Latest Comments by AnnieOaklyRN

AnnieOaklyRN, BSN, RN, EMT-P 27,078 Views

Joined Oct 24, '06. AnnieOaklyRN is a RN, Paramedic. She has 'RN 11 years, Paramedic 14 years (EMS 20 years)' year(s) of experience and specializes in 'ED, IV team, Paramedic serving 6 towns'. Posts: 2,137 (34% Liked) Likes: 2,561

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  • 0

    Thank you so much for your thoughtful response! I feel a bit better today as I have had more time to process it and I do think that I did the right thing for mom and baby, as difficult as it was. As you said it would have had a bad outcome no matter what given the situation. The mother had a difficult time accepting that we did not aggressively work him because he was fully developed on the outside so she couldn't see the fact that his lungs and other organs were not ready for life on the outside. I think maybe he would have had a better chance if he was born in a hospital and immediately resuscitated, but that was not to be, and even then it could have been months of suffering.

    Thank you for helping me process this call and learn from it.

    Annie

  • 1
    caliotter3 likes this.

    I am with you there, even when I worked full time as a nurse I had no interest in committees etc, I just want to work and go home. I was working 60 hours between two jobs and what little free time I had I wanted too spend doing other things not work related!

    Annie

  • 1
    chare likes this.

    Hi all,

    I had a terrible call the other night and it has been on my mind since then, I keep second guessing myself and getting upset about it, and wondering what if I had...

    Anyway we were dispatched for a woman in labor, updated enroute to the baby has been delivered, updated enroute to shallow respirations, updated to CPR in progress. It was in the middle of a bad snow storm so it took us about 20 minutes or so to get there. Fast forward to arrival there is a 26 year old woman sitting on a toilet at home holding a very small baby while a police officer gives blow by oxygen (They do not have the appropriate BVM so that is the best they could do) and doing compressions. The baby had no muscle tone, no pulses, and a very occasional gasping breathe. The eyes were still fused and his mouth was so small I honestly don't know that I could have even intubated him if I wanted to because the smallest we carry is a 0 blade and I don't think it would have fit. I had my people start ventilations with our neonatal BVM, the baby's face was so small the mask covered most of it. We continued CPR and I called my medical control doctor because I felt the baby was to early to be viable given his size and skin etc. Speaking with her I advised her that the mother reports some movement in the baby on initial delivery and she advised me to work him for a while and gave me the OK to stop efforts if there was no response. The mother had no idea she was pregnant and when asked she reported her last period was about 2 months ago (clearly that wasn't her period of course because this baby was a lot further along than 8 weeks). I asked when her last period was before that and she said she didn't know, so figuring out gestational age was even more difficult.

    Per the mother, she felt cramping discomfort like she had to go to the bathroom for a couple hours starting around 2330 and when she got into the bathroom she felt a gush of water, pushed once and out came the baby. The baby was born around 0300 hours and we didn't get there until around 0340 ( for some reason there seemed to be a lapse in time from birth to the 911 call, but her times may have been off). The baby was probably about 6-7 inches long from head to toe ( I am totally estimating could have been more or less), as I said his eyes were fused, and his mouth was about 1 inch long maybe even more like a half inch. We did CPR with ventilations for at least 10 minutes and had no response other than a very occasional gasp, but no brachial pulse or heart sounds so I made the difficult decision to stop efforts and not go to Epi or IV fluid. I am now totally second guessing myself.

    The weight at the hospital was 526 grams which I have read is a baby that some hospitals would do a full resuscitation on. Was I wrong to call it and stop efforts and not try and intubate or try epi? The labor and delivery nurse called me later to ask some more questions for the records and she said that they more than likely would not have tried to resuscitate that baby. She also said they were unsure of the gestational age and were still trying to figure it out (this was two hours later). It is a community hospital with no NICU or SCN.


    Any advise or comments would be helpful, even if you disagree with stopping efforts, I need to learn in case this happens again. This is the first time I have ever had a field deliver of a preterm neonate so I had nothing to compare the baby too as far as using that to figure out an actually gestational age and viability.



