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  1. http://en.wikipedia.org/wiki/Emergency_Care_Practitioner http://www.londonambulance.nhs.uk/working_for_us/from_our_staffs_perspective/ian_wilmer_-_emergency_care_pr.aspx Judging from the description of the ECP's role in the British health care system, the above position would definitely be my dream job (I currently work in an ICU). The description says that ECPs come from the nursing field as well as paramedicine. I'm just wondering what people's opinions are on whether or not such a role would be possible to incorporate into the US health care system- given the fact that we have far fewer referral resources than in the UK (especially for people who are uninsured) and that people here love to sue health care providers and institutions.
  2. edogs334

    What states have a prehospital RN scope of practice??

    Someone in a previous post stated that "people line up to volly" as EMS providers in some states- which would negate the need to have RNs in the prehospital field. I can tell you that's definitely not true where I live- we don't have enough people to staff the ambulance 24/7 at my volunteer fire company- let alone enough paramedics or ALS providers to staff the ambulance at the ALS level all the time.
  3. edogs334

    Need some Precedex advise

    We just had an in-service on Precedex and I can tell you that facilitation of intubation is definitely NOT one of the labeled indications for this drug. Those docs are either very ignorant or just plain crazy- the outcome of that intubation attempt is definitely their fault and not yours. I think some docs just like to use new(er) drugs like Precedex because it's the latest and greatest new thing and they just read all sorts of literature about how well it works. Well, evidence-based practice is all well and good, but sometimes they overlook the individual patient (as opposed to a population of patients in a study) when making decisions about which sedative to use. In my unit, we usually use Precedex for intubated patients who are closer to being weaned off the vent (ie- going on PS trials), but still have some intolerance of the ETT and/or being on the vent itself. Precedex is good alternative to Propofol and Versed in the sense that it doesn't have the respiratory suppresant effect that Propofol and Versed do. Plus, if (and that is, only if) Precedex actually works for a particular patient (there's a good percentage of patients in which it does not work), then you can also do accurate neuro assessments on them while maintaining them at a comfortable RASS of -1. Precedex is supposed to keep patients in a state where they are resting comfortably (RASS of -1), but they can wake up and follow commands when told to do so. Precedex also doesn't have as much of a hypotensive effect on patients in comparison to drugs such as Propofol. So in my experience, Precedex is really hit or miss. There are some patients who will still be buck-wild on it, but for the patients in which Precedex is therapeutic, it's like dealing with a sleeping lion- they can become agitated when stimulated, but they go back to resting after a period of not being bothered.
  4. edogs334

    Feeling like the 5th Wheel at Work....And I feel stupid :(

    When I was on orientation not too long ago, I got an admission from the ER at around 0530. I forget what the patient's chief complaint was, but the sending RN (from the ER) had said in report that the patient's K+ was something like 2.9 (I forget exactly what value- something low, none the less) and that she had already started repleting with 10mEqs:eek: Being a brand new nurse on orientation, I did not yet realize that this was WAY too little an amount of IV potassium to give someone with a K+ of that value (I think our protocol- for non-renal players- states that at least 60mEqs should be repleted for a K+ of :eek: If I remember correctly, I'm pretty sure I stopped the infusion once I noticed. However, the oncoming nurse chewed me out because I had not asked the docs to order more K+ for the patient. I profusely apologized to her, but I realized apologies were useless when she said, "well, I just hope the patient isn't going to suffer because of what you didn't do." I remember feeling so mad at her- I mean, what right did she have to say that to me? I obviously didn't know any better- being brand new- and that's something my preceptor should have picked up on. And yes, I did go to nursing school and graduated with a respectable GPA (3.33). I think there are some nurses who either forgot what it was like to be a new grad or came in as new grads who thought they knew everything (and were reinforced by key people in their unit to believe as such). The truth is, nursing school never taught every nurse everything they need to know. It's like complaining that a construction company hasn't built a house in 1 month after they've only had time to lay the foundation. And that's what nursing school really is- just a foundation to build upon.
  5. edogs334

    NP Residency Programs?

