EymieICURN 2,379 Views
Joined: Nov 2, '03;
Posts: 44 (36% Liked)
; Likes: 63
ACLS is just taking the next steps after starting CPR (BLS). It doesn't automatically qualify you for tele or especially ICU.
It doesn't give you any more "power" or "authority" to give any drugs you can't already give as an RN, it just teaches which, what and when to use the specific cardiac emergency drugs that are currently being used.
The course has been so simplified that it is easily doable, and learnable; much easier than the orginal Megacode-stress-you-out for 2 days that it used to be.
First, I would be absolutely positively sure that she forged these certifications.
And....if you are sure, I would tell your manager.
Anonymously is for high school - in the real world, you own up to your own statements or in this case, accusations.
Again, I would want to be very very sure before I start to make trouble.
I wanted to take a minute to say--
I work with some awesome nurses!!
As some of you know, I left my first nursing position after a year in search of better teamwork. Well, I found it!!
The last shift I worked, we got slammed! All of us were stretched to our limits and then some. Our nurse manager came out to take over the charge nurse role, and we got slammed with yet another admission. My heart fluttered when she jumped up and took the admission herself! We all worked together to get done what was necessary. High-fives and "good jobs" were passed around at the end of the shift like I had never seen before.
Awesome, awesome, awesome! I have always dreamed about working someplace like this, and now I do!!
THANK YOU to all of the nurses, techs, and support staff that make crazy days bearable and sometimes even fun!
[Ok, now I'm done bragging!]
...or the wrong thing?
Pt has Accucheck and coverage AC and HS. HS BS level was 50. Rechecked and it was 68. Gave OJ and Applejuice. Notified Charge RN. Rechecked 30min later and it was 150. Charge RN said to give the insulin coverage and give juice after wards and to hold the Lantus.
My gut feeling was that I should have held the short acting insulin and given the Lantus. The pt was sleepy, but drank sips of the juice when I gave it to her (which had some added sugar too).
Anyway, I told another coworker (staff RN) about the situation and the RN had the same idea I did: hold the short acting, give the Lantus. But instead I followed the charge RN's suggestion since...she had more experience and was the charge nurse. So I held the Lantus and wrote in it "held since pt did not eat dinner"...the pt only had 20% of her meal.
I'm up late and just worried about the pt. I guess 68 isn't horribly low, but it's still low. What should I have done?
Anyone having earned an MD, Phd etc, is entitled to be addressed as Dr. if they so desire. As it is anyone else's to be addressed as Mr. Ms. Mrs., etc.
It is proper etiquette to let the other person (whether CNA or MD) take the lead on how to be addressed.
I have recently done a research study for my MSN degree about the HESI and other exits tests that are out there. Some schools are using the results to determine remediation programs or changes needed in cirriculum. Others do make the students pass to graduate. One program director I talked with has several students who graduated a year or so ago who still haave not been able to take the NCLEX abecause of it. I know programs want there pass rates to be high but I think holding this over a student is wrong. Use the results for remediation but let the students graduate.
The HESI has a 97.8% accuracy rate of who will succeed on the NCLEX and who will fail. They have individually studied 4 years of the HESI Exit test to prove this. Of course they will give the school all sorts of summaries to help them. I think they are trying to make money. I feel that the student should receive remediation all along and not wait until the end of the program.
I'm sure I'll get burned for this, but today I attended a graduate panel for my former nursing program. The students got to ask us questions about pay scale, what we enjoy about nursing, and how to find jobs... etc. Well all my fellow nurses went on and on about how you touch people's lives, and you become a part of their families. They love all their patients, and *tears flowing* we're just so honored to be like Florence Nightingale. They told stories about sitting around with their patients telling stories about grandkids, and exchanging pictures. The usual cliches; a patient doesn't care how much you know, until they know how much you care. I feel like an outcast because I don't treat each patient like I'm their sweet old granny.
Seriously the way they describe nursing is like a wal-mart greeter in scrubs. Don't get me wrong I have people tell me I'm a great nurse, and a great person. I sit with little old ladies and hold their hands when needed. But can we get the sugar out of nursing? Can we stop calling everybody sweetie, and saying how cute they are? I'm a professional, if you have pain I'll get you a pill, I'll call the doctor, or I'll try my best to fix it, but I won't kiss your boo boo. If you need to be changed, I will change you. If you're scared, then we'll discuss whatever issue you may have. I run my rear off everyday providing care for my patients but never have I treated them like my puppy. Furthermore I don't see doctors acting like Pre-K teachers with patients. Honestly as a patient I don't care how sweet and loving you are, if I'm having a massive heart attack do you know ACLS?
The patient should be positioned in the left lateral Trendelenburg position, this, moves the air bubble away from the pulmonic valve.
Did you preceptor tell you it takes a ridiculously large amount of air in the IV line to cause a problem? As in, the only way it could be done is if someone did it intentionally?
The small air bubbles that are always present in IV lines just get absorbed and processed.
We're never concerned about unstable diastolic BP in the ICU when it's low. It's only when it's high and the pulse pressure narrows that we worry. I don't think I've ever called a doc about a low diastolic, and often when we give report we don't even mention the diastolic, only the systolic. Maybe I'm missing something, but in my vast 3 years (joking - I know that's still a neophyte!) of CV ICU experience I have never once known this to be an issue. Her MAP is 80.7, which is almost right smack in the middle of normal and at worst the lower end of normal, so I don't see what the problem is. Even when her pressure went to 142/50, her MAP remained in normal range.
Also, quite often in older people you can hear a diastolic beat all the way down, so it's entirely possible you've got your diastolic numbers incorrect.
