Bruce RN

Although I haven't worked in an area that employs LPN/LVN's in a long time, I have to say that for someone to speak for all RN's and to say that we feel that LPN/LVN's are "useless" from our "point of view" is a little harsh and somewhat distorted. From speaking to the med/surg floor nurses that I often bring patients to, I can tell you exactly what the "reality" is: The concern in CA is not about how useful the LVN role is, the concern is in the language written in the CA BNE Nurse Practice Act and how RN's end up being responsible for an LVN's patients, from a legal standpoint. An RN can end up being legally responsible for 10 instead of 5 patients, for example, when assigned responsibility for an LVN's patients. There is a lot more to patient care than IV's and initial assessments and the fact that CA doesn't want LVN's completing these tasks hardly makes them useless. Rather, it's time for CA to begin to re-examine the LVN role in patient care and how some modernization and updating in old school thinking can help to alleviate CA's nursing problems. Many other states allow LPN/LVN's to start IV's, hang and even push many IV drugs, central lines, etc. and patients are not dying in numbers simply because these tasks aren't being performed by RN's.

I have lived around alcoholics and fully agree about the selfish behavior and only thinking of "I". It irks me to no end! I also noticed a couple of posts commenting about how they had relatives that are alcoholics. You can't let your own personal experiences cloud your judgement. I just picture a board of nursing consisting of nurses who are bitter from having alcoholic parents or spouses and therefore, take it out on licensees in an effort to get back at some alcoholic who did them wrong in the past. Shame them all you want people. You're turning your back on a whole mess of nurses. If you think that any of you aren't working with some impaired nurses right now at your place of employment, think again. It took me a long time to forgive people who had substance abuse problems in my life. But I learned that being angry and trying to punish any current substance abusers who cross my path is never going to make me feel any more whole or better. I was only fooling myself. Taking a nurse's license away and putting them in jail isn't going to make someone's miserable childhood memories any better. Again, I ask, why are so many nurses experiencing these problems? Am I the only one disturbed that our fellow RN's and LPN's are getting DWI's in numbers?

I'd like to add that the OP doesn't need to be judged or shamed any further than what has already happened. Telling her that she could have gotten into an accident with a car with a baby in it isn't helpful, IMHO. It just adds more shame and stress to an already bad situation. A baby's life isn't any more valuable than if she were to have hit a 45 year old pedestrian while driving drunk. Many, many nurses have had DUI's. And many, many more have never had one but should have because they've driven drunk on plenty of occasions but were never caught. I'm sorry, but I've read too many comments here that have a high brow tone to them and are literally shaming nurses for getting DUI's, yet so many nurses have had them. The number of threads started about the subject alone is evidence to that. Instead of judging and shaming nurses who have gotten them, why are we not examining why so many nurses (or nursing students)are getting them in the first place? I have a feeling that it goes much deeper than bachelorette parties and simple momentary lapses of judgement.

I can't speak to your comments about your friend in medical school because I'm not familiar with the requirements, but even if that is the case........ Does that make it ok to lighten requirements for CRNA school because some med school did the same? Are we, as nurses, here simply holding our breath waiting for a medical school to define who and what we are, define our requirements, and bowing down just because they did the same and that we should shadow them simply because they are a medical school? We've all worked with way too many bad doctors to allow medicine to define what we are and what our requirements should be.

Although I would consider this to be excellent advice to the OP from an actual CRNA, I can't help but feel the need to remind all of you who are critical of the original inquiry that this is coming from a brand new grad, not one of your seasoned vet peers, and to keep that in mind when responding. I know that when I was a brand new grad, I was very unsure of how much I'd learned in my basic nursing program and equally unsure about how I was going to put it all together and apply it "in the real world" of hospital nursing. Even though I'd made it through graduation, jumping through hoops from one clinical rotation after another, reading tons of chapters and passing a multitude of exams, I still wasn't sure if my nursing program adequately prepared me for the RN role and I had much anxiety about how well I'd perform as a nurse. A new grad is not yet at a stage where they are able to truely realize and appreciate what they've learned and it is very common for them to have doubts about how much they've actually learned and/or how useful this new knowledge will be to them. Certainly we all agree that to bipass the BSN, dismissing it as inapplicable to CRNA education, and make CRNA programs direct entry associate degree programs, or allow anyone with a bachelors in anything, be it business or arts, to enter a CRNA program, would be unimaginable. The OP, IMHO, was just attempting to make sense of, and find a connection between basic nursing education and CRNA level education from where they are standing right now as a new grad BSN.

