AngelRN27 2,155 Views
Joined Aug 11, '12.
Posts: 155 (30% Liked)
I am currently an active Paramedic in Georgia. I am in my last term of nursing school for RN as well. I can shed a little light on some of your questions in your post. In Georgia Paramedics cannot legally pronounce someone dead. When we are called to a scene (be it a residence, business, healthcare facility, etc.) we operate under protocols and standing medical orders that are preapproved by the medical director of the EMS/Ambulance service. We have SMO's in place that address cardiac arrests and also operate under the ACLS guidelines of American Heart Association. It is the discretion of the Paramedic on scene to decide based on clinical condition of the patient as to continue CPR, or even start CPR on a patient. This decision is backed by ACLS and the SMO in place by a licensed physican that is the approving medical director of those SMO's. If CPR has been established then we allow that to continue and call medical control and speak with the doctor and provide current patient clinical findings and our suggestion and then the doctor will give us the approval to stop resusitation efforts or to continue and transport. Generally, the doctor will support the Paramedic's decision/suggestion and that doctor then needs to sign the patient care report for that patient signing that he agrees with termination decision. If we respond to a call of cardiac arrest and no CPR has been established then the Paramedic makes the decision based on current patient clinical findings and no physican contact is usually needed if it is an abvious death such as those findings that are recognized by AHA such as mortal wounds, Asystole, hospice patient. If the death occurs in a healthcare facility the county coroner is notified. If the death occurs outside a healthcare facility then the county coroner must be contacted on all those death suspicious or not. It is the county coroner or medical doctor that pronounces a person dead, not the Paramedic. The Paramedic determines whether or not to start or continue resusitation efforts. If the death is outside a healthcare facility then the coroner comes and investigates the scene and the patient and then will decide to either release the body to funeral home or if autopsy must be done and then they will arrange transportation of the body to the state crime lab. It can be a little confusing at times. This is pretty much how it works in Georgia. I am sure there are some more finer details concerning the coroner and death pronouncement that i am not aware of.
Nurses (RN's) should be allowed the same ability and supported in being able to make that determination of CPR or not. RN's are highly skilled and knowledable of patient care and it is in the best interest of the patient and the family that they be allowed to make that clinical decision.
Great story. I enjoyed your writing even more so. Very descriptive and eloquently written. Forces me to ponder over where you were before nursing...
Addiction is a physiologic illness centering in the brain..you guys better read some current research
I would ask your DON about the sharps container. You want to get organized and get a routine down as soon as possible. It will be so much easier and once you get a good routine going, you wont be staying so late after your shift. Also what works for you, may not work for someone else. I can share my routine and then maybe you can tweak it for your style and your patients.
I just recently relocated and currently looking for a job, but my last job was in a LTC and I worked day shift (6am-230pm) on the sub acute/ rehab unit. I averaged about 26-30pts with a team of 3 CNAs.
The first thing I did in the morning after recieving report was check the calendar for appointments and/or doctor rounds and made sure the proper paper work was ready. (Sometimes the night nurse was too busy to complete the paperwork.)
Then, I would make sure the med cart was stocked and ready to go. I also made sure my partner and I had enough supplies in our coolers (juice, applesauce, puddings, water ect...)
Then, I would take all vitals that were scheduled for the day and those that needed to be checked prior to meds; start any breathing tx that were scheduled, and any blood sugars that needed to be done (most were done on the night shift except those who were with sliding scale). I would also check on any patient concerns that came across during report (ie..someone had a fall, SOB during the night...)
At the same time, if any of my AAOx3 patients were up and waiting for me at my med cart, I would go ahead and give them their 7am meds.
I would also try to change any dressings that needed to be done prior to the patient getting up for the day.
I would have all the above done by 0730am on a good day with no major problems and then start my major 8am med pass and on a good day complete around 1030am. Now I had my fair share of interruptions, patients fall, the phones are always terrible and assist the aides with their patients. Trust me, I have had days that were horrible...it only takes one patient to throw the whole routine off. There was this one patient I had, I literally spent the first two hours of my shift on...she was very unstable and i was doing my best to get stable while at the same time trying to get her shipped off to the hospital...but the doc wanted to try everything to keep her with me first...
You will have days like that...lots of them ...but you have to remember two things: ALWAYS ASK FOR HELP and YOU ARE ONLY HUMAN!!
You also need a good cheat sheet. You can find some good templetes on this site or you can google them. I had on the top of mine the vitals that was needed, a space for bloodsugars, input/outputs, daily weights, and a space for my notes. A good cheat sheet saved my life. Trust me, once you get into a good routine, it wont seem so crazy. Good luck, hope this helped.
The lack of sharps containers and needed supplies is ridiculous.
As far as prioritizing, when I was in LTC, I probably looked like there was no rhyme or reason why I did things in the order I did. But when you have the same patients every day, you learn who your diabetics are, so you can give insulin at the right time rather than suddenly finding the order on the MAR an hour after lunch. You learn their habits and preferences, and that saves a LOT of time. I imagine being new you'll be a bit like a chicken with the head cut off for a bit, but once you have the unit's routine down and you know your residents, things go more smoothly, even if it doesn't look like it from the outside.
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