celeste7767

Wow, am I ever behind on what's going on!! I thought that most state boards wouldn't even allow someone to take the NCLEX if they had more than a traffic ticket on their criminal record. Personally, with the exception of some white-collar crimes that are felonies but seem to fit into the gray area in between (like bouncing checks or criminal speeding), I don't think we need people in our profession that have a history of felonious behavior. ANY crime that involves reckless or deliberate disregard for the life or well-being of another living organism whether it be a person or animal should be an automatic reason for excluding someone from the nursing profession. We need people in nursing who are compassionate, empathetic, and reasonable. I believe it is better to err on the side of the patient this matter.:heartbeat Celeste

I definitely remember Hilary making a derogatory remark regarding the nursing profession several years ago during the period in the 90's when hospitals were laying off RN's and lived to regret their decision when morbidity and mortality rates climbed as patients were cared for by those who had little knowledge of maintaining sterile fields, etc. I do not remember it being something that we read in print. I hate to attempt to paraphrase something that someone said when I can barely remember it myself. I only remember the substance of the comment was equivalent to saying that nurses don't have the education nor does their job require the intellectual requirements necessary that they should demand salaries in the range of MD's, lawyers, etc. It was during the time in the 1990's when there was a short-lived glut of nurses and they were being laid off and replaced by CNA's,LPN's, PCT'S in favor of the "bottom line". Hospitals (if not all their patients) lived to regret the err of their decision when mortality rates as well as morbidity rates increased with higher numbers of nosocomial infections and length of hospital stays. Unfortunately by the time the numbers were in, no one went back to Hilary to ask her opinion at that time. It is a darn shame when the people in charge of life and death of so many have to continually prove their worth to society. :redpinkhe

I got more than 60 free Contact hours from various sources and once one gets your name you get offers from others. Check out the following which you can do online, download the material if you want and some will even send you monthly free ceu offerings: www.infectioncontrolresource.org www.meniscus.com www.medscape.com www.safepractices.org I would strongly suggest not taking Basic Disaster Life Support or Advanced Disaster Life Support classes offered by an organization named CREST and usually supported by a respected university. I took the classes in Sept. 2007, passed them and was given a homemade certificate that did not list the 21 contact hours I was supposed to get. We were all told then that we would receive our CEUs and cards in the mail from the AMA. I have called and emailed several times and 5 months later and we still are waiting for our documents. WHAT A WASTE OF TIME AND MONEY. Try those above. You may spend time on the computer, but you'll get your ceu's immediately. Good luck to you!! Celeste7767:twocents:

Last Sept. 12, 13, 14 in Socorro, NM I took Basic and Advanced Disaster Life Support Classes sponsored by the Univ. of New Mexico Center for Disaster Medicine and for which I was supposed to get 21 contact hours Cont. ed. Well, after the classes concluded on the third day we each were given one certificate for each class with a blank space for us to fill in our names. No mention of any Continuing Ed. hours anywhere on the certificate. We were told by the course coordinator that we would get official cards from the AMA and certificates with the number of CEUs. In November I called the UNM Center for Disaster Medicine to find out if mine had gotten lost or what. I was told that the AMA has ONE SECRETARY TYPING UP ALL OF THE DOCUMENTS FOR EVERYONE IN THE ENTIRE COUNTRY!!! I JUST SENT ANOTHER EMAIL TO THIS PERSON AT THE UNIV.OF NEW MEXICO BECAUSE 5 MONTHS IS UNACCEPTABLE AND I THINK THE ENTIRE THING IS A BIG SCAM. I WOULD SUGGEST THAT IF ANY OF YOU ARE CONSIDERING TAKING THESE CLASSES, WHICH ARE LISTED OFFERED BY AN ORGANIZATION CALLED "Crest" and are listed as Basic Disaster Life Support and Advanced Disaster Life Support , don't take it. Although it had some good information, I cannot imagine that a professional organization would have one lone secretary (who has other duties as well) in sole charge of sending out thousands of documentation to students who have taken these classes. The person at U of New Mexico said that the secretary was slammed with 6 classes back to back after ours in September. if that is even true, you can bet that the class that I took in September which was one of the first has been delegated to the bottom of the pile or perhaps even further down to the bottom of the waste basket. PLEASE LET ME KNOW IF ANY OF YOU OUT THERE HAVE HAD THE SAME PROBLEMS GETTING YOUR CEU'S FROM THE AMA/CREST. Thanks, Celeste 7767:angryfire

