gtmoore

Thank you so much, great idea.

i am trying to determine if there is a "safe" and maximum number of patients that a monitor technician should observe at any given time. for those hospitals that utilize monitor techs, how many patients do your monitor technicians watch simultaneously at your hospitals? also, if the maximum number is spelled out in policy at your facility, could you state that as well? finally, is anyone aware of any research or practice standards concerning this issue? thank you so much for your input.

Are floor/tele nurses at your facility allowed to d/c EJs, or does it have to be someone on your IVT team? My first thought was that it is considered a peripheral line so the same considerations apply as to other peripheral lines. As a tele nurse at our facility, we are allowed to d/c IJs and other central lines (with the exception of PICCs), so why would we not be allowed to d/c an EJ? Any thoughts?

It is 125 questions; however, only 100 count. The remaining 25 are questions they are "testing out" for possible future use. You do not know which 25 do not count. I did a two day PCCN review course in March that was sponsored by AACN. I did not pick up a single book or study material until 3 days before the exam. I started looking through the study materials from the course. Then, I realized that I should just try to do as many sample questions from my study book as possible, focusing on the Respiratory and Cardiac areas, which is the majority of the questions on the exam. I did really bad on the cardiomyopathy sample questions and some of the electrolyte questions, so I went back and re-read those two areas. I think you'll be fine. Do as many practice questions as possible and make sure you understand the rationale for the correct answer.

The Joint Commission standard is to label the multi-dose vial with an expiration date 28 days after opening.

I procrastinated and waited until the last possible day allowed to take the PCCN exam. I did not get a chance to do much studying, especially with a new baby. I did not think the exam was that difficult and was elated when I found out I passed the exam, and by a significant margin over the 70% minimum passing score. :)

Thanks for everyones input.

I believe I came up with a couple more: Insulin Propofol

Can you guys help me out? I'm putting together a powerpoint on IV medication administration and safety. I need to know which medications should never be filtered. I know chemotherapy (except Taxol). I know there are others. Can anyone think of any other medications that should never be filtered? Thanks

I would give the CNA the benefit of the doubt first. I would get her/his attention by saying "excuse me". I would repeat the request. If the CNA still continued to ignore me and talk on the phone and it appeared it was not an emergency and clearly a personal call, I would say something along the lines, "I need you to work now and it is against policy to talk on the phone at work in a personal conversation and if you continue to ignore me, I'm going to call the nursing supervisor and have her send you home since you don't want to work".

I disagree regarding Baltimore area. There are very few openings in the Baltimore area. My hospital had 84 new nurses apply for 15 slots for the new graduate program. Most Baltimore area hospitals are on a hiring freeze.

I'm developing competencies for our PCTs. PCTs are pretty much the same as CNAs or PCAs except, at our facility, they can do more advanced skills. These skills include IVs, phlebotomy, & inserting Foley's. I'm OK with them doing these skills. Some of the current items on their competencies indicate they can perform endotracheal, tracheal, nasotracheal, & nasopharangeal suctioning and trach care. I personally do not feel comfortble with them performing these tasks as it is something that is done so infrequently on most units. Can PCTs (or whatever they're called at your facility) do the suctioning/trach care items listed above at your facility? What is your opinion on whether they should be able to do them? Thanks.

Thanks for your input.

I had a patient receiving continuous tube feeding with 100 cc of tube feeding residual. I referred to our tube feeding protocol and it stated to only hold tube feeding and notify MD if tube feeding residual is >250. Doesn't that seem like a lot of residual? I always thought that you were to hold and notify MD if the residual was greater than 20% over the hourly feeding rate. What do you all think?

Agree with the other posts that it depends upon the type of PICC line whether heparin should be used or not. If the person is getting at least 6 meds through IV daily, why not consider running the line at KVO? Another thing to consider whether or not to use heparin is if the patient is on lovenox or arixtra, heparin is contraindicated. Also, if the patient is in with a bleed or suspected bleeding, you don't want to use heparin. Hope this helps.

Can hypomagnesemia be corrected during hemodialysis. I know low K can be corrected, but I've noticed that magnesium usually is unchanged after dialysis. It came up when I wanted a novice RN to call the MD to get an order to give Mg for 1.5 Mg. The primary RN stated calling the MD was unnecessary since the patient had gone to dialysis the day before and that the Mg was "corrected". Our facility does not do post-HD bloodwork. Can Mg be corrected during HD?

At our facility, you cannot leave hospital property while you are on duty. Even while at lunch, you are still considered responsible for your patients, and cannot leave the facility.

It doesn't matter who it was, RN, LPN, CNA, MD. Arguing in front of a patient is not professional. I would have simply not talked at all about this issue in front of a patient. Take it outside of the patients room and talk about it where nobody, especially a patient, can hear you. Get the charge nurse involved, if necessary. But, never in front a patient, very unprofessional!

Thanks for the replies. Obviously, hanging a 1000cc bag was silly because she was going through like 1-2/hour. I was also just thinking that if the NS is good enough to go in IV, it should be fine to irrigate the bladder.

As soon as you graduate, you are considered an NG and do not need a CNA per the BON. You do however need to take the NCLEX ASAP. Do not wait. I understand you don't have your ATT yet. You need to call your school and not the state as the ATT comes from your school. You need to call them now. The longer you wait to test, the less likely you are to pass. Also, there are plenty of jobs out there, just keep looking. Try to get into a residency program.

Although LPNs are a dying breed at my hospital, we do team nursing. LPNs give all the non-IVP meds and RNs do the assessments.

Personally, I hate going in and not knowing where I am going. It is very stressful to me.

Not lethal but certainly the patient is in renal failure. Many patients on dialysis still produce some urine. 136 + 22 is high, never seen dehydration do this alone.

Evaluations are done based on anniversary dates at my facility. Raises are given in July, to all nurses. We have a "cost of living/market adjustment" component and a performance-based component of the raise. It is not routine to get a raise after being on the job for 3 or even 6 months.

Wow, you guys are staffed really tight if only one nurse can be off at a time. What happens if someone calls out sick for 3 days in a row?