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Answers to Your Nursing Career Questions

It’s Patient Safety Awareness Week from March 6 to 11, 2011

March 4th, 2011 by – Marijke Durning

Did you know that next week is Patient Safety Awareness Week? It’s an annual observance led by the National Patient Safety Foundation. According to the website, the foundation’s mission is to improve the safety of patients by:

- Identifying and creating knowledge associated with patient safety

- Identifying how to spread the knowledge

- Developing the culture of patient safety and

- Raising public awareness of the issue

So, what exactly is the week for?

The week is to help health care personnel from nurses to lab technicians and doctors to pharmacists to remember, identify, and/or learn about issues in patient safety. The foundation encourages initiation of conversations and programs, and assessment of patient safety in various facilities.

While it may be too late to do any official planning for your facility this year, it’s never too late to discuss patient safety with  your colleagues. A few  minutes during shift change or a staff meeting, if one is planned, are good times to review basics and perhaps ask if there are issues that your colleagues would like to discuss.

Why is this needed?

Patient safety involves many different things. Patients can be harmed by falling, by medication errors and by other mix ups in procedures. Although many of these incidents are labeled as accidents, most are not truly accidents but occurred because someone skipped a step or failed to identify a danger.

Constant reminders in the form of programs, posters, meetings, workshops, and reviews of incident reports can help nurses understand and remember where the accidents may occur and how they should be avoided.

Nurses don’t voluntarily go in to work saying they’re going to harm a patient, of course not! But, reminders, such as this awareness week do help us remember that mistakes and accidents happen – and many are preventable.

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Posted in Patient Interaction

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Working with difficult people

March 3rd, 2011 by – Sue Barton

[question]  One of the doctors here is rude to everyone and short tempered.  I can’t afford to quit my job.  What can I do? [question]

Difficult and rude people are found in many work environments.  Perhaps it is even more of a problem for nurses because we tend to work in settings where it takes a team of people working smoothly together to get the job done right.  Many times the work environment involves a high level of  stress inherent in taking care of people who are ill and frightened.

You can’t ultimately control how other people behave, although you can and should document and report behavior that is abusive or harmful.  You can decide how you will respond to rude behavior; the more professional and confident you are in your own role, the more likely that you can do your job with minimal disruption.  Avoid the temptation to respond in kind, but do set limits on how you allow others to treat you.   For example, you could respond by saying  something like,  “I expect courtesy from the people I work with here, and to be respected for the work I do.” You may also need to find someone either at work or outside of the situation with whom you can share and problem solve.

Posted in Doctor/Nurse Relationships, General

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Nursing courses online vs. clinical hours

March 2nd, 2011 by – Derek Brocklehurst

Can I do all my nursing classes online?

This is a good question. In an ideal world, you would be able to keep your full-time job and go back to school at the same time, completing all of your courses online. Realistically, you are not too far from reaching that goal.

Nowadays, there are many different nursing programs to choose from. Online degree programs offer a majority of the courses online. These courses would focus on the theory of nursing, basic nursing skills, maternal and childbearing health, pediatrics, medical and surgical, psychiatric, geriatric, and community health nursing. You will be able to watch online lectures or view powerpoint presentations, answer questions, submit homework online, and take an exam at the end of each course.

Clinical hours are needed for the latter 7 courses listed above. These hours must be completed in-person at an accredited local health care institution. You will be managing and assessing your own patients, under the supervision of an RN, and learning how to apply some of what you learned online in the clinical setting. Check out Medi-smart’s Online Nursing Schools directory for more links and information about online courses.

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Posted in General, Nursing School

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Nurses and doctors have fun while reminding you to wash your hands

March 2nd, 2011 by – Marijke Durning

We’ve heard it all before: Wash your hands. There are tricks to be sure you wash your hands long enough, such as singing the entirety of  “Happy Birthday” while washing. We know to be sure to  get in between our fingers and to remember to wash our wrists and thumbs.

We also know you’re supposed to wash your hands between patients, after you take off your gloves (yes, gloves aren’t 100 percent protective), after going to the bathroom and before touching food – and yet, handwashing audits show that many nurses and other health care personnel don’t wash their hands!

