Nursing 10 years ago

[kauffman]

I was just wondering what nursing was like 10years ago and how has it changed?

[TazziRN, RN]

I graduated in 1997 and my first ICU job we made our own KCL bags! We used 0.9NS and injected the 10,20, or 40meq's ourselves! Now that is NOT done anymore!!!

Oh, yes it is!! The hospital I just left does not carry pre-mixed bags of anything with K except for D51/2 with 40 of K. Most of our orders were NS with K, or D5NS. We took rider bags of 20 or 40 of K and pulled out what we needed, injected it into the main bag.

[ERRNTraveler, RN]

Regarding the whole gastric pH thing...... What about people who are taking antacids or proton pump inhibitors (prilosec, protonix, etc)? I have read that people who are taking these meds can have a gastric pH of around 7.

[hogan4736, BSN, RN]

...Nurses were not taught to interpret EKGs (woe be unto those who had the temerity to suggest that a mere nurse could do such a thing.)

What exactly do you mean interpret EKGs?

[TazziRN, RN]

I think she means interpret rhythm strips.

[Spidey's mom, ADN, BSN, RN]

Oh, yes it is!! The hospital I just left does not carry pre-mixed bags of anything with K except for D51/2 with 40 of K. Most of our orders were NS with K, or D5NS. We took rider bags of 20 or 40 of K and pulled out what we needed, injected it into the main bag.

Oh yes it is too . . .at least until recently. I did it myself, as the nursing supervisor/ER nurse. Many times.

steph

[pickledpepperRN]

What exactly do you mean interpret EKGs?

Ten years ago we interpreted rhythms including wide complex tachycardias.

12 leads I don't say, "It looks like an inferior MI."

I say, "There is tombstone S T elevation in II, III, and AVF."

Some nurses say , "Inferior MI."

Ten years ago we had to wait for CEP results.

[hogan4736, BSN, RN]

Just wanted clarification...b/c I just encountered that the night tele nurses at the hospital where I work, were initiating CP protocol (with an order of course) and then interpreting the EKGs themselves, putting it into the chart, and letting the doc see it at 0800...THAT was a problem, now they fax it to the night doc...

I KNOW that RNs cannot interpret EKGs...Rhythm strips, yes...

[TazziRN, RN]

RNs can interpret EKGs if they are certified to do so after an extensive class.

[hogan4736, BSN, RN]

here's what happened on our tele floor at 0200 one day last week; The trained RN noted NO changes on the EKG, and called no one; day doc shows up, immediately orders a tridil drip, xferrs pt to ICU...

Tazzi, you work in the ED...would you interpret an EKG w/o showing it to the ED doc?

And are you also saying that, after interpreting the EKG, that a change in the treatment plan can also be initiated by said RN?

I feel that RNs can take all the classes they want, as far as EKG interpretation, bottom line is that we are still going to show it to the doc anyway...

If a doc orderes a CBC, and pt has a white count of 40,000, you're going to make the call...If it was 1400, you'd run the EKG over to the hospitalist doing rounds...

sorry to hijack...so my answer to what has changed in the last 10 years, is that some nurses like to play doctor in the middle of the night...

[ERRNTraveler, RN]

here's what happened on our tele floor at 0200 one day last week; The trained RN noted NO changes on the EKG, and called no one; day doc shows up, immediately orders a tridil drip, xferrs pt to ICU...

Tazzi, you work in the ED...would you interpret an EKG w/o showing it to the ED doc?

And are you also saying that, after interpreting the EKG, that a change in the treatment plan can also be initiated by said RN?

I feel that RNs can take all the classes they want, as far as EKG interpretation, bottom line is that we are still going to show it to the doc anyway...

If a doc orderes a CBC, and pt has a white count of 40,000, you're going to make the call...If it was 1400, you'd run the EKG over to the hospitalist doing rounds...

I work in the ER, and I interpret EKG's every day. If it's a STEMI or other life threatening rhythm, we initiate protocol orders before the doc sees it. We do show it to the doc as soon as possible, but if he/she is not immediately available, we start protocol orders before they see it.

[TazziRN, RN]

here's what happened on our tele floor at 0200 one day last week; The trained RN noted NO changes on the EKG, and called no one; day doc shows up, immediately orders a tridil drip, xferrs pt to ICU...

Tazzi, you work in the ED...would you interpret an EKG w/o showing it to the ED doc?

And are you also saying that, after interpreting the EKG, that a change in the treatment plan can also be initiated by said RN?

I feel that RNs can take all the classes they want, as far as EKG interpretation, bottom line is that we are still going to show it to the doc anyway...

If a doc orderes a CBC, and pt has a white count of 40,000, you're going to make the call...If it was 1400, you'd run the EKG over to the hospitalist doing rounds...

sorry to hijack...so my answer to what has changed in the last 10 years, is that some nurses like to play doctor in the middle of the night...

Okay.......if I were certified to read an EKG, it would be my responsibility to read it and get the doc on the phone asap and say "Mr Smith is complaining of CP, I ordered an EKG and it shows a new inferior MI." A nurse who is not certified to read an EKG is responsible for calling the doc and telling him, "Mr Smith is complaining of CP and the EKG is in progress right now, how soon will you be in here?" No interpretation done.

As for the example you gave above, that nurse obviously needs to be remediated or lose her cert. A nurse not certified to interpret EKGs cannot chart "No EKG changes." If a nurse certified to interpret misinterprets it, then she needs to be held to the same standard as an MD who misinterprets an EKG.

[hogan4736, BSN, RN]

I work in the ER, and I interpret EKG's every day. If it's a STEMI or other life threatening rhythm, we initiate protocol orders before the doc sees it. We do show it to the doc as soon as possible, but if he/she is not immediately available, we start protocol orders before they see it.

protocol is the key word...a doc has signed off the protocol, and what the protocol is, is likely ASA, NTG, etc...and you show it to the doc ASAP, NOT 6 hours later, and you aren't likely starting thrombolytics, or even tridil without your ER doc seeing the EKG...

we have no such protocols...

I'm not saying that we aren't capable of interpreting, but the doc will always see it, like any lab result, and we aren't initiating our own treatment.

As I explained to the nurse that just stuffed the EKG back into the chart, that, if this ever came to court, she would be blowing in the wind with her cowboy attitude...