Cathy Jones

*Telephone triage-assessing symptoms when patients call in, directing them to the ER, scheduling appt if necessary with provider, or for an EKG, and recommending their next steps, or talking to a provider and calling back with their recommendations.

*Medication refills-patients call in and ask for refills, leave messages on the refill line letting us know they need refills, or we receive faxes for refills. Following standing orders, refill as appropriate based on criteria for each medication, whether it be they need an appt based on last visit note, or an annual visit, labs, chest x-rays, pulmonary function tests, and EKGs. If any of these are needed, orders placed and patients notified of need and that only a bridge for 90 days has been filled.

*Tilt test-explain procedure, apply EKG leads from crash cart monitor to patient, BP cuff on arm and finger, start IV, take vitals every 5 minutes, or as appropriate as test progresses and/or at provider's direction, run 6 second strip from monitor for provider's review when interpreting test results, and monitoring patient for symptoms as the test progresses. Recover patient before discharging home.

*Dobutamine stress echo-start IV, titrate dobutamine as test progresses according to weight, push epinephrine if needed for maximum heart rate for age, then pushing metoprolol to slow it down once dobutamine is stopped, if heart rate is not decreasing as it should quickly enough for patient to feel the effects of the dobutamine wearing off. Recover patient before discharge home.

*Cath packets-Once a provider decides a patient needs a procedure that will be done in the cath lab, such as, a cardioversion, a heart cath, a TEE cardioversion, a loop recorder implant or explant, or a pacemaker implantation, or generator change, instructions are given. Per provider discretions, instructed on which medications to disconitnue, and for duration, NPO duration and time, what the procedure entails, approximately how long it will take, including prep time and recovery, going over their medications and allergies, and date and time of arrival are all gone over with the patient and patient signs understanding. It takes coordination with cath lab, scheduling, anesthesia, and sometimes, echo. These packets are put together by nursing, as well.

*Nurse Visits-Patients are scheduled to come back to see a nurse for a follow up on their BP to assess whether, or not, their medication needs further titration. Vitals are taken each nurse visit, last office visit charting is consulted and used for documenting nurse visit. If nurse visit is for an EKG, it must be shown to provider before patient can be discharged and if BP is not within range according to last visit note, provider must be consulted. Follow up for wound assessment after pacemaker placement or loop recorder implant/explant procedures are also done in nurse visits to assess healing, wound apporoximation, any drainage, or signs and symptoms of infection.

*Echo assists-IV starts for echo procedures, such as contrast and bubble study echos are needed.

*Direct admits-Patients are directly admitted from the clinic, sometimes. An IV must be started, house supervisor must be called for a room assignment, SBAR filled out for calling report to receiving unit, and transporting patient on monitor for heart rate and rhythm with a second nurse to room after faxing SBAR and calling report.

*Patient assessment-Patients will come to check in desk in distress and nursing will be called to go assess them. They may be determined to see provider, a rapid response called, or we may take them to the ER, depending on our assessment of their symptoms, history, and what they can tell us has been going on.

*Task box-Providers send tasks for us to call patient with lab and/or test results, to check on their health status, to let them know of a new medication that's been ordered or a dosing change, to let them know of a test that's needed, or a referral that's been placed. Medication refills also come in through the task box, as well, as medical records from HIMS to let us know to alert providers of labs, or recent records they've requested.

*Order entry-place orders from our providers, from providers our patients see in other cities that can have testing done here and results faxed to them, referral orders from our providers, requests from patients that we refer them to a specific provider for a second opinion.

*Rooming patients-called patients back, took their vitals, confirmed their medication list was correct in the computer, asked why we were seeing them at that appt, let the provider know they were ready

*Task box-called patients with test results, let them know if medications, or doses, were changed, anything the provider wanted us to let them know

*Medication refills-Providers would order medications to be continued for one year at visit and give nursing order to send them to pharmacy

*Injections-Immunizations were given at this clinic. Medication was drawn us using sterile technique. Area for injection swabbed with alcohol, allowed to dry, injection given, and patient monitored as appropriate for signs and symptoms of adverse reaction. Education information would be given to patient to continue monitoring.

