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flightnurse2b LPN

EMS, ER, GI, PCU/Telemetry
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flightnurse2b is a LPN and specializes in EMS, ER, GI, PCU/Telemetry.

flightnurse2b's Latest Activity

  1. flightnurse2b

    Really irked

    don't worry about it, our job as nurses encompasses the CNA's work and as long as you were getting your LPN pay to do the job i don't see any harm done. our floor regularly is short CNA's and we just rotate which nurse will work the hall as the CNA that night and it works out fine. some nurses actually don't mind it, myself included. some agency nurses have guarenteed 3 shifts per week by the hospital and if they do not staff the nurse they still have to pay them per the contract. that is probably why you got bumped. if it happens again and you get pulled again, then i would ask why you are the one being pulled, but i wouldn't be too offended by it.
  2. flightnurse2b

    No Nicotine!

    oh yes, they do. i just moved from north carolina. worked at two different facilties in the raleigh/durham area. smoke free hospital campuses with same rules, you get caught smoking at work on hospital grounds and you get fired. not sure where in FL you are, but here in south FL, all hospitals are smoke free too. i could care less if people smoke, but please don't do it around me. i was a smoker for a long time. but after i quit (one year and 8 months now yah!!) i realized how bad i smelled and how offensive i must have been to other people who didn't smoke, esp my patients who were respiratory compromised. yes, i think hair testing for nicotine for employment is drastic and stupid... it's not like cigarettes are illegal.... but it has nothing to do with being liberal.... i think it has more to do with common courtesy and setting a good example, oh, and keeping those insurance premiums for employees lower. :)
  3. flightnurse2b

    Potential Complication of TPN

    yeah, i would def go with hyperglycemia.
  4. flightnurse2b

    Evidence of swine flu risk to pregnant women rises

    what is the incubation period for the swine flu and how long are you considered contagious? i assume as long as you are still sneezing/coughing/febrile, you are still contagious, since the flu is spread by droplets? a nurse at my mom's hospital who she worked with and ate lunch with on monday now has the swine flu... mom said her friend had a sore throat on sunday, a fever on monday and on tuesday had some serious respiatory distress before they even sent her to employee health to be tested. i am scared to go to my mom's house for fear she may have been exposed to it. my OB says he has no idea, but he thinks the incubation period should be anywhere from 2-10 days, and i've read the maximum was 9 days, so he said to be just be careful. i think alot of doctors are kind of baffled by the swine flu, to be honest. he didn't really know what to say about it. this thread is scaring the crap out of me. i feel like i need to be walking around with a N95 to go out of my house right now. 9 more weeks to go.....
  5. flightnurse2b

    No Nicotine!

    wow that's crazy. i don't smoke but probably 85% of the nurses on my floor do. we are a smoke free facility and we do not have a smoking patio or area anymore, so the rule is that if you are an employee and get caught smoking on hospital grounds you get fired. they will walk accross the street, sit in their cars or hide in the woods to get their smoke breaks. but since cigarette smoking is not illegal, i don't understand how they can insist you subject to hair analysis? that's kind of drastic.
  6. flightnurse2b

    Help! Me and my family needs health insurance

    here is the nurse's service organization: http://www.nso.com/personal-insurance/ i would try BCBS in your state though. they usually are somewhat reasonable unless you have a pre-existing and have good coverage.
  7. flightnurse2b

    excelsior college

    i am going to be starting the program as soon as i get my official review back, i sent in my transcripts a few weeks back and now i am just waiting for that so i can get started! i am really hoping to finish within a year and a half or so, hoping i can stay motivated and on track with a new baby coming in november. i am excited to start because there are no other LPN-RN programs within 90 miles of where i live. we have alot of great resources here on AN to help us too who are graduates of EC and are working RN's now. :)
  8. no one can prod you or force you to become anything. the only thing you must become as a nurse is nonjudgemental. when i took my ethics class, we spent quite a bit of time on abortion, and because i went to nursing school in north carolina, most of my classmates were very conservative. i, on the other hand, am a raging liberal and i am very pro-choice. it got ugly. anyways, there are going to be lots of sitations you are faced with as a nurse where you feel like your feelings are sometimes hard to overcome when the scenarios are difficult to handle. i, for instance, had the assignment of caring for a known child molester/rapist (he was an inmate) while he was in the hospital. as a human being, i was disgusted by him. as a nurse, i gave him the good care i would have given to any other patient, and yes, it was very hard! one night he stopped breathing. i had to help save that man's life, even though i hated what he did--i am not the one to pass his judgement. he ended up on a vent and eventually died in the ICU. i guess the point i'm trying to make is, you don't have to participate in an act that is against your moral or religious beliefs (ie, an abortion)... but you do, however, have to care for the physical and emotional needs of that patient afterwards and be able to do so nonjudgementally. you'll do fine. all the best in your studies. :)
  9. flightnurse2b

