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akulahawkRN ADN, RN, EMT-P

Emergency Department

Wee bit about me!

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akulahawkRN has 5 years experience as a ADN, RN, EMT-P and specializes in Emergency Department.

I have approximately 20 years experience doing patient care in some form or another, finding along the way that Nursing has been calling me about 10 of those years. I consider myself fortunate that I am now able to answer that call. I hold a Bachelor's in Sports Medicine and now proudly hold an ASN. I feel lucky to have found a position in the ED, a position I have long desired and I enjoy every minute of it.


Got a license to learn! 

Had around 3k "likes" before the new format...

akulahawkRN's Latest Activity

  1. akulahawkRN

    Gloves at all times?

    I rarely use gloves for a med pass. Most of the meds I give will go directly from packaging to a medicine cup or into an IV line. If you wash in and wash out (or at least foam in/out), your hands will be sufficiently clean. I will use gloves if I'm expecting to deal with body fluids. I'll double-glove when cleaning patients as it's difficult to put new gloves on when I've got sweaty hands... the first set of gloves generally stay dry so putting new gloves over them is relatively easy. Personally I get the feeling that "Miss Perfect Nurse" could be a closet germophobe. It's not necessarily a bad thing, just that it could result in some behaviors that may not be welcome. When I first started doing patient care stuff, I was told that I must wear gloves during all patient contact. As I learned more and more, the amount of time I wear gloves during patient contact has decreased quite a bit. I rarely wear gloves, but when I do, you can be sure that the wearing of gloves is a good idea.
  2. akulahawkRN

    Scheduled and PRN Doses

    Restlessness usually isn't a pain issue. It's more of a psych issue or it can be a reaction to a medication. It can be an expression of agitation. As for following a PRN dose after a scheduled dose, give the scheduled dose sufficient time to take effect before you administer a PRN. The reason for the PRN is to allow you to administer a medication in addition to what's scheduled. You should also be judicious in administering PRNs and wait for those doses to become effective before you administer additional PRN meds for the same reason. For instance, I'll look at recent NSAID or acetaminophen-containing doses before administering a PRN for pain if the ordered meds contain an NSAID or acetaminophen. How much and when was "it" given previously? If my patient is complaining of moderate to severe pain, I'm not likely to give a PRN pain med for "mild pain" before advancing to a "moderate to severe" pain med. If the order is for 1-2 doses as a PRN, I'll give a first dose, reassess for effectiveness and give 2nd dose if needed and consider it as following a single PRN order, of course documenting 2nd dose as such.
  3. akulahawkRN

    Gender Separation and Nursing for American Muslim Man

    As a male, I routinely perform tasks/procedures on females, even those areas one usually considers "intimate." This does NOT mean that I simply go ahead and do that stuff without concern for my patient. If the patient is able to answer, I will always tell the patient what needs to be done, and I let them decide if they prefer a female nurse or not. Unless there's significant urgency in the matter, I will always have a female in the room with me, preferably another RN, but any staff will do. I do not take offense if a patient prefers a female for that stuff, I just let them know that occasionally it may take a while for a female nurse to be available as they've got their own assignments. Because males may also request another male for certain procedures, I will also make myself available as much as possible for those occasions when a male makes a similar request of their female nurse. Generally speaking, if it's been medically ordered or your nursing judgement deems that something is necessary (and within nursing to do autonomously) then it's OK to do in the medical environment. If the patient prefers that someone else do the procedure, try to make that happen.
  4. Be ever so thankful that your area practices this. Other places aren't so eager to follow that and are very resistant to change. I'd be quite surprised if some of this resistance has to do with lawsuit avoidance because "withholding" oxygen in the normoxic patient isn't exactly considered standard practice. At least not yet.
  5. Lack of oxygen in hypoxic patients is going to be "inherently more lethal" but in the normoxic patient, the patient isn't hypoxic. You don't have flood MI patients with oxygen, you just have to keep their SpO2 levels between 94% and 99%. People that do hyperbaric medicine have known for a very long time that oxygen can be quite toxic to the body. That being said, hyperbaric oxygen can also be beneficial but those situations are very specific. Mixed gas divers are probably about the most attuned to oxygen levels as nearly anyone I've ever met... but I digress. What I've seen over the years is that it appears that simply keeping patients between 94% and 99% is pretty much the Goldilocks zone. Do what you must to achieve that. Ventilation is yet a different, but related beast.
  6. akulahawkRN

