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Answers to Your Nursing Career Questions

Prioritizing patient care

August 12th, 2010 by – Sue Barton

I am working on an assignment for school that gives you a brief description of a patient’s hospitalization, relevant orders, and summary of night shift report.
Based on that info you are supposed to determine the priority assessments for entering the room. There is a column for objective/subjective and safety issues. Please clarify if you can exactly what it is asking for. I know I am probably over thinking this.

It looks to me like the key to this assignment are the words priority assessments.  You have been given a fair amount of information about your patient, and as you walk in that room to take over for the next shift, you need to be able to prioritize the most important pieces of information that you need to provide nursing care safely.  If you are able to have a plan in mind based on the information you already have from the history and the shift report and the medical orders, you will use your time most effectively and are less likely to be distracted or sidetracked by peripheral concerns.  What questions do you need to ask the patient? That’s your subjective information.  What observations and measurements do you need to make?  That’s objective.  Is everything in compliance with safety standards?    Don’t hesitate to discuss this assignment with your instructor, as he or she is of course best able to clarify for you what specifics need to be in your answer.

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Saying Good-by to Your Coworkers

August 11th, 2010 by – Marijke Durning

That’s it – it’s your last week at work and in a few days, you’re starting a new job in a new hospital in a new specialty. But, you cut your teeth in this unit. This is where you spent your first few years as a nurse. The nurse who precepted you became your mentor and the nurses you worked with, your friends. How can it be that you’re excited to leave but sad to go? And how can you not feel guilty knowing that they’re short staffed as it is?

What you’re feeling is normal. Don’t worry about feeling excited about new adventures even if you know your old unit needs more nurses. The unit’s staffing issues aren’t yours and if they need more nurses, it’s not your fault. What’s that saying, “looking out for number one”? That’s you. You want to grow professionally and you have the opportunity. Don’t let guilt keep you back.

Saying good-bye to your friends and colleagues at work comes with the territory of work. Whenever you work with other people, you never know how long they will stay around and, to be perfectly honest, you don’t even know yourself how long you’ll be there. So much happens in life – we switch jobs, we move away, we may even win the lottery and never have to work again. And right now, it’s you who is moving.

How you say good-bye is up to you. Some people don’t like to share that they’re leaving until the last minute, while others tell their coworkers right away. Some would like a good-bye outing while others prefer a quiet exit – there’s no right or wrong way to leaving. How you do it is up to you. So, finish up those last few days, say good-bye and don’t worry if you shed a few tears. Just remember that your experience there, for good or bad, taught you a lot about the nurse you are today.

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Posted in On-the-Job Fears

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Community Health Nursing

August 10th, 2010 by – Sue Barton

  What is community health nursing? 

Community health nursing is the application of nursing principles to a population group in order to promote better health outcomes.  This is in contrast to providing care to an individual in an acute care setting such as a hospital.  Community health nurses are assessing and evaluating aspects of the community that can impact health of the population, such as birth rates, infectious disease trends, and environmental toxins, among others.  Interventions may include educating women about contraception, providing prenatal care and childhood vaccines, teaching about and testing for lead poisoning, interviewing people with infectious disease to determine sources and contain spread.  Community health nurses are often employed by local health departments, but may also work for private agencies.  They often work out of clinics in neighborhoods, and may make home visits.  The focus of community health nursing is on prevention and early intervention, so finding effective ways to communicate information about healthy living is key.  This involves knowing the culture and values of the community and advocating for access to services.  The terms “community health” and “public health” are often used interchangably.  Medi-Smart”s career comparison site has information under both headings gives you more details about this field.

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Pain and Your Cognitively-Impaired Patient

August 10th, 2010 by – Derek Brocklehurst

How do you assess pain in a cognitively-impaired patient?

Oftentimes called the “5th Vital Sign”, pain is an important sensation to measure that, if untreated can adversely affect a patient’s care. There are different pain scales used in the clinical setting based on a patient’s developmental level and cognitive abilities. Pain scales can include facial expressions, sounds or noises to listen for, and a 1-to-10 rating scale.

