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!!

Well, one easy way to think of it is to remember that the proteins in your blood require a certain pH. Messing up that pH can alter the shape of proteins, rendering them less effective or simply non-functional.

Thank you for your comments. Several of your comments reinforce that I'm not crazy! Lol. To answer a few of the above question, we do not have a physician medical director at the company. We also cannot monitor pulse ox in the state of CA as an EMT. And I used the hyperventilating patient with the spasms asan example why you wouldn't go straight to oxygen, since the problem was deal with CO2. Thanks,again!

Hello, all.I'm currently a nursing student working as an EMT for a BLS company. Several of my coworkers like to offer our patients oxygen for "comfort reasons." Most often, they will note a patient to be anxious on a non-emergency transport, and ask, "Would you like some oxygen?" despite having no other real reason to offer the O2.I have never felt this to be a reasonable justification for oxygen on a transport (and, of course, I am speaking in general terms, as each patient is different).I was surprised to learn that my manager supports this practice. I feel that offering 2 liters by nasal cannula is not really going to have any ill effect, as it only bumps up room oxygen by roughly 4 percent. But what really surprised me (and what prompted this post) was that my manager thought I should have offered a psych patient who was highly anxious and hyperventilating some oxygen "for comfort." Interestingly enough, in that same shift, I treated a separate patient whose hyperventilation due to anxiety was so bad that he was experiencing carpal pedal spasms. I could perhaps see oxygen justified only if the overall breathing rate could be slowed, but obviously, figuring out how to calm the patient is key.What are your thoughts on this? I am asking nurses this because i also have run into similar situations in clinical, and I see this mentality occasionally at other medical facilities.Thanks in advance!

I would definitely put into consideration the facilities you would be doing clinicals at as an important factor, and how much clinical time and help you'd get both in the classroom and at the sites. Our program also does a 4th semester preceptorship that not all programs have.

I'd have a hard time believing that you would regret LMC. As much as I want to pull my hair out sometimes, I wouldn't choose any other ADN program. If you'd like specifics, feel free to PM me :)

Well, I hope you end up having the same luck I had last year! I was alternate #15, and I am now nearly 1/2 done with LMC's program. Woot woot!! I believe they may be waiting to announce the results because they need to know their budget first, as this will definitely influence the number of students they can accept. Good luck!!

I think that is some reassuring advice, ambgirl2nurse, and it is an excellent point. In retrospect, I do wish I had done that - just to be absolutely safe, since I did get that "iffy" feeling, and you certainly are right in that it does no harm to the patient. I certainly hope that as I become more experienced, these decisions become easier to make! Thanks for your input.

GrnTea -This was my partner's rationale, as well. As a new EMT, I cannot help but highly scrutizine my actions just because I want to make sure I am delivering the best care I can, so I appreciate your input. Cayenne06 -I was pretty surprised to learn that the pulse ox was not in our scope of practice back when I was getting my certification. I definitely encounter nurses on a regular basis that are surprised to learn that we cannot obtain it, too. I even once had a nurse scold me for not obtaining a pulse ox at a private residence.

I thank you all for your excellent input! Contacting medical control definitely came across my mind. Because my partner, who is a senior employee felt it was better to return to the SNF, and once again, because the dialysis nurses seemed unconcerned, we went the route we did. And of course, I am now evaluating this decision, especially as I am new to the field. And as several of you have already stated, obtaining a pulse ox is not in the EMT-B's scope of practice - which I completely hate! A pulse ox would have definitely been a helpful tool in this situation.....

Hello, all - I am a nursing student working as a new EMT, and I ran into a difficult situation on the job recently that had me thinking, and I would love your input. My partner and I were on a call for a typical interfacilty transport (dialysis back to SNF). When we arrived on scene, I was surprised to find that my patient was in mild to moderate respiratory distress. The dialysis nursing staff stated that she had been wheezing all morning, and that they did not feel there was an acute issue. I honestly wasn't sure if I trusted the staff's opinion, as her respiratory rate was fluctuating between 18 and 26, she was speaking 3-4 word sentences, she appeared somewhat labored, and the wheezing was audible without auscultation. As a result, I began to consider whether or not this call warranted an ER visit, and I automatically offered my patient oxygen. However, she refused the oxygen, stating that she felt the nasal cannula was uncomfortable. I continued to interview my patient regarding her symptoms, and she kept saying, "I feel fine. I want to go home," even when I asked if she wanted to see a doctor. For me, this patient was alert and oriented x2 and showed some signs of confusion, which I was told by the dialysis nursing staff to be normal for her. I struggled to decide if my patient was of sound mind to refuse treatment. On one hand, the dialysis nursing staff did not seem concerned and the patient was refusing treatment, but on the other hand, I felt that my patient needed treatment. Because the SNF was less than 15 minutes away, we decided to transport the patient back, and allow the staff that knew her to make the call. In the back of the ambulance, I noticed no change in mental status, but I did note that her respiratory rate would increase to about 30 for one minute after coughing. Turns out my patient was on Zithromax for PNA, but the receiving RN knew little else about her, as she had just returned from vacation. So, my questions are: Did my patient have the right to refuse treatment given her history of confusion (and possibility for confusion related to SOB)? Do you think I was jumping the gun to consider switching this to an ER call? If she was sound of mind, what are ways you would recommend to document this? Thanks!!