psnurse

Well I guess it would depend on who you ask. But since you are asking me, the ER is the only place I want to be. Went to nurse practitioner school to be a ER NP. I worked critical care before coming to the ED but found that the ED is the place that felt the most like "home". If it is ok to call it that. I went on a float the first time and was quite nervous, but everyone was very helpful. I had such a good time that I floated every night until I was eligible to transfer and then I did. I have always found a great team sort of environment. That might have to do with the fact that one doc cannot see the number of patients needing to be seen right away by himself. So there is some reliance on the judgement of the nurses he/she is working with to do what needs to be done. It is not a place for the faint of heart. You will most likely do things and get the order later more than once. But there is one promise I can absolutely make to you...... You will never have exactly the same day twice in a row. Good luck!!

I think it is a great idea. It is already happening. I am sure the AMA is whining about it, but it is happening anyway. I hope to attend one of the programs and have been investigating. What would be wrong with nurse practitioners having increasing autonomy? Many of us practice autonomously anyway and it would eliminate another ball of red tape. I am all for that. Of course, there are then 50 states to be convinced that a completely autonomous practice for NPs is a good idea. That probably would not occur until long after I am too long to run those ED halls.

I have been an ED nurse for awhile and recently started my first NP job in the ED. I don't have great websites, but I did find some really helpful books on the ACEP website. ACLS and PALS is also available these days online. I went to the AANP conference this past summer and they had some good hands on learning sessions such as chest tubes, central lines, arthrocentesis, ect. I love working in the ED and hope you enjoy it as much as I do.

Interesting. I hadn't really thought about this topic until just now. I will finish my MSN for FNP in August 2004. I haven't caught anyone referring to me in any proprietory way. I haven't heard anyone refer to my FNP clinical preceptor in any proprietory way. Her patient's just love her, and a couple apparently think I am ok too because they make their appointments on my days. My second clinical site is in the ED where I am also employed. Everyone is very respectful. My friends tease me about being the doctor today, but that is all that it is. One of the teasers has enrolled in an FNP program and another goes to an info session this month. Perhaps I inspired them in some small way and THAT is truly a compliment.

Should nurses be allowed to strike? Absolutely! This is a personal choice each nurse must make. When the choice is made they must also be prepared to live with the consequences this may cause in their life. You see, I am currently a scab. Not by virtue of working for a company that supplies nurses to hospitals when a nursing strike occurs, but because I continue to cross a picket line where a number of our nurses are on strike. I would do it again. I hear the complaints and I have objectively looked at them. I find the complaints to be invalid. It took almost a year for the complaints to be uniform across all the strikers. Before that it was a collection of personal agendas. The contract proposals are so transparent you can almost tell who suggested them. I listen to the mantra of collective voice and have to chuckle to myself. How in the world is splitting the nursing voice between competing unions a collective nursing voice? It seems almost comical. Besides, the lack of voice is not really the problem I perceive, a lack of knowledge about how to efffectively use the voice nursing has is the root of the problem and not likely to be solved by union tactics. As I said, a nursing strike is in progress where I am employed. From experience, this strike has done more to divide the nursing voice than one could hope to repair in a lifetime. The crux of the matter seems to be union security. Don't laugh they actually admit this. I don't see how this has anything to do with patient care or working conditions or nursing. That issue is purely about the union. The way I see it, the constitution provides for freedom of association, but if the freedom to refrain from association is not also implied, freedom of association itself is a worthless tenet. Good luck as you debate this matter. I have undertaken this as a thesis project.

After 10 years, I still don't do snot. It isn't the trach thing that bothers me, the ET tubes are ok. But let someone actually spit a specimen into a cup and I lose it. This was confirmed the other day in the ED when a patient was coughing on arrival and someone handed him a cup. I looked up and found the snotball sitting there on his lower lip and had to excuse myself gagging all the way. But this is improvement. I used to suction ET tubes and trachs with a trash can at my feet.

Yes diabetic neuropathy causes pain. Sometimes severe pain. Neurontin can be helpful. But if not narcotics are indicated. Research shows that tolerance to narcotics may begin to develop as early as 2 weeks after regular dosing. The sustained release narcotics allow for better pain relief and better functioning during the day. MS Contin 30 mg twice daily isn't an extraordinary dose. The patient will invariably be titrated even higher before it is all said and done. I would suggest a pain clinic if one is available in your area. These practitioners are most helpful to manage chronic pain, such as pain associated with diabetic neuropathy. There seems to be confusion surrounding the ideas of physical dependence (which someone chronically taking narcotics will develop), tolerance (which will also develop with chronic narcotic use), and addiction (which is a physical and psychological phenomenon). This confusion often results in people taking narcs for chronic pain being labeled as addicts. Oops, got up on my soapbox for a minute. I have to add.... How realistic is it to allow tolerance to go this far? Quite realistic.