*Ear lavage-Saline would be used to wash out ear wax that was lodged in patient's ears. Patients would be monitored for dizziness and unsteadiness once wax was removed.

*Order entry-Orders entered as given per provider or using standing orders for medication refills

*Phone triage-Patients assessed for symptoms that would need follow up with a provider sooner than their appt, or if they needed medication changes.

*Charge Nurse-Assigned patients to nurses each shift, assisted nurses with their patients as needed with position changes, medication witnessing, and received baby at delivery. Coordinated OR when needed in emergency situation, assigned first assistant to case when only one scrub tech available, called day shift to furlough when low census, and furloughed on night shift as census allowed. Continuously watched fetal heart monitor for all patients in the unit and directed nurse to respond, or helped in situations when needed.

*Labored women-watched monitor for fetal heart tracing in relation to contraction pattern, assessed strength of contractions, performed sterile vag exams and determined dilation and effacement of cervix, if membranes had ruptured spontaneously, if delivery was imminent, and baby was vertex. Started IV and drew blood for required labs, assisted with epidural placement watching vitals and keeping patient focused and calm. Placed foley catheter using sterile technique after epidural was effective. If induction, started pitocin and maintained titration per protocol, then increased it after delivery to help control bleeding. Performed fundal massage per protocol until patient was transferred to post partum unit.

*Baby nurse-received babies at delivery drying them and warming them under the warmer, obtaining vitals, weighing and measuring them, giving them vitamin K injection, swaddling them, or placing skin to skin with mother, if desired, assisted with breast feeding when needed

*C section-when patient needed to go to OR and was not emergent, prepped in room by shaving lower abdomen, making sure IV was patient, cleaning abdomen up to umbilicus with chlorhexadine, put on hat and booties, made sure gown had plastic snaps. In OR, keeping patient calm and focused while spinal was placed, laying her down immediately after with a blanket under left hip, then placing foley catheter using sterile technique, using surgical scrub from below breasts to upper thighs and allowing drying time, placing grounding pad on leg. Running for anything needed during surgery. Then, assisting with transfer to cart for recovery and performing fundal massages for 2 hours after delivery. Transferring to post partum, giving full report to receiving nurse.

*Triage nurse-patients might come in any time thinking their water broke, or they were in labor due to contractions. Would monitor contraction pattern and assess cervical change to determine if they were, in fact, in labor. Would use litmus paper. watching for it to change from yellow to blue to signify confirmation of SROM, if not overtly evident. Patients would be admitted if in cervix changing, or SROM, but sent home if not. Phone triage, as well, where patients might call asking if they should come in, and based on their description of what was happening, how they were breathing if contracting, their gestation, and history, we would determine if they should come in.

*Charge nurse-Assigned patients to staff according to acuity and experience, helped with patients where needed, took a team of my own if short staffed, placed orders as needed, worked as ward clerk, admitting patients on night shift, creating charts and placing orders, assisted with turning patients and toileting as needed, furloughed day shift, or called for extra staff depending on census.

*Staff RN-Assessed patients head to toe, focusing on surgical incisions, or breaks, if pre-op. Patient may need traction set up if just admitted with a fracture, would need cap refill monitored, as well as, movement of toes or fingers, swelling, and feeling. If post op, the same, but also drainage, if a drain, measuring output from it, but also, watching drainage on dressing from incision, how often dressing needed changed. Most needed intake and output measured, assistance with ambulation devices. IV starts, foley catheter placement, neuro checks depending on admission for accidents or cervical spine surgery, or lumbar surgery. Some had halos for cervical fractures that needed extra care in learning to balance and move with it.

Preceptor-worked with new RNs, teaching them what to do and watch as they began their career on Ortho, learning sterile dressing changes, wound debridement, traction set up, trapeze set up, communication with providers, patients, and their families.