Caffeinated RN

I'm always caffeinated....for reals

In my case, I spoke with the charge RN who hooked me up with the right person. As it was stated earlier, you would want to seek out your own facility's chain of command, as this could vary. I am very fortunate in that I work in a very positive, supportive environment. My preceptor would have never dreamed of saying such things to me (unless he was playing around)! I suggested the apical HR because the patient may have been experiencing some non-perfused PVCs, or even runs of v-tach, especially if s/he had electrolyte abnormalities related to pancreatitis (nausea/vomiting/poor intake). Of course, if he was on tele, you would know this, so forgive me if I'm missing the mark here (I wasn't sure if by monitor, you meant pulse ox monitor or telemetry). I wouldn't think twice about a patient who was asymptomatic in the 40s, but the 30s would make me nervous, too! Then again, I personally haven't seen a patient with a HR in the high 30s in sinus brady. The last patient I had with a HR in the 30s was in a junctional rhythm....and coded shortly thereafter I am sorry you have to deal with your work's unsupportive environment.

What kind of cardiac history (if any) did this patient have? In that situation, I would have gotten an apical pulse and a full set of vitals, in addition to your assessment. I think an EKG was the proper thing to do, as well (though I probably would have ran it by the provider first....it depends, of course). I've seen this happen before, but only in patients whose histories have been well elucidated, there is a pacemaker in place, and the vitals (and patient) were stable. Did they give any other reason besides the fact that they were asymptomatic? That is very frustrating. I'm a pretty new nurse, and I have already had some "What the hell are you thinking!" moments with providers, which has taught me to continue advocating, especially if your gut is screaming at you. In those cases where I went around providers using our chain of command, I was right. A doctor once personally thanked me for being so persistent. But it can be tough! Keep on persevering!

Personally, I do not irrationally fear losing my license. Like previous posters have stated, schools may have something to do with this pervasive myth. This myth may also be fueled by lawsuits. I feel like this nation, in general, is "sue first, ask questions later (or never)." As such, this could lead to a hospital investigation that is very stressful for the nurse, even if the accusation is absolutely frivolous. Perhaps the thought is that a lawsuit means the BON will be involved, further spreading the "lose your license" falsehood?

This is why I love having a drug guide!

Do you have a friend that can record the lecture? I was once in the same situation - but instead of the first day, it was a test day. Per my school's policy, I would lose 5% if I took it the day after. It was a hard decision, but I ultimately did the job orientation. In my case, it was worth it, and I still don't regret it. Check your school's policy first, though.

A majority of my test was SATA...maybe 60-70%. I passed in 75. Everyone is different,though.

I took the NCLEX today, too. I swear my test was 50-60% SATA at least - no joke!! Answered 75 questions and got the good pop-up :)

Thanks for the responses!

Will I hear anything before the ATT from New York? Will they send me a letter or email saying my app initial app has been approved?

I applied to the NY BON 2-3 weeks ago (mid-April). I graduate at the end of May from a school out of state. Does NY send a letter or email to let you know if the initial application for licensure has been approved...or at least received? Or will I have to wait until I graduate to simply receive the ATT? I really just want to know if NY has received my initial application for licensure and if it has been processed....

In ny, you do not have to report abuse OUTSIDE of work. Doesn't mean you shouldn't, though, of course. I just completed their child abuse course for licensure and was surprised to learn this.

As a night shift aide, and based on the number of patients you've stated, I have no idea why your aides seem to have the time to sit around. Sorry you have to deal with this :/

Wow! I was not expecting so many responses! Thank you! I am no longer going crazy. Haha

I feel like this is a silly question, but it is a topic that recently came up in class (I am just about to finish nursing school), and it is driving me off-the-wall CRAZY! We all know that our ABCs are paramount to our practice as healthcare professionals. My instructor, who is a wonderful, very knowledgable ICU/recovery room nurse, recently insisted, in a nutshell, that the ABCs come before establishing the level of consciousness. Now, as an EMT, I have always been trained to think that LOC comes before ABCs in major part because this can help dictate the airway adjunct. Are they semi-conscious? Well, then, they likely have a gag reflex, so drop an NPA. Are they unconscious? Drop an OPA. That sort of thing....And of course, if they are unconscious, we may very well not have any breathing or circulation, and we need to initiate CPR. In real life, healthcare professionals can multitask, and we are not sitting there going, "OK - I just evaluated his airway. Now, let me assess his breathing and circulation. Hmm..." In other words, we make several assessments at once regarding LOC, ABCs, what have you. So, why is this whole thing driving me crazy??? Well, in addition to not feeling like a dummy, I'd like to one day become a Certified ER nurse. And I suppose the NCLEX is important, too ;p I feel as though my teacher has a slightly different perspective as an ICU nurse, which is why she states this is the correct answer. She, after all, usually receives the patient with an airway in place, etc. Feedback would be great! Thanks so much!!