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RUBICON is a RN, EMT-P and specializes in ER / ICU.

RUBICON's Latest Activity

  1. An obituary is a description of the accomplishments of the departed. It's the "dash" between birthday and deathday. Anything and everything can and should go in it. Nothing to police there.

    How would you handle this ....

    Jory, I'm so in agreement with you. Manipulative. We wouldn't allow this man to leave because he supposedly lacks capacity while he's up walking around ad-lib, voluntarily deciding what he can & will not do, expressing his rights, this is America, etc. ... yet only 3-4 weeks ago, another patient was brought back from the brink of death following an intense course of treatment. We literally saved his life. He also mocked us and his care, this is America, etc all the while arguing very well that he was okay to go home. In the end, we gave him extra clothing and he walked out AMA to his awaiting Taxi cab. That ICU doctor said the patient can make stupid decisions, this is how the world rolls.

    How would you handle this ....

    I refrained from saying the psychiatric background, because too often times we jump on the "he's Bipolar" or "he's a Schizo" train as if it's the definitive answer for his immature & annoying behavior. And it certainly factors in, especially his ability to manipulate where he got to go each time. I couldn't see manhandling him into a room and "restraining him if need be" for the sake of his not accepting anything less of his ICU bed and care. I felt that was ridiculous on the doctor's parts to suggest this. I guess the focus on this Post asking how you would handle it, is that it became a matter of someone else's problem, from the doctor to the nurse, and on somehow making him accept his new environment. "If he refuses, then Security has to do something about it" as the Hospitalist said. What? You cannot force this man into doing or accepting what he doesn't want. You also cannot allow him to manipulate and drive the bus, as he was doing. And the nurse is always caught in the middle.

    How would you handle this ....

    It always amazes me the stories & experience we get each day. Here's another. How would you handle it?... A gentleman has been in the ICU for *only* a week after suffering a cardiac arrest at home, in which he was resuscitated by EMS and had no neuro sequalae as determined by an MRI. Skipping to the chase, he is developing ICU delirium (in my opinion), becoming more agitated with his stay and noticeably irritated whenever family arrives. He is sassy and mean to his wife, and he is mocking the care he has received. He eventually pulls out his PICC line, demands to leave AMA, and says the doctor is allowing him to go outside for 2-puffs of a cigar. He now gets a Sitter. He does have psychiatric disorders, and a psychiatric consult is ordered, of which he refuses the evaluation. After getting downgraded from the ICU to his new room, he refuses it, complaining of small details. After a short stalemate, the supervisor brings him back into the ICU room, where he was demanding to go back. Now the fun begins: the ICU doctor says the man was downgraded, and there was no medical reason to bring him back in and that it was wrong to do this. The patient is not under ICU service any more and he is someone else's problem .. the Hospitalist. The Hospitalist doctor arrives and says he cannot offer the man anything we have not already done. The 2 doctors discuss options and both state that the man has no choice and can be physically removed by Security and restrained if need be. Now, I may not know much, but I'm pretty certain if that route were taken, you would be learning about this on CNN and not thru Allnurses.com; eventually the Supervisor finds an "acceptable" option of another room, and the patient even mocks this, but is willing to go while continuing to say he has called a Taxi and he knows what we cannot do: detain him. The ICU doctor states the man is not under psychiatric certification, but that he is medically delirious and cannot be allowed to leave because he lacks capacity, and that he will continue to attempt to manipulate us into believing he is okay. Now, again, I may not know much, but after caring for the patient for 4 days and watching him progress, etc, I'm pretty certain the patient was not mentally incompetent and, although I do not impress upon AMA, in this particular instance ... let him .. we've done what we can in a week, he's stronger, and maybe all this poor behavior/ attitude/ decisions is simply HIM. How would you handle it?
  5. To each his own. You shouldn’t be made to feel like you’re somehow a show-off or know-it-all simply for expressing your pride in reaching a distinguished level of achievement. How you present yourself does. Sadly, people want to hide or cover up their badges for a variety of reasons, and in every hospital I have worked for (except one) they restricted the allowance of anything after RN on the badge. They also had strong restrictions on being reimbursed for additional credentials. Thats just more bureaucratic baloney we could discuss in another thread. Funny, you won’t see any of these forms of punishment being placed on the doctors. Instead they’re applauded in their achievements. So express yourself and be proud. It’s exactly what the hospital aims to take away from you.