In addition, this whole thread is just another example of why visitors shoudn't be allowed into the PACU in the first place. The fact that there were two visitors, visiting adult patients recovering from seemingly normal surgeries, one of which was apparantly still quite anesthetized (very inappropriate for a visitor to see any of that) who overheard conversations (again inappropriate for privacy reasons, PACU is all one big room, visitors should not be in there to have the opportunity to listen in on conversations) is really what bothered me the most.

I agree. The breakup was most definitely not her fault. However, giving out opinions and unproven theories disguised as fact, when the employee was dressed in scrubs and employed in the PACU, put the family member in a vulnerable position and she most likely bought the story about people not being able to lie while under anesthesia simply because the person telling her that was dressed in scrubs and working there. Very irresponsible regardless of whether the employee was an RN, LPN, CNA, or housekeeper dressed in scrubs.

I respectfully disagree. She most certainly did plenty wrong. You don't have to watch everything you say just because someone will report you. You must watch everything you say in front of patients and family members simply because every morning or night that you wake up and put on those scrubs and nametag that flashes RN, LPN/LVN, CNA, lab tech, RT, EMT-P, or whatever, many people will take what you say very seriously and it could hurt them, as in this situation. That wife was taking for granted that since the woman talking to her in scrubs worked there, she was a competent and knowledgeable source of information about anesthesia and had no reason to believe otherwise.

I totally disagree. She most certainly made inappropriate comments and did plenty wrong. As much as we've all encountered patients and family members who think that they know more than we do about nursing, medications, etc. the vast majority still take what we say very seriously and when you get up in the morning and put on those scrubs and nametag with RN, LPN, CNA, lab tech, etc. after it, many people will assume that what you say about medical related things are completely true and would not question it.

I agree that whether or not he was cheating is not the issue either. I also agree that the wife was sneaky and inappropriate in her methods of probing her husband while he was coming out of anesthesia. My post was responding to your saying "the fact that he was cheating" when in fact, it's not a fact simply because he said that he was doing so while under the influence of anesthesia. What people say while under anesthesia cannot be taken as valid testimony. I will disagree however, with your labeling the nurse's statements as "an offhand comment." Her comments were highly inaccurate and based on no real evidence or research and it hurt both the patient and family. As licensed nurses, we cannot go around making such "offhand comments" because many lay people will take what we say about things like medications very seriously. No nurse who ever went to any reputable school of nursing (let alone an actual PACU nurse - for crying out loud) has ever been taught that people are "completely incapable of lying" when they are under or coming out of anesthesia and therefore should not say such things unless newer evidence and research has been done to prove otherwise. If she was a nurse who normally did not deal with anesthesia in her practice setting, and she "heard" rumors or stories about anesthesia making people tell the truth, then that would be the time for her to start doing research of her own on the subject. And until she could find any solid info on it, she should restrict her underproven comments to her co-workers in the breakroom who as licensed health professionals, would not take her comments quite as seriously as a family member would.

That's a matter of opinion and you will get a lot of varied answers here as Texas cities often rival one another. My answer as a traveler and a TX resident: San Antonio has cheaper housing, but the nursing salaries are lower than Houston to go along with it. So I really couldn't answer the million dollar question that people always ask as to which city you'd be more financially better off living in. Weather- Houston is hot and very humid most of the year being so close to the gulf. SA is just plain hot, not quite as humid as towns closer to the water. SA also gets less rain than it's coastal neighbors as well. The two are very different cities culture wise, and I'd recommend which one was best for a person if I knew their personality and circumstances better. SA is definitely the more quiet of the two. If you need a lot of nightlife, clubs, entertainmant, shows, art, etc. SA can get boring real quick and Houston by far is a lot more happening. However, if traffic, smog, and miles of skyscrapers aren't your thing and you need a city more smaller scale and livable, then SA is the way to go. I really love both cities but for different reasons.

