Nursing 10 years ago

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

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.

Just like nurses intubating pts, it depends on the facility. The last place I was at, nurses were not allowed to interpret EKGs. Rhythm strips, yes...EKGs, no. There were also no standing protocols for cardiac pts. Our ER docs would cover us if we initiated stuff before they got to the ER (24-hour shifts so they were often in the sleep room), but everytime a new ER doc came on staff the first thing I would ask is, "How do you feel about nurses getting stuff started if you're not in the department?" If you, Traveler, took an assignment at that ER, you would not be officially interpreting EKGs.

Hogan, you started this by asking if a poster meant actually interpreting EKGs. Am I do understand that you don't have a problem with the act of interpreting, but with acting on it on his/her own?

In both examples you gave, Tazzi, the doc was called...that's my point...My nurse called no one...We can take 10 EKG classes, but we still call the doc to initiate treatment....

And your comment about a certified RN misinterpreting an EKG tells me that there are nurses interpreting EKGs and not calling the doc...scary

Okay, I see what you're saying. Agreed.

HOWEVER......even if your nurse had called the doc and told him "The EKG is normal," she would have been responsible for misinterpreting it.

Okay, I see what you're saying. Agreed.

HOWEVER......even if your nurse had called the doc and told him "The EKG is normal," she would have been responsible for misinterpreting it.

sure, but the doc would be a fool for not wanting to see it...

our policy is to now fax every EKG to the doc, when not on site, and I have suggested to them that they chart that the EKG was faxed, and if they want, make the fax confirmation a part of the MR...

Hogan, you started this by asking if a poster meant actually interpreting EKGs. Am I do understand that you don't have a problem with the act of interpreting, but with acting on it on his/her own?

you are correct...treat it like any (abnormal) lab value...I just don't want nurses hanging themselves out to dry...

Oh, and for your question about NGT pH, it's the gastric secretions ;)

couldn't resist:rotfl:

Oh, and for your question about NGT pH, it's the gastric secretions ;)

couldn't resist:rotfl:

:o *sigh*.....we really need a raspberry smiley......

:o *sigh*.....we really need a raspberry smiley......

Oh . . .that's why you asked. Now I get it.

steph;)

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.

Ten years ago, we had programs on the EKG machines that would interpret them for you. Being an orthopedic nurse, who does EKG's maybe once a month at best, this was great. Then they took away those programs and gave all of us a basic interpretation class once a year. The theory being any nurse should be able to do basic interpretation. I usually ran them off and sent a copy to the cardiac floor for interpretation. I didn't look at enough of them to know what I was looking at. Now we have the lovely rapid response teams, so usually if someone is getting a stat EKG, they are already involved and take care of it.

Those computer interpretations are sometimes wrong.

Best to have a competent experienced human being look at the EKG and the patient.

Analysis and synthesis of data is key to knowing what intervention, if ant, is required.

Specializes in neuro/trauma/surgical/medical ICU's.

It's a pandemic, not just a regional problem. What can we do? I'm not a psych nurse, I'm in the ICU. A good percentage of our pts. are purely psych pts. because they have nowhere else to go!

Hmmmm...let's see...

In 1997, we didn't have...

Hospitalists, Rapid Response Teams, Pixys/Accudose, Code STEMI, pagers, portable phones, CPOE, EMARs, robotically packaged/dispensed meds, insulin pens, premixed KCl IV solutions in anything but 20mEq per liter, 75% of the chemo drugs we give now (or their side effects), needleless systems (funny how we can't totally get rid of the buggers, eh?), such a large number of patients too large for their beds, as many resistant bugs, shorter stays with higher acuity, RAPID IMPROVEMENT PROCESSES :uhoh3:, etc....

More computer interface these days, and more paperwork...:eek:

(wait a minute, wasn't that supposed to give us LESS paperwork???)

My 2 cents....

NFuser

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