LovingLife123, RN 2,795 Views
Joined Dec 20, '16.
Posts: 466 (73% Liked)
For an emergent transfer of course we call 911. This does not require a Dr's order.
To get a CT scan to head when pt is otherwise stable, that requires a drs order. Now some Dr will give nurses room to make those judgment calls, but some Dr's will refuse to order a CT to the head after the fall unless pt is on coumadin, eliquis, xarelto, lovenox, heparin, etc. I've seen Dr order CT's after a fall to be done days later, as well.
If i had just sent the pt w/o a physician order, and lets say pt sustained injury during transport or in ER, then i would have been liable for that. I'm sure the Dr would have thrown me under bus (as Dr is trying to do now, throw me under bus for NOT sending him out w/o order, bcuz HE decided to turn off his pager all night).
I want to emphasize this pt had a primary RN doing neurochecks all night and was reported to be stable, no change in hematoma, no change in condition, no report of pain. How can i order a 911 EMS transfer for a stable pt? And again, getting a CT to the head require a MD order. I could have just assumed MD would be okay with that (and that was probable), but its also *possible* he wouldn't be, and there is always a small risk with anything, even pt transfer to ER. I've seen pts get injured during transport as well.
If i had the legal authority to order diagnostic tests and transfers i would have of course ordered this pt to get a CT then. I do not have that ability, I am a nurse not a MD, and the pt was not unstable requiring 911 EMS call.
The only thing i could have done differently was call the medical director. In hindsight i should have done that. But again, the pt was stable, as per report from the primary RN who was the one actually assessing and monitoring this pt.
Why do you want to switch careers? And why nursing? These are two important questions.
What is the new grad market in your are? What are hospitals hiring? ASN or BSN nurses? How is your physical health? Do you think you can do night shift?
Lots of questions you need to think about.
Do you need an order from the physician to send to the ER? While not every fall can be sent to the ER, a fall and hit to the head should be. Was this patient on any blood thinners? Most elderly are.
The patient may have look fine on Neuro assessments but that doesn't mean there isn't a slow bleed in there.
All head injuries in the elderly should get checked. I would contact my malpractice insurance.
You just fill until the vacutainer stops filling. Some only need 1mL or 2, others need more. Are you putting more in?
I'm sorry I don't feel comfortable stating the country where I'm currently working. Reading your responses, I just realized that we don't have respiratory therapists in our hospital. And, I just did some googling and, RT doesn't even have it's own pie on the chart of therapist workforce percentages. And, the existing education program is more like a continuing education seminar (for nurses, OTs, PTs, and medical engineers) compared to the four year Bachelor's in my country of origin.
Most of the patient's we have aren't fully alert but we do have a lot of instances were we have to do nasotracheal suctioning of an awake, conscious, and coherent patient. If we don't reach deep enough, we can't remove the significant amount of secretions that will lead to death. Most of our patient's are frail elderly people. I guess I can say that they have poor coughing mechanisms.
Personally when I was first blamed for a patient desaturating because I didn't suction enough, I was like WTF. "Did I apparently slept sometime during nursing school and missed something very vital on suctioning?" Back then I never new nasotracheal suctioning existed and that it is what our patient's needed.
Just be prepared to be told that a patient wants another nurse. As someone who has spent time in a pregnancy forum a little over a year ago, there are many, many women who will not even go to a male OB these days. There are many who don't care, but I personally noticed a trend that they want women caring for them.
We as nurses don't see an issue with it as we all know once you've seen one, you've seen them all. But the general public for the most part doesn't feel this way. It was an eye opening experience for me at least to see how little pregnant women value medicine. They are very odd and particular about their "birth experience". They all think they know more than the nurses and doctors. They want women treating them with no medical interventions. Epidurals are the devil and cause nothing but problems for the rest of your life. Being induced? Umm no. The baby will come when it's ready even if it's 45 weeks and pitocin is a guaranteed csection and then it's deemed a traumatic birth if you have to have the dreaded csection. Then, it's all about the breastfeeding "experience" and formula will most certainly make your child fat and dumb with no immune system.
The particular birth club had 23,000 members so I got a decent idea of how people think. The debate of male vs. female OBs came up more than once. And don't even get me started on vaccines, antibiotics, testing for gestational diabetes, and cervical checks. Don't you know you have the right to decline cervical checks? They do nothing but send you into premature labor and if your OB/midwife is doing them, they are idiots. And why on earth are nurses doing cervical checks while they are in labor? Nurses are not qualified to do those and again there is no need for a cervical check!!
OP, I think you should go for OB if that's where you want to be. Just be prepared for patients to ask for a female nurse every so often.
I would need to know why you NT suctioning an alert patient? It is horribly uncomfortable and painful for that patient. I've only ever seen it done on an alert patient one time and it was a very last resort and it was left up to the RT. I was not attempting it.
This article shows me that nurses do not understand addiction either by most of these comments. It's not the simple, oh it started with a pain medicine prescription for a toothache. The problem of addiction is much deeper. By placing the problem squarely on the pills, it's leading to much bigger problems.