    I'm not an NP (I'm an ICU nurse atm), but I have the same question. My hospital uses NPs extensively, but I've never heard of a formal residency program for NPs- at least not at my hospital (or the others I've worked for). I think having a residency program makes every bit of sense, though- especially if you're, say, a brand new ACNP in specialty unit such as Neuro or CV ICU. There's so much specialized knowledge you need to learn that's specific to a particular critical care specialty. The lack of NP residency programs is why I think hospitals like to hire NPs with experience in a particular kind of unit (for specialized areas such as the ones I mentioned).
  6. edogs334

    Want to do Flight, but, well, I cannot stop eating CRAP!

    If you can't kick the sweets habit, then there's always ground critical care transport. Not as sexy as flight, but some of the patients can be just as challenging. On a diet note- try eating fruit for dessert instead of ice cream- or have fruit and (low or non-fat) frozen yogurt.
  7. edogs334

    Vent: MD visitors who are NOT intensivists

    In my unit, we have restricted visiting hours from 7am-9am and 7pm-9pm specifically so the nurses can give uninterrupted reports and complete uninterrupted assessments (without family member interference). The only exception to this rule is if the patient is actively dying or if our nurse manager makes an exception for a specific patient/family. If this guy were in my unit interrupting my report, I would say to him that that patient's sats are 100%, that they aren't in any distress or having SOB, and that I would get to it in a few minutes after giving report. If he still complained, I would explain our visiting hours policy and that he would need to leave during these hours- no exceptions. Don't get me wrong, family visitation and involvement is important to the patient- especially in the acute phase of their critical illness. But some family members think they can practically get away with anything in terms of the demands they put on the nursing staff. Especially when a nurse has two vented, busy patients- some family members need to get it through their heads that we can't pay attention 100% of the time to their loved one- unless they are acutely decompensating (or are about to do so). I once had a non-ICU nurse ask me what a particular antibiotic was for. I stated what it was for and that the infusion had since finished. She said something like "well, it looks like it hasn't because it's still dripping." What she was really seeing was the small remainder of the fluid in the secondary bag dripping because the secondary roller clamp was still open and the primary bag was still lower than the secondary- even though the pump had switched back to the primary basic infusion a long time ago. Hence the pump was still pulling fluid from the secondary due the the effect of gravity in relation to the position of the primary bag.
  8. edogs334

    Parents won't support my decision

    EXACTLY!! So many people over the last few years have said to me "well, why not just become a doctor?" As if it's such an easy thing to do to just take the pre-med courses, go to medical school, go through residency and Voila! you pop out with MD after your name at the other end. I wonder if they would have asked me that question if I was female (I'm a guy). To reiterate what Jay Z said, these same people have no clue about what exactly doctors do and what they had to do to earn their title(s). After being an ED Tech myself and seeing the grueling hours some of the attendings worked (ie- administrative duties from 7am-3pm, clinical shift 3pm-11pm, finish charting from 11pm-1am) I had to say "thanks, but no thanks." Plus MDs basically lock themselves into one specialty- it's very hard to do another residency in a different specialty if they get sick of the one they're in. Nursing's a lot more flexible- it's a profession where you can have lots of different, challenging roles throughout your career and still retire comfortably (without even leaving a particular hospital, in some cases).
  9. edogs334