I understand how you feel. I felt, in nursing school, that the whole nursing diagnosis thing was actually condescending to nurses. Feeling a lack of respect? Awww. Here's a bone we can throw you. Look! You can diagnose too! You're just as important. Me, I don't need to be given permission to diagnose in order to feel like an important and respected member of the team.
But...maybe nursing diagnoses serve a purpose. Maybe the physicians do need to see that in order to realize that we are colleagues and peers, not handmaidens working FOR them. As older physician retire and younger ones rotate in the mix, I see this as less and less of an issue (except with some, but for the most part, it's getting better).
Another thing I've realized since leaving nursing school is that the NANDA is a really good tool for learning and teaching. It makes student nurses figure out the "why" of what they're doing instead of just blindly following an order. Why do you check a pedal pulse in a cath patient every 15 minutes, then every 30, then every hour, then every two? Because of potential for altered tissue perfusion related to invasive procedure.
I think that they need to exist, if for no other reason than to be used as a teaching tool.
Actually, I think your suggestion to force everyone who goes to grad school (even if they are not specializing in education) to teach is a horrible idea. Forcing people into a job they are not educated for or want will only create more problems than it solves. Not everyone who goes to grad school should teach -- particularly not beginner-level students. Teaching beginner-level students is a very definite specialty.
How about ...
1. Raising the admission standards so that only people with a reasonable chance of graduating, passing NCLEX, and succeeding in a nursing career are admitted? That would "weed out" a lot of students who are now using those valuable clinical slots, making room for others who are more likely to succeed.
2. Compensating the hospitals for providing clinical sites to nursing students. In a lot of areas, it's the lack of clinical sites that is the bigger problem.
3. Increasing faculty pay so that an instructor can earn at least as much as a new graduate earns in the hospital? ... thus making the faculty job more attractive
4. Hiring clinical faculty as full time employees so that they can get benefits such as health insurance, a retirement plan, etc.? Many (most?) clinical faculty are only adjuncts and not eligible for benefits. That eliminates a lot of unmarried people for those jobs who don't have husbands to provide those things.
5. Supporting faculty members who try to enforce high standards rather than catering to student convenience in the name of "customer service."
These are just a few thoughts off the top of my head.
Edited 6/29: I apologize for my careless failure to use inclusive language in #4 above. I should have said "partners" rather than "husbands." It's just that I was thinking of a few personal friends in this situation who happen to be heterosexual women as I wrote the post. I did NOT intend to exclude men or homosexuals. We are all in this together -- and I apologize if anyone felt excluded and/or was offended by my original wording.
1. I don't see any reason the last two sentences shouldn't "co-exist." Sounds perfectly reasonable to me. Be ready to introduce yourself and others with you to someone joining the group.
2. In healthcare, we don't tell our clients, "When in Rome ..." and expect them to accommodate to our culture (even though they are in "our house"). We strive to understand and accommodate their cultural/ethnic/religious needs and preferences as much as we reasonably can. That's our responsibility as "helping professionals," in addition to being simple good manners (plus, it's mandated by law ...) Has that not been explained to you before?
3. Communication in healthcare settings, by healthcare providers with clients (and, for the most part, with colleagues), is supposed to be therapeutic/professional in nature and focused on the clients' needs, not casual chit-chat, and esp. not on topics about which clients (or colleagues) may have strong feelings (different from yours) -- religion, politics, etc. Again, this sounds perfectly reasonable to me, and, unfortunately, plenty of people in healthcare need to be reminded of this now and again.
4. Part of therapeutic communication in healthcare settings is being aware of your body language and what nonverbal messages you are communicating to clients (and others). Arms across your chest or on your hips are generally perceived as somewhat threatening or intimidating postures. It is best to keep your hands loose at your sides (not in your pockets). This sort of thing is esp. important when dealing with highly charged situations.
5. I imagine most of us can benefit from being reminded of this once in a while ...
6. Even in acute care settings, with potential body fluid "encounters," appearance is important and, again, communicates (nonverbally) more to others than most of us realize. One can look neat, polished, and professional while working in an acute care environment -- do you think that is an excuse for coming to work looking like something the cat dragged in? (Although I've noticed that many nurses do consider that a valid excuse for looking like something the cat dragged in ... My personal opinion on this is that it's part of the reason nurses aren't taken more seriously as professionals.)
(7. Oops, don't have anything to offer on this one, other than that I'm sorry the author's grammar isn't up to your standards.)
I don't see any problem with the "tips," and I think they do a decent job of quickly summarizing ways to present a professional appearance at work. Given your dismissive reaction to them noted here, I can't help but wonder if there was a particular reason why your preceptor gave you the article to read (hint, hint). I would encourage you to think seriously about what kind of image you are projecting in the clinical setting, and whether your preceptor was trying to hint politely that you need to make some changes. I'm not saying I'm sure that's the case; just that it can't hurt to think about it.
Here's my take. She might have lost her license, but her degree cannot ever be revoked from her. I assume the patient has attained an MD degree, so she is still a doctor by virtue of possessing a doctorate degree (just not licensed to practice medicine).
Dr. Robert Jarvik, the inventor of the artificial heart and a spokesman for Lipitor, earned his MD degree in 1976. However, he has never been licensed to practice medicine in any state or country. He has spent the past 30+ years working in research, so he has never really needed the license. However, he can still use the title of 'doctor' since he has attained a doctoral degree.
Your patient is a doctor and may use the title as long as she's got her degree to back it up, but she cannot legally practice medicine without being licensed. If calling her 'doctor' nurtures her spirit, then so be it.
Train people well enough so they can take the role of preceptor.
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