    Article: Paramedics equal to RNs

    There is much that I can say about this Article and several of the Commentary I have read, yet I will keep it brief. Just as in the daily News, one must read past the juicy Headline which is often written in a way to gain attention, sometimes inciting immediate reaction thru bias, before learning what the real story is about. For example, the Headline to start off this Thread is quite catchy .. "Article: Paramedics equal to RNs" .. yet nowhere in the article does it make reference to, or insinuate, this inflammatory statement. It's bait .. and you've been caught. Also nowhere in the article does it make statement about an EMT-P's qualification, but instead some of the education that has been pulled from CEN & CCRN material. Thus education does not equate to qualification, and certainly not experience. And please make note how I have written "EMT-P" here in the preceeding sentence. Paramedic is simply a level of EMT. In EMS we are all EMTs. So the article actually IS about EMTs, albeit aimed specifically at the Paramedic-level). There is much Arrogance in the commentary .. and this is truly unfortunate. Paramedics are not equal to Registered Nurses, not in education nor in skill level or critical thinking. And the reverse is also true. RNs are not equal to EMT-Ps, in education, skill, or critical thinking. And it is because our respective working environments are different while at the same time sharing one important detail in common: Patient Care. Everyone in healthcare is a valuable member, as we are a team .. or supposed to act like one anyway .. yet how often do we allow ourselves to get caught up in the very immature and unprofessional nature of who is better than who and why. Who cares? Well there's always a few. And they are the Ones I would not want taking care of my family, your family, and their own family.

    ER Experience

    It depends on your background. If you have a Paramedic or other Advanced-EMT experience, than I would say starting in the ER is fine, because (as a medic) you already have been exposed to critical care issues, assessment, skill, fore-thinking and reaction. It also depends on the support/preceptorship that the hospital will give you. Generally speaking, an ER/ICU is less practical for new grads (who have no prior critical care experience) because of the time needed to invest and learn, etc. There are always exceptions to the rule, like people who are clinically smart and can anticipate situations versus waiting for more serious signs/symptoms to appear before red lights go up. I worked on, and still work on, many ambulances for 18 years before becoming an RN. For me, the transition was not difficult because I used my experiences to guide me. While at the same time, 2 new grads with zero prior health experience were also hired. They both do well, but one seems more aware than the other, in regards to assessment and anticipation of things worse to come. So I think it boils down to knowing yourself: We all have Potential. But what are your Abilities and what are your Limits? Take care and Best Wishes!

    The Little Engine That Could...

    Hello All... I guess I'm just looking for a little boost of confidence from those who have been in my shoes. Like many, I have an interest to fly. I'm in my 18th year of working ground ambulances (yes, that's plural, I love :redbeathe my job as a Paramedic and I had, and still own, many ... apparently it's been said that makes me an EMS sl*t:smokin:) I'm now an RN for 1.5 years and have worked solely for a community hospital ER, which sees about 33k patients annually. Becoming a nurse is a good thing, but leaving EMS (the job I love) to become a slave to patient needs/argumentative whining and losing my autonomy/performing advanced field skills has really beaten me down . I don't enjoy work, because of the endless responsibilities that are bestowed on us from :bowingpurOn High. Not to mention how the Supervisor belittles, and Patients & Families are overly demanding. Much of this is probably because a community hospital needs to pamper their customers for hopeful payment and influx of repeat business, and the community becomes spoiled and expecting particular high-end treatment ("can I mix that sugar in your tea for you??"). I know I need to be back doing what I Love and also what I do Best. I was far, far more compassionate and felt good about myself, even if I had no calls for the day. I have a profound desire to work in a different setting of EMS (flight) because of the higher acuity, it's teamwork driven by motivated professionals, and, let's face it... a Dauphene is more sleak and interesting than a Ford . I've applied to a few flight services, but I feel undeserving should I be offered a job. And what are the chances of being offered that job? :uhoh21: I hold the certs (CCEMTP, RN, TNCC, NRP, blah, blah, blah) and experience of many years, but not "in a busy EMS system" or for a mega-city hospital. Although I've seen and dealt with my fair share of serious patients, especially given the difference of Rural EMS and InnerCity (much longer transport time, high-speeds, etc.) How do flight agencies consider their multitude of applicants? Am I written off and need to get my butt kicked harder in a Large Level-1 ER for 3 more years and absolutely have a BSN and then still get cast aside... or am I comparible? As stated in the beginning, maybe I just need a boost... but I also need the truth. Has anyone felt this way, been in these shoes, or otherwise landed a flight job with similar or less experience? Your responses will be insightful. Thank you, ALL