Kallie3006

Just flew into Philadelphia for COVID crisis and the amount of people in the airports wearing N95s is astonishing, the ones that are wearing them properly are few and far between, which is highly frustrating. Then there are all the ones wearing gloves that touch EVERYTHING, then their phone, then their face..... I understand the need to protect oneself as well as those around them but if wearing the PPE improperly the protection and safety equipment is null and void.

I'm with you on the mind set that everyone has it. At least knowing the pt is + takes out the "I wonder if" aspect.

Ultimately the choice of you working shifts outside of your scheduled ones is your choice and it is you and you alone that has to live with the choice you made, whether or not someone on an internet forum agrees with you or not. You can't see the future and know if you were to go to work and get exposed and bring it home or go to the grocery store and have the same thing happen. Whether you go back and work at this facility or not maintain social distancing and use hand hygiene like you will never have the chance to wash your hands again, and keep you and your baby as safe as possible.

No offense to those who asked who is paying for the program, but IMHO it doesnt matter who is paying financially, because, technically in the end, YOU are paying with your time, effort and motivation. If you choose to do something you are not passionate about the patient's suffer, co-workers suffer and most importantly YOU will suffer. If you know what it is that you are interested in you need to pursue it for YOU, because in the end YOU are the one that reaps or suffers from the choices of your actions that are dictating YOUR future.

Maybe I'm the only one confused but when someone tells or orders a bolus I generally associate that with a "large" volume in a "short" period of time. You stated that you came into the room a short while later, finding the MD, charge, and preceptor in there, and if I'm understanding correctly, the fluids was set to infuse at 100cc/hr, which would mean the patient received 200cc/hr, or less if you rounded on the patient in less than 2 hours (which I'm assuming is the case especially with being in the ED), and the mistake was found. You also stated that there was a 1L bag and a 500cc bag hanging ready to be infused, with me concluding that both bags had at least enough fluid in them to ask for clarification on which to hook up as the bolus, so pt has received less than 1500cc since both had fluid in them. Pt has an elevated BNP, edema and not medication compliant and an elevated LA. LA elevating is one tests that is used to help with a sepsis dx but not always is an elevated LA caused by sepsis. Pt has CHF and is presumed at this point to be in CHF exacerbation (if I'm understanding correctly). When CHF is a current problem the deminished blood flow means there is a diminished oxygen supply being sent throughout the body, which the body then starts to break down carbs to meet the energy demand, lactic acid is created as a byproduct which raises the level results of the blood draw. If this is the case with this patient then sepsis may not be the underlying cause but the pt's comorbidities, which the original assessment, corroborates. Bottom line, everyone makes mistakes, none of us are immune to them. What makes a good nurse is those that admit to those mistakes, asks questions and learns from them. Remember that and this situation will make you more aware and clinically stronger to other patients you care for, students, new nurses, or orientees you precept, will be able to have someone that is able to share their experience to heighten awareness for situations like this, that is not only encountered in the ED but with critical care and floor nursing as well. Thank you for sharing your experience and don't beat yourself up!

Surgical unit-- Goal of the day- pain >4 DC instructions- no important decision making, driving or Facebook while taking Norco Report that patient has been here for a couple days post fall and we are not doing anything for them- pt had surgery 2 days ago and you charted on the sx site

I know in Tx the BON has the scope of practices available to look at

When we went live with computer charting, from paper, we had super users available, only had 2-3 patients at first and employees of the program company that came around and checked on everyone. The doctors also had extra support staff on their side that assisted with their layout and questions. The facility also provided snack and beverage carts that came around the units, a specific theme each day as well as massage chairs with massage therapists. Dang we was spoiled, needless to say the transition was not stressful at all and your situation sounds like a nightmare and patient safety isn't a priority at all. I hope this is fixed soon for all of you.

Just some food for thought..... our nurses must have a experience of a year at least to take nursing students.

I couldn't imagine what families are going through when it comes to the involvement of their children, and how their lives are affected by this woman. I know first hand how life-altering a false positive drug test is and how completely time, mind, body and soul consuming trying to prove innocence is. My life was turned upside down because of a drug test that was incorrectly reported to my employer and subsequently the BON, but my children were not involved in that nightmare. And $2,000 bond?!? That's outrageous and does not seem fair at all in comparison to the time lost between those families this being attempted to destroy.

When I changed hospitals I felt like being a new grad would have been easier, the charting system about killed me. Learning anything new takes time and how much depends on you and the exposure you are getting to whatever element you are having to learn. Look up policies and procedures on whatever drips or procedures you are having to do and familiarize yourself with them. Do you not have a preceptor that is able to help show you this? If not, find out who you need to talk to and who you are able to call and ask. Don't be afraid or ashamed to ask questions or seek help, especially if you don't know.

This was my thought as well, triaging is a skill that is developed over time and experience, IMO

I work at a hospital in Texas and we do not do anything of this sort and we get surveyed like anyone else. Seems like a waste of time and manpower that could surely be used in a more productive way.

If this was the worst thing that happened to her ( The Doc) this shift, then I would say that is a pretty good shift.

I once gave a 1x dose of ativan for a patient that the neurosurgeon wanted to watch his EEG on. The doc told me he was ordering it and for what so once it came up to pull I did so and pushed it, then told the doc. Was the doc ready to go? Heck to the no. The day was crazy and I was trying my best to stay afloat. I had been a nurse for 3 years when this happened. A nurse I used to work with guy a patient from PACU who was in a lot of pain when they got to the floor so she gave the ordered prn pain med. She failed to look at the mar to see when it was given last, and it was to soon. She had been a nurse for over 10 years. I went to a new hospital and learning the charting was horrible for me. This system was awful, and I still stand by that. I missed a whole rotation of antibiotics, new orders and lab results. I swear being experienced was a disadvantage, it was horrible. I now charge on that same unit. Book smarts is wonderful until it's not. You are learning to draw connections between what you learned in school and how it applies to your patient population. A+B=C or D or Y and YLMK, school teachers you A+B=C and the rest comes with time and practice. If you can go in early and read over your patients info, get labs and imaging results, write meds and times down, and your orders for the day, then use this to get you a game plan down. Cluster your care when possible, and ask questions. I used to write down different diagnosis and meds used and studied them, then when I would get a patient with said dx I would have an idea of what to expect. Get you a brain, one that works for you so even through the chaotic times you have a reference of what is due and when. Get organized. Have you thought about nights? Nights has it's own set of advantages and disadvantages but generally the pace isn't so fast like days, you usually don't have many admits or discharges. This could help you feel more comfortable in your work environment and you critical thinking. You sound like you are someone that is willing to learn, accept when mistakes are made to learn and grow from. Don't give up yet, you're still new.