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  1. AnnoyedNurse

    Diabetes Management in Phase II Recovery

    Djmatte- Thanks for your insight. I did clarify with our Senior manager that blood sugar checks upon admission to Phase II is NOT the standard. But to state that just because my boss has a plan in her mind makes it the standard contradicts the very basis of evidence based practice. If the hospital has a policy that is not the standard, then we still follow it because it's hospital policy. If there is no specific policy, then we follow the standards based on evidence. In this situation, there is no policy that states we must check blood sugar on every single diabetic upon admission to Phase II- only when symptomatic or there exists another reason such as an Provider order or holding the patient for a long period of time and having to provide them a tray; therefore I was looking for more insight based on the practice of others if supported by literature. (Phase I it is mandated by the standards set forth by ASPAN and ASA).
  2. AnnoyedNurse

    Diabetes Management in Phase II Recovery

    This patient was supposed to be admitted but since surgery went well, the doctor decided admission was no longer necessary, and the ACHS order remained even though she was no longer being admitted. To add to the situation- our manager is trying to say that we must check blood sugars on ALL DIABETIC PATIENTS upon admission to Phase 2 recovery. She's obviously wrong. I'm going to bring it up in our shaded governance committee and if she persists that she wants to mandate this be standard, I'll escalate to our medical director. Thanks for the suggestion!
  3. AnnoyedNurse

    Diabetes Management in Phase II Recovery

    We're also very confused why our manager is blaming this nurse. This patient happened to have an ACHS order in place and that's why she checked it. Otherwise she would not have checked it.
  4. AnnoyedNurse

    Diabetes Management in Phase II Recovery

    Hi Nurses! So I have a question about diabetes management in Phase 2 recovery of the ambulatory surgical patient. It seems to be standard of cafe in Phase 1 (PACU) to get a POCT blood sugar upon admission and treat hyperglycemia if it is greater than 200 or 300 depending on the anesthesiologist. In Phase II or post-op, is it the standard of care to immediately recheck the blood sugar upon admission to Phase II? My practice and the nurses practice who I work with in Phase two has been to check the blood sugar only on patients who are symptomatic, the patient states they "feel" like their blood sugar is high, OR if a doctor's order is in place such as AC/HS. Further, if a patient is symptomatic, i.e. polyuria, and you do recheck the BS and is elevated, and the family and the patient refuse the insulin, the nurse informs the doctor, does this fall back on the nurse, the physician, or the family? There seems to be a confusion with one of our new managers on a unit I work at Per Diem and she is trying to place blame on the nurse. I've attempyed to research ASPAN guidelines but I am unable to find anything specific to Phase 2 recovery. Your opinions and links to articles would be helpful. Thank you!
  5. AnnoyedNurse

    Male Nurse Disgusted by Female Nurses

    As a male nurse, I want to just say that this nurse uses some harsh language towards our female counterparts and in my opinion leads me to believe that he might be somewhat of a mysoginist and if he is married, he usually calls his wife a drama queen instead of taking responsibility for his actions. I agree- nurses are apathetic when it comes to political change. Even in the unionized environemnt that I work in, some nurses are "afraid" of being fired by management. Prior to becoming a nurse, I envisioned myself becoming a nurse manager and growing the ranks and becoming a Chief Nursing Officer. Now that I have been a nurse for a little over 3 years, I would rather die than become a nurse manager or worse a CNO. Once you join management, you immediately become the servant of the corporation. As a bedside nurse, I would rather be the healer and serve my patients needs. Now, I am fully engaged in political action and changing nursing and bringing safe ratios to light. I am working with my union, NJSafeRatios, and legislators to change our profession. It's not JUST about getting our breaks and lunches, but it's abiut patient safety. Starting now, let's Unite. Let's not argue over how much of a coward the O.P was for being "disgusted" by his fellow female colleagues. Let's instead focus our energy on improving our profession and improving the quality of care our patients receive. Follow me me on Twitter @ahmadCCRN and stay up to date on all happenings in NJ for safe staffing.
  6. AnnoyedNurse

