The Sphynx

The ability to be calm, collect, and clear thinking through it all. That is not something that cannot be taught.

I believe the moral objection applies.Unlike the clinic's, you are not the medical assistant or nurse regularly taking part. You would likely have other nurses who can step in if they feel compelled.

Forget the lasix part. I just remembered, if you are on a psyche unit then your patients would'nt have IV's either. Your only option would be to get them down to the ER/ICU (No 02, no monitor, no IV, no drugs). Even if you had called a code, what is the chance that they would have responded with a crash cart? Why would they put a 86 y.o. on the psyche floor for major depression? You would thinnk that she would be on the medical unit. There are a lot of things questionable about the scenerio but its definitely not you.

I got 4 questions: 1) Why did'nt the physician order lasix? 2) Where was the house supervisor? 3) Why the ER and not the ICU? 4) Why don't they have a crash cart? Intersting. ....Interesting. Sounds like there are bigger issues here? Psyche units are not treated the same as medical units. Never mind that some psyche issues are biological in nature (like bipolar illness). There is a disconnnect there within the system. Anything that fast sounds left ventricular to me (could possibly be new also) I don't see what your options were. You made the call and you did'nt have support available. I'm not approaching this from an ER or the ICU perspective for reasons of discussions.

Follow the patients request. Let the family sue!!! It's not your problem. It's the familys lawyer's problem.

1.4 mL sounds right. Call your pharmacy.

I deal with this stuff all the time in the ICU. If the patient is A&0x3 and states to medical personell what he wants..that's it! End of Story! Family can go find a judge to change it (they will not overide the patient w/o justification from medical personell). Go in with the charge nurse and maybe the physician too.Document the neuro finding and what he tells you in quotations and write the DNR orders. If family wants to get upset, direct them to the manager and administration. If they get biligerant,call security and have them removed from the building. Medical POA only applies when patient is not able to make decisions for himself. General POA is a different issue and of no concern to the medical facility/physician, orthe nurse. In states such as Nevada, the lines are clear: Legal spouse, children over 18, parents, siblings,ect...

I would check the calibration of the manuel cuff first. Manuel pressure would seem more definitive but it's easy for the calibration to be off and not properly checked by biomed. Its little things like that that get easily overlooked.

1) Don't be intimidated and don't let the Type-A's bully you 2) Learn all that you can but don't go too fast (Don't get ahead of yourself) 3) Trust but Verify. Check the patient and not the machines. 4) Stay with your assigned preceptor. If you are being jerked from one preceptor to another: Everyone is going to tell you that you are doing it wrong cause that's not the way they learned it. They will then start bitching and questioning your skills to the manager (when they don't question the preceptor). 5) Stay the course with your routine and remain systomatic. Assessment, meds, charting notes ect... so that you stay on track and not miss anything. It's sink, swim or float (do the latter two).

Thats a good point. You will have a good number of years to work on your masters anyway. Take some clinical OIC spots to make the resume look nice (even in a small ER) and you'll be looking good come eval time. You already got experience that others won't have so you can likely get moved in the critical care slots. These are not usually fast bust your butt high stress kind of places. You can moonlight downtown for that doing per diem work (keep your skills fresh).

When the ICU opened up at the old Nellis hospital in 1992 it was 4 beds but they never really used it. The physicians shipped everyone downtown so they would'nt have to be on call. 1n 1994, they opened up the current Nellis hospital. (I got out of active duty just as it was opening). I visited Eglin AFB while in reserves. I later went to Patrick AFB but that is now a little reservist base now. These are really small areas. Unless you are at Lackland. It won't be extravagant When I was oversea's at RAF Lakenheath from 1986-1989. It was a 4 bed ICU in a bay area room (About the size of my living room). As for Major, I think your Masters can be in anything. I don't think it matters in regards to the rank. I have a per diem nurse at work who was in the officer ranks. I'll ask her next time I see her and ask her. If you do get out here let me know and I will show you around. It's something that I never got when I arrived.

Good thing we were not in the Navy or we would be the one's looking good.

The ICU at Nellis is awesome! You will mainly see the old stuff and take part in procedures (broch's ect... in room 8). Plan on drinking lots of coffee and mentoring the enlisted medics. As stress free as it ever gets. I was last there on 9/11. (you are in Las Vegas baby) Its a 8 bed ICU with mostly 4 patients the majority of the time. (I was mainly at the old 1 story hospital that closed in 1994) Eglin is out in the country part of west Florida panhandle (area called crestview). Very small townish area. The medics are the primary caregivers. Officer nurses will be doing more mentoring and managerial duties. You can still give the IV meds and the narc's. You will have to fight the medics if you want to put in the foley or do IV sticks. You will get a lot more advancement oppertunities in the air force that you will not get in civilain practice. You will be more on par with the physicians also. Its much more teamwork oriented. Everyone will be more familiar with everyone. Pay will be less than the civilain sector initially but it goes much further. You will pay less in taxes, get a food and housing allowance, no healthcare worries, and don't expect a lot in terms of war deployments. Our casualties and mortality rates are small despite the antiwar anti-Bush media frenzy. The army nurses will get most of it. The chow hall food still sucks...but that's government.

