bebbercorn, BSN 9,942 Views
Joined Feb 25, '13.
She has '6' year(s) of experience and specializes in 'Emergency, Critical Care'.
Posts: 436 (50% Liked)
I haven't read all of the responses yet apologies if I am redundant. I am all for harm reduction. As a nurse anything to help keep a person alive can't be a bad thing. The idea that safe injection sites or needle exchage programs encourage drug use and cause people who don't use to start using is preposterous. Actually most needle exchange and supervised injection sites also provide resources to addicts who are ready to get clean. In Manhattan at one needle exchange program they have a bathroom with an intercom in it and if someone goes in there they are required to check in every 2 minutes or so and if someone stops responding the door is unlocked and someone is standing by with narcan. They have saved 25 plus lives since implementing this. Its not a supervised injection site officially but same concept. Addicts lives are worth saving just as much as anyone else's. Until some better solution comes along people are going to do drugs. No getting around that.
It's an epidemic. Take it from someone who lives a stones throw from Cape Cod.
These places save resources, provide assistance when the person is ready and make it safer all around.
Addicts are going to use until they choose to get help. Thats all there is to it.
While I fully agree that addiction is a disease that is poorly manged it's not just the addict that is affected. I have a hard time getting on board with a program that condones and supports illegal drug use rather than treatment.
I am a needle exchange nurse, HIV/AIDs certified RN and am a strong supporter of harm reduction for injection drug users. There are nursing organizations in Canada and Europe who have been running needle exchanges and injection sites for many years. Check out Insite in Canada and the documentary Street Nurses about Canadian nurses working with injection drug users. I look forward to seeing more of these sites around the country run by nurses who support harm reduction and understand the utility of needle exchange.
A very strange story.
UDS can surely be run on anyone and some ERs now just automatically do it for every patient, but standard UDS only detects "opiates" in general. Tests which detect particular drugs exist, but they are expensive and are not typically used in hospitals. Furthermore, they are not necessary, as actions can be taken out of concerns about potential danger for a dependent person (such as newborn) after the "overall" UDS alone.
I never saw "confirmatory" tests being considered in situations when positive UDS alone deemed to justify that phone call. Authorities usually appear before any "confirmatory" test is done. BTW, it is their, not provider's, responsibility to tell the patient what is going to happen next. I, as a provider, cannot go in the room and tell the patient that, since he was found in his car overdosed from pain pills with two of his little ones strapped in backseat, I am going to take his kids to foster care, then call his employer and then take his driver's license. I can only call appropriate authorities and tell the patient that I am going to do so and explain my reasoning. Moreover, I can only call the authorities who are responsible for actions/prevention of situations which are potentially or actually life-threatening. I can contact CPS or police, but it would be illegal for me to call licensing authorities or employers, or, say, immigration. And in no way I can act "strange" toward a patient in such situation. That would be just unprofessional.
I would definitely request independent re-test. The volume of patients who go through any ER in any given day can be high and mistakes with labs do happen sometimes. Plus, fluoroquinolones and diphenhydramine (which is common Benadryl OTC) can cross-react with opioids in immunoassay tests:
False-Positive Interferences of Common Urine Drug Screen Immunoassays: A Review | Journal of Analytical Toxicology | Oxford Academic
What do you do in a situation like that? I just quickly changed the conversation & de-escalated her, then she was fine.
Klone hit the nail on the head. You will not, and should not be blindly following orders because the physicians are the ones who put in orders.
Understanding pathophysiology and being able to figure out what's happening with your patient allows them to be treated quicker and more efficiently. It allows you to better care for them as well.
Every single day on my unit, I round with physicians and it's never just them assessing the patient and just giving me orders. We discuss the patient's case *together* and come up with a plan *together*.
Example: I had a patient a few days ago who has no history of kidney disease, yet he hasn't urinated a lot duringy shift. I knew this because I had been *assessing* him all day. I understand the *pathophysiology* so I was able to take action. I went and grabbed the ladder scanner to see if he was retaining or if he just plain wasn't drinking enough.
Turns out he had retained a bunch of urine in his bladder. I then straight cath'd him (we have policies in place that allows this) Why? Because I knew that not only would this cause him discomfort, but that it would damage the bladder had it continued. Off the top of my head, I could think of about 5 different things that could be going on with my patient that would cause this. I assessed him further, called the attending, and we came up with a game plan.
That is the role of the nurse. It happens everyday, everywhere.
You need to understand and get sharp at assessments. Small changes can indicate large issues that you'll miss if you're not assessing properly.
You need to understand how to read diagnostics and lab results. You'll be the one following up on the care (patient has a potassium of 2.5 - you need to know what to do) Patient has a diagnostic come back showing a small bowel obstruction - you'll know that you're going to need to place them NPO and prepare for surgery.
There is so much more to nursing than random tasks throughout the day. The job, when done correctly, is much more mental than physical.
My advice: stop bemoaning the thought of advanced education and focus on your current level and what they're teaching you. If you don't, you can be placing your patients at unnecessary risk because you thought you knew a nurses job better than those who were trying to teach you.
Gone are the days when nurses are physicians' handmaidens and we blindly follow orders. You need to know much of what the physician knows so you know whether or not it's an appropriate med/treatment/intervention. If you carry out an inappropriate order, YOUR license is on the line.
And yes, pathophysiology is incredibly important to know. Nursing is not tasks.
Not only can you give blood through an IO, it probably would have had a faster flow rate anyway. A 20 cm 14 gauge CVC lumen has approximately the same flow rate as an IO or 20-22 gauge angio when placed under pressure. Smaller CVC lumens are going to have slower flow rates, and after you get one IO and start infusing you can go ahead and start another. An IO is far from my preferred access in a trauma but you work with what you have.
Whoever told you blood cannot go through an IO was misinformed. Blood can absolutely be given through an IO.
Simply put I believe that many of the people I have personally encountered lack the scientific inquiry that I believe is necessary to become a successful provider. I've seen firsthand the material provided by the numerous online programs and it's laughable at best. Relying on pure memorization and regurgitation with no reliance on the why. I think THAT is far worse than people with little to no nursing experience entering the field. (Granted, I DO believe there should be an experience minimum requirement).
The fact remains that people that could care less about diagnosing or treating are only switching to advance practice to get away from the bedside, in search of the "grass is really greener" and THAT is not okay in my opinion. Unfortunately it happens and WILL continue to happen so as long as these fluffy NP programs continue to pump out graduates, and the NP title will continue to be the laughing stock of the healthcare/medical community.
I'm in nephrology in the midwest and am fried.
I loved being an ED RN.
How is this your business?
I am unsure if I can place links here but on amazon, take a look at this book: Housecalls 101: The Only Book You Will Ever Need To Start Your Housecall Practice by Dr. Scharmaine L. Baker. If you have any questions @rn_solutions on Twitter or IG
Any nurses or NPs working in a mobile clinic setting? I know that starting a business definitely have lost revenue, but I'm trying to estimate how many patients one would see in a large city in a day? Is 8 a fair estimate... (for a newbie) And do you travel to them or do they come to a site? Thanks for the input.
Advertise With Us