PetiteOpRN

This is just not sitting right with me and I feel like I need some insight from other nurses. In the facility where I work(surgical sub-specialty clinic with on-site ambulatory care operating room), an RT (who was working as the receptionist) was recently promoted to "clinician." The new position requires: administration of medications (oral, IM, IV) assessment (NOT directly related to respiratory status, including orthopedic/complex wound assessment) teaching (preop, conservative management, medication...all not related to respiratory status) nursing procedures (dressing changes, suture removal, starting/ dc'ing IVs) triage (urgent patients in house/taking patient phone calls) evaluating/discharging post op patients I can't find anything that states that any of this is strictly limited to nursing. I've read the state statutes regarding RT scope of practice (with a fine-tooth comb). Basically, it includes everything that nursing does (assessment, treatment, med administration) but is specific to respiratory care. But the first line is , "The 'practice of respiratory care' includes, but is not limited to:..." So my employer is using "is not limited to" to equate RT with nursing. Don't get me wrong, I don't think RTs are beneath RNs at all, but I think there is a scope of practice issue here, and I'm worried about patient care. I would not expect an RT to do sterile dressing changes or first-assist in the OR (in my state, now all scrubs must be certified or RN/LPN), let alone administer medications (obviously, respiratory meds aside). I've scoured the internet for anything more specific that would apply to this situation, and I'm pretty much empty-handed. Am I completely off base?

Mostly "debriefing" throughout the day ("If Dr. Bones doesn't make up his flipping mind soon, I'm gonna loose it again," "Dr. Brain just announced that the resident is no longer allowed to speak to or instruct the nursing staff...it's going to be a long 3 months") And alcohol. Truth is very few of us ever actually drink, but we the docs probably think we're a bit lush.

I'm confused. Why is everyone using the word "crazy" in such a negative context? I've always thought it was a term of endearment for people in hospital administration. As in, "You just missed Crazy. She came in to make sure the blanket warmer was below 85 degrees (F), so that we don't accidentally burn or warm patients." Canes, you are one of the most compassionate and sympathetic people on AN. I'm sure (if anyone can) you will be able to approach this person in a respectful way and hopefully resolve the situation. I have seen surgeons throw orientees out of the room if they are too chatty. And one you have a reputation, it is hard to change it. The sooner he gets the message, the better.

Most people who seem miserable here are venting; they work stressful but rewarding jobs, and venting helps them to give better care to their patients day after day. Every job has ups and downs. Nursing is no different. If someone is intent on being miserable, they will manage to be miserable in absolutely any job or profession.

You can also make a few holes in the top with a blunt fill needle, invert, and squeeze for a quick, controlled irrigation.

We all know that surgeons can be the worst offenders in terms of language. **** this, **** that, blah, blah, ******* blah. How do you respond? Do you reprimand ("Dr. Jones! Do you kiss your mama with that mouth?!?)? Ignore it? Follow in suit? I've seen nurses do all of the above. I tend to ignore it, until it get really obscene (generally if it becomes sexual).

The hospital my husband works at has done this for about 4 years now. Each employee must do the "health risk assessment" each year. Urine samples are required to test for tobacco derivatives, and those who test positive must complete a tobacco cessation class in order to be eligible for benefits. The hospital is not unionized, but it is a magnet hospital.

When it was implemented in my hospital, we had to take it in order to change our shifts around (staying within the same department, but switching your day off!). Most nurses in my department failed (OR). My favorite question was "are you addicted to smiling?" "Why, yes I am! In fact I often find myself grinning widely at 2am during an emergency ruptured aneurysm evacuation. I'm saving up vacation time so that I can go to that posh rehab place out in SoCal, but on the peanuts you guys pay me that'll be a while!!!"

Walk it in. Hand it to the manager, if possible. When we have someone mail a resume in, it is generally filed in the back, because it doesn't mean much to me. When someone takes the time to walk it in, and then sits and fills out an application as well, I know that person is really motivated. Furthermore, having a face to put with the resume makes it stand out more. Bring your resume, cover letter, and confidence and SHOW them how great you would be for them.

MA's do not inject anything (in most facilities). Estheticians/nurses/PAs generally do laser treatments (sometimes the MD). Depending on the state, estheticians may or may not be able to administer fillers/botox. (Kansas does not require licensure; Missouri requires at least an RN).

search "aesthetic nurses"

There are plenty of DPTs and DPhs that walk around in white coats and call themselves Dr. Soandso. Their scope of practice is nowhere near that of an MD or DO. In healthcare, the lines have become very blurry in terms of titles. To most patients, "nurse" means "the person who spends time with me, takes care of me, and helps the doctor." Techs fit that description.

