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azhiker96 BSN, RN

PACU
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azhiker96 has 10 years experience as a BSN, RN and specializes in PACU.

Married, three kids

azhiker96's Latest Activity

  1. The shutdown is not without long term negative effects. Rural hospitals are hurting. This one in southern Arizona is the only hospital between Tucson and Nogales and might shut down. https://www.azcentral.com/story/news/local/arizona-health/2020/04/04/hospital-southern-arizona-says-may-have-close-due-covid-19/5119264002/ I also just read that Threadgills in Austin has decided they will not reopen. Other small businesses and restaurants are hurting.
  2. azhiker96

    ICU Nurse Fired For Refusing 3rd Patient

    I have refused a new admit in PACU three times because it would create an unsafe staffing. I could have been fired but taking the patient would have put the patient and my license at risk. It also would have violated national standards by ASPAN. We need national safe staffing laws. I hope she is able to get a tidy settlement.
  3. azhiker96

    Giving Narcan to Your Own Patient

    Good experience. I've seen patients go apneic from 2 mg of Morphine and had pt's ask for Benadryl after a 6mg Dilaudid push. Individual patients respond differently. I would second the comment about a lower dose of Narcan. In the field or ED with an overdose pt it makes sense to give the full 0.4 mg amp. In PACU I usually titrate in 40 mcg doses or 20 mcg if peds. I want the patient breathing, not screaming. With my docs I can ask for a lower dose, and generally get it, based on my assessment and judgement. Narcotics should be titrated to effect but I know the Joint Commission don't seem to want or respect nursing judgement. Glad I work at a facility that uses DNV instead. In PACU I have several PRN meds for pain and give them based on patient history and response.
  4. azhiker96

    Supervisor Asked Me to Falsify Records

    Depending on how hard your supervisor pushes this issue I'd also consider calling the compliance hotline or filing a Midas report. You should never be asked to document medications or treatments you did not give or perform.
  5. azhiker96

    Federal Marijuana Ban Lift Effects on Nursing

    I don't think disability discrimination comes into it. People with chronic pain can legally take narcotics with a prescription. However, BONs and employers don't allow nurses to work while under the influence of narcotics.
  6. azhiker96

    Verifying Medications in PACU

    We give the meds the patient needs. I know pharmacy reviews the orders as quickly as they can but for the good of the patient I don't wait for that to occur. We have an EMR but also the ability to pull any medication for our patients. As a critical care area I think that is vital. I understand the hospital wanting the pharmacy check on whether the med, dose, route, etc is appropriate but when my pt has room temperature BP, stridor, severe bradycardia or any other life threatening condition I am not going to wait for a pharmacy sign off.
  7. azhiker96

    Murphy's Laws of Nursing | Life of a Nurse

    If a patient is a hard stick either: A. Get a call from the lab that it is hemolyzed. B. The doctor adds on another lab 15 minutes later that requires a new draw. Never try to influence which patient you get in PACU. If you do the Karma of the PACU will slap you around. The ICU pt you ducked will be awake, stable, and pleasant. Status is just precautionary or for q hour neuro checks. The simple lap Chole you get will arrive with room temperature BPs, severe sleep apnea, and when finally awake 10/10 pain and throw up on you. The sickest patients are admitted on days with low staffing.
  8. azhiker96

    What do you like most about your specialty?

    I love PACU. It has the right balance of autonomy and teamwork for me. I get a pt and a slew of PRN orders which I apply based on my assessment and judgement to stabilize and normalize my pt. If things head south, I can get lots of help pronto. If I need something else I can call the Dr/CRNA and get an order. It is not for everyone. You must learn when you have to watch every breath and when you can relax a little.
  9. azhiker96

    What's your best 'Nurse Hack'?