Here’s a bit of fun from a health care facility that got many employees and even a famous face (NHL hockey fans may recognize the famous dad) to participate in this video about washing hands.

The video is called Wash Your Hands.

Posted in Common Nursing Procedures

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How to recognize acute otitis media

March 1st, 2011 by – Sue Barton

  How can I tell when my child has an ear infection?

Acute otitis media, or middle ear infection,  is most common in the early childhood years because of the relatively short length and flat angle of the eustachian tube connection between the middle ear space and the posterior pharynx.  This predisposes infants and toddlers with sore throats and nasal congestion to develop fluid and secondary bacterial infection in the middle ear.  Diagnosis is made based on the examination of the typanic membrane, or ear drum, with an otoscope.  With infection, the ear drum changes from a transparent shiny membrane to a red bulging opaque appearance.

As a parent, you most likely can’t examine the ear drum, but a classic picture can give you reason to be concerned and to bring your child for evaluation.  Typically the infection comes later in the course of the illness, which often starts out as an ordinary cold.  Be suspicious if the congestion gets worse about the time you would be expecting the cold to be getting better (7-10 days).  The child with ear infection will be uncomfortable, sleep poorly  and may develop an eye discharge or a fever.

Some ear infections may resolve without antibiotics, but under age 2, antibiotics are generally recommended.  The drug of choice is amoxicillin in doses of 80-90mg/kg divided into 2 doses daily.  Acetaminophen or ibuprofen is used for discomfort.

Posted in General

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Troubleshooting stomach pains and cramps

March 1st, 2011 by – Derek Brocklehurst

Since Friday, I have had a stomach cramp that started off feeling like gas and it hits me in the afternoon even harder. I am feeling nausea and using the bathroom has become difficult and painful. Its a stomach ache that makes you hurt so bad you want to cry. Any guidance?

If you are having stomach cramps that are not relieved by Tums, Rolaids or other antacids, you should seek medical attention immediately. Monitor yourself for vomiting, nausea, pain and blood in your stools. It is also a good idea to monitor the consistency, color and frequency of your stools and to report the findings to your primary health care provider. This can help to give clues about the etiology of your symptoms.

You could have a variety of diseases, infections or ailments. Food poisoning typically brings about vomiting and severe diarrhea for the first 24 hours and then dissipates. Stomach flus or viruses will typically cause a fever anywhere from 99F to 104F. This is commonly accompanied by night sweats, stomach pains, nausea, diarrhea and possible sinus congestion. Parasites can be caught from unwashed hands touching food items or drinking unhygienic water. They can be a common cause of writhing stomach pains of unknown origin. Giardia, Flagella, worms and other parasites would need to be diagnosed by a stool specimen and blood draw at your health care provider’s office.

If you have questions about your symptoms, have a fever above 100 or have severe cramping and stomach pains, you should see your primary health care provider or your local urgent care center as soon as possible.

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Posted in General

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3 reasons nurses make medication mistakes

February 28th, 2011 by – Marijke Durning

In nursing school, one of the most important things nursing students are taught is how to prevent medication mistakes. Whenever you give a medication, you must have the:

- Right patient

- Right medication

- Right dose

- Right time

- Right route

And yet, medication errors still happen. How is that?

1- Misinterpretation of the doctor’s order or an incorrect order

Doctors’ orders can be difficult to understand. Part of a nurse’s role when transcribing orders is to ensure the orders are correct. If she has any concerns or questions about an order, it is vital that she question the order rather than assuming or guessing.  However, mistakes aren’t always done because an order is misunderstood – sometimes the doctor makes a mistake. This is why the nurse, again, must be very prudent. By knowing the different types of medications she has to give and looking up those she doesn’t know, errors should become apparent.

2- Incorrect transcription of medication order

While transcribing orders, the nurse shouldn’t be uninterrupted, leaving him or her to concentrate on the task at hand. Unfortunately, this doesn’t always happen and the nurse can become distracted and make an error in the transcription. Even when double checking, the nurse may not notice the mistake.

