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AnnieOaklyRN, BSN, RN, EMT-P 27,909 Views

Joined: Oct 24, '06; Posts: 2,180 (34% Liked) ; Likes: 2,663
RN, Paramedic from US ED, IV team, Paramedic serving 6 towns

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  • Mar 18

    Speaking as someone who does medical malpractice claims for a living, I endorse these comments. I would also point out that the malpractice insurer, your employer, or the state medical or nursing associations may offer what we call 'second victim' support activities, ranging from speaking with a therapist or peer, to group support meetings. I have run many of these activities, and they can be very helpful.

  • Mar 17

    I can't say I "regret" getting my NP, but I definitely would not have pursued the degree if I had been able to foresee the future. I was working as pediatric nurse and loved it and worked with a PA and a PNP who both encouraged me to go for my NP. The thought of having more autonomy was appealing, as was the increase in pay (or so I thought). Fast forward to when I finished my two year PNP program. My RN colleagues who were working in the hospitals were earning significanty more than the NP positions I was looking at. I ended up working as a PNP and a Nurse Manager at the same time so I was seeing patients and acting as Nurse Manager. As stressful as it sounds, it was actually an enjoyable time. I earned only slightly more than if I had been working as a RN. A few years later I had my first child and decided to stay home. I maintained my NP license thinking I would go back as a NP but in the end found more appealing work as a RN. So I ended up "using" my degree for all of 4 years. My pediatric knowledge definitely helps me in my current job (I am a school nurse) but I always have to take a step back and remind myself that as a RN I cannot diagnose so while I will know what a student most likely has, I can only recommend that the child be seen by a provider to "properly" diagnose which is frustrating. If I had known that I would only be using my NP license for 4 years I would not have pursued it, and I have no desire to go back as a NP now since I love my job as a school nurse.

  • Mar 9

    Eyes fused ,no resp effort after 10 min ?The nuero sequelae would have been devastating.It is so hard to determine age cause it could be 24 weeks iugr or 23 weeks lga or sga, you did fine ,stop beating yourself over it .Good work.

  • Mar 9

    "I don't really want this job but I need money so please hire me"

  • Feb 24

    Not the be rude, but your English is horrible:
    "I got my rn license in August of 2017. It is not February 2018 and I still having been able to secure a job. I have associate of science and currently in schoo doing the bsn.I live in south Florida. Why is it so hard to get a job? I'm not even getting interviews. What can I do to increase my chances of getting a job? I thought there was a shortage of nurses."

    Once you clean up your English, you should be able to secure a job. Maybe...

  • Feb 24

    Transfer of care from EMS. This has always been a shortcoming in the ED and has huge barriers to improvement, but also could greatly improve patient care.

  • Feb 24

    It may sound heartless, but nature knows. You saved that baby's life in a different way - from a longer life of suffering and eventual death.

  • Feb 22

    Here's a link to the best Children's hospitals--grrr, the link isn't working.

    Access Denied

    Can I just say that my state (Ohio), has FIVE hospitals in the top 50 NICUs in the country!! Obviously, living in the semi-cold winter conditions isn't for everyone, but we have 4 seasons, excellent metro-parks, are a union state, and have a really good cost of living to earned wage ratio. In addition, we have some of the best libraries in the country, plenty of good restaurants, symphonies/operas/plays/concerts in all our major cities, and some really darn good zoos. Columbus is getting more and more direct fly routes every day. We're also a pretty quick drive or plane ride form Chicago with all the perks of a MAJOR metropolis there.

    In the end, there's plenty of great places to choose from, but I just wanted to put that out there. Best of luck in finding a place you love to live!

  • Feb 21

    Please stop second guessing yourself. If it had been a witnessed birth maybe. But the fact that there is no way of knowing what the down time was before you arrived makes it most likely that this was not going to have a good outcome. You did everything you could and I'm sure the family is grateful for your help.

  • Feb 20

    There is nothing more you could have done. Even if you had the skills to intubate with a 2.0 tube and a 00 blade and a fully equipped Neonatal transport ambulance (Baby Buggy) with a heated isolette, at 526g born in the toilet, it would have very little chance of survival. It was probably in the 22-23 week gestation. At that age, even born at a hospital with a NICU team (docs, nurses, RT) ready to intubate at delivery and directly admitted to a Level IV NICU, there is a very slim chance of survival. I have not seen a baby born less than 580-600g survive longer than a week that were born in the ideal setting (adult hospital attached to a Level IV NICU).

