Yuppers21

What a nurse has available to sedate/wean with is entirely up to the physicians. Each hospital/physician has their own protocols and "comfort levels" if you will for what they do with patients needing sedation. Can a nurse ask for certain medications to assist with weaning or increased sedation? Of course! Does that mean it will just be handed to them if the physician is not accustomed to ordering those things? Consider for a moment that one might not fully understand the situation as explained and therefore doesn't have all the answers or the moral high ground. Take the title of the thread for what (I assume) is it's intent: a little dark humor after a crappy, busy day. We all know how ugly it can get when a patient has an undesirable outcome and lawyers get involved. No need to hash it out.

Or follow the thread. Her post was literally the next post down. It was not difficult at all to know what she was referring to.

If I can make the request work and it still benefits the patient and unit needs, I will usually do it regardless of the reason. If it messes up my ability to match patients with the level of nursing experience they need or puts some kind of burden on the unit as whole then I won't. I won't bump nurses off assignments they had the previous shift to do so. I also would be reluctant to give in to a nurse who is always dictating what assignment s/he wants.

The nurse's comment is true and a valid point IF s/he is currently busy with a task that is delegated to nursing only. It is not an excuse to get out of helping the aides with patient care. I worked as a PCT for a short time before becoming a nurse so I am familiar with the struggles of both roles, though not in LTC. The next time you are in a situation where you need the nurse's help, try framing your request in a direct and polite way that does not make it easy to get out of the task. For example, next time you need to get a 2-assist patient up, try approaching the nurse with "The pt in 204 needs to get up to the commode and is a 2 person assist. When will you be available to assist me with her transfer?" This does not allow a "yes" or "no" answer. If the nurse responds with a "you can't do my job" answer, reply with "I understand you are busy. I am the only CNA here tonight and I must have another person help me with this transfer. When can I tell her that we will be available to help her up to the commode?" If the nurse is still resisting (without a valid excuse) calmly explain that both you as the CNA and she as the nurse are responsible for her care and right now is in need of both. If the nurse refuses to offer a solution, gently but firmly inform her that you will have to notify your supervisor/manager/DON that you are unable to complete necessary patient care due to the inability of staff to assist you and then follow through with it. Don't just use it as a tactic to "bully" staff into helping, actually notify someone (in writing)of the problem. It truly is putting the responsibility back on the facility to provide their residents with all the resources needed to give adequate patient care. Whether that means hiring more CNAs or retraining of nursing staff to help one another is up to them. By the way, you are not paid nearly well enough to be expected to "manage up" your senior staff in this way, but since you won't leave and want to be loyal to the facility and other coworkers, this is the only way you can do that without sacrificing patient safety AND protect yourself.

Thank you again MBARNBSN and bobjohhny for your replies. They have been very helpful and given me some more things to consider for my resume. The interview advice is bonus! Looks like I have some work to do to tweak my current resume

Thank you MBARNMSN, I really appreciate your feedback. I am currently a charge nurse and a member of a clinical committee on my unit so I will make sure to display those in a way that is informative and visible. Thanks for the tip on reducing the amount of space I give to my patient care experience, I will work on that as well. My resume starts with a short mission statement which basically states I am looking to advance my career as a nursing leader at my workplace while obtaining my graduate degree in management. Since I'm applying to leadership positions, would you recommend including a cover letter that goes into a bit more detail about my career goals and remove the mission statement from the resume? I imagine that those responsible for hiring might want a little more "meat" from a applicant for a leadership position than someone applying for a floor nurse position, but I'm just assuming. Do they too spend little time browsing through resumes simply because of the sheer number they need to get through - in which case a cover letter would just be skipped where as a mission statement might be noticed?

Hello all! I am in search of any resources that can assist me in creating a resume suited for entry-level nurse manager/leadership positions. My current resume is focused on bedside patient care and needs to be updated with the leadership experience I have acquired in the past few years but I am having a difficult time deciding how to best format it. The examples I have been able to come up with online are more relevant for someone who already has held manager/director experience. Any help is greatly appreciated!

