qanik

ED new grads were I was working were getting about $24.00/hr Qanik

OK so first I will tell you that I think the whole theroy thing ranks up there with the nursing diagnosis thing- useless and a buch of time wasting BS. Now having said that I had to do the same thing in graduate school. So if you like Orem and the self care model use that with any patient. The alcoholic who comes into your ED is obviously not caring for themselves. Then explain how this person can be helped through nursing. Use things like universal self-care deficit as well as developmental self-care requisites and health deviation self-care requisites. You see here is my *****- you don't need to have a theory that says Mr. Jones is an alcoholic so he has a self care deficit and I can help him because I am his nurse. I don't need to read Leininger's chapter to know that different cultures are handled in different ways- IT IS COMMON SENSE. good luck with your project Qanik

OK I have to ask. Where is the manager in all this? I made my living as an ED manager for many years. Why is he or she not informed about these types of preceptors? Are your managers involved in your orientation? I routinely was on the unit without preceptor or new orientee knowing it watching the interactions between the two. I called the new hire into the office every week to ask SPECIFIC questions about orientation and the preceptor. I also spoke with the preceptor weekly and met at the end of every week with both at the same time. Sometimes we needed to switch preceptors. I inherited a bunch of veteran nurses who were nasty and terrible preceptors. I sat them down and explained the role of a preceptor and my vision and goal for a new hire and it certainly wasn't going home crying! The second meeting with some of them was their last as a preceptor. And the third meeting with some of them was their last in my unit. Speak up and don't be afraid. The days of having to put up with these old crass unstable nurses have long past. My goal is to have you competent and happy and to translate that into your patient care and hopefully like working in my unit and stay with us awhile. If you need an extension then so be it. And when you come off orientation you should always have a "go to" staff member to bounce things off or just talk to if needed. I also would continue to meet with you weekly just to make sure things are working.Just another side to this story. Respectfully, Qanik

It is loaded with openings out here. Some hospitals looking- University of Chicago, Loyola, Northwestern, Delnor, Hinsdale, Evanston, Stroger and on and on. Qanik

I will make a brief comment in reference to another post. There has been alot of good post here. Seems to be some brains on this board which is always a good thing. I mention my background only as I am trying to prove that I have seen it from many ends. I have been a paramedic for 21 years a nurse for 16 (the last 10 as a flight nurse) and a new CRNA. I won't get into who can do what I will leave that up to you and yours. What I would like to comment on as I mentioned in a previous post is this. While in CRNA school I did my research project on Conscious sedation and its liability. I will challenge you who are doing Conscious sedation as an RN or Medic WITH MD orders and conscious sedation protocols to look up adverse outcomes liability when there is a bad outcome- (aspiration, hypoxic event, arrest, etc) What always happens is the same. A lawyer presents the definition of conscious sedation from the AANA or other anesthesia professional group. Then the question gets asked- Was the patient able to answer questions appropriately during the procedure? Could they follow all commands appropriately? Kind of hard to say yes when they aren't breathing and had to be bagged briefly. In most cases they are settled out of court. You WILL be named whether you are the MD the RN or the Medic when something goes wrong. several articles have also found that up to 80% of conscious sedation protocols are written in such a manner that if they were followed and charted perfectly the hospital would still be held liable for poor outcomes. Just a thought to keep in the back of your head. None of us want to end up on the stand someday. Last, as many of you already know there was another conscious sedation death involving an RN and propofol last week- please be careful Respectfully, qanik

CRNA 70 I totally agree. Pinknuts- While in CRNA school I did a project on conscious sedation and the legal implications. You may have that cowboy mentality that if they stop breathing just bag them but you have obviously NOT done conscious sedation if they stopped breathing in the first place and I will tell you if there is a bad outcome you will have NO defense legally because you were NOT doing conscious sedation. QANIK

I think you folks are missing one main point- the start of this thread was asking for conscious sedation- the definition of conscious sedation is " a medically controlled state of consciousness in which PROTECTIVE REFLEXES are maintained. This patient retains the ability to maintain the airway and CAN RESPOND appropriately to physical stimulation or verbal commands such as open your eyes or squeeze my hand" This is the definition provided by the American association of nurse anesthetist and the american society of anesthesiologist. Look up legal cases involving conscious sedation and one common theme stands out- If the patient stopped breathing or was unresponsive to commands then they were beyond conscious sedation and whoever was involved is going to be liable if a poor outcome is involved. Having worked in the ed and icu and flight world for years I have seen exactly what you are describing the brevital bolus and the brief knock out that comes with it to relocate a ortho injury- not conscious sedation! The propofol bolus breif apnea perform the procedure and done- not conscious sedation! After attending CRNA school and actually seeing the defintions of conscious sedation, deep sedation and general anesthesia you realize when a doc or crna comes to administer the drug it has nothing to do with reimbursement issues it is purely a legal and competence issue to protect you and the hospital. Hopes this helps Qanik