My husband was recently hospitalized for 11 days for placement of urostomy via ileal conduit for bladder cancer with bone mets. Although I may sound like supernurse, in 32 yrs of nursing I have never had any experience with stomas. I do remember that in 1975, my first job on a surgical floor had patients who got colostomies, ileostomies, etc. and that when they were emotionally and physically able, they and a family caregiver attended classes where an ostomy nurse gave classes to these people whose lives had taken a sudden hairpin turn into no man's land and they were depressed and frightened. But there were always several other experienced nurses in the classes to help them learn about the various appliances and what would fit and work best for their body type, etc. When they went home, they had the name and phone number of one of the ostomy nurses to contact in case of emergencies or just questions or help walking one through their first pouch change. I know this sounds like a fairytale, but there were more things good about the 60's and 70's than just the 60's and 70's. We were enabled to give the best patient care we could devise. No idea was turned away if it helped prevent complications, promoted well-being and optimum health. 21st century health care is more like medical care was before Semmelweiss discovered that bacteria was the cause for puerperal fever in new mothers. Only the poor delivered their babies in hospitals; the wealthy delivered theirs at home with a midwife because upwards of 89% of newborns delivered in hospitals died within 5 days of unknown causes. It seems we have come full circle today. My husband's surgeon said that the nurses were all experienced in stoma care and would teach him all about it. No one on that unit knew anything about them and even admitted they did not get many there. On his last day before discharge, an ostomy nurse on her way to a "conference" dropped in to give my husband's nurse "the basics" on ostomy care and changing the appliance. She never told my husband her name, never addressed him by name and never addressed any of the instructions to him or allowed him time for questions or concerns. She never returned. The next day we were sent home with minimal supplies, no information with the exception of a 4 page ostomy care sheet that was incomplete and ended in mid sentence. It gave no practical advice or explanations or discussions of the various devices, how to place them, what is some kind of powder for, would we need it. It must be what this NEW KIND OF NURSE TEACHING IS ALL ABOUT. (NANDA) Tell the patient how it will affect his life; don't eat cheese, it will make the urine smell; what kind of clothes to wear. But no step by step instructions and illustrations to help with the practical side of such a radical change to ones body image. And discharge instructions!! WHAT A JOKE!!!! We were supposed to have a Home Health nurse out within a week after d/c. Still don't have one. She is supposed to come out Friday, 8 days late and the skin is breaking down and weeping because we don't have the supplies or instructions we need. Also, 30-40 years ago, there was a name and phone number of a contact person if the patient had any problems when he got home.No one, no where. ALL THE COMPUTERS, TECHNOLOGY, AND EVIDENCED BASED PRACTICE IS NOT GOING TO IMPROVE NURSING CARE AND MEDICAL PRACTICE WHEN NO ONE IS PRACTICING IT! AND NONE OF THE NURSES WITH THE EXCEPTION OF THE ONES IN THE STEPDOWN UNIT SEEMED TO CARE WHETHER THEIR PATIENTS WERE LYING IN FECES OR SCREAMING IN PAIN. THEY WERE ALWAYS GATHERED AROUND THE DESK AND THEIR COMPUTERS. It really is time to go back to the good old days.....and the well known old adage that went like this: "STAY AWAY AND OUT OF HOSPITALS NO MATTER WHAT HAPPENS TO YOU. EVERYONE KNOWS PEOPLE ONLY GO THERE TO DIE!! Celeste7767:madface:

When is it OK for the nurse to push the PCA button?? When you just got the patient up in the chair and he number and positioning of the infusion pumps, pleurevacs, O2 tubing etc. and the arterial line and CVP poles are separating the patient from being able to reach the PCA cord button. My husband was just such a patient in the hospital after surgery for bladder cancer and when he asked for his "pain button" we all looked at each other then searched until we finally found it. My husband asked if someone would push it for him; a very understanding and empathic nurse said, "Normally, this is a big, NO NO, but in this instance, its a YES, DEFINITELY. I am sure that that nurse will try to keep a closer eye on how she arranged the various apparatus from now on, so it was a good learning experience and I would have done thing. Critical thinking is separating following the book to the letter no matter what,from analyzing each situation, analyzing the "rules" and what situations led them to be written, drawing on previous evidenced based knowledge and using all of the above to make the best possible decision for the patient at that moment in time. There are no "all the time" or "never, never, evers" in nursing. :w00t:Celeste7767