ICU ratios at my work have been far more kind than what has been represented here. 1-2 patients, on rare occasion a 3rd can be added if no other option presents itself. I almost never see anyone stay later than an hour. I live in Utah, there are no unions or ratio laws. I just happen to work for a system that still allows us to staff appropriately. I can only hope it stays that way as our med/surg floors have not been so lucky. I don't think I would stay in an ICU such as you described.

Charge for the shift going off determines how many nurses are needed and who gets called off. Charge for the shift coming on determines patient assignemnts.

If smoking weed is that important to you, it would seem easier to pick a new profession than a new country to live in. Remember, the grass is always greener on the other side

Sorry, I just have to address this as I feel you have completely undervalued the respiratory therapist in all this. A RTs value goes far beyond intubation and short term ventilator set up/management. While one can argue that a RT is not needed in a RR or code if a paramedic is present, no argument is needed to prove that a paramedic is also not required when a RT is present - because it is already has been done so -successfully- for quite some time now . I get what you are saying, but what I don't get is this - who needs a Jack of All (emergency) Trades when all the specialists are already there? MD, RN, RT, Tech? Again, ICU experience here, not ER so maybe I have come to some incorrect conclusions?

Truly, this is all very interesting as I have very little knowledge on the scope of practice a paramedic has. However, with all this back and forth banter I still have not seen a good argument for why paramedics are needed in the ER? There are already staff that currently exist who can start IV's, do triage, give medications, intubate and run codes without paramedics. So how does the addition of a paramedic improve this? If an ER is understaffed, it is often due to budget issues, not lack of qualified applicants who can be trained for the role (of course, certain rural areas are the exception). I can hardly argue agaisnt a movement to bring paramedics into the ER setting if there is a need for it. Is it a staffing and cost saving measure, such as the use of NPs and PAs in what was once strictly physician territory? Everyone can provide anecdotal evidence of an incompetent clincian in field A and a super star cowboy in field B, but that's neither here nor there. Smart, competent and hardworking people entering every field of healthcare. The question is how does incorporating a role that has been formed and molded to provide the best care possible pre-hospital into a model that has been functioning quite well on it's own without them benefit the population as a whole? I'm ICU, not ER so I am not aware of the particulars in this arena. No opinion here, just trying to understand

Is the MD of the spinal fusion patient aware that he is thrashing around to the extent you describe? I can hardly believe that the physician would be ok with that as far as the patient's recovery is concerned, no less your own safety. I have cared for many detoxing patients with the CIWA protocol and have rarely encountered a situation you have described. Are restraints not an option? Are you applying the CIWA protocol appopriately? Do your coworkers not support one another when you have combative patients in order to keep each other safe? My facility, coworkers and physicians I work with are not perfect, but I do feel like protocols have been put in place that keep both the patient and staff relatively safe. If a patient is being combatitive and violent, staff are expected to assist one another with cares that could leave the caregiver in a vulnerable position, physicians are expected to order any medications and restraints needed to keep everyone safe and management/corporate have used time and resources to train staff to how to protect themselves and avoid potentially dangerous situations. Also, security is always just a phone call away and we have used them as necessary when patients or family members get out of hand. I would not be ok with working in any kind of place that provided anything less.

I think both choices sound excellent. The no debt option is less risky (in the event that you can't find employment right away) but 30K in student loans is not overwhelming by any means. Just keep in mind, it is far too simplistic to do calculate projected salary and student debt to determine how you will come out ahead or how quickly you can pay the loan off. Life always finds a way to throw off the best laid plans. You may not make as much as you anticipate and/or your living expenses will increase after graduation.

The only reason these schools can charge these outrageous tution costs is because there are students who will pay it, not because they are worth that amount. As many others have said, look for other options. I paid approx $20k for my BSN at a well respected state school. The private, for profit schools in my state run upwards of $60K+ and I discourage others from going that route unless there is some extenuating circumstance to consider. The realization that there are nursing programs that charge over $100k is maddening. Unless the tuition is being paid in cash by wealthy students/parents, then it is being bought by loans which burden the student far too much. The only winners here are the bankers and the school administrators who have an obligation to keep "feeding the beast" without proof of value to the purchaser.