2 rn's both bsn, ond nearly NP fin leave bp high

[the nites]

This ADN took over after 2 consecutive 4 hr shifts had fin for 2 rn's, both bsn, one nearly done w/NP, one a Critical Care float who is paid more b/c she comes to our ICU as a float--they both had one pt., nasal cannula, alert nsr post stroke clot retrieval, sbp ord 110-140 w/ iv push meds if over 140. Both 4hr shifts the bp was 160-170, this adn came on at 4 am and had to correct w/iv p meds and bath the pt who had not been bathed. I of course had another sick vented trauma pt. I am an adn w/20 yrs experience and hope the ones pushing for the bsn completion in nursing I hope this pt was their mother.

[abbnurse]

Definitely! You know, after I read it for the fourth or fifth time, I actually (kind of) got it....but for a minute there I felt like I was attempting Sudoku (and I am absolutely terrible at Sudoku)....

[calivianya, BSN, RN]

My facility uses a goal of 160 systolic for fresh strokes - it increases perfusion to the brain. Dropping a stroke patient's BP as low as 110 is a big no-no. Good for your coworkers for recognizing an inappropriate order and not following it. Maybe you should read a little more about how post-stroke patients are typically managed before assuming your coworkers were wrong.

Doctors are not gods; they can make mistakes. Don't fall into the trap of doing what a doctor says no matter what. It is your license on the line if the patient is harmed because of something that you did. "Just following orders" is not a card you can play because you are an educated professional, too, and you should know better.

[jadelpn, LPN, EMT-B]

You come in, do what you need to do for how the patient is presenting at the moment, and call it a day. You are only responsible for what you do on your shift. What someone else did or did not do is on them, and the responsibility of the manager of your unit to deal with if things are done inappropriately.

As an LPN with multiple years acute care experience, there are many MD's who are all over the shop when it comes to where their ideal SBP comes into play. And that is not even at the ICU level. The MD's I was working with want fresh (or nearly fresh) strokes at 160ish SBP, due to perfusion issues--so perhaps a call to the MD for a clarification could have been a thought. Because this is a ICU level patient, could be that in fact the SBP was holding its own until your assessment. Given the odd nature of how an acute stroke and aftermath presents, anything is possible. As you know, there are even MD's who want manual BP's as they tend to believe that the automatic cuffs put a BP "too high"--is it possible that the manual BP was around what it needed to be? Who knows, but you can only do what you can as a patient presents to you.

Be careful, and I say this with the best intentions, you have 20 years experience. You can't get this in a year or 2, no matter what the degree. However, you may find yourself on the teaching end of an inservice on why SBP control is important, before they thank you for your 20 years of service, and find a way to let you go to hire 2 more BSN's for the salary they are paying you. Happens every day.

If the patient was continually monitored, it will be up to the RN's before you to explain the rationale behind why if a SBP was recorded (and those monitors record everything) as over range for the order, there was no intervention. Per an order.

I would however, look at how the patient is trending--and response to your intervention. If an hour later we are still in the same situation and the patient is not responding, you may have to call MD for further orders. Which stinks at 2am, however, I am sure the MD is going to be very interested in how the patient came to the place that they are at present. And you can only state what you came on shift to, your intervention per order, and otherwise, you can not say for certain what the heck happend.

I get the frustration. When highly educated nurses are held in such regard as well as paid more for not doing things correctly, it gets old, quickly. With that being said, there is a huge thing about "evidence based practice" however, RN's need to get into the habit or clarification of orders as opposed to interventions or no interventions based on them exculsively.

[PauperRN]

We have nurse that could venture into full literature here! The responses were just like from the renaissance drama times!

