wibobr

I entered nursing after retiring from the USN. I too did the ADN program. After the service I was rated by the VA @ 60% for a variety of problems. As a nurse (ER), the only thing that has troubled me in practice is my back, blown out about a year before my retirement. I thinkm you'lle do just fine!

This probably the wrong spot for this but.... I've been on medical leave for the past 6 months following a near emergent craniotomy to repair a large left cerebral aneurisym. I've recovered reasonably well all things considered but some defecits remain, most notibly speech(defecits when exposes to cold, stress), ROM(about a 50% reduction)right arm, parathesia and motor defecits. I can't write, struggle with a keyboard, and..according to the wife,memory and situational defecits. I've been conversing with co-workers privately and they have advised that it maybe time to leave the profession. "A big liability issue." Some have advised a return to college to open more opptunities. I'm only (an happily) an ADN, retired from the armed forces and of course older (58). My experience is exclusivley ER. I'm at a loss as to "What to do?" Suggestions?

I don't know about Florida, but here at home, if it's identified as a critical care drug and titrated no, an LPN is NOT allowed!

Been using 20's almost since CT PE came into being. 18 is preferred but 20 will do just fine. You will need to check w/CT though about extension PRN adaptors. Those with tubing may not be able to take the pressure infusion of IV Contrast.

We are doing the same although our medics have been leaving slowly but surely. Staffing has been cut for economic reasons. What hurts is when we are at max patient load with NO back-up, NO "float"RN. Gettint the same from our managers. The er is a "dumping ground" for every MD and clinic in town not to mention the only place many can go to recieve care.

Further research has relealed that there are three distinct area in which children can enjoy perfect confidentiality in all but two states. On ANY matter of self incrimination (drug use), sexuality to include birth control and STD care and last but not least Psych care (with significant limitations) As well even if the parent brings the child in and is either asked to leave the room during the objective and subjective exam phase, the law applies, the child must give permission for the information to be disclosed to parental authority. In working with our HIPPA expert here, thus is the rule we must follow. As well, insurers are equally bound to not reveal protected info to the parent if such information wouuld compromise patient confidentiality.

Unfortunately, we do not have a firm policy within the dept. We have experienced multiple run-ins on this issue and in an in-service a couple of years ago we were told that under law, Once a child reaches the age of puberty, they could initiate care for themselves on any sexually related matter,(stds'/pregnancy tests) and enjoy complete confidentiality for the same. As well, they could refuse any care including that which may compromise their life-styles (ie: Drug testing by demand of the parent.)and, that at such age where they understand the implications/ramifications and potential adverse outcome of any care after being so informed of the same, could refuse such care and enjoy complete confidentiality that HIPAA has provided. I realize we are talking about two distinct issues here, but I feel that they are directly related. We have frequently had issues with parents asking for test results of their children some of which may include std/pregnancy related issues, requests for drug testing and the infamous "virginity" check and specific care that was provided. I personally find it VERY difficult informing parents of their child's rights under both HIPAA and applicable state law as I understand them. I have been called to the carpet multiple times for protecting an adolescents privacy. Yet after researching the subject(after such an incident)find our states statures are often contradictory and just plain difficult to decipher. Guidance anyone?

How are others treating parental rights to medical information for their own children, especially teens?

All I can tell you is to seek help IMMEDIATELY! I'm sure your employer has an Employee Assitance Program or something similar. Hate to say it but "been there, done that" all too many times. I can still remember the one trauma that lead to a major meltdown that cost me my job and almost caused me to leave nursing altogether. Sit down with your director, get the kleenex, loose the hard outer shell and admit to yourself that first, your human and have emotions, second, you have a problem and you need help. You may even need to take a short leave of absence. Prayers and hopes go to you from me and I'm willing to bet most of the community.

Look at the ENA websight, there have been numerous articles over the past couple of years on the subject. From experience I will tell you it is a learning curve but one that is easily mastered with practice. In our facility, we are allowed to draw blood from IV's, we also have CNAs trained in phlebotomy. I, as a standard of good practice and in the interest of patient comfort and satisfaction, ALWAYS draw blood from an IV start. (I hate to pay for the sale of the same real estate twice!) If the patient is febrile, I will also draw at least one blood culture. In most cases, thee blood is immediately sent to the lab to be spun down. Such practice definately increases TOT for lab results, increases patient satisfaction (one stick instead of many) and our docs love the forward, critical thinking!

As the old song goes..."Welcome to my nightmare..." I too have had serious back issues both from my career as a paramedic and as an RN. I am currently on medical leave status post lumbar lam and per my surgeons advice, contemplating a "kinder, more gentle type of nursing. Most ER nurses I know can tell stories of at least one former co-worker who has faced the same decision making as you and I. Nurses by and large are taught that surgery should be the last option and it DOES apply here. Most folks I have known who treked down the OR pathway do one of two things......miraclously better or horribly worse. Right now in my case the vote is still pending but If I lefy you with any advice at all, try EVERYTHING else first. Look into advanced pain management procedures, physical therapy, yoga maybe even chiropracty (If your primary concurs) give all the alternatives a fair and fighting chance (I did them all multiple times) or had short term relief or some form of re-injury that placed me back on square one. So in short, we both share the same bucket of you know what. Take a good hard look at your skills. I for one am actively trying to have an IV team in our facility and with the local nursing homes we service (Don't tell me you've never had the opportunity to be called to the floor for an IV restart or received a Nursing Home patient for nothing more than An IV start). Look into cardiology (You're ACLS, right?) Some recent opportunities here are for out patient stress testing, cardiac rehab etc etc. Look into your local clinics (I'm awaitng some word on a recent application to the veterans administration) as a clinic nurse, (same salary, no week-ends, no holidays, no on-call (WOO-HOO!)) Bottom line is this, good luck (seriously)and DO NOT sell yourself short! You might be able to take the ER nurse out of an ER ,but never take the ER out of an ER Nurse! Good Luck!

With the poor economy and health care dynamics at the moment, there's not much difference in the ER. Census is up, staffing cut to the bone, demanding pts with primary care type woes and moans, those that are sick are really train wrecks needing ever bit of skill and knowledge we possess. And then there's the customer service stuff lead by Press Ganey. Nope, not much difference except to say the pace is much faster!

Sounds to me like you have the background to be a great tech! Good luck!

We've had Paramedics in our ERs for quite some time. Initially it was a"love/hate" relationship. There were significant deltas in their training to be truly effective (Sterile technique/psych/social etc etc) but some have been blessings, some have been disasterous. We have allowed then pretty much a free reign in the ER, require them to maintain the same annual competancies as RNs. They can assume pt care, D/C, pass meds (Non critical by hospital policy), can't hang blood, can't do IV sedation. As a former P'medic myself, I can state it takes a VERY special medic to function effectively. They MUST be able to drop the "Dump em off and run" mentality. They have been a good addition to our ER.

I personally was considering Occupational Health. Can't help but think that being a "plant nurse" with almost 20 years in EMS/ER would be a BIG plus (without the growing pain of the ER!)