  • Feb 19

    The edge of viability is hard enough in the hospital setting; bless you for confronting it in the field. Please be kind to yourself.

    The combination of the birth history, delay of treatment, iffy gestational age (sounds like *maybe* 23-24 weeks based on weight and fused eyelids) no heart tones or response after 10 minutes of CPR... This would not have been a good outcome no matter what. Even if resuscitation measures were to achieve some sort of stability long enough to achieve transfer to a level III/IV facility (sounds highly unlikely), there would probably be discussions of withdrawal of support due to overwhelming neurologic devastation or sepsis. Or, down the road, NEC as a result of gut ischemia from being "down" so long.

    It sounds to me like you handled a terrible situation in a way that gave dignity to both mom and baby. Thank you for the work that you do. <3

  • Feb 17

    You've gotten a lot of good information here. Don't spend much more time second-guessing. Next time you'll know what a seizure looks like and you'll react with more confidence.

  • Feb 4

    Quote from Matt8700
    How do you maybe a provider that is either unwilling to treat a patients pain or is under treating a patients pain.

    Example: patient waits 8 hours in the lobby to be seen. Provider orders Motrin for the patients chronic hip pain. I know the condition is chronic but the patient appears to be very uncomfortable. Provider is approached and is unwilling to listen to or collaborate with nurse. Patient leaves unhappy.

    Example: patient c/o headache. Given toradol and is ineffective. Discharge. Again provider unwilling to listen to nurse.

    Example: patient fell, negative xr of knee. Given Motrin after waiting 10 hours to be seen. Patient appears uncomfortable but provider not willing to discuss pain management plan.

    These instances are all involving the same provider. But how do you all speak to a provider when they don't want your input. This particular person hates when nurses approach and will not listen. At times the nurse is made to look bad because the provider is not willing to listen to our assessment of the patient. How do you all handle?
    #1: The AMA recommendation is to treat chronic pain with NSAIDs not narcotics. As a provider myself, there is nothing that I can justify prescribing for the patient's chronic pain that he/she doesn't already take at home. And if they take it at home, they can take it at home. If the patient is in continued pain, he should see the MD that prescribes the medication. That is the contract patients sign when they are in pain management. As a provider, I'm also looking at the state-wide pharmacy database to see what the patient has already had filled. I'm not necessarily going to share that info with other staff member either.

    #2: Again, narcotics / opioids are not indicated for a headache. Period. If I prescribe morphine or dilaudid, I'm almost guaranteeing a rebound headache.

    #3: I'd give motrin or maybe even an Ultram and send this pt home with a script for naproxen and a referral to ortho.

    I think we have created a society that feels like we should always be 100% pain free and providers should throw whatever medications at patients to facilitate that. This is partially why we have such an opioid crisis.
    As a provider, I don't have to justify my orders to anyone but the patient and my boss. I realize that sounds very anti-nurse. While I do appreciate what nurses bring to the patient care equation, I would get very tired of being questioned about every little thing I order. Don't be that nurse.

    If you are having an issue with that one provider, I'd talk to him or her about how to best communicate patient needs and your concerns. I would also encourage you to chart and document objectively. Keep it to the facts and your patient's response. You can always chart, "MD made aware of patient's pain assessment. Awaiting further orders."

  • Jan 29

    I think new grads make around $25/hour here...but I don't know for certain. Most hospitals pay more for BSN. Nurses working in the "big 3" (Cincinnati, Columbus, or Cleveland) make significantly more than nurses in small towns. For that reason, a lot of us live in rings around the cities and commute in. Best of both worlds--the cost of living of a small town + the pay of the big city. You just have to be ok with a 30-40 mile commute. Also, any of the big cities have great parks, fantastic libraries, lots of sport options, great restaurants, good zoos, etc. I love it here!

  • Jan 29

    I've done it several times in my long career -- but not lately. I don't regret it because I got to see several different parts of the country and saw the different cultures in each region. It also helped me to advance in my career.

    However, it can be lonely -- and you have to use your vacation time (and budget) to see your family, which means there is less vacation time available for "fun stuff." To be happy and succeed you either have to be the type of person who makes friends easily -- or be the type of person who doesn't need a lot of social interaction in your life. The best situation is to be a bit of both types.

    And you have to be somewhat strong and independent -- able to take care of yourself -- and not need someone to hold your hand during all of life's challenges. Moving somewhere close to some relatives or friends helps with that, though. Two of my moves were to places where I already knew some people and that helped a lot. For a couple of moves, I didn't know a single person in that region -- and that was more difficult and required more strength.