NickB

Now that I do not disagree with. I feel like there should be more of a minimum requirement for NP school due to the limited hours in our clinical rotation. I do like that I did all of my 600 clinical hours in inpatient pediatrics which is probably more than a PA did in peds for their training.

I'll bet that there are hardly any PA's that were previously a flight nurse. And I use that example because that role is the most autonomous in the nurse profession. PAs have a miniscule amount of required medical experience prior to entering their two year PA program. That's why their clinical requirement is so much longer than NPs.

Sure thing. Just as soon as a PA student spends 6 years as a flight nurse before beginning school like I did. Let's also not forget the small detail that PAs spend two years learning about all patient populations while NPs (except for FNPs) spend two years learning about a specific population.

Not questioning running a code. I'm questioning stopping a code.

Thank you for your post. I just searched the bills referred to in the word document you attached and they both show that these bills were withdrawn. Where did you gather this information from? Do you have an internet link? Thanks again.

I am graduating in three weeks from an AC-PNP program and curiosity has gotten the best of me. I plan to work in a Peds ED and I'm curious if anyone can provide me with some info. I am curious if there is any state law pertaining to a nurse practitioner stopping life sustaining efforts in a code situation. I will be practicing in Florida and have not been able to find any definitive information on this topic. I have been a neo/peds flight nurse for the last 5 years and I have made the decision to stop efforts on a neonate, but I have called a physician into the room to agree with me before we stop and they have officially been the one to call it. Will this be the same if I am running a code as an NP? Thanks in advance.

Here, this is the quote that my original response was for. I think you and I are making the same argument. "Completely true, but in some instances you can't maintain an airway without the intubation. It's a slippery slope, but we need a middle ground" My response to this is if they find themselves in the situation, they have a middle ground and that would be an LMA.

I think you misunderstood my first posts. I was responding to someone at the beginning of the thread questioning why they didn't have a middle ground available, regarding some nurses being able to intubated instead of no nurses ever being able to intubate. My point wasn't that nurses should be trained in intubation, my point was that if they find themselves in a situation where a nurse would need to intubate with no one trained, their middle ground is something like an LMA. I've been trained to intubate but would always defer to my RT.

That's funny that you make the points you do. My RRT and I arrived to an outlying facility last Friday and walked in on an extreme Pierre Robin term baby who had an LMA inserted. This was after two RTTs and an anesthesiologist tried multiple times. We have these devices for a reason. They are a middle ground for pt's who cannot be intubated. This pt would not have survived without an LMA. And let's not forget that highly trained personnel are not always "around". On a side note, my RT intubated this pt on his first attempt. But he has been an RT for 25 years, 15 of them in nicu and I also sedated this pt prior to his attempt. He said it was one if his top 5 most difficult intubations. Middle ground airways have there place in healthcare.

You have a middle ground. It's called an LMA.

80 bed nicu. We have a picc team consisting of day and night nurses. Some staff and some transport. We place all lines and manage all dressings.

I think you'll be hard pressed to find any NICU nurse who doesn't find that pt interesting.

Funny. I was just having this conversation with a new grad in our unit yesterday. I used to old term persistent fetal circulation to help her understand it. That seemed to help a lot. PPHN is most often caused by three disease processes: Meconium Aspiration, Congenital Heart Defect, and Diaphragmatic Hernia.

Stand by for just one second. I am a NICU nurse and a parent and I find this post not only very interesting but also very helpful. We are fully aware that they are babies as we work with them at least 3 days a week. I have already learned of 3 different diseases I have never seen or heard of just by reading this post and I work in an 80 bed level 3 NICU and I am on the transport team. The original post is the whole point of this website.

There is absolutely nothing wrong with how you felt. I often go home for a long stretch and will call the unit to check on a critical patient that I was taking care of. I think the key is that you never ever make anything about you. We are human and we work with children who sometimes die and it is sad. There is nothing wrong with being sad. Heck, we celebrate with the family when patients who have been with us defy all odds and finally go home after months of being in the hospital. Is it wrong to be happy for them and show our happiness?

No way in hell will a paramedic be able to do a neonatal transport. I'm not sure of California, but florida requires a minimum of 2000 hours in the NICU as an RN before you can perform a NICU transport. The skills are way different than an adult transport.

Of course it depends on the Doc but generally: Vag with no tear or epis. = Motrin 400 q 4 prn or motrin 800 q 8. Vag with tear or epis. = Motrin 400 q 4 or motrin 800 q 8 and 1 percocet 5/325 q 4 prn as well as epifoam and tucks pads. C-section = Toradol 15 or 30 q6 (depending on blood loss); Dilaudid 1mg or 2mg IM q 3 or 4 (MD dependent); 2 percocet 5/325 q 4 prn (when tolerating PO) and motrin 800 q 8 after 4 doses of toradol have been given or if pt would prefer PO meds. Hope this helps.

