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Anna Flaxis, ASN 26,920 Views

Joined Oct 15, '10. Posts: 2,867 (67% Liked) Likes: 8,637

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  • Aug 16

    I started out in nursing because I felt I had missed my window of opportunity to go to medical school, and nursing was a far more realistic and attainable goal. When I started nursing school, I thought I'd become an NP or CRNA. I had no intention of stopping with a 2 year degree and staying an RN.

    Things have changed. My priorities have changed. I don't want to spend the next several years of my life in school, going further into debt and taking on greater liability. I want to spend my free time enjoying my life, doing the things I love to do, before my life is over.

    I've seen too much tragedy, human suffering, pain, heartbreak, and regrets for risks not taken, life not lived to its fullest before it is cut short, and I don't want that to happen to me.

    I know I'm smart enough to be a doctor, but I'm satisfied with my role as a bedside RN. My decision to stay an RN has nothing to do with how intelligent I may or may not be, but rather, how I envision my life path.

    And to be honest, "NP" doesn't automatically confer intelligence, IMO. In my relatively short time in health care, I've seen plenty of NPs that aren't exactly brilliant. One can manage to make it through an NP program and pass the boards and still not be the brightest bulb of the bunch.

    So, I say let them think what they will. Someone with that attitude is just setting herself up for some really humbling experiences. Just smile and nod, knowing this.

  • Aug 5

    OP, I completely understand your frustrations. I almost went to MS right out of nursing school, but ended up on a post interventional cardiac unit instead. Though the specialties might be different, they're still both floor nursing.

    At first, I would get sick to my stomach just thinking about going to work. During my shifts, I would look longingly at the elevators and fantasize about what it would be like to get on them and never come back.

    But, I did what someone told you to do, and just kept going. Just kept trudging along. And you know what? It DID get better.

    After 2 years, yes, I still had the occasional crazy shift with no time to tend to my personal bodily functions, just glad nobody had died on my watch, but more often, I felt like a pretty darn good nurse. I learned how to structure my days, and when structure had to go out the window, go with the flow. I learned tons about pathophysiology and pharmacology, and feel now like that experience was a solid background for starting in the ED.

    I would give it some more time. It will get better. You'll either continue to hate it, or you might actually start to like it. If you continue to hate it, then you can transfer to a different specialty with a solid clinical foundation under your belt.

    Best of luck to you!

  • Jul 17

    Quote from Learningtobenurse101
    Yes, my managers sided with me on the out of scope of practice, but did still choose the preceptor over me and it makes perfect sense, they've invested a lot of time, money and energy into them more than me and human nature tends to value the those opinions we've built a relationship with over a newer relationship, just part of our nature. Also I would be the most expendible due to being the most new and less skilled of the two. While it may not add up to you, that is okay. It is what it is, and I do need to move on. While I do feel that I would have thrived with a different preceptors whom I worked with side by side in different situations and they taught me well on certain skills, that doesn't really matter either since doesn't change the outcome now. The reason I had written the original post is more due to trying to figure out how to move on, and figure out how to pursue my next job since it was already difficult to get a job as a new grad, let alone someone who was let go.
    A simple incident as you described wouldn't normally result in management having to choose between you and your preceptor.

    It really could be a matter of a simple corrective action- or not. If they value that employee as much as it sounds like, then no formal corrective action absolutely has to take place. Verbal counseling is an option at the manager's discretion. And had you shown potential to be an asset to the unit, they would have held on to you and found a way to make it work- whether by assigning a new preceptor (even if they are few and far between, that does not equate to impossible) or keeping you with your current one, working with the two of you to develop a plan, and scheduling frequent check-ins with you both.

    The fact that they chose to fire you instead of working with you tells me that your rigid, inflexible, and challenging behaviors were red flags signaling that the likelihood of you fitting in and being a part of the team was slim, so they saw the writing on the wall and decided to let you go before investing any more resources in you. This wasn't a matter of choosing anyone over you. They let you go based on your demonstrated behaviors.

