lckrn2pa 2,641 Views
Joined Feb 4, '11.
Posts: 166 (60% Liked)
I didn't read all the post but everything about this screams PE to me, within the 1st few sentences of your presentation.
Recent surgery, central cyanosis, SOB,fever (common in PE pts). This is a PE until proven otherwise.
I will not talk to an out-sourced employee. I request that my call be routed BACK to the US, where my call originated from. By law, if you ask where the employee is physically located, they must tell you. I will always ask "are you in the US?". Most times I get "no Ma'am" and they move right along. I will interrupt and ask where specifically they are.
These kind of discussions always amuse me and I wonder what these "all knowing and all powerful" nursing instructors think about small town hospitals where you routinely take care of neighbors, family and friends. The reality of the world we live in means we will cross paths with people we know and we must know how to handle this. Instead of telling the OP no contact the "instructor" should have taken this as an oportunity to evaluate the students knowledge in privacy (which is good I may add). You handled the interaction very well, you discussed the parameters of your role in their care and the limitations. As far as the "instructor" is concerned, they need to educate themselves not only on privacy but on how to just take care of folks, since thats our job. Now, since this person is in a role that could determine your future then do what they tell you but understand you handled things very well. Your "insturtor" is well, my mom told me if I don't have anything nice to say then keep my mouth shut....
I've always used the back of my hand to sweep them out of the way when needed. I go about it in a professional manner and don't make any type of event out of it. Move swiftly and profesionally and get it done.
What has nursing come to? Your failing clinical cause you can't "chit-chat" with patients and they don't think you will make a good nurse. Amazing, if you had multiple drug errors, always late, never prepared then I could see the issue but cause you don't MINGLE, REALLY?? WTH?? And to base it on one clinical instrutor is even more ridiculous. It takes time to develop the confidence to walk up to a complete stranger, that is half naked and at their most vulnerable point in life, and discuss their history with them......and that time is called NURSING SCHOOL. I would never expect a 2nd semester nursing student to have the same level of comfort as I do and that is why your instructor is there, to encourage and foster that confidence.
Discuss things with your Student Adviser.
These nursing schools really scare me now days. To me this is a completely non-issue but what do I know as a 20 year ER nurse?
So your saying that because someone isn't passionate about nursing or they are doing it because of what you perceive as financial gain then that makes them less of a nurse?
I ended up in nursing for financial reasons, 20 years ago my best friend and I were fishing on guntersville lake in north Alabama and he turns to me and ask what I thought about going to college a couple years and get out make 12-13 bucks an hour. I thought is sounded a lot better than the sock factory I was working at for 5.25/hr. I went to nursing school and he didn't. I'm in PA school now and he is on management tract for the company he works for and makes 6 figures with no college degree. In my 20yrs I've had 1 write up from a co-worker and 2 patient complaints. One of which because the wife felt I did not show the proper level of concern when her husband was having runs of Vtach and I calmly walked over and cardioverted him on a symptomatic run. Oh well, I saved her husband but was excited enough about it.
The point I'm trying to make is that I'm a good nurse and I got here as a means to financial stability, my reasons for doing so do not dictate the level of care I give.
Not saying the PA is right in his/her actions because it was completly inappropriate to yell at anyone for any reason but where was the patients primary nurse? I see your the tech, so are you the only person that does vitals on the ER patients? Just curious as to why you would be the one held accountable when the ultimate responsiblity falls to the primary nurse or at least that's the way I was taught in nursing school and the way I would teach those I precepted when I was still working in the ER.
You should never, ever, ever, ever put yourself in the position where your actions or intentions could be questioned. Never. You should always have a female colleague anytime you have to do an exam on a woman that involves exposing them. As a provider doing pelvic exams on women I always, always, always make sure the female co-worker is at the bedside and standing over my shoulder watching everything I do to ensure there will never be any question to my exam practice.
There is no law that I'm aware of but if there is ever any question as to what you are doing when doing an exam on a female then it will be your word against theirs and the standard is to have a female chaperone with you in the room. Your instructor established that standard by telling you to do so.
One thing I learned recently that I never really thought about much, don't argue with the doc during a code. Recently during my ER rotation in PA school I went upstairs to step down unit for a code call. Primary nurse gave report as she went in to check on patient and he appeared to be having a seizure and the monitor was vtach. Ok, easy enough, the Vtach was not sustained and now the guy was alert, restless with some unifocal PVC's, couplets and 4 beat runs. Doc orders amiodarone 150mg IV and a RN and RT begin to argue that it was not Vtach but artifact from the guy being restless and refusing to give the amio. I pick up the original strip, look it over, yup, Vtach, no artifact to it. I hand it to the doc, tell him, yup, looks like Vtach to me. Super Nurse and RT-god glare at me and the nurse says "oh, your a student" very snide....to which I respond, yup, student PA, oh and 18 years ER experience, 2 years CVICU, past 8 years travel nurse, 30 or so different ER's from Norfolk to Hawaii, about a dozen Level 1 trauma centers and that strip is still Vtach lol. She would have been angry if the guy had not decided to have another symptomatic run of Vtach about this time and she finally comes on board with the doc and pushes the amio.
Moral, if you disagree with the doc the do so in a professional manner and discuss the options, don't become territorial and irrational.
Electrokardiogram developed by Dr Willem Einthoven, a dutch physician. He won the 1924 Nobel Prize in Medicine for this.
The Original EKG:
I dated an ER-NP that did that schedule but was 11-2300. It was hard, especially the last 2-3 days but we enjoyed it because I was working registry as a RN so I'd schedule myself the same hours/days so we would have 2 vacations a month.
If you consult a drug book/ resource, you will find that Augmentin is indeed available in Iv form.
It is always best to consult your institutional drug resources or pharmacy with any question about a medication. It is the only way to provide safe care as a nurse, to cover yourself and not cause an unneccesary incident to a patient. I would always confer with a pharmacist regarding safe dosages/practice over a nursing forum where everyone has different experiences and ideas of what is right.
Oh, as a side note, Augmentin is not available in IV form only PO
Argumentin...............love it! Next time I have a patient not agree with my treatment plan I'm going to write for 2gm Argumentin cephalically lol
The first thing that ran through my mind when I read that the nurse documented but did not give the stated med was, "Wow, no wonder this pt was tx to the hospital needing several transfusions." Then I thought, "Holy cow. That stuff is expensive. I hope the pt wasn't charged for it."
I hope this gets handled properly by administration.
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