lapappey

Beth Israel Deaconess has a good reputation for treating their nurses well. They're also a fantastic hospital. Mass General is a wonderful hospital, medically speaking, but not as well paid as certain others; I have been told that the hospital quite seriously tells it's nurses that "the pay cut you'll take is worth having MGH on your resume." Also, the physical plant of certain parts of MGH leave much to be desired. Brigham and Women's is physically nicer than MGH. It's also a union hospital. They are much better paid than MGH, another member of Partners, but you'll have to pay union dues and so forth. Tufts/New England Medical Center is also union, and is smaller, it is seperated into the Floating Hospital for Children and the adult hospital. Boston Medical Center provides a lot of free care and probably works with a more disadvantaged population than the others. It also recieves A LOT of the major trauma. Children's is a very good pediatric hospital (again medically speaking). I am not very familiar with working conditions for nurses...

Acute Pancreatitis: I GET SMASHED I - idiopathic G - gallstone E - EtOH T - trauma S - steroids M - mumps (paramyxovirus) and other viruses (EBV, CMV) A - autoimmune S - scorpion sting / snake bite H - hypercalcemia, hyperlipidemia and hypothermia E - ERCP D - drugs, duodenal ulcers

Belize from Angels in America ... yes, it's a play, but it was on TV (HBO) ... so I guess it counts :chuckle . Doctor: Nurses are supposed to be in white! Belize: Doctors are supposed to be in bed in Westchester! :rotfl:

PACU's will probably like acute care experience, which can be a sort of catch-22, since most acute care nursing assistant jobs like acute care experience ... however, it may not be a requirement. In my PACU, PCA's are responsible for 12-lead EKG's (fairly easy to learn), drawing blood (takes some time to become proficient), attaching patients to monitors (not rocket science), taking out IV's and arterial lines, and doing a variety of other tests. You may be expected to transport patients on a stretcher up to the nursing units, with an RN if they are sicker. Most of this stuff can be picked up on the job, or the hospital in question may have formal training availible. Best of luck to you. If you have any more questions feel free to post or send a private message. As far as a pediatric unit goes I'm not really sure what PCT duties entail. Probably includes blood drawing and kids can be very tricky to stick.

Our PACU (large teaching hospital) has a few new grads who worked as PCT's here beforehand. Other than that, most RN's have med/surg if not SICU experience beforehand. If you're really interested in PACU nursing and still in school I would suggest going the route of getting a PCT job. You'll get to do and see a lot.

Ratios are nice, but some of these particular ones seem like oh so much pie in the sky. 1:2 in my PACU? I'd love it. But do we have it? No sir. But wouldn't it be nice? And what does: mean for Surgical Techs in Michigan???

Well, without seeing it, I'm not sure that quoting from a research study qualifies as "bashing." I know that there is research out there that says that CRNAs are just as safe as MDs and also that CRNAs tend to have better pt satisfaction ... what exactly is the study that they are referring to? I assume that it says that CRNAs aren't as safe as MD's. Is the other research just ignored? Or what?

Ideal? No. Safe? Maybe. But in these situations, you do what you have to ...

qd (night shift techs) and after a patient on isolation or if they are exposed to blood or bodily fluids ... infection control wise I'm sure we could be doing better, but typically, the pt is wheeled out of the slot (PACU) just as the next one is being wheeled in ... so in practice it's very unlikely ...

Introduce myself as working in the "NEUROLOGY" department to my UROLOGY pre-op patient (seeing as I work all services) and, without missing a beat, start the pre-op interview ... until I saw the look on the pt's face ... :stone ... I guess I was the one who needed some help 'up there' today ... :chuckle ... pt genuinely believed he was about to have "wrong site" surgery in a big way, wow ... :uhoh21:

Look at what showed up as an advertisement on that page (granted, not something that the author endorses, but still something that a pt could very easily come across) ... http://www.healthy-heart-books.com/ Just goes to show that you never can tell.

