breaktime 1,972 Views
Joined Feb 16, '09.
Posts: 71 (54% Liked)
I agree with limaRN. I see this as no different than extubating a pt when withdrawing care. You are stopping a medical treatment/intervention that a pt no longer wants. It's not like you are smothering a pt with a pillow (in the case of extubation). In the case of stopping a pacemaker, you are not stopping the pts heart, you are stopping the device (read as treatment/intervention, that the pt expressed they do not want) that is keeping the heart going. In my mind their is a big difference. I think you did the right thing.
I work in pediatrics so I can only comment on that and not adults. Further, my ICU handles all types of patients with the exception (generally) of cardiac patients as we have a separate ICU for that. We are a well known hospital when it comes to neurology/neurosurgery and those pts make up a large portion of our pt population at any given time. Our ICU pt load is 1 or 2 depending on acuity. The floor is 4-5, again depending on acuity but usually it is 4 pts. Pts with EVDs go to step down where the pt load is generally 3. In addition, pts confused enough to be a significant falls risk or at risk for pulling lines and such will often have a sitter. Again, I have never worked with adults and don't know if these same numbers apply to that population even in the hospital I work for, but I figured as long as I clarified that, it couldn't hurt to provide you with what I could. Hopefully some other nurses with more relevant experiences will also reply.P.S. Sorry for any typos or grammatical errors. I typed this on an iPad with its less than ideal keyboard and often terrible (yet humorous) autocorrect.
I live in the southeast and make a little over 50K per year as a relatively new nurse (been working here for 1.5 years, first job out of school). That is actually a bit lower than the other hospital systems in my immediate area but I work at the hospital I wanted to work at, on the unit I wanted, with the schedule I wanted and that matters more to me. I make the same as another nurse who started the same day as me who is a diploma nurse. She's an awesome nurse and I have no problem that we make the same amount.
That said, I can see where people are coming from when they say BSN nurses should earn more because they have a higher level of education/degree. In many jobs and professions, even if hired at the same time (sometimes even if you have less time and/or experience) and doing the same job, the person with the higher education (whatever that level may be) is paid more. I've heard (from the people who make the decisions on how much to pay their employees) various rationales for this, but the three most common are these: one is that the higher education (sometimes even if not related to the current position held) is still exactly that, more education, and is seen as another tool in the skill set of that employee; two is that the person with the higher education had the motivation and took the time to earn a higher degree and that should earn them something (I equate this one to a situation where two people can work on some system or technology with equal skill but one has a piece of paper saying they are certified to do it, and so sometimes earns more simply because they took the trouble to take the test); and three is that the person with the higher education often has more opportunities open to them and if not given some type of incentive such as higher pay, will likely leave their current position for one that either pays more simply because of their degree or requires their level of degree and happens to pay more.
I'm not saying I agree with any of these rationales, nor that I disagree for that matter. They are simply reasons I have been given over the years for why people in the same position with different levels of education might be paid different wages/salaries. Personally, as long as I make enough to not be worried about my family's financial situation, and I (most days at least ) enjoy my work, I'm satisfied (especially in this economy).
P.S. I apologize for any poor grammar or spelling, my browser is acting strange and after I was a few lines into the second paragraph I could no longer see what I was typing as the screen continually scrolls back up.
I agree with both of the above posters. I think people should be educated about their options in end-of-life care and death should probably be something we think about more in our society. However I also agree that changes need to happen elsewhere because thinking talking to people about death is going to make them stop taking extraordinary measures to prevent it is naive. Stories about the fountain of youth didn't start in our modern society. People have been trying to stave off death probably since the first caveman keeled over (likely at the ripe old age of 30 or something like that). Look at most modern medicine. A lot of it isn't mean to end suffering, but to prevent death. Take chemo for example: chemo generally makes people miserable, but it might prevent them dying, so people take it (I know this is a broad generalization here, as I'm using it for an example, not an analyses of chemo or the people who use it). My point being we, as humans, are willing to suffer to prevent death. If it turned out that lighting yourself on fire allowed you to live longer, we would be living in a world full of charred centenarians.
Just another example of how nursing has become a cash cow for so many schools, and they are milking that teat for all it's worth.
I keep reading how the people complaining are Martyr Mary and yet generally it is within the same post people say you can find time to take a break. No, YOU can find time to take a break, that doesn't mean every other nurse out there does, as people and situations vary greatly. In addition, saying they can find time is suggesting the problem is them, and not with the environment many nurses work in. What I really don't understand is why we are arguing about whether or not there is a problem, instead of simply agreeing on what the problem really is: hospital systems and what have you that don't care about their staff and our inability as a profession to, and here is the key, collectively stand up for nurses/nursing. Unfortunately the best thing we've got right now that I know of is the ANA, which certainly doesn't stand up for us (nor have the respect/power) as the AMA does for doctors. A single nurse, or even a small group of nurses going to management about staffing issues, or even safety issues, is not going to phase the upper management of large corporate systems. Even pointing out research about the correlation of patient ratios and mistakes/errors won't work. Why? Because until that corporate entity is actually feeling the financial impact of those errors, they don't care.
I don't understand, are your pts so unstable that they would die or come to serious harm if you popped in the BR for two minutes. Anything less than a true emergent situation can wait a couple minutes. Pain meds can wait. Assessments can wait. Dressing changes can wait. Enven a new admit or a transfer can wait as long as they're stable. Even if I'm way behind at work I can stop to take a leak. What are you afraid is going to happen in two minutes? No one will die.