    Advice I received when I was in nursing school, "Our patients survive in spite of what we do to them." You will make mistakes and see mistakes in care. Always let the doctor know and them resolve to do better in the future but don't beat yourself up too much. I've come up with a corollary, "Some patients will die despite our best efforts." We started a trauma OR case with compressions and epi. Even though we regained spontaneous perfusion and controlled bleeding the pt soon passed away from a herniated brain stem. I keep a small sheet on each Pt with relevant information on it; allergies, Hx, meds given. That is handy when a doc walks up and wants to know recent pain meds. Also, when I'm ready to call report I add the current vitals and can then call from any phone on the unit and give a good report to the floor RN. After the pt leaves my note goes in the shred bin. Sure, all that info is in the chart but it's a lot faster to have it at my fingertips.
  10. A very sad case and I bet it is not the only instance at that facility. There had to be some reason the family felt compelled to set up the camera.
  11. azhiker96

    Family keeping Information from the Patient

    You might look at nursing theories and relate how keeping information from the patient is either in line or in conflict with the theory. I like Jean Watson but there are many and your school may have a favorite. Consider that keeping information from a patient includes deception. After all, what do you say when the patient asks directly about their test results, diagnosis, prognosis? I don't know if anyone has done a study. You may have more luck finding articles using the search words withholding and dying. Here is an article from an oncology journal. When the Family Requests Withholding the Diagnosis: Who Owns the Truth?
  12. azhiker96

    PTO granted

    Requesting PTO a year in advance is ridiculous. I barely know what I'm doing next month. We can put in requests up to 6 months in advance but the deadline is two weeks prior to the next schedule. Granted, you have a better chance of approval the earlier you enter a request. I often don't know about events such as concerts, festivals, or workshops until a month ahead of time.
  13. azhiker96

    OT

    Salaried employees are called Exempt because they are exempt from the fair labor standards law. When I was an engineer working in semiconductors a typical week was 50+ hours and I could be called on nights and weekends. I once received written discipline for being out of reach wilderness camping on a weekend and a piece of equipment failed. That is a big reason why I switched to nursing. Some employers will give time off to exempt employees in exchange for extra time worked. On a big project, my wife has received calculated hours extra pay for working extra at her salaried RN position. However an extra hour here or there is just part of the job.
  14. azhiker96

    Nurses with children always go home early?

    I guess I've been lucky. The places I have worked ensured holiday signups were fair. People could switch or try to find someone to take a shift if they liked. Going home early is tracked so that we share the wealth of a bonus day or half shift off. I have seen people get off early to handle the unexpected; a sick child, sick pet, spouse in a car accident, water heater leak, etc. Other RNs pick up the slack because in general our coworkers are our friends. Also we would want similar consideration. I did have one coworker who would frequently ask me to cover a call shift because her family included small kids. However, she would never cover a shift for me. After the second time she declined to cover a shift for me I stopped agreeing to cover her call shifts. One time she asked me why I couldn't cover her call shift and I said "I have plans." She accepted that but had she pressed for details she'd have heard my plans were to eat supper with my wife and get a good nights sleep.
  15. azhiker96

    PACU Standards - 2 RNS

    I did some PRN at a facility that expects the noc RN to cover by herself unless it was a particularly unstable pt. They told me that during the interview and said I might cover nights occasionally. I saw a copy of the ASPAN standards book in the room and mentioned that I was certified, was familiar with the standards, and would always practice at or above the minimum standard. When I covered nights I did call in a backup RN and never heard boo from management. If they had tried to press their point my plan was to do a Midas about being told to work outside of published national standards. A Midas would have been reviewed by risk management and I'm pretty sure they wouldn't want to see something like that documented. It never came to that. Granted, they could have let me go but they didn't. Also, I was a bit bolder because it was not my primary employment. My main job believes in and works within ASPAN standards. I made sure of that when I interviewed years ago. Bottom line, if I worked without a backup and there was an incident ( emesis with aspiration, desaturation, code, etc ), the hospital and I could be seen as negligent. It would be a personal injury lawyer's dream. I will not risk my license, my assets, and my livelihood so a hospital can save a few dollars.
  16. azhiker96

    Emergency outside of work

    I have stopped and aided at several MVAs, especially when I'm there before Police/Fire/EMS. I work in critical care and maintain certification in TNCC as well as other certifications. However, without a bag of supplies I can really just help stabilize C-spine, support airway, apply direct pressure, etc. Every little bit helps though even if it is just keeping a dazed person from wandering into traffic as I did one time. However, I'm happy when EMS arrives so I can give report and leave them with someone who has the equipment to intervene. Also, I don't stop every time. Sometimes I do a 50 foot assessment and can see someone is not in acute distress and should be fine standing with a small crowd milling around talking on their phones.
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