As the only male in one's class, one gets used to the class being referred to as "ladies, and, um, gentle-man" fairly quickly ... :chuckle

Oops Should've given credit where credit was due That was Carl Elbing's "Nurstoons" http://www.nurstoon.com/

You know, all those registered NURSES with associates degrees in NURSING who desperately want to be NURSES ... wait a second ...

Point taken, point definitely taken-- So should all pulseless patients be shocked in the field? Does ACLS only mandate not shocking asystole because in the hospital we have resources to confirm that asystole is asystole? I really don't know. Any opinions?

Glad to see a sense of humor. Just busting b###s. :chuckle

Holy needle cricothyrotomies, Batman! It's an arrogant paramedic! Can we give this divisiveness a rest please? Both of you! Play nice! There's room enough for both of you. From scene to E.R. doors, the patient is yours. From E.R. doors to OR, the patient is the ER nurses's. From OR to PACU, the patient is the circulating nurse's. From PACU to floor, the patient is mine. Mine! MIIIIIINE!!! :chuckle From floor to discharge, the patient is the floor nurse's. Okay? Room enough for all! And I would add that RN's have QUITE a different role from paramedics. Emergent, focused assessment, initial stabilization, lifesaving intervention, and maintenance of life until definitive treatment ... versus cephalocaudal assessment, stabilization, maintenance of life, lifesaving intervention, provision of definitive treatment, and restoration of health. Not to knock paramedics. Not at all! They're wonderful at what they do and no, a nurse cannot do everything a paramedic can. But the past poster is correct, even if it was not stated to your liking.

There would be no change in time for defibrilation if VF was obvious in Lead II(AED's do monitor lead II, right? I said Lead I earlier and that was definitely wrong now that I think about it). If asystole was detected, then the AED would go ahead and monitor Lead MCL1, or Lead I, or what have you, and if VF was found there, zap; if no VF, "No shock indicated." (BTW-apparently the two leads monitored need to be perpendicular. So I and III? Hmm. BTW again-what the heck lead is being technically being monitored if anterior-posterior placing of the pads is used?) Most definitely AED's are a Good Thing and they are at the very least better than nothing. What I'd be interested to see is if there is an easy enough way to give the 2.5% of VFers who are occult in one lead a chance to get shocked by an AED. I think coorificer VF = more electrical activity = more electrical activity to become organized electrical activity after depolarization. Read this somewhere, but I can't give you chapter and verse on it. An interesting paper on this is Cummins & Austin (1988) in Annals of Emergency Medicine 17(8). The abstract says: We investigated the frequency with which a "vector of ventricular fibrillation" may exist in persons in prehospital cardiac arrest. Emergency medical technicians trained in defibrillation were directed to record the rhythm in three different monitor leads whenever they noted an initial flat line. Before these lead switches, the technicians performed a flat line protocol that included inspection of the lead connections to the patient and to the defibrillator, and checks of the calibration and battery status of the devices. They performed this flat line protocol for 127 cardiac arrest patients; 118 were in confirmed asystole after technical problems were corrected. Ventricular fibrillation was detected in only three (2.5%) when the monitor lead was switched. Initial technical problems were more frequent and were identified for ten patients (8%). The frequency of occult ventricular fibrillation (three of 118 asystolic patients) yields a 95% confidence that the true frequency is no greater than 8% to 9%. This suggests that ventricular fibrillation masquerading as asystole is rare. These data do not support protocols for empiric countershocks of patients with an initial flat line on the monitor. **** I read this as saying that a policy of "shocking everything" is bad (which we agree on), but however that switching leads is important enough. An interesting web page arguing that ACLS should drop the policy of not shocking asystole is: http://www.defib.net/asyswk.htm. ACLS '92, quoted above, says: Rescuers should confirm asystole as the rhythm when faced with a flat line on the monitor by changing to another lead on the lead-select switch or by changing placement of the defibrillation paddles by 90(degrees). Operator errors that lead to "false asystole" are much more common than VF that masquerades as false asystole. **** With reference to the above article. What a can of worms I've opened up :stone

"Nursing" and "Medicine" are two different disciplines and models of healthcare delivery. Not all laypeople, well, in fact, not all healthcare providers, "get" this, but getting the point across would be even more difficult if we used a different title, especially something like "Medic" or what-have-you which implies not only (a) a medical model but (b) subservience to MD's. Just my $0.02. Latin, "nutricius", from which nutrix, nutricia, nurse, means "that which nourishes", by extension, tending to, i.e. doing patient care. That's what we're about. Patient care. And I'm male, BTW. I have no problem with the term "nurse."