WARNING: THIS POST IS REALLY LONG. BUT I HOPE MANY OF YOU WILL READ IT. I THINK IT IS A VERY IMPORTANT ISSUE FOR ALL NURSES. I haven't written a post for quite some time. My husband learned today that he has a "high grade invasive bladder cancer" from a cysto and biopsy he had done one week ago; he was originally hospitalized in acute renal failure which was reversed after one run of hemodialysis, the insertion of 2 nephrostomy tubes and a foley cath all of which he came home with on 11/3 and which I have been caring for. During the past several years I have witnessed some disturbing trends in nursing. In a world famous MAGNET hosptital in HOuston, TX. for 6 days no nurse did a head to toe or systems assessment on my husband; no nurse did a neuro check; no nurse asked questions regarding pain or other discomfort; no nurse ever physically touched my husband. I did all of his care and I wanted to do it, but I did wonder how the nurses charted on him when the only thing I had seen ANY of them do was give him his meds in spite of the fact that he was on a telemetry floor and was acutely ill. He had been admitted because of a sudden onset of mental status changes with confusion, disorientation, visual and auditory halucinations, slurred speech and stuttering, staggering gait and weakness of the extremities, particularly the legs. The did EEG, cardiac echo, MRI and MRA of the brain and extracerebral circulation, doppler of the carotids, skull films. The only thing they did not do was a lumbar puncture and I don't know why they didn't because he was discharged minimally improved with no diagnosis. I never saw any of his labs, but I bet his CBC differential showed elevated WBC's with a shift to the right because I have often thought that he could have had West Nile encephalitis since he came down with this where the mosquitoes that carry it were prevalent and I have cared for patients with viral encephalitis and he had many of the symptoms. He gradually recovered completely after several weeks. The point I really want to stress however is that from what I observed back then in Houston and now with nurses and Nurse Practitioners at the VA here in Arizona, I believe our profession to be at a critical juncture. Nursing is at the brink of losing its status as a profession partially due to the continuing shortage which initially brought about much needed increases in salaries but when the pay did not have the effect of bringing more competent, quality people into the ranks, desperate measures were sought to fill the vacancies left by aging baby boomers. We now can evaluate the consequences of some of the less desirable means utilized to fill the positions for competent RN's with what amounts to the equivalent of "warm bodies". Because of the current job market, former truck drivers, auto production workers and people who would never have considered nursing as a possible future job for themselves are signing up at record rates because it is a guaranteed job. People are going into nursing because they know they have a job waiting; because they can travel; because it is one of the few professions that you can start out in with an Associate Degree and I recently read that there is a push to get RN's out and working in something like 3 semesters. Many of these candidates have no realistic picture of the myriad of tasks that are involved in being a RN. Many would rather work in a sewer than touch or be touched by another living person's bodily fluids. Some people actually consider it from the prospective of the accessibility of narcotics. Recently when my husband was in the hospital in renal failure, he told me that one of the nurses did not give him the correct dose of his scheduled pain medication. He said that when he told the nurse that he was supposed to get one more pill,the nurse replied, "Well that's what is ordered". Yet for the 2 days that he was on that unit, the night nurses gave him the correct dose, the exact same dosage and the same pills that he had been taking at home for more than one year so there is little chance that my husband was mistaken. Unfortunately, he did not tell me this until after he was discharged and I admit that right now turning in that nurse is not my top priority. I would say for the most part that the nurses who write into this forum are the good nurses. Why? Because the bad nurses could give a rat's ass about anything to do with their job after they go home. I can hardly believe that they would spend time on their computer reading what other nurses think and say about their profession. To the bad nurses, nursing is just a paycheck. And most will get advanced degrees so they can "get away from the bedside", which is a good thing when you get right down to it. It is so sad to me to think that all the work that thousands of dedicated nurses have done over the past 3 decades to bring nursing the respect and status of professionalism that it deserves may be lost when the public gets wind of the some of the "trailer trash" types and "gangstas" we are letting into our ranks. I can't work right now; 30 years of 12 hour shifts, most without breaks and most that ended up being 13 or 14 hour shifts, took its toll on my body. I have too many ailments to list, but right now there isn't any kind of nursing that I would be able to do. Just sitting and typing this, I have had to stop several times because of the pain and stiffness I get. Nursing is not the kind of job that everyone should do. It is a profession that you really have to desire from the heart and know that there comes with it a lot of things that most people would call "icky"; but in spite of the "icky" if you can derive satisfaction from the patient who thanks you for starting his IV because no one else could, or who remarks "You must have been doing this for a long time; I can tell just by the way you can talk and work at the same time." If you can look back and feel good because you KNOW that there are people walking around today because YOU were there to provide expert emergency care that was needed during that critical moment between life and death and no one gave you a medal or a bonus or a raise but it was enough to know that it was your hands that helped save a life, THEN YOU KNOW YOU ARE IN THE RIGHT PROFESSION. Then you know you are a "GOOD NURSE". I know there are still good nurses out there. There was one in the ER named Manny who is young and fit and eager to learn, yet compassionate, caring, never forgetting that it is a human being in that bed. And when I read a lot of the posts in the forums, I see that you are out there and I thank God for you. Because we baby boomers are getting old and tired and we look at you because we see ourselves on the other side of the bed someday and hope that we will get one of the "good nurses". God bless you all!! SORRY THIS IS SO LONG,....AS USUAL..............

Geez, I almost had a stroke when I first read the question! My first reaction was, "Oh God, no, Please don't tell me that employers are regressing 50 years into the olden days when nurses wore long sleeved starched uniforms that were mid calf length and ALWAYS a cap and your school pin." What a relief when I read on some more. I have worn just enough make up to look "normal" since I was around 14 years old. I have very light strawberry blonde hair, green eyes, and my eyebrows and eyelashes are nearly invisible they are so light. (When I first got married I went to bed with my make up on and got up before my husband to wash it off and redo it!!) Also there was actually a period in the early to mid 1970's when minimal false eyelashes were in vogue as well as wigs. We all wore those to work as well, but no one thought anything about it because it was the fashion at the time and no one had a "Tammy-Faye" look about them either, God rest her soul.

