Deaconess

This is where a lactation consultant really came in handy for my first baby. To build up my milk supply I pumped after feedings and then fed my baby what I pumped plus formula to equal one ounce. I don't think he needed more than 2-3oz of formula total and my milk supply built up quickly. About creating a culture where breastfeeding is the normative mode of feeding, all demographics need education on natural feeding techniques (nursing, pumping). Many of our mothers and grandmothers never breastfed, so they are poorly equipped to support their daughters. For generations we did not need lactation consultants because knowledge about techniques, inverted nipples, and how to improve milk supply passed from mother to daughter. As I have breastfed my children at church, shopping malls, restaurants and other places in the community I have had many older women ask questions like, "How do you know they are getting enough?". I am more than happy to educate them, hoping that they will be more supportive of daughters and granddaughters who want to breastfeed. I also recommend that any first time mother who wants to breastfeed have an evaluation with a lactation consultant a few days after leaving the hospital. Many pediatrician offices now have them.

It sounds to me like the true problem here is leadership. Obviously the leadership of the unit and the hospital from preceptors to charge nurses to managers, has not set a proper tone or expectation of professionalism. We have many young and new nurses at the hospital where I work. We have our own school of nursing. Our young new nurses are professional, work hard and are responsible because they have proper mentorship, leadership and role modeling. Our charge nurses and nurse managers are not afraid to give a gentle reminder if young nurses are crossing a line. Sometimes they need to be reminded of the boundries. Having worked at several hosptals in my career, avoiding work, laziness, socialization at the expense of patient care, excessive pranks and the like, are not persuits limited to young nurses. I've seen a number of older nurses who always come in 20 minutes late, take hour-long breakfast and lunch breaks every day, and hand pick the easiest assignments. Again, its not a generation thing, its about nursing leadership that looks the other way.

I will be giving birth to my second child by this coming Friday 5/27 come natural contractions or Pitocin. I did make a birth plan, but I will probably not bother taking it to the hospital. For me, it has served the purpose of helping me to think through some of the choices I might need to make. It doesn't contain any information that I can not tell the L&D nurses at the time - they may monitor me however seems prudent, my veins are tricky to thread with the IV catheter, and I will probably want an epidural. Inspired by this birth plan, I did try to include some humor in mine. For example, the title is "Hannah's Birth Plan (for what its worth)".

My #1 pick is the Birkenstock London. They come in white, among other colors, are VERY comfortable, and last for years. They cost about $150, but considering that my last pair lasted about 4 years (full time) they were a good value. Before that I was replacing traditional "nursing" shoes about every 6 months at $40-$50 a pop. My #2 pick is a mid-end New Balance running shoe. Of course the shoe sales people will insist on a walking shoe for nurses, but I work in the ER. A running shoe gives good support and breathes well and is durable. Unfortunately, they do not come in all white.

After living in Va Beach, I prefer "y'all" to the even more annoying "you's," heard in Northern New York State. Its like nails on a chalkboard!

My vote would definitely be for Margaret Houlihan and other nurses of M.A.S.H. Like few T.V. shows depicting nurses, M.A.S.H. shows nurses who can triage, advocate for their patients, close for the surgeons, identify post-op complications, and think for themselves. They are not the physician's handmaidens but a respected part of the healthcare team. The same can not be said for any contemporary TV show I've seen except for ER.

I posted a few months ago, but have had a few thoughts since then. I am an RN, BSN with 9 years experience. I currently work in the ER (or at least I will again once this baby decides to come out). I that part of the uniform and recognizability factor in nursing stems from many major changes in our profession in the past several decades - more men, expanding roles, people entering the profession later in life, among others. The solution is not to go back to all white and caps, but rather design a uniform that fits with nursing's new roles and image. It should be unisex and functional like uniforms worn by paramedics or police officers. Perhapse a white button-down collared shirt made of scrub material with RN insignia patch, pocket for pens, etc., place for name tag and ID badge. And dark colored pants (or skirts, for those who desire) with utility pockets and places to put pagers, PDA's, and various "pocket clutter" we need easily accesible to do our job. Just a few ideas for the nursing uniform of the future. Leave plain scrubs for unlicensed personell.

