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.