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popmode77, ASN 2,646 Views

Joined May 27, '08 - from 'phoenix'. She has '1' year(s) of experience. Posts: 66 (21% Liked) Likes: 30

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  • May 2

    Aren't you supposed to push 6mg, then 12mg? Wonder why the MD told you to push another 6mg instead of 12mg? Not how it's usually done. In my ED, yes, the MD would be at bedside and heck yes, the pt would be on the defibrillator/cardioverter/monitor just in case. It's a big darn deal stopping and restarting someones' heart. Yes, it's usually fine, but, if the pt stayed in asystole or went into a lethal arrythmia, it would be YOUR **s.

    Then you would be scrambling like a crazy person trying to get help, and everybody would wonder why you pushed it without the MD at bedside. You did right (except the 2nd dose, the MD ordered the wrong dose).

  • Apr 26

    Monitor tech calls me while I'm in a patient room (not room 9).

    Tech: your patient in room 9 needs batteries changed. She's down to red now.

    Me: it's okay if she dies. She's discharged anyway.

    I hang up. Then I look up to horrified expressions on the faces of the patient and spouse in front of me.

    I immediately pull my foot out of my mouth to clarify, "her batteries!!! It's okay if her batteries die! Not the patient!"

    I then go into patient education regarding the function of telemetry and our monitor tech.

  • Apr 1

    I dont mean to step on anyone's toes and Im not even sure how old this post is, but i feel that many of these posts are concerning and actually scary. If you feel like your learning NOTHING in nursing school, your doing it wrong. There is nothing difficult about nursing school, but there is also absolutely nothing thats breezy about it. YES it is a lot of busy work. YES it doesnt always teach you the best way. But what nurses NEED to know in order to provide safe care and intelligent evidenced based care is imperative and we are life long learners. It is ignorant of nursing and degrading to your profession to essentially say nursing is a breeze, dig deeper than! Rant over. Not trying to start anything.

  • Mar 15

    hello again to everybody on here. I just want to say that I took it today and I passed w/ 86 correct. I used david woodruff's cds which were shockingly close to the test format. I also did a practice test on the aacn website, which was expensive ($50 for 50 questions) but worth it. Very similar content. I studied exact topics from that and they showed up again on the actual test. Another thing that helped me a lot was I read the research on their website, especially the "practice alerts" which were on the exam too. lastly, I just followed their test outline and made sure I could check off everything that they said would be on it. With complete disregard to GI and some other things that I didn't care about lol. And it was fine. Focus on cardiovascular (esp. hemodynamics and EKGs), pulmonary, and ethics, just like they say. Remember their emphasis on research and being independent and a leader.

    thought this may help others who are searching the internet for advice, as I did for weeks prior to my test date. good luck!

  • Mar 15

    Hey There!

    I'm PCCN certified and have been for over three years now. When I studied, i actually used the ACCN CCRN Dvd'd (because It was cheaper to borrow than buy PCCN), I went to a two day class PCCN review, and used the PCCN Certification Book by Brorsen (great book, worth it to purchase). I studied for a good six months before taking the exam. I personally felt the exam was harder than the NCLEX which I had taken!

    Good Luck!

  • Mar 15

    Old-school RN here. Studied for Boards (before they were called NCLEX) while traveling West in a wagon train, fighting dinosaurs along the way. Cut my teeth in several ICUs, when Swan-Ganz catheters were becoming all the rage. Have seen trends and treatments come and go, the pendulum of nursing practice swing first one way then the other way.

    Background: I worked in IR (Interventional Radiology, which included staffing the Cardiac Cath Lab) for 21 years. Most recently (past 10 years) I work exclusively in Cardiology: Cath Lab, Stress Lab and Cardiology Case Management.

    Current Issue: Two recent encounters blew dust off a few dendrites, and got me wondering about the practice of transporting cardiac patients from either the ICU or tele unit to various procedure areas.

    Encounter One:

    Patient with NSTEMI (non-ST-elevated MI, the "less" dangerous form of MI) and +chest pain in the past 24 hours arrived via bed to our Cath Lab. He is not on a cardiac monitor. Say what???

    Repeat: He is not on a cardiac monitor. His accompanying nurse reported "the doctor said he could go unmonitored."

    EncounterTwo:

    Waiting for my next patient to enter the Stress Lab, I heard a familiar beep-beep-beep and turned toward the door expecting to see a gurney roll through, patient attached to the monitor, RN in attendance.

    What rolled through the door: Nuclear Med tech pushing a wheelchair, on which sits a patient with the transport monitor in his lap. Beep-beep-beep. No RN.

    My question: WHO is monitoring the patient???

    And now I ask you, gentle readers:

    1. Do you know your OFFICIAL hospital policy regarding transporting cardiac patients (or any ICU or telemetry patient, for that matter) off the unit for procedures?
    2. How old is the policy?
    3. Is it reasonable, sensible and sustainable (i.e., is there sufficient trained staff to accompany a monitored patient off the unit for two hours, while other nurses cover the transport nurse's patients)?
    4. Do ALL tele patients and ICU patients require RN attendance and monitoring for transport for procedures?
    5. Is it time for re-evaluation of said policy?