Nursing involves patient and family teaching in almost any setting. I too tend to be a "teacher." This has come in very handy working inthe ER and previously in ICU. In the ER I am constantly teaching from triage to discharge or admission. As I have become more experienced, I am orienting new nurses and resourcing student techs. Some paths that are particularly suited to someone like yourself may be Clinical Nurse Educator (orientation/inservice education for staff nurses), Lactation Consultant (if you are inclined toward OB), Diabetes Educator, or Clinical Instructor. Once you get out and work as an RN you will find your niche. It sounds to me like you are someone with a broad range of interests, which is good. Nursing does not have to be your whole life (as some professors might suggest).

As a graduate of a 4 year liberal arts college-based BSN program, I think that going for the BSN right off makes sense for a "traditional" college student. Maybe she might be willing to take responsibility for the additional expense by finding scholarships and working for a hospital as a student tech (thus also getting tuition reimbursement). Even if she has to take out a few loans to fund her "college experience," having all of her education out of the way might free her up later in life. I think that ADN programs are economical and provide a good solid clinical base. I would never discourage someone from persuing their RN through an ADN program. These programs are especially ideal for adult students. But even for younger students they provide a quick start to a good income. What I liked about going to a four year college ( I was blessed with good scholarships), was that I was able to persue some other academic interests besides nursing. I took elective courses in history, Christian ministry, and music. My social group were students from a variety of majors including accounting, music education, and history pre-law (my now husband). Living on campus and having to get along with roommates, etc. had many other good lessons for me too. What I did not like was all of the "fluff" that you get in a BSN program. But I would have had to put up with the "fluff" sooner or later to go back for the BSN. I hope you and your daughter can figure out what is best for her and her circumstances. Either way I'm sure she will do just fine.

1. I have worked as a nurse for 9 years. 2. I currently work in the ER/ED. 3. I practice in NY state. 4. I am an RN with my BSN. 5. I am not in favor of a return to whites, hats or other "uniforms" unless it were perhapse hospital-supplied scrubs or jump suit for infection control purposes. I think that scrubs are practical, easy to launder, easy to move in, modest and professional. Traditional white uniforms were once practical in times before modern laundering methods when bleaching was the easiest way to maintain a neat appearance in frequently laundered clothing. I would attribute a lack of professionalism in nursing to a general shift in our culture at large. To talk to seasoned nurses, before the 1970's entering nursing school was almost like going into the convent or Bible college. Curfews, rules about dating, dress codes and other archaic devices that perhapse also fostered a sense of vocation. Today's nursing education seems to focus more on nursing as a profession (which it certainly is). But a profession with poor staffing, brutal hours, weekends and holidays does not feel very "professional" without a sense of vocation. Uniforms may be symbolic of that sense of vocation, but they are not the answer.

My husband is a solo practice attorney. Needless to say, I carry the health insurance.

I have hair that goes down to the middle of my back. I work in the ER and I ALWAYS keep it tied back. My favorite way to wear it is twisted up in a clip so that its off my neck (cool) and I can grab my stethescope from around my neck easily. Alternately, I may wear it in a high ponytail or single braid. Either way I keep it out of the way of patient care, sterile fields, and chest compressions - not to mention the little tots I have to weigh. It seems to me to just be common sense and hygeine to keep it back just as I do when cooking or baking. But you will find that not all nurses follow common sense.

We wear Navy scrubs in the ER. So I wear any color/style of udergarments I want. All my panties are by Victoria's Secret. They are comfortable and last a long time. When I wore white, I stuck to white and tan tones.

Don't you know the other name for a surgeon? Seriously, if a surgeon or other physician goes over the line with verbal or physical abuse (throwing sharps or bloody sponges, perhapse) towards nursing staff it is a legally reportable incident. The "legalese" for this is Physician Abusive Behavior. Physician Abusive Behavior does not only impact the staff at which it is directed but also results in poorer patient outcomes. When possible, it is probably best to work out more minor incidents as you and your nurse manager did.