This entire thread has turned into a personal attack. Some of these posts don't even make sense anymore. You all have gotten two entirely different trips to the ED mixed up in your need to try to belittle me. And yes, jumping on someone for spelling a word wrong is a personal attack as are numerous other attempts on here. But don't worry, none of these hurt my feelings because the majority of you are real tuff when there is a computer screen between us. You're right, we won't know how it feels until we walk in your shoes. And guess what, you'll never know how it feels until you're in the pt's shoes. Guarantee more than half of you have never been there. What this thread has done is show how prone the majority of you are at making assumptions about people. I feel pity for the majority of your pt's. The majority of you walk around the hospital acting like you know more than the MD's the majority of the time (see this thread: https://allnurses.com/emergency-nursing/worst-doctors-orders-333899.html) until you need it to your benefit and THEN the MD becomes the almighty voice of reason. I always include all of my pt's in their plan of care. When I have a nurse as my pt, I give them the respect that they have earned and if they don't know what they are talking about or have a false assumption, I talk them through it. I didn't know what to do next. I'm a freaking obstetrics nurse. I was in an extraordinary amount of pain. Pain I'm sure the majority of you have never felt (Look up Occipital Neuralgia and cluster headaches sometime.) I tried to take the least aggressive approach and take the weakest drug I could that would still work. When it didn't work anymore, I went back out of fear and desperation. When your 21 week pregnant wife and 3 year old are crying because you are on the floor in agony, there's not much left to do. If a freaking LP was so important, than the ER doc should've said so instead of nonchalantly (did I spell that right spell checker?) saying, "well, we could do an LP?" And yes, they were talking about me outside of my room. And even if they weren't, have some freaking couth (did I spell that right?) and go talk about people at the nurses station.

It's obvious the ER nurses are offended here. Maybe because they are being called out for their normal behavior. Fine. I didn't decline narcotics, I tried to use the least strength med that would work and when that no longer worked, I went back. Continue to treat your pt's this way and take nothing from this post. If I decide to write a letter to the hospital, its my freaking prerogative. I'm tired of all of the old jaded nurses labeling every pt in pain as a drug attic. It happens on my floor as well. The open minded nurses reading this may use it as something to think about. The rest of you will continue to walk around in your own little jaded world and complain about everyone who walks through the door. Peace out.

I went to the hospital because I could no longer stand the level of pain I was experiencing. Think of how humiliating as a nurse it is to admit that and than think how much more humiliating as a nurse it would be to be labeled as a drug attic. Then you will understand my frustration. All of you are basically saying "you should have stayed at home and sucked it up." When your step-father who has been an MD for 35 uswest says maybe you should go to the ER, you go. I didn't want to, but I also didn't want to die that night. I didn't expect to be treated like the pill head that they thought I was. If the LP was that important, they should have said so instead of talking about me in the hallway.

i don't care about working in this hospital. i said i thought about working there in the past. i have been a business owner in the past and would want to know if this is how people (especially fellow nurses) are being treated in my hospital.

I'm not complaining about freaking water. I'm not offended by the fact that maybe they didn't know what else to do. I'm offended that I was labeled as a drug seeker because I complained of pain. I'm offended that they spoke loudly enough outside of my room that I heard them. I'm offended by the lack of communication. I'm offended by clear assumptions and a negative attitude because I declined a senseless test that carries its own set of risks. Of course I listened to my pcp. She's knows way more about me than an ER doc who has never seen me before. As a matter of fact, he was the ER doc at my first visit and he did an exceptional job. He included me in the plan of care and factored in my thoughts and opinions. It was the people at my visit later in the week that I have issue with. In response to someone else's post. I have never had a baby nor will I ever have a baby so if someone tells me something they are feeling, I don't ever make biased assumptions about it. I listen to them and try to work through it with them. I'm sorry you have found a way to be okay with doing that. By the way. The ER doc did nothing for me. It was the pain doc two days later that did something for me. But at the time, I was experiencing a pain that I'm sure the majority of you have never experienced and I wish none of you will ever have to experience. That is why I went back to the ER.

Another thing I would like to say is that this hospital is in the network of hospitals that I work in. I have actually spent some time in their special care nursery and do not want to be labeled as the nurse who is a "drug seeker." I have thought about employment in the hospital in OB a few times. This letter will not only bring light to nurses doing what we were all taught not to do in nursing school, but will contain all of the records of this experience so I can now save face that a few wrong assumptions have created.

I had an LP 2 years ago when the whole swine flu thing was going around because of extreme bilateral headache, 102.9 oral temp, and stiff neck. All indications of possible meningitis. I have had nothing like this. LP is for menigitis and for checking to see if there is a bleed that has been present for at least 12 hours or that may be so small that CT won't show it. I may not be an ER nurse, but I'm not an idiot either. I read and research a lot.

Since it is obvious that the ER nurses are the only ones offended here this post is for you. #1 I waited 3 days to go to the ER because it is only a place for emergencies and I didn't feel this headache was of that magnitude until Sunday night. This was under constant guidance with my Step-Father who is a General Practitioner of 35 years. #2. I didn't fill the scripts of neurontin and tegretol under the advice of my PCP (Primary Care Provider.) Just following doctors orders. #3. I never once asked for any type of drugs. I only asked for someone to help me. My second trip to the ER was because I was at a point where I thought that I would either die or kill myself because of the pain. #4 If one of you can please explain to me any indication as to why I should have received an LP, than I'm all ears. I still can't think of an idication. #5 The comparison of a patient refusing a digital exam was weak at best. There would be a clear indication to do one. She is infact pregnant. No guessing there. In that situation, we would do an ultrasound to determine fetal position and let her continue to labor while we convinced here of the importance of a digital exam. I had no one inform me of the importance of an LP. It was clearly a CYA for the ER doc. The first ER doc was perfectly fine with not doing one. #6 All I wanted was relief. The tegretol I'm on now is basically for nothing. The neurologist cut the dose to 1/6th of what the ER doc wrote. The nerve block is doing everything. And the neurologist and an anesthesiologist who specializes in pain management both said a big NO to the neurontin. These ER nurses made unjustified assumptions as are the nurses above. It is letter worthy, because if it happened to me, it is happening to many others. If you are so jaded on being an ER nurse, than get the h*ll out of the ER. The are plenty of other nurses out there who would love you job.