I hated anatomy. Neuro anatomy in particular. Now I specialize in neurosurgery. I set a goal (become a nurse) and one of the things I needed to do was pass A&P, which I did. It wasn't until years later that I gained an appreciation for anatomy and learned to love it. It sounds like your teacher has a very high opinion of themself and their subject. You won't like absolutely everything in life, but that doesn't mean you should abandon your goals.

When people on my unit did that, their orientation ended that minute, and they served their two weeks as a regular nurse with full load. Be careful, it could turn out very differently than you expect.

Neuro. Peds and adults; about 50/50 craniotomies/spines. Ortho sometimes (backs and trauma). Plastics if they're desperate.

There is one solution to these kind of attitudes: cross-training. If the OR nurses are trained to do pre-op and PACU (and pre-op/PACU nurses are trained to the OR...and in some places it is like this) there is much more camaraderie and less of the us vs. them. Heck, even shadowing would be helpful. Many OR nurses ARE resentful that the nurse preparing the patient for surgery had no idea what goes on in the OR. It is hard to prepare someone for something you know nothing about! The result is a very cookie-cutter assessment and less critical thinking.

Is Dr. Lambotte on staff in your OR? Everyone wears while silk gloves? I wish I was that good. All my patients tend to bleed.

It is within your scope to care for a patient's hair, nails and skin. It is not within your scope of practice to receive compensation specifically for these services. So you could file and paint and do whatever else you wanted to the nails, but the patient could not be charged for a "manicure" or "pedicure" unless is was done by a licensed cosmetologist. Licensure for cosmetology and aesthetics exists to protect income of the professionals in the field, not to protect patients, like nursing licenses do.

1. Yes, typically pneumatic and adjusted based on blood pressure. Once they are up for 120 minutes, we let them down for 20. 2. No.

It is just like circulating any other case, just without anesthesia. Clarify with your charge nurse about the time of death and whether or not you need to fill out death paperwork and how to do so if it is your first time. Do not put anything in the eyes or tape them. The transplant team has people who are specially trained to talk to families. Treat them like any other patient family: be gracious and courteous and do your best to answer questions. Find out ahead of time where to direct questions to (ie the transplant team).

I have work in aesthetic plastic surgery and now manage the clinic and med spa. When I am interviewing a potential new nurse, I am looking for the whole package. I want someone who has a great rapport with every client, no matter how difficult or demanding -- we do not have a captive audience, so to speak, and if that client considers you a friend right off the bat, they are more likely to come back. Clinical skills have to be excellent. There are times when a patient needs an IV (for instance, a procedure under conscious sedation) and there is no IV team there to heal you get the IV. I need you to be able to do a focused exam that is quick but thorough, and I need meticulous documentation (we don't have a department to audit your charting). I want someone who is comfortable selling (and upselling) to clients. If their schedule is light, they are emailing and calling people to fill the exam rooms. Most of my nurses have been to aesthetic school, and can do facials and skin consultations. I have one who studied photonics and is our expert in laser and light therapies of all kinds (from fraxel to laser hair reduction to IPL). If you do not have something like this that really makes you stand out in this industry, come to me with a plan for how you are going to become the best nurse in town at xyz. Hope that helps

I always do off the field (epi, neo/poly). We don't have sterile filter needles, so I can't use filters on the field (ie to draw up methyl methacrylate).

1. Get a copy of Alexander's Care of the Patient in Surgery, it is your best overview to OR nursing. 2. Orient to the OR as a nurse. You can't lead effectively if you don't know what your nurses do. For instance, if a surgeon walks up to your desk and barks orders, you won't have any reference point for whether or not they are reasonable unless you have some experience in the room. 3. Learn to scrub and learn the basics of sterile processing. Those things are integral to the OR. In most ORs, if all hell breaks loose (the entire staff calls in, there's a case that can't wait), management is expected to step in to whatever roll is needed.

We have cameras going in all of our rooms (displayed at the front desk). Patients are not told of the camera and do not sign any consent. They are there to protect patients. They have also cut down on doctors throwing things at staff. At the desk, they can watch all rooms simultaneously (but very small and hard to make anything out) or they can zoom in on one room. So at any given time, you may or may not be being watched. Most doctors and staff members use it to glance at the room to get an idea of what's going on before they go in,or to try and figure out where someone ran off to. If it's a quiet day and the room is empty, I'll grab a few other people, silence the pagers for 30 seconds, and we'll have a dance off for the people at the desk.

Wow, it must really suck being judged based on your appearance like that. I can't imagine how I'd feel it someone made judgements on my qualifications based on my hair, makeup, clothing, teeth, height, or the size of my rear end. Oh wait, I'm a girl, so yes I can. Good luck, hope it all works out