highlandlass1592

Since you don't know what the responsibilities are, your post is incorrect. When you say cover an RN, we have not been told what the job entails. It's also premature to say it could cost future licensure

What I haven't seen anyone do is direct you to your board of nursing: THEY ultimately regulate what you can and can't do. Get a job description from your employer, detailing exactly what your responsibilities are then contact the BON with your question. As a tech, you will never complete RN duties, as you call them. You can however complete tasks delegated to you by the RN

I think you are wise to be cautious. And honestly, reading some of the other posts I'm disappointed in the level of snarkiness being expressed. You not only wanted to protect yourself but your license. People may appear to be A&O x 3 but may not have a true understanding of consequence. Having been in a couple of situations like that, the team asked for an emergent pscyh eval to complete an extremely thorough assessment. One case the pt was found to be truly competent to make such a decision and we documented the heck out of everything and called him a cab. In another situation the pt was not competent and was compelled to stay. Bottom line, sounds like you did the best you could. I'd recommend speaking to your manager to review your policy for such situations

Let's back the truck up a bit. I know of NO ONE who would say families can't contribute to a patient's well being and recovery. However, society has become so "me- focused" many family members are stretching the limits of nursing sanity. If I have to climb over 6 people to get to my patient, time to leave folks! My patient in that bed is the priority, not you. I've actually had family members yell at me when they were staying at the bedside and their sleep got interrupted because I had to turn a light on to care for the patient. I've also had family members get mad when I ask them to wait a minute with their question as I'm verifying a medication. I grow so tired of hospitals that are more worried about satisfaction scores than the quality of care being delivered! It's all about making visitors happy not about saving/impacting lives. I've had family members not leave and the patient has begged me to make them leave so they can rest. Then I get talked to when the visitor complains???? Folks, in should be about what is best for the patient. I've argued with fellows who want to come in and wake my patient up at 3 am for a non-emergent procedure consent. I've argued with families who pile on warm blankets because the patient looks cold...well, I'd look cold too if I wasn't perfuming due to sepsis...putting 5 blankets on while I step out of the room causing the temp to go to 41 degrees Celsius is a problem. Administrators have gone too far off course and families are out of control. I get tired of beating my head against the wall

Make sure you file a change of address with CA BON. Also make sure your CEU's meet CA requirements and then you just pay your renewal fee. If you don't ever plan on practicing in CA again, you may want to check to see if you can place it on inactive staus

wanted to take a moment to address a couple of your points. I've cared for many LVAD's on CRRT in our ICU. I realize outpatient is of course a different ball game but I have found flow on the LVAD to be a great first line assessment for fluid shifts. Depending upon the device, if a patient is becoming unstable, you will get flow and possibly speed variations which will clue you in to a possible problem. This can prompt you to assess BP. BP in an LVAD can be a challenge. Best way to assess a continuous flow device patient's BP is via Doppler. Another alternative is to use a Terumo cuff (which is a special BP cuff that frequently works on LVAD's). However, if the BP is too low , even a terumo cuff may not help and you'll still want a Doppler BP. i can't speak to staffing in your situation. But I do a lot of teaching with LVAdS and would be happy to help if I can. Feel free to contact me. Best of luck

Have to be honest, I may only check a cuff pressure once a shift. If I've got a good, functioning A-line, that is the gold standard for monitoring. Continuing to use a NIBP seems just silly to me as well as putting an extremity's perfusion at risk, especially with a critical patient. Interesting article: http://www.medscape.com/viewarticle/563819_5

1) AACN: American Association for Critical care nurses 2) Missions statement link: http://www.aacn.org/wd/aacninfo/cont...s?menu=aboutus 3) Again refer to the mission statement but in a nutshell why I belong is they further the education of critical care nurses who provide care to critically ill patients. It drives "excellence" which is something I can support. 4) Networking with other professionals in critical care, yearly conference to further continuing education, they set the nursing gold standard for those providing care in both critical care units and intermediate care units. They also support nursing driven research in critical care. 5) They look into practice issues and currently are driving both research and practice guidelines to eliminate Healthcare associated infections, I'm not sure however if this question is looking to discuss something like nationwide healthcare. 6) I support the practice guidelines, research. I like the ethical ideals presented by the organization. The certification it provides show excellence in clinicians, it's not an easy test to pass. The continuing education opportunities keep me at the forefront of both medical and nursing procedures. I have gotten a lot out of my membership..definitely worth it. (I posted this for someone else. Don't know if you are the same person. Hopefully not. As your questions were the same, copied my post for you)

I also belong to my state's nursing association, not sure which type of organization your rubric desires, if it's that one, I'll be back on in about an hour,can answer those questions for that one then.

1) AACN: American Association for Critical care nurses 2) Missions statement link: http://www.aacn.org/wd/aacninfo/content/mission_vision_values_ethics.pcms?menu=aboutus 3) Again refer to the mission statement but in a nutshell why I belong is they further the education of critical care nurses who provide care to critically ill patients. It drives "excellence" which is something I can support. 4) Networking with other professionals in critical care, yearly conference to further continuing education, they set the nursing gold standard for those providing care in both critical care units and intermediate care units. They also support nursing driven research in critical care. 5) They look into practice issues and currently are driving both research and practice guidelines to eliminate Healthcare associated infections, I'm not sure however if this question is looking to discuss something like nationwide healthcare. 6) I support the practice guidelines, research. I like the ethical ideals presented by the organization. The certification it provides show excellence in clinicians, it's not an easy test to pass. The continuing education opportunities keep me at the forefront of both medical and nursing procedures. I have gotten a lot out of my membership..definitely worth it.

what do you need answered?

Actually, this patient had gotten fluid earlier so depending upon an in-depth lung assessment (which the only information given here was "tight") as well as a cardiac assessment, Lasix definitely may have been indicated. And some form of diuretic therapy IS indicated in heart failure management, especially exacerbation which might be caused by right heart failure. Diuretic therapy is driven by kidney function, better to be a bit dry than wet. And re: orthopnea, that was not listed when the symptoms were discussed, what was stated was " he had been complaining about not getting much sleep". As this pt was post-op for CABG, that is not an uncommon complaint. Your post jumped to some conclusions that weren't supported by information presented by OP. And as this patient went into an acute situation rather quickly, NTG and ACE inhibitors wouldn't have been indicated, IV inotropes would have been indicated as well as the possible use of Milrinone if the patient stabilized, which unfortunately didn't happen. IMHO the OP was looking for support regarding a situation which deteriorated rather rapidly...not a lecture on presumed heart failure management.

This is a no-win situation, unfortunately. I've learned that lesson the hard way, many years ago...listen to my instincts. I may not always know what's going on but I can tell when we've got a problem...and if I have to push the issue I will. It's hard to lose a patient, standing there and not knowing what's going on to be able to try to fix it. I lost a dear patient I was close to a little over two years ago...one of the hardest codes of my life. She kept telling me "I'm dying, don't let me die..." and I worked my butt off to try to prevent it. That one will haunt me till the day I die...I've lost patients before, it's a part of critical care nursing..but for her to keep calling my name over and over, asking me to stop her from dying...wow. I honestly can't tell you that you'll get over this..but you will find a way to deal with it.

Why would you say to this nurse Lasix was a poor choice? Based on the information they shared, how would they have known this was an acute event?? I just don't get that...

Yes, very appropriate..it's called "networking". Go for it