Yes, the fun never stops in RehabLand. Days ago, the State Board sends out renewal notices and today, they send out their regular newsletter.
Guess it's a reminder to answer those questions correctly.
We have plenty of our regulars: lapsed licenses and drug testing abuses. Here's the ones from this edition that you really need to put on your "DO NOT" list, students (and any other RNs for that matter...).
1. Do not attempt to substitute blue mouthwash.
Yes, we all know that certain forms of morphine smell just like some of the mouthwashes on the market, but stealing pain meds from terminally ill patients, is, was, and ever shall be unforgivable.
It will also cost you your license (there were actually two mouthwash switchers in this edition from RehabLand State Board of Nursing).
2. Don't go to a party, get wasted, then trespass.
This is also a problem, especially when you are convicted.
3. Do not share your Pyxis/Omnicell/drug dispenser password.
One person lost his/her license for this (and diverting narcs), but my question is, what happened to the idiot who shared the password?
Here at the Hotel, you would be fired for violating the information security policy.
Speaking of policies...follow them.
4. Don't assess the patient after a violent incident involving security.
This nurse was reprimanded for leaving that lil' old task to someone else. If your facility states you will assess following any altercations you must.
Besides, it's a lawsuit waiting to happen. Remember: you're considered in a position of power.
5. Don't just "borrow" a retiring physician's prescription pad.
When you are from a little town, people talk. And those pharmacists are smart. Hence the reason why they didn't fill any of your prescriptions.
And finally, my personal favorite:
6. Don't go offroading in the company car.
This applies to anyone really, not just nurses, unless of course your company car is an off-road vehicle and/or your job demands it.
Home health RN was out on his/her regular route seeing patients when he/she ran off road and damaged the axel of the car, requiring towing. Luckily, no one was hurt, but since this is a recordable incident while on duty, HHRN was required to submit to a drug screen.
As you may have guessed, he/she flunked (positive for marijuana). Remember kids, buzzed driving, driving while high (or getting high during working hours) is really NOT a good thing.
Showing posts with label assessment. Show all posts
Showing posts with label assessment. Show all posts
Saturday, February 14, 2015
Thursday, November 18, 2010
EAA part one
Yes, the Evil Accrediting Agency came today, and thankfully, they send a relatively congenial inspector. He/she was observant and noticed only one detail out of place (relatively minor).Despite this, he/she kept telling us things looked good and the area has a bright future at Madison.
Yours truly got to escort the inspector and the intern with him/her to a special lunch on the unit the volunteers have on a regular basis. Inspector was impressed. We were, too. Lots of Thanksgiving food was out and everyone was having a good time.
Happily, the afternoon meetings passed quickly. I'm hoping things go well tomorrow on the final day
of assessment.
Stay tuned...
Yours truly got to escort the inspector and the intern with him/her to a special lunch on the unit the volunteers have on a regular basis. Inspector was impressed. We were, too. Lots of Thanksgiving food was out and everyone was having a good time.
Happily, the afternoon meetings passed quickly. I'm hoping things go well tomorrow on the final day
of assessment.
Stay tuned...
Monday, January 26, 2009
Get up and go Monday
I managed to get up and go, even if I felt a little slow. So did a couple of our patients.
Our first admission was on site when I arrived around 0715. This is highly unusual, but this patient came from home and was not picked up, so this added another element of excitement to my day when I went into report and I found out that I'd be the admitting nurse.
Happily, I got my assessment and some paperwork out of the way before I started getting my other two patients ready. One of the volunteers set up one of my patients and he got ready and I didn't have to do too much.
I got him ready and up in his chair, and away I went to the next patient. The next guy was a little perturbed that he had to wait for the docs, but that's what happens sometimes when they're rounding and talking. Better late than never to therapy!
The rest of the day went reasonably well, and I even got to eat my lunch by 1330. I got my patient to therapy for all of the afternoon session. He went back to bed and watched a movie on his laptop, which thoroughly entranced his roommate, who had never seen a DVD before.
It was all good, even if I escaped a couple of minutes late. More fun tomorrow...we'll see how crazy the weather is! Stay tuned!
Our first admission was on site when I arrived around 0715. This is highly unusual, but this patient came from home and was not picked up, so this added another element of excitement to my day when I went into report and I found out that I'd be the admitting nurse.