I'll tell you one thing you can do but unless you want to get fired like I did, you better get most of the nurses on your unit to do the same thing. After I explained what would work to the other nurses, I was let go the next day I came back to work. This is it: Say you are shortstaffed and you're in charge; or you aren't in charge but you have a number of very sick patients or too many patients so that you can DOCUMENT THE REASONS CLEARLY WHY IT IS UNSAFE. You type it up, name the date, shift, and the supervisor(s) you notified about the problem and why it could result in poor patient outcomes or even a sentinel event. DO NOT USE PATIEN T NAMES IN YOUR REPORT SINCE THAT WOULD BE A BREACH OF THE HIPPA LAWS. USE EITHER ROOM AND BED NUMBERS OR MEDICAL RECORD NUMBERS TO IDENTIFY THE PATIENTS WHO ARE AT RISK. Explain how you presented your case to your immediate supervisor, then called your unit Manager and tell her that as a courtesy you are notifying her that you will be filing a report documenting the circumstances surrounding the events that have transpired thus far and any untoward events that may result possibly due to the understaffing issue. Explain that you will have a copy sent to the hospital administrator, the Director of Nursing or Executive Nursing Officer and keep a copy for yourself. Tell her this is the only way you can see that you will not be held ULTIMATELY LIABLE SHOULD A SENTINEL EVENT OCCUR, since without any evidence stating any different it might be construed that you never notified any of your superiors of the conditions on the unit during that shift. Believe me, documentation is the last thing administration wants because they have no or very little defense when faced with the cold hard facts that they each blatantly ignored. If you are in Charge, you may need to call the Executive Nursing Officer if your manager will not step up to the plate and find a solution like closing the unit to further admissions or coming in herself to work. If you are a staff nurse you can document only what your personal situation is with the patient load you have and explain in great detail why it is unsafe and that you do not want to risk not only a person's life but your professional license as well should things go south. You may also want to notify some of the physicians of your patients who you know would be sympathetic and concerned about your plight and their patient's welfare. I was the charge nurse in an ICU in a small community hospital and I was forced to type up such a report. I also explained to my nurses what I was going to be doing and allowed them to read it. I told them that uncontrovertible documentation is their only defense when faced with Shift Supervisors who refuse to get permission to close a unit to further admissions or worse with Nurse Executives and CEO's who won't back up their nurses because of the bottom line. Not one nurse would relate that they believed that they were understaffed and their patients at risk (even tho' they all complained about it to me) and they did not lose their jobs. I did lose mine but when I filed a wrongful termination claim with the Arizona Dept. of Economic Security, the Hospital was found in the wrong and I received 3 months of unemployment pay. Unfortunately, I have learned in 30 yrs of nursing that most nurses talk the talk, but are ultimately afraid to walk the walk and take that chance by fighting the good fight. Maybe if more would do it, hospitals would become more afraid of that tactic and might try a little harder to get staffing.

I graduated in 1975 and in 1980, started working 12 hour shifts in Critical Care, ER, CVICU, PICU, hemodialysis. After 30 yrs total, my body is wrecked , ruined. I have chronic vasculitis of both feet and ankles, arthritis of both feet, hands, knees, acetabulum bilaterally, spinal osteoarthritis which has decreased my height from 5ft 8inches to currently 5ft 6 and 1/4 inches. I have chronic pain nearly everywhere; I received Social Security disability effective November 2004, but just got eligible for Medicare but I have been without insurance coverage for 7 years until this May. I also have nerve entrapment at the shoulders and elbows as well as Carpal Tunnel syndrome of both hands and wrists. I started my nursing career at age 26; I am now 58 and can barely get out of bed. I could have all kinds of elective surgeries done to allegedly help increase my level of functioning and decrease the pain. Unfortunately, after what I have seen and what I now see in the medical arena in spite of the wonders of modern medical technology and such catchy phrases as "evidence based practice" and "patient centered care", I think I will take my chances continuing to wear wrist splints and doing what I can when I can and easing up when I can't do anymore. As for 12 hours shifts, the human body isn't stuctured to be able do the type of work required of a competent, compassionate, patient-driven nurse. Especially, when I would bet that 90% of all nurses who work 12 hour shifts work more than their required 3 shifts. I routinely screened my calls because I almost never worked more than my 3 required shifts but I was always being called to "help out because we're short tonight". There is no h istory of arthritis in my family, nor carpal tunnel. I know what is responsible. As more of us are forced to retire early due to job related maladies, hopefully it will become more apparent to the nursing profession as well as to the employers that the nursing shortage is not going to be shortened by wearing out employees 10 years prior to the normal age of retirement.

