bindikwan

Hello fellow nurses, I need your input! I work for a large hospital system in Texas. Recently management rolled out a class that is mandatory for all nurses. It's called "Advancing Acute Care Nursing" and this class entails is teaching how to titrate drip medications that are typically reserved for IMU/ICU. Some of the medications include Diltiazem, Epinephrine, Lidocaine , Vasopressin etc. Here is the issue, after this class we will be expected to start these medications on med/surg floors. Management is pushing for this because "we cannot delay patient care". Of course this comes with huge issues, which we have brought up to management. Is our patient to nurse ratio going to change if we are expected to do this? These drugs require much closer monitoring so are we expected to do this with 5-6 patients as it is currently? Management has given us no clear answer about this and has made statements such as, "well you're nurses, you can't hang a medication when it's ordered?" And specifically regarding the concern with the amount of patients we take now and how are we supposed to do this with patient's who need much closer monitoring while on these drips, management has told us that, "Other hospitals are also doing this". This doesn't make me feel any better but I want to know if this is indeed true. Is this a new thing at your hospital on the med/surg floors? I would love to hear back specifically from med/surg nurses in Texas. In talking to my nurse friends from other states they have all said no, it's not a thing. Thanks in advance guys! Appreciate you!

Not a textbook, instructor! lol

I'm in nursing school and they taught us this in first semester. They called it "hospital corners" and we had to show we knew how to do it.

I've heard something similar about draining the bladder too. Maybe we had the same professor? :) This is directly from my notes: "if you have to catheterize someone to drain urine, clamp after 600ml's and let the bladder adjust to have less and then unclamp and continue draining, this will help to prevent a neurogenic bladder."

I've read a lot of posts on here talking about bad or lazy preceptors and I feel the need to say something to both my fellow students and the nurses who fill the precepting role. I've been very grateful to have two amazing preceptors who I work with well and I've learnt so much from them. With that said, here are some random thoughts about precepting. I don't know if my preceptors are being paid a differential to precept me but I really hope so because having me on the floor with them is extra work. At this point in my learning I am keenly aware of the fact that I am slowing them down. I create extra work and stress for them by being there and I think it's important that students realize this – you are not necessarily helping your preceptor with their patient load, in a way you are adding to it. With that in mind I try to double up and help extra with ADL's, getting water, taking the patients to the bathroom, walking with them etc. These aren't the glamorous parts of nursing but I feel it's the least I can help with so that my preceptor can sit down to chart, or check my charting and make sure I haven't screwed it up etc. To all the students out there who think that they are helping their nurses so much and should be rewarded and given total freedom on the floor – you're not, so get over it. And to all the preceptors who accept students, thank you. I know it's an extra load to your already busy day and we are truly and sincerely thankful for the time and effort you put into teaching us on top of everything else you have to do.

Thank you! All very good points. We do have some patients with much higher parameters for their BP due to thrombotic stroke. I remember the first night I worked there I took a patient's BP and it was 200 hundred something so I ran straight to tell the nurse. She saw the panic on my face and explained it to me. Very nice of her, even though it was crazy busy. I had just started 1st semester at the time I didn't know anything about anything. Also, it's just this one particular nurse and they do yell at the other CNA's about vitals. The other nurses on the floor are awesome men and women who work their butts off for their patients and we get along great. I'm sure there is a reason why this nurse doesn't want the higher BP charted but I'm not brave enough yet to ask. I don't like confrontation and I really don't like getting yelled at. >> Anyway, I'm working with them again tonight so we shall see how it goes. :)

I've got a question but my background is I work nights as a CNA on a tele/stroke floor and I am also currently in nursing school. My question is this. I regularly work with a nurse who doesn't like to cover patient's BP meds, if its too high. Often the orders read give X med for SBP >160 etc. It usually goes like this, I'll take the vitals on a patient and if the BP is high, I let the nurse know. They will always have me recheck it. If it's the same or higher they get upset and take it themselves but they lay the patient completely flat on the bed to do it and they always get a slightly lower reading, just under the parameters of where they'd have to cover it. Last time it was 158 SBP when they took it, right under the 162 SBP that I got without lowering the HOB. Now here's my question, is the lower BP the more accurate one? Because most of our patients have orders to have the HOB raised at 30 degrees or more because they are aspiration risks etc. so I don't lay them flat to take their BP. I make sure they are on their backs, with legs uncrossed etc. This is becoming an issue to where I don't want to work on the same shift with this nurse because I'm actually scared to give them their patient's vitals because I get yelled at. The last time I told them about a high BP, they followed me to the room to watch me retake it and it was the same. They got super upset, kicked me out of the room and laid the hob completely flat and retook it themselves and it was slightly lower. What's the deal? Should I be doing that too? I asked my nursing instructor at school and they said the most accurate BP's are done with the person standing up. My thinking is that if the person is going to be spending most of their time with the hob raised then it makes sense that their BP in that position is their most accurate BP but not according to this nurse that I work with. It's very confusing.