Happily, I got my assessment and some paperwork out of the way before I started getting my other two patients ready. One of the volunteers set up one of my patients and he got ready and I didn't have to do too much.
I got him ready and up in his chair, and away I went to the next patient. The next guy was a little perturbed that he had to wait for the docs, but that's what happens sometimes when they're rounding and talking. Better late than never to therapy!
The rest of the day went reasonably well, and I even got to eat my lunch by 1330. I got my patient to therapy for all of the afternoon session. He went back to bed and watched a movie on his laptop, which thoroughly entranced his roommate, who had never seen a DVD before.
It was all good, even if I escaped a couple of minutes late. More fun tomorrow...we'll see how crazy the weather is! Stay tuned!
Tuesday, September 30, 2008
Vacation...all I ever wanted!
Yes, I'm now officially on vacation until next Monday from Madison. Hooray! Hooray!
Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.
I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.
One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.
I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.
We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.
I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.
As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?
Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!
Stay tuned...back to work next week!
Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.
I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.
One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.
I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.
We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.
I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.
As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?
Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!
Stay tuned...back to work next week!
Thursday, January 31, 2008
Heard on the unit...
Today's installment, actually from yesterday, is mostly patient quotes. I would have had them up sooner but I was just too tired.
One of my patients is a retired high school math teacher. Fr. V. is also hard of hearing, so this makes conversations really interesting.
Me: "Father, I heard you were a teacher, what did you teach?"
Fr. V. "Idiots."
Me: "Weren't you a math teacher, Father."
Fr. V.: "Yes, I was. I only taught the idiots. The smart ones learned all by themselves."
Even funnier thing...one of his likely students (Mr. G.--he left on Tuesday) was about two doors away. Now I'll never know if Mr. G. fell into the smart ones or the idiots on his initial high school math classes.
Fr. V. also had some spiritual distress, once I got him thinking about tests. Neuropsych had sent one of their students to do an assessment on him and he could not hear her well. As a result, I had to call the neuropsychologist on his behalf to see if they'd let him retake his exam. It should be interesting.
"That night nurse really doesn't like her job, does she?"
Mr. R. mentioned this to me as I was assessing him. He told me this nurse makes him feel very much like an inconvenience and that he's just trouble. Sure, Mr. R. gets up at 0500 to watch the news and drink his coffee, so it's not as convenient as staying in bed. Now, I make sure he has his coffee in his room whenever I get on the unit. If he doesn't, I make him some. He's fallen twice since he came to us, and he's staying until he can get his new cervical decompression next week, so we have to keep him out of trouble.
This is a sore subject for me. I hate dissing my coworkers, but some patients are very observant, and now I know why some of them actually ask their docs if I can be their nurse while they are on our unit. I never actually say anything about the coworkers, so I just let the patients vent and get their feedback. Most are very positive.
More later...gotta warm up the car and go to work. Mr. R. probably needs his coffee by now!
One of my patients is a retired high school math teacher. Fr. V. is also hard of hearing, so this makes conversations really interesting.
Me: "Father, I heard you were a teacher, what did you teach?"
Fr. V. "Idiots."
Me: "Weren't you a math teacher, Father."
Fr. V.: "Yes, I was. I only taught the idiots. The smart ones learned all by themselves."
Even funnier thing...one of his likely students (Mr. G.--he left on Tuesday) was about two doors away. Now I'll never know if Mr. G. fell into the smart ones or the idiots on his initial high school math classes.
Fr. V. also had some spiritual distress, once I got him thinking about tests. Neuropsych had sent one of their students to do an assessment on him and he could not hear her well. As a result, I had to call the neuropsychologist on his behalf to see if they'd let him retake his exam. It should be interesting.
"That night nurse really doesn't like her job, does she?"
Mr. R. mentioned this to me as I was assessing him. He told me this nurse makes him feel very much like an inconvenience and that he's just trouble. Sure, Mr. R. gets up at 0500 to watch the news and drink his coffee, so it's not as convenient as staying in bed. Now, I make sure he has his coffee in his room whenever I get on the unit. If he doesn't, I make him some. He's fallen twice since he came to us, and he's staying until he can get his new cervical decompression next week, so we have to keep him out of trouble.