I did my preceptorship on nights and loved it. It is true things are a little different on nights. You will probably get fewer admissions on average than if you on dayshift. You'll also see the docs a little less (on the floor, the other services if in ICU) and fewer bedside procedures. However this isn't always a disadvantage. While there were fewer procedure on nights, I was allowed to assist with bedside procedures far more often than those on dayshift. I still inserted foleys, started IVs, put in NG tubes and all the other tasks we do on a daily basis. Also, my preceptor, due to the less hectic nature of nights, also had more 1 on 1 time with me. The final benefit, and the one that has me working all nights now, is that I have more time with my to spend actually with my patient as opposed to running around (usually sorting out miscommunications between our MDs and other services). Good luck, and I hope you enjoy it!
Our usual gtts are also fent and versed, with precedex often being the next added agent if needed and of course the pt doesn't brady on us. We don't have a 24 hour rule with precedex, only with propofol for the reason mentioned above so it is only used generally for preparing for extubation, or if child requires short term intubation for an MRI for example. I've also (just recently) heard of the apoptosis study and then had a pt where we added precedex for the sole reason of being able to decrease the versed gtt. Some of our long term kids with tolerances that a bus of junkies couldn't match, we switch over to morphine or dilaudid gtts instead of using fentanyl. We very rarely use pentobarb gtts but it isn't too uncommon to see it in the list of prns. Also as mentioned above, we start our kids on either methadone/ativan weans, or substitute valium in for the ativan if they have been on sedation for any length of time. Paralytics, now that's a whole different beast...
I agree with all of you, family members, friends, and whoever else we talk to who doesn't work in a similar field just don't get it. Luckily for me my family doesn't ask too many questions, and can handle a short, unspecific description of a bad day. However the above mentioned scenarios, those are the ones I don't mention. The patient we "saved" that we all know/wish we wouldn't have, but unfortunately had no choice. I was asked recently by a student how I dealt with losing patients. My response was: it is not the dying patients that I struggle with, it is the patients we save but shouldn't because we did things to them instead of for them. I don't think there is any way to effectively explain the emotional anguish those types of situations cause, to someone who hasn't experienced it first hand. If there is a way, I certainly haven't figured it out, and don't really plan on trying. For my family's sake, I think some thing are better left unsaid.
I agree with the above posters. I think you might be surprised at how medically complex some of these kids are today, and yet they are managed primarily outside a hospital setting. Seeing kids like that who do a lot of their own care (e.g. a 7 yr old who suctions his own trach) can teach you a lot about how to provide good care when they are in the hospital environment, but also what they are capable of. If you've already seen a young kid suction his own trach, then maybe when you see a similar kid in the hospital who wants to do the same thing, you'll be more likely to let him. Most kids I care for love to be included in/participate in their own treatment and care. Good luck, and enjoy it, working with kids is incredibly rewarding!
Personally anyone who thinks an ambiguous med order is OK scares me a little. "All nurses" know Bactrim is Bactrim SS? If both medications (SS and DS) are in the formulary, I would want to know which one specifically was ordered. I'm a nurse and wouldn't automatically know it was SS. Granted I'm a relatively new nurse, but I think the simple fact that [I]any[I] nurse might not know is reason enough to clarify the order.
Even if these other nurses have been alright with orders like this and "regular tylenol" in the past, you pointed out that it was possible for the order to be unclear, so the "we've always done it this way" attitude is, in my opinion, inappropriate. Of course, like I said, I'm a new nurse, maybe this is perfectly acceptable, but I'd still be uncomfortable. We frequently request our MDs to rewrite BID, TID, and daily orders as Q12, Q8, and Q24 orders when appropriate for the sake of clarity. Med errors are one of the things that scare me the most, and anything that will make it less likely that I make one, is a good thing in my book. That's my
I would say go for OB if that's what you want. For one thing, after spending more clinical time there you will have a better idea of whetehr or not it is really what you want to do. Also, as someone else mentioned, with new grad jobs being so scarce in most areas, having your preceptorship in OB may be the thing that makes you stand out and get the job over someone else. I totally disagree with the idea that you need to start out in med/surg. Given the job market I wouldn't turn down a med/surg job if offered one adn you don't have an offer for an OB job yet, however not applying for an OB job because of this idea that all new nurses should start in med/surg is crazy IMHO. There's a lot fo nurses in my family (and even more on my wife's side of the family) and several have never worked med/surg (including me) and have all done just fine. If you do end up in med/surg though, the statement that the skills you pick up there apply anywhere is true, so view it as a step in the process of reaching your goal, and not an obstacle. Good luck!
It's actually even possible to test for a license in another state, while you're still living in CA. Just call the BON for the state you plan on moving to and they can explain the process. It generally takes slightly longer than testing for your home state (as far as getting the date to test set up) but otherwise it's really no different. I will say this in regards to getting your license, better to have on from out of state than not at all. When I graduated and started applying, I heard nothing until I had already received my license. In this economy, it seems the days of hospitals hiring you before you take your NCLEX are over (at least in the areas I was looking for jobs). Good luck on the test, and on the job hunt!
Good advice, all of it. I would add that it is important (and difficult at first) to make an effort to remember you are taking care of pts, not just performing a series of tasks. What I mean by that is when you're very task-oriented, as most new nurses are (I know I certainly was) you may miss a change in your pt that only becomes noticeable when you look at the big picture. Being less task-orientated will also make prioritizing easier. When you run short on time, which happens a lot (again, especially as a new nurse) knowing why you are performing each task let's you better decide which ones can be put off and which ones can't than if they are simply a list of things you need to accomplish at a certain time. To any new nurses out there, keep at it, it DOES get easier!
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