EmilyCCRN

Anti-platelet therapy depends on several things, such as whether the patient received a bare metal or drug-eluting stent. Generally speaking, all stented patients should take ASA "indefinitely" and Plavix/Effient for at least 30 days (bare metal) or 6-12 months (DES). But dual anti-platelet therapy (DAPT) is the standard recommendation. They should be on ASA and a thienopyridine together, not one or the other (unless they have an allergy, etc.).

I was called in at 0300 one night for an anterior STEMI. As we were wheeling (i.e. running) the pt to the cath lab, he starts going off about how "I have insurance! Don't kill me because you don't think I can pay for this stuff. I know you guys don't try to save people if they can't pay! My insurance card is in my wallet! Let me get my wallet!" (he starts trying to sit up, pulling on his multiple IV lines, O2 tubing, etc. as we're flying down the hall). After repeatedy (and politely) trying to explain to the pt not to worry about money and that our only concern was taking care of him, I guess I got frustrated when he wouldn't shut up about his stupid insurance, not to mention the insulting comments about how we kill people who can't pay. Finally I said, "I don't give a sh!t about your insurance. We are trying to save your life here!" Not my finest moment, but it apparently worked. He shut up about his insurance after that and let us take care of him. He walked out the door 2 days later, hopefully with his insurance appropriately billed.

EKG results in 45 minutes? No way! An EKG needs to be interpreted immediately to rule out STEMI, new onset LBBB, etc. In 45 minutes the patient can lose a lot of muscle...and/or DIE...hopefully their EKG didn't show v-fib. And back to the original topic, our door to CT averages 16 minutes.

Holy cow! I would NOT want to be a patient in a lab where non-RNs are allowed to mix and give drugs. To answer the OP's question, no, we are not required to take the RCIS. The CCRN is a more popular choice for us, although my hospital does give incentive pay for the CCRN or RCIS to CVL RNs.

You have NO IDEA how long I've been beating my head against the wall over this issue. My "life" before nursing was in the IT realm, so the way technology-related items are handled in my facility drives me CRAZY! Believe me, if there was ANY WAY to get around this issue, I would do it...but there's not at this point in time. The answer is always that "we don't have the money to upgrade these systems". We still print out our cath lab reports because the hemodynamic monitoring system doesn't interface with Cerner. I am half-way through my MSN program specializing in nursing informatics, so my colleagues are used to me (half-jokingly) saying that I'll fix this issue someday. Wish me luck!

It sounds like the PCCN exam could be appropriate for you, then, if you have the minimum number of hours, etc. Good luck with your studies! :)

Just my , but a patient who is 6 hours post-PCI (percutaneous coronary intervention - 'PTCA' is not used very much anymore) should be pretty darn stable, especially compared to the other patients in this scenario. The patient should be on hourly groin/vital sign checks and could very well be off bedrest at this point, too. I would see patient #4 first, then 3, 2, and 1. Here is my rationale: #4 is going to wind up coding if we don't address his breathing and IV situation right away. And I'm a cardiac RN through and through - get that guy back on the monitor STAT! #3 needs a glucose check to make sure she's not tanking. She just came from ICU today, so it sounds like her sugars aren't very stable yet. #2 received her PPM for CHB, so we need to check on her for three reasons: she has a fresh surgical incision following a procedure where a major chest vein was punctured, she probably received moderate sedation during the PPM insertion so her LOC should be assessed, and she received the PPM for a life-threatening dysrhythmia, so she's probably pacer-dependent. Let's make sure she isn't unconscious or bleeding out and that her pacer is still firing (which would be 'unconscious' for a different reason ). Also let's give her a quick reminder to keep her left (or right) arm immobile to prevent the lead(s) from being dislodged from her heart muscle. #1 (see above). This guy should be relatively stable since it has been six hours post-procedure.

Good answer! :) To the OP, I would recommend taking a look at the exam blueprints for the PCCN and CCRN exams to see what seems to fit your job description the best. At my facility, for example, the telemetry RNs would not fit the criteria for either exam because the higher-acuity patients are either admitted to ICU or PCU, not med-surg tele. Every hospital is different, though, so take a look at the blueprint(s) and you should find your answer. Good luck! :)