I am confused about IV push meds and IV certification. Where I live only LPN's are required to have an IV certification. Even after that, they still can't push meds. So if this is the case, the preceptor is requiring something outside the scope of practice which would need to be addressed.

Ok... I have read about writing the reason the provider says you should be off on the excuse. I disagree with this and would require a new note with simply the date I could return and any applicable restrictions. We are bound to uphold confidentiality with regard to our patient's records. Why don't you expect your own medical care to be confidential? The exact nature of interaction with my health care provider is on a need to know basis. Unless I am at the office for a work related reason, my employer doesn't need to know.

The IV Nurses Society is probably where this originated. At least that is where they point when we ask about this policy. And how to tape your IV is a policy where I work. No tape under the transparent dressing. Can chevron outside the transparent dressing. Have no problems with them falling out.

It is worthy to note, we had very few call ins on the weekend. People would come to work half dead to avoid making up the time. Not sure this was the best way to do things, but it was effective.

Where I work now, there is no policy regarding weekend call ins. Sometimes they are a problem. Where I used to work, it was policy that you made up the weekend time. Not necessarily the next weekend, but sometime in the future. The nurse manager kept a list of who called in on what weekend day. She would plug you into the schedule when she needed coverage and mark the weekend call in to be made up off the list. Once I found myself on an extra Saturday night. I asked why. So she showed me the list where I had a Saturday call in 6 months before. Was time to pay the piper.

Yes hoolahan, The points system is a nice thing if you are requesting off. It eliminates all those nasty little conversations about who is who's favorite. The other side of it doesn't make everyone as happy. This same point systmen is used to decide who goes home on adequate staff time if no one is requesting off. Again, the most points wins. So in that way, it might not be ideal. Those who love to pick up extra time don't always want to go home, even if it is their turn. But let's face it.... the above situation almost NEVER happens. There is usually at least one person willing to go home early or take an unplanned day off. But it is all written down. It is systematic. And everyone knows the rules in advance.

Here is another question that has plagued me for quite some time. What about those 11a - 11p people? They are on shift for 2 ordinary people meal periods. Are we saying that they are entitled to only a meal before work and one during their shift?? I guess the same is true for 7a - 7p, but the period they are on after the normal dinner hour is shorter. Are we saying you should have breakfast, come in at eleven, take a late lunch, and then not be hungry again until midnight when you get home. I think this is ridiculous. I have occassionally worked this shift, but attempt to avoid it on a regular basis because it seems that this is the expectation. One of the charge nurse where I work recently proposed, as a measure to be sure everyone gets a lunch break, that food be delivered to the unit and people eat in the break room where they were immediately accessible. I blew my stack. My break time is MY time to do with as I please. Covering my breaks is an institutional responsibility. Instead of trying to make things easier for the institution, why are we not demanding the same consideration other workers enjoy?? I will take my break, and I will cover for others to take a break. Do whatever you want on your break... stand on your head in the corner, grab some local fast food, pick up a prescription, or dance the hula... I don't care. It is YOUR time!!!

I will attempt to explain how we do holidays, but it gets complex. So if I stop making sense....... well you will have to ask questions. We maintain a holiday rotation list. Everyone is required to work every other holiday (our facility recognizes 6). So usually what happens are the holidays are overstaffed BIG TIME. So the scheduler can go by seniority and start asking who wants to shift their holiday to another day during the week. Usually there is enough takers, these people work another day during the week for holiday pay (2 1/2 times). If you are not one of the ones who has been there since the cornerstone was laid, you can request off. This is handled on a points system. The points are maintained by the staffing office. If you come in extra you get points, if you stay late you get points, if you go home because of overstaffing you get points. Get the picture. The one requesting off with the most points wins the prized day off. But you never know until the day and the unit needs are evaluated. The regular charge nurses work every other holiday but....... Our relief charge nurses get this perk.... they only have to work 2 holidays per year to everyone else's 3. And they ask me why I do it!! The relief charge nurses also get to choose which holidays they wish to work. Last year I was to work July 4th and Labor Day. However, since the facility pays 2 1/2 times for holidays, someone usually wants the money more than me, so I traded off July 4th, and requested off Labor Day. I had to work 8 of the 12 hours on Labor Day, so I worked 8 total holiday hours all year. I was off Thanksgiving, and will be off Christmas. Was to work New Years, but am going per diem, and our per diems have no holiday requirement or weekend requirement. This discrepancy between the regular charge nurses and the relief charge nurses may seem unfair, but our regular charge nurse traded holiday deal to keep from working any weekends. Also Christmas Eve and New Years Eve, and the Friday after Thanksgiving are not considered holidays and no one is required to work them are part of any holiday rotation.