I'll start right off telling you all that I am probably the most CYNICAL nurse that is a member of this forum. When I started nursing school in 1971, I had no idea what the starting salary was; it was what I wanted to do so I didn't care. In 1975 in Indiana, my first job on nights on a major surgical unit with 26 beds, me and and a CNA on duty, I made $5.27 per hour. I worked 11pm to 7:30am, 8 hour shifts, every other weekend off. We almost never worked any overtime, we got our lunch and breaks, and we got out on time. After working 26 out of 31 years doing 12 hour shifts in Critical Care and ER, mostly without any breaks or any time off my feet, I am now on Social Security Disability at the age of 58. I have lost 2 inches in stature from severe spinal arthritis, I also have severe arthritis of my feet, knees, hips, hands, and right shoulder. I have severe carpal tunnel syndrome of both wrists. I wouldn't become a nurse today because today nurses are the ultimate fall-guy no matter what happens; the nurse is always to blame, (not the pharmacist, not the charge nurse, not the doctor) because the pharmacist and doctor have associations that PROTECT them from liability while the Boards of Nursing exist solely to PROTECT THE PUBLIC FROM THE NURSES and that crap about Charge Nurses being responsible for what other nurse do is just that, CRAP. And NO, I have never been disciplined by the board for anything. But I have seen it happen to 4 other excellent nurses that I know of and I cannot imagine how many others it happens to that I don't know of. I was not a workaholic either; I worked my 3 twelve hour shifts a week and that was it. But when I worked, I gave it 200%. I practically RAN down the halls as I gave my patients the best that I had to give and there are many people who are alive today because I was there when they needed a good nurse. But if I could do it again, I would NOT be a nurse. I would be an attorney or a medical technologist. NO amount of money is worth the emotional and physical toll it takes. Nursing is a job with lots of responsibility and very little authority or power. It is known as a job with the worst of both worlds. To those of you who are still taking prerequisite classes I say: GET OUT WHILE YOU STILL CAN!!

Sounds like a Circolectric Bed, used primarily in the early 1970's to 1980 for the quadraplegic patients to prevent skin breakdown and to change positions gradually to avert some of the autonomic problems associated with this class of patient. This was preferred over the Stryker frame by many neurosurgeons at the time because the patient was not flipped from supine to prone like a pancake. As with everything else in medicine, newer more comfortable and more efficient beds came along to replace them.

Whether someone gets terminated over something that is obviously "human error" in which no real crime, civil or legal, was committed and no one was hurt depends on one thing: Is there any other reason why they (your manager or the hospital) wants to get rid of you. If you have been there 6 years, you have presumably gotten 6 evaluations and been retained during that time for good reason. If you ARE terminated, file for unemployment. The hospital will state you are not eligible due to the termination. Then you file an appeal which you will be told how to do in the letter you get from your state's employment or labor dept. notifying you that your claim for unemployment has been denied. Then you prepare your case. You can have someone help with you like an attorney if you wish or you can do it on your own. Most unemployment hearings are telephone hearings done with an administrative law judge presiding. Whether you win or not will depend a lot on whether your Human Resources dept. followed the company's disciplinary action policies as stated in your employee handbook. You should get yours out and review the policies. Many companies give their employees a smaller version of the entire manual but the section on disciplinary action procedures should be in yours. I sincerely hope you do not have to resort to any of this. But from personal experience and from working as Assistant Director of Human Resources during a vacation from nursing about 16 years ago, I can tell you that when it goes to administrative leave, it usually means that the company is getting their ducks in a row for termination. I know this is not going to make you feel better. But keep in mind that you really have done nothing wrong; your explanation taken at face value makes it clear to any rational person that the worst thing you did was succumb to being human......you were overwhelmed and you FORGOT the pill in the pocket; but you were doing what every nurse is taught to do from day one: Priortize based on the acuity of the situations at hand. You could have ignored your patients and instead, taken the time to call the pharmacy, ask your charge nurse to help you rectify the error with the Pyxis and observe you wasting the medication. It probably would have taken 20 minutes to do that but you would not be in the situation you are in now. It might have been worse. You might instead have a patient who aspirated on vomit, or one who suffered a broken hip due to a fall; in other words incidents that could have been prevented had you not chosen to take care of the pill in the pocket first. The pill fell on the floor. It happens. You did right to take care of your patients FIRST. You forgot what in the total scheme of things was minor, but due to policy, narcotic laws, etc, etc, etc, has gotten you into a snarled mess. You still had the pill as evidence that you had no intention of diverting drugs for yourself or anyone else. When I read "med error", I thought you gave the wrong drug to the wrong patient or something like that. You did not commit a med error. A med error is wrong drug, wrong patient, wrong dose, wrong time, wrong route. Remember that from nursing school?? You made a policy error. You may still get terminated I am very sorry to say, because it would be a very stupid move on the part of the hospital. But the reality is that it does happen. But if it does, don't let it destroy you or your career. Fight it. Appeal it. YOU REALLY DID NOTHING WRONG. My prayers are with you. The very best of luck to you. You sound like a very good and conscientious nurse.

While I agree with the substance of what you are saying, I must state that when I hear a non-medical person say something that sounds medically dangerous or unsound I WILL make a comment. Like they say, "It's all in the delivery". We have an elderly man who sprays our house for insects (we live in the mountains of AZ with scorpions, centipedes,etc) monthly. This month he mentioned he had cataract surgery and that his surgeon had had to aspirate blood from his eye a couple of times; I know this man pretty well over the past 8 years, and know that he also takes aspirin prophylactically due to previous CAD. I merely mentioned to him that he should make sure that his surgeon is aware that he is on aspirin and any anticoagulants or NSAIDS. Another time while shopping at the local food coop, I ran into a young mother who had a 14month old who had had a severe case of croup; she said she had been scared to death when her infant started the typical "crowing sounds" of croup and seemed to be having some difficulty breathing. She said she took her to the ER and they told her to get a humidifier so she was using an old hot steam vaporizer that her mother had. I suggested that the cool mist humidifiers were more effective with decreasing the swelling that occurs in croup; I also mentioned what we used to tell mothers in the ER where I used to work: If your infant develops the symptoms of severe respiratory distress at home, take them out into the night air if its cool or as a last resort, while waiting for EMS, open the freezer and stand so the baby can breathe the cold air. It has saved more than one infant's life that I know of. Call me crazy, but when I know that someone is in need of some simple medical knowledge that could make a real difference in their life, I cannot withhold it and back off and tell them just to see their doctor. I always end ANYTHING I do tell them with, "But make sure you see your doctor about that", or "That's something you really need to let your Doctor know about." I have worked as a RN for more than 30 years and have never had a complaint or incident report against me for any reason.