    A Heart Broken Annie

  • 0

    Hi,

    I got an ER job as a new grad because I had worked there previously like 20 years ago fresh out of high school as an ER tech and also I had EMS background which really helped!

    Other new grads that were hired were previously ER techs or had worked in EMS, I never saw them hire anyone without either of those.

    Annie

  • 5
    canoehead, brownbook, Kitiger, and 2 others like this.

    Hi,

    As far as seizures go they are usually self limiting and just making sure the patient is safe on a flat surface and not at risk of falling is basically all you can do.

    You should just leave them as is, there is no need to move them to there side during the seizure or put anything in their mouth etc. Calling 911 was the smart thing to do.

    Also be aware some patients have seizures when they initially go into cardiac arrest, usually if they are in VTach or Vfib, and will present very similar initially to someone who is just plain having a seizure. Just be aware of this and I recommend if you have an AED you have someone go get it just in case, don't put it on unless they have no pulse of course.

    Annie

  • 13
    psu_213, Nursetom1963, prmenrs, and 10 others like this.

    Document that the patient has refused to turn, each time they refuse, and that you have explained the risks and benefits to them with regards to position changes, AND that they verbalize and understanding of those risks and benefits.

    Annie

  • 1
    NurseSpeedy likes this.

    Dear Millennial,

    If you work in a hospital and it snows, know that you will STILL have to come to work, because the patient's do not go home because it's snowing, your co-workers want to go home after their shift, and the people who did put forth the effort to get to work expect to have some help and for everyone else to get to work as well! Think of the needs of all of those people before your own!

    Stop with the excuses, it's not your family's fault, or your co-wrokers's fault, you are an adult now, be responsible and have a little work ethic. If your car cannot handle the snow then you need a new job that will allow you to stay home during snow storms!

    I had a decent car when I was your age (not four wheel drive though and I still made it to work with snow), no one gave it to me or handed it to me, I worked full time right out of high school and bought it myself. I worked full time throughout all my college years, mostly making about $8.00 and an hour, and mostly what I hear on this board is "I cannot work full time while I'm in school", " I don't want to work full time while I'm in school", or "I'm not ready to work full time yet". You get what your work for in life!!

    Annie

  • 1
    FSZ Student Nurse likes this.

    Hello,

    I recently interviewed for a similar hospital, which was 1.5 hours away from me in an area that literally has nothing to do except hiking and outdoors stuff. There are no stores, just nothing. You would have to drive at least 45+ minutes to get to an area that is more livable, so of course I didn't take the job because of the drive and no desire to live there.

    I really think this hospital, like yours, may be able to recruit and retain nurses if they offered some sort of bus or shuttle, although I know it would be expensive, not as expensive as constantly loosing nurses though. An alternative would be to offer a moving incentive. The area where they hospital is in does have a nice little down town area, but again that is it. The house prices up there are absolutely insane and not affordable unless you are working as a physician, which is also a turn off.

    Anyway my point is, is that your hospital needs to come up with ways to attract nurses to your hospital with some creative ideas. I think sometimes the people who build these hospital don't think about the big picture. This hospital was build in the early 90s and had they built is maybe 30 minutes south of where it is it would have been a lot easier to recruit people because it would be much closer to civilization!

    Annie

  • 2
    ruby_jane and brownbook like this.

    Reading this makes me so happy I am an IV nurse, as boring as it can be....

    Annie

  • 3

    We won't be able to answer that on here, as the other poster stated he needs to talk to the pharmacist at the pharmacy where he purchased it.

    Annie

  • 0

    Quote from Crass1017
    Annie,
    your input was very helpful!!
    i am currently in school to earn my emt and aemt certification. Both are imbedded in the course I am taking. I plan on getting at least a years experience before taking the AAS for paramedecine and get to be a paramedic.

    i do live in the state of Georgia if that helps by the way.
    i have a couple more questions.

