DixieJeanne

I guess I should clarify that I work in a rural facility at the moment so our docs are not always available immediately (one doc covers the entire hospital). Therefore we have to initiate this without them assessing first frequently. We also are ER/ICU/Everything nurses so we do it all, therefore training happens because it has to and worrying about staffing isn't an issue because we do it all (unfortunately..... or fortunately, depending on how you look at it I guess). We use a Respironics also. But like I said in another thread.....rural nurses are jacks of all trades and masters of none....... so it is what it is at this facility anyway. I do agree with all your points though. And yes, we would never leave them on a BiPap for an extended period of time waiting for them to wake up. It can be a great rapid fix though in some patients, and if it's not working then progress to an advanced airway rapidly.

Haven't cared for one of these in a while, but I remember we had strict orders for NG care/boluses/etc. I would definitely go on a Dr-by-Dr basis, ya know? Sorry there are no concrete answers.

I've worked in a small, rural facility. We always said we were "a jack of all trades and a master of none." YOu don't get to see enough of the same thing to become an expert, but you do become great at saving lives for a few hours. We had the patient for 2-3 hours waiting for planes/helicopters to get there (the next closest town was 130 miles away and our hospital service area was just less than 10,000 sq miles). We had to manage to keep them alive without ANY specialists, special equipment, or experts in any field. Heck, we didn't even have ultrasound capability on weekends or evenings. No FAST scans for us. Our family practice docs and all the RN's did hte best they could with limited resources. I was very impressed with the care we did provide, even if it wasn't the best that could have been provided (such as if they were at a Level I Trauma Center, etc.) When it snowed, it was even worse - waiting 5 or 6 hours for transports. But the nurses there could work in any field if they chose to move. We would have to cover ICU, Med/Surg, Peds, OB, PACU, ER, and Cardiac - sometimes all in the same day. 16 bed facility with 5 ER beds. So did I lose my skills? Yes and No. Did I gain invaluable skills? Absolutely. I always challenge people now who poo-poo on rural nurses to image stepping out of the ER and going to do a shift in OB. How comfortable is that for most of you (general you)? For a rural nurse, it's a weekly occurrence.

They can't take money from you if it is earned by actual hours worked. On the other hand...... if you had a sign on bonus or some such worded thing, then they can withhold a check as "repayment" of that bonus.

I work with a doctor that gets even quieter when you ask him to repeat himself. He admits he does it on purpose to "get you RN's to listen closer." So when he does that I read back his order as something totally off the wall....... "OK, so 784mg of IV paxil every 2 minutes until pain controlled?" He has learned to speak clearly and loudly with me. I love it.

Every facility will have a different theory on this and have multiple studies to back it up. Go with the flow (no pun intended of course;)) of your current facility but I hope you feel comfortable there discussing the different view points. Maybe your coworkers will tell you why that culture exists at that facility regarding IV sizes. The facilities I've worked in have all had different unofficial rules about this. meh......

Good Lord - Seriously? Is this a place that no other people are allowed to post at and to express their opinions? RN's ONLY? That does not encourage much learning from each other now does it? I, for one, love hearing/learning from people outside of my own scope of practice - be it MD, EMT, EMT-P, CNA, ABC123, or whatever. How can we provide well rounded care for a patient if we only get one piece of the puzzle? As for the OP - I "read" more that he felt disrespected in his knowledge - he wasn't saying he HAD to perform the same skills as someone else (RN). Think about it this way......... if an MD disrespected your knowledge in an area and poo-pooed your skill set, you KNOW you would be on here whining about how big bad Dr. Poopypants didn't respect you as a professional. RN's can't do the same as MD's but we sure as heck expect professional respect from them. I see it the same in this situation. The OP can't do the same as an RN in a civilian hospital, but they sure as heck expect professional respect from them/us. Golden rule goes a long way people.

We use BiPap on a lot of our COPDers. It's a great tool. We don't need RT to initiate it though. We have the freedom to do so as long as an MD assesses pt soon after initiation. Yes - exactly. I would agree that in extreme lethargy it MAY not be wise to use it, but I've seen BiPap work wonder in lethargic COPD pts. In fact, enough to raise their LOC.

What a great idea! That's a new one for me - I'm gonna try it on my next shift. Thanks!

I laughed so hard at this. What a perfect response! We keep ours in a fridge style warmer. Fluids in top (seperate) compartment, blankets in bottom compartment. They are individually controlled so different temp ranges are not a problem. Wonder why they had such an issue with it? They should have given an explanation as to why in the report.

No last name on my badge. Won't have it. Luckily I work at a place that supports that. There are crazy people out there that develop unhealthy obsessions with caregivers. I don't see police, judges, teachers, lawyers, etc. (as named in a previous post) as being as high a risk as nurses because we offer care for patients. We "fix" them in a sense. An unstable person can take that and run with it, believing there is a connection or relationship there that doesn't actually exist. The same person may not do that with the other professions as they are (usually) not "taking care" of that patient and "making it all better." No way, no how would I allow my last name on my badge.

Oh please.... I am not going to spend my time being all smoochy sweet to my coworkers......"Sally sue, could you pretty please get Mr President in room 208 some water? It'd be such a great favor to me. Thank you so much!" Um, no. I don't have time for that. Working in the ER I have to get stuff done and get it done fast. I'm gonna say "Sally Sue - the guy in 208 needs water." Period. Actually, I'll be saying it as I run by her on my way to give morphine to my trauma patient with an open fracture. Too bad if she doesn't like it. I'm taking care of people who need me more than I need to be nice to Sally Sue. Guess that's why I like working the ER. Nobody gets their feelings hurt nor do they go all crybaby on each other. We're mature enough to know it is not personal and emotionally stable enough to not get in a big high school fight about it. I might yell directions to Sally Sue 4 or 5 times during a shift and we'll still walk out the door together talking about the kids or going out and grabbing a beer.

Don't be annoying. Listen to what your preceptors are telling you. Watch what they are doing. Ask confrontational questions later - not in front of the patient. If you make your preceptor look stupid, they will make you look stupider. Seen it done. Not pretty. Don't be afraid of jumping in and getting your feet wet.

If people are complaining that "noone has been in" doing hourly rounds isn't going to help. Then you'll just get "they didn't come see me for a WHOLE hour after I asked for pain medicine/pee pot/hot blankie/have my foot scratched/etc."

What is the best shift in the ER? The one where you have a competent doc to work with and excellent team mates. Times don't matter.