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Fgr8Out

Fgr8Out

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Working on my Masters, and who knows what else from there. Definitely too many irons in the fire for any rational person to remain sane ;)

Fgr8Out's Latest Activity

  1. Fgr8Out

    Schwarzenegger Says Nurses are "Set Dressing"

    I too, read the opening for the original to this post as if Schwarzenegger were saying "nurses" were the "set dressing". Of course, after reading the entire piece it became apparent that the Governor was referring to the protesters, not nurses in general. I'm not voicing an opinion one way or the other as far as what goes on in California. I just wanted to comment that if we wish to appear knowledgeable, well spoken and truly well informed on a subject and an individual, then we need to pay attention to what is really being said and avoid at all costs such "knee-jerk" reactions as some of those posted here.
  2. Fgr8Out

    Outrageous Tuition for CNA Classes

    That's a very unusual rate, to be sure. The Community College where I teach CNAs is somewhere in the neighborhood of $500, I believe. There is a big difference in what is taught from course to course too, as evidenced by how some of these candidates perform at State Board testing. Believe me, I can tell who had the quickie 2 week course, and who had a well rounded class that lasted 9 weeks. Additionally, in our state, graduate CNAs can have their entire tuition costs reimbursed if they work up to 6 months at an extended care (ie nursing home) facility, prorated if they don't start right away after graduation. It's the law.
  3. Fgr8Out

    How about this for an order?

    I believe it's used as an adjuvant, as previously stated by others.
  4. Fgr8Out

    transferring vaginal deliveries to postpartum/gyn unit

    L&D keeps patients beyond 3-4 hours? Our facility is so hopping, we often receive a post partum mom little more than an hour following delivery. There aren't enough L&D beds to keep a post partum mom there until she's been able to void or regain total sensation following anesthesia. L&D = labor and delivery. Post partum = following delivery. Newborns are in transition for a couple hours in nursery, so we're able to have some time to care primarily for Mom. And there are many reasons voiding might not take place for some time after delivery. I've never heard post partum complain, other than at the sheer volume of patients we might receive... and like we have control over that :roll
  5. Fgr8Out

    Questionable Pain

    Someday, Nursing will accept that pain is whatever the individual experiencing pain says it is. Why do we persist in this need to control an issue that is out of our hands, namely a patient's report of pain? There is no way to measure pain through biomechanical means, no magic machine that pinpoints the exact site or severity of pain. Pain is completely subjective, yet there are those in Nursing who simply can't or won't accept the fact that we don't have the ability to say "Yes, here is proof you have or haven't pain" with any reliability. Patient's with a history of drug use/abuse can certainly develop a tolerance to opioid narcotics which require that they receive a dose higher than that of an opioid naive patient. This does not mean that individual is making their pain up and even if they are, again, Nursing cannot accurately assess this. The best we can do is administer pain medication as ordered once we've assessed our patient to determine there is no respiratory depression, and continue to monitor and intervene if it becomes apparent that an individual is overmedicated. Patient's who are awake do not code from respiratory depression, especially not with the dosage of opioid generally ordered. This is not to say Nursing should be cavalier in administering narcotics. We need to realistically look at our patient's level of sedation in relationship to the amount of narcotics they've been receiving and, with our critical thinking skills, assess the effectiveness of their pain management and treat them accordingly. As for the use of placebos, who does this benefit? Certainly not the patient, who should have every right to expect that they are being cared for in a professional manner. Placebos are deceptive at best and can be considered malpractice. Physician's should be discouraged from ordering placebos and Nursing should never substitute NSS for a narcotic to verify if a patient does indeed have pain. To do so is completely presumptuous. People in pain may or may not display behaviors that we consider indicative of "being in pain." Coping mechanisms such as distraction or avoidance, may often mask a person's true pain level. I believe that if health care professionals expect someone in pain to act a certain way, some patient's learn to adopt those very behaviors. They become concerned that if they don't "look" as if they are having pain, their report of pain won't be believed and they won't receive the proper pain management. What exactly does that say about our practice? So long as a patient has appropriate respirations and arouses easily, their report of pain should be believed and appropriate measures taken to alleviate it. Pain assessment, including sedation and respiration, should be ongoing to determine efficacy of the medications and ensure no undesirable effects are occurring. Lastly, the use of adjuvants such as vistaril and phenergan should be discouraged. These products DO NOT enhance the analgesic effects of opioids and may actually contribute to over sedation and other side effects. Because the opposite has been reported for so long, (that phenergan and vistaril potentiate the effects of opioids) destroying this myth is ongoing. The American Society of Pain Management Nurses has a website with research based information for Nurses to better care for their patient's in pain. http://www.aspmn.org/index.htm
  6. Fgr8Out

    Opinion re: getting a new patient at the end of your shift

    Pamela, As a med-surg nurse on the floor, I have to agree with you. ER is not the place to be once a patient has had an initial assessment and is no longer in need of emergency care. It's important to get them on the floor as soon as possible and free up the ER for the next wave of patients.
  7. Fgr8Out

    Opinion re: getting a new patient at the end of your shift

    I'm in total agreement with you, Marie. Get a set of vital signs, ensure the patient is settled and preliminary questions answered, check the orders to see if any are stat and get those ordered. Attend to the immediate needs first, assessments/admitting paperwork are not the priority.
  8. Fgr8Out

