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MunoRN 58,673 Views

Joined: Nov 18, '10; Posts: 8,862 (71% Liked) ; Likes: 23,766
Critical Care; from US
Specialty: 10 year(s) of experience

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  • 3:17 pm

    Quote from dudette10
    I think we are getting stuck on the definition of the word "interpret" so let's skip that part and go directly to a role discussion.

    It seems that what you're saying is that, as a matter of course, nurses are fully able to bypass in-patient pharmacy all together and administer any medications a provider orders that he/she also agrees is clinically appropriate.

    It leads to the question, then, why have in-patient pharmacists at all?

    Do you believe they have no important role in the patient medication process, and that a nurse's education and clinical expertise suffices to ensure patient safety?
    Pharmacists certainly play an important role in the medication review process and they should be utilized whenever the clinical situation allows, but they aren't a required part of the process between a physician writing an order and the nurse interpreting the order and giving the med.

  • 9:55 am

    If the position involves rotating shifts and you can't do rotating shifts, then there is no reasonable accommodations to be made, even if the reason you can't do rotating shifts is due to a protected disability.

  • 8:44 am

    The Sepsis guidelines have never actually recommended initiating basing antibiotic treatment on the screening tools in use, the screening tools are only meant to trigger further assessment to determine if the patient actually requires antibiotics. The most recent guidelines (Sepsis-3) not only reinforce that basic screening tools shouldn't initiate treatment, but that they really shouldn't be used at all since they are too broad.

  • Apr 21

    Quote from kbrn2002
    I guess LTC really is a different beast. It's not at all uncommon for us to send meds, even controlled meds home with a resident. We will send meds out with a resident during a therapeutic LOA if they are going "home" with family for a few days, there is even a separate category in our Pyxis type machine for dispensing LOA meds.

    On rare occasions we have discharged a resident with controlled meds. This is dependent on their payer source, for example if the meds are covered by insurance and recently filled their payer source may not cover another refill after discharge. In that case the meds are sent home with the discharging resident. If they are responsible for themselves they sign that they accepted the meds upon discharge, if they have a POA that person signs that they accepted the meds.
    The difference there is that meds given in an LTC have often already been dispensed for that specific patient by a pharmacy, the LTC is then giving the patient meds from the patient's stock of meds, not the facility's stock of meds, this is technically assisting with self administration rather than administering. There's no problem sending these meds home with a patient because they were dispensed for the patient from the beginning.

  • Apr 21

    Quote from kbrn2002
    I guess LTC really is a different beast. It's not at all uncommon for us to send meds, even controlled meds home with a resident. We will send meds out with a resident during a therapeutic LOA if they are going "home" with family for a few days, there is even a separate category in our Pyxis type machine for dispensing LOA meds.

    On rare occasions we have discharged a resident with controlled meds. This is dependent on their payer source, for example if the meds are covered by insurance and recently filled their payer source may not cover another refill after discharge. In that case the meds are sent home with the discharging resident. If they are responsible for themselves they sign that they accepted the meds upon discharge, if they have a POA that person signs that they accepted the meds.
    The difference there is that meds given in an LTC have often already been dispensed for that specific patient by a pharmacy, the LTC is then giving the patient meds from the patient's stock of meds, not the facility's stock of meds, this is technically assisting with self administration rather than administering. There's no problem sending these meds home with a patient because they were dispensed for the patient from the beginning.

  • Apr 21

    I would declare your experience on an application as what it actually is; progressive care. There's certainly nothing wrong with progressive care experience, but it is by definition a different level of care from critical care. As someone who as served on hiring committees, we would be more likely to consider progressive/intermediate/step-down experience when we're looking for critical care experience then we would be to continue considering someone who wasn't honest on their application.

  • Apr 20

    I don't think you need to worry about the fainting so much as this part: "another I had to resign because I couldn't give a certain shot for religious reasons", the first problem with that is that there are no shots where there is a valid religious objection, and even if there was employers don't have to accommodate that and would likely be very wary of your history of imposing your religious beliefs on your patients, not to mention your license which I've seen other nurses get suspended for this sort of thing.

  • Apr 20

    The Sepsis guidelines have never actually recommended initiating basing antibiotic treatment on the screening tools in use, the screening tools are only meant to trigger further assessment to determine if the patient actually requires antibiotics. The most recent guidelines (Sepsis-3) not only reinforce that basic screening tools shouldn't initiate treatment, but that they really shouldn't be used at all since they are too broad.

  • Apr 20

    I would declare your experience on an application as what it actually is; progressive care. There's certainly nothing wrong with progressive care experience, but it is by definition a different level of care from critical care. As someone who as served on hiring committees, we would be more likely to consider progressive/intermediate/step-down experience when we're looking for critical care experience then we would be to continue considering someone who wasn't honest on their application.

  • Apr 20

    It sounds like what is actually an acceptable practice has been taken too far, intubation for instance is a medical intervention that really should be based on the MD's personal assessment.

    But in general, nurses particularly in the ICU are expected to act with a common understanding with the MD, this means that actual orders are not always required. If it is well established that in certain situations or under certain criteria that the MD would expect you would get an ABG or check electrolytes then no specific order is required, the order comes from that common understanding. If there's any question as to what the common understanding might be, or if the MD is legitimately just being a lazy-ass, then that should be addressed.

  • Apr 20

    I would declare your experience on an application as what it actually is; progressive care. There's certainly nothing wrong with progressive care experience, but it is by definition a different level of care from critical care. As someone who as served on hiring committees, we would be more likely to consider progressive/intermediate/step-down experience when we're looking for critical care experience then we would be to continue considering someone who wasn't honest on their application.

  • Apr 20

    Giving a patient a medication for them to self-administer typically falls under "dispensing". You could either administer the medication before they leave, or have it properly dispensed by the hospital pharmacy if they are able to do that, which means properly labelling and packaging it for self-administration.

  • Apr 19

    Giving a patient a medication for them to self-administer typically falls under "dispensing". You could either administer the medication before they leave, or have it properly dispensed by the hospital pharmacy if they are able to do that, which means properly labelling and packaging it for self-administration.

  • Apr 19

    The Sepsis guidelines have never actually recommended initiating basing antibiotic treatment on the screening tools in use, the screening tools are only meant to trigger further assessment to determine if the patient actually requires antibiotics. The most recent guidelines (Sepsis-3) not only reinforce that basic screening tools shouldn't initiate treatment, but that they really shouldn't be used at all since they are too broad.

  • Apr 19

    Quote from NurseCard
    Are you talking about CPR? Or what?
    I'm referring to pretty typical ICU care that I provide in patients where the family doesn't see any downside to what we're subjecting them to. (I'm not agreeing we guilty of "brutality", but it is refreshing to see someone complain that maybe we need to provide less interventions sometimes).


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