1.04.2009

The continuing education of one RN supervisor

I spent a lot of time on the phone with MDs on my last overnight shift. Our usual house doctor wasn't on call, one of his associates was. The other nurses seemed surprised that he called me back so many times. The trick, they told me in school, was to be concise and have all of the relevant information at hand. I also keep the portable in my pocket if I'm away from the desk so I can pick up every time they call.

It was very educational for me, I'm lucky enough to work somewhere where I can preemptively write telephone orders for labs and treatments, and I'm starting to get the hang of which lab results the MD wants to see before he/she'll give orders for different situations. A lot of it's common sense, but getting to know the on-call MDs through routine interactions has been instructive. If one of my residents is passing blood in her stool, I can get that lab draw for a CBC and Pro Time -before- I call for orders. I actually write the telephone order for the labs first, then when they get faxed over I page the MD for orders so I only have to bug them once instead of twice.

I'm starting to see what a complex issue infection control is. We always have a few people on antibiotics, mostly vancomycin, keflex or flagyl (or some combination of those). When we detect a new infection, we send out a sample if we can, but in many cases there's no drainage to send out for a culture-and-sensitivity, and antibiotics are ordered empirically. Let's see what this one does! I find that concerning but it seems like standard fare. What if the organism is resistant? When we DO get a C&S back, what I usually see nurses doing is tell the MD that it is susceptible to a particular antibiotic we have in stock, even if it's not the therapeutic agent that the bacteria is MOST susceptible to, information that no one seems interested in.

Something new to me in this job that I never saw in the hospital was the use of probiotic supplement pills alongside antibiotic therapy. This makes sense to me, since lost of intestinal flora can be a big problem for elders taking antibiotics. Is this a new thing? How come I hadn't heard of this until I started working in a SNF? Culturelle or VST#3 are the probiotics I see most frequently. I haven't looked at any of the research regarding outcomes with their use with antibiotic therapy, that might be a fun weekend research project for me to undertake sometime.

I find myself laughing at work a lot. I like working with the younger LPNs (well, I say younger but they're older than I am). One of them was surprised when I told them that I love my job. They're the closest things I have to preceptors in this job, I should make sure they know how much I appreciate them.

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