respectall

Study your subject like you've never studied before!. I was in the same predicament where I was assigned to block hell. I know the instructor were doing what's best for the class and they want you to be COMPETENT nurses. Observe your instructor's train of thoughts to better able anticipate her questions and expectations. Well, let me tell you, eventhough I passed my class (OB) without flying colors, I proved to my instructor that I have the capability to tackle her obstacles. GOOD LUCK!

If the pt is status post op, there are many possible etiology to his afib. 1. fluid vol deficit or overload 2. electrolyte embalance 3. pulmonary emboli 4. sepsis 5. substance withdrawal ( etoh, tobacco) If all of the above have been corrected and the problem persist then It is a circuit problem caused by an ectopic pacer cell. Electrophysiology study might be necessary or simply start pt on beta blocker or amiodarone po, no need for drip unless pt remains in UCAFIB without conversion.

This pt needs cardiology consult ASAP to better handle his arrythmia.

Being competitive for egotistical reason is WRONG. Competitive to be competent is GOOD. Often times the degree of experience in the field makes staff think they have the right to punitively judge other staff who acquire less experience. This is ABSOLUTELY UNACCEPTABLE!. Those nurses who practice this behavior are a danger to the field. Unit policies and protocol changes frequently, so guidelines of practices often gets changes and upgraded. LPN and RN have different scope of practice. If you think this LPN have crossed the line, then go to your chain of command. Report the improper conduct so a appropriate disciplinary action is taken. Adding and or Correcting someones charting is illegal and ground for disciplinary action.

I'm NOT being defensive, I just want you to understand my RATIONAL.THANKs

Blondy206, WHY do you think many Cancer pt have a portacath? 1. Chemo tx requires a central venous line d/t its cytotoxicity. 2. DAILY blood work for inpt to monitor CBC c diff espicially post chemo tx. and outpt scheduled hematology 3. venous access, because majority of these pt population are not candidate for phlebotomy. So when they are admitted as inpt they don't need to be stock. 4. Parenteral nutrition for those who are nutritionaly compromised. I am sure there's more.... My point is, IF THE PT IS VASCULARLY DEFICIT AND HAS AN ORDER FOR FREQUENT HEMATOLOGICAL TESTING, IT IS APPROPRIATE TO ADVICE THE ATTENDING M.D FOR CENTRAL LINE PLACEMENT. YOU AS THE NURSE SHOULD BE AN ADVOCATE TO YOUR PT WELL BEING. Majority of the time Docs are receptive to this suggestion, at least where I work MDs and RNs collaborates profesionaly. One IMPORTANT thing I want to emphasize: YOU DONT JUST ASK THE DOCS FOR CENTRAL LINES ON ALL PTs JUST BECAUSE HE HAS DAILY BLOOD WORK. YOU MUST FIRST ASSESS THE ACUITY OF THE PT, ask yourself questions: why is the pt needing daily blood work? what is his diagnosis?, what are his Vital signs, Is the pt hemodynamically stable? what is his code status? etc.

The 18g cath was just an EXAMPLE added to my question to you. I know PICC and PIV are two different venous lines - you're absolutely right. But the question arise, would you continue drawing DAILY blood work from peripheral IV in these pt population (poor venous access) and risk lossing your one and ONLY site or WOULD YOU ask the MD FOR CENTRAL LINE PLACEMENT?

CORRECTION: 18GAUGE catheter in the L anticubetal.

Let me ask you a question. If your 75yo pt admitted for hematochezia on chronic steroid use for COPD has a h/h q8hrs ordered. He has no visible and or palpable vein for pperipheral blood draw, BUT he has a 18gauge needle placed in the e.d that draws wonderfully. 0500 comes time for AM Labs, 3 unsuccessful try by you and then the next staff and then the next staff still unsuccessful. Do you just STOP and wait 'till the Doc comes in to round and say... sorry doc no luck with Mr flat vein's blood draw while at the same time he's in the BSC dumping 350ml frank bloody stool ready for you to empty? OR DO YOU GET YOUR 10CC SYRINGES FLUSH THE ESTABLISHED 18G IN THE L ac, apply turniquet 3-4 cm above the insertion site and aspirate for blood return, draw waste and then collect you h/h sample and promtly send to lab?

