Whatthe?

I have good news. My friend told me that she looked up the PP for administering Propofol for the clinic she works at and it states that RN's are not allowed to give it, only MD's and CRNA's. So, she has her behind covered and made copies for all the employee's and doctors to read reiterating the policy and plans to discuss it with the MD who signed it.

I know, like we have time to sit and pour over the paperwork, right? Obviously, the people that come up with this are the ones who can sit and pour over the paperwork at their desk and don't realize what we really do. We don't do life-threatening emergent cases but on some of our smaller cases that are fast paced with quick turnovers, like cataracts, I barely have time to get the lens stickers in the right places and the charting done. We still do paper charting so I'm writing as fast and sloppily as possible to keep up and I'm not going to count alcohol preps. I'll keep track of a JP drain but not a glove or 4x4. We'll see how far this goes.

If you have the drive and the passion, that's half the battle. It's good you're seeing a therapist but a life coach could help as well to help you see your strengths, etc. Even if you are not strong in one area, you could be a master in another. I;m an OR nurse and I tried office nursing but I hated it half the time. I sucked at phone triage but I loved the office surgical procedures and dressing changes, etc. I felt like a failure because I couldn't triage someone and take a good history on the phone, but the doctors loved me helping them in the rooms. Find your strengths and play those up. You have them, just identify them and feel good about it. Everyone is not good at everything and every nurse is not good in every area. We all have areas we love and areas we hate. I love the OR but other nurses hate it. It takes all kinds.

If you're driving from the western suburbs remember that I-290 construction starts TODAY. 290 from Thorndale to downtown will be underconstruction along with the Congress bridge, and Wacker Dr. There are alternates like Roosevelt Rd on the south and from Sacramento off the Ike you can take Warren Blvd. I saw the signs posted yesterday. The other expressways will probably have heavier traffic in areas due to alternate routes. Keep that in mind so if you can take public trans that may be your best alternative.

I've worked with some doctors who are on staff there in an office setting and thought they were great but I don't know about the hospital itself. They are building a new, beautiful building on the south end of town. If you find out anything let me know.

A friend of mine works in a center that performs gyne surgery (tubals, etc) and in some of the procedures the OB/GYN has the RN administer Propofol instead of an anesthesiologist. She is not ACLS certified and feels confused because giving it is under a doctors orders but she is not certified to administer anesthesia. I was under the understanding that a non-CRNA could not administer Propofol if it is to be titrated. An RN can if it is in drip form at a constant rate such as in the ICU where the patient is vented. I've read different rules on this and the rules are governed by each state individually. I have given conscious sedation before with Versed and Fentanyl under the surgeons orders but not Propofol. Have you ever been put in that position? I would not feel comfortable because of safety issues (no reversal agent for one) but she doesn't feel she can refuse.

I work at an ASC which is owned by an out of state corp. Up until now, we were using a package pricing or I think they call it "global billing" to charge for our cases. The corp is transitioning us into charging for individual items, which is what the hospitals I used to work for did. But, I think it's kind of strange to charge for individual alcohol pads and pieces of gauze that anesthesia uses from leftover packages of 4x4's (that are clean, obviously). To me that seems like a waste of time and effort for those little things. Also, we use multi-dose vials of Lido and Marcaine, etc. so how do you charge for that? I'm not an accounting person but shouldn't things like that just be lumped together into some misc. talley like x=5 or something? I'll write down every package, suture, whatever but charging for individual alcohol pads seems ridiculous. Anesthesia is having a field day mocking this. What do you do at your place? I wanted to get some ideas to perhaps bring to the materials manager in case there is something else that can done.