea and pain. AND I got out on time, due to all the charting while sitting (standing) with this patient while she was still unsafe to leave. We did bedside shift report, which I hate doing "bedside", but I was being a good nurse example for the new hire. At one point I mentioned that she had not had any pain medications yet due to being sedated on arrival, I discussed the non-pharm methods used, and suggested that she could probably get something for pain if nausea came more under control. Said "bye, I'll see you tomorrow" and went home. The next day the noc charge came to me and said "no matter what anyone says, you are a good nurse and you did what was right" and left without another word. Bewildered I asked the day charge (same as the previous day) what the heck that was about. She told me the patient fired me as her nurse because she thought I was not compassionate enough and didn't care about her pain. This charge disagreed and thought I did a pretty good job of maintaining safety in that situation. Even if it was wise to give medications when she was unsafe, we were locked out of most medications simply due to that most were DCed when she left PACU (as they should be) and the ones remaining were too close in time to when they were given in PACU. After I could actually talk to the patient and get a response, I had assessed her for pain and at a 3/10 she was OK then. I probably should have reassessed pain before end of shift, but I remember her complaining more of nausea than pain at that point. I checked in with my manager and the manager said I should have given IV pain medication, and that I was being too cautious. I didn't really have anything else to say, but I am rather flabbergasted by this entire situation.
  12. Ioreth

    How could I do this?! Forgot to give report.

    All was good this morning when I came in. I ended up discharging that patient immediately after handoff this morning. The night charge has always been a mentor to me and share some funny handoffs-gone-wrong stories. We had a giggle and that was that. Will NEVER do it again. Weird thing is I do have a system to make sure I'm done. I have one of those folding clipboards and I keep a separate sheet for each patient, which I keep until they discharge. I just write my notes for each day in a different color. When I'm done with report, I go through them and stack them in room order behind the unused sheets. This time I just went "yup that patient discharged too" and tossed the sheet in the shred bin. Now I'll do that while checking against the bed board.
  13. Ioreth

    Nurses with Unusual Diets

    My diet has been better while my hospital is providing meals during a Covid surge in my state. That surge is pretty much past, though at a higher baseline of cases than before the surge, so the hospital is stopping those free meals soon. I usually eat a combination of candy, caffeinated drinks, and the token attempt at a healthy lunch. Half the time I don't even have time to take a lunch so I chug a couple of shelf-stable shakes (Ensure/Weight Watchers/Soylent) that I keep in my locker. Nasty, but it's fast calories. Even with what I do eat on work days, I generally get half the calories I need. I'm always ravenous on my days off, so I'm eating everything in sight my first day off. That's generally not healthy stuff either...
  14. Ioreth

    Insurance for your license?

    I just looked at the options from the various professional nurse organizations I'm a member of and took the cheapest one. They all looked to be equivalent coverage. Good thought to get malpractice insurance. One of the more experienced nurses on my unit has worked at 5 hospitals and said that everywhere she goes the malpractice insurance your employer provides is there to protect the employer. The insurance you buy prioritizes you over your employer.
  15. Ioreth

    Superstitious Nurses

    If my patient is nauseated even a tiny bit, always bring an emesis bag to the bedside. ALWAYS prep a post-surgical room with an emesis bag, even if the PACU nurse said that the patient hasn't had any nausea. If the patient has an emesis bag, then it will never be used. If there is no emesis bag, then there will be a huge mess to clean up. I even tell my patients "I'm going to put this here, because if it is here then you won't need it."
  16. Ioreth

    Using PTO

    Check your unit and facility policies. At my hospital, PTO is paid out as a cash sum when you leave the hospital. At other, non-hospital places I've worked before my current life in nursing, getting PTO paid out like this requires working there a certain number of months first. As far as scheduling PTO, my unit requires that we ask for PTO before that schedule goes out. Asking for PTO after the schedule is out isn't allowed. If I wanted that time off that I'm already scheduled, then I have to switch shifts with someone else. The only exception to this is a call off the day before if I'm sick or "sick" (though I've never called off "sick").