    Hospitals in Nine States Jeopardize Patient Safety

    i am not surprised at all to see FL on the list. i wouldn't be able to tell you what my hospital has planned, if anything. but was the survey only conducted on the states mentioned and not all 50?
  10. flightnurse2b

    ethical dilemma with a DNR last night

    that was the problem. the ONLY thing on this chart was a peice of paper similar to one of those that you would sign to sign out AMA or refuse any other intervention, signed by the patient, with the check mark next to the box that said "i refuse the following treatment or intervention" with the paragraphs of baloney underneath saying i understand the risks of refusing this intervention and blah blah blah. this is the refusal of treatment form i posted about in my initial post. this form, in the end, ended up causing the most confusion. the patient and the day shift nurse signed it--the MD did not (which, in retrospect, might not have made a difference if we're following the reasons of why my boss said we couldn't honor it). however, bc the MD did not sign it, did not initiate the hospital's required set of DNR paperwork and write a written order to continue hospice and to officially make pt a DNR, he was not considered a DNR. no state paperwork, no hospice paperwork, no five wishes paperwork, no living will, no HPOA, no nothing. just this refusal of treatment form with the interventions listed being CPR and intubation. the hospital requires, per their protocol, for the 3 forms (verification of incapacity, certificate of condition and withholding of life support) to be signed by 2 MD's before the pt is considered a DNR in our hospital... so when i asked my director why we could not honor the refusal of treatment form, my previous post was the answer i got. this is why i am a lowly staff nurse. too much BS for me... makes me dizzy. my hands were completely tied by all these policies and i am disappointed in all of it. it never should have happened....
  11. flightnurse2b

    ethical dilemma with a DNR last night

    my supervisor said it's because we don't know that the patient was in his right mind and although he answered all questions appropriately still could have been "incapacitated" due to advanced disease to make this decision. also because the pt was on scheduled dilaudid she stated that made any documents signed by the pt within a 4 hour window of dilaudid being administered (which they were) could be questioned in court. and lastly, the refusal of treatment form refused only "CPR and intubation".... she said that leaves alot of ACLS out, and she's correct, because that does not address cardiac meds, extenal pacing/defibrillation. i can see her point, i guess. i just didn't look at it that way, so when i brought it to her attention afterwards that is how she explained to me that we could not honor it. after the case was reviewed, it was actually found that not only was it the admitting doc, something happened with hospice, they had not followed this pt to the hospital after the hospice nurse (per the family) who assessed the pt decided he needed to be admitted r/t dehydration and bowel impaction... it is policy of this hospice to follow pt to the hospital here and approve orders of what is appropriate and inappropriate for the pt. when the pt expired, i called hospice nurse on call, who stated they weren't aware of pt being in the hospital? BUT... what i'm wondering is that if the pt's family took him to the ER. the pt's family stated to me that they could not afford a funeral at the time the pt died...and that they weren't ready for him to go... so we don't know what happened, if they thought him being in the hospital would bide them some time, and the admitting doc didn't know the whole story? all very interesting to me. he made it through the ER, the admissions unit and 2 other nurses on PCU without it being addressed. the day shift nurse before me had good intentions by having him sign the refusal of tx form, but really there was a period of 48 hours where it's kinda like.. what happened? i learned a whole bunch of technical stuff i wasn't even aware of. lots of policies and procedures and loopholes. my director has reviewed the scenario and this is what she explained to me. hmm....
  12. flightnurse2b

    Nurse Survey Shows Deficiencies in Hospital Swine Flu Readiness

    i haven't heard anything about my hospital screening during admission in the ER or any precautions as far as swine flu is concerned. we only have 2 negative pressure rooms on my floor which are usually occupied by patients with TB, i am wondering if the pt's with the H1N1 need to be in the negative pressure rooms. i have always refused to reuse an N95 respirator mask, but we do have lots of them.... it's just identifying the patients that scares me.... i am wondering about the vaccine, when will it be ready, and are health care professionals first in line to get it? my OBGYN told me yesterday that a pregnant nurse from our sister hospital was given a patient with the H1N1 virus, accepted the assignment, and is now testing positive for the swine flu. i'd clock out and leave before i ever took a patient with the swine flu or the symptoms of. my job is not worth my baby or my life.
  13. flightnurse2b

    ethical dilemma with a DNR last night

    see, the patient's admitting orders were admit to PCU with telemetry. we have a med-surg floor and an oncology floor that he could have gone to, but he was specifically admitted to PCU with tele. i read the entire chart like 100 times. no order for continue hospice, no order for DNR, no order for anything but IVF, an enema, a few cardiac meds, pain meds and reglan. and even if a patient comes in with a state of FL DNR, we do not honor it. our hospital (HCA owned, if that tells you anything) has our own paperwork that must be completed for the pt to be considered a DNR--a verification of incapacity signed by 2 MD's, a withdrawl/withhold of life support signed by 2 MD's, and a certificate of terminal or vegetative condition signed by 2 MD's. you don't have that, you get coded. i live in an area where medical malpractice lawyers make a killing..... people sue for any and everything around here. it is so unfortunate to me that because of this process, the patient fell through the cracks. we do not as nurses have the autonomy where i work to do much of anything without an MD order, not even collect a stool or urine sample for instance, we do have standing orders for some things such as AMI, CVA, etc.... d/c tele is definately not one of them. i would have been roasted for taking the monitor off this man without any orders. anyway, i was thinking about bringing the process to the attn of the ethics committee. if a pt is on hospice at home, they should automatically go to med/surg or oncology--not PCU with tele.... and if they have their own DNR, why the heck can't we honor it? i know the doctors and hospital are afraid of being sued.... but the man was dying before i even laid eyes on him. thanks all for the input. i am still wondering from any hospice nurses--what is your protocol when your pt's get admitted to the hospital? are they still on hospice care? do you visit them there?
  14. flightnurse2b