I signed in during my shift a couple of weeks ago because I was 14 weeks pregnant and started heavy lady partslly bleeding. Should I have gone home and made a doctor's appointment? No, I watched TV while I received 2L RL, waited for an ultrasound, and wondered if I was going to lose the pregnancy I had waited over three years for. I was glad to have some distraction because I needed it! You know as well as I do that not every problem appropriate for ER care is a matter of life or death. Compound fractures, INR of 11, and right lower quadrant abdominal pain can't wait for a doctor's appointment. Besides, the TV's are to help distract the family members. Ever had two family members just stand and stare at you while you lay on a stretcher? Please, sit down and watch some TV!

We got TV's in each exam room about a year ago. Many, including myself were skeptical about them. We were afraid of an increase in bogus sign-ins by homeless, lonely, etc. But we found a decrease in complaints about wait times, patients seem to be glad to have a way to pass the time, and thank God for Cartoon Network for the kids. When I was a patient about a week and a half ago, I was very glad to have a TV to watch while I waited for my husband to make the 90 minute drive to join me. ( I happened to be working at the time.) Overall, I think that the TV's were a good improvement.

A few posters have expressed that unordained nurses have no business praying for patients. Traditionally, though, prayer and other means of "spiritual care" are very much part of the nurse's role. My hospital, like many other Catholic hospitals have policies by which a nurse may baptize a miscarried or stillborn infant. (Doubt it is used anymore). Prayer and spiritual care were taught as part of my BSN nursing program at Roberts Wesleyan College. How a nurse choses to provide spiritual care (or not) will depend on his/her beleifs and background. I pray with patients who request it. Often times "small talk" or religious literature at the bedside reveal common spiritual beleifs. I certainly would never preach to anyone or be insensitive to a differing religious view. By the way, I don't usually pray for the dead, but a lot of Catholic nurses I work with do the sign of the cross before perforning post mortem care. I'm not sure whether it is prayer, superstition, or a sign of respect. Perhapse all of the above.

We had Ketamine pulled from our Pyxis several months ago because #1) it was not being used and #2) there were concerns about its safety because of its irreversibility and long half-life and lack of staff knowledge about the drug. I have seen it used twice by DOCTORS for lac and ortho moderate sedation in kids. Doctors can still order it from pharmacy, if they want it. I don't like the drug, personally. Our docs like Diprivan for moderate sedation proceedures because of its short half-life. CYA nurses! Make the MD administer this drug on non-intubated patients and document that the doctor administered it! In general, I like this drug for moderate sedation for otherwise healthy adults. I have seen a few patients require ambu for several breaths and we had one elderly patient who retained CO2 and needed Bipap after she did not wake after 1 hour + (new grad RN and MD slow on the draw for that one). Hypotension usually reverses upon withdrawal of drug. I love Dip for intubated patients, but watch out with CHF-ers. That SBP of 200 will be in the bargain basement once the 80 of lasix and nitro paste kick in and you finally have the Dip titrated to keep the patient from bucking .

Our protocol for RSI is Etomidate 20mg and Succinocholine 100mg. Post intubation we use vecuronium and/or propofol as necessary. For moderate/conscious sedation proceedures we use either propofol or versed. I've never seen Etomidate used for anything but RSI in our ER.

Our CT scan standard is 20ml gastrograffin in 500ml of water or clear juice to be consumed over 20 to 30 minutes. CT scan to follow in 1 and 1/2 to 2 hours or later if they are trying to view further down the GI tract. On the overnight we get prelim results back within 45minutes. The radiologist views the films at home via computer and faxes the results.

