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akulahawkRN ADN, RN, EMT-P

Emergency Department RN

Wee bit about me!


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  1. akulahawkRN

    Join the ER or go to another specialty?

    The ED is very "squirrel." Basically all we do is triage. We very rarely get to do definitive care. All the care we give is basically done "now" and not on a given schedule. We constantly are reprioritizing the care. Sometimes we have to "hold" patients in the ED that are supposed to be admitted to the hospital but that's not an optimal thing because ED nurses aren't Med/Surg or Tele nurses. What do I get to do every shift? Well, I show up, find out what my assignment is and then I go do that. I have absolutely no idea what I'm getting into until I get there. And I have to be ready for it. My last shift I basically had 4 patients the entire shift. At the end of it, only one of those patients was the same one that I started with... the other 3 rooms each changed patients at least 2 times each. That meant that I saw at least 7 patients that shift... I could have seen more than that if none of my patients didn't have to be held in the ED because they were waiting for a bed somewhere. I've had the same patient several times. I have had patients suddenly change acuity. I have had patients all from the same family. I've had patients that come in because they basically have a hangnail and I've had patients that pretty much don't come in unless they're dying... and they are. The ED is both high-performance and very street. The only thing that gets more chaotic is the street and I've done that too. How did I choose the ED as my specialty? Well, I looked at all the various jobs in the hospital that nurses do and the one that fit my personality best was the ED. While I would do well in other areas, most of them would just be rather boring for me, even though I'd be busy at times, simply because of the routine.
  2. akulahawkRN

    Any facilities actually using an AccuVein? Any thoughts?

    I have used those vein finders before. What I've found is that they're helpful at certain times in locating veins but most of the time I really don't need to use it. The vast majority of the time I use it as basically a scanning device to clue me into where a vein might be. Once I know that, most of the time I've been able to get the line without much difficulty. I've only actually needed it to guide me in starting a line a couple times. Good piece of equipment when used correctly, when it's not, it's an expensive toy.
  3. akulahawkRN

    OMGosh! Did I really lose all my "likes"?

    That's what's odd. Some people lost all, some lost most... Anyway, we get to start fresh!
  4. akulahawkRN

    OMGosh! Did I really lose all my "likes"?

    What's odd is that I also have one random "like" from the previous iteration that carried forward. Mine is from 2014. The "like" system was supposed to be cleared out so we all start "fresh" (at least as I understand it) and it somehow kept some. Odd behavior. While I also had thousands of "likes" I thought of them more as a curiosity than anything else. Sure, it was nice to see the notification that some of my posts had been "liked" but I never cared that much if I logged in and no new "likes" had happened.
  5. akulahawkRN

    Investigating Cannabinoid Hyperemesis Syndrome

    I first saw this about 3 years ago and one of the more interesting things is that the typical antiemetics only work for a little while. Since then, any time that I have a patient whose complaint includes nausea and vomiting, especially for several days, I ask about marijuana use. Even if I get a "no" answer to their use of marijuana, I do a quick teaching about marijuana and this syndrome, basically to the effect that sometimes marijuana use can have a paradoxical effect of causing nausea/vomiting which is what it usually stops and the only truly effective (and lasting) treatment for this is to stop using marijuana. I'm not trying to keep a patient from using marijuana to stop the vomiting, rather to educate that marijuana use doesn't always relieve the problem and therefore to be careful about using it.
  6. akulahawkRN

    ECG interpretation

    Good catch! Though I must say that I'm not going to use my calipers on my screen... might cause some, shall we say, damage to it. I would be more confident of it being a respiratory pause variant if we could see a longer strip to catch another pause and see if it coincides with a respiratory cycle.
  7. akulahawkRN

    ECG interpretation

    To me, it looks like a Sinus Brady with Sinus pause. Nothing complicated about it. This isn't any type II block as there's not a P wave without a QRS complex. All we're seeing is three normal beats, a pause and then two more normal beats after the pause. Unless the bradycardia is symptomatic, you don't need to treat it. Just doing a quick guesstimation, the heart rate is just under 60, however given the limited info of just a 6 second strip, the effective rate may actually be closer to 50. A sinus pause can be a very normal variant of normal sinus. What's interesting with this is the pause exactly marches out. If you measure from where the "missing" beat should be and where it picks back up again, there's no compensation for the missing beat. The SA node picks back up right on time/schedule.
  8. akulahawkRN

    Passed NCLEX in 75 Questions: My Experience

    Greetings! I also passed in 75 questions and all I used for NCLEX questions was the NCLEX 4000 program and Saunders Q&A. My program also used the ATI stuff as well. At this point I don't recall my blend of questions but they were quite difficult and if this was scored "traditionally" I'm sure I would have failed. Fortunately this doesn't score traditionally and tries to find your ability level instead and uses that to determine pass/fail. Yes, I nearly hurled at the end of the exam. Here's the thing: I met up with a classmate at the testing center and we both finished in 75, both of us also got our licenses numbers about 35 hours after the exam was submitted for scoring. The PVT does work but it depends upon 2 things to be reliable: the 2nd scoring must be done and the pass/fail result must be communicated to the billing system. I suspect the billing system defaults to making you pay unless it sees that a "pass" flag is set, which intercepts/stops the billing process. These are two separate systems. Licensing boards will have access to the results and will be able to see if you passed or not probably before the billing system does. In my case the "old" PVT system indicated a "pass" within 30 minutes of walking out of the test center and that result held true. That old system didn't put $200 at risk like the current system does. The biggest factor for licensing speed probably has to do with how quickly your licensing board receives your completed background checks.
  9. akulahawkRN

