Guest219794

This is surprisingly common. My 96 year old aunt had DNR on file with the hospital, and was admitted full code. And, in the ER, we sometimes get the information late, and wrongly resuscitate.

I think you are mistaken. The research was done by three economists one of whom is a JH professor. Apparently a well known (in some circles) conservative/libertarian who contributes to the conservative National Review and is a senior fellow at the CATO Institute, a libertarian organization. That being said, the fact that three well known economists are willing to stake their reputations behind the study make it worthy of discussion. Now, if it was a peer reviewed study by experts in the subject matter, rather than by economists, it would hold different weight. On a side note, for anybody interested in how medical issues and economics relate to each other, there is an interesting podcast by an economist/MD.

This has actually been an educational thread. Daisy- thank you for posting that link. It gave others the opportunity to show how something with a grain of truth can be manipulated. It really got my attention that a Johns Hopkins study about lockdowns showed them to be ineffective. For starters, I learned how some define "lockdowns": “lockdowns are defined as the imposition of at least one compulsory, non-pharmaceutical intervention (NPI).” I had thought that a lockdown meant some kind of meaningful restriction in movement or commerce. While it includes that, it also includes mandated mask wearing, distancing, or other strategies that are, at worst, inconvenient. Now when I hear folks object to "lockdowns", I will have some context. And, referring to that paper as a "John's Hopkins Study" reflects either ignorance or malice. I suspect that the article Daisy linked to was a result of ignorance and laziness (article author- not Daisy). On the other hand, FOX created this graphic. No doubt those who saw it believed it was a product of Hopkins, rather than a product of FOX. The fact that three leading economists put their reputations behind this paper makes it worth discussing. Daisy presented it for discussion. The discussion, while it appears to have hurt some feelings, was educational, and spurred me to do a bit of reading.

Are your educators educated? Serious question. Not an expert in the subject, but I am pretty sure the whole point of Curos is sterile access. I am 100% that compliance with a 30 second prep of an IV has an minute compliance rate. As far as the OP question- think about the amount of medicine delivered by a GTT in the time it takes to prep an IV. It is not the same as a push drug. Don't give your actions a second thought, particularly since they were generated by the peanut gallery.

That's an interesting take away. I was thinking they must have had good mitigation strategies. How does their mitigation compare to ours?

In answer to the question- Let HR know when you expect to meet their job requirements, and see what you can negotiate. You have proven your ability to make your case with both your school, and the BON. Use the same approach to solving this problem, and you may do well.

More accurately, it is satire. Fake news is yet anther dormant screen name coming to life for the sole purpose promoting the narrative that has worsened this pandemic.

If I had the opportunity to talk to this man before he got on the flight, I would tell him to order the kosher meal. Many people find it tastier regardless of dietary preferences. As far as Covid is concerned, pretty sure it wouldn't make a difference.

I really appreciate all your feedback about how one day I might develop into a competent nurse. I will be sure to incorporate it in my various roles as triage, charge, preceptor, and hospital code team leader. The first 18 years have been a bit tricky, but maybe when I have some real mileage, it will all come together for me. I especially appreciate the stories about nursing back in the day with none of these fancy machines, when nurses had to rely on their senses and smarts to care for patients I will draw on that as I maintain my board certification in emergency nursing. That spidey sense sure would come in handy with covid when patients who have good skin color speaking in full sentences and SPO2 in the 70's. But- we aren't talking about me. I regularly start lines, run fluids, insert foleys and NG tubes without orders. I am pretty sure I could manage that fluid order. We are talking about the OP, and their work environment. And, despite the fact that you are 100% sure of what this order means, your interpretation, (and mine) is very different from that of the OP's supervisor. And, to be clear: no amount of obstinance or condescension changes the fact that there is not rate specified in the order. And, in return for your coaching about how I might develop my critical thinking skills, I will share some information about technology. You mentioned it's not your strong point. The bold button does not make incorrect information right any more than typing in ALL CAPITALS. "60 ml per hour is CLEARLY stated in the order. " Above is the digital equivalent of yelling. Yelling something does not make it right. To quote a very experienced nurse: "Use your noggin". Good talk.

I do. "IV 1000ml D5 1/2 NS 60ml x 24 hours" To be clear- I do not question the intention regarding the rate. That is- assuming the clinical condition of the pt matches the order. But- the rate is not specified. It is a bad order. I interpret it differently than the charge RN in this scenario. An order that two seasoned nurses read differently should be questioned. From the sounds of it, this nurse does not work in an environment in which they are supported by the docs. "I got written up for calling a doctor about a fall that didn’t result in injury." If a doctor is going to create a hassle for a nurse who is following policy he, or she is creating an environment in which nurses should call to clarify this poorly written order. That doc could just as easily say "Why did you only give one liter?- the order clearly states that it is to run for 24 hours", despite the charge nurse telling the OP to do exactly that. Bottom line is, that the medical staff has not earned the privilege of nurses covering for their shoddy orders. So- while you can say that nurses should use critical thinking as professionals, the OP does not work in an environment that supports this. I do. I would not have given this a second thought- I would have run this at 60 ml/hr for 24 hours. But- I work in an environment that supports this type of thing. If it been written by a doc who had given me crap for making a mandated call, I absolutely would call for clarification- at 3 AM if that's when the issue arose.

The best way to be ready for an emergency in regards to an IV is not to have somebody verbalize to you their memory of the IV. Even if they checked it recently, and report it accurately, there is nothing saying it is working now. If you want to be ready, flush and cap the IV yourself.

So what? Of course they don't like being called- who would? So what? They chose a particular job, and that job involves call? I do all kinds of thing in my job I don't like. Including trying to figure out poorly written orders.

Apparently, we can. Until somebody wins an expensive lawsuit, and this abuse becomes expensive. Right now, it is the easiest path. I hope somebody makes it harder.

False dichotomy. I like the job. I like the pay. Best pay I can get with a 2 year degree, and scrubs are comfy. Also- occasionally I save lives, and sometimes I get to use a load of skills I have accumulate over the years.

Absolutely. There are nuances that are not charted that help the oncoming nurse understand the big picture. Family involvement, pt pet peeves, that sort of thing. And, having the off going nurse provide an overview gives context to the details that can be easily seen in the chart. The night nurse telling me the patient had no relief from MS, 4 mg, so she gave dilaudid 1 mg, which tanked his pressure, and she then gave 3 liters NS was helpful. She told me he was still a bit soft in the low 100's, but that was normal for him. That narrative was a good use of report time. The exact pressure, location of the IV, etc are easily found details I don't need verbalized. But- tell me something that helps me understand the big picture, and I find it helpful. I agree- why not? I do. Every single time. I skim the H&P in under 2 minutes. If it's relevant, I might even look at the labs. This does not take me time, it saves me time.

The fact that we allow this abuse of patients is a disgrace. There is no possible justification for it. Hospitals allow it because the victim is entirely powerless, and cannot object, or sue. It is completely irrelevant whether the family member's intentions are benign or malicious, it is not their decision. And, they are not at fault. When the patient made these wishes known to the hospital, the hospital agreed to carry them out. But, the hospital takes the easy way out at the expense of the patient. I would love to see a prominent and expensive lawsuit in which the hospital is sued for abuse dictated by a third party.

Silly and lazy. Interesting perspective. I would say it is silly to think a verbal report is more accurate than charted documentation, and lazy to expect another nurse to spoon feed it to you. But, tomato tomato. (That works better when it is said with two different pronunciations.) But, I guess a lot has to do with your EMR system. When I click on a chart, I can see the IV documentation immediately. I have found many nurses don't seem to be comfortable with quickly accessing critical information, and rely on the same hand written "brain" their preceptor's preceptor's preceptor used before EMRs. And, I agree there should be more education out there about IVs.

I noticed you used all caps for ASYMPTOMATIC. Almost right. Just remove the "A". It is now considered OK for for those with "mild" symptoms to return to work after 5 days of quarantine. "Mild" is not clearly defined. So, to be clear: The CDC guidance is for people who are SYMPTOMATIC to work, after a certain number of days if they are needed. My hospital has adopted this policy.

No comparison. Not even close.

Why? Why are folks focused on the bore of the IV? The integrity of the vein itself is absolutely critical for vasopressors, vessicants, etc. But why does anybody think that the guage IV is related to what drugs go through it? I am pretty good at IVs. Let's say I put an 18 or 20 gauge into a vein, and it takes up most of the lumen of the vein. Now, I have minimal blood flowing around that catheter I expertly threaded into a narrow vein. Whatever I put through that catheter enters the vein with limited dilution. Compare that to the exact same vein with a smaller catheter. The potential irritant is much more diluted because of the increased blood flow. A 24 g catheter can handle 1,000 ml/hr. Blood can be transfused through a 24 gauge IV, as evidenced by all of the neonatal/pediatric transfusions that run through 24s. I am an ER nurse. I like 18s. I use them a lot. I am comfortable putting difficult IVs in, and get them sometimes even when the doc can't get one with an ultrasound. But- small IVs have their place, and can be lifesavers. I think the IV size thing is a one of those persistent nursing myths.

Sure you can. When my hospital was requiring strict and long quarantines, they were not testing nurses. Obviously, had they been testing nurses, they would have had to have more staff in quarantine. My non-medical friends were all pretty surprised that we weren't screened. Contrast that with my nephew. He is a tech on m movie sets. It is very important to them to avoid an outbreak, so they test everybody every day. I still have never been tested by my hospital. I have included an actual photo of admin discussing staff testing.

Its a legit concern. But, the only thing is, there is no other way to handle it. As is, patients are getting sub optimal treatment as they languish in ERs.

ER nurse perspective here: It's silly and annoying, but I generally know where and what the IVs are, so I pass it on. To the floor. In the ER, when we pass this on to each other, it is generally as a joke, right up there with last bowel movement. If, somehow this information is relevant, and not charted, we actually will pass it on- "She has a 20 in her AC, and the pump keeps occluding, so I am running ABX on gravity." Bowel movement would get passed on if the PT had an abdominal issue, possibly related to last BM. If a patient has inadequate access, I'll address it, as that can't easily be found in a chart. If you are getting a pt with a 22 in the boob and a 24 in the foot, clearly that was the best I could do. I'll tell you that the intensivist has been informed, and I advocated for real access. But, this outdated tradition of verbalizing IV information is part of a bigger problem: Verbal report. Verbal report developed in an ERA in which hand written information was kept on pieces of paper, and it might be difficult tor retrieve. I can 100% guarantee that by using Epic, I can get the general situation, and any details I find important, much faster by reading than you can pass it on by talking. And, more accurately. Kids play a game called telephone- the whole point is to see how garbled information gets when passed on verbally. Why on earth are we still doing this? Why not pass the information on in a pantomime, or an interpretive dance? If we aren't going to use the best tools at hand, we should at least make report more amusing. Verbal report should very briefly cover the big picture, and anything relevant that is not easily found in the chart.

Are you making contact with known Covid without a fit tested N-95? If so, something is wrong. Somebody screwed up. A policy is being bypassed.

There are some great podcast out there. The fact that there are schmucks out there using the medium shouldn't keep you away. Mein Kampf was a book, but we still read.