SFRN

It's a SAD state of affairs when a nurse questions/worries that giving a tylenol to someone with a HA is grounds for license discipline or acting out of an RN's "scope" of practice. WOW! what is our legal system doing to the nursing profession?

umm you sound like a GREAT nurse. PLEASE don't leave the profession. It is hard and I have been in working environments like the ED you currently work in. It's tough and all I can say is hang in there. Eventually you won't be the new one anymore. And, no matter what there are TOXIC, LAZY nurses in most places and unfortunately you have to deal. I have been a nurse for 5 years now and I am to the point that I no longer deal with people's drama or attitude. Good luck. Remember life is short if you want the Behavioral medicine unit-GO FOR IT.

In a word....UNION!

YES the ADO form DOES protect you!! If you have refused the assigment and OBJECTED then the supervisor and witnesses sign the form essentially you are saying this assignment is UNSAFE and this form protects you because you were given an assignment despite refusing the assignment. I am not sure if all places have the form. Here in California every hospital (all have been union) that I have worked in have had the form. And should you be called to court and the plantiff attorney asks why such and such happened, this form proves that you 1.) Refused the assignment and the supervising nurse/s knew of the objection and 2.) You had no choice in the matter and were assigned the patient. I HAVE NEVER seen or heard of a nurse that wanted to submit the ADO and still receive a patient--HINT, HINT. I once wanted to submit the ADO after refusing another patient due to the fact that I had a patient on multiple pressor gtts, CRRT, tubed, etc. and guess what? They found another nurse for that patient.

If, for ANY reason, you are not competent to care for a particular patient it is your legal as well as ETHICAL responsibility to refuse such patient by notifying the charge nurse. If the charge nurse assigns the patient and you are not competent to care for patient you NEED to fill out the ASSIGNMENT DESPITE OBJECTION form, this will indicate that you have refused the care for a patient for whatever reason and the patient was still assigned to you. As a charge nurse I WOULD NEVER assign a patient to a nurse that is not competent for that specific patient.

Hey PsychGrad07, Not sure why you can't PM me. As for the costs, well it was a pricy number attending Hopkins, fortunately I had some grants/scholarships and I didn't leave with too much in debt. I was also worried about the costs prior to attending, but I figured this is an investment in my education/finding stable employment and went for it. There was the opportunity to do clinicals overseas, for community health I went to St. Vincent and the Grenadines (union Island). Some students went to Singapore/South Africa for his/her practicum. I did my practicum at Johns Hopkins Hospital. When I came out of school jobs were plentiful not like the situation now, but realize that nursing jobs are cyclical with periods of surplus of jobs and then times, like now, where it is difficult to find a job. I would say that you will eventually get a job in nursing--albeit may not be the job you like. As far as paying off loans-- locked in my interest rates when I was in school and so far I am not having difficulty paying them off. I live/work in the Bay Area and I am actually working 2 jobs by choice. The average Bay Area nurse is making around 100,000 per year---yes, yes the cost of living is higher in the Bay Area but you CAN live comfortably with that kind of salary. Ok I think I answered your questions, any more just let me know. Good luck with whatever you do. I was in your shoes at one time and it was scary packing up my truck and driving to Baltimore for school.

Well as a Hopkins nurse I am BIASED! But I say go to Johns Hopkins. I graduated in 2005 and had a GREAT experience. I lived in Charles Village area and although I left Baltimore for my native California, there are days I actually miss Baltimore--cheap housing, adorable row houses, sigh.....Good luck in whatever you do, But I can guarantee you will get a GREAT, solid education at Hopkins. PM if you have any specific questions!

OMG. People are getting so crazy with this "I might get sued" mentality. There is NOTHING wrong with taking the neighbors blood pressure!!! In fact it's a nice gesture for a neighbor. If her blood pressure is out of the norm then refer her to her PCP, or if it is unstable in any way then refer her to the ED.

There are numerous reasons why one would have low diastolic pressures. A common reason is being fluid depleted. Often giving volume will increase the diastolic pressure.

You DID EVERYTHING you were supposed to do. Don't feel bad. I think the comment made by the House MD was unprofessional and inappropriate but that's how some behave. Remember sometimes you gotta pat yourself on the back cause aint NO one else going to.

I supose he could have been compressing too hard. However, this would be the exception to the rule. In my experience most people don't compress hard enough OR they don't allow enough chest recoil. You should be able to palpate a pulse with good chest compressions.

It's tough I just took it yesterday and PASSED! I was real happy. I suggest as previous posters have mentioned that you transfer to ICU if you plan on taking the exam. I work in a cardio-thoracic ICU so the cardiac part (Cardiac and Pulmonary) make up the most part of the exam...which was easier for me. Neuro was my weakest. Good Luck.

I'm confused. The deltoid is a muscle. So, where is there error?

It is ABSOLUTELY within your right to review your charting, in fact kudos for doing so! So many nurses seem to be lax when it comes to charting. Let me just offer some friendly advice. First: Always document incident reports when equipment such as the barcode scanner or computerized system is not functioning properly. Second, I suggest you retain legal counsel. Third: Since you see your nurse managers true colors, I suggest you have a paper trail with regards to correspondence with this manager. Good luck!

I hate that! She absolutely owes you!!

It sounds like you are doing fine, it is always difficult when you first start out. I work in a cardio-thoracic ICU and I still have difficult times, especially when you have a confused pt. We never have more than 2 patients! I can only imagine what it's like on a med-surg/telemetry unit. Keep up the good work and for Gods sake DON'T leave nursing. If you find you are not happy you can move to some other area of nursing.

Uhhh UCSF is NOT downtown, rather it is in Cole Valley/ Inner sunset area of San Francisco...FYI.

I am sorry that you are feeling so scared, etc. As for the first pt. I don't think 40meq PO is a lot of K. I have given way more via IV. However, having said that....what was the pt.'c creatine, was the pt. receiving blood. With a K of 7.2 I am just wondering if this pt. was in RF and also if the pt. received PRBC's this can bump up the K. As for the 2nd pt. well I think this sounds like a system that failed......it sounds like you notified the docs which is good, but I can't stress the importance of good documentation. Anyways, good luck and I hope everything works out.

Wow! in Texas, that sounds like Bay Area (CA) wages

What prison are you applying to? I, too, have an interview at a California prison...kinda nervous.

You know I work in a cardiac surgical ICU and rarely do the cardiac pt.'s have a PCA...however, pt.'s that have undergone any type of major abdominal surgery will def. have a PCA.....usually the cardiac pt.'s can have their pain managed with IV meds initially and then Percocet or Vicodin once they can take oral meds....

Having started my career in a NICU I have definitely learned some good IV skills....now I work in an adult ICU and starting IV's on an adult is MUCH easier! When I worked in the NICU I would often use my wee-sight transilluminator it worked really well in some babies and you could see veins not visible to the naked eye and ones that certainly couldn't be palpated.

OMG I love this suggestion I am definitely going to use it the next time I get yelled at by a surgeon....and see what happens!!! One time I did complain to my nurse manager and it did seem to help.....but if I did this everytime I dealt with a hostile surgeon her e-mail box would be full......

I have did it more than once. In the NICU I was using a transilluminator and cannulated a brachial artery. And, also in an adult. It happens, usually it is pretty obvious when you hit an artery!

If you have a situation where you need a buffer but the pt. has a high sodium then one can use THAM.