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Anna Flaxis, ASN 24,850 Views

Joined Oct 15, '10. Posts: 2,863 (67% Liked) Likes: 8,601

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  • 1:18 pm

    Quote from HMNguyLVN
    Wow , what a Jerk, Jerk Off, and yes PA are not MD ...you should call him by his first Name.
    Always address people in the work-place by appropriate title, or by what they request you to address them as. A lapse of professionalism by one person does not rightly begat that of another.

  • Dec 6

    Quote from lnvitale
    I see people complaining about the amount of NPs being created, however it is good that nursing is addressing the problem of healthcare provider shortage. .
    Speaking only for myself I'm not complaining about the number of NPs being created what I am complaining about is the lack of RN background, lack of criteria for appropriate applicants and superficial education that I, as someone who went through 2 well respected brick and mortar NP programs, believe NP programs are lacking. It disgusts me to hear this justified due to a lack of providers and time frames they are trying to fill to meet these needs. This is especially disturbing to me in my specialty, psychiatry, where we are treating particularly vulnerable patients who need and deserve quality prescribers who actually know what they are doing.

  • Dec 6

    Family doctors are more critically needed than ever. NPs are not the equivalent to an MD no matter how much some think they may be.

  • Dec 6

    Quote from AAC.271
    Wow. There are more people applying than residnecy spots? How is that possible..... we have a physician shortage so why do they keep it so low on purpose tou have toask.
    To protect their profession from becoming over-saturated and easy for anyone to get into, unlike Nurse Practitioners have.

  • Dec 6

    Quote from Anna Flaxis
    Assuming this is not a rhetorical question, to put it simply, the smaller the sample size, the less precise the information is.
    [...]
    I understand, and agree with everything that you have said in both of your previous posts. If we are going to continue to teach this paradigm, then yes, further study should be done.

    The problem is this. No one seems to know where this came from, and why it was originally included in the ATLS curriculum as there is zero evidence to support it. Nor does anyone seem to know why it was removed. Unfortunately, both medicine and nursing continue to believe, and teach it.

    And thus the intent of my previous post. Don’t you think that there should be some evidence behind what we teach and practice?

  • Nov 22

    Quote from HeySis
    How about we talk to our patients instead of each other, ask them about where they live, what they do, who's waiting for them? do they have kids?

    So still an easy and relaxed conversation and they are not just listening in, but participating.
    I'm trying hard here to not get annoyed at the suggestion "how about we talk to our patients instead of each other". Perhaps you didn't mean to sound condescending but that's how I interpreted the wording "how about" and perhaps you weren't implying that I don't talk to my patients and ask them questions. I specifically wrote that I do talk to my patients. I've done many
    c-sections lately. The surgical drape prevents the patient from having the surgeon/OB/gyn, OR scrub nurse and nurse midwife in her direct line of sight. The patient usually see their surgical caps above the drapes, but that's about it. The surgical staff of course mostly have their eyes directed at the surgical site but even if they were to turn their heads in the patient's direction and address her, the patient wouldn't see their faces. I however for obvious reasons sit next to the patient's head on the non-surgical site side of the drape and can speak to my patient and have eye contact with her. So yes, the patient and I generally have patient focused discussions. Sometimes just chit-chatting about mundane/everyday topics like for example the questions you listed and sometimes if the patient wants to know; explaining how the surgery is progressing.

    Some patients actually don't want you to talk to them and they don't want to answer questions but prefer to just listen to what others are saying and some want the room to be as quiet as possible and just relax/doze off. Some want to listen to music but no conversation. They/we are all different.

    If the patient clearly expresses that hearing the rest of the team chatting away is soothing/ comforting as it reassures the patient that the surgery is undramatic, I'm not going to fault the team simply because it doesn't meet some people's idea/standard of professional behavior. As always, it's of course important to talk to your patient and find out what he or she prefers. The patient gets to decide.

  • Nov 22

    I agree with previous posters that discussing the outcome of the election in front of patients was inappropriate. There are some potentially divisive topics like for example politics and religion that are best avoided altogether in the workplace, especially so in front of patients.