Ah, but shocking asystole can actually have a negative effect on outcomes. So we can't shock asystole indiscriminately on the basis of "it might be occult VF." I was poking around on the net and apparently about 2.5% of VF's are occult in at least one lead. Not a large percentage. Not an insignificant one either. Is it the case that the coorificeness of fibrilitory waves bears an inverse relationship to the incidence of successful defibrilation? Is there a significant difference b/t occult & obvious VF in terms of outcome (barring treatment of VF as asystole.) What if AED's had, as they do, two pads, plus a brown electrode that the user is instructed to place over the heart, and then we could monitor one or another of the MCL's? That's not too challenging. Or weren't the two leads asystole is confirmed in supposed to be perpendicular ... that would require RA, LA, and RL (or what have you.) Now, AED's used by EMT-Basics are a bit more worrisome to me than AED's used by laypeople (this was actually what the discussion I was having was about but I totally didn't put it in my post) ... now, EMT-Basics are not qualified to read strips, but they're certainly not incapable of hooking up five electrodes, and if this caues 2.5% of the population to have a better outcome, why on earth not? Especially since EMT-B's may well be with the pt for a considerable length of time before ALS arrives. Come to think of it, recognizing VF & VT isn't rocket science either. If an unlicensed monitor tech can do it in a tele unit, why on earth can't an EMT-B?

Was having an interesting discussion the other day and wondered what people think. AED's were criticized for their inability to recognize occult VF, seeing as the only monitor one lead (lead I?) and per ACLS asystole should be recognized in more than one lead before treatment, i.e. before deciding not to shock. Now, anyone who has heard healthcare professionals gripe about medical TV shows knows that we don't shock asystole, blah blah blah. How should this problem be dealt with? If AEDs used a five-leadwire system, then the AED could r/o occult VF masquearding as asystole by checking more than one lead. I guess this would be characterized as being to complicated for laypersons but "green and white are on the right, christmas trees below the knees, chocolate lies close to the heart", or whatever isn't exactly rocket science. Would this be a decent solution? Is there even a significant problem? What do folks think?

As a OR tech, a lot of the MD's I worked with really encouraged me to go to med school (well, to go pre-med and then go to med school). I decided to go into nursing after seeing what exactly MD's have to deal with-insurance companies, lawyers, all kinds of B.S., and seeing that the RN is the "front line" of pt care ... saw immediately which one was for me. It's cliche, but nurses treat patients and physicians treat illness. Not to knock MD's at all ... most of the ones that I work with are wonderful, and very good at what they do, but the two professions are really that--two very different perspectives on pt care and two very different professions! I think that one can have a hugely positive impact on pt care from either one ... and both are essential.

I know of a gentlemen who discovered his latex allergy in a rather, uh, memorable way (hint: not gloves.) I really can't imagine how unpleasant that would actually be ...

Re use of EtOH based sanitizes as a surgical scrub: Was this a clear gel or a white foam? We use the white foam as a surgical scrub, it's been studied multiple times and proven effective as compared to Betadine, CHG, or what have you. The gel has not. Both are EtOH based. Personally I like it the foam. I would not, of course, be using it on soiled hands. If I feel the need I wash with soap and water before scrubbing with the foam. Most of the nurses and techs use the foam, and a lot of the docs, but some of them like to use the scrub brushes. It's really just a matter of preference. Scrubbing with the foam is a lot quicker than the brush because you don't have to go through the long process of scrubbing from front to back and so on.

Really? I thought that was considered permissible. How about autologous blood donation? I'm pretty sure we've had JWs who did it pre-op.