Anna Flaxis

Huh? I have no idea what you are asking.

Hi Steve123, At face value, this is a very disturbing story. Some questions I have are: Are you certain this patient has no indications for Vanco? Are you certain that the physician was being "honest" vs. making a sarcastic, jaded comment? If the situation is exactly as you describe and there is nothing more to it, then I would have a couple of suggestions. You could take this up the chain of command and talk about your concerns, starting with your charge nurse and going up the chain from there as needed. Alternatively, you could skip that process if your work environment is such that you suspect that it will be futile and/or you fear retaliation, and make an anonymous report to risk management/the hospital's patient safety officer. Good luck!

Again, what harm does swallowing a nipple ring do? Sure, there is potential for harm, but most of the time, they pass without incident.

What harm have you seen swallowed nipple or navel rings cause? I'm trying to understand this, because it's not a button battery or a magnet. It's a small foreign body that will most likely pass with no adverse sequelae. Am I missing something? I'm really more curious than anything...

Totally normal! If trial by fire works for you, you'll do well. Give it six months to a year before you don't feel like a complete idiot, cry your whole drive home, and lie awake at night re-living all of the things you did wrong. You'll do great!

Sounds like a real cluster, and you were thrown under the bus. I'm glad the attending apologized.

I would have made this patient a 2, but not because of the reason cited by your supervisor. Your supervisor is playing a dangerous game making triage decisions based on how often the patient presents. The reason I would have made this patient a 2 is that she had vitals in the "danger zone" and a potentially high risk condition, and did not require immediate life saving intervention.

I think it's appropriate to have patients expressing SI/HI dress down and to remove personal belongings from the room. This can include removing jewelry if the jewelry is of a nature where it could be used to cause harm to self or others. However, it is hard for me to imagine how the average nipple or navel ring could harm anyone or interfere with the plan of care in any meaningful way. As an ER RN, this is not a hill I'd choose to die on, and I'd err on the side of protecting the patient's rights.

What??? Why not? It is completely within your scope of practice as a professional R.N. to provide this information. Granted, I might advise taking the family members aside and gathering more information about why they feel the need to deceive their loved one, but I would also inform them that as a competent adult, she has a right to know, and that as a professional R.N., your duty is to your patient.

I think it really depends on the way this is implemented. I see nothing wrong with an action plan, per se. If the director is participating in a supportive manner to assist the employee in coming up with an action plan, assisting with the formatting, suggesting references, etc., then it could be a potentially constructive intervention. If, however, the director is not providing any guidance, support, or assistance, and is letting the employee flail about in stormy seas, then no, I'd have to say it's not something I'd advocate for. And, I do not think the employee should be required to do this on unpaid time. It should be on paid time and in a supportive environment. Otherwise, it is punitive and may be actionable by the labor union if there is one, or if not, then by the State Labor Board.

Words of wisdom: It's normal to feel like a complete incompetent idiot as a new grad. Take your co-workers' "ambushings" as opportunities for improvement. Pick yourself up, dust yourself off, and come back and do it again the next day.

Well, then there ya go. I would suggest applying to an agency, but I have really strong feelings about new grads taking agency work, so I won't. Good luck to you!

Hi, I've been on both ends of this. More than once when I was a CNA did the RN say within my earshot that "The CNA will do that" when they were in the freakin' room. More than once have I changed the soiled bed of a dependent patient *by myself*. Does that always feel good? Well, I only know how it felt to me when I was a CNA. As an RN, I've had to pass on assisting with ADLs because of other more pressing issues. If you let it bother you, it will eat you up. Just do your best to provide the best patient care you are able, and if the RN won't help you, f*** 'em. Just remember what kind of RN *YOU* want to be (if that is a goal of yours). Take care!

If you've given it a chance for six months but still hate it, you're never gonna love it. Just my opinion. Start looking for work elsewhere.

"I get the feeling that she is socially starved." Ya think? Maybe find a way to compliment her once in a while. Find something about her that you appreciate and tell her so. Humor her kitty pics, but hold her accountable for unprofessional behavior. Remember that you never know what battles others might be facing, and try to be forgiving.

I don't know about anyone else, but I don't consider that Northern California. That's the Bay Area, as far as I'm concerned. The previous poster was correct in this being an employer's market and not being licensed yet. What caused you to move to Solano County? Are you willing to relocate?

Admittedly, I have skipped all of the replies. You do you. One of the first things I ever learned as a new RN was to do an assessment you can take to the bank. Now that I'm not so new, I feel a bit more comfortable with shooting from the hip. But, I am fully aware of how that can bite me in the butt. Again, you do you and don't worry about what the other nurses say.

What did the OB-GYN have to say about this?

Gero-psych certainly wouldn't hurt anything. We see a ton of that in the ED, so having some experience with it wouldn't be a bad thing at all. But to be honest, if your passion is ED, then go for ED-with one caveat... if you don't expect much more than a sink-or-swim orientation and you are a person who can deal with that, then go for it. If you need a lot of hand holding, then please don't. The ED is a busy place, and if you don't have the ability to pull up those hip waders and wade right in, then it may not be a good fit.

Depends on the clinical picture. Is this a new medication for the patient, or have they been taking it for a while? If it's new, I agree that it would be safest to have them on the monitor for at least the first few doses. If they've been on metoprolol for some time, and it's simply a route change due to NPO status, it is important to avoid abruptly discontinuing the medication, as this can lead to a whole host of problems, such as Acute MI. It would be of great import to make sure they get their dose. If you're not comfortable with an IV push, then mixing it in a mini-bag and infusing over 10 minutes would be a good compromise.

What are your thoughts?

The doctors do it where I work.

Of course, just as I think that when citing evidence to make a point, one should verify that such evidence is reliable. :-)

Assuming this is not a rhetorical question, to put it simply, the smaller the sample size, the less precise the information is. Say, for example, you receive a shipment of 500 widgets, and the supplier guarantees you that no more than 10% will be defective. You can't check every single widget, so you take a sample of 10 and find two defective widgets. You could conclude that 20% of the entire shipment of widgets is defective, or you could understand that perhaps you just happened to pull out 2 defective widgets when selecting your sample. Now, what if, instead, you select 50 widgets as your sample, and 2 of them are defective? That would be 4%, and consistent with your supplier's guarantee of 10% or less. You can apply this principle to individual experiments as well as what we call the "body of evidence". Two studies (with small sample sizes, no less) is not a large body of evidence upon which to form a strong conclusion, it is merely a starting point for further research.

First, please note that this is a single study with an n=20. This is not a large enough sample size to be statistically significant. Second, please note that in Group 1, the group in which radial, femoral, and carotid pulses are present, 8 out of 12 patients (67%) had an SBP >/= to 70, and 11/12 (92%) had an SPB >/= to 60. We would need to conduct more experiments with greater sample sizes to be able to draw a reliable conclusion. Also, please see: Accuracy of ATLS guidelines for predicting systolic blood pressure