ella2990

No, it's not the ONLY reason why I decided to do NP in the first place. I wanted to have a deeper background on patho/pharm. And I think nursing is always changing and continuous learning/education is necessary, so I don't know why I'm interpreting some of the replies on my post so negatively when I stated I wanted to learn more. (Maybe that's not their intention, but that's just my vibe) But anyway, yes I wanted to be more than just a bedside nurse. I wanted to be more involved in decision making regarding pt care and hopefully in the future be part of a specialized team and act as one of the providers. P.s. I wanted to be a Dr when I was a kid but screwed up my high school grades when I fell into depression. So didn't get accepted to med school.

I relocated from CA to VA. I was a nursing assistant at a teaching hospital in NorCal, I was unable to work in CA because I was a foreign grad and it's too complicated for me to process my RN license in CA at that time and I wanted to start working as an RN right away so I thought I'd move to another state that I can endorse my HI license to. That's how I ended up in VA. No prior RN experience. I applied at multiple hospitals in VA and eventually was called for an interview for a FT med/surg tele floor. I flew from CA to VA just for the interview. Before the week was over I was offered the job! I told them to give me 2 more months to save up before I relocate, and they were very supportive. FYI tho, our hospital is hiring new grads!!! :)

Yes! That's what I'm itching to learn. I want to have a deeper background in patho to be able to explain to pt's in layman's term. I feel like for my BSN, I can explain some diseases just fine and some diseases I just flat out forgot the patho! Also one of the reasons why I wanted to do NP and didn't want to do bedside nursing in the long run is because I injured my back, back when I was in 8th grade. So being in med/surg unit where we also get quite a few bariatric pts is taking quite a toll on my back. And yes, I am starting my program this fall, I just wanted a reassurance that having less years in my belt wouldn't hurt me when it comes to doing clinicals. Thanks so much!!

Intervention wise, she did another EKG when tele reported that pt's heart rate dropped down to the 30s but it was normal. She didn't call a rapid on him since he was asymptomatic, it was a brief drop and didn't stay that low.

This was not the first time this specific DR. had ignored me. He notoriously known for not really caring about his pts. When we do 10am rounds all he would say is "I'm discharging this pt." "He can stay 1 more night".. like no discussions as to what is needed to be done so the pt can be discharged or any progress for this pt, or no explanation at all why he thinks the pt needs to stay 1 more night as a matter of fact NO DISCUSSIONS AT ALL. He'll just say who will be discharge today and who needs to stay another night or two. Why he's still working at our hospital, I don't know. One time we had to call a code sepsis on one of his pts, he didn't even show up! We had to call another MD to give us orders. I really did want to call the MD supervisor when this happened but our unit secretary said that before I call the MD supervisor, I need to notify that Dr. that I'm going to report him. I don't know why we have to do that, but because I wanted to avoid additional tension/drama, I just let it go.

I wouldn't say I'm incompetent, I guess what I'm trying to say is, I want more knowledge, I want to be able to explain to pt why s/he is experiencing this and that, and why this medicine is prescribed by the doctor vs the other medicine. I don't know if I'm making any sense at all. I am in no way saying that I'm uncomfortable with performing my role as an RN. I guess I want more educational background. We had a travel nurse before and he too is on his way to becoming an NP student, I admire him a LOT!! He was able to explain the pathophysiology of the pt's disease and the mechanism of action of a certain medicine is helping the pt. I want to be that kind of nurse. I hope that made sense, I'm not really good at expressing my thoughts in writing. lol

Hi, I just hit my 2nd year mark as med/surg nurse. I am starting my bridge program for FNP this Fall. I was reading some threads and noticed that a lot of nurses acquired more than 5 years before they went on to go for their NP school. Is being a nurse for 2 years enough experience? I received my BSN abroad (third world country) and let me tell you, the education system was horrible!! I don't think I'm competent enough to take very good care of my patients, that's why I decided to continue my education, go on to earning my masters and become FNP. Does having more nursing experience makes you a better NP? Any thoughts?

I wonder, is the policy regarding how many layers of fabrics/chux different if the pt is in an ICU or Med/surg unit? I work at a med/surg unit. If the pt is on an air mattress bed our policy is one flat sheet and 1 chux. If the pt is on a regular hosp. bed, policy is 1 fitted sheet 1 draw sheet and a pad/chux.

Funny you mentioned that, while he was busy ignoring my text page, I caught him walking towards the stairwell and called his name, he kept walking away, and I had to run to catch up! When I did, he kept climbing down and ignoring me as I was clarifying one of the meds he prescribed to the pt WHILE trying to catch up with him to have a face to face conversation. -___- let me tell you I was out of breath by the time I went back to the nurses station..