    Not to defend the staff who discussed the election, but I do wonder if the fact that the campaign had been so vicious and the voters so polarized might have contributed to the inappropriate conduct. Less than 24 hours after the result was in, I assume many people were still reeling from shock of the election outcome. It might have made people who wouldn't normally talk about things like politics in front of patients become more "loose-lipped" as they were processing the result of the election.

    As I've already mentioned, I don't think that politics and religion are ever suitable topics for staff to discuss amongst themselves in front of the patient. But I do think that there are times when staff discussing less incendiary topics in front of patients can actually be beneficial. Of course it depends on the patient, we all have different preferences but as a nurse anesthetist I find that patients often find it calming when the medical team around them are relaxed enough to discuss their dinner plans or child's birthday party or whatever. I've had many regional anesthesia, minimal or moderate sedation, surgical patients express that they get scared when the team is all quiet and focused on the job. Even though I'm talking with my patient, the silence from the rest of the team, makes the patient fear that something's not going well since the team is concentrating so hard instead of talking and sounding like they're having a routine day at work. Some patients certainly prefer this quiet focused on the "task at hand" approach, but some definitely don't.

  • Aug 31

    Something I have learned from my experience in the diagnostic role: you miss some. You do your best but some will still surprise you.

  • Aug 25

    Quote from Been there,done that
    Per NIH "no compelling evidence for routine cultures or empiric treatment with antibiotics. Further research is required." This is my kid we are talking about. Use sterile procedure, culture that green and yellow stuff, determine if and what antibiotics are necessary. I would expect the same for my patients.
    I don't have time right now to research it, so I can only offer anecdotal "evidence." We had a male in his late teens who had an abscess in a sensitive area. Surgery was called to I&D it. After the procedure the ER doc asked the surgeon "what antibiotic should I discharge him on?" Surgeon replied "I just drained the abscess. Why would he need antibiotics?" No culture was sent. In the absence of cellulitis, I see almost no one from the ER sent home with ABX (or having had a C&S done) with an abscess I&D.

    FWIW, the surgeon did use sterile technique.

  • Aug 25

    I do I&D's as a clean procedure. I do not culture or script abx unless there is a complication.

  • Aug 25

    It is a clean procedure where I work. Instruments are sterile but sterile gloves are not used. I don't routinely culture unless the patient has recurrent abscesses. Antibiotics are not necessary unless this is a recurrent problem or the patient has systemic symptoms. This is per our health system's protocol.

  • Aug 25

    Quote from BCgradnurse
    I use a disposable scalpel, which is sterile. I only touch the handle and never touch the site after it's cleaned. The sterile blade is the only thing that touches the abscess.
    Same. Alcohol prep, local anesthesia, povidone-iodine prep, drape, disposable scalpel, and clean gloves. Once the abscess is opened its non-sterile anyways.

  • Aug 25

    I certainly hope not.

  • Aug 25

    Quote from Anna Flaxis
    What about experience; how many veteran nurses and new grads are there?
    This seems to be the biggest factor that our facility has identified in regards to patients deteriorating without being noted. We had a relatively high proportion of new grads (about a year ago we had somebody that had been a nurse for 5 months doing charge on a med-surg floor). There has been significant improvement as our facility wide level of experience has increased.

    We've recently instituted a family initiated rapid response to help reduce the number of code that occur outside of ED & ICU. It has not been implemented long enough to garner any data.

  • Aug 22

    Great thread with lots of thoughtful responses.

    A couple of thoughts for OP

    Its unwise to "jump to solutions" until you actually know what the problem is. In my consulting years, a lot of work involved reversing the superficial "improvements" that were implemented to solve problems - AKA, it seemed like a good idea at the time. My mantra became "Today's problems were yesterday's solutions". Don't fall into that trap.

    Look at the research being done on "missed nursing care", "failure to rescue" and "nursing surveillance".... there's a ton of evidence out there to inform your decisions. Better yet, start analyzing those near misses or nursing failures using a system like HFACS or a rigorous root cause analysis process to determine the systemic problems that may actually be the causative factors.


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