mced

Duct Tape...heals anything, holds everything.

Rabid Badger, What you are stating as your job description is what many nurses that work in modern day Medical/Surgical, Telemetry, and ICU stepdown units deal with continuously in the United States. It is a hard job, but people with adequate orientations and preceptorships negotiate these tasks and other complications each day they come to work!

Dude, Benner's Novice to Expert Theory is exactly that, A THEORY. Below are some publications that back up actual practice. New graduates with adequate orientation programs and preceptorships function and survive in a critical care setting without increasing M&M to the patients they care for. Almost everyone I am in school with now went straight in to critical care after graduating from their nursing program. None of us had any trouble functioning at a competent level after completing an orientation and preceptorship program mentioned above. Though my statement only speaks for a small number of nurses (n=19), the articles cited below show that when applied nationally, these programs work. Ihlenfeld, JT. Hiring and mentoring graduate nurses in the intensive care unit. Dimens Crit Care Nurse. 2005; (24) 4 175. Lindsey, GL. & Kleiner B. Nurse residency program: an effective tool for recruitment and retention. Journal of Health Care Finance. 2005; (31) 3; 25. Nibert, AT. New graduates a precious critical care resource. Critical Care Nurse 2003; (23) 5: 47. Reising DL. Early socialization of new critical care nurse. Am J Crit Care. 2002;11: 19-26. Seago, JA. & Barr, SJ. New graduates in critical care. The success of one hospital. J Nurses Staff Dev. 2003; (19) 6: 297-304 Thomason, TR. ICU orientation and postorientation practices: a national survey (Intensive Care Unit). Critical Care Nursing Quarterly. 2006; 11: 237

"no brand-spanking newbie nurse is going to be ready for the full on assault that is our tertiary care ICU wards. It would simply be unsafe". Are there any solid nonbiased studies that back up these kind of statements being made on this thread? I have not been able to find any.

I guess it is a good thing you live in Canada then.

Focker got the poison gimmick. Sugammadex is an upcoming drug. Basically it is a cyclodextrin that specifically encapsulates aminosteriods such as rocuronium, vecuronium, and to a lesser extent, pancuronium. It completely reverses paralysis regardless of the patient's twitch response. There is a professor in my program that has done a few lectures on this product. Hopefully will be out for general use within a year or so.

Law III: At a cardiac arrest, the first procedure is to check your own pulse. Things always run smooth after doing this!

Rat poison (coumadin) takes longer to reach a therapeutic level than lovenox. Once her INR is around 2-3 they will probably d/c the lovenox. In the meantime the lovenox helps to prevent any further clot development.

Anticholinesterases aren't given by CRNAs in your OR?

300 patent: 2.560.237, ESRD dude

Not all schools require a BSN but, you do need a BS in something before you can apply.

It has always tasted good to me, try washing it down with some acetylcysteine. Kayexalate is a good mixer too, but is a little counterproductive.

I think you are putting too much thought into this. If the patient is in distress, you will know.

I have heard that is should be available for general use within two years. Looking forward to its arrival. Giving someone poison to reverse paralysis seems a bit odd.

You are worried about "fatigue" from nursing at 21????? Before going back to school my routine was to work 3-4 consecutive 12 hour shifts a week and solid partying afterwards. Most of the younger guys I worked with followed this routine. Only old people are allowed to get this... "fatigue".

Get a job working as a tech PRN. You will make more money and can schedule around tests and clinicals. The best part is that you will be able to directly apply what you are learning and develop basic nursing skills, especially if you work in the ED. Makes school much easier.

Sounds like another excuse for the federal government to take MORE of my money. Really inspires me to work harder.

I'd be willing to bet you patient was hypoxic as hell and you perceived it as anxiety. With an Spo2 stat of 82 percent what would be worse than withholding oxygen besides applying a pillow directly to the face. Co2 does not regulate respirations, it is hydrogen ion concentration. If these gomers need oxygen you have to give it to them to atleast crank the Sp02 some where into the A minus percentile.

There are always two sides to a story. You are presenting one side. If your "auntie" is as upset about this as you certainly seem to be, then she needs to take her argument to someone relevant to this dispute. Someone such as her boss.

How about the patient's failure to take responsibility for their own actions. That is our facility's major problem and unfortunately there is not too much that can be done about that.

I don't care who you are THAT...is funny!

I find it interesting that you say an RN has no place in maintaining an airway. In the trauma center where I am currently training as an SRNA, the CRNAs are the ones the paramedic students come to when learning how to intubate. This is because the CRNAs are the anesthetists responisble for providing the majority of all anesthetics given at this facility. Sometimes it can be quite amusing observing these guys, kind of like watching a monkey bang a football. I believe you were right, you really can train a monkey to intubate!

Suggestions on alternatives that might have worked for the next time this happens? I totally HATE not having an airway- we spent 2 hours. pH7.04 and PCO2 162 when he left- he seemed to be exhaling into his belly! Sats stayed in the low 90's with bagging so I certainly got a demonstration of how the SpO2 can be misleading that night. What about a retrograde intubation?

I thought that the responsibility of an emergency department is to stabilize emergencies. Someone with a blood sugar of 300 and no ketones does not sound like an emergency. It sounds like a primary care or endocrine issue. Further more, starting intravenous fluid loading to protect the kidneys in an admitted patient whose dx is hyperglycemia, seems like a safe and responsible order to be started in the ED. Giving boluses of intravenous insulin and causing sudden abrupt shifts in glucose can be very BAD for the brain in someone with a CBG of "800". That is what the ED practitioners leave to the admitting internist to solve. That is also why your cardiac floor will often initiate these insulin gtt orders.

I always give patients like this the standard Virginia Henderson response. Nurses do for the patient that which they cannot do for themselves. Example: If they cannot breathe, we will breathe for them. We are not there to provide for their every need. We are there to assist and help them recover back to a point where they are doing as much for themselves as possible.