As far as your question regarding demerol, I do know that in high doses or with patients who have decreased renal function, the active metabolite from it, normeperidine, does accumulate and can cause seizures. Demerol is NEVER used for chronic pain or in the terminally ill, because unlike morphine which has no ceiling dose, Demerol can reach toxic levels and cause seizures.

First born, Dad was a functioning alcoholic and probably drank as a buffer against mom who has severe personality disorder. I have curly hair, not married to cop or paramedic, but am married and will be 40 years this July 7. Not codependent. Cant remember the other things mentioned.

I got my AAD in nursing from Indiana University in 1975. I took all my pre-reqs in summer school sessions between the 2 years or 4 semesters of Nursing Classes because I wanted to be able to concentrate exclusively on my nursing classes during the fall and spring full semesters since except for Fundamentals of Nursing which was an 6 credit class, the rest were 10 or 12 credit courses which of course included lectures 3 afternoons a week and clinicals 8 hours on 2 days and 4 hours on 2 days. We felt like we lived nursing. By the last semester when we also had to take a course in Nursing and the Law, we were all burned out before we even took our boards. It seems that the pre-reqs are more demanding than they were 30 years ago when there were no computer classes required. But our Anatomy and Physiology course was 8 credits and 2 semesters I had to take that during my first fall and spring semester with my Fundamentals of Nursing course and Nursing Care of the Adult Patient (10 credits). Yes, I took 14 credit hours the fall semester and 18 credit hours the spring semester, and it was hell, but I did not have the time to drag out my education over several years. Financially, I needed to be working again as soon as was possible. I had 2 small children and although my husband worked, it wasn't enough. That was the worst year, but after that the second year was hard but doable. Personally, I felt that I got an excellent nursing education from IUN and was pretty well prepared to take on my first job after an 8 week internship at the local hospital I started at. All of our Nursing instructors were PHD prepared full or associate professors and came from places like Case Western Reserve University and Penn State and were 100% dedicated to their mission to make us into top notch RN's. We had a 96% pass rate on the State Boards too. I don't know why but it seems to me that nurses are extremely impressed by having a multitude of initials after their names, i.e. RN, BSN, MSN, CCRN, CEN, CMC, CNS, APRN, FAAN, BLAH, BLAH, BLAH. Considering that the pay for a new grad with an Associate Degree differs by approximately $10,000 to $20,000 a year from the RN with a BSN, MSN, PHDn or with multiple specialty certifications, I wonder if we are all on some sort of competitive ego trip. I got my BSN, my CCRN, my CEN, and then became trained in hemodialysis, Pediatric ICU, Trauma, Cath Lab and have taken ACLS every 2 years since 1982, and PALS and NALS every 2 years since 1993. SO WHAT!!!! It's a good thing I am physically disabled and on Social Security Disability because no hospital would hire me for what I am worth considering my vast and varied experience and knowledge. They would rather hire someone with less experience and maybe 7 to 10 years in nursing instead of 30 years. At this age, I am a liability. I thought I was making myself more marketable by learning so many different skills; I was definitely wrong on that count. The market is not what it used to be. Celeste7767:innerconf

I graduated from Indiana University in 1975 obviously I took the old 2 day exam in 5 sections; the one with the least questions was Psych Nursing with 90. The passing score for most states was 250 on each test section, except for California and New York who required 500. My scores ranged from 723 (Surgical Nursing) to 606 (Psych Nursing) which was the only one that was below 700. So, yes I passed, but talk about STRESS. And I have never studied for large comprehensive exams since I had one instructor who claimed, (and I believed her), that it is impossible to "cram" or even to raise one's scores by "studying" for a test that covered such a massive amount of material. She likened it to studying for an IQ or SAT tests. I took the CCRN exam in 1982 and passed it the same way--never studied for it or took any CCRN review class, but I had been a Critical Care nurse for 6 years and had taken a lot of CEU classes during that time. I took it again in 1994 and passed the CCRN once more and the same way. I AM NO GENIUS. MY IQ IS ABOVE AVERAGE, THAT'S ALL. BUT ONE THING I CAN SAY IS THAT I REALLY DEDICATED MYSELF TO LEARNING EVERYTHING I COULD BECAUSE I LOVED THE SUBJECTS AND BECAUSE I WANTED TO BE THE BEST NURSE I COULD BE. I always went into a test with confidence that what I needed to know was in my brain, simply waiting there to be retrieved. I also ALWAYS had a very good breakfast with lots of protein, carbohydrates and some fats to keep my in working order. Call me stupid and crazy, not to mention old fashioned, but I cannot see how any 75 questions could accurately measure the knowledge and apptitude of a person regarding such diverse areas as sterile technique, care of the woman pre and post partuem as well as during labor and delivery, infection control, pre and post op care of adults with a variety of medical and surgical diagnoses and possible complications to watch for as well as the most common drugs used, care of infants and children and their anatomical differences that must be regarded and the concerns that arise because of them during different disease states as well as post op. Knowledge of all of the organ systems and the potential disease processes and the care of all of them. Drugs, drug calculations, adverse reactions; Transfusion of various blood products and the precautions for all. In the AZ. Board of Nursing Journal, nursing schools with NCLEX pass rates of 83-88% decided to review their curriculum and adjust them to more accurately reflect what NCLEX wants in order to pass it. My question is this: Are we teaching people the knowledge and skills needed to safely care for a diverse patient population or are we teaching people to pass one exam?? I welcome your opinions. Celeste7767:nurse:

