DennRN

I haven't been in Med-Surg long but the managers have already discussed how I should get some more experience and can transfer to the ICU in a few months if I want. Their words were "med-surg will teach you time management, you have the knowledge base, you just need to get some time and experience." I told them honestly I still feel overwhelmed at the moment, and would like to grow in my current position and learn as much as I can on my current floor before considering any moves. Long story short, options will present themselves if you apply yourself.

Some people would subtly hint that CNAs aren't licensed, but that's not me hehe What I meant to say was welcome aboard, we'll be passing through some rough weather ahead but the temperature at our destination is a balmy 85 with sunny skies. Thank you for choosing to fly CNAirlines!

Social Studies is the closest related field to nursing? You sir have officially crossed into the realm of the Grimm's fairy tales. :igtsyt: Beware all ye who venture beyond this point. All travelers crossing this bridge should pay the troll-toll.

The first 3 min of my psych rotation a 300 pound guy started posturing like a gorilla and staring at me. I edged behind the nurses station and he pounced on another male nurse punching him in the face. Next thing I know, the 60 year old female nurse that was sitting at the desk somehow gets the pt in a headlock, and starts talking to him in a calm voice about how it isn't nice to hit people and slowly brings him to the ground without a struggle. I was both impressed and terrified at the same time. Kudos to all psych nurses that know what they are doing!

I grabbed a 3ml syringe last night while rushing to my last med pass. I never got a chance to even look at what I was holding because another nurse saw me with the insulin vial and asked me what mistake I just made. I felt pretty embarrassed too. This is nursing, we make mistakes, some greater than others. I know I wouldn't have administered the dose since I would have never been able to draw it up without a leur lock sq needle, but I took another lesson from what happened to me. From now on, I will not rush when gathering important supplies such as syringes, and will pay close attention and ask if I can help with anyone who rushes in and out of the med room. Thank you for posting this, many people have made the same mistake as us, and some will do so in the future. Your posting this may have prevented some, I just hope the rest are as lucky as we are, and as good at following protocol as you were.

Or was the pt actually receiving plasma to restore blood volume after a coumadin overdose with bleeding, given vit. k which would reverse all coumadin, switched to heparin while inpatient and waiting for vit k. to wear off, made an error ordering the units of heparin and asked someone to correct to 50,000 units of heparin? I'm just spitting out a plausible scenario that could result in the key things you mentioned happened, the reality of the situation is that we can go all day thinking up things that can go with 50,000. My scenario actually makes a lot of sense, as will tons of others. We need more info and so do you. My advice, think of this as a learning experience, and speak up if you have a question. I have never allowed anyone to make me feel stupid for asking a genuine question, and you shouldn't either. Remember you are asking for your pt as well as yourself.

To Imthatguy, Because if nursing is not a science than nurses are doing tasks without the basic principles of why these tasks need doing and what might be the right task to do for one patient, is completely wrong for another patient with the same problem but a different set of co-morbidities. It is the science that guides our practice and why a new nurse knows that a pt with low oxygen saturation needs O2, but because of the way that the body responds to oxygen levels climbing in a COPD pt, we as nurses should not administer high flow oxygen or we risk suppressing respirations. It is science that serves as the reason why a nurse tells a physician they cannot administer this medication to a client because they might respond in this manner, and requests further clarification of an order. Tasks alone, or relying on other sciences to make nursing decisions for us are not sound practice and would result in increase incidence of negative outcomes. It comes down to the whole irrefutable fact that nurses make decisions. Without science to base these decisions upon there will be needless suffering and increased mortality rates for all of our pts. Do you understand that it is science that will help you understand that certain medications can be given late but later doses will have to be re-timed? How about the fact that giving certain medications to a pt can have horrible side effects such as poisoning if given under certain circumstances? I mean come on, something as common as lithium can become toxic if the pt gets dehydrated, the cascade of clotting factors can be altered by coumadin, but vit. k is the direct antidote, but it can also be taken in through diet, and pts have to be warned about foods such as kale when receiving therapy. I could go on for days behind all of the small things I do or say to the pts I have had recently based upon my scientific understanding of what they need.