    I offer food for thought in the form of four articles my newly-dusted dendrites found when I did an online search for "monitoring patients going off the unit."

    First is a short thread from our own allnurses.com, in which members describe a wide range of policies and how they are implemented: Transporting Telemetry Patients off the unit - page 2

    Next I found a 2004 article - a statement of practice guidelines! - from the American Heart Association: Practice Standards for Electrocardiographic Monitoring in Hospital Settings

    (make some popcorn and settle down for serious reading with this one)

    Patients are divided into three classifications according to diagnosis and condition, to determine the need for monitoring. Lots to consider and ponder.

    I was pleased the website search revealed a wonderful small article outlining how one facility empowered nurses to formulate an algorithm to use that "enables safe patient transport without an RN or monitoring."

    The article is written by Nancy J. Mayer, MBA, BSN, RN, and published in the AJN Nov 2009. The algorithm is simple to use, takes a lot of guesswork out of the decision-making and requires a second nurse's (usually the charge nurse) approval for the transport plan.

    Look up Transporting Telemetry Patients -Aligning Forces for Quality (pdf)

    And finally, a short article about, well, exactly what the title says:
    Telemetry monitoring during transport of low-risk chest pain patients from the emergency department: is it necessary?

    Targeted mainly for patients being transported from the ED to a tele or ICU unit, this is a thoughtful study. Lots of ideas here.

    Oh, and the encounters I described earlier?

    Encounter One:

    I respectfully requested the nurse re-evaluate each transport situation. Patient with NSTEMI and chest pain within 24 hours who is going to the Cath Lab (which means, we don't yet know for sure the extent of coronary disease but he just had an MI, so it is quite possible he has cardiac disease!), no matter what the MD writes --- I will transport him on a cardiac monitor!

    Encounter Two:

    Think about it: Yes the patient was sent on a monitor. However, is sending the patient on a monitor, without an RN in attendance to watch the monitor, really carrying through with the intent of the policy of monitoring a patient during transport? IMO,either send him on a monitor with an RN or obtain an MD order to transport without monitoring.

    Ah, my old dendrites are tired now. Hopefully your patients who need watching (to paraphrase the Bard, [mis-]quoted in the article title) "must not unwatch'd go."

    Thank you for your attention, and I wish your patients EXCELLENT care!

  • Mar 5

    You need to approach this cardiologist and say something like " I do not appreciate the comment you made about my team. In the future, please know that we are all ACLS certified and quite capable of giving mag for torsades. "

    He was deflecting blame for poor medical management on you and your coworkers. He did it to save face for what sounds like a real cluster. Would he ever openly make a disparing comment about his colleagues who were supposed to be managing the patient? I think not.

    If your department does not routinely assist with transvenous pacemaker insertion, maybe that is what he was alluding to, and if so it was still a very unkind and unnecessary comment. I think you need to let your manager know about this whole event so that she can teach him some manners.

    Ask her if the whole incident should be documented in an adverse drug reaction report.

  • Mar 5

    I need to vent...I have been thinking about this for days.

    Telemetry nurse of a little over a year here. Had one pt starting Tikosyn. Spent all night worrying about his ever changing rhythms. Did a total of 8 EKG's - spent all night on the phone with the hospitalist. Ran all over the hospital to show them the EKG's - only got an order to keep atropine at bedside. Just happened to have a cardiologist there for an emergency - chased him down. He basically told me just to keep the crash cart at bedside and he stuck around to see how it went. Well sure enough - 5 minutes later - torsades. Called the code and long story short - pacemaker in place and saved - thankfully.

    After coming out from the pacemaker placement I over heard him thanking the ICU nurse (who I graduated with) for coming because me and the other girl I was working with didn't know what to do. Not in a nasty way, in a "I am sure they tried their best" and laughed type of way. Then they both saw me standing there and changed the subject. All the ICU nurse did was push mag because the cardiologist said so. I could have done that.

    I am not expecting a medal or anything. But that comment sure did feel horrible.

  • Feb 6

    I started in telemetry.

