peddler

I liked it. It allowed for 3 at a time where i was. It certainly prevent people from hording scrubs the day they are restocked. Our cart goes empty quick. In a training facility, every resident in every program feels he can walk into the OR and walk out with a handful of our stuff.

Metabolic, respiratory, correcting, corrected, uncorrected, and besides daily acetic acid intake (how many decades had that been going on) what was her sig PMH? All acidosis' aren't the same...in my book anyway...but again...i'm just a nurse. No matter her history, household vinegar (~5%) is a very weak acetic acid (pH ~ 2.9), whereas the gastric juices typically consist of a strong acid (hydrochloric - pH ~ 1ish..fluctuates naturally...but i think 2 to 3 is pretty standard normal gastric lumen pH). Can you hurt yourself by chronically ingesting weak acidic fluids...of course, but i imagine it would more than likely present as oral/esophageal/pharyngeal - and then probably as an erosion. Bulimics will present with erosions (remember, they are puking up pH ~1 through the oropharynx) to dental enamel and may be in alkalosis from always dumping their gastric contents. Does chronic ingestion of a weak acid (less that normal gastric lumen pH) cause the secretory mechanism to lower gastric pH? If vomiting can lead to alkolosis, then wouldn't supplementation of gastric juice lead to a low production of HCL? Again, chronic versus acute versus underlying disease processes plays a part in the decision making process. In the end, I think ABGs on room air, Chem 21, and urine combined with good Hx would help determine why she is acidotic. Who knows...maybe it's from too much vinegar drinking:)

I hate to split hairs, but "Officers" applies to alot of folks. USAF Nurse Corps Officers have a very specific timetable as laid out by our governing agency, AFPC. They determined last year that we will move after 4 years, but no later than 5 years. Naturally, there will be circumstances like extending at a base past the 5 year mark waiting for entry into a graduate school down the street. Certain sets of timing will always cause an exception, but we cannot simply apply to stay in a place and "homestead". The enlisted troops can stay at a base for 20 years if they like and i know surgeons that have specialized into such a narrow focus that they stay at base x for 20 years, true to our heritage, nurses hate each other and still have to move move move.

I did get my first choice when i came in. I paid my own way for everything and was an experienced ICU nurse when i offered my services to the USAF. However, my first choice was really dumb luck. I go the call from the recruiter saying that the USAF was going to hire me and that base x, y, and z were available with slots a and b. I was given the pick of the three, not necessarily the pick of anywhere i wanted to go in the world. Luck had it that my first choice was one of the 3 jobs i was offered. Your actual experiences may vary as I'm sure the Officer Acquisitions process has a waiver for everything.

Completely different missions comes to mind when comparing the Navy and the Air Force. I don't know where Navy nurses deploy to, but imagine it's on a big ship with air conditioning, and all of the amenities of home. I do know where the Air Force deploys nurses and it's not surrounded by water....but it is by a famous historically significant river....oh...and HOT.

I've never heard a bad word spoken about Alaska. Everyone i've known has enjoyed being stationed there and would go back if given the option. The problem with the USAF is that going overseas is actually difficult sometimes. Too many people and not enough slots. Top that with the nurse corps now moves at 4 to 5 year intervals and you might never get overseas if that was your true reason for joining.

sirI, I thought it might be cumbersome to read intially, but opted to let go "as is". I edited it to show the opposing rationales as natural. Thanks.

Trust every parent's historical information as gospel when they describe an Apparent Life Threatening Event (ALTE) and use that as a working Dx until 24 hour obs on a monitor and pulse ox says they are safe. Never, never, never dismiss these as maternal concerns.

I have a couple thoughts on the original topic...NP with little or no RN experience. On one hand: It requires zero experience to go to Med School. It requires zero experience to go to PA School. Why should it require experience to go to NP school? Are NPs so hard to train that they have to arrive to college "pre-trained"? On the other hand: My personal thought are that some people may do well wilth limited RN experience while others may make poor practicioners. 50% of doctors, nurse, and PAs graduated in the bottom half of thier class. I'd be for an RN experience rquirement with certification (ie, acute care NP program could require CEN) prior to acceptance into a NP program. It would just produce high quality, smart, learned people that take very good care of the patient. Money drives that education train, though so don't expect to see my version any time soon.

