snizzlenort

They do give analgesics and anti emetics, but patients sometimes have pain or PONV regardless. Hypertension is rarely an issue, and generally speaking, our anesthesia department does a great job. Some patients have a history of chronic pain, so they need more opioids, and sometimes no matter how good the anesthesiologist/CRNA is, people wake up in pain from surgeries. My goal is to be proactive and efficient in treating whatever complaints they have.

I work in PACU, and frequently have been pulling meds before or very shortly after a patient lands. Generally, I pull oxycodone, acetaminophen, dilaudid, fentanyl, and zofran for almost every patient. If it's ordered or I think I'm likely to need it, I'll also pull reglan, scopalomine, and / or toradol. I find that having these meds at the bedside makes it much easier to immediately respond to patient reports of pain or nausea, and it doesn't violate any policies. I know a lot of Endoscopy and procedure nurses pull up meds they expect to use during as case, but I wonder if anyone in recovery uses a similar method to streamline care. edit, to address some of the comments: I have an order for the drugs, and I find that I use at least a portion (25 - 50 mcg fentanyl and 0.2 - 0.4 mg dilaudid in most patients) of the narcotics in 95% of the cases. We don't need a witness to return zofran, so that isn't an issue. Oxycodone and APAP are the typical discharge prescriptions, and we frequently start those right before the patients leave. The policies don't prohibit this; I've read them multiple times.

I don't want to claim to be an expert in the matter- I've lived in the area for about 2 years now, but I'll gladly tell you what I know. There are mainly two choices here- either Carilion or HCA. Carilion runs most of the area hospitals- Roanoke Community and Memorial, Franklin, Giles, NRV, Stonewall Jackson, and a few others. HCA's biggest hospital in the area is Lewis-Gale, but they also have Montgomery Regional and Pulaski. I've heard good things about Lewis-Gale, not so much about other HCA facilities. Carilion is, from what I can tell, a reasonable place to work. I just started (new grad) and they're very customer service focused, but from my understanding, so is everyone else. There's definitely plenty of jobs in the region, and I think it's a good place to be. Check out the websites for Carilion and HCA, and let me know if you have any more questions- I'll help with what I can!