I am a big fan of safe staffing ratios, but I have some concerns about legislating these. First, the ratios are listed as RN to patient ratios. It seems that if hospitals were forced to implement these ratios, it would force the removal of LPN's, phlebotomists, CNA's and other support staff out of the hospitals. This is just pure economics. Second, in light of an already existing shortage of RN's, it seems that these ratios would force inpatient beds to close and plug up ER's. It seems that it would be impossible to enforce such ratios in the ER since ER nurses are responsible to triage every patient and then to provide, at minimum, follow-up vital signs as patients wait to be seen. This is a problem that ER nurses in California are reporting. (California has mandatory staffing ratios.) Third, it seems that State legislated ratios would inevitably result in usage of mandatory overtime to maintain staffing. We already know that mandatory overtime is a contentious issue with RN's. Fourth, it seems that the staffing ratios seem to lack account for acuity. For example, not all ICU patients require 1:1 care. A fresh open heart with complications or "hot trauma" might require 2:1 while a DNR, no meds on ventilator (which still has to go to the ICU in my facility) would do just fine with a 1:2 or 1:3 depending on the other patients. These types of judgements would seem to require at scene decisions rather than a one-size-fits-all set of legislation. It seems to me that the best way to improve staffing ratios is to legislate disclosure of staffing ratios. Hospitals and other health care intitutions should be required to report ACTUAL staffing ratios by specialty area quarterly, delineating those providing direct care from charge nurses, Nurse Practitioners, and nurse managers. This way the consumer can decide which hospital has staffing to best provide their care. With increasingly saavy health consumers, hospitals will be more motivated to recruit and retain proper staffing, especially if they think it will affect their bottom line.

Our ER does not accept new RN grads unless they already have been working in the ER as LPN's. Otherwise they have to have a year of Med/Surg or ICU experience. ( Having worked critical care most of my career, I'm not a big fan of new grads in the ICU's either, but my hospital has an excellent orientation program.) Our ER is high volume, high acuity and we have a lot of nurse autonomy to initiate standing orders and start treatments. This requires organizational skills, and nursing judgement that most new grads do not have. There's just no way around experience. Thats not to say I haven't seen student nurses who would probably do fine in the ER, but we aren't set up to offer the type of structure and orientation they need as new RN's.

Our official nurse/patient ratio is 1:3 but I have carried as many as 6 patients - seven if you count the one in the hall waiting for discharge or psych eval. Our more usual understaffed weekend night ratio is 1:4. Probably the worst night I had was when I had six rooms with one ICU hold (which we thankfully got downgraded during the middle of the night) and a very sick ICU pt (intubated, insulin gtt, chf, diprivan, crazy family). In such cases care gets prioritized in such a way that if you aren't dying, I don't see you. The other three nurses on the floor were in the same boat. One had a drop-off stabbing (which we all were working on at first) that went to the OR and the other had an ICU patient as sick as mine. When all else fails, prioritization, prioritization, prioritization. Don't forget to get payed for your missed lunch.

I would also love to use my nursing skills in a mission setting. Some organizations I know of are YWAM's Mercy Ships, which are hospital ships that sail to various ports offering surgeries and other medical care. YWAM also has a division called Mercy Works that also sets up medical mission trips. There is also an organization out of Oregon, Northwest something or other, that is a Christian medical organization does disaster relief work and medical mission trips. I would also ask any Christian doctors that you know if they know of any opportunities. In my region, several Christian doctors have organized their own medical mission trips through their churches. My recommendation is to become active in an outreach and evangelism-oriented church, get some good RN experience behind you and opportunities will find you. Start praying that God would place you on the right team in the right country at the right time.

We staff LPN's in our ER. All are med and CORE (telemetry, etc) certified. I wouldn't be without them. They take assignments in the acute ER, staff Observation and Fast Track. They grab an RN if they need an IV push, critical drip hung, or have other needs outside their scope of practice. In a full arrest I would not be without my man, J.J., to slip in the 16gauge IV's. A.A. worked CCU and has the nitro gtt chart memorized. S.S. thinks on her feet and doesn't lose sight of the forest for the trees. Our LPN's are well trained, competent and professional.