Latest Comments by nurse2033

nurse2033 26,661 Views

Joined: Jun 6, '07; Posts: 2,119 (46% Liked) ; Likes: 3,078

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  • 0

    Well what state are you in? I had to find my own Capstone and cold called until I found a location.

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    MissIllCrisis likes this.

    You can always live in Virginia, but living in Japan might be a once in a lifetime opportunity. Gannbatte!

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    Can I assume you are still a student? Meaning you have a school to back you for liability and student status? Feel free to message me. I don't know if I can help you but I am an educator. This is to gain a CO license?

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    JoRose1 and brownbook like this.

    Yes, nurses get assaulted every day. The odds of it happening to you are higher than ever before. Yes, the nurse should call the police and press charges. Many don't because of the hassle involved though. Yes, if the patient is mentally ill charges may not be brought, but it should always be reported to law. A patient at our facility was recently charged with attempted murder for an assault on a nurse. Deescalation and situational awareness are key skills that nurses should posses. Otherwise, you may defend yourself against an attack as any other person is allowed to do. You would not lose your license for defending yourself. High acuity areas such as ED and ICU are probably the highest risk areas by far, but floor nurses get assaulted too.

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    Did he offer this to the guys on the unit? If not, it was sexually motivated.

  • 4
    Joe V, marshars, tnbutterfly, and 1 other like this.

    The ALTO program (alternatives to opioids) in the ED.

    Last year the Colorado Hospital Association (CHA) pioneered the ALTO program. Ten hospital emergency departments across the state participated and decreased the use of narcotics from 31-46% (CHA, 2018)!

    Colorado, as well as the US, is in the grips of an opioid epidemic, as I'm sure you are aware. We have the 12th highest rate of abuse of prescription opioids in the US (CHA, 2017). According to the CHA (2017), "the vast majority of those who become addicted to opioids, both prescription and illicit, received their first dose from a doctor". This effort is to reduce the unnecessary use of opioids, and thus one of the pathways to abuse and addiction.

    The key to the program was creating treatment algorithms based on pain pathways. The idea that all pain can and should be treated with narcotics is not true. All pain is not created equal. So the Colorado ACEP (American College of Emergency Physicians) developed Opioid Prescribing and Treatment Guidelines. (This can be found on the CHA web site.) This method treats pain by targeting the pathway that causes it. They identified the following;
    · Headache/ Migraine
    · Muscoskeletal Pain
    · Renal Colic
    · Chronic Abdominal Pain
    · Extremity Fracture/ Joint Dislocation

    For each source of pain, they prescribe a set of drugs or treatments, always starting with non-narcotics, progressing to opioids as the last resort. As previously stated, a major reduction in opioid use resulted, with no reduction in patient satisfaction scores!

    The medications that are used are familiar to us, but not necessarily as pain medication. Topical as well as IV lidocaine, low dose Ketamine, Toradol, Tylenol, nitrous oxide, Haldol, Benadryl, and a number of antiemetics were all used with good results. Trigger point injection is also an intervention, in which lidocaine is injected directly into a nerve bundle, or muscle fascia. It can relieve muscle tension and spasm, and works well for the release of scalp tension headaches and other muscle pain.

    As a nurse who was involved in the pilot, I can tell you this works. Not only are patients looking for alternatives, but we are providing better care with less risk. Patient satisfaction scores did not go down overall. Hopefully as providers get more experienced in using these protocols, satisfaction will go up.

    Preparing a hospital for the ALTO program is a huge project. Pharmacy, purchasing, IT, and physicians and nurses all have to be on the same page. New standing orders needed to be written, new order sets generated, new dosing guideline for smart pumps, and new products, such as lidocaine patches had to be ordered.

    The Colorado ENA (Emergency Nurses Association) provided nursing education that included scripting in how to explain the program to patients. Nurses explained that we are looking to make patients more comfortable, or reduce their pain. Complete pain relief is not always a realistic goal, as we know. It is also realistic to discuss with patients the risks of narcotics, and the risk of abuse and dangers of having narcotics in the home.

    It will be exciting to see how far we can go. There were many lessons learned that will only serve to improve this model and how it is delivered.

    CHA (2018), Colorado Hospital Association, Colorado Opioid Safety Pilot Results Report, retrieved from Opioid Safety | Colorado Hospital Association

    CHA (2017), Colorado Hospital Association, Colorado Opioid Safety Collaborative

  • 2
    Armygirl7 and KeeperMom like this.

    1. Probably yes. You will be expected to use the protocols when things are busy, and that's always- in the numbers you describe.
    2. That's too high. 4:1 is about right, with some patients being 1:1.
    3. Not to plug my own post but try this
    4. You will be pressured and rushed, get used to it. It will probably take 6 months to a year to get a really good handle on everything.

    We use this book in our orientation, I highly recommend you read it. Sheehy's Manual of Emergency Care - E-Book (Newberry, Sheehy's Manual of Emergency Care) - Kindle edition by ENA, Belinda B Hammond, Polly Gerber Zimmermann. Professional & Technical Kindle eBooks @

    Good luck!

  • 6

    This is a med error, but your MAR system contributed to the error. This is an excellent example of how a root cause analysis would reveal that the order should not have been red. It was entered incorrectly, or the system didn't allow for delayed administration. If you report it, then the organization has an opportunity to correct the MAR.

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    brownbook likes this.

    You did violate HIPAA but if no one looks you will probably not get caught. Why would you put yourself at risk?

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    pdav likes this.

    Hey don't lose all hope. Waiver is possible, 20 year retirement is not. If you are super fit for your age and have no health problems you might be able to swing it. I've heard about physicians over 50 getting waived in... If they really need FNPs you might be able to convince. One problem is it can take more than a year to get you in. You would need federal recognition (9 months), then to COT or RCOT, which might take another 9 months. The school is short but the wait is long. Then, I don't know if there is a FNP school to teach you the military side of things. If you are an ideal candidate, ie. no arrests, no drugs, otherwise exemplary, you could make a case. Contact a HEALTHCARE recruiter, or find a unit that could use your skills. If you apply at the unit level, they will refer you the their recruiter. Good luck.

  • 1
    Ryjin01 likes this.

    I know the Air Force will take you up to 48 for medical jobs, although I think this is less for active duty, but I'm sure this is for Guard and Reserve. I thought all other services were less but can't confirm. In the AF they will give you credit for years of nursing only. You might come in as an O3 (Capt.) with more than 5 years. Your former enlisted status would give you more money. This is easily seen on the pay charts.

  • 0

    Yes, read that. We use it as part of our orientation.

  • 0

    Quote from Nishstar1
    Thank you all for responding and supporting my stance. I've been a nurse for one year and the nurses I work with have been working in ICU and ER For over ten years, but I've been taught to go with my gut instinct.

    I have quit working there (unlike me to do this) but there had been no changes and nobody can plan when an emergency should happen. Here you go, JKL33

    Also, to elaborate on interruptible tasks, this includes labeling the GI specimen, filling out the entire pathology requisition form, clicking on the cecum tracker, entering in, start times for procedure on one laptop, drawing up meds, selecting and making notes on the docs computer (to show that the doctor did physically assess the patient) which he does not auscultation he heart and lungs as TJC wanted,(this was a safety feature, which the nurses override by having the doctor log in in the morning and he does not do his own charting or reassessment).
    Please notify the state. It is illegal to chart under anyone else's login, fines and firings await... I'm glad you quit but please consider the patients who are still going there.

  • 0

    Make sure the school is accredited. Get your ASN so you can start to work in the field. You can then pursue further degrees at your leisure. Good luck.