This is a sore subject for me. I hate dissing my coworkers, but some patients are very observant, and now I know why some of them actually ask their docs if I can be their nurse while they are on our unit. I never actually say anything about the coworkers, so I just let the patients vent and get their feedback. Most are very positive.
More later...gotta warm up the car and go to work. Mr. R. probably needs his coffee by now!
Thursday, January 24, 2008
Nuggets for January 24
Here are a few interesting nuggets I've seen lately: in various publications:
From http://www.nytimes.com/
From http://www.nytimes.com/
- FDA requiring suicide assessment for new drug studies
- High mercury levels in tuna sushi
- Can too much cola cause kidney problems? Read this article and find out.
Monday, October 1, 2007
Heard on our unit...
"Remember that DNR. I've changed my mind. I want to be resuscitated."
This is what one of my patients on Saturday told the MD yesterday when he actually came in to talk to him about the DNR he wanted me to take as a verbal order. G. told me about this today. I just about fell over on that one....what?
"He's C-diff positive."
Not Mr. Z., since his results are still out, but Mr. K. my recent amputee patient won the prize (not our fault) and got his very own room. We now get to gown and glove to see him, and wash our hands each and every time we go in the room. Silence may be golden, but then again, so is C-diff.
"48 (blood sugar) is in the ballpark."
Famous words of a non-Saintarama diabetologist who only had the nurses calling him q2-4 hours re: his 19 year old IDDM patient's blood sugars. This kid came to us straight from the land of tubes and wires (ICU) with his own PRN vent.
I'd don't know about you, but I don't want to play in that ballpark, thank you very much!
"I don't like that antibiotic."
My patient, Mr. T. (yes, I took him back this week after a week of vacation from him on my team) after I gave him his Cipro two hours post corn flakes and milk. At 1020 he has emesis of about 200cc. At least, I didn't see the pill in there. The best news is that his Cipro will be over after his 2100 dose tomorrow. Note to self: give him his Cipro as soon as I can get it.
"Can I have lots of ice? I like ice."
We must have the best tasting ice on the planet, or we have some people who really love it. I heard this over and over today.
I had a pretty good day today. I had a brand new patient (another BKA) come in early enough that I was able to stay over a bit to help the evening shift. I got her assessed (found 2-4 small PUs) and set up in the room and helped J. get the care plans in the computer, since she took my team. The secretary was still around, so she helped with the rest. I still managed to get out just before 1700. Hooray.
More fun and excitement (and surely, ice) tomorrow. Stay tuned!
This is what one of my patients on Saturday told the MD yesterday when he actually came in to talk to him about the DNR he wanted me to take as a verbal order. G. told me about this today. I just about fell over on that one....what?
"He's C-diff positive."
Not Mr. Z., since his results are still out, but Mr. K. my recent amputee patient won the prize (not our fault) and got his very own room. We now get to gown and glove to see him, and wash our hands each and every time we go in the room. Silence may be golden, but then again, so is C-diff.
"48 (blood sugar) is in the ballpark."
Famous words of a non-Saintarama diabetologist who only had the nurses calling him q2-4 hours re: his 19 year old IDDM patient's blood sugars. This kid came to us straight from the land of tubes and wires (ICU) with his own PRN vent.
I'd don't know about you, but I don't want to play in that ballpark, thank you very much!
"I don't like that antibiotic."
My patient, Mr. T. (yes, I took him back this week after a week of vacation from him on my team) after I gave him his Cipro two hours post corn flakes and milk. At 1020 he has emesis of about 200cc. At least, I didn't see the pill in there. The best news is that his Cipro will be over after his 2100 dose tomorrow. Note to self: give him his Cipro as soon as I can get it.
"Can I have lots of ice? I like ice."
We must have the best tasting ice on the planet, or we have some people who really love it. I heard this over and over today.
I had a pretty good day today. I had a brand new patient (another BKA) come in early enough that I was able to stay over a bit to help the evening shift. I got her assessed (found 2-4 small PUs) and set up in the room and helped J. get the care plans in the computer, since she took my team. The secretary was still around, so she helped with the rest. I still managed to get out just before 1700. Hooray.
More fun and excitement (and surely, ice) tomorrow. Stay tuned!
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