cdsga

No You are exactly where you need to be. You know you are on the right path when you are itching to be on your own. I would express this to your clinician or educator and let preceptors take a more distant check-in with you during the day. Have them check your work before the end of the day or at scheduled times during the day just to see if you had any issues or unusual things come up.

Instead of strapping arms or wrists tot the armboards we hold hands to keep the muscle relaxant and fasciculations from causing their arm to flop off and keep them secure until after they are asleep. Males are usually stoic and many will not show fear until they get ready to go to sleep you can tell by the way they hold their breath frown grit their teeth etc. Talking.g to them holding their hand many times makes things easier. You bring up a point though that everyone should honor wishes and we do try to do what we can.

Are you a nurse? Does compassion care empathy allying fears mean anything to you?

Most AAA's are now repaired endoscopically, in hybrid OR's where grafts are placed through the femoral with x-rays-even if ruptured, so back to your question. The backflow is handled by limiting the clamp time, doctor's must move fast. Also anesthesia regulates the blood pressure and fluid replacement during the case. It is not so much the backflow but the obstructive issues with lack of circulation to the periphery dependent on the aortic level of the aneurysm. Open abdominal aneurysm repair continues to have a high morbidity and mortality rate. The key is to have a physical to detect an aneurysm before it becomes the size of an orange.

Try to get into a residency program. There are many out there and that will train you well. Probably will be a time commitment after the program is completed, but if you want to really feel confident in the OR you have to stay for a couple of years to coming into your own.

When you first start you are afraid of everything-experience makes you competent. You are a novice. Open your ears and eyes and learn what you appreciate in nursing practice and what you would not want to emulate. There are nurses today that would never be my role models, despite their years of experience-others I would still like to learn from. The key to growing as an OR nurse is the learning. It never stops. It takes a year or more to feel fully confident that you can be put in any case and perform well. Give it a chance.

OR nursing is about more than skills. Someone asked me one day about patient advocacy in the OR while the patient has no recall of the nurse(s) who cared for them while they were anesthetized. Being a patient advocate in the OR is about ensuring that you do your job well. What does that mean? Think about putting on a play. You can't have a good play without a script or props or actors can you? That's what nurses do. They make sure that your properly safely working props are in order, you make sure that the actors in the room are credentialed, assigned correctly, if not you ensure that extra safeguards are there to make it work for the case and the patient, you communicate, collaborate, inspect, safeguard, then do the patient care skills that are required for you to do. You keep a little bit of stage fright for every case, so that you do your best-expecting and anticipating that things can and will go wrong. There is no complacency. When you meet the patient-their loved ones, you allay fears, you explain what's going to happen, what you will be doing, know the case, what's going to happen, quickly study the diagnostic or elective choice reasoning behind the procedure, review the diagnostic results, know the pertinent drugs, what the patient takes, how to mix and administrate them, you defend the rights of the patient that you have come to know in a very short period of time. You monitor aseptic technique. and on and on it goes. I cannot imagine when the conscience of a room goes to solely non-nursing personnel-the respect and care for the patient declines and all goes to saving money, time and disregarding proper guidelines. Fortunately or unfortunately-we are also scribe who document correctly and concisely about the procedure, personnel, supplies, drugs and solutions used. Why? We are the ones legally required to do so--why?? because the document and the patient are the only ones who will recall the outcomes. Anesthesia documentation has it's own set of guidelines. We help them remember too. Nursing is the most trusted profession year after year because nurses care. They care without judgement of the person. They care about their contribution to the surgical outcome of the patient as well as personal pride in their quality of skill-sets. God help us all when the conscience of the care goes away. It takes more than properly putting in an IV or foley-or if a nurse is judged on how quickly they can turn a room over. But only one who embraces the art and science of nursing and works to bring the two together to know how challenging and rewarding that can be. That takes time and commitment to the craft.

"Snitch" means tattle tale. Police use them (usually the snitch gets something in return) to get the skinny on people that they can't get to tell the truth or share the reality of what's going on. Poorly performing managers use this type of person to put the ear to the ground for them. That is a dangerous proposition. Once that tattle-tale is exposed to the rest of the group (which most suspect anyway), false rumors get spread and the real issues go underground. The trust is lost and everyone suspects everyone else. Terrible environment.

It is tough to confront someone during work when you are dealing with patients and so much to do. These types of issues take focus off and makes life miserable and too stressful-really unnecessary. If management feeds into this, keeps a record of it and then surprises with these comments at a peer evaluation without a forewarning or allowing one to correct behaviors then that is a problem of management for sure. People should know if their behavior is distressing to others and allow them to correct or make amends. You never know what's going on with a person on a given day. Get to the bottom of it, and get involved in order to mediate and allow the parties to air their differences. Managers who take innuendo and gossip as truth should not be managers. "What you permit you promote"-so the wise people say.