    Patient Code of Ethics

    A CODE OF ETHICAL BEHAVIOR FOR PATIENTS: 1. PAY YOUR MEDICAL BILLS PROMPTLY AND WILLINGLY: You should consider it a privilege to contribute, however modestly, to the well-being of physicians and other humanitarians. 2. DO NOT SUFFER FROM AILMENTS THAT YOU CANNOT AFFORD: It is sheer arrogance to contract illnesses that are beyond your means. 3. NEVER REVEAL ANY OF THE SHORTCOMINGS THAT HAVE COME TO LIGHT IN THE COURSE OF TREATMENT BY YOUR DOCTOR: The patient-doctor relationship is a privileged one, and you have a sacred duty to protect him from exposure. 4. NEVER DIE WHILE IN YOUR DOCTOR'S PRESENCE OR UNDER HIS DIRECT CARE This will only cause him needless inconvenience and embarrassment.
  9. Fgr8Out

    foley catheter insertion harm?

  10. Fgr8Out

    epidurals

    Our facility has implemented an annual competency program which includes care and maintenance of epidural catheters. Depending upon anesthesia orders, we can attach and set up a pump for continuous infusion, or administer a bolus of the specified medication (generally preservative free morphine of fentanyl). We are taught how to check for proper placement or the catheter and our policy defines the parameters for which we are to report to the anesthesiologist when we run into any inconsistencies. The anesthesiologist rounds daily on the patient and does a check of their own as well. In addition, so long as an epidural catheter has been in place no more than 72 hours, RNs may remove them when ordered by the anesthesiologist.
  11. Fgr8Out

    Fired nurses in Louisville, Ky

    No amount of harassment or blinders on the part of administration or whomever justifies practicing medicine without a license. Period. Not only does one put their license in jeopardy, but there is also the risk of criminal charges. I'm certainly not willing to go to jail for my employer. Nothing my employer threatened me with would force me to risk MY livlihood for a business. I truly would seek employment elsewhere, notify the AMA, the press and my Representatives, the Ombudsman and anyone else I could think of, to expose the practices of such an institution. I simply would not allow myself to be victimized and I won't be swayed by any conspiracy theories or anything else to that effect. Thank you, Sbic56, for your professional response to my comments.
  12. Fgr8Out

    Fired nurses in Louisville, Ky

    Please elaborate. I'd love to know what "the real reason" has to do with bad Nursing Practice, regardless of extenuating circumstances. If a situation is bad, you get out. Period.
  13. Fgr8Out

    Fired nurses in Louisville, Ky

    All of your excuses do not negate the fact that you willfully sedated patients without an order, with medication that was 'left over' from a previous order, in a manner that was not prescribed. If that isn't "harmful" I'm afraid I don't know what is. You and your cohorts are ignoring a cardinal rule in nursing... ACCOUNTABILITY. You are NOT accountable when you negligently fail to communicate with a physician that a patient requires pharmaceutical intervention because of a reluctance "to wake a doctor up in the middle of the night." You are NOT accountable when you say "everyone was doing it." You are NOT accountable when you attempt to play martyr and foist YOUR lapse in judgment onto others while you KNOWINGLY jeopardized lives that you were responsible for protecting. Regardless of the fact that others in this hospital may have been negligent as well, no one put a gun to your head and forced to you act as you did. Just so you (and those respondents who appear to SUPPORT this event) don't think I'm without understanding... I can't imagine working under the conditions that you relate and I sympathize with the obvious frustrations that most certainly were felt. To try and practice in a facility where physicians and administration were not accountable would surely elicit fear and insecurity in myself. However, you chose to remain in spite of this knowledge and willingly participated in the malpractice that was supported by this institution. You DID have options, including leaving that particular Unit, notifying the appropriate authorities or even leaving the hospital entirely. Unfortunately, you and your coworkers made the wrong decisions and you are being held accountable for that action. To blame anyone else for your decisions is simply further evidence of your lack of accountability. Yes, I'm sure you and others will berate me for my comments with such logic as "no one would support our efforts to properly care for our patients and unless we acted as we did their lives would be compromised anyway, so we chose the lesser of two evils." To which I would once again respond, "where is the accountability?" Two AM phone calls to physicians, documentation, changing shifts or units, reporting to your supervisors/managers/administration and even resigning are examples of being accountable... and preferable to the decisions you made. It's certainly fair to say you were in a no win situation. I offer my prayers to you and hope the administration at your hospital is held accountable for their deplorable lack of action in this case.
  14. Fgr8Out

    ADN/BSN Debate on the Floors?

    Ahhhh yes.... Nursing Professionalism at it's BEST! Kristin... the world is full of opinionated people who will go out of their way to make you question yourself. Generally these people only feel good about themselves when they are able to degrade another, and do you really CARE what this sort of person thinks? Stick with your goals and keep your eye on the prize... earning your RN! Should you later decide to further your education, none of this uncalled-for debate will matter in the least, I assure you. I suggest you look for those in the Nursing Profession who display the behaviors and attributes you yourself would like to exhibit and develop a rapport with them. Remember, "No one can make you feel inferior without your consent." ~ Eleanor Roosevelt ~ Good luck in your studies! :)
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