    1. Do you possibly know the restrictions for Georgia For paramedics in the ER? Are paramedics licensed in Georgia or only certified?
    2. I have seen that you have to renew your license/cert for paramedics, how hard is it to do?
    3. I am 19 and worried about the strains on my body, I am currently physically fit and stay in shape. How long do people last in the field until they have an injury from the job?

    thankyou in advance

    Glad to hear your are in EMT school. I recommend getting at least 2 years of experience before doing the medic program, just to make sure you like it and also to get used to sick and not sick and get the basics down.

    You would have to look at the Georgia bureau of EMS website to know whether they certify or license providers, or you could ask your teacher in your program. I would have no way of knowing what restrictions they have working in an ER, as I said it depends on license vs certification, as well as the policies of a particular hospital.

    To renew my paramedic license Every two years I have to take 60 CE credits or 30 plus a refresher course. I am nationally registered so I also have the option for testing out, so basically you are taking the national registry paramedic written exam in leu of credits and a refresher. The downside to this is if you fail you have to then take a refresher and have all of the credits done. You also are mandated to have BCLS and ACLS as a paramedic and must keep it updated, it's not like nursing where it isn't required to have an active license. Some states are not national registry states, thus they may have there own recertification requirements, which you could also find on the EMS bureau website for the state you plan on working in. I am licensed as an RN in two states, one requires 15 CE credits and the other requires 30. It is MUCH easier since I can just take the credits and sign that I did them. As a medic for the national registry I have to write down every class I did on their online website, one by one, it's really a pain to be honest.

    There is no timeline for injury. It's all up to you and I will say men tend to get hurt more than women. This is because they tend to be more embarrassed or ashamed to ask for help when lifting someone that is beyond their capabilities. I started this job when I was 20 and so far so good. I do have aches and pains, but no major injuries from lifting/carrying people. I did break my mandible a few years ago and some teeth and lacerate my chin after I slipped in the soap water on a cement floor while washing the ambulance, so you never know what or how you will get hurt. The only thing you can do is protect yourself by staying fit, not gaining weight, and asking for help when needed.

    Annie

  • 1
    FSZ Student Nurse likes this.

    Quote from Mary3010
    Annie, you said that being a paramedic is tough for your body. In what ways would it put strain on yourself? Is this the same as nursing/other healthcare professions?

    Also, is there a way to avoid this strain on on your body?

    Thanks!!
    Hi Mary,

    No it is worse than nursing because you are physically lifting 100% of someones body weight with someone else while carrying them up or down stairs, either on a stair chair or scoop, and sometimes this involves lifting them above your head to maneuver around tough areas. You are lifting them again on the stretcher and again into the ambulance. You are constantly putting strain on your joints with all the lifting, as well as getting in and out of the ambulance, crouching on floors etc. A lot of injuries occur with lifting as you can imagine, second to slipping on the ice or tripping. When you are at home you have an awareness of what hazards you may come across when you are at someone else's house you loose this awareness and if it is night time in the winter the danger is worse.


    They manufacturers are getting better at making equipment that is better able to take some weight off of EMS personal. Our stair chairs now have treds which are tracks that hook on the stairs as you go down so that the stairs are taking a lot of the weight and not us. This unfortunately only works going down, going up you are on your own. Also manufactures are making stretchers that hook onto the ambulance so that we are no longer dead lifting an entire stretcher from ground level, which is how it was when i started 20 years ago. Now half the stretcher hooks onto the ambulance while one crew member holds the other end another one lifted the wheels and in you go. They also have stretchers that are all automatic as far as raising it up and down and the legs to get into the truck, but those are also heavier and more cumbersome.

    Nursing is stressful on your body, but generally you are not dead lifting someone, and in general you have more help since there are more staff members present. You are also not having to carry someone out of an unfamiliar house or lifting them above your head etc. The downside to nursing is you are on your feet most of the day so that can put a stress on your back and legs, but the risk of injury, in my opinion, is far less.


    To avoid strain on your body it is important to maintain a healthy weight and a level of fitness, including doing exercises to increase your body strength. Also lifting with your legs and not your back is vital as well. I notice some people are ashamed or afraid to ask for help with lifting, this can set you up for an injury. Always ask for help when you know it is beyond your abilities.

