JohnnyGage

The company I fly for routinely does interstate transport. Because the company is licensed in Minnesota, and we as nurses are licensed in Minnesota, we are covered. Basically, while the patient is under your care and covered by your protocols, orders, etc., they are considered to be "in your state" until care is transferred.

Congrats! As for this... I have two words: Rotor Blades.

While I am quite comfortable with chest tubes and the questions you've raised, I don't think I could adequately answer the questions in a forum like this... I'm much more of a hands-on teacher and for something like CTs, even more so. However... Have you thought about contacting the company to see if they could arrange for one of their education reps to do a hospital inservice? Most are very willing to arrange for this type of education seeing it as a cheap and easy way to keep customers.

Overall fitness is key. A good fitness program will include flexibility (especially back and hamstring stretches), strength (we all know about the increase in "bariatric" patient populations), and definitely endurance. Not only that, but important components in my opinion are also spiritual and mental fitness, however you achieve those. Personally, I have been in training for my first triathlon. It has helped in every one of those areas.

They died as heros. May they rest in peace.

What parts are you having trouble understanding?

We waste every time unless we're "actively treating or titrating". Basically it comes down to: if you feel confident enough about your patient to leave the bedside you should waste. That is, if you're actively treating chest pain or acute agitation and you wouldn't want to leave the room, you can hang on to and re-use the syringe. A lot of the older nurses think that wasting is wasteful, but one of our NMs posted a little tidbit of drug cost to the patient vs. court costs for a potential lawsuit and it opened many people's eyes.

When the creative commercials for Listerine Strips give you ideas of how to deal with "neuro breath".

flyeeng and wurking Trahma prety much rooned all of my dangrus hobees. I still luv to rok clime, tho. I never rid motercykles and sertianly wont ever. Spelling purposely changed out of spite.

Sounds good. Just remember to tell them if you feel more orientation is needed! However, also remember that orientation is not to make you a "great" nurse, just a "competent" nurse. The "great" is up to you and your work ethic.

I never give IMs any more, but when I did, I always changed needles. Mostly for the fact that going through the rubber on a vial will slightly dull the needle and I always wanted to give my patient the sharpest needle possible... less pain that way. I figure, why not? In the grand scheme of things needles aren't very expensive. I guess my question is why wouldn't you change them out?

Hard to say, but I would guess: CVICU is a surgical unit taking open heart patients, probably also any aortic surgeries, possibly thoracotomies (ie cardio-thoracic stuff). CICU is probably a cardiac medical ICU taking critical coronary cases on vents, IABPs, CRRT, etc. CCU is most likely also a medical cardiac unit that acts more as a stepdown taking coronary patients that are on simple drips like NTG, amiodarone, diltiazem, etc. but not dealing with the machines they work with in CICU. Most of the MIs probably end up here, along with most of the post-intervention cases. If the heart recovery plan is typical, this is also where the open-heart patients complete their recovery after they transfer out of the CVICU.

Well, it seems to me that "advanced care" is just another name for "step down" or "progressive care". One more term to throw into the mix to make the public think that it's innovative. Yup. Our hospital's got 'em. Don't know why there isn't a forum for it, though.

What does an "advanced care unit" consist of? Is it the same as stepdown or "progressive care"?

Never strip pleural tubes. As I mentioned before, we strip mediasteinal tubes to prevent clotting and tamponade. Yes, it can bruise the heart, but what's your other option -- death?

OK... Yes, I've clamped chest tubes for a couple of hours -- in a patient with a previous pneumo. We do it occasionally for a couple of hours and then get an x-ray to see if the pneumo will return once the tube has been removed, as has happened occasionally. Yes, we strip chest tubes. Not purely pleural ones, but mediasteinal ones sometimes after cardiac surgery. Many times we have to in order to prevent the tubes from clotting with blood. We "milk" them when possible... but sometimes it's not adequate. Our other option is to allow clots to form in the mediasteinum that might progress to cardiac tamponade. Now neither one of these practices is routine -- only under special circumstances. But don't get yourself into the habit of thinking that nursing doesn't have any shades of grey -- no matter what the litterature says.

