Kastiara

7pm Friday to 7am Monday

Thanks for all the replies and suggestions. Just a quick update. I had plans to call the house supervisor if/when I found her sleeping again but, for the past two weeks, she hasn't slept while on duty. In fact, last week, she worked harder than I have ever seen her work. I was truly surprised. I've worked with her for a few years now and she has always been very lazy and has always slept while on duty. I don't know if our manager said something to her or if she realized she was putting her job and license at risk. Maybe a bit of both. I really hope it lasts. If it doesn't I will escalate the issue up the chain of command.

I work as a charge nurse in an ICU. I am having a problem with a nurse sleeping while on duty. I'm not talking about sleeping while on her 30 minute, unpaid break but rather, sleeping for hours at a time, every single shift. She doesn't let anyone know, she just disappears into the computer room at the back of the unit or into the family conference room and sleeps. Her patient's end up being horribly neglected all night as a result and the other nurses on the unit end up picking up her slack by having to answer her call lights or silencing her pumps. Not too long ago, one of her patient's coded and, while I have no proof of this, I strongly suspect she was sleeping just before it happened. I have spoken directly to her about. I wake her up every time I find her sleeping. I have went to management about it. Nothing works. It seems like management couldn't care less about the situation and, since she keeps getting away with it, the behavior continues. I have no idea what to do about it now. I just feel like eventually a patient is going to be harmed and/or will die as a result of her sleeping. What would you do in this situation?

It's going to depend on how Epic is set up at your facility, but I do the following: 1. Orders tab to review the patient's current orders. 2. I read over the doctor's notes to see what the plan is for the patient. 3. I go to the Chart Review tab and look at any imaging/procedures/tests the patient has had. 4. I go into my flowsheets to look at the patient's vitals to see what their trend has been. 5. Finally, I go into the MAR to take a look at their current medications and to double check that I got an accurate report on what drips/fluids are currently running.

We have to pick up 6 weekend shift in a 6 week period regardless of how long you have worked here. We self schedule, so people pick and chose what weekend they want to work. Some will work one weekend day/night each week. Some will do every other weekend. I personally prefer working weekends for the higher differential.

I'm in kind of the same boat; sick but had a negative test. However, my facility isn't pushing for me to come back. They told me to take as much time as I need to recover. I'm sorry your facility isn't being supportive. Hope you feel better soon.

Gloves and gowns are one time use only. N95s are used for up to 12 hours of continuous use then we get another one. Face shields are wiped down with Sani-Cloth in between uses. Compared to some places, my hospital is doing a pretty good job at protecting their workers.

I'm in GA. My unit has a couple r/o Covid patients and several confirmed Covid. The patient's that are confirmed aren't doing very well. All of them are on ventilators and pressure support and we'll more than likely be proning them soon. We've had a couple nurses and doctors end up testing positive. All employees are screened for fever or SOB when coming on shift. Our PPE has been locked up and is being rationed out. We use N95 masks, face shield, and gowns for all r/o or confirmed patients. We also have to change into a set of hospital issued scrubs if we are taking care of these patients. Our census has been pretty low. Before this my unit was full. They were begging nurses to come work OT last week; this week, they're calling people off. The ED has been seeing fewer patients as well. It's eerie.

The titration parameters are in the order. The order will read something like: titrate by 1 mcg every 5 minutes to keep the MAP greater than 65. If we go up or down by more or less than the order states, we are supposed to fill out a form with how we titrated and why and then have the physician sign it. A lot of the nurses don't want to do that so instead they'll modify the order to reflect how they titrated the drip. I had a patient not too long ago where the physician had me turn off their propofol due to low BP (they were on two pressors). At that point, all I had for sedation was fentanyl that I had orders to titrate up on by 25 mcg every hour. I had five nurses in there holding this patient down to keep them from pulling out the ETT. I went up on the fentanyl by 100 mcg every 30 minutes or so until the patient settled down a bit. I filled out one of those forms for the physician to sign and got a lot of crap from some of the other nurses. They told me to just modify the order which I refused to do since I had not actually got an order from the physician to do so.

No, not standing orders. My unit doesn't really have many standing orders. They'll put in labs (not routine morning labs) if they think something is off. They'll modify the titration orders on critical drips to match how they went up or down on the drip. Things like that. There are quite a few physicians that round on our unit, most of them I have never met in person. Some of them don't seem to mind when a nurse puts in an order under them but others have thrown fits over it. It just makes me really nervous.

Do you ever or have you ever put in orders without actually getting an order from the doctor? The other nurses on my unit do it all the time. Lab orders, restraints, modifying medication orders, and I've seen some even put in medication orders. I can't bring myself to do it, mainly because I'm worried it will land me trouble both at work and with the BON. The other nurses say I'm too cautious.

pH 6.5; bicarb 2.5. The patient was discharged home 3 day later.