    ARC/SCC ADN FALL 2019

    That means you have been accepted, and your first Semester will be in Spring 2020. The "provisional" part means you still have stuff to do and there are deadlines associated with those things. Pay very close attention to that stuff and make sure you meet all those deadlines. That stuff is very much a part of your selection process and you are being looked at as of right now for your ability to follow directions. Your entry to the program will not be "finalized" until you've completed all the requirements that they want you to do and this includes the first days of school because they will go over all the paperwork and such to finalize entry at that time. Basically the first couple of days are "housekeeping" stuff to finalize your enrollment in the program. As long as you do your part, congratulations! The SCC program is very good and you'll need to be a bit flexible about your actual on-campus classrooms as they tore down Mohr Hall and are replacing it. Mohr Hall housed much of the healthcare programs, including LVN and RN.
  7. The idea that supplemental oxygen can cause damage in normoxic patients has been around for at least 5, probably more like 10 years or more. I very much agree that it is very difficult to change practices when MONA has been beaten into Nursing and EMS providers for decades. Hyperoxia is also known to cause damage in stroke patients too. At my first job in an ED, I routinely did NOT apply oxygen to normoxic patients precisely because I knew that hyperoxia causes more damage and in normoxic patients, the patient's body is receiving all the oxygen it really needs. IMHO, about the only time one should be considering hyperoxygenating normoxic patients is in those situations where the patient could benefit from being in a hyperbaric chamber. Even then you have to be very wary about oxygen as it can become quite toxic when under pressure.
  8. 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.
  9. akulahawkRN

    Working during school

    I have a favorite saying: "Everyone wipes the butt!!!" This is because in healthcare, it's pretty much true. Once you're doing direct patient care, at some point you're going to be the one that has to wipe the butt. There's truly nothing wrong with it as this gives you an excellent opportunity to do a skin check. I've seen everyone from the lab tech to the physician wipe the butt. Now then, in order to keep the lab techs from going completely batty about this, if there's a butt-wiping that needs to be done and they were the ones that discovered it, I'll happily do it, and if they're willing to help a little bit by helping position the patient, that's better! While you're going to nursing school, you're not going to escape this... However, you might be able to cross-train over to a different position at your work. Be wary about that as it may put you at the bottom of any seniority in that new position. You might not get a work schedule that is compatible with school. If you're currently working as a CNA and you've got a schedule that does work or will work around your school schedule (and your clinicals too), you may want to keep that and bear with it for a while. The other good part about working as a CNA is that you'll be far better at doing the very basic nursing tasks than most of your classmates so you'll be able to focus on learning the classroom stuff. Toward the end of the program, that "advantage" will diminish toward nil but you'll have to keep yourself a little bit "in-check" at work as your knowledge and skills will have progressed well beyond that of any CNA, though you won't have license to exceed that at work. Tough spot to be in... What I would recommend as far as a work-schedule goes is to look at the general schedule for the school over the past few semesters for all portions and look at what they have generally required and then look at a work schedule that will accommodate that with minimal disruptions to work. Then look for a work schedule that may allow you to study while at work. This, if it's possible, will help you increase your available time at home to do the tasks of life. When I went to school, I had to work full-time and went to school full-time. Fortunately for me, I was allowed to study and do much of my "homework" while at work. Generally my school schedule was Mon-Thurs 8-2pm. My work schedule was Thurs-Mon 3p-11p. This meant that there were only a couple days that actually overlapped. On those days, I'd get most of my homework done at work and I might have to do another 1-2 hours at home to finish up. That usually meant surviving (and I mean that) on about 6 hours of sleep many nights. It was exhausting and I'm sure I got burnt out more than a couple times but when you know there's an end-date to the madness, you know it's possible to get through, take a good break and get recharged. Nursing school isn't really all that hard, it's just that there's so much thrown at you... Yes, I'm also a Paramedic and P-school was pretty much the same way. Huge volume of info in a short period of time, but not that difficult otherwise. Neither program was truly difficult academically. I do also have a BS degree in Sports Med. That was a very difficult and rigorous program. I've had nothing that hard since...
  10. 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.
  11. akulahawkRN

    Does nursing school matter?

