taj09

Julie, I'm sure you did what you had to do. I respect that you knew the limits of your ability to safely care for the people under your care. Unfortunately, it's going to continue to get worse. Come work in Texas where you have some recourse. Your state, Florida, participates in reciprocity with Texas. It is not too late to contact The Joint Commission about safety concerns and violations at your facility. Make a paper trail. Always email directors with your validated detailed concerns and mail yourself copies of your own and the replies you get from admin. https://www.bon.texas.gov/forms_safe_harbor.asp-Good luck! The Texas Board of Nursing's purpose is to protect the public, not the nurse

It seems to me that your facility has the problem. Joint Commission states that facilities must implement a standardized approach to HAND-OFF communications. It is a National Patient Safety Goal. Ineffective hand off communication is recognized as a safety problem in healthcare. Dropping off a patient without report and a accepting nurse puts the patient at risk as well as both nurses. I would approach the issue with this is mind. Some hospitals are more concerned about passing a JCAHO inspection than "patient safety". I just today had to fill out a survey at my hospital on our environment of safety and I think it might have been the 4th time in the preceding years that I have done the same survey, but would you care to know what has changed over the years? Absolutely nothing, sad to say. Regardless, every year I fill up the comment section, the only thing in my control.

"If you could do the same job for more money, wouldn't you?" The pay scale for nurses in my facility is based on years of nursing service and not education level. They are asking for BSN prepared nurses without paying them more money. ADN's and Diploma nurses with more experience make more because they have longevity. How can they expect this higher level of education (wall paper) in my opinion and strive for Magnet when they don't pay for the professional levels correctly?

I work full time in a mid-sized hospital in Central Texas in a cath lab where we are off some holidays and on call others. Our hospital lists Holiday benefits and recognized holidays with pay as New Years Day, Memorial Day, Good Friday, Independence Day, Labor day, Thanksgiving and Christmas. If we are "off" we do not get the holiday pay. If we work it, we get regular pay for time worked only. Is this legal that some people receive this benefit (admin) and clerical, et. al. but not nursing? How can they list this as a benefit when it doesn't apply to all employees? Anyone else run into this?

I'm sorry if my answer disappoints you, however, I can't imagine why any lab would advertise for a APN. A higher level of nursing care in the lab itself is not necessary because the MD is present and all decisions are physician driven. The job requires critical care nursing skills, the more experienced, the better. They are also expected to do other jobs below their level of ability and function as a team player. Even as a APN, if you do not have nursing experience in critical care, you will not have the knowledge or skill to respond immediately to the emergencies that occur in the cath lab. Most labs will not hire a nurse and train them, rather they want cath lab experienced applicants. The APN job should be a position working for a interventional cardiology group, helping them get the admitted patient's seen in a timely manner and assisting to discharge them so the lab can load more beds up. Now, perhaps there is a position where they are needing you to do non-nursing type work such as statistics, or other regulation paperwork but you didn't specify in your question.

To JoPACU RN, "Suggest you get studies to prove this as what you do is no longer standard of practice." So my question is what is the current standard of practice out there on elective cardioversions and whos standards are being followed?

Yes, I forgot to mention- we aren't a teaching facility and don't have the luxury of anesthesia standby. I just want input on the Boards Position Statement and the response from Risk Management.

I need some sound advise from experienced nurses regarding IV Conscious Sedation in the setting of elective cardioversion. In our Texas cath lab we perform these with the cardiologist at the bedside. We are administering the med-usually midazolam and mepheridine concurrently (never propofol). We are ACLS/BLS current, and have the reversal drugs at hand full monitoring equipment, etc. Problem enters with Texas BON position statement that "it is beyond the RN's scope of practice if the patient goes beyond the concept of moderate sedation" yet they admit that sedation is on a continuum and it is not always possible to predict how an individual will respond. We are actually rendering the patient unresponsive (deep sedation) to give up to 3 stacked shocks. So I ask the facility risk manager- her response was "as long as the physician is qualified to rescue an airway"... and is current in his qualifications we are "okay". So I ask who's responsibility is it to make certain the cardiologist is qualified (assuming it is the facility) and I haven't received a response. It's been 2 months now. Now I have been a critical care nurse for 16 years, a cath lab nurse for 7 years and know the docs. We haven't had any bad outcomes and I feel confident in rescue and sometimes feel like I can handle the situation better than the doc. So what are your thoughts on this?

h-e-l-l-o, h-e-l-l-o-, isn't anybody out there listening???? We need change, quickly or there won't be any of us left...........................

I've heard that (in Texas) nurses working in hospitals are held under a different standard of Wage and Hour Law Rules. Can anyone out there please explain this to me? We also go home, mandatorily on call and have to use our personal leave (vacation time) to make up for the shortened check at the hospital where I work. Does this have to do with being "on the clock"? I cannot discuss this with HR, or they perceive I am a "trouble maker" by questioning their rules. No I'm not totally paranoid....I have experienced defensiveness, without reason:confused: on their part in the past.