But is it really a fact that he WAS cheating? Simply because he made those statements while coming out of anesthesia? I think that a point is getting missed here and that is that the theory about anesthesia being some powerful truth serum that compels people to speak the truth is a highly underproven and controversial science at best, and little more than a myth at the very least. Often times, the truth comes out when people have had enough alcohol in their systems, that does not make alcohol a truth serum. Impaired judgement from anything, be it alcohol or propofol, can make people say and do things that they wouldn't normally do, it doesn't make their statements any more true. If anything, his statements are even less credible due to the fact that he stated them under anesthesia. I hope that wife doesn't have any big dreams about using his statements in the PACU as her ticket to some big divorce settlement because that "evidence" will be laughed right out of court. And no matter how one wants to divide up the blame for what went on in the PACU that day, whether or not the nurse is responsible for ruining someone's marriage, she still gave out very misleading and even outright incorrect information to the family member about the effects of anesthesia. Not only are the nurse's statements so ignorant to the point of embarrassment to be coming from any PACU nurse, i.e. "You know, you can find out anything from them when they're coming out of anesthesia. They are completely incapable of lying....." but it was also very irresponsible and caused the wife to genuinely believe that if you pump someone full of anesthetic agents, they will spew out nothing but the truth. She probably could have gotten the same information out of him by getting him drunk enough on a given evening.

Your solution is not a bad idea at all so please don't think that I'm cutting it down. I do not, however, believe that nurses should be resorting to such tactics as dating diapers just to prove to a family member that we were in the room 15 minutes ago. Instead, we need to be addressing why visitors are allowed to act this way at all in the first place. A lot of the disruptive family/visitor behavior that I've seen over the years would cause me to be arrested if I were to act like that to a flight attendant on a plane because I didn't like the food served. Or if I screamed and pounded my fists on a hotel front desk to a hotel clerk the way I've seen many visitors scream and pound fists on a nurse's station, I'd be escorted off the property by hotel security and not allowed to return. Let's say I abused the flight attendant and hotel clerk because a close loved one is dying and I'm having trouble dealing with it. Does that make my behavior acceptable and/or excusable? I have a dying loved one, so now I'm no longer responsible for my own behavior? Like a few others here who mentioned it earlier, I too, am tired of nurses placing diagnostic labels on family members in an effort to excuse their behavior. "Poor coping skills" and a few other labels only go so far before the behavior can no longer be excused and should not be tolerated.

I have to disagree with at least some of this. There most definitely is such a thing as telling too much info to visitors and I must admit that I've been accused of doing it by my co-workers on occasion. You are right in that family teaching is a part of our job, but I think that the teaching that Bahamagirl was referring to was with respect to hemodynamic monitoring. A family member being taught that this bag of medication that I'm hanging is to help maintain their loved one's blood pressure is appropriate family teaching. Going into the details of hemodynamics, waveforms, etc. is not appropriate and can lead to a lot of trouble. You can give any family member a crash course in hemodynamics, rhythm interpretation, or what have you. However, they are still lacking in the knowledge base and experience of a licensed nurse and their new-found skills in reading/interpreting what the monitor is saying can, and all too often does, quickly lead to very well-meaning, yet very unnecessary and inappropriate drama and worry. Artifact on the monitor could be interpreted as V-fib to the undertrained and inexperienced family member who then starts screaming into the hallway for help. Same goes for a flat line that resulted in a lead falling off. Both of those situations happened to me personally simply because I was telling family members way too much as a newer nurse. As far as asking every question that one deems necessary goes, I'm not really clear as to how assertive or perhaps even agressive you may be to the staff as a visitor, it might just be how I'm interpreting your post and what I'm about to say may not be you at all, but this is a little of what I got out of it: Badgering nurses with a multitude of questions whenever they walk into the room or while they are trying to give meds, etc. can be a very intimidating and frustrating experience. Making it known either outright or perhaps more subtly that you are an RN and are "watching" them to make sure that no errors are occurring does little more than make the staff dread your presence and therefore, dread even going into the patient's room at all. This is not a good way to ensure that a loved one is receiving the best care possible. I believe that the quality of care actually goes down and mistakes may be even more likely, even by the most competent of nurses once they get the feeling that their every move and nursing skill/technique is being watched and questioned. Well-meaning questions can take a lot of time and attention off the patient and instead be placed onto the visitor. This does not improve care or patient outcomes.

Every hospital I've worked at in TX hires their new grad interns as graduate nurses (graduated from their RN program but not yet taken the NCLEX). Most of the time you will sign an acknowledgement that your continued employment is dependent upon passing the NCLEX. If you don't pass the NCLEX, you will be removed from your internship position. Oftentimes in this situation they will place you in a nursing assistant type of position until you take the NCLEX exam again. However, not all hospitals are willing to do this so you need to be aware of that when deciding to move to San Antonio. I would continue with your plans if I were you. You should be able to get a position and get settled in time. SA is a great city and most people that I've worked with on my assignments seem to be happy living there.