    These things are red flags that the program is in trouble. Serious trouble. If this is a private, for profit program, this should be even more troubling. While you may be considering going to an out of state location for a job, you should worry that your prospective program may not be considered a qualified program for you to get a license in that other state even if they remain open long enough for you to get the BSN they offer. Remember that one of the things you can put on your Resume regarding your education is the rotations you completed. If you have none listed, your future employers have little to weigh your Resume with, and if they do a little research about your program and find it's wanting... your application could very likely be tossed out in favor of a more rounded/experienced/appropriate candidate. Just something to consider... and do so very carefully.
  12. akulahawkRN

    Omnicell vs Pyxis

    Where I'm at, we use Omnicell. In the past I have used the Pyxis and also simple tool-chest type carts (100% manual) with paper logs for controlled substances. Which one do I prefer? None of them. I've even used open cabinets and lock boxes for controlled stuff. Seriously, I don't care what I've got as long as I can get whatever I need when I need it. My only issue with automated systems is that pharmacy may have to "approve" certain meds, therefore if I need to administer something quickly, I have to either wait for pharmacy to approve the med or try to override the item. With manual systems, you don't have to wait... but you must also be VERY sure what you've pulled. So... I just get trained on how to use the system I have to use and then I use it. The only thing I like about automated systems is not having to count controlled substances at every shift change. If the system won't dispense it, you just enter a "current" bin level and then pull what's needed. The next person behind you enters a current bin level and that's when any discrepancies can be found. The only caveat is that you have to be very accurate in counting or you could inadvertently trigger a witnessed recount.
  13. akulahawkRN

    NCLEX RN today at 75 questions

    At 75 questions, you either did very well or very poorly. Most of the time I do not suggest trying to do the "PVT" as it very easily could result in you losing $200. It's better to wait 48 hours and do the quick results if it's available in your state. Otherwise look at your state's license system as sometimes they post your license within a couple days. My license posted 35 hours after I submitted the test for scoring. I'm in California and we don't have quick results. My PVT results used an old system that they no longer have so it's much riskier to try. Best to wait.
  14. akulahawkRN

    Just took Nclex and Did 181q

    Congratulations! Now you get to start really learning. You've now earned a license to learn and keep learning!
  15. Whether or not you should go ahead and pursue the BSN really depends upon whether or not you want to move into an area of nursing that requires a Masters Degree or higher. While I am "just" an ADN, I have a Bachelors. It's going to be relatively difficult for me to transition to a Nursing Masters without formally getting a BSN. The fact that I have a Bachelors just means that I don't (or shouldn't) have to repeat a lot of the upper division GE but that's about the only stuff I get to "skip" as I still would need certain nursing courses that an MSN program would require. The good news, if any, is that once you're an RN, the courses to upgrade will be academic. That just means more reading and writing and probably a lot more writing than you're used to if the only education you've attained to this point is an Associates Degree. If you've already earned a Bachelors in another field, it shouldn't be much worse than anything you've done so far. In short, it's all up to you. Of course, if you're looking at getting out of nursing, why not look at a Bachelors in something else that interests you? Just don't toss the RN... it earns you money and could be a good backup until you get a job that pays you at least as well in another field. I worked as a security guard (full time) through nursing school because that allowed me to pay the bills and I could study while at work. It was a means to get me to where I am now. Down the road might I leave nursing? Sure but I don't see that happening any time soon, if ever, at this point.
  16. akulahawkRN

    Just took Nclex and Did 181q

    Well, if you did 181 questions, then you've done 181 questions. All you can divine from doing 181 questions is that it took the computer 181 questions to determine whether you passed or failed. Same goes if you'd done 75 or 264. Once you hit 265, a different rule determines pass/fail... The hardest thing about these questions is not reading too much into them. There are no trick questions. They may be difficult, but they'll be straightforward.
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