3- Break in the 5 Rights

Many nurses know that feeling – that feeling that hits as soon as they realize they’ve given the wrong medication to the wrong patient. The same happens when the nurse has picked up the wrong medication to give to the patient. Many errors happen when there’s a break in the 5 Rights, often due to inattention or distraction from other people while giving out medications.

These three reasons are preventable. We just have to remember to use the utmost attention when giving medications.

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Posted in On-the-Job Fears

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Nurses with disabilities

February 26th, 2011 by – Sue Barton

  I was born missing my right hand and arm just below the elbow.  I use a cosmetic prosthesis, but honestly there are very few things I can’t do with one hand.  Should this give me any reason to not pursue applying to nursing school?

People with a wide variety of disabilities have been able to successfully pursue careers in nursing, and you should be no exception.  You already know how to adapt to doing tasks with one hand, so you will  be able to adapt to the challenges of doing procedures that most nurses do with two hands.  Since you work with a prosthetist for your cosmetic device, you could look into prosthetic options that may give you the ability to grasp with your affected right arm when needed.   Alternatively, you may find that using your foreshortened arm without any prosthetic works best at times.  You of course are the best judge of your own abilities and capabilities.  Occupational therapists can help you access  adaptive equipment and problem solve specific challenges.

The National Organization of Nurses with Disabilities can help you with advocacy and resources.  Nurses with disabilities bring much to both their patient care and to their health care colleagues from their own experience and perspective.

Posted in General

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Correcting an error in a patient’s chart

February 25th, 2011 by – Derek Brocklehurst

If you make a mistake on charting what’s the proper way to correct it?

Charting, or documenting your nursing notes in a patient’s chart, is an important aspect to nursing care. Charting properly can prevent ethical, legal, and safety issues from arising. When learning how to chart, pay particular attention to the timing of procedures. You want to make sure the exact times are recorded for assessments, evaluations, blood draws and medication administrations. At any time, JCAHO, or the Joint Commission on Accreditation of Healthcare Organizations, can show up at your health care institution and scrutinize your work. Be prepared by organizing a clean and easy-to-follow chart!

If you make an error or mistake in a patient’s chart, do not use white-out or make multiple cross-outs to the error. The best way to correct an error is to make a single black line through the error, date and initial next to the line, and write in the correct information above or next to the line. Never throw out the piece of paper and start all over as that would indicate you were trying to hide something.

Make sure you check out Medi-Smart’s Do’s and Dont’s of Nursing Documentation directory for more information.

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Posted in On-the-Job Fears

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Nurses: It’s work your proper hours day!

February 25th, 2011 by – Marijke Durning

It’s February 25, 2011 and today is Work Your Proper Hours Day in the United Kingdom. Maybe with all the overtime nurses are expected to do here in North America, it’s time to introduce the day here, too.

In some parts of the United States and Canada, nurses are obliged to work overtime hours. It’s not easy to think of any other profession that would have such a requirement. Can you imagine a pilot being told she must fly an extra flight across the country despite the fact that she’s exhausted?

Nurses who are tired can  make more mistakes than ones who aren’t. More medication errors are possible, fatigue may make it so you aren’t as observant as you could be and you may not move as quickly:  all things that affect patient care.

Even if you’re not working 16 hours straight, how effective can you be if you get home from working from 4 p.m. to midnight and you get called early in the morning to come in for an 8 a.m.-to-4 p.m. shift?

It’s not an easy situation. The hospitals need to have nurses covering the floors. The patients need care. However, the nurses have to be in the physical and mental condition to be in those hospitals and to deliver that care safely. Just being there isn’t good enough.

So, what are nurses to do? Some are threatened with their jobs if they don’t work the overtime shifts. Other nurses are made to feel guilty if they don’t accept the overtime hours. And then others need to work them because they need the money: their regular pay or number of shifts aren’t adequate.

What is your solution? What do you think should be done to help ease the situation on nurses who have to work overtime?

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Posted in Work-Life Balance

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