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grandmawrinkle

grandmawrinkle

adult ICU
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  1. grandmawrinkle

    So much negativity towards Associate Degree Nurses

    This is not really true everywhere and it certainly hasn't been true in the past. ADN programs have gotten competitive because they are generally inexpensive (community college tuition) and the payoff at the end is a decent sized paycheck, so they are having you take your prereqs ahead of time as "weeder" classes prior to application/admission. There are still CC ADN programs that will admit you straight out of high school and do indeed take you only two years if you go full time. This means taking your sciences and liberal arts concurrently with your nursing curriculum. It can be done and is still done. I did one of these in the late 90s -- I happened to have a BS, so I only went part time, but I did go to school with a bunch a people that had very few or no college credits and they graduated the same time I did.
  2. grandmawrinkle

    Colorado Doctors Sue After RNs Approved To Give Anesthesia

    I wasn't trying to persuade you in particular. I work in a SICU that takes CVICU patients direct from OR and turns into the PACU on evenings and weekends, in a hospital that is affiliated with a CRNA program. Many of my former colleagues have gone through this program and I would estimate they all had a minimum of two years in the SICU, some more like 10 years (with the exception of one bad egg, and there is always one of those.) All had other bedside practice prior to working in the SICU. A lot of them get hired. From what I have seen, they are excellent practitioners right out of the gates. Maybe the new grad CRNAs you are used to seeing come out of a crappy program. IDK. There is a program in my area that is on probation/in review right now and I can't speak for those graduates. Or, perhaps the program that I have been exposed to the most is exceptional -- can't really say.
  3. grandmawrinkle

    LPN to RN, thinking of dropping out :(

    Are you admitted to an LPN to RN program? If you are, then don't drop out. The sciences are the hardest part of any ADN program. As an LPN, I would imagine you would breeze through clinicals. Just put your head down and keep plowing through. You aren't even halfway through the semester. Just try to nail what you have left and hopefully you'll pull out a B. My second semester of A&P I felt like an idiot. I did well my first semester (A) and then my second semester I got a B-. Why? Because I bombed my neuro section. No, I really bombed it. I think I got a 50%. I am now a SICU/CVICU nurse working on my MSN. You can do it. I am still very weak in my neuro knowledge. Everyone has some weaknesses -- you can work through yours. You can do it!
  4. grandmawrinkle

    Colorado Doctors Sue After RNs Approved To Give Anesthesia

    They have these in some states. They are called anesthesiology assistants (AA's.) Here is some info on them - it looks like there are only seven programs nationwide. The Ultimate Anesthesiologist Assistant Educational site, for the Anesthesia Assistant, Anesthesiologist Assistants! Some MD anesthesiologists claim to prefer these because they are trained in the "medical model" and, in no way by any type of legislation practice independently, which keeps them firmly under their thumb and out of the running as far as competition. Some MDAs also advocate for training PAs in anesthesiology for the same reason. I have never met an AA (I don't think my state uses them at all) so I don't know if they are any good, but at first glance, I wouldn't want a non-medical person with a couple extra years of grad school administering my anesthesia. However, I could potentially be swayed if I knew more about them. Nearly all CRNAs that I know or those that I have known that have made it into a CRNA program have been stellar nurses even if they have only had a few years of practice under their belt (I have only met one that IMO didn't think should have been admitted ... didn't even have a whole year in, very green, but very book smart and I am sure she rocked her GPA/GRE/interview, which is why she got in.) I would honestly rather have even a relatively new CRNA provide my anesthesia as opposed to an MDA, any day of the week. All the MDAs I know are pretty sloppy, "cowboy" sort of practitioners - not exactly the type that you want to very carefully administer medications that might kill you. ICU nurses turned CRNAs are used to administering dangerous IV gtts and monitoring patients all the time, are usually supremely detail oriented, and pretty anal retentive. IMO, pushing drugs and monitoring patients (a big part of what CRNAs do, every day, all day) is totally, completely, exactly what a nurse does. Doctors don't really do that, at least not as a part of their core training. Does anyone know if any MDs from other states had such an uprising after this type of legislation was passed in other states, or is CO trying to set a precedent here? I am pretty sure this is already a lost battle for them, but it would be interesting to know if anyone had attempted this.
  5. grandmawrinkle

    Do you give meds without seeing the MDs order if he MAR has been checked?