I can tell you first hand that this hospital chain most definitely varies by location and buyer beware. I worked at one years ago on the east coast. I liked my co-workers and managers so much that I renewed my contract several times causing me to work through winter (and normally I never take any winter assignments up north where it snows.) Anyway, it was starting to get cold again so I decided that I needed to get an assignment farther south. My agency offered me a contract at one of their Texas locations and I jumped on it since I had such a great experience at the first hospital. Like night and day! The Texas hospital was awful. The administration was literally a reign of terror and reported people to the board and that "Group One" thing left and right. I worked in their ICU and their vent unit. In the ICU I often took 3 patients rather than the typical safe ratio of 2. In addition, they often "floated" in staff with minimal or even no ICU experience at all so they were heavily relying on me for help with their patients as well. On the vent unit, I typically had a 6-7 patient assignment. All 6 or 7 were on vents and total care with nightmare families to boot. The CNA's easily each had 12-16 patients to bathe and care for. Almost every day I saw their "case managers" giving tours of the unit to family members of potential patients. They would lie and say anything to fill the beds. Many times I heard them say to family members that each nurse never had more than 4 patients and the CNA's never had more than 8. I was certain that those case managers had no conscience and sold their souls to the devil for that job. So just be aware and approach with caution when you see so many job openings at some of these specialty hospitals.

Hurricane season has officially started and although I'm currently far away from hurricane country, I'd like to find out how Gulf and Atlantic coastal hospitals are handling the possible threat this season and if any of you are working at a hospital that has since either learned it's lessons from Katrina and/or Rita and is changing it's policies and procedures or if nothing has changed at all. The closest I've ever come to this situation is when I took a PACU assignment shortly after Rita at a teaching hospital that absorbed many displaced anesthesia students and residents from Katrina ravaged New Orleans. Those anesthesia students/residents told me some of the most horrific stories of the things that went on in those hospitals after the storm. Their stories were bad enough to frighten me from taking any future gulf coast assignments between June and November. I guess that in the past I was always naively under the impression that hospitals who were literally in the line of fire would evacuate to inland hospitals and never put their patients or staff in that much danger. I was sadly mistaken. So for those of you working in hurricane prone areas in hospitals located very close to the waterfront, how is your hospital planning on handling a cat. 4 or 5 storm headed straight your way this season? What are they expecting from you as employees this time around?

Although they are two completely different states in many respects, they also share some similarities which as a Californian you could appreciate, which therefore, makes your questions not quite so black and white and easy to answer in a short summary. Having worked extensively in both states in multiple cities/small towns, I can tell you that TX, like CA, is so big that each area has it's own quirks, and therefore, it's pluses and minuses. It all depends on what you really value in life. I know that having a good supportive work environment is something that you mentioned, but that is something that you could find just about anywhere, it just takes time and effort to find the right work setting. Sometimes after moving to a new city it takes starting and quitting at a couple of places before finding your right match. I could tell you that one hospital in San Antonio was the best ICU experience in my life and had a great supportive environment, but if you work med/surg at that same hospital based on good reviews, the staff on your new unit may be completely different and not so supportive of their co-workers or could have a very toxic manager. What I can do is to tell you particular units within certain hospitals in TX to stay clear of and to not accept an employment offer based on my own horrible experiences as well as that of others, but that would be about as much help as I could offer in this respect. As a whole, TX offers much fewer protections to nurses such as staffing ratios and the fact that TX is a right to work state is often exploited by particular hospital administrations. Also, the DFW metroplex is plagued with the blacklisting practices of "Group One." With that said, it certainly doesn't mean that one can't find a decent job and be happy with their life in TX. I started working in TX years ago and decided that I liked it so much, that I bought a home here and TX has been my home base for many years now. I still take many assignments in CA and am often there more days out of the year than anywhere else, but CA just can't offer me as a homeowner what TX can offer me, thus my home base is back there.