It may already be difficult to measure pain in patients with certain conditions including burn victims, trauma victims, or suicidal patients. If a patient is cognitively impaired, it may be doubly difficult to assess pain. Try relying on external factors that deviate from their baseline: subtle facial expressions noticed when cleaning or tending to the patient; noises such as sighs, grunts, groans, or screams emitted during patient care; and when mobilizing the patient during regular care, take note of any changes you may notice when certain muscles are flexed or used in the movement, as any changes deviating from baseline may indicate pain. Relying on family members may be the best way to assess pain in your cognitively-impaired patient, as they tend to know their relatives better than anyone.

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No Gift Policies

August 9th, 2010 by – Marijke Durning

Most health care facilities have a  “no gift” policy when it comes to their nursing staff. This means if a patient or a patient’s family offers a gift to the nurse or aide, they must refuse it. In theory, this sounds reasonable. After all, all patients should be treated equally and there could be the perception of some patients receiving better treatment than others simply because they give gifts to the nurses.

Gifts from patients and families are meant as an expression of gratitude for the care the nurses are providing. The families want to provide a token of their appreciation, which can range from gift cards to plants to money. Some gifts are very minimal in value, while others are quite expensive. But the nurses can’t accept them.

Exceptions to receiving gifts may be made if families donate something to the floor or unit as a whole, including all staff though – after all, the care the patient received is usually part of a team effort. While this is true, is it really fair though?

Some nurses and nursing staff go above and beyond to provide great care to their patients. And, just as some nurses go above and beyond, some only do the minimum their job requires and nothing more. One could argue that nurses should always perform at the above and beyond level, but in reality, this isn’t so. Should the good nurse not be rewarded in some way? Is it right that the great nurses are lumped together with the no-so-great ones?

Obviously, limits must be placed on gift giving. There’s a big difference between a 10.00 Starbucks card and an expensive watch, but if it makes the gift-giver feel good, if the gift isn’t extravagent, what is the harm in accepting the gift?

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Posted in Patient Interaction

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Why choose nursing?

August 7th, 2010 by – Sue Barton

  Why did you choose to become  a nurse?

After WWII,  it become more common for women to pursue work outside the home and to consider post-secondary education.  Nursing and teaching where the fields most often considered appropriate for young women.  Both were thought to be jobs that would complement a woman’s primary role in the home, and often were given up when she became a mother.  For decades, there were few men in the nursing profession.  With the societal changes that came in the years after the advent of the birth control pill and the feminist movement, all of that began to change.  As more options opened up for women fewer chose  nursing , instead pursuing  careers in law, engineering, medicine, and other fields.  Meanwhile, nursing itself was evolving into a profession that offered greater autonomy and challenge. College campuses have largely replaced hospital based nursing schools.  The variety of settings that employ nurses has broadened into the community as well as academic and research settings.  As the economy has been in flux, both men and women are recognizing that nursing is a career that provides many rewards and challenges.  Anticipating a future nursing shortage, applications to schools have recently been at all time highs.

Why did I chose nursing?  I enjoyed science, I was fascinated with the drama  of the struggle to win the battle against disease, and I wanted to help people. What about you?

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Don’t Let Your License Lapse: Get Those CEUs!

August 6th, 2010 by – Derek Brocklehurst

I need CEUs for license renewal. I just retired but I want to keep my license. What’s the best option for me to get CEUs?

If you are thinking about retiring but might want to consider practicing again in the future, never allow your license renewal to lapse. If you do not renew your license, trying to get a new nursing license through your state board of nursing can be a  bureaucratic nightmare: taking the current version of the NCLEX, obtaining nursing school records, sending transcripts to the state board. Get those CEUs because they can be quite simple and easy to obtain!

You can obtain CEUs by attending local lectures, seminars, reports-back, or other nursing-related talks in your community. Be sure to check ahead of time to make sure the organization offers CEU credit before committing yourself and your time to a talk. Online CEUs are available as well.  Check out this earlier posting about CEUs for more information!