Almost time for shift change, I admitted a very young male who was very confused but pleasant. Hooked him on tele and noticed his heart rate was very irregular it would be as low as 50s to SR to as high as 120s-150s at rest. EKG was done and was uremarkable. No cardiology consult was put in the order. No H&P was documented since he was very out of it when brought to the ED the night before. BMP was also unremarkable except for k of 3.0 and ammonia level of 48umol (which in our hospital is considered critical value). Looked at the ED documentation and pt was given 4 doses of Latulose and no repeat ammonia level was done and also no documented repletion of K was done. I tried paging the doctor who admitted the pt but I already know he won't be calling me back since it was already past 1900 and I also called the on call MD for that night but I know I won't be hearing any call back anytime soon. So the best I could do at that time was document all my findings and my attempt on calling both the hospitalist and the on call. I also told the night nurse to page the on call again if she doesn't get any call back within the hour. I came back the next day, and the nurse reported to me that his heart rate went as low as the 30s and his lactulose level was still 48 after giving one dose last night. K was also still at 3.0. I text paged the MD of the situation. No call back after 30 mins. I call paged the MD 2x since I thought that it was critical that the MD be notified of the pt's heart rate dropping to the 30s. MD finally called me back and told me that he will be discharging the pt today to the psych facility and almost hung up on me as soon as he finished his sentence. I told the MD of what happened last night and that his K and ammonia are still abnormal. He told me he's not at all concerned about it. At first I thought I was imagining things. I mean yes I only have 2 years of nursing experience vs. how ever many years he's been practicing, and the thought of questioning him I thought was insane! But it still bugged the crap out of me. At that time I was very nervous and braced myself for whatever's about to happen. I repeated myself and told him that maybe his heart rate was all over the place because his K was low. He said "well he can just get K supplement at the psych facility", I told him, I don't think the pt was safe to be DC with such erratic heart rate and maybe the pt will benefit for a cardiology consult. I also told him maybe his high ammonia is contributing to him having altered mental status. I can already tell he was very pissed and annoyed. He told me well go ahead and and put the consult in but want him DC today! To make my story short. Cardiologist saw the pt and told me that the pt was not safe to be discharged and was glad I insisted on consulting him. Turned out the pt was in junctional bradycardia and that if the pt was DC'ed at the psych facility, there was a big change he'd code and be sent back here or the ICU. My question now is, why was the primary physician angry at me? I feel like I did the right thing. I did not disrespect him or was aggressive in anyway.

Yes we do reporting and I did explain why she rapid in my previous replies. When I say I am a new nurse, I am not looking for an excuse, IMO 2 yrs of experience is nothing compare to 5 or 10. So yes I have a lot to learn and a long way to go. Like I said our unit is very young 70% of the nurses in our unit are new grads and our most seasoned nurse has 4 years of experience. So I didn't really get the kind of advice that I got here when I asked around our unit for opinion. I really do appreciate all the post here as it did shed new light on how to handle pain management. And I never really knew how high their pain tolerance is because most of my pts who were post op only required a low dose of pain meds. So when I saw the dosage and frequency I freaked. AGAIN THANK YOU ALL FOR TELLING ME YOUR EXPERIENCES.

And I am guessing you did not read my previous replies. I did not have anything against the pt at all. That was the first time EVER that I held pain medicines to a pt asking for it --because again based on my assessment it wasn't safe. And yes, after reading all the post, I admit that what I did was wrong and it was a learning experience. and I appreciate the knowledge constructive or not although some I admit was rather harsh. I did what I did based on what was seen during my assessment and other nurses in our unit's opinion and NOT BASED ON MY PERSONAL BELIEF.

Sorry, I meant to say --I did not get any information why she rapid on that day -- it was end of shift and NOC are wanting to start the reporting. I before I left the unit I asked the charge nurse if they needed anymore help with the pt.. she said no they got everything under control -- as curious as I was, I did not stick around that night to gossip. But yes when I became her nurse, yes I asked why she rapid. I might as well explain what happened.. Tech was doing her vitals because pt requested that the tech check her temp because she felt like she's getting a fever. I do not remember all the specifics I believe her bp is low but not below 90s rr was low. What I did remember was her PR was in the 1teens and spiked a temp of 103 orally. The nurses checked it the pt will flag as septic and she did - her wt count was elevated but that was not new since she was also being treated for klebsiella. They activated a sepsis code. Then they did what they needed to do during sepsis code. Then she started complaining of shortness of breath and started "shaking" so a rapid was activated. They did another set of vitals, they wanted take her temp rectally and the she apparently started screaming she is in so much pain and trashing and cursing all the responders. When they did her temp i believe was 98.9 or 99. They continued treating her - got all the specimens that were needed to be collected. Short story short the infectious dse thought it might be from the CL because the pt is known for picking at her CL line. The nurse that was giving me the report also said that the night nurse supervisor asked what the pt was on for pain meds. The supervisor was shocked that the pt is getting that much pain meds that often (granted she doesn't really know the pt's extensive hx).

Oh god no!! I never meant to demean the pt!! Let's just say I am the type of nurse that is very nervous questioning Dr's orders..I was nervous and not arrogant or aggessive towards the DR. When you said hx with the patient? You mean bad blood between me and her? Oh no!! We might have had misunderstanding when I didn't giver meds q1hr like she wanted but no never ever held anything against a pt. In fact we greet each other when we see each other out in the hall way. I guees came out being an an ASS NURSE because of the way I presented my situation. i apologzie. That is just me being frustrated with me because I didn't know if I did the right thing or not. Yes the pain meds were ORDERED, therefore I should have given it -- but like I explained -- I was a new nurse, so I asked around if I should just give the pain meds or not. Majority said no. So I didn't

Blondekristi and Been there,done that Please read my previous post. I explained everything regarding personal beliefs, and why I thought it was unsafe based on my assessments. It wasn't solely based on MY judgment. I ASKED OTHER NURSES FOR THEIR OPINION. They too were not comfortable.