60 drop tubing (or microdrip) is more refined. If you want 120 ml to manually infuse over an hour-use microdrip tubing at 120 drops per minute. The rate is equal to the drops per minute. We mainly use it for free flowing antibiotics. Easy to figure out and a lot less math. Everything else is macro tubing. Don't expect much in terms of IV pumps in regards to test purposes. Concentrate more on macrotubing calc's due to testing purposes (difference in rate with 10, 15,20, and 30 drop tubing) I never use it in the ICU setting with the infusion pumps. On rare occasions it comes in handy. It's old school stuff...always good to know.

In High School, considering being a male nurse was out of the question because I found the field boring and their was the stigma of being gay. I went in the air force and was made a medic. I liked it and was encouraged to go in the field by the male nurses that I worked under. The stigma was broken as I realized that these were mostly battle medics from vietnam. (Except for one nurse who went into the field to get out of the hot rubber factory so he could have air condition). They were hard to work with but they made you learn your stuff. They were way ahead of the other officers and understood the enlisted mindset.

By the way, if you get a chance at a union pension. Continue to take advantage of the 401K's, 401K's and 403b's are IRS supplementals so you can have both the pension and your portable savings.

Originally, I was not in the pro-union camp. They did come to my aid when I needed them. In Nevada (particularly Las Vegas), the entire health care system is owned and run by for-proft hospitals. That is 9 hospitals by 3 corp's and they have not treated their nurses well. They would keep everyone underpaid despite having the largest nursing shortage in the country. Give you an excuse of "supply and demand" and tell you that they can't afford to pay nurses well. At the same time, they would brag about their high profit margins. If you did'nt like it you were told you could leave, however, they would try and make sure you could'nt go to the competitors by trumping up charges against you with the nursing boards. Even with the union contracts, they fail to abide by the fedral laws. However, the nurses are protected by law because of it. The union does provide good advantages for nursing: 1) Political organization skills are what unions are good at and nurses are not. The high school theorey of writing your congressman will only get your letter in the trash can. But strength and political access wil get you much further. (The dues are tax write offs along with your other nursing equipment) 2) At CHW where I now work at. We actually have a collaborative relationship and are the only private non-profit in the area. SEIU(Union) actually assisted in pulling the organization out-of-the-red. It gave the staff, more of a voice and makes us more competitive against our local for-profit competitors. 3)Nurses need to realize that the state hospital associations are not friendly to the objectives of the nursing association. We are outmanuevered here and need a more level playing field. The interesting thing that I learned was the ins/outs of the system. I did'nt know that over 50% of the hospital profits were from tax payer dollars. I also found out that the local high profits were funding the other hospitals outside Nevada with far less nursing shortages than we will ever see. 4) Collective bargaining units are exempt from recent overtime changes by fedral law. Nurses won't have to worry about being slapped with straight salaries as a cost cutting move by extremely proftable groups. It is not in the unions interest to put a company in the red. 5)The SEIU union never acts alone. It is managed by the nurses for the nurses. We stewards are their to make sure the contract is being followed. The nurses voted it in and it must be followed and respected by fedral law. The corp's cannot thumb their nose at fedral law on a whim like they often try to do here. In short, it takes a lot of resentment and desperation to get nurses to bring in a union. That resentment is only because of horrid treatment by the corp's. Now people are not worried about being fired over the accusations of a bad physician. It has improved our physician-nurse relationships at least psychologically on both sides. If your hospital treats you well without one-more power to you. If you are ever in Las Vegas, it is wise to be a part of one with a union (which is growing at astronomical rates) or get out altogether (like others have chosen to do). If we can't attract nurses to Nevada, we won't be able to maintain a already crumbling health system. Many nurses have found more profitable careers here outside of nursing where they can get paid more and are well respected by their new employers.

As a former service member, Ex-demo and ex-repub, I stay anti-partisan. I admit to giving Bush a big pass especially after the Clinton Administration as a matter of fairness). President Bush is the Chief commander. You don't have to like or dislike him. You can choose to respect or not respect him. However, regardless of one's feelings, you have to respect the position he occupies. Don't let your dislike for any president to interfere with your respect for the position. Do not fall prey to the political distortions of either side of the isle. If you choose to serve your country you are a definite patriot. Wars have no bearing on it. That is the mission we are given. We did'nt agree with vietnam, Iraq 1, Bosnia, Grenada,ect... As a nurse in the military, you are their for the troops to care for the sick and injured. You are also there to provide care for the civilian people caught in the middle of the war, and the enemy combatant (like us, is serving their country for similar reason) THIS DOES NOT INCLUDE TERRORISTS BUT YOU STILL HAVE TO DO IT OUT OF MORAL OBLIGATION! What is said politically is to be said behind close doors and not in public forums. The Military has evolved republican as the democratic party has shifted away to pacifism over the last 35 years. Like the democrats years ago, the republicans are now declining in the number of veterans who have served their country through military service. Don't let the war or our presidents define your willingness to serve our country. Your service alone will define you in an age when so few are willing to serve anything or anyone.