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Living Through Orientation

August 6th, 2010 by – Marijke Durning

All nurses have to do it and most more than once in their career: orientation. But not all orientations are equal. Where you work and in what area you work in dictates the type of orientation you’ll receive. In some places, the orientation is so thorough, it may seem like you’re going through a preceptorship while in others, it’s a quick “here’s the crash cart, there are the charts, and here are the keys to the narcotics,” and you’re on your own.

So, what do you do if you’re in the latter group, receiving an inadequate orientation? First, you can speak up. You can ask the administration if you can have more orientation. If they say “no,” because of time constraints or inadequate staffing, you then have two choices: You can choose to move on to another job elsewhere or you can try to make do with what you have.

Moving jobs isn’t always an option. While in some places, there is a nursing shortage, in other places, there are no jobs to be had for nurses. So, if you’re stuck, then you have to make do with what you have.

When you begin working on your unit or your new environment, make a list of things you need to know. If you’ve worked elsewhere, try to remember back to when you either had your own orientation or, even better, if you oriented other nurses. Take note of all the things you learned or taught and remember the various issues that came up after your orientation. These are issues that would pop up and you weren’t sure how to handle them because no-one had mentioned them to you.

Once you have your list (which can be constantly updated), you need to have a treasure hunt to find things and you need to ask questions. The only way you’ll learn in this sort of situation is by taking the initiative.

It’s very likely that the nurses you work with feel that the orientation is inadequate and it is frustrating for them too. It’s difficult to work with someone who hasn’t been taught about procedures. Keep this in mind when you ask your questions.

Once you start to feel comfortable with your new work place and if you don’t think you had a good orientation, you may want to think of ways to improve it – for the nurses who will come in the future. Once you’ve outlines what you think needs to be done, it might be a good idea to meet with the administration and outline your idea for a more effective and thorough orientation for new staff.

There is always the chance that they’ll not agree, but you never know. There also could be the chance that they didn’t realize their orientation process wasn’t as smooth as they had imagined it was.

Hang in there. Orientation can be stressful, but a good nurse is a good nurse no matter where he works.

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Posted in On-the-Job Fears

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Problem Oriented Recording

August 5th, 2010 by – Sue Barton

  What is problem oriented recording in nursing? 

Problem oriented recording is a systematic method of record keeping that focuses on identifying the problems facing the patient and progress notes that are directed toward those specific problems.  The first step is the problem list which may be long or short depending of the situation, but should be as specific and concise as possible.  Progress notes for each problem will follow a SOAP format.  S stands for subjective information, that is, what the patient or someone else states about the problem.  Most nursing/medical history taking falls into subjective information.  O is objective observations, including measurable things like vital signs and directly observed aspects of the examination.  A is the assessment statement which is drawn from the information gleaned.  P is the nursing plan which is implemented to address the problem based on the nursing assessment.  Problem oriented formats can be adapted to group situations such as family and community health problems as well.  Once you have some experience with problem oriented records and the SOAP format, I think you will find that this approach is useful in focusing your thinking, as well as simplifying recording and making it useful to the next person to pick up the record.

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Troubleshooting an Elevated White Blood Cell Count

August 4th, 2010 by – Derek Brocklehurst

What causes WBC count to be high for 4 months or longer? I was tested for infection and there was none.

There are different types of white blood cells (WBCs) when you get a complete blood count: neutrophils, basophils, eosinophils, monocytes, and lymphocytes. Seeing a breakdown of which specific types of cells are high may help figure out what is going on. A high WBC count could be caused by several different things. Systemic infections, generalized allergic reactions, inflammations, or leukemia can all cause increased WBCs in your circulating blood.

Other external factors such as stress, cigarette smoking, and caffeine can cause elevated levels of WBCs. I would suggest getting an allergy test with your primary care provider to see if there is something you might be allergic to that is causing the increased WBC count. Cutting back on smoking and caffeine might also be beneficial to the elevated count. As for stress, try meditating, deep breathing, and stretching any tense muscles to help relieve some of the tension in your body due to stress. This may decrease your WBC count as well.

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