    Giving meds early/late

    I know this is an old post, but for other new nurses who may be reading this: whenever meds are given earlier or later than facility policy, the doctor always needs to be informed. Otherwise, you can get in trouble for practicing medicine without a license. More than likely, the doctor will just say, "okay." But you still have to let them know. Also, some meds like tacrolimus need to be given on time especially if the levels are being drawn at a certain time. Use your judgement but always let the doctor know to CYA; also as others have mentioned, call pharmacy and ask them to retime the Med and ALWAYS be truthful as to why a Med is being given early or late and provide documentation on which doctor or practitioner you informed.
  7. AnnoyedNurse

    Ageism in Nursing: A Pervasive Problem

    VickyRN - I think your mentality is skewed. There is more discrimination and negative attitude in the workplace against younger nurses than senior nurses. I have witnessed older nurses gossip and question the competence of new nurses many times. I think your comment about seniority is important. Yes, they have earned the right to have some leniency is scheduling, however, that does not make it appropriate to treat new nurses as slaves or at the bottom of the barrel. Just because someone is new does not mean they are incompetent or should be treated any differently. Quite frankly, in my opinion, seniority rules is organized discrimination against young people. Nursing is not a trade- it's a profession- all members of the team should have the same scheduling requirements including senior nurses. I've worked for a magnet Level 1 Trauma Center where meritocracy ruled and the culture was amazing. I currently work for a union hospital, where seniority rules, and the culture can be somewhat pervasive and against the standards of professionalism. I have witnessed senior nurses bully new nurses for whtever reason they wanted. I have witnessed younger nurses quit because of maltreatment bynew nurses. Rarely have I seen older nurses being bullied. Quite frankly, we are the future of nursing and the belief system of seniority rules will be retiring soon as well. We are professionals and we should act like professionals and not expect speciality treatment just because we are older. That is a sense of entitlement more than a new nurses expecting to be treated with decency and respect.
  8. AnnoyedNurse

    What do nurse managers and clinical directors actually do?

    MBARNBSN, lots of what you state are delegated tasks.
  9. AnnoyedNurse

    Is this a smart tactic in huddle...

    Wait I am confused. Why is this not an appropriate forum? I think it's the most appropriate forum. It allows me to get the opinion of other professional nurses without having to discuss it with my coworkers or other leaders at my hospital who would assume the statement came from my leader and potentially reflect poorly on her. Allnurses has been an incredible resource for me and many nurses and quite frankly, you are nobody to tell me what is appropriate to post here. With that said- my question was a nursing management topic. I have gained some real life insight and have drawn up my own conclusions and will be able to incorporate it into my own practice. Thank you for your opinion but please refrain from telling people what is or is not appropriate to post here. You are not the Nurse God.
  10. I mean you're still a nurse. Many nurses feel intimidated by working in an area they have never worked before but you have the "baseline" knowledge. My suggestion is to choose an area where you think you might enjoy vs choosing an area that is "easy." Im in critical care and most nurses say, they'd never be able to do it. But I disagree. I am a firm believer in doing whatever you set your mind on doing. With that said- pick an area based on desire, passion, curiousity, and interest. Talk to nurses from that area and see if you can shadow a nurse in that area within your hospital for a shift or two. Then, buy some books and start studying. By the time your six months is up, you should be ready to start orienting in your new speciality. Then after about 12-18 months start working towards certification in your new speciality! Good luck with whatever area you choose and remember, nothing in nursing is easy, so follow your dreams and make your dreams come true :)
  11. AnnoyedNurse

    Nurse Career Battery

    I'm applying for per diem jobs in NYC and it seems like the major hospitals that anyone would want to work for have implemented this battery. I am not sure how effective they are at choosing the right nurses. But I do hope I passed!
  12. AnnoyedNurse