It may vary from state to state. I would check your state's medical practice act to be sure. This may become more prevalent when staffing issues arise or if in a very rural area with limited resources. To be safe, if the patient is stable and not emergent, I would wait until there are qualified rad techs available. Dr. may be mad, but then call your supervisor to back you up on the possible delay.

Well we've gotten off track once again. To set it straight. LPN's have less education but have a similar skill set. The RN has supervisory roles of all those who are not RN's and also do initial patient assessments and meet requirements of job skills and responsibilities set by each individual state. RN's are paid more, have more possibility of career advancement. LPN's also have the capability to advance, but are limited by state statutes. People choose vocations based on their ability to devote time and money to levels of education. Each person has the ability to advance to higher levels of education at any time in their lives as situations allow or if driven by personal motivation. No judgement here.

Doctors will use less expensive help and will design programs to allow others to take over the RN role. Nurses have yet to define effectively what value we bring to the table on a daily basis. Yes there are studies to provide evidence that having RN's bring better patient outcomes...but ask an RN to define the value they bring to the table and you will find task oriented statements rather than the value. If you think about it, the caring part of the nursing role can be accomplished by just about anyone, but the science behind what you do, keeping up with new drugs, treatments, and safety separate the nurses from laypeople or those with less training. Nurses are more than run and fetch it people. We can question orders because we know how to separate what is safe from unsafe, what has an adverse outcome over what is desired. We understand the whole person rather than just the problem so we can plan care that would optimize health for people. I think it is high time that nurses articulate their value and be able to readily answer "What is a nurse?"

To get back on track. The number of patients entering health care with untreated/undiagnosed chronic diseases is on the rise and is expected to increase dramatically with the new health care law implementation. If this expectation is true, then health orgs must anticipate the need for improved nursing education, improved on-site orientation efforts, better ideas on service demographics, and improved health communication within the communities served. Pay for performance, care non-payment for re-admissions is a constant threat now and orgs need to understand that it is not only the nurse's responsibility but all players are in it-that includes nutrition, therapists, pharmacy and medical. That means that the org must catch up to the snowballing effect of this new challenge-which only a few hospitals and community public health services are on top of. To reduce staff at this time is non productive, and will in the long run cost more money. Even the small things will save the orgs money and guarantee solvency to pay staff for needed services. Smart and collaborative leadership pays off and the biggest thing in my opinion that is lacking is those nurses who are not truly passionate about leading. You don't have to have a formal title to lead. Those with titles have to listen to the grunts, assist in removing barriers to getting the job done. Quickly. Instead of piling on, get rid of the redundancy-the paper work-the fear and get in there and be available, knowledgeable and compassionate instead of "I got mine...now you get yours".

I have done some legal consultation on cases where nurses were calling the doctor for patient problems and the result was that the patient had a bad outcome due to the lack of physician courtesy toward the nurses on the phone in the middle of the night. The nurse documented, reported the doctor's response and the doctor had to deal with the consequences. He could not blame the nurse because she (in this instance) had the correct factual encounter documented and involved her supervisor who also appropriately documented the behavioral responses of the physician. You are there for the patient, that's all. Doctors know you are the eyes on their patients when they are not present-even though they are rude at times-they know it. You cannot solve the issue on your own. This behavior should be addressed by higher ups if it is a persistent problem. Unfortunately it is demeaning, devaluing and devastating to the patient in some instances when care is delayed and they are made to suffer unnecessarily. So my advice is to remember why you are calling, and don't take it personally. If it does become a personal attack ("you are stupid to call me about...") you should address it with the doctor with a supervisor present. NEVER alone.

I've worked in many settings and in many different locales and have found paradoxically that appropriate staffing numbers do not always tell the tale. I have seen limited staffing perform better than when fully staffed why? Maybe because it's a sink or swim issue of everyone having to really work together to get the job done. If staffing mix is not resolved, you will see fast burn out and quick turnover, especially if you don't streamline the workplace to resolve hardship issues, bureaucracy, and unnecessary steps in the nursing role/functions. So many things can be done to make a place of work more efficient, but leadership (I have found) is lacking. People are in fear of using creative solutions without formal consent, while we tout critical thinking skills, we don't give permission to fully use those skills. It's painful and you must always look to the systems, workflow, adequate ability to take a break, or eat a lunch/dinner in peace; meaning you have to have enough staff to provide relief so that workers can stay focused and alert/less irritable and be able to work together as a team. Unless an organization really wants to retain staff, they have to look at these issues of workflow, redundancy, support staff, and be serious about it. Not just constantly be on a recruitment journey paying bonuses etc. We have enough satisfaction surveys to show what needs to be done, just do what is necessary. If leadership is lacking, get people who have the right skills for the job. Have a balance of experienced and inexperienced, pay people a good wage, and provide an environment that is safe and well laid out. Listen to the employees who stay, and implement their suggestions within reason. Most times they have the answers, not someone that never works in that environment.