  • Jul 17

    Quote from Learningtobenurse101
    The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

    So Yes, I am CERTAIN the preceptor went outside her scope.
    In some settings and under some circumstances, medication administration can be delegated to a PCA.

    "Borrowing" medication from another patient is common practice in some settings.

    also it was not prescribed yet either.
    Since you used the word "yet", this suggests that an order was forthcoming. While it is discouraged to administer a medication without an actual written order in place, there are situations where it would be reasonable and prudent to do so.

    Real-world nursing is not as black and white as nursing school nursing. When you see a nurse doing something differently than you learned in nursing school, it behooves you to assume nothing and ask questions.

    While you are on orientation, your job is to keep an open mind and ask questions about the things you don't understand.

  • Jul 15

    Thanks, guys. It helps to know other people understand and aren't judging.

    I have seen bodies, young and old, mangled by car crashes, heavy machinery, freak accidents, falls or jumps from heights, gunshots, stabbings; I have seen dead babies, children with skull fractures, some head wounds you wouldn't believe, a young man with his face shattered beyond recognition; I have seen cardiac arrests, debilitating strokes, electrocutions, near drownings, amputations, successful (and many unsuccessful but impressive) suicide attempts...shall I continue?

    You don't think that I am *acutely* aware of what horrible things can befall my friends, my parents, my siblings, my chidren, my lover, my SELF?

    For anyone to imply that I lack empathy for what the victims and their families endure in these situations, simply because I chose to vent about a frustrating aspect of my workday shows such a complete and total level of ignorance and holier than thou-ness that I can only shake my head in utter amazement.

    Don't you dare lecture me on therapeutic communication until you have been the one reassuring the pediatric trauma patient's mother as you push the sedative and paralytic into his little vein so the doctor can intubate him.

    Seriously!!!

  • Jun 26

    I think that until the DEA removes marijuana from Schedule 1 designation and the FDA approves the smoking of marijuana as a medical treatment, then Nursing as an institution is hardly any more responsible for relegating marijuana to CAM status.

    But to me, that's beside the point. I don't think of "CAM" as a dirty word. I don't think things have to be mainstream or FDA approved to have value in the health care milieu.

  • Jun 26

    As far as I know, nurses are not employed in marijuana dispensaries.

    I've cared for many patients who use MM. Since smoking is prohibited at my facility, they are not allowed to smoke it while at the facility.

    I think, with the question of dispensaries staffing nurses aside, the role of the nurse with MM is the same as the role of the nurse with any type of CAM.

    I want my patients to trust me enough to tell me what other modalities they use. This is important information for the health care team to have. For example, nutritional supplements and herbals have many interactions with pharmacalogical preparations (St. John's Wort is a biggie).

    Even if their CAM doesn't have any known interactions, it's still important information to have. For example, if my patient sees a Reiki practitioner twice a month to help with their PTSD symptoms, that's good information. It tells me a lot about that person, and can open the door for further communication.

    How I might feel personally about any particular CAM does not matter, and should not interfere with the patient's ability to trust me enough to disclose their use. I want my patients to trust me, and I work to make sure that trust is well deserved by being nonjudgmental about their health care choices.

  • Jun 6

    The "Ebola Crisis" caused me a significant amount of distress. When my workplace started preparing, they gave us PPE that left parts of our skin exposed. The room they selected to place potential Ebola patients had glass doors, and I was told that the doctors would not be required to go inside- they could just look in through the glass. The phlebotomists would not be required to go inside- the nurse would do all of the blood draws. Housekeeping would not be required to go inside- the nurse would do the cleaning. When I questioned all of this, the exact words were "It's for the greater good".

    Paramedics are flogged with "scene safety" and are not required to put themselves in harm's way in order to do their job- because if you don't take care of yourself and keep yourself safe, then you can't take care of the victim.

    And yet, nurses are expected to sacrifice themselves for the greater good.

    Good for Nina Pham. I hope she wins.

  • May 10

    Quote from Farawyn
    Oh dear.
    I think that's "Oh deer".

    Ugh, sorry, someone had to do it.

  • Apr 30

    Quote from lavenderskies
    I want you to be my family members nurse!
    ...aw, shucks.