It is disheartening to read some of these comments, because aren't we ALL supposed to be caring for the acute MI patient here? The "us against them" mentality is really unfortunate and has the potential to adversely affect the outcome of the patient. WE need to get this patient's coronary opened and stop their MI, and this takes everyone, from the ED tech to the interventional cardiologist, to accomplish this feat. At my facility, the cath lab team reports to the ED and transports to the patient to the lab. For STEMIs, we are routinely paged based on EMS reports of ST-elevation in the field, so I am often in the ED as the patient rolls in, or at least within a few minutes of their arrival. The outstanding ED RNs at my facility generally have two IVs and meds given (ASA, NTG, metoprolol, etc.) before I get there (if I'm not there before the patient rolls in), so often the first thing I do is mark the pedal pulses and prep the groin. I will also assist the RNs with medications and IV access if needed. Like I said, we are all one team. I don't consider certain jobs to be "ED" and others "Cath Lab". While I agree that IV access is a huge priority, the MI cannot be stopped - i.e. the coronary ballooned and stented - without a groin prep! So in my book, prepping the groin/wrist (if a radial approach will be used) is pretty darn important! Care and interventions should always be prioritized, but clipping the groin should be somewhere on the list. We're not prepping the groin simply to prepare the patient for bikini season here! And regarding the comments that the Cath Lab just sits around until the patient arrives, let me tell you what I need to do before I can receive a patient in my lab (assuming it's an after-hours case). 1. Perform QCs on the ABG machine, glucometer, Hemochron (ACT machine), AVOX (for right heart caths - O2 sat measurements), the code cart/defibrillator. (5 minutes) 2. Turn on three different computers, each requiring two separate logins. (2 minutes) 3. Log into a different program on each machine. Cerner on the mobile workstation, the angiography viewing portal on the 2nd computer, and the hemodynamic monitoring program on the cath lab terminal. (3 minutes) 4. Turn on the x-ray to let it warm up (takes about 2 minutes of standing there in order to accomplish this part). 5. Set up the ACIST, which is the iodinated contrast delivery system for shooting coronaries, LVs, etc. (3 minutes) 6. Ensure that the exam has been ordered on the Cerner computer, then look patient up on hemodynamic system and open the case. (hopefully 7. Ensure that the exam has transferred to the x-ray system and open the case there. (hopefully 8. Pull supplies for procedure (sterile table setup, catheters, sheath(s), IABP setup, transvenous pacing catheter/equipment, table fluids - heparinized saline and lidocaine, etc.) so they will be ready for my scrub RN or RTR to open. (2 minutes) 9. Manually add patient to Pyxis (first, last name, DOB, 11-digit ID number) in order to pull meds (starting with the heparin and lidocaine). (30 seconds) 10. Grab linens from supply room for cath lab table (1 minute) There are more things that need to be done before the patient can be received, but the terrific RTRs in my lab accomplish these tasks as they are specific to their scope of practice. (In my state, RNs cannot fluoro, so I don't touch the x-ray past letting it warm up.) I only list these things as a reminder that ALL OF US are busy and are scrambling to meet that door-to-balloon time. Based on what I'm reading here, I can see that I'm really lucky at my hospital because Cath Lab and ED get along really well. I have a great deal of respect for the ED RNs and they always treat us with respect, as well. Tolerance and undestanding. These two things go a long way!

I was hired onto a horrible 46-bed combined ICU stepdown/ medical telemetry floor right out of school. We took five patients each and had no CNA's, so we were responsible for all of our own vitals, etc. There weren't enough BP/SP02 machines to go around, so you had to rush out of report to try to "claim" your machine in order to do your vitals. There were no bedside monitors (and the tele packs did not have EKG screens), so you just PRAYED that the monitor tech was paying attention and would notify you if your patient, oh I don't know, went into V-FIB or something. Anyway, I took the job because it was offered to me six weeks before I graduated, and it was busy and offered tons of experience. ("Trial by fire" experience, but I digress...) Oh, and I drove an hour each way. After four months I "woke up" and realized that THIS.WAS.STUPID. There was a great hospital less than a mile from my house. I applied, interviewed, and was offered a critical care position on the spot. And I've been with them ever since. :)

You may need to contact the BON to find out whether your hours will count toward your certificate. A lot of administrative-type jobs/tasks can count toward licensure, but the BON should be able to tell you for sure. :)

My hospital actually does a decent job celebrating Nurses Week. Last year we had a different event every day, including having our CNO and other administrators make us ice cream sundaes and Italian sodas. They also had contests (like "match the baby photo to the correct CNM") and there were a bunch of prizes. They also gave us goodie bags. Our Nurses Week starts on the 6th this year and goes through the weekend, so I'm not sure what's planned yet. I hope they're doing Italian sodas again, though. :)

When I started nursing school in 2004, Washington County did my fingerprint card for me. I think it was under $10. I would check with your local county government to see how to do it. Good luck!

What about something like "acupuncture versus narcotics used for pain control in individuals with chronic back pain"? Good luck! :)

I think that certain types of volunteer work can also count toward your hours, and could possibly help your job prospects. Good luck!

...and it can be reversed with protamine, unlike LMW heparin (i.e. Lovenox). :)

5,000 units of unfractionated heparin given IV push is actually a pretty standard dose given to acute MI patients before starting a IIb-IIIa inhibitor (like Integrilin). The standard dose for anticoagulation with unfractionated heparin during PCI is 60 units/kg, so it's not uncommon for me to give 7,000 units of heparin IV push (or more) in the Cath Lab. As others have said, SQ has a slower rate of absorption than IV. The route matters!

