olympiad27

I have several thoughts here: First your husband should not be on two different beta blockers. Second, beta blockers work (in this instance) to control/slow the rate, not convert the rhythm. You did not mention whether or not he was on an antiarrhythmic (he should be) in order to cardiovert him. If he is young & healthy he may tolerate a rate of150 for awhile but otherwise he will become symptomatic at that rate. Some people become quite symptomatic. He should be on aspirin to reduce the risk of stroke although that is not as much of a consideration in atrial flutter (since there is organzed atrial activity) as in a fib. But frequently people go from aflutter to afib. Not always. Anyways those are my thoughts.

Oramar I would have to disagree with you on the statement about being salaried as the explanation for the behavior. As a CNS I have always been salaried, and it has never stopped me from speaking out against poor medical practice, unfair, rude or discourteous treatment of nursing staff or unethical medical decisions. I may not always be popular with administration but there are certain things that I believe strongly in and one of them is to place value on a good staff nurse and not compromise my integrity be looking the other way when some physician is delivering bad care. I can then sleep well.

I've been a nurse a long long time and have worked in a variety of roles, now a CNS for the past 10 years. My question is for all those nurses who have chosen administration/management roles. I ask: What happened to your integrity? your sense of what is right? Where is your backbone? Have you all forgotten why you went into nursing in the first place? Are you so desperate for your job that you are willing to give up on your values or do you even know what they are any more? Time and time again I have heard nursing administrators "talk the talk" of "quality" "optimal patient outcomes" and "accountability" . And repeatedly I see these very nurses backing down , failing to support their nursing staff and avoiding a confrontation with physicians . We all talk about things like "shared accountability" but in reality it is all about keeping physicians happy. Lousy physicians are allowed to practice poor medicine without repercussion. All the while we as nurses are put in positions of having to work along side them, risking our own licenses and compromising our integrity. I'm sick of this. No wonder nurses leave the work force in droves. Why should they even pretend they can make a difference when those who have the authority to speak up back down.

You need a solid understanding not only of pathophysiology but also anatomy and pharmacology to be able to provide care to patients. Especially in today's world where patients are much sicker with multiple comorbidities when they are hospitalized.

If you had to list the top 3 things that would prevent agency nurses from going back to working for a hospital what do think they would be? Pay? Hours? Just curious.

Amy , you are not alone. What you are feeling is very familiar to almost every nurse. For the most part we all went into this because we genuinely care and want to do the best for our patients. Those who do care fight an uphill battle to deliver that care with rapidly increasing cutbacks in resources, fewer nurses , more responsibility and very little in the way of recognition or reward from our employer or society.

I couldn't agree more! It is time we as nurses put our foot down. We have enough problems with the shortage without being made to feel responsible for physicians shortcomings. If we continue to try and cover for them, run after them to sign orders or prompt them then we are continuing to put ourselves in a position of " serving the doctors". THey need to be responsible for their own actions or inactions. It is no different than what we teach our children. You suffer consequences for your actions. If your orders are illegible then you'll get repeat phone calls for clarification and the order will be delayed. And if orders can't get carried out because they are incomplete or illegible then that reason should be documented. Just so you don't think I am a doctor hater, I'm not. I'm happily married to one. I just think nurses need to stop feeling responsible for every problem.

I have never worked anywhere where it was the RNs responsibility to remove the IABP catheter . Currently where I work it is always removed by the physician, or his mid- level practitioner (ie. PA, CNS or NP) who has been trained to do so by the physician in most cases. This skill falls under the category of advanced practice in my opinion and should not be performed by an RN.