Um no, your understanding of the scientific process is flawed Tippy. I agree with most of your post, however you forgot the part about how evidence based practice uses data to further refine hypotheses and control for variables. In the scientific method, when an unexpected or imperfect result is observed, it warrants further study and refinement of hypotheses. Just because an experiment does not produce a perfect or expected result does not mean that the experiment was not scientific, only that there are one or more factors unaccounted for.

"I don't think nursing is because the theories and the applications don't seem scientific in nature." Hmmmn name one field of science that hasn't had questionable theories? When it comes to energy levels, therapeutic touch, and all those other theories, you clearly missed the explicit or implied, "feel free to disregard" clause. But let's follow your line of reasoning with physics, something you believe is a pure science. It has a branch called quantum mechanics with non-observable theories such as string theory, membrane theory, multiple dimensions... Do these ideas make physics less scientific? Okay, let's forget about quantum physics for a second, and consider something observable. When a leaf falls we say it is due to gravity, but where does gravity come from? Here is a wacky idea, mass creates distortions in space-time that allows radiation from an unobservable plane of existence to bleed through and exert an attractive force on objects relative to their mass. CRAZY huh??? Sounds like your definition of the "crutch of evidence based practice" in that it is using "conclusions of research studies to go about solving some issue". Lets follow your thought process which I will call the associative-absurdist theory of negation to disprove physics as a science. Objects fall to earth -> something is acting on these objects -> objects with greater mass exert greater gravitational force -> physics relies upon gravity in part to theorize how the universe works and was formed into its present state -> idea I can't conceptualize or choose not to agree with -> physics is not a science. Seriously, if you have a problem with a particular theory, that's fine, but that doesn't mean a field is not based upon sound scientific research. Nursing achieves its status as a science based upon the natural sciences, (those based upon empirical data). It draws upon the other sciences as a foundation. Observations are made and interventions (experiments) are conducted. This results in empirical data that can be analyzed, and used to create new hypotheses. This is evidence based research, also known as the scientific method. Stop trying to rationalize, (irrationalize), why you feel the way you do about nursing, you are making generalizations that are based on illogical reasoning that goes against the very principles of science. Phenomena are observed, a hypothesis is formed, experiments are conducted to test these hypotheses, theories are formed based upon repeated observations. these theories remain valid until disproved with empirical data. To circumvent this process and follow your feelings that nursing is not a science because you dislike a few theories is beyond ironic. Where is your empirical data that any of these ideas are not valid? The funny thing is if you do have any proof of your claim, you will just be adding to the body of knowledge we call the SCIENCE of nursing. You just can't win can you?

It depends upon dosage and if the pt is opiate naive. I would address the Rights of Medication, if you need clarification, go straight to the source and ask for clarification from the prescribing physician, to do otherwise is like waiting to see if you get hit by a car to judge if it's safe to cross the street. The order is probably for IV on purpose so that you can use your nursing judgement, but better safe than sorry if you have concerns. Personally I have never encountered an IV dosage of an opiate that made me question if I needed to administer it over 30 minutes, and if I did, that would mean I would have to pace out my rounding/charting to allow me to check on my pt every few minutes until peak efficacy, which would start at 30 minutes and last for an 1.5-2 hours after the 30 min IVPB ends for dilaudid for instance. Then comes the problem of clearance time for the opiate, with the tail end of, say, q2 dilaudid still circulating when the next dose is administered. Since IV dilaudid peaks can last 2 hours when pushed, subtract 30 min from that and you can see that the next dose will be available to the pt before the client has metabolized half of the first dose. Check the peak times, you need to be in the room when the normal stated peak is and tack on the 30 min delay for the infusion to run. Then address the problem of what if my pt wants another dose within the clearance time. The medication is there to relieve pain! If it is infusing slowly, it takes longer to bring the pain down, meanwhile the pain is not under control and will need a higher dose to be effective. Lastly IV opiates have a short half-life, and are fast acting. Personally I feel safer pushing it because I know I'm in the room observing the pt when it starts to kick in and will return while it's fresh on my mind. Narcan won't do anything if I have left the room and forgotten about them. In short I would say if the prescribing physician says use your judgement, do what you are comfortable with and get a baseline RR. Peek in every once in a while to see if there is a significant change, and factor in some extra time if you are using IVPB.