I am 57, been a RN since 1975. I can relate to your statement, "it is not the land it used to be." I have noticed ads in some of the nursing journals regarding nursing in other countries. There even were one or two travel companies that offered the option of overseas nursing which would make the obligatory red tape with licensure etc. much less painful I am sure. I am permanently disabled and receive Social Security Disability which will eventually be my Social Security Retirement; I know that I can move to all but 8 countries and still get my payments sent to me whereever I am. My husband is 60 and we have been exploring several different countries to which to expatriate. After hearing the many comments made by our colleagues from other nations, I DON'T THINK YOU ARE HAVING THE 'GRASS IS ALWAYS GREENER' syndrome. In this case, I believe that the grass is greener in many other nations. In fact, don't take my word for it, I just read an article in the July, 2006 issue of THE SMITHSONIAN MAGAZINE entitled, "INTERVIEW, Joe Robinson, Vacation Advocate, Santa Monica, Calif." by Jennifer Drapkin. (page 26). Facts from the article include that Americans take fewer days off than the Japanese, Chinese, British and all continental Europeans. Also, even though 40% of us work 50 hrs a week, workers from Holland, France, Norway, Belgium and Ireland are more productive per hour than we are and THEY ALL HAVE 4 OR 5 WEEK VACATIONS. American workers are highest in per person productivity only when all the overtime they do is taken into consideration, according to Mr. Robinson who is a journalist and founder of a group Work to Live. The article confirmed for me what I have long suspected just by virtue of being a member of the American workforce since 1965 when I had my first job at age 15 as a carhop at a drive-in hamburger joint. Because the nature of my personality virtually COMPELLS me to do everthing that my job required I worked those 12 hour shifts usually without breaks, without lunch, and generally into the 14th hour. I am now the inhabitant of a body that at the age of 57, and with no insurance, is unable to perform any task for a prolonged period of time. Severe Carpal Tunnel of both hands with nerve entrapment at the elbows as well which requires surgery that I am unable to have done, compression fractures of the thoracic and lumbar vertebrae that have decreased my height from 5'8" to my present 5'6" and which causes intermittent but severe pain to my back, ribs, and my iliac crests bilaterally, chronic swelling of my lower legs and ankles due to vasculitis of both feet and varicosities of my legs, and traumatic arthritis to my left knee from prior injury while hiking which necessitated a meniscectomy (when I still had insurance and was working). I also have a "growth" on my thyroid but in the Great State of Arizona, I make too much money to qualify for their woefully inadequate and pathetic version of Medicaid, known by its acronym, ACCHCS, which stands for Arizona Cost Containment Health Care System and yes, they certainly do contain the costs, at all costs. Am I cynical?? Yes. Disgusted?? Yes. But there is still hope; my husband and I can and will leave for those greener pastures. Good luck to you as well!!

To Nightnurse47: Good for you!! I am so glad you got out before it got to you! What management is doing so rampantly is not only unethical but indefensible and yet there is no stopping them; , importing foreign nurses who come from countries where they may be accustomed to putting up with anything goes in the workplace I fear will simply make the rest of us a troubling minority and will make it that much easier for hospitals to get rid of us. I wish the very best for you as you start working where you will be valued as you should be. Please read my post which I believe is directly below yours. Celeste7767