    Hope that answers your questions.

    Annie

  • 0

    I have to be honest, neither of your options sounds to appealing, but I would choose the shorter commute. An hour and 45 minute commute will get old rather fast!!

    Annie

  • 10

    Paramedic:

    Lot's of autonomy compared to a nurse, you assess and treat patients solo, and sometimes with online medical direction, but the treatment will always be based on your assessment, not the doctors.

    24 hour shifts, so you can work two days a week if you like. This of course depends on where you end up working.

    Lots of skills : IV insertion, intubation, IO insertion, injections, IV medications, 12 lead EKG interpretation. You must get good at this because it will be your responsibility as in some systems you may the only medic on the call.

    You get to go into peoples houses and other different places, some of which can be kinda scary at times, but it is a lot less matoninous than being in the same place all day everyday.

    I love being a medic because you never know what your day is going to bring, there is a total lack of structure because you don't know when someone will call 911.

    Less management as well since you are generally with a partner on the road most of the time or at a base.

    Recently, at least in my area, there has been an increased utilization of paramedics in different jobs like urgent care, emergency rooms, EMS hospital liaisons, and stress testing.

    Patients are generally quite pleasant and thankful because you are giving them immediate gratifications generally speaking, in other words they aren't sitting in an ER waiting room waiting for fluids or an antiemetic.

    Paramedic downsides:

    Less money, but remember it isn't always about money. I am far less stressed working as a medic than I was when I worked full time as a nurse. I just enjoy the job more and that in itself is worth it. Honestly I make less hourly as a medic, but it balances out since I work two 24 hour shifts a week which givens me an automatic 8 hours of OT every week.

    Transfers bite. I am not a huge fan of transfers, especially the BLS ones or the stare at the monitor as a "precaution" transports from hospital to hospital. Thankfully I did my time and only work on a 911 truck now and that is far more enjoyable.

    Frequent flyers. You will have these, every system does. They are the people who call 911 at least once a week, often times more for some BS complaint that they want to go to the ER for. I find most of them have nothing better to do or they are just lonely and want someone to talk to. Do your best to treat them like people and respect them, as irritating as it is. Some of these people are transients that have underlying substance abuse problems and they want to go to the er for three hots and a cot.

    BS calls. This is as annoying as frequent flyers. These are people who call you for crap because they can't find a ride, they don't want to bother anyone for a ride, they cannot afford a cab (wait until they get the 2000 dollar ambulance bill), they have a cold and they just cannot handle it anymore, they want to get seen faster (we put them in triage purposely and it feels good to do it). You get it... ABC ambulate before carry for these people!

    Disrespect from nurses. Yes you will get this and yes I am a nurse and I am saying this does exist. Some ER nurses treat us like we are beneath them for whatever reason, even though our scope of practice is broader. Anyway I have been in EMS for 20 years and this has never changed, it does seem to have to do with the culture of the staff most of time. I don't mind it because when the drunk, or the patient with SI doesn't have a hospital preference guess where I take them.

    24 hour shifts can be exhausting!

    The job is VERY tough on your body, we tend to get over weight. Your body will hurt after a few years if you do not maintain high level of fitness and even if you do you may end up with a back or other injury. One of my co-workers just injured himself and had to get surgery and now will be out of work for 6 months. One of the reasons I became a nurse is because I new I wouldn't be able to do this job forever, one injury and it takes you out of the game possibly permanently. If you do this job make sure you have adequate long term and short term disability coverage. I broke my ankle last may and was out for 2 months, but didn't have to worry about it because of that.

    If it's snowing, raining, a tornado is coming through, the car is upside down in a ditch full of mud you are working in it. You are exposed to all sorts of environmental changes depending on where you live etc. Cars in the woods are lots of fun when they are surrounded by poison ivy...


    Nursing Pros:

    The money, there is a lot to be made depending on what area of the country, but as I said above it isn't always about that.

    Less autonomy can equal less pressure and stress. When you have people staring at you expecting YOU to save their loved one and not a doctor the stress can be high. As a nurse you generally will not experience that, there will be stress, but it is a different kind.

    You have lots of other nurses to help you, especially when you are new! Difficulty starting IVs or questions about medications, no issue, lots of resources.

    Lots of options as far as jobs go. If you don't like one area you can figure out another one that interest you. Although here the job market is poor, even for nurses, so trying to switch areas can sometimes be tough.

    In general you get to work in a warm building without worrying about being exposed to the elements or falling on the ice etc.

    Generally you get more respect within the medical community.

    Generally nursing is A LOT easier to renew every two years.

    You get to wear scrubs which are like wearing pajamas compared to wearing a uniform.


    Nursing Cons:

    Stress and lots of it. When you are on the ambulance and you have a needy patient or family they are only your problem for about 20 minutes or so. When you are a nurse they are your problem for hours or days. When patients are waiting for hours in the ER guess you gets the brunt of their dissatisfaction, and I will give you a hint it isn't the doctor.

    Not a broad range of skills for lack of a better term, especially in the ER. Where I worked we weren't allow to place IOs or EJs, and definitely not intubating. No interpreting 12 lead EKGs etc. Stuff I like to do, I could not.

    Lack of autonomy

    Depending on where you live the job market can be really tough, especially as a new nurse fresh out of school.

    On your feet a lot and very little time for breaks or to even pee! Unfortunately I find this is allowed to happen in many nursing areas which is disgraceful.

    You have not just one patient but 4-8 depending on where you work and less staff to help as more hospitals cut staffing and budgets.

    Scrubs, they are comfortable, but unfortunately if you are wearing them a lot you can loose track of your waistline!

    2) Restrictions on paramedics in the ER is very dependent on the state and the hospital. In my state I am licensed so if I worked as a medic in the ER I could do whatever the hospital allowed that is within my scope of practice. In the state next door paramedics are certified so they are working under someone elses license when in the ER, generally a nurses of physicians, thus they are much more limited on what they can and cannot do. Some hospitals allow medics to do everything a nurse does, plus the skills they are allowed to do in the field. Some hospitals however limit paramedics to being glorified ER techs that can only give a very limited amount of medications and mainly transport monitored patients upstairs, and from what I have seen those paramedics end up unhappy and quitting within a short time frame.

    3) The whole ADN vs BSN has been battled out numerous times on here and everywhere else. Ultimately you would more than likely eventually have to get your BSN as more and more hospitals require it to initially hire you or require you to sign a contract stating you will get it upon your hiring within a set number of years. You could always do the ADN first, get a job, and then do your RN-BSN. That is what I did and I am thankful I did it that way because it was a lot less student loan debt. I was able to work extra and pay for my BSN as I went so no more student loans!


    Are you an EMT? I thought in most states you had to be an EMT basic before you could become a medic? I strongly advise you to do that first if it isn't to late. In my experience people who become EMTs and then immediately go into medic school make poor medics because they have no foundation in which to build the house. Just some thoughts for you.

    In summary whether you do nursing or medic all depends on your personality and what kind of working environment you want. This is America so you can do as you wish, and you can even do both, as I did.


    That is kind of a broad comparison between the two. I was a medic first so the autonomy loss was the biggest thing that made me run back to the ambulance, that and needy patient's and families, I just didn't have the patience for it! I have been in EMS for 20 years and a nurse for 10. I do not regret going to nursing school, as I know I will eventually have to revert back to that full time once I cannot physically handle the ambulance any longer.

    Annie

  • 3
    Beth1978, Here.I.Stand, and KelRN215 like this.

    I have to be honest this is assisted living, it is not a nursing home, thus I don't think they are actually responsible for your mother's brace or other medical devices.

    I think it sounds like your mother needs more of a nursing home rather than assisted living, as she sounds like she may be beyond the abilities of an assisted living facility. Assisted living facilities, to my knowledge, do not provide nursing care, and are intended for elderly people that still have a high level of independence, but who need help with meals and cleaning etc.

    Annie


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