No, I have not. Interesting... I'd like to a) see the actual documentation and b) see how they go about proving something like that. I'd like to clarify something I mentioned earlier... A bribe is given with expectation of influencing an outcome in favor of the giver. A gift is given spontaneously as an expression of affection or gratitude. Payment is an exchange of an agreed upon amount of money or property for services rendered. Nurses get paid. Bribes are unethical. Gifts (under most cercumstances) are OK.

I know lawyers that have accepted gifts. Gifts are just that -- gifts. Bribes are different in that they are given and a favor is expected in return. While I am a firm believer in ethical practice, I am also a firmly against zero-tolerance rules. Just think of the slippery slope that could lead to... teachers can't accept gifts because it might lead to favoring one student over another... parents can't accept gifts because they could get sued for favoring one child over another. Of course I'm being facetious. If there is a question about a nurse's ethical practice and gifts have turned to bribery, that's one thing; however, if a nurse occasionally accepts a gift from a truly grateful patient or family member, I don't see any violation. What about a nurse's ethical duty to respect different cultures. What if she refuses a gift and as a result a patient is insulted and refused to go the hospital again? (Yes, it's an extreme example.) How about thank you cards? Are nurses more inclined to be more caring if they know that a thank you card or a good word might end up in their employee file? Best ban those too! No one goes into nursing for the money -- or the gifts. If a nurse is letting gifts influence the work of caring then there are bigger issues at stake.

I agree that you shouldn't expect a gift, but there are many times when I think it is appropriate. When a patient is discharged from your unit and give candy and a card, that's OK. If the little old lady you're taking care of gives all the nurses that took care of her a hand-knitted washcloth, that's OK but only if she would be offended if you didn't accept. In fact, I think that's a good rule anytime: if the giver would be offended that you didn't accept (as is the case with many cultures) than accept. If in your heart you feel you can't, then donate the gift elsewhere. Certainly if the gift is given quid pro quo than it should not be accepted, but most patients, I've found, are only trying to be nice in return for the niceness given, and isn't that what it should be about anyway? If a nurse is really so anti-reward, than why get paid? Do we give better care as our wages increase? Nope. Do I give better care in the hope of, or because, I've received a gift? No again. All of the above are, naturally, only my humble opinion.

I think if you have a lot of patients you should be checking more often. You definitely don't want to give one patient another's insulin or heparin dose by mistake.

Ow. Ow ow ow ow ow! I mean really... Just the proportions involved (even for a >ahem! I once worked triage in ER on a very busy night. There were two of us working the desk to maintain traffic flow. The other nurse was fielding a phone call when a gentleman walked in and sat down on the chair. Now, he was obviously mentally disabled but I wasn't expecting his chief complaint. I asked him what was wrong... He replied in a very loud voice (one loud enough to make several people in the waiting room look up), "I did a very bad thing! I put a Q-tip up my member and it got stuck!" Now, if he would have moved closer and whispered something like, "You know, I was messing around and got a Q-tip stuck up my weiner," I would have been fine. No problem. I've dealt with strange things before. However, I was not expecting a full-throated explaination of this sort. I just about choked trying to hold back the laughter. When my partner got off the phone she asked me about his CC (she had not heard his outburst). I stiffled the laughter and got out, "You ask him!" before I ran out of the waiting area to laugh hysterically for about five minutes. The Q-tip was removed without incident and the man was discharged with a straight catheter to use as he saw fit.

It didn't used to be a policy at out hospital -- "old school" was the line of thought. However, after a couple of sentinel events, it is once again strict policy for both heparin and insulin. I do find it amusing that we don't have to double check more lethal drugs, however. Maybe it's because heparin and insulin are so "routine" that more mistakes are made. The more unusual and dangerous drugs are more carefully checked by nurses. I dunno.

My standard response in situations like this, whether dealing with an MD or another nurse (and when I have done my research and know I'm right) is: "Show me the proof." That is, find the article, textbook, or documentation to support your case. This accomplishes two things: 1) If they are in fact correct, you learn why, and 2) If they're blowing wind, they shut up.

I was helping turn a patient when she projectile vomited into another nurse's mouth (she was talking). Blech!

Really? Huh. The things you learn.