    Nurse Practitioner vs Physician Assistant

    There are a couple of differences in education of the NP or PA. One of those is the PA has to take a couple more classes and attends more rotations. The PA is, in effect, a generalist. They can go from department to department fairly easily. Your PA that was in Ortho today could tomorrow change to Cardiology or Oncology or Surgery. They're already educated to make that switch. The NP is typically trained as more of a specialist so your FNP isn't going to be be able to switch jobs to some other area of medicine without typically having to go back to school to be certified to work in that new position. This is not to say the PA or the NP is a better provider, just that the training they receive is different. Within a given field, a PA and NP should be nearly interchangeable and should draw the same salary. The only major difference is the PA technically requires a supervising physician whereas the NP may (or may not) be legally required to have physician oversight. It's also true that the PA does have to retake the PANCE every so often while the NP only typically takes their certifying exam once.
  10. akulahawkRN

    Do Bachelor's Degrees Save Lives? - The Facts about Earning a BSN

    This issue has been around a very long time and it's not likely to stop any time soon. I have a Bachelors in an allied healthcare field and that program was far more rigorous than my nursing program in terms of pure academics. I subsequently completed Paramedic school without cracking open the book much and a few years later, nursing school (with a solid B average) by usually studying the Powerpoint lectures and opening the book when necessary. My exam grades were never lower than a B. Here's the thing: with the background I had (and if all routes were open at the time) I could have done an ADN program in 2 years, a BSN program in 2 years, an ABSN program in about 15 months, or an ELM program in about 2 years. All of those would have had approximately the same academic workload. The ABSN would still have been a 4 semester program, I would have not had my summers "off" from school. What was "missing" from the ADN that the BSN+ programs have? A community health class (would have gotten me certified as a PHN) and a "research" class. The "funny" thing about this is that my Bachelors required lots of research reading so I'm very much capable of both understanding and conducting research. What would I have wanted from a BSN would be better pharm and pathophys than I got in nursing school. I got quite a bit of pathophys in my prior program (primarily injury pathophys, fascinating subject, but I digress). From discussions I've had with some recent BSN grads near home is that I got essentially the same classroom "stuff" that the BSN program had. I'm a relative recent grad and "only" about a 1 year working nurse. During my orientation time and even now my preceptors and supervisors haven't been able to stump me much, if at all, when asking me pathophys stuff. I know the subject very well as it is and I know very well where I'm at clinically. I'm not yet at the point where my clinical skills match my academic knowledge; that point is on the horizon. Also because of my prior education, I could (relatively) easily skip BSN and go for an MSN program. While I want to do the pathophys and pharm at that level, I don't want to pursue a full-on MSN program. Not yet. I want to seriously solidify my clinical skills.
  11. akulahawkRN

    The Worst Wound I Had Ever Seen.

    I've seen some Stage 4 ulcers that were large enough to tuck a football into, with room to spare. I was lucky enough to be able to follow a patient over the course of a few months that had such a wound and I got to see it progress from a large Stage 4 to about have the diameter and 1/4 volume Stage 2, all with excellent wound care. I wasn't a nurse back then. Good lessons to remember...
  12. akulahawkRN

    We'll Have A Farting Contest If You Let Me Put An IV In You.

    Never mind that this is from 2008... this is not only a great story, it's a reminder that sometimes you just have to think outside the box, remember your dev. psych from time to time and come up with something so creative that just works, leaving everyone else wondering when you're in a pickle, what else will you pull out of your ....?
  13. akulahawkRN

    PVT IS DEAD! Don't try the "new" trick

    I suspect that the "new" PVT is just as accurate as the "old" PVT was. The big change is that the new process essentially has you submitting payment for a new exam and if your results as of the moment you submitted payment has you as "pass" it intercepts and stops the payment from processing. I would imagine that everyone that ended up paying $200 and later passed probably "failed" the exam at the first scoring and later the 2nd scoring determined they'd passed. Remember, the opposite is also very true... but if you try the PVT and you initially pass but later fail, you might not find out for a little while. I would suggest that people that want to try the new PVT wait at least 24 hours and be ready/willing/able to afford to spend $200 to take the exam again. If your State participates in the Quick Results, you'd be better off to wait the 48 hours and pay for that because that will be accurate, even though it's "unofficial". My license popped up 35 hours after I took the exam, so even if my State did participate in Quick Results, it wouldn't have mattered...
  14. akulahawkRN

    PVT IS DEAD! Don't try the "new" trick

    The PVT never was 100% accurate right away. This is because your exams are scored twice. The 2nd time is the definitive scoring and probably takes place about 24 hours after you take the exam. Unfortunately they won't tell you when that's happened, and the PVT will be 100% accurate after that. The fact that some people have had their PVT results flip from one status to another indicates that the 2nd scoring changed the test results from pass to fail. About the only time I'd really trust it would be if it shut off at the minimum.
  15. akulahawkRN

    PVT IS DEAD! Don't try the "new" trick

    The old PVT is dead. The new one risks $200 right now if you have failed. The up side is that if you pass, it won't complete the payment on the card.