highlandlass1592 RN

I think the point you are making would be radical to some. I don't agree with those people, I do agree with YOU. IMHO, essentially what you're proposing is offering the patients the psycho-social support we all learned about back in school but in today's nursing practice, many of us find we have little time for. Patients are bombarded by news media about the "obesity epidemic" as well as the "type 2 diabetes epidemic" but with that bombardment comes little in the way of true education. People who develop type 2 diabetes are then criticized, for example in this thread- "you could have prevented this if only......." but we don't think about what cost emotionally this diagnosis means for them. We throw a bunch of medication at them, tell them they now have to perform painful procedures "x" times a day (for those who may poo-poo this, try poking your fingers with a needle 4 times a day and see how you like it! it ain't fun!), rush them through a diet teaching program to make their heads swim, tell them if they don't do what we say all these nasty things will happen! How can patients possibly process all this information, deal with all the education they must undergo, and then face the stigma of being called "one of THOSE people". No wonder complicance is such a huge issue. I was diagnosed with Type 2 diabetes over a year ago. I'm a nurse, a good one but didn't realize this was happening. NO ONE in my family has ever had diabetes. Yes, I am obese...my sister who was much larger than me never developed diabetes, neither did my mom or paternal grandmother, all women who struggled with weight issues. How did I GET SO LUCKY as to get a gene that decided I needed to get this illness? I struggled for a long time with denial, this couldn't be happening to me. Tried different meds, let my PCP manage things but when my A1C remained high, I finally accepted this diagnosis and sought out an endocronologist. My diabetes is now undercontrol with an average A1C of 6.8. Do I use diligence in monitoring my daily glucose levels? Not as well as I should. Do I follow the diet and take my meds? Religiously. For some reason, poking my finger puts me in a place of anxiety. I accept I'm a diabetic, I accept I need to manage this disease and I am doing my best. But let me be honest: I already have issues regarding my weight, now this pushes me further into a mental arena that makes life even more difficult. Self-esteem is a problem as is PTSD from an issue from a few years ago. You know what hurts most? The looks I get from others about my now being "one of those people". Because I'm fat, it is now considered acceptable to judge me because I now have this illness. How I"m a drain on the healthcare system, how I could have prevented all of this, how I"m a bad person. Yes, there are consequences for not managing my disease properly but instead of judging me, why not offer a hand to help? Your blog reminds us all that if we wonder why our patients are non-compliant, we need to look to make sure we are TRULY supporting them. Have we truly given them our best or just shoved a bunch of papers at them and said "good luck"...when they stumbled did we offer them a hand up or just give them the emotional equivalent of a "smack-down"? I have dealt with my share of non-compliant patients (my primary patient population is heart failure patients) and yes, some of them drive me crazy when they don't do as they should...but I will never give up on them. I will try to support them the best I can as much as they will allow me to. It may require some deep breathing on my part but I still try. Just some thoughts.

:yeah::yeah::yeah::yeah:

"Being a nurse is hard" Yes, it is and from my view, there is NO greater job in the world! Thank you for showing how much nurses can impact a life. I don't know if you've already considered it but may I suggest you submit your article for publication in a journal? I think this would be perfect!

You could file a complaint with AHA because the people conducting your class are not following guidelines. If you wanted to, you could order a book for yourself from a AHA supplier. I like Worldpoint. You can also do an online program through AHA on your own

Yes I do

Not overreacting at all. I hope things work out

Are you talking a pharm guide or a guide to help in acute care? I've got quite a few apps I use on my iPhone and also have a hard copy of my favorite general ICU reference, Kathy White's Fast Facts for Adult critical care. (She now has it available as an app for your phone).

Actually, I didn't see that there was an inference that all EMT's are trained on VAD's. My point, as you cared to highlight it is that there are inroads being made into training more and more first responders about VAD's. As more patients are implanted this type of training will become more and more necessary. I have many friends who are EMT's and Paramedics. I find it disheartening that their training doesn't adequately prepare them to care for many patients...their learning takes place on the job, similar to nursing. But I also have to admit until we had an influx of VAD coordinators who actually cared about teaching, I became a self-directed learner about VAD's and now find them to be my favorite patient population. There is so much misconception out there about VAD patients which, in getting back to the origin of this thread-is clearly demonstrated. By thinking that VAD patients are too high risk to be handled at an outpatient dialysis clinic shows a lack of education regarding VAD's and their uses. It was that ultimate point I was trying to address. As a side note, at no time in my post did I make a unilateral statement-which is what you seem to be implying. I wanted to share the experiences of our VAD center and maybe spur discussion amongst others.

Our VAD center offers training to first responders in the area where a VAD patient lives. They go and teach classes discussing VAD's, how to troubleshoot problems, quite a bit of information. I know this first hand as a friend of mine who is a VAD coordinator actually went to inservice the EMT's of a small town where one of our patients lived. The town was 5 hours away. She coordinated the class, drove up, spent 2 days inservicing everyone then drove home the following day. I do agree that LVAD's aren't taught to EMT's as a part of regular coursework. But to say ALL EMT's aren't taught LVAD's, just isn't true. I am not sure if ALL LVAD centers do this but I know mine does. And, just as an aside, they teaching first responders get about VAD's is way better than I got when I first started dealing with them. The VAD coordinators where I work have put together a great education package.

As others have stated, there are many variables that go into issues like these. Area is a top one. Yes, some FNP's here in Michigan can make $80k to start out. I disagree that neonatal NP's aren't in demand, research I've done actually shows it to be a growing field for NP's (as many other areas are growing as well). There are many, many articles out there that speak of when the mandated health care plan goes fully into effect of a need for primary care providers to increase. I've also read of an increased need for Hospice providers. Why not do some research of your own? Look at ads for employment, contact the organization for mid-level practitioners that you would like to join and gather information? Contact some practitioners now to get their point of view.

It's truly a difficult situation. If the patient is truly avoiding care, then maybe they should just be discharged. For some patients, it's a matter of embarrassment or even a lack of education regarding the current plan of care. But ultimately, patients do have the right to refuse care from anyone. The core of the issue is thorough documentation regarding the incident, attempts at re-educating the patinet regarding the need for care and then the patient's response to the re-education. What can be hard for any healthcare provider to remember is that all patients have the right to make bad decisions.

The new materials are just coming out. Any of the AHA material providers should either have them now or will be getting them quickly. My favorite is Worldpoint: http://www.eworldpoint.com/?i=jI0y00dl5HcEZD2mhTgD3w%3d%3d link for their site. And when I pulled it up for you, it said the new acls materials are available for preorder. Just a thought: if you don't want to wait, if you pull up the issue of circulation online, you can go to the relevant sections of the journal explaining the changes and print up the new algos; not quite as nice as professionally published but could tide you over till the stuff comes out. I did that for a power point I'm working on. Hope this helps.

Yup! (Ok, it won't let me say just yup! LOL)

Uh, I have that on a tshirt..but don't wear it to work. probably should. LOL

Is it for a staff position or a travel position? This "test" and I use the term loosely, has a notorious repuatation. Some facilities use it to guide new employee orientation while others use it as a tool to fire agency/contract nurses if they don't "pass" it. The test itself was never intended to be used a firing tool for nurses. I have taken the critical care one. Basically, it asks you to think like a doctor in reviewing certain situations on videos then writing about what you see and what you'd order. If you google it, you should have some websted pop up that will have testing hints and review information. I won't work again at any facility that requires it...but that being said,I have many facilites in my area to choose from. Good luck in whatever you decide.