    I don't think anybody does this or it is even reasonable. Our eMARs are signed off by the pharmacist, then the administering RN. After that, the next shift signs it off as well, so it essentially a double-check. After that, nobody looks at the original order. So for patients on 30 different meds that have been there for 3 weeks you are supposed to go back and look up every original order? That's nuts. Nobody would ever get any work done.
  6. grandmawrinkle

    OSA in the ICU

    We have no EtCO2 monitors either. We are behind the times IMO on a few things like that. That will hopefully be my next project.
  7. grandmawrinkle

    2 job offers... now what???

    Do you work for the VA? ...because a lot of the stuff you said is not true. Health insurance is not free. It's inexpensive as opposed to the private sector, but not free. The old pension program that allowed those types of retirements was cut about 10-15 years ago. There is still have a 401K type plan with a good match and a tiny pension, but it is not the retirement of years ago. It is still, however, much better than the private sector. Promotions are not based on seniority and experience. You have to interview for upper level positions the same as anybody else does, and often there is stiff competition because everyone wants to stay in the system and have a better job. Level of education does come into play to some degree (as it does everywhere) as the VA is pushing higher standards of practice/educational preparation across the board...Nurse managers now need MSNs. BSN grads are preferred for bedside roles.
  8. grandmawrinkle

    A time to reform nursing education?

    I don't understand this statement. A baccalaureate degree in nursing does not have one enroll in the science prerequisites that are required for application to medical school (although one could probably squeeze them into one's electives if one was really motivated), nor does a BSN prepare you to sit for the MCAT, and why should it? Most nurses don't want to apply to medical school. If the curriculum was changed to include these prerequisites, what would be thrown out? My assumption is that you are suggesting that the "fluff" coursework should be tossed and replaced with the hard sciences. I'm not sure that the hard sciences would be any more applicable to our actual work than the "fluff", to tell you the truth. The hard sciences are certainly more difficult and would raise the bar for nursing programs across the board, but it would also probably prevent a lot of people that could be successful nurses from gaining entry to the profession. Not all of us are capable of college level organic chemistry, physics, and calculus, and I think that's ok. I do agree with this. There should be higher standards in some way .. what way, I'm not really sure. Should we pass an entrance exam? Should we have a higher GPA requirement? Should we require healthcare experience? IDK. Also agreed that the NCLEX is a joke. The nurses that have to take the NCLEX 3 and 4 times before passing scare me.
  9. grandmawrinkle

    maybe I wasn't being nice.....

    TO CLB -- That is all well and good and likely not an isolated situation with the way things are going in healthcare. It is also a management problem. OP did not say that the staff on her ward (unless I missed it somewhere else in this thread) weren't trained in tele/ACLS so I was assuming that was not the case. In my area (heavy nurses union involvement) what you were describing would never fly. I have worked in parts of the country, though, where I could see it. I was going to say this before, but really, although I DO feel that the floor nurses needed to get involved in this situation instead of standing around with the "deer in the headlights" thing going on, it probably would have been wise for OP to jump in and get things started as far as treating the patient as well. I would have felt really bad as an ICU nurse dropping off that patient. You bet your ass that those nurses after OP left talked the rest of the night about the "dump" they got from ICU.
  10. grandmawrinkle

    Need advice on how adjust a new RN attitude

    IMO, I don't think being professional/unprofessional has anything to do with your age. I have known plenty of horribly unprofessional nurses that are 50+. However, I do think, in some ways, professionalism comes with experience. If you make enough screw ups to the wrong (right?) people and you get called out on it, you will clean up your act. The best advice I can give you is to just be verrryyyy mindful of what is flying out of your mouth. Often, it is helpful to bite your tongue even with what you would consider mindless chit-chat. Listen to others, as opposed to speaking yourself, at least to start with ... and after that, make sure that what you are saying is really what you want to say, and make sure you don't deliver it in an inflammatory way.
  11. grandmawrinkle

    2 job offers... now what???

