pwiser69 1,240 Views
I bought pizza for the family and the biggest bag of dog food for my mastiff!
In the 19 years that I was active as a volunteer EMS member of my local fire department (2 years NREMT-Basic + 17 years NREMT-Paramedic), I was often amazed at the difference between a "scene" on the day of getting a call, versus the same location a day or two later.
I'd pull up on a horrific motor vehicle crash...car into tree...partial rollover...pinned screaming pt. You work to stabilize/extricate/transport the victim of the crash. Do the paperwork, and move on. Same with a shooting....stabilize, transport, "wash down" the ground to clean away the blood.....and move on.
A day or two later, I'd be on my way home from work, and might drive by the same location. Sun shining, pretty green grass. Maybe a scrape on the bark of the tree, a little shattered glass or a discarded rubber glove on the ground, but nothing else to indicate that this is the location where a human life ended or was forever changed. Just another spot of ground...nothing more.
Now, as an ICU nurse, I sometimes experience the same dichotomy ("here" vs "not-here"). A couple days ago, I was taking care of an elderly pt with a dissecting/ruptured AAA. While in the OR, the pt received 16 units of packed red blood cells, 18 units of platelets, 8 units of FFP, 6 liters of fluid, and 4 liters of fluid from the intraoperative "cell saver".
Upon arrival to our ICU, the surgeon was very straightforward with the pt's family....the pt was not likely to survive.
Over the next couple days, the pt ended up getting multiple units of PRBC and platelets, along with liters and liters of fluid (plus pressors and hemostatic agents). The pt's family (spouse and children) hoped for the best, while the medical staff could see (from blood work) that multiple organ systems were failing.
The pt's family ended up withdrawing care....finally...after multiple "talks."
The pt's body was still in the room yesterday (awaiting transport to our hospital morgue) when I came into work. The body was eventually removed, leaving an empty room.
And the room remains....a bare, sterile room in our ICU. Ready for the next patient. The only sign of the deceased is the family contact information written on the dry-erase board.
As with scraped tree bark, the family contact information is the only (short lived) sign of yet another human having passed from this world to the next. Wipe it off with a paper towel....set up the room for the next patient.
Transient...Here vs not here.
I work nights on Med/surg. My guess is your instructor was right and they wont hire a brand new aide, but its always possible.
Med/surg is just that, medical patients and surgical patients. Youll be doing pretty much the same thing youd be doing in a nursing home on night shift, except youll be checking vitals constantly and most of the patients will have IVs running and some will have tubes and drains attached you dont normally see in LTC. Like LTC you'll still be toileting people, recording I/O, repositioning people and cleaning them up when they are incontinent.
A lot of the medical patients come from nursing homes and taking care of them wont be much different, only theyll be weaker and more confused in most cases, and will often try to yank IVs and NG tubes and even foleys out or try to get out of bed, dragging everything attached with them. Occasionally theyll be in restraints, especially if they have an NG tube, but thats rare. usually you just have to keep an eye on them constantly.
Ambulating and repositioning orthopedic surgical patients can be a little different than other people, since there are things to keep in mind depending on if they have say hip surgery or knee surgery. Knee patients might have a CPM device hooked up at night that goes through range of motion.
The biggest difference between med/surg and long term care is the variety. LTC is the same grind shift in and shift out. Med/surg varies greatly and you will constantly have new patients.
How sick your patients are might depend on how big the hospital is. If its a smaller hospital you will probably have sicker and less stable patients much of the time, since the next step up is the ICU and patients might not qualify for that. Big hospitals have units that are more acute than med/surg and less acute than ICU, so med/surg patients are probably easier generally. Ive only worked in a small hospital so thats just a guess on my part based on patient transfers Ive done as an EMT to bigger hospitals.
One more thing. In a hospital you will probably have to be BLS certified and respond to any code blue/cardiac arrest on your floor. If you have more than one CNA or PCT they may just designate one to be the responder while the other one/s take care of patients. The nursing home we worked at CNAs did the same thing, only there almost everyone was a no code so it was almost a formality. Not that cardiac arrests on med/surg are common either, but they are a little bigger consideration than LTC.
Patient ratio varies where I work. You might have 8 patients or 18 depending on admissions and discharges.
You are soo WRONG! where did you get all this? Jean is a great nurse who worked a lot of overtime that was available at CMC when the state hiring freeze was in effect. We could all make as much as her if we worked overtime everyday too. By the way, CDCR salaries are determined by barganing units (union contracts) not location in the state.
Men do it all.
I honestly think this was a good question. I am sure there are others who are afraid to ask. From my knowledge, 2nd hand mj smoke won't be picked up during a UDS. If I were you, I would ask him to please not smoke in my car & just leave it at that.
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