Blondy206, You totally misunderstood my point. When I said that pt who have daily blood draw need central line, I am refering to pt who have poor vein access and therefore NOT candidate for phlebotomy. I did not say that if any pt have daily blood draw that you should advocate for a central line placement on ALL of them. If the pt has no, none, ZERO accessible vein then why subject that pt to endure needle after needle sticks just to say.. I'm sorry I didn't get your blood and have to repeat the same tortous experience. Your more likely going to put that pt at risk for cellulitis than line infection. If that same pt have daily blood draw i.e. H/H, CMP, PT/PTT/INR, I anticipate blood product administration, electrolyte replacement, Anticoag theraphy, Maintenance IVF ,etc....... why Not stablish a mutlipurpose vascular access early before your pt start to crash.

If they work in the floor they are paid similar regardless of degree held. however it's different if NPs' work for primary MDS', it is up to that group's discretion of how much they wage their NPs. NP's are often use as substitute for MDs in their offices to bridge the gap! and in some case NP's are being utilized in inpatient setting to make rounds/take calls for their MD partners! In our hospital our MANAGEMENT actually terminated this practice because of liability issue that have come up. Personally I would rather DEAL with the pt's attending MD than to the NP. In most cases when a crisis arise, I end up corresponding to two advisors who often have dissimilar approach and you as the Nurse ENDS UP the mediator and usually the MD supersides. One NP in our hospital was actually discharged from his position d/t malpractice. This particular NP would come in our unit and started changing Orders from the attending md. fURtheremore this NP would changes pt code status. I personally reported his actions to our ethics commitee which subsequently may have contributed to his demise.

You're correct, when the PIV was just inserted it's absolutely OK to draw blood spec from it. After insertion it's no longer "adviceable" to get spec from the PIV because of risk of LOssing the site and extravasation. BUT when the ONLY way that a spec is obtainable is thru that PIV then use your judgement. You don't want to STICK your pt if he is not a candidate for phlebotomy. NOW if the pt has daily blood draw, say for... PT/INR, CMP, H/H, etc.. Then you as the nurse need to advice his attending M.D. to place Central line.

Learn basic first then advance as tolerated to more critical consistency. I started this way and NEVER regreted it! I am comfortable floating from ICU to MS . Been a ICU nurse now for 4 yrs.

You must have lots of time on your hand. If you know what it mean, then just do it! You have sick pt that you could be doing something more productive, like researching about their DX and PMhx or helping them up the BSC. How pathetic!

Those ICU nurses that think they're "it", usually have a personality and EGO problem. I personally think they're nothing but bullies. They're so insecure about themselves that they pursue evry oppurtunity to step on something/someones shoe just to get well high and above. We're all nurses why can't we just be supportive of each other.

YES, there are a few ICU nurses that demean MS nurses. I have a few co worker in ICU who are narcissistic. Their Illusion of grandeur pass well beyond MS nurses to new MDs. Their number of experience and "knowledge" of the field makes them think they "know it all". NOT even that, Just the label of them being "critical care" nurse makes them feel they're much prestigous. I am an ICU nurse and to hear this nurses in the unit talk about how much of a "dingdong" this nurse or doc makes me sick to my stomach! ICU plan of care outcomes are so much different from MS. In the ICU, vital sign stable may mean that MAP =/> 60mmhg and in the MS that may mean SBP>90. Each unit approach crisis in different mode. If you're a nurse regardless of area of occupation you must have that critical thinking capabilities. Some develop those skills naturally and for some it takes time. Its because you have that experience and skills, that doesn't make you superior to the rest. You can make that talent a tool to help others grasp and understand and NOT feel inferior to you. I started my nursing in MS/ortho then to PCU and finally to ICU. I gain tremendous knowledge in each unit from the nurses that I worked. I look at those nurses as my colleage and confidant and NOT a counterpart because we all have the same GOAL at the end of our shift.

was there a PRN pain med that was ordered for this pt? If so why wasn't it given. A pain of 5/10 is considerable and could get even worse if no intervention is promtly implemented early. When you said "MD Aware" did you mean you consulted him about the pt's discomfort, and since no intervention was made did the doc NOT order any analgesia?

TERMINATION was the best thing that could have happen to that employee. Pt safety should ALWAYS be a priority amongst all. There obviously were a pattern of her negligence over a period of time and they were appropriately addressed by her preceptor. It was clear from her responses that she did not acknowledge the real problem. she Instead focused on her will preserved self EGO. I've been in situation were I almost hurt pt and made mistakes when I was a GN . I took responsibility for my action. I took my preceptors criticism to heart and made it a learning tool to better improved my skills and ability to make critical thinking in my decisions. I am now a preceptor and I ALWAYS made sure my orientee are able to make synapses to problems and creat a safe hypothesis to their care plan.