    You know, it's really not obvious. It looks like you have two really excellent offers. My personal bias is the VA position. Federal jobs are the bomb (I have one.) You will not get better benefits anywhere, or more vacation. The thing is your schedule is not going to be anywhere near as awesome as your outpatient schedule will be and it sounds like the specialty of the unit isn't quite what you are used to. I didn't look and see how old you were, but if you are looking for a health system that is going to set you up with a good salary, retirement, and potentially a very long career, the VA is awesome. There is a lot less of this system redesign/consolidate/liquidate/lay-off business happening in the government sector. It is a very, very stable job, which may or may not mean a lot to you.
  12. grandmawrinkle

    How did you get your job?

    Is it even possible? I have been looking around for something different and it appears (from what my co-workers have told me) that I have some natural management ability. I have 10 years of clinical experience and am working on an MSN. I'm certified. I sit on a hospital-wide committee. I have a lot of first line supervisory/charge experience -- been doing it about 1/4 to 1/2 my shifts for the past 9 years. I am just getting really discouraged. In the past year/18 months, I have applied for two assistant NM positions at my facility and rejected for both. (I did get interviews.) (That said, my hospital was more or less transitioning a "unit coordinator" role to an ANM role, and both those jobs went to the people that had the unit coordinator position previously.) I recently applied to a (by reputation, very competitive) hospital-wide internal leadership program and got rejected from that -- I was about 75% I would be selected for that one (that was a written application only process, no interviews involved.) So, what am I doing wrong? I would like to try to get my foot in the door before my MSN is complete, but it is just not working out for me. Am I being unrealistic with my expectations for myself? Should I just stop trying? Is nursing management really that competitive? As an FYI -- I have not looked outside my facility. I didn't want to shake up my life too much while I am still taking classes. I don't know if I would have better luck if I looked elsewhere or not. Any tips would be appreciated.
  13. grandmawrinkle

    post-baby boom generation and nursing theory

    There are exactly two nursing theories I give two seconds of thought -- Orem -- if I had to choose a theory that aligned with my own practice, it would be hers. To refresh your memory, she says (more or less) that nurses do for the patient what the patient cannot do for themselves, and the goal of care is to get the patients in a well enough spot to do their own self care. Well, duh. Benner -- the novice to expert business. This has been widely incorporated into promotion programs and clinical ladders across the country -- it works because it can actually be applied. I have a liberal arts/soft sciences background FYI and even I think most of this stuff is bunk. Nursing is a highly practical, applied field of employment. There is hardly anything practical or applied about most nursing theories.
  14. grandmawrinkle

    Heparin - syringe to use?

    Your drug book says 25g needle (thin) and 3/8 inch (short) because it is referring to the type of NEEDLE that is recommended when giving a SQ heparin injection. That is a typical SQ needle size. Typically heparin SQ comes in a 1cc vial, so you could use whatever size syringe you wanted to draw up the 1cc of heparin in (most people I have seen use a 1cc, but you could use a 3cc). You should NOT be using insulin syringes for anything other than insulin. If your facility doesn't stock SQ needles so you can use a regular syringe, they need to get them.
  15. grandmawrinkle

    maybe I wasn't being nice.....

    I don't think so. If you take monitors on your floor, you need to know ACLS and what to do in an emergency or ACLS situation. 4 nurses standing around the bed is just plain dumb. Cracking jokes, however, was uncalled for. It's always the best thing to be respectful of your coworkers (even if they ARE stupid.)
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