    Don't tell anybody, okay? Reputation and all that...

  • Apr 15

    Depends on the clinical picture.

    Is this a new medication for the patient, or have they been taking it for a while?

    If it's new, I agree that it would be safest to have them on the monitor for at least the first few doses.

    If they've been on metoprolol for some time, and it's simply a route change due to NPO status, it is important to avoid abruptly discontinuing the medication, as this can lead to a whole host of problems, such as Acute MI. It would be of great import to make sure they get their dose. If you're not comfortable with an IV push, then mixing it in a mini-bag and infusing over 10 minutes would be a good compromise.

  • Apr 6

    Depends on the clinical picture.

    Is this a new medication for the patient, or have they been taking it for a while?

    If it's new, I agree that it would be safest to have them on the monitor for at least the first few doses.

    If they've been on metoprolol for some time, and it's simply a route change due to NPO status, it is important to avoid abruptly discontinuing the medication, as this can lead to a whole host of problems, such as Acute MI. It would be of great import to make sure they get their dose. If you're not comfortable with an IV push, then mixing it in a mini-bag and infusing over 10 minutes would be a good compromise.

  • Mar 26

    Let me first preface by stating that I do not work corrections, but I do receive inmates on occasion in the Emergency Department.

    I would think about the harm that could come from making the wrong assumption. If you determine that the patient is lying, and it turns out they really *are* having an MI, they could die.

    If you determine that the patient is being truthful, you follow protocol, send them to the ED to r/o MI, and the workup turns out negative, what is the harm that can come from this? None, that I can see.

    My advice is to follow your facility's protocol to the letter, and leave the question of whether the person is lying or not out of it.

  • Mar 21

    Quote from 35Nurse
    The rationale is if the H&H is 1/2 of what is should be but all are saturated with 02 then of course your going to get a decent sat BUT they don't have enough RBC's to adequately oxygenate the rest of their body. Is that correct?
    Correct. Which explains why the patient was dyspneic and anxious even with sats in the mid 90s. She was probably tachycardic as well.

  • Mar 21

    Quote from LalaJJB
    My question is: If a patient is in respiratory distress, what do I do especially if the MD is nowhere to be found and my RN co-workers are busy with their patients? I’m new and I don’t want people to die on my watch.

    Thankfully for this patient, she got an ICU room before her breathing got too bad. She was also perfusing fine and her O2 sats were reasonable if she wasn’t doing anything. I’m just scared for when I get a patient who is in respiratory failure and I have nobody to turn to. PLEASE HELP ME!!
    You needed a doctor, an RT, and another nurse or a tech in the room with you. That you were alone with this critically ill patient who needed interventions beyond your scope of practice and level of training and experience is really at the crux of the matter.

    Remember, airway, breathing, and circulation in that order. She had a patent airway, but was not ventilating (breathing) effectively because of the lack of red blood cells (circulation). Your priority interventions are to put her on NRB and get that blood transfusion going *yesterday*!

    Do you guys have lab techs/phlebotomy services? If so, get a lab tech in there to get your type and cross. If not, get a tech or another nurse in there to help you get the sample and get it to the blood bank as quickly as possible. If you can get the sample with an IV start, great, but you've already got a patent IV, so hang a liter and keep that line open! Use what you've got! Getting some more fluid in her might help find a vein for better peripheral access, and it will help if the doctor decides to place a central line. Warm her up with some blankets to help those veins pop up. Gather your supplies for the blood transfusion; blood tubing, a pump, a mini bag of saline, any consent forms you need, so that you can start the transfusion the moment the blood is ready.

    While you're doing these things, continue to monitor for s/s of deterioration and be ready for RSI.

    Edited to add: Sats in the mid 90s on 4L NC, HOB at 90 degrees, anxiety and feeling of dyspnea, does not paint a picture of someone who is perfusing just fine! Do not be afraid to put the NRB on someone like this. If she is a retainer, you can fix that later. She needs more O2 now. It's no different from someone with a cardiac history who is in septic shock. You will still aggressively fluid resuscitate, and worry about fluid overload later.


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