The answer is simple but not easy. The ones that are good do everything regardless of what shift they work. The ones that are trouble will try and duck out of the"little things" because they either lack the knowledge of what it means to a client's care, or don't care. Simply cleaning a client could mean the difference between infection, skin breakdown, sepsis, even death if you want to go to extremes. The CNAs I trust and respect are the ones that do everything within their responsibilities as the situation requires regardless of what the clock says or if the sun is anti/post meridian. Btw I am a rn that does everything my client needs as time permits before I choose to delegate a task out to a cna. I got certified as a cna while in nursing school and recognize how important you and your peers are to each of our patients.

Wow, this thread is starting to scare me... Nursing IS a science, let me elaborate with just one real life example from last week. A pt presents with an abdominal aortic aneurism, as new grad I rely on my understanding of biology, pathophysiology, chemistry, and pharmacology to know what is happening to my patient, what could happen to the patient, what lab values to watch (what they are indicative of), the medicines he needs/which ones to question, and what symptoms to watch out for (what these symptoms mean for my client), what diagnostic tests he needs (how to interpret the results and apply them to the plan of care), and prioritize his care versus my other patients. THESE ARE ALL THINGS THAT ARE NOT ONLY WITHIN THE SCOPE OF NURSING, BUT ALSO PART OF THE RESPONSIBILITIES THAT CANNOT BE DELIGATED TO ANYONE BELOW A NURSE. If you are not practicing the SCIENCE of nursing, you are a liability plain and simple. Going back to the original question, med-surg is difficult if you cannot tie together the sciences of pharm, patho, physiology, chem, and various others and apply them to the multiple diagnoses your average pt gets wheeled in with. If you don't think nursing is a science, I don't think you are nurse material, at least not the kind I want anywhere near me or mine. If you are wondering, he was one of the most stable pts I had last week.

Thank you for posting OP, This is certainly a topic that impacts us all. Personally I got a great education for 30k worth of loans. Payments are ~$430 Unconsolidated, and I'm rounding up to $500 a month to pay down the higher balance early. Proper money management and budgeting is something that needs to be learned. I was lucky to have a gym teacher devote a few days to teaching us the basics in 7th grade in a way that really stuck with me. Anyway, investing in yourself is USUALLY a smart move, just be mindful of credit pitfalls. I always look at it as a game of mitigating losses. Things like consolidaring loans are smart if you can't pay them down individually, but the down side is the lower payment and longer term means you pay WAY more. I know this is obvious to most of us, but I'm constantly shocked by how many people I know that can't plan beyond I need this bright shiny thing right now. Back to the OP, I want to say congrats on graduating and landing a job, hang in there and make the sacrifices you need to in order to pay off your highest interest/balance debts as soon as you can.

Yes, after a while it became easy. I just transitioned to listening for moment while the second hand of my watch moves to a position I'll be able to remember. While I'm doing this I listen to the speed/tempo like it's music. The first few times I did this I imagined a metronome swinging back and forth and only counted the swings to the right. Do this a few times with an automatic bp cuff on and you will see you will be within a beat or two. After a few more times you should be able to count out out an abnormal hr with no issue. Mainly it will come down to listening and letting go of your self doubt.

:igtsyt: Please refrain from feeding the troll.