Don't sweat all of that. When you start traveling, you will find that many things are done differently than your comfort zone hospital experience you have right now. It always amazes me to start a new assignment with the staff doing things a certain way and they are completely amazed that things aren't done exactly the way that they do it at their hospital from coast to coast. I did a little travel nursing as a med/surg nurse, then decided that I should get some more experience before traveling again. I ended up working in an ICU where the nurses not only drew their own gases, we inserted our own A-lines. That was how I was introduced to ICU and knew no differently. I took my first ICU travel assignment and the charge nurse about fell over passed out when she saw me get my supplies ready and set up to put in an A-line after the doc ordered it. Nurses putting in A-lines at this hospital was absolutely forbidden and that only MD's were allowed to insert A-lines. Well how would I know that as a brand new traveler???? (I studied the practice act prior to starting work and it was not outside of my scope in this particular state.) I learned quickly to ask a lot of questions and not to assume that every ICU works the same way as the one I was trained in. You'll do fine.

Plenty of fellow travel nurses are well over your age and doing great. I'm 36 and some nurses my age or even younger are so out of shape they can't walk up one end of the hall without getting out of breath let alone be able to do the normal daily physical patient care in an ICU. Meanwhile some of their age 60+ co-workers are running circles around them. Now who's too old to travel and who needs to be put out to pasture? Get out there and do it. There are plenty of assignments out there, plenty of places to go. Some days are hard but overall I'd never trade my experiences for anything. You'll probably say the same thing one day. You'll miss out if you listen to those kinds of comments and let others determine your career choices.

She's probably not confused. I can't speak for Canada, as I'm not familiar with their history and evolvement of nursing education, but I do know that the evolvement of practical nursing started with no formal education and was learned on the job at the bedside. Over the years, states began to change and differ in their requirements for the practice of practical nursing. In some states, nursing assistants who received additional on the job training and/or were nursing assistants for a specified number of years could be grandfathered in as practical nurses as an alternative to attending the traditional programs that began emerging. Other states allowed nursing assistants to challenge the LPN board exam and they could practice as LPN's without going through a traditional program as long as they could pass the board exam. You most likely would not be working with any of these LPN/LVN's as most who were able to achieve LPN/LVN status by one of these routes have long reached retirement age, and the LPN/LVN's that you would be working with today are those who have attended accredited LPN programs because this is now the current requirement for licensure and has been for many years. The only exception to this that I know of is that some states allow certain classifications of military corpsmen to be licensed as LPN's in the civilian world.

Tweety, I completely understand what you meant. I just didn't want it to get interpreted by others as "Well gay people can just as easily have legal papers drawn up so they don't need to have marriage legalized for them" so I just wanted to clarify. I didn't want to add any more criticism to some of the comments made here, as one particualr poster was being grilled enough IMHO, but since no one else has touched on it, I think that it's important to this discussion: Heterosexual marriage was referred to as "legal and natural" earlier. It was pointed out that it's a "fact" that it is legal for heterosexuals to get married and not homosexuals in the vast majority of states. Using the fact of whether or not something is currently legal as a means to justify what is ok or not ok in our society is wrong. Laws need to continually be challenged and updated with the times. Not so long ago, up until the early 1970's in some states, interracial marriage was not considered to be "natural" and was therefore illegal. It too, was considered by many to be going against the natural grain for a very long time.

I respectfully disagree. If the option were available to me, I would have much rather had a quick drive through wedding in Vegas in a heartbeat. (Not to mention, much more fun LOL!) It's a lot of work getting legal papers drawn up and signed in an attempt to cover all of your bases in the event that some irrational or greedy parent or other relative tries to step in. And even these measures can and sometimes do get challenged in court by a dead or incapacitated partner's family. Any legal measures taken by a gay couple still do not have the legal strength of an actual marriage. We're just doing the best that we can within the limits of the law.

I guess it is an individual thing and we're all giving advice based on our own experiences. I really couldn't say either way as to which approach is right. I started traveling with barely a year of med/surg experience and it was very hard at first. I had two other fellow old classmates who were doing it after only one year of RN experience but they were LPN/LVN's for years prior so they were more than ready to hit the ground running. Not me. My first assignment was pretty rough on a medicine floor. The nurses were nasty and very unhelpful. I'm sure I was still moving slow as a snail as a fairly new grad and it probably irritated them. I was still looking up a lot of drugs and still wasn't great at starting IV's. But I learned a lot. Nonetheless, I can only speak for myself and I'm quite sure that I definitely started travel nursing way too early and should have gotten more experience before traveling. Oh well, look at me now..........