Just had to post as last weekend while at anesthesia school felt this strange palpatations and got lightheaded. Went to the ED. Workup = nothing. Sent to 23 hour obs. 6 hours later went into rapid a-fib. Rate 180-190. Cardiologist happened to be in the next room (large teaching hospital) I maintained my BP. They put my on a continuous 12 lead and tried some adenosine 6mg and then 12 to see if it was SVT. It was so fast you couldn't tell. Got the cardiezem bolus slowed me to 120-130 and you could clearly see a-fib. Stayed on the drip that night and spontaneously broke in the A.M. the plan was cardioversion later that AM if I didn't break. I had a follow up echo then stress echo- all normal that day. Went home on 180 cardizem CD for a month. Things I learned- don't take your morning prednisone (myasthenic) with a venti Starbucks. You can cardiovert up to 48 hours after initial a-fib without thrombus worry. Criteria for anticoags- Over 65 years of age, HTn, recent stroke, LV failure, onset more then 48 hours, past clot hx. Anyway that was my fun for the weekend. A heart rate of 190 is something, it feels like it is going to jump out of your chest Qanik

I would add a few things. A calcium score of 12 is NOTHING. But just as important is there is no correlation between Ca+ score and coronary disease. As some have mentioned you can have a score of 0 and have an MI tommorow. Ca+ again as someone mentioned is only one component of the plaque. Having been a patient of one of the pioneers of the CA+ scan I have had much experience with the scan and his interpretation. I was 35 years old with a score of 98. Higher then most of the population in that age group. I have had more invasive test which showed NO blockages ZERO. Strange thing is when I was healthy and 35 I had the same score and was running marathons. Now I am 42 with myasthenia and BIG doses of steroids and no excercise and my score is 90- go figure. As my Doc stated "it is more of a screening tool for POTENTIAL risk of cardiac disease. If he gets a patient who just won't listen and shows a score of 800 then he feels like he has something to show them and they may listen. Anyway have a good day Qanik

Not quite sure what your asking. Buy any scope you want. No one is going to use a scope in the helicopter (you can't hear anything but engine) unless you have a electronic one attached to your head set or helmet. Qanik

Humiliated, I can't believe your response. Having worked as a medic for 18 years and a nurse for 15- I will say this, With a statement like that, you have alot of growing up as well as learning to do. Also, if you think the patients sats went from 90-100% because you dropped him 2 liters- OK:rotfl: . PSS -"In our ER in an emergency setting we nurses do what we need to do if a doctor is not around, ranging from thoracostomy" Didn't know chest tubes were part of the ED nurses training these days- and next your going to tell me you have a protocol for ED nurse thoracostomy right, and insurance to cover you? Sometimes my own profession scares me to the bone. Qanik

Just relax and have fun. The crew will stress to you the importance of safety and will do a orientation for you regarding the (do's and don't). Take it all in. See what the crew does when they are not flying, it will give you and overall feel for a typical day. Have fun Qanik

Check out the flight nursing area

I think if you look back you will find other discussions on the board regarding this topic. I can say I researched the US News rankings for a paper and after MUCH MUCH digging, I was able to get the methods used which where nothing more then a questionare sent to the directors of all the programs and how they ranked the schools= popularity contest. Brent

Sounds like a tough situation for you to be in. I agree with you he should have had a central line put in quickly. Also note trauma's post about EJ's they are good quick lines That nurses can usually place. IF you read any good RSI literature they will advocate 2 Good lines. Now that being said you can also find yourself in a situation where the A may not wait for the C. I have been on flights where patients where huge (tough IV periph or central) and their respiratory situation was deteriorating quickly (burns), where I have made the decision to RSI them By giving IM succs and then intubating, following that with IM MSO4 and Versed as well as a Non depolarizing agent like Vec. Now you have accomplished A and can progress to C. I think its important to remember A before C. As you noted you may get into a situation where you need the IV for the BP ( although in this case, etomidate and succs should have minimal hemodynamic effects). Most likely when he went down you took the "fight" out of him and that was the loss of BP. In this case it sounds like your resident was afraid of the procedure or unskilled in it. I think your right on to be upset as it is another case of delaying A for ever while you fiddle for C. Brent