Did I mention that I love this thread? Here are more "gems" I have personally encountered: ...when you can't pee, don't wait THREE days before telling anyone about it, or else you might wind up in the ER where they insert a foley and drain 4.5 LITERS of urine from your grossly-distended bladder. If you do decide to do this, you might wind up keeping that foley for quite a while. ...when you're in a semi-private telemetry room and the patient in the next bed goes into v-fib arrest and the code team rushes in to code the guy, don't scream "Where's my grape juice? You said you would bring me more grape juice!" at the nurses. They're a tad too busy at the moment to address your "urgent" request. ...don't *repeatedly* insist on defecating in the trash can in your hospital room instead of in the toilet (that's actually closer to your bed than garbage can!). [The worst part of this story was that the patient's husband was "helping" her to use the trash can as she was weak and wasn't supposed to be getting out of bed without a nurse, anyway. I repeatedly told the patient and her husband to CALL FOR HELP if she needed to get up, and that the trash can was NOT a commode! I was a brand new grad RN when this happened. Never, in my wildest dreams, did I think that I would ever have to explain that a toilet is the "preferred" place to deposit one's BM!]

I get 205 hours per year. After five years of employment it goes up by a few hours (I think it goes up to 220-something). Last I heard, my hospital provided the most PLH (paid leave hours) in my metropolitan area.

I would imagine that it's just like it would be in any other profession. Unless you signed a contract, there's no legal reason you couldn't turn it down, but you run the risk of burning some bridges by accepting the job and then backing out at a later date. And believe me, nursing is a pretty small world. Today's hiring manager at ABC Hospital could easily be tomorrow's DON at XYZ Healthcare System. You need to do what's right for you, but if a person commits to something, they should follow through with it. And if you do decide to turn it down, do so very carefully, with as much respect and tact as you can muster. Good luck!

EXACTLY what I was thinking! Sounds like "school envy" to me! With respect to WGU, I don't know much about the nursing program (except that it's obviously accredited--DUH!), but I know someone who is attending this university for a (second) bachelor's degree in IT. He has shown me some of the class materials, and I can tell you that it is NOT a "diploma mill", unless this term means "extremely complex course requirements, high standards, and tons of proctored exams". (Maybe I just don't know the definition of "diploma mill." ) The class that this person told me about that really stood out to me was an "integrated" science class, that covered more areas of study than I have ever seen on one (proctored) exam. There were questions about genetics, biology, physics, chemistry, geology, and astronomy..and possibly more...all on one test. The syllabus for this class (for ONE class!) was over 125 pages long. I have two college degrees, two certifications (CCRN and CMC), and am halfway through my MSN, and I have NEVER seen a syllabus or heard of a test like that before! TIME Magazine called WGU "the best university you've never heard of". I think I'll take their opinion over that of a person with obvious "school envy".

I drove about 45 minutes each way when I was in nursing school, and I would have driven 2 hours each way if that's what it took. :) My work commute is now 10 blocks (yippee!) and my school (MSN program) commute is zero blocks...I'm in an online program. Good luck to you!

I agree that only "highly-trained" personnel should be pulling sheaths, and cath lab techs (radiology techs and UAPs such as CVTs) generally have extensive experience in this arena. It is important to note, however, that an RN must be on hand during the sheath pull to monitor for complications such as vasovagal reactions. If I'm the only RN around, I am NOT the one pulling the sheath. My tech will pull while I monitor the patient. If I have a second (critical care/cath lab) RN, I get to pull the sheath. I am quite experienced at pulling sheaths, which are mostly CFA (common femoral artery) access sites. My cath lab performs both cardiac and peripheral interventions, so it's not uncommon to see antegrade CFA access. These are a little trickier to pull, IMO. We do a ton of radial approaches here, but the MD always pulls these (whether diagnostic or interventional) at the end of the case, as we use a form of mechanical compression for radial access sites. We rarely use a brachial approach anymore, but I have pulled these sheaths, as well. If a procedure was diagnostic only, heparin should not have been given during the case, which means that the sheath can be pulled right away. If anticoagulants were given and the MD is unable to use a closure device (Starcose, Perclose, Angio-Seal, Mynx, etc.), we generally wait until the ACT is less than 180 before pulling (unless Angiomax was used--it's a direct thrombin inhibitor that cannot be measured by ACT--the protocol is to pull the sheath 2 hours after Angiomax was dc'd). Cath Lab digest is a free periodical that is an excellent resource for arterial sheath management, among other things cath lab-related. Oh, and not that you asked, but I must throw in my regarding the pulling of arterial and venous sheaths. ALWAYS pull the arterial sheath first and NEVER pull them at the same time!!!!!

One of my colleagues calls Valium "val-ee-oom". It drives me crazy!

I work in a specialty area where there are no aides. We (RN's) provide all the care, from physical assessments to airway management to medication titration to hemodynamic monitoring. And when the patient starts puking while supine on the cath lab table, you can guess who's there to catch it!