God, I am so glad that someone has brought up what I suspected but felt I was being too paranoid to bring up. I have been a RN since 1975. NEVER had a write up. NEVER had a bad eval; NEVER made ANY errors that resulted in an incident report being written up. Early in my career I made the decision to make certain that I would always be marketable by becoming knowledgeable in a variety of areas in nursing. My experience with being weeded out was devastating to me emotionally and professionally. I worked for a total of seven years at a prestigious university med. center where I initially worked in their CVICU and was promoted to Clinical Leader; then I cross trained to the ED, the PICU, the Trauma ICU and was working in their Critical Care Resource Pool in 2000 when I got my first write up for not having a current CPR card; I had submitted a copy of my new BCLS care dated March 2, 2000 to my manager the same day I got it but it must have been misplaced because when she obtained a computer listing in August of people who supposedly were not current my name came up. Nevertheless, because SHE DID NOT HAVE A COPY, I WAS WRITTEN UP. After I cleared that up I ASSUMED that the write up was removed; it was not removed but I did not know it until I received a SECOND write up for excessive absenteeism. I had the flu at the begining of October and missed 2 days; I came back for one shift even though I still felt badly because they were extremely short staffed due to the flu. I then suffered a relapse which caused me to miss another day. Because 3 months earlier I had sprained my ankle and was out for that, I was not in compliance with their absenteeism policy and was written up for that. I was told that since that was my SECOND write up in one year, if I received a third for ANY REASON, I COULD or MIGHT be terminated. When I reminded my manager that the first write up was in error, she showed me where it is written on the bottom of the write up forms that an employee has 15 days to contest the validity of a write up and request a review and/or removal of it. Because I didn't do that the write up stayed even though it was inaccurate and erroneous to begin with which made no sense to me whatsoever. I received my third write up which resulted in my immediate termination on November 12,2000; I was caring for a 2 year old in the PICU who had a ventriculostomy tube to drainage and was ventilated and the resident in charge that night refused to change the sedation while the child was thrashing about, obviously extremely uncomfortable and I was fearful of complications in light of his tenuous condition. I used the "B" word regarding this female resident and contacted the attending MD of the unit who changed and added medication to calm and comfort my patient. Apparently the resident overheard my comment, however, and reported me to administration. I was written up for using profanity on the unit (there were NO PARENTS ON THE UNIT AT THE TIME I MADE MY COMMENT, JUST ME AND THE OTHER STAFF.) What is interesting is the following: 1. My manager was not COMPELLED by policy to terminate me; it was her decision in spite of my otherwise unblemished record regarding patient care, etc. 2. On November 9,2000 I had applied for a "Staff" or "Core Staff" position as an Infusion Nurse and also had submitted one to work in the EGD dept. My Resource Pool position had no benefits; the staff positions I had applied for would have FULL BENEFITS AND BECAUSE I HAD 25 YEARS OF NURSING EXPERIENCE, MY SALARY WOULD NEARLY BE AS MUCH AS I HAD BEEN MAKING IN THE RESOURCE POOL WITHOUT BENEFITS!!!! I did not work for 6 weeks after being terminated; I filed a wrongful termination claim to our state Dept of Economic Security to receive unemployment benefits.. I WON MY CASE AND RECEIVED BENEFITS UNTIL I SECURED ANOTHER JOB. THE TRIBUNAL WHO HEARD MY CASE SAID THAT I WAS WRONGFULLY TERMINATED. I could have requested to go back to work at the facility but I just couldn't do it. I have not worked since November 29, 2004; I am physically disabled with carpal tunnel syndrome both hands, compression fractures of my vertebrae and suffer constant pain. I receive Social Security Disability and know I will never be able to utilize my nursing skills again but that's OK. I LOVED NURSING; I LOVED MY WORK. THERE ARE A NUMBER OF PEOPLE ALIVE TODAY BECAUSE I WAS THERE WHEN THEY NEEDED MY CONSIDERABLE SKILLS AND THERE ARE THOSE WHO DIED COMFORTABLY BECAUSE OF MY COMPASSIONATE CARE AND MY WILLINGNESS TO GO THE EXTRA MILE AND BE A TRUE PATIENT ADVOCATE NO MATTER WHAT. It is truly unfortunate that Hospitals particularly are willing to settle for having one or two highly skilled, seasoned nurses on each shift and fill the remainder of the staffing needs with new grads or nurses whose skills are inadequate to meet the needs of their patients. BE CERTAIN THAT I HAVE NO PROBLEM WITH NEW NURSES; THANK GOD FOR THEIR ENERGY AND ENTHUSIAM!!!! But ideally, I think that a ratio of 50% experienced nurses to 50% inexperienced is a necessity on any unit. Anything less and the new nurses are overwhelmed and robbed of the opportunity to learn from their more experienced colleagues; furthermore, the experienced nurses may feel more stress due to a moral obligation to assist their new grad coworkers with questions and clinical decisions and still provide competent care to their own patients. The solution?? I don't have one and I don't know that there is one. I do want to thank all of the new nurses out there who are taking the places of people like myself who have given all that we can give and now have to bow out of the nursing profession and to all of you who are still out there in the trenches I have two things to say: TO THINE OWN SELF BE TRUE!!!! and SOMETIMES JUST SAY, "NO THANKS, I'M SORRY BUT I JUST CANNOT WORK THAT EXTRA SHIFT". Celeste7767:nurse:

:wakeneo: since I see that you are from Maricopa county which has the 6 highest number of millionaires living there of all 50 states, I will try to not be too sarcastic or harsh in my response but it is going to be a stretch. FIRST, without unions which arose during the Industrial Revolution in this country in the 1800's when child labor was rampant and 18-20 hour days common, we would still be expected to labor 7 days a week, holidays, unlimited hours, and overtