Chaserr
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Exactly
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surely there are multiple factors in play here. If it was strictly same job - same outcomes - same pay, then we wouldn't see ACT practices today skewed towards MDA>CRNA income. The only place I see this actually happening is in the CRNA independent practices in the future.
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I understand why a MDA gets paid more than a CRNA even for the same job with the same outcomes across the board. I believe MDAs have different experiences and thus bring different views into practice as do CRNAs that MDAs don't, which both views are equally valuable to a holistic patient approach. MDAs are less abundant and cost more to produce, thus should get paid more - basic economics. What I don't understand is how they make double, and in some cases almost triple the amount as a CRNA. It's absurd to undermine the Nurse Anesthetist's knowledge by inflating MDA wages for the same job and same outcome. I understand MAYBE 20-50k more than a CRNA, anything more and the system is blowing smoke up their a**.
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Honestly man the last thing on your mind should be 'looking sexy' for your nursing shift. Saying that find out if your hospital allows or doesn't reinforce rules about wearing T-shirts as tops. I wear these nice slim-fitting t shirts from Express and they make me look sexy as hell - Jus' sayin'.
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I work in an ICU where all the men have some sort of beard and we wear the papr respirator with TB patients - NBD. Also if your institution can't provide a papr in a timely manner before you are assigned the PT you can legally refuse to care for that PT.
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I know a nurse with gen med experience in orientation on a VERY busy neurosurgical ICU who has no ICU experience acting as a know-it-all who is facing termination because of it. It's a very dangerous mindset.
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You did the right thing, everyone makes mistakes.
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What you SHOULD have done was requesting a STAT chest xray and worry about his pneumo getting larger or maybe an ABG to see if he was retaining CO2? SpO2 and pCO2 do not have an inverse relationship... He could have been progressing into a tension pneumo or developing a worsening effusion while you're worried because you 'made him feel worse'. In these situations you REALLY have to look at the big picture and think about what exactly is going on.
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You realize it's quite difficult to get HIV from even a needle stick let alone having if be splashed on you. I wouldn't worry about it one bit.
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I'm kind of at a loss for words. Indwelling TpA and infusing TpA and completely different therapies as mentioned above. if the clot is INSIDE of the port then there would be no facial swelling and would require indwelling TpA which is anywhere from 30-120 minutes on indwelling. Now if for some reason the line CAUSED a venous thrombus of some sort then transfer to an ICU and infusion of TpA would be an option. Facial swelling could be from literally hundreds of etiologies, unless they had solid proof of a clot via sonogram results then they would have to go back to the drawing board and figure out what's going on...
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Well if she had itchy eyes and a puffy face obviously it could be a sign of an allergic reaction in which you are right to suggest benedryl because it shows your thought process and what you're worried about. I work in a neurosurgical ICU and I suggest medications all. the. time. the docs have the discretion to take my suggestion or to leave it, either way I covered my ass and put a note in the chart saying I notified the doctor of the observed symptoms. Its the safest practice for yourself and the patient. In your scenario I would have done exactly that then monitor the PT very closely and if anything worsened even by the slightest bit i'd be back on the phone calling the doc.
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Show me the proof.
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I believe a lot of people are misunderstood in this forum about the role of the CRNA and what the future holds. I believe it is a state by state basis, but there are CRNA independent groups to where they do 100% of the anesthesia under no medical direction. The physician that you're 'practicing under' would be the surgeon - who has no anesthesia training whatsoever. There are also CRNAs who branch off with a surgeon and have an independent practice. There are also practices where MDAs and CRNAs practice in the same hospital, but the MDA does not oversee or manage the CRNA at all. Finally the most common in which most people know about is the ACT practice where an MDA will manage 3-4 suites and has to be present during certain stages of the case, which is basically them opening the door and giving a head nod. With cost cutting initiatives running rampant in today's healthcare suspect the aforementioned to become more of the norm over the ACT practice. Yes MDA's have more knowledge and education; No their patient outcomes are not better than CRNAs