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dream'n, BSN, RN 12,243 Views

Joined: Aug 28, '06; Posts: 979 (58% Liked) ; Likes: 2,806

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  • Feb 21

    Do you mean that you are interested in becoming a STAT or resource nurse? That is who responds to rapid response (or ERT--emergency response team) call at my facility. These nurses are expected to be experts at critical care and patient triage. They also have to be skilled at communication, as sometimes various people involved have differing opinions on what exactly is going on, and how critical the situation is. Generally nurses have at least 3 years of critical care experience prior to joining the STAT team.

  • Feb 21

    Use of a doppler is not mentioned in ACLS or BLS algorithms for what it's worth.... AHA teaches that if you cannot definitely *Palpate* a pulse within 10 seconds, start CPR. A carotid pulse weak enough to necessitate doppler is probably not providing adequate circulation to vital organs.

    I've used a doppler before (with a manual b/p cuff) to get a b/p reading on a patient who was circling the drain. SBP was 60, DBP was unreadable (even with doppler). She was quickly transferred to ICU.

  • Feb 21

    Next up is BMI/blood glucose and cholesterol readings. Are we willing to sacrifice our protected health information to get a job? I am of normal weight, no health flags. But what is next???

  • Feb 21

    That sounds absolutely ridiculous. Will it be the RT having to call the doctor all night about O2 changes, since that department came up with the policy? I am guessing not... I am guessing, somehow, that all of that responsibility will fall on the RN.

    And seriously... like you say... O2 requirements can change hour to hour, even minute to minute for some of these kids!! Whoever came up with that policy has obviously never worked a night shift with pediatric respiratory patients. The order at my last place of employment was, titrate O2 to keep sats>90%, sometimes "up to [4L/8L/50% etc]." then notify the MD if higher concentration of O2 was needed. But it sounds like they want you to call every single time a patient falls asleep and desats, or needs extra O2 after trach suctioning, or has a rough CF night, or anything. I hope that policy does not last long for you all because that's absolutely ridiculous. Good luck.

  • Feb 15

    Quote from OsceanSN2019
    I did not know about the insulin needle thing. My classmates acted as if I was stupid to give heparin in a insulin needle. Also the charge nurse did scan the patients bracelet and the label on the package before she administered it at least.Plus, when she scanned the medication label she did have to click "ok" on the box that kept poping up on the screen after every scan, so I guess that also helps.
    So she *did* read the labels. This makes more sense now.

    She saw the drug and dose on the MAR. She saw them again on the label when she grabbed the vial of heparin. In real world nursing, the check doesn't necessarily involve holding the vial up to the computer screen, or something super obvious like that. Then she saw the patient's name on the MAR. And again when she scanned the wristband. And she saw everything yet again when the computer prompted her to click "OK" with each medication. Sounds like at least 3 checks to me.

  • Feb 15

    Quote from OsceanSN2019
    I was not teaching anything to the charge nurse as I was just shadowing her. Plus, I did all what she wanted me to do. And you are very rude. I guess the saying is true that nurses do eat their young...
    Good gravy. Just STOP.

  • Feb 15

    You are there to learn, not to teach. Focus on improving your own practice, not picking apart what actual nurses are doing. There's nothing worse than a know it all student.

  • Feb 11

    Quote from dimari
    You did the right thing but her behavior makes me think that maybe your co-worker is the addict and has been stealing the patient's morphine for herself (I've witnessed this in previous hospital jobs I've held). She might be furious that the PCA won't require her to get narcs every 1-2 hrs. Just a thought.
    That didn't even occur to me but sounds totally plausible given her strong negative reaction to the PCA order. Things that make you go hmmm....

  • Feb 11

    Stop working for this nurse on your day off.

  • Feb 11

    I would have done the same thing.

  • Feb 11

    I loved playing music at the bedside in the ICU whenever possible. I would ask families what the patient liked to listen to, and for bath time I would find a station on my Amazon Music app on my phone that coincided with the patient's preferences and play that. I cared for extremely high acuity patients in the ICU, and my brain works well when combining music with my detail oriented work. Our tvs also had a relaxation station that played classical and relaxing music along with nice scenery and I played it for my patients most of the time. If I were the patient, I would much prefer to hear music rather than all of the beeps and alarms in the ICU.

  • Feb 6

    Quote from Susie2310
    I don't agree with this idea at all. It's too bad that some nurses and physicians are disgruntled. Health care IS a service business. Nurses, by virtue of our scope of practice, and code of ethics, are PATIENT advocates. I don't see any questions on the HCAHPS survey that are unreasonable, unless we want to go back to the bad old days (I have been an RN for over 20 years) when patients (and family members) had a much lesser voice in how they are treated by health care professionals and the health care system. When my family member received an HCHAPS survey they were happy to provide feedback on the survey, and also to the hospital administrator who called them and asked them about the quality of the care they had received (the facility was having problems with the quality of patient care). We were thrilled on a separate occasion when an administrator called into my family member's room to ask them about the quality of care they were receiving; administration was listening to patients experiences and taking actions to improve patients experiences, and we saw concrete evidence of this.