Everybody thinks, lets just stop prescribing. Hold the doctors responsible for this mess. No, that's not the answer. The addicts simply then turn to the street and start up on Heroin. I saw this happen to a community I used to live in. Our government patted themselves on the back for shutting down three doctors. The Heroin epidemic is now in full swing. Needle exchange stations have popped up. HIV is on the rise...... because nobody wants to take the actual time to understand and try to fix addiction.
Meanwhile those with chronic pain are ostracized. Cancer is not the only painful condition out there.
I strongly encourage nurses to attend an NA meeting. I did years ago and it opened my eyes. These people have problems that started way before taking a Percocet. Most were addicted cited to something else, the percocets were just cheaper. Their addictions often weren't any type of drugs, nonetheless they were an addiction. Pills were easier and cheaper.
We need to fix why these people don't find everyday life satisfying. I feel that is a societal issue as well as the message is given everywhere that our lives have to be fulfilling and meaningful. People compare their lives to what they see from their friends on social media. They get depressed when they think they don't have as much or don't have the perfect life that all their coworkers and former classmates have. There's too much to put into words on here. But you can see where I'm going.
We are not the pill pushers. The doctors did not create this. Acute care is not the place to fix this. I'm not treating the pain I see on my unit with an ibuprofen. And while I explain to each patient that their pain will not fully be gone even with narcotics, I do my best to get it under control.
I'm tired of the evening news doing shows on it every night. Those people understand the least and the pendulum is getting ready to fly in the wrong direction 100% with people who are in horrible pain getting a Tylenol and ibuprofen which is laughable, to say the least. I've never had a Tylenol do anything for pain. It helps with fever. Too many ibuprofen will destroy your stomach.
Let's actually deal with the problem. It's going to take a lot of money and work, but let's actually get the government and mental health professionals to deal and fix the problem.
I'm not going to at my level, nor do I want to. I don't have the resources nor do I have the time at the acute care level to do it. I'm treating their pain by the number I'm told.
We cannot give medical advice on here.
But it begs me to wonder, why has our society gotten to the point where we no longer trust medical professionals and refuse life saving medications. I especially see this with pregnant women.
You are paying this person thousands of dollars and trust them to get you and baby through delivery safely. That's why you hired them.
I just shake my head anymore. We in the medical field are so disrespected anymore and 80% of the problem is doctor google and mommy blogs. Where any mom or man living in his mom's basement gets to dispense inaccurate medical advice and for some reason the world takes it as gospel.
Why did you get a nursing degree to start with?
This wasn't written for the general public.
He is uninformed about Magnet; his point was that there's something supposedly "status"-worthy about their nursing environment that they broadcast at the same time that so many endeavors do not support nursing. Call it an award for nursing support or culture or retention or whatEVER you want to call it; nurses are struggling in many of these places. Mired down by protocols, policies, cultures of writing up and reporting every little thing, autonomy redacted wherever possible, the "culture of change" which means "get used to the rug being pulled out from under you weekly as we come up with new ways to have you do more with less...."
This whole topic is about the problem of placing value on making something look (or sound) like something good, as opposed to placing value on (and doing) the good thing.
He could've been more to the point (or written something a little more cohesive) but I disagree that this was meant to be some sort of assault on bedside nurses.
You don't look at their parts as sexual, you look st them as anatomical.
I call horsepucky on this. First of all, since when is magnet status prestigious to the public? Ask 50 members of your community what magnet status means, not one can tell you. And this doctor is extremely misinformed himself on what it is. It's not excellence in nursing care, it's RN retention which should ultimately lead to better patient outcomes. That is all.
Second, who on earth can as a nurse honestly sit there and stand the alarms going off for 45 minutes and two hours? God, I can't deal with longer than 30 seconds on those bed alarms, but 45 minutes? Come on. Two hours for a blood pressure alarm? No way. If I'm at the nurses station, I will look at what room is beeping. If I know it's a false reading, I can maybe take 3 minutes tops. But two hours? Not even the laziest of nurses can go that long.
I think this doctor is relying on exaggerated family reports. He did not witness any of this or he would have been out there quickly flashing his doctor credentials. Because if all these nurses did was follow policies as he states, they would have most certainly known that alarms are to be answered immediately.
His story makes no sense. Either they were policy following robots or the biggest moron nurses in the face of the earth.
Maybe I should call him out on it.
I read it and you are still wrong. Attending wanted versed. Not propofol. Resident got the prop ready. As an icu nurse, I would have been upset getting that whole mess dumped in my lap expecting me too go off your report. I would have called the attending or resident to get orders. I'm sure they would have went off knowing you hung propofol while versed was wanted. What thecattebding wants trumps any resident.
It doesn't matter that you had 3 other patients. Clarification on current orders needed to bectahen care of. Especially since you got conflicting orders.
I know when you have a patient that needs sedated at that moment, it's a pain, but you had different things thrown at you and you took what was easy and right in front of you.
Anytime you put Levo on a patient, it's not a good thing. I will say you fentanyl needed to be started before propofol. Treat pain before sedation.
And, I could understand if that patient was going to be under care for another hour or so. But you left the ER and dropped this whole mess on the icu with no orders or clarification of orders and wanted to wipe your hands clean of it.
When you realized there was no order did you call the MD to get an order put in? Or could you put it in as a verbal? Yes, you were wrong if you just hung it with no attempt to get an order or put on in. How was the next shift to know that you had a verbal?
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