[Ruby Vee, BSN]

This ADN took over after 2 consecutive 4 hr shifts had fin for 2 rn's, both bsn, one nearly done w/NP, one a Critical Care float who is paid more b/c she comes to our ICU as a float--they both had one pt., nasal cannula, alert nsr post stroke clot retrieval, sbp ord 110-140 w/ iv push meds if over 140. Both 4hr shifts the bp was 160-170, this adn came on at 4 am and had to correct w/iv p meds and bath the pt who had not been bathed. I of course had another sick vented trauma pt. I am an adn w/20 yrs experience and hope the ones pushing for the bsn completion in nursing I hope this pt was their mother.

WOW! I guess that shows you that education is useless, huh!

One thing that education helps with is basic written communication skills. Perhaps those more educated nurses you're bashing could have communicated the information you're trying to get across in a more coherent and understandable manner.

You are always going to run across nurses who didn't get their job done, who leave things undone no matter what their level of education. Are these nurses chronically leaving things for the next shift? Or was this a one-time thing, perhaps because the one nurse floated and wasn't aware of unit standards and protocols?

If you yourself have a bad shift one day, don't finish your work or make a bad call, I hope no one treats you the way you've treated those nurses.

[RNsRWe, ASN, RN]

[ktwlpn, LPN]

In other words, you can jump on the BSN degree bandwagon to ensure your future in acute care hospital nursing, or you can take your chances in your local employment market with the ADN degree.........

I have an ASN degree, but am enrolled in a BSN degree completion program as a hedge against the future.

I work in an LTC-25 years ago the place could not keep the MINIMUM number of RN's in the building. Today we have a number of unit managers-these positions were created specifically for RN's and about half have been filled by BSN's.More new positions are being created now and they are requiring a BSN.I see the schism in the middle of the team of unit managers-it's the ADN's vs the BSN's,alot of infighting and jealousy.We LPN's still run the units, we just don't get the compensation for it.. The unit managers are geared more towards the administrative aspects of the home.

If you want to stay relevant in nursing you really need to considering obtaining that BSN-unless you WANT to stand at a med cart until you retire. Nothing against LTC but the opportunity for advancement is small and the job is a killer.

[HappyWife77, BSN, RN]

Thanks for saying this....I cannot understand at all what is being said here, especially the title of the post. Is the OP asking for something, or telling us something? Everyone else who has responded seems to understand, maybe I'm just loopy tonight. Anyway, the responding posters are some of my favorite AN members, so always enjoy reading their opinions....but, sheesh, I'm still lost.

Thanks for reading my mind!! Good grief....I haven't a clue what the OP is saying...either.

[dudette10, MSN, RN]

You could clean up the blood, dammit!

[SeattleJess]

BTW the best nurse I have seen in 20 years of healthcare was a associate's degree nurse with 2 years experience.

Great post. Can you please tell me more specifically about what made this nurse the best? (I may not get there, but I do want to strive for that.)

[scottaprn]

Hi Seattlejess.

Here arena few things that made him.the best I have seen and what he taught me. He was an ER nurse just to give some context.

1) Do the basics and do them well. I never saw the guy fail to do basic care on anyone in any situation.

2) You get better working on the skills that you are the worst at not repeating things you do well. For example when I first met him he was a great IV stick - he was always willing to help if you needed a line but he was more interested if you had an ABG ordered on your patient because he was working on getting better on those. The process repeated itself for various skills until he became the go to thing on seemingly everything.

3) Interest in learning. If you had a patient with a diagnosis that he was not familiar with chances of you leaving the building before he knew all about it were very slim. I had a patient with Brugadas syndrome and was on the phone with cardiology etc. he wound up buying me breakfast the next morning so I could talk with him about it since I had taken care of the patient and knew the plan. You never left until he understood it as well as you did.

4) Critical thinking- This is the hardest too describe but I will try. He saw the "whole" before anyone in the room saw it. Lab values, assesments or changes in condition never happened in a vacuum-It all related together.

5) Teaching- he believed that if you didn't know it well enough to teach a novice then you really didn't know it well enough. So he taught patients, familiar or other nurses every chance he had.

6) new technology.-he was the first one to volunteer when something new came into the ER. example: IO

Hope that made some sense. feel free to pm me with any othet questions.