To the NPs; would you become a NP again given the same opportunity to do anything else and if so, why? I currently work in the OR and ask all of the CRNAs i meet the same question. I'd like the same feedback from NPs and would them ask in person, but i am only exposed to CRNAs and surgeons during my day. Thanks in advance to all who respond. Irrelevant background info: The OR has been a great break from the pressure cookers I've worked in, but it has served its purpose and it's time to go do something cerebral. I'm officially bored to death and just trying to get a feel for what setting will bring me the most reward for the effort. My ICU experience has me comfortable carrying on intelligent conversations with anesthesia whereas my ER time has me longing to assess, Dx, and manage pt's. Medical school was my first choice, but family and career goals just don't fit that plan for me.

To comment on the original question; " Are Techs And RN's equal in managements eyes? " The answer is a simple "No" It doesn't demean anyone's ability, dedication, or worthiness...but simply stated, the RN is required by law. State Nurse Practice Acts are laws. Hospitals must follow them or close up shop. OR Techs, CNAs, Cath Lab Techs, et al are "Unlicensed Assitive Personnel". Many of those specialties attain multiple Certifications, but certs don't add up to Licensure. As for all other mentioned issues: I say follow money. People with strong work ethics are going to work hard and care about the job no matter where they do it. Go somewhere that is going to pay you the most for your skills. Poor staffing, hard work, rush rush, too many pt's so little time - it's the same in every hospital on the planet and only getting worse. Follow money.

SO my kid eats pasta sauce one night made with shrimp, but removed because he thought the shrimp were nasty and didn’t want to try one. Enter deviated uvula, angioedema, difficulty swallowing, cough……..and all be happy that dad is a smart ER nurse at the time. I max load H1 blocker, H2 blocker, and prednisone….had no epi at the time just lying around the kitchen (I do now). I live 6 minutes from work with traffic….i make it to the ER in about 30 seconds doing 100mph. Throw my kid in the trauma bay with O2 and pulse ox and tell everyone I need the ER doc now and I log into the pyxis and grab epi. The point isn’t yeh me, or good catch…the point is that I have no idea what component of that meal caused his life-threatening anaphylaxis. The kid was dying rapidly. Ingestion to ER was minutes. Is the elemental iodine the culprit? Is protein x in the shrimp the culprit? I haven’t researched it and I don’t know. What I DO KNOW is that a 911 act now or watch your kid die emergency is no fun. Please treat your patients as though they were your family member and take historical data as fact. If a little old lady says she is allergic to horses….she is. What she really means to say is that she is allergic to the medicines that were derived from horse byproducts. Please let the relationship loose or otherwise stand and error on the side of caution. If you have a surgeon that is cavalier about anything….call him on it. They back off quick when you show them that your brain has more spark than two sticks rubbed together.

HR and RR would have been better vitals to closely monitor as temp is usually a late sign. The family Hx of MH triggered many red flags in the OR and i bet the depolerizing agents that cause MH were nowhere near the room.

Everyone can tell anyone "You don't get to speak to me like that". Folks certainly don't have to say please and thank you and may I have another. But they certainly never get to speak down to you. Tell 'em and they'll either straighten up and NOT speak that way to anyone again (unlikely) or they simply will put it on the buck slip "do not let nurse X in the room" which is fine by me as well.

I've only been in the OR for 8 months, but I too am looking forward to moving on. The two years I spent in ICU and the two years I spent in the ER really made me engage my brain and my type-A take-charge tell everyone what to do personality is more in-tuned with something besides counting bloody rags, checking consent forms, and being responsible for crap that a surgeon does to a pt. Don't get me wrong; in the OR we have it so easy that I often tell coworkers that this job really isn't a RN position (and then I get the usual earful). The "earful" is always from a long-term OR nurse or someone who walked into the OR straight out of college and doesn't know anaphylaxis from prophylaxis. But that's ok. Not everyone is meant to diagnose and treat and save souls. I do find it amazing how many of my counterparts are scheming right along with me though to get back to nursing. Good luck in whatever path you choose. I think CRNA would be an incredibly hard program to get into, much less succeed in if you get into an OR nurse groove. I'm steadily losing all of that incredibly hard to get knowledge like normal PAWP, CVP, ICP, CCO, RAP, and the like. I spend much more time listening to staff anesthesia teaching residents than I do to "can I get whatever on an SH".