    Unionized vs Non Unionized hospitals

    Currently work for a Union a hospital in NJ. Most of the management is ****. They are rude, disrespectful, and are always talking crap about the union. When I speak to the union, they are kind, supportive, and truly are there to protect the nurses. I love the Union and will never work for a non-union hospital every again. We get paid better, our benefits are superior, and we always have someone protecting us and letting us know our rights. We have rights.
  13. AnnoyedNurse

    Navy Corpsmen Caught

    A corpsman is an enlisted servicemember. A Nurse is a commission Officer in the service. It is possible for one to first enlist in the military as a corpsman or medic, and qualify for advanced education in nursing and be commissioned into the nursing corps as an Officer.
  14. AnnoyedNurse

    I Thought I Had My Dream Job, but My Past Took It Away...

    First- I am truly sorry for you! Don't be hard on yourself- our past has formed us into who we are today. If you made a mistake, I hope you have learned from it. So here's the deal with security clearances- you can always appeal them. I am not an expert so I can give you exam forms to file- but if you google the internet you can find the information on how to appear the disposition of your security clearance. I've read about it online in the past. The purpose of a security clearance is to determine your suitability and fitness for certain levels of clearance. I believe with prison jobs you are only required to attain and maintain a Q-clearnance or Secret Clearance, which are the lower brackets of clearances. Do your research- get reference letters ready and appeal your revocation. I know money is tight- but clearances are a HUGR financial ROI, so I would look into hiring a civil/administrative law attorney to help you navigate the ins and outs of clearances and working for the government. The important thing is to be honest! And show how far you have come and how much you have grown as a person. As far as advancing your credentials to RN- I would suggest this. RNs do receive a certain extra layer of respect among the community. This includes among HR recruiters, Security clearance investigatirs, etc. Plus, the increase in salary, increased autonomy in practice is truly worth it. I would HIGHLY advise against taking non-nursing jobs in order to make ends meet. If you have to work LTC or skilled nursing or whatever, it will help you more in terms of suitability for your clearance and future job prospects. Any gap in nursing practice is usually looked down upon. So avoid this at all cost. Worst case scenario- get yourself a desk job with an insurance company or do research for a pharma company. I know an LPN who was a research nurse at Johnson and Johnson while she was in RN school. Nursing is HUGE- you can do absolutely anything. Last piece of advice- please always be honest on job applications, clearance applications, Board of Nursing applications. Honesty is key. Failure to be honest can put your license at risk for revocation and sometimes can put you in legal trouble. So avoid it. Id be more than willing to help guide you with my own opinions more specific to your situation. If you're still needing guidance, PM me and I'll help as much as I can- but remember, please be honest! Good of luck with everything and you're an awesome person for doing everything you can to take care of your family :)
  15. AnnoyedNurse

    Calling in for no sleep

    I agree. Good deeds do come with their punishments but this is a situation where I knew that I had to call out regardless of what I wanted. I don't like that my coworkers may have to work short handed anymore than my managers likes to have to have her unit be understaffed. But, with that said, I learned my lesson. I'm going to be more of a stickler when it comes to my sleep schedule. I usually don't have trouble with sleeping, but I purchased Benadryl and will keep it around for these days where I see I am unable to fall asleep. Regardless of my managers response, good or bad, my commitment was to work and I couldn't and the reason doesn't really matter to her. In my eyes, I did the right thing and I don't feel bad about it. I would feel terrible if something happened to a patient if I went in 36 hours no sleep. Hey, it's just an occurance- I think it's written in our contract that we're allowed certain call offs so it is what it is. My point in sharing my experience was to shed some light that lack of sleep in nursing is surely unsafe. Only you know your limit and once you reach your limit, take any action necessary to safeguard your license, your patient, and your facility. In the grand scheme of things, I'm sure our managers and CNO's would rather us call-off of the rare occasion of true sleeplessness than come to work and be the cause of a multimillion dollar lawsuit.