    In addition, let's not forget that the patients and family members, along with their insurance companies (usually) are paying the bill, and that health care professionals jobs are dependent on patients seeking health care at the facilities they work at.

    Are some people objecting to the expansion of Medicaid in some states? The fact that poorer people in some states can more easily receive health care now? This demographic, which has found it difficult to access health care for years have medical problems that have gone untreated/undertreated for prolonged periods. KatieMI, you frequently post about the unreasonableness of patients and family members; perhaps you should consider another career where you don't deal with the public. The ACA has been a boon for patients and family members in my opinion. The authoritarian model of healthcare is obsolete, and should be.

    My personal experience, and that of my family, with the facilities we receive health care in, is that patients and family members are accorded more respect since the ACA; it is certainly not a panacea however. As the John Hopkins study suggested, medical errors are the third leading cause of death in the US. Patients and their family members can and do play a big part in helping to prevent medical errors if/when they are listened to, and the ACA has assisted them in being listened to.

    My opinion on the attitude of the nursing staff when my family member/s are hospitalized is this: Since the ACA I find some nurses more polite and pleasant, and more ready to listen to patients/family members concerns. This is by no means universal; some nurses are very rude; fail to introduce themselves when they enter the patient's room to provide care for the first time, provide care with their name badges turned backwards, and ignore patient concerns brought by patients/family members. I would never leave a family member alone in the hospital, as quite simply, too many medical/nursing mistakes happen and too many patient problems are not recognized or are ignored.
    I am pretty sure that neither you, nor any of your family members come to hospital to show a whole list of orders written on paper with melodramatic demand that "that's what I WANT to be done for me right away" (the list in question had, among other things, dilaudid 2 mg Q2h IVP scheduled, Ativan 1 mg IVP Q3h scheduled, scheduled penergan IV, 2 pills of Norco 10 Q4h PRN and some other good stuff enough to kill a mammoth, together with regular diet for A1C >12 and Cr. 2+ and being wheeled around the unit in wheelchair when he felt like it. After the guy happily signed out AMA, I kept it as a souvenir).

    I am talking about that kind of patients, not just concerned relatives and people who have normal, reasonable expectations and questions. And I am speaking not about rude nurses and uncaring providers - I am speaking about ones who do not follow a patient's every whim about medically and socially inappropriate interventions because, well, hospital is a service industry but yet it is not Disneyland.

  • Feb 5

    Quote from KatieMI
    These observations prompted me to ask a silly question: can "customer service" paradigm actually attact chronically sick patients with significant knowledge about the system in hospitals and therefore negatively affect their health on the long run? And, as an opposite, can lack of "customer service" promt these patients to finally take better care of themselves and therefore provide significant benefits for them?

    I would be thankful for others' observations and ideas about this topic. "Customer service" is pushed down the throats of all health care providers nowadays, but I never saw any research showing its benefits or lack of them in terms of long-term disease process.
    The "Customer Service" paradigm does seem to negatively impact patients' health. Whether it's the patient wanting gourmet food and hot and cold running opiates or the family screaming about drinks for the whole clan, blankets for everyone and oh, yeah can you find out how to get the Super Bowl on this crappy TV? -- customer service seems to be bad for health. As long as folks can run to the hospital and get whatever they want, there seems to be no incentive to take care of themselves. And nurses actually give them things that are contraindicated for their condition, just to keep them happy. It's nuts!

  • Feb 5

    Quote from Davey Do
    Again, interesting, Katie!

    So, in essence you're asking "Is the customer service we are expected to provide enabling our patients to continue with their self-destructive lifestyle whereas if we allow the patient to have to deal with the ramifications of their actions/inactions they are motivated to behave therapeutically?"

    My answer is "yes". For many of us, we only have illuminating revelations through having to deal with those conscious changing trials and tribulations that are often self inflicted.

    Karma can be a bi-otch, but it can also be an opportunity for learning and growth.
    I made a solemn promice to myself and my husband to stop my formal education after MSN. But right now my hands are itching about making a small scale research project about this observation. I was suspecting for a long time that "customer service" must not be good for people's health but I had no evidence to prove of disprove it. The fact that "patient can be satisfied one moment and go to body bag next" is just a common sense, not a hard schience, and that some of hospitals which proposed "customer experience" as their prime and main gig, like University of Toledo/Ohio Medical Center, have otherwise awful indicators of morbidity, readmissions and mortality has way too many cofounders to make any reasonable conclusions.

  • Feb 5

    Quote from KatieMI
    These observations prompted me to ask a silly question: can "customer service" paradigm actually attract chronically sick patients with significant knowledge about the system in hospitals and therefore negatively affect their health on the long run? And, as an opposite, can lack of "customer service" prompt these patients to finally take better care of themselves and therefore provide significant benefits for them?
    Again, interesting, Katie!

    So, in essence you're asking "Is the customer service we are expected to provide enabling our patients to continue with their self-destructive lifestyle whereas if we allow the patient to have to deal with the ramifications of their actions/inactions they are motivated to behave therapeutically?"

    My answer is "yes". For many of us, we only have illuminating revelations through having to deal with those conscious changing trials and tribulations that are often self inflicted.

    Karma can be a bi-otch, but it can also be an opportunity for learning and growth.


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