I work in a medical-surgical ICU so lots of CVCs. I was taught that, when pulling labs, you have to stop all drips or fluids running. Doesn't matter if it's pressors or sedation running, you always stop them. The rationale was not doing so would/could cause a dilute sample. Doing this has always caused me a bit of stress, especially with some of the more unstable patients that drop their BPs quickly. I usually set everything up in advance and work as quickly as possible all the while hoping that the line isn't positional or something. I was just reading on another thread (from 2013 which is why I created a new thread) that you should never stop pressors, just pull from another lumen. So now I'm seeking some clarification. Stopping drips/fluids during lab draws is common practice on my unit, everyone does it and every new grad is taught to do it. Is this wrong? Or is it a matter of hospital policy? I'm also going to add that I am a relatively new nurse (just 3 months shy of 2 years) and am still learning new things.

It's funny OP because I am also in GA and did not feel weeded out during my prerequisites. Yeah, it was difficult, but A&P is a difficult class, as is Microbiology. They both require a lot of effort and dedication to pass. Instead of making excuses about not getting the grade you wanted, put more work in and actually get the grade you want.

Yeah, I wasn't adding the 10mL of cipro into the calculation. Thanks.

I am in my third week of nursing school. We just started drug calculations this week. I'm doing a practice problem in my book that has me stumped. Either the book has a typo or I am missing some concepts. The problem is as follows: Order: ciprofloxacin 0.1g IV q12h Available: cipro 200mg/20mL Set and Solution: secondary IV set with drop factor of 15 gtt/mL; 100 mL D5W Instruction: dilute ciprofloxacin in 100 mL of D5W and infuse over 60 min Question one wants to know how many mL per does should be given, which I set up as: 100 mg / 200mg x 20 mL= 10 mL per dose Question two wants to know the IV flow rate in drops per minute. I set it up like this: 100 mL x 15 gtt/mL / 60 = 25 gtt/min The book says the answer is 28 gtt/min. I cannot figure out how they got that number. They set the problem up like this: 10mL + 100mL x 15gtt/mL / 60 min = 100 x 15 / 60 = 27.5 or 28 gtt/min I am so confused right now. Can anyone explain this or show me how I am doing this wrong? Thanks in advance.

The testing center at my school provided everyone with a basic calculator for the test. It didn't do anything special besides addition, subtraction, multiplication, and division. It did have the ability to do decimals. Your school/testing center could provide a different calculator through, so you should probably give them a call to see if a calculator capable of doing decimals will be provided. I had 4 hours to complete the test, no time limits on individual sections. I started with the section I knew I would complete the fastest (vocabulary) and moved to those that would take me the longest (math). I completed the test in under 2 hours. The A&P section was not overly specific. There were a few questions that asked about specific parts of the body but most of it was just general questions. I had only taken A&P I when I sat for the HESI and still made a 92 on that section. The HESI was easier than what I was expecting. Good luck on your test.

Congrats on the A. I took A&P II and micro this semester and got an A in both. I actually made a 100 on the micro final, which blew my mind as I had to guess on quite a few of the questions.

I'm 30 years old and just got accepted into my nursing program. I'll be 32 years old when I graduate. I don't feel too old to start a new career. If you really want this, then go for it and ignore the nay-sayers

I can't remember anything specific, I took the test back in July. Most HESI study guides give a conversion chart, I memorized them. Examples would be converting kilograms to pounds or ounces to milliliters.

The HESI was easier that what I expected it to be. I made an overall score of 93 on it and only started studying about 2 days before taking the test. I would recommend going over every body system and getting a general idea of each for the A&P section. I don't remember there being any pictures or diagrams in the A&P section, it was all multiple choice questions. As for math, know your conversions, ratios, and fractions. I rented HESI Admission Assessment Review 3rd Edition from Amazon. It goes over everything you will encounter on the test and offers practice tests at the end. I also used HESI A2 Secrets Study Guide by Mometrix. My school library had that one available. It offers practice tests too. Good luck on your test.

I took it after completing A&P 1 and made a 92 on that section. I read ahead in my A&P book to get a general idea of the other body systems not covered in A&P 1 and also rented HESI Admission Assessment Exam Review 3rd edition from Amazon. It had some really great information in it for every section the in the HESI exam and it offers practice tests.

I start in January in southern GA. The 11th cannot come fast enough for me.

I have my final in Microbiology tomorrow and should be studying but just can't find the motivation. I think I'm just burned out on the prerequisites at this point and am so ready for my nursing courses to begin (start in Jan.). I also think that the fact that I don't need a high score to pass the class (I need a 55 to keep an A) is contributing to my lack of motivation. I do need to study at least a bit just so I don't completely bomb the test. Anyone else having motivational issues at this point? Any advice on how to get motivated?

Yeah, I agree that they complement each other. My most recent micro test covered host defenses which had already been covered in A&P 2 when we went over the lymphatic system several weeks ago. I can't see why taking these two classes together would be discouraged.