shortd

Every nurse on our unit explains perc trachs, central lines, bronchs, chest tubes, laproscopy, anasthesia, major surgeries, etc,etc because I'm often witnessing for their telephone consents. two weeks ago I was in a position to explain a swan-ganz catheter. Thanks, I'm never doing this again.

No problem here: your clinicals, internships, residency, first job as a NP will be giving you the specific skills. I didn't feel I needed to become a LPN before an RN. Get your NP or APRN now before you're required to get a DNP.

Every nurse on the unit performs "consents". Never heard of any nurse declining to do one. My first career was in research so I know a study would be shut down and litigated without a legal consent. Status quo and peer pressure... Will bring this up to my clinical leader. Thanks.

Holy jeez! How about just writing an order to take a 2x4 to pt's head? Call the doc, question to see if was a typo, then make an SBAR note of the exact conversation and make a copy of the order. I'd be more party to it if he was intubated and on HR, RR, o2 sat, and bp monitoring. Have flumazenil at bedside. Week ago I had an etoh DT pt with an order to start an ativan gtt at 4mg/hr. I liked that order because of past experiences with DT pts but I titrated starting with 2mg/hr because he settled down when I decreased some of the restraints, turned off the lights, and began talking to him about his work, family, etc. During report night shift and I decided to go to 4mg/hr just so we wouldn't have any more outbursts and it was a specific order. Literature is saying now to try other meds since benzos can give frightening hallucinations, cause hypoactive delirium or paradoxical effect. Other side, we transferred a pt to med/surg only to be returned the next day because the nurse did not give his scheduled ativan, a pt addicted to benzos and a history of d/c'ing 7 piccs, his wound vac over an appox 6x10 abdominal incision, and a t-tube drain during anxiety episodes. She charted she gave it but told the doc she didn't give it. Whoa, go back and re-chart before you admit you falsified a pt's medical record. Sad story, he went back to the floor without a med/tele box even with a HX of recent cardiac events and coded, has an anoxic injury, GCS of 8 now.

The way I understand it an informed consent is when the MD explains the risks/ benefits of an invasive procedure to the pt/ representative and the nurse's only legal obligation is to witness that the pt consents to the procedure. I dutifully carry out the order "obtain consent for such and such" of probably 90% of the procedures done on my pts. Will this bite me if there's a lawsuit about a procedure I signed the consent when legally speaking there was no consent? Should I go to the administration about this?

The nursing shortage and physically demanding nature of the job probably have a lot to do with it. I would say the older nurses worked in the years when there were less care techs, physical therapists, and lifting devices involved in moving patients so their backs are probably forcing them in positions less physically demanding than the floors. I started out in our SICU my first job out of school because our hospital doesn't have a competitive starting salary or signing incentives so it's pretty hard getting experienced RNs. Our new clinical leader has somehow been able to hire experienced RNs so kudos to her. In a year day shift has had about 75% turnover so it's been critical to get experience. However, I got 6 months orientation before set loose on my own whereas experienced RNs only get a month. Which is not enough when you come from a non icu position. Also I've been on days which gives me much more experience with doing md rounds, bedside procedures, and new orders compared to night shift. There's stuff that makes me cringe the older nurses do like looping iv tubing into the y-site port when taking it off, squirting saline flushes down an ett to lavage, or not starting over with new foley when it has clearly been compromised. Experience is indispensable especially with assessment and I take advantage of any advice or criticism. But, I'm about ready to start defending my clinical judgement which makes me a little nervous but it might be what it takes to stop being pigeonholed as the newby nurse. We'll see.

The problem with this intimidation and fear is that if the tech messes up and puts the pt in danger they may try to hide it before coming that nurse. It is probably breaking down all communication, she's probably affraid to relay any concerns of a pt's condition to that nurse. Compare this to a beligerent MD and how easy it is to page him/her. The fact of the matter is there's a nursing shortage but a big pool of applicants without degrees ready to replace a tech quitting. This tech being a nursing student also means she won't be in this job for long anyway and no guarantee she'll work for the hospital. The nursing manager has an experienced nurse on her staff, a bird in hand is worth two in the bush. I don't don't know what Flo would do. I work in the SICU so don't have any UAPs exept unit secretaries whom I would be lost without. Compare how much this tech does for you compared to what this nurse does for you. I was a PCT while in nursing school taking care of the pts while the nurses were hanging out in the break room or texting in the med room. On my unit I'm taking vitals, I/Os, feeding, bathing, ambulating, turning, cleaning poo, and sometimes even talking to my extubated pts along with everyting else a nurse does. I would treat like gold anyone who did any of that for me. I support you however you want to handle the situation because you've got to do what you have to do (or don't do) to survive this job.