    *Get Dubin's EKG book.
    *Take ACLS.
    *Learn what electrolyte does what to a heart rhythm.
    *Get a CCRN study guide. It's a good resource for the days when you go home and can't figure out what you saw or what you saw them doing/what was happening when you rolled your crashing person into the ICU.
    *Expect to see people die.
    *Be nice to everyone. Even if you want to shove them in front of a truck. ESPECIALLY if it's a doc.
    *Learn where the crash cart and ambu bags are. I go check at the start of every shift I work that the ambu bags are in place around the unit. You don't want to find out in a crisis that the last shift used the last adult bag on the floor and didn't replace it. And that has happened.
    *Take every and ANY acute care, cardiac, or "my patient's going down the tubes" class your hospital offers.
    *You just think you had to learn meds in school. I've learned more about cardiac meds than I ever knew existed. Learn what can be piggybacked into what fluid. In a crisis, you don't have time to go find the drug guide.
    *If you don't get along or have a personality clash with your preceptor, ask for a new one -- your preceptor should be there for YOU (I know I'd be glued to a preceptee like a limpet mine, but some precept so they can be queen of the nursing station).
    *Stay out of gossiping, witching or politics. You can swim with the sharks later.
    *When you've got a spare minute, ask the experienced nurses questions, especially if you're worried about a patient. I'm not upset when a new nurse asks me a question. But we're all ticked off when a pt's going bad and a new grad didn't say something about it until we've got a real mess on our hands.
    *Don't be a wallflower
    *Don't be a know it all.
    *If another nurse says, "did you check their potassium?" that's usually a polite way of saying "I just checked your patient's potassium, and you need to call the doc ASAP."
    *Go to every code. In the beginning, you may just be throwing the furniture into the hallway and comforting family, or you might start out with compressions. Watch and learn, watch and learn.

    And finally...I spent the first 3 months feeling like I was going to kill everyone I touched. Second six months feeling like I was going to kill only half those I touched. Now, the new nurses are coming up to me and asking about things like hanging aldomet (no, you can't piggy back that with NS, no matter how many times you ask. Start a second site 'cause that's got to run with D5, and anytime you've got a seizure med, DON'T RUN IT WITH KCL). You'll be surprised how fast you learn, but there's always going to be something you haven't seen.

    Watch and learn. Watch and learn.

    See you out there in the world...

  • Feb 2

    Reply to cienurse:

    "Do you fear the unknown?"

    Interesting question. I fear that you would not give me a job, for my answer would be yes. However, I would follow it up with my definition of bravery:

    Bravery is not the absence of fear. It is being afraid but acting anyway.

    Only fools do not feel fear when the situation calls for it, because they fail to understand the gravity of the situation. Seeing a carotid bleedout for the first time? Terrifying. Being brave enough to act anyway? Priceless

  • Feb 2

    Don't beat yourself up. You did fine. Nobody knows it all. Best practice standards are not all universally used. You would follow your facility policies. Interviewers ask the dumbest questions. "What are your weaknesses? Do you like people?" Come on. All that does is make the candidate feel like a fool, and not act themselves.

  • Dec 15 '15

    Quote from janfrn
    I blanched when I read that you're putting Foleys in when patients pull out their PEGs. That's a REALLY dangerous practice. There's nothing to stop peristalsis from pulling that Foley balloon into the proximal duodenum and causing duodenal rupture. PEG tubes are designed with a flange that snugs the balloon up to the gastric wall and prevents much movement of the balloon. The cost to your facility of having a handful of PEGs on hand for this sort of situation is far lower than a wrongful death suit if a patient's bowel ruptures and they die... as happened on our unit recently.
    WOW! I did not know that. I'm sure it'll fall on deaf ears if I inform them of this. I was put off by and I questioned the idea of a foley in the first place, as it doesn't seem right in many ways let alone you can't even see if anything is clogged etc...and my concerns were immediately dismissed as they've done it a million times before, they've been nurses a long time, it's perfectly normal etc...

    I'm working on getting out of there. For many reasons, mostly it's just not a fit for me, but I'm trying to do the best job I can w/ the circumstances while I'm there. However we sometimes can't get our normal supplies let alone an item like a PEG. The resident has orders though that she can be sent out to the hospital if we can't get a foley in. That'll take care of that on my shift anyway.

    Thank you! I do love to learn as much as I can.

  • Dec 15 '15

    I blanched when I read that you're putting Foleys in when patients pull out their PEGs. That's a REALLY dangerous practice. There's nothing to stop peristalsis from pulling that Foley balloon into the proximal duodenum and causing duodenal rupture. PEG tubes are designed with a flange that snugs the balloon up to the gastric wall and prevents much movement of the balloon. The cost to your facility of having a handful of PEGs on hand for this sort of situation is far lower than a wrongful death suit if a patient's bowel ruptures and they die... as happened on our unit recently.

  • Dec 15 '15

    Quote from elkpark
    Isn't it a widely accepted ethical/professional boundary in healthcare that we shouldn't be caring for family members (or anyone with whom we have an existing personal relationship)? I, personally, would not comfortable with that at all. Nor would any employer I've ever worked for (in acute care, not LTC) find it appropriate to have staff caring for family members or friends.
    I agree.

    My father-in-law was admitted hospice before he died at the beginning of this year. I opted out of being the nurse and wanted to be the daughter-in-law only. My colleagues were supportive of this but some of my family members were not.

    They wanted me to come out to the house and explain hospice to everyone. They wanted me to be the one to call them if there were issues. It was rather frustrating.

    When my father-in-law died at 4:30 a.m. the phone rang and the hospice nurse asked to speak to my husband and she told him so I wouldn't have to be the one to do so.

    Very grateful.

  • Nov 14 '15

    My charge nurse is married to a CC MD. They're celebrating their 30th aniversary this spring. She told me it taught her patience and respect for MDs, and it taught him the same for nurses. Win-win for them.


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