    OK we get it STUD, you're straight

    When I was a nursing student (not too long ago) there were definitely male classmates who did and said stuff to prove their "masculinity" and made comments like "not that I would be into that" or "not trying to imply anything (hahaha)." And the whole "Man Enough to be a Nurse" campaign? Really? Just because you're a nurse who happens to be a man doesn't mean you have to be hypermasculine to prove that you're straight. Like I've said in previous posts, I've known 2 or 3 MD residents who were openly gay- sexuality has nothing to do with one's profession. Being straight isn't about being married, being into college football or owning an F550 Powerstroke Diesel (which is I think is pretty sweet, btw). Rather, it's about which sex you're more attracted to. Just like I don't have to be into the latest bubble-gum pop, the latest fashion trends and be a woman's best friend to prove that I'm gay. I just know that I'm attracted to other guys when I see one who strikes my fancy. Also, most straight guys don't have to worry about getting hit on by gay men- because most gay guys, like everyone else, respect the concept of PERSONAL BOUNDARIES (DUH!). I'm guessing that straight (or "straight") men worry most about guilt by association- meaning if they associate with known gay men too often that they'll be thought of as gay (by people on both sides of the fence). Which is completely stupid, because that kind of evidence (for someone being one way or the other) is just idle gossip and completely circumstantial. I can attest to that fear, having been deeply in the closet myself for more than several years before I came out in my 20's. PS- I love powertools- roofing with a nailgun is freakin' awesome!
  10. A good tech is worth his or her weight in gold- that's all I've gotta say after today's shift. Thank you for all you do- as an RN, I truly appreciate the work that techs do as part of our team. You make my job that much more manageable and provide me with vital information that I use in my assessment and in conferring with the team in rounds. Also, by performing basic nursing skills, you allow me to concentrate more on assessing my patient and tasks that require RN licensure. It's really nice to have accurate and timely numbers for q2h vitals, temps, I's & O's and finger sticks when you have 1,001 maintenance meds to give + q4h assessments + labs to draw and, oh, the docs want to do a procedure right now when you're in the middle of something else. When I see -on the board- that I'm going to be paired with a tech who's hard-working and self-starting (and one who thinks, at that), I know I'll have a good day no matter what happens :redpinkhe
  11. The only situation in which we officially have 2 nurses taking care of one patient is when a preceptor and their orientee take care of a sick patient who is 1:1. I did this a few times during my orientation- such as one night where my preceptor and I had a septic patient who was on propofol, fentanyl, levo, vaso, multiple antibiotics, insulin drip- well, it seemed like you name it, the patient was on it. It got so busy that I basically acted as the documentor while my preceptor provided the majority of the patient care (because things had to happen that fast). Other than that, if there's a really sick 1:1 on the unit, a float nurse might help out the nurse who is assigned to that patient; the float isn't "dedicated" to that patient, however.
  12. edogs334


    I'm not a moderator, but you'd be better served if you put this question in the Nurse Practitioners forum- under the Advanced Practice Nursing Specialty group of forums. There are several people there who are ACNPs and can better answer your questions. Also, are you already an RN? What is motivating you to look into NP programs?
  13. edogs334

    Patients who are too unstable to turn

    There was a patient I had when I was still on orientation (or was it when I was off orientation? I forget - been off for a few months now) that would brady down to the 30's if you turned, suctioned or otherwise stimulated him significantly. I kept Atropine at the bedside and actually had to push 0.5mg once. The attending ordered a Scopolamine patch because evidence has shown it worked- for what reason he didn't really know. Anyways, the Scopolamine actually worked in the sense that he didn't brady down when stimulated- so we were able to turn him more often after the patch was applied.
  14. edogs334

    College Student Looking for Career Advice...(RN vs EMT-P)

    In terms of accelerated programs, don't do anything less than 14 months- that's just downright crazy (14-16 months is already a crazy pace). My school had accelerated 14- and 16-month cohorts in addition to their 24-month program and I personally knew many of the accelerated students (as we took some of the same classes together at the same points in time). After seeing what it was like for them to go through a program like that, I'd say the successful completion of such a program is really dependent on the individual student. If you're a complete spongebrain (ie- most everything you learn clicks on the first pass), can learn while flying by the seat of your pants and are disciplined enough to study for several hours a day (in addition to classes), then I'd say go for it. Also, most of the accelerated students did not work during the program (ie- per-diem at the most) and had a good support system at home. So if you possess those characteristics, then I'd say go for it (no sarcasm intended, honest:)).
  15. edogs334

    What is your Kryptonite?

    Yeah, something neurosurgical- like a patient with an IVC drain or a Camino Bolt- well, especially an IVC drain. No matter how often other nurses and my manager have explained how an IVC drain works, I still can't get it straight in my head (I've never had a patient with one, though). I'm afraid I'd turn the stopcocks the wrong way at the wrong time, thus fatally increasing the patient's ICP without realizing it Oh yeah, and screaming kids are NOT my comfort zone- my anxiety level went up whenever I was floated to the peds ED as a tech. I think it's kinda twisted that anyone would consider screaming kids their comfort zone (but maybe peds nurses couldn't imagine working with adults- especially some of the patients I work with).