    ethical dilemma with a DNR last night

    so this situation is over and done with, but it's weighing heavily on my mind. i would like any input on what you guys think.... i had a patient last night with metastatic CA (originating in the bladder) who was on home hospice care. apparently he was admitted the night before with a bowel impaction, was disimpacted and was being given IV hydration for comfort before being sent back home with hospice. the patient had signed a refusal of treatment form to say that he did not want CPR or intubation should his heart stop. day shift nurse passes on to me in report that we still need to obtain the physician's signature on the paperwork and a written order to honor the DNR. i spoke with my charge nurse at the beginning of the shift and she said we cannot honor the DNR that he signed without the doctor's order, she said we can call in the morning, he is stable and has no changes (our charge calls docs for night shift--and it has to be a supervisor plus 2 RN's to take any DNR order over the phone). i thought if a refusal of treatment was signed for anything, it meant don't do it, right? pt was AAOx3 for the time i had him, got scheduled tramadol and one dose of 2mg dilaudid. vital signs were stable except he flip flopped being tachy-brady, which was no change since his admission the night before. at around 2:30am, the monitor tech calls to say he bradyed down to 47 and tached back up to 140 and back down again, just wanted me to be aware it was more frequent now. i went to check the patient, he was resting quietly and still breathing. i called the nursing supervisor to ask the what if question of what this man goes into an arrest, do we really need to code him? she said yes. i wanted him to go in peace if it was his time. his wishes were made clear by him and he was supposedly a hospice patient at home. at 3am, the pt went into a 3rd degree AVB. i went to check the patient again and saw he was taking agonal gasps. his color had changed to very dusky and he had a very weak pulse. he was hardly perfusing. so with a very heavy hand, i pressed the code button and stood there like a dummy. i didn't want to start CPR, i didn't want to open his airway, i wanted to hold his hand and honor his wishes. i waited as the team arrived with the ER doc and i explained the situation to them. the ER doc was kind of just as perplexed as i was about the whole thing but he said i did the right thing in calling the code, he said he really needs the approval of the primary MD to terminate ACLS. so here we are, code in progress on a supposed hospice patient with DNR wishes and metastatic CA. CPR in progress, i finally after 3 attempts and 10 minutes later, got a hold of the primary who spoke with the ER doc and told him to cease the code blue. where was the hospice paperwork? why didnt the doctor write a DNR under his admitting orders? i was really in tears at this point. everyone kept saying i did the right thing. i don't feel like i did. i did what my supervisors told me was legally correct, with their stance being that the family could come back and say the pt was not AAOx3 at the time when the refusal of treatment paperwork was signed.... but the patient was on hospice care at home! is hospice rescinded or something if the patient gets admitted to an acute care area??? legally correct, yes. morally correct, no. i feel like the man was assaulted and battered and that we did not honor his wishes just cover our own tails. the man was suffering and in pain and wanted to die naturally. we did not intubate or defibrillate, and he only had one round of meds, as the ER doc was conservative in treatment bc of the situation. i feel awful about it. why so many technicalities for this poor man? where did the line get drawn or the ball get dropped or whatever? why isn't a refusal of treatment good enough? and what's the deal with hospice pts in acute care? i am so confused. i feel like it was a code that never should have happened. ugh. i need to go to sleep.
  15. flightnurse2b

    Why is LVN to RN a waste of time?

    being an LPN is not a waste of time. it was very worth it for me and i am enrolled in excelsior LPN-RN program and will be done next year. i am making alot more money than i did as a medic and i am working on a telemetry floor getting great acute care experience that i would not have been able to if i sat around waiting for my name to pop up from the waiting list for the ADN program. do what's best for you in the long run. there are definately some cons to it.. but if it's the best way to get your foot in the door, you have to think about that too. i'm going to work now to go and be the good employee who does what she's told because she can't think for herself. i really love the posts that make us sound like a bunch of trained chimps.
  16. flightnurse2b

    Bad night last night

    yikes. sorry you had such a bad night. tell your charge nurse to sit on it, you're entitled to be stressed out.... and she should have been helping you instead of criticizing you. losing a patient is always rough, especially when you work so hard to try and stabilize them, i know i sometimes just feel this horrible sense of failure. i actually had a semi-decent night, apart from being split with 8 patients and having 3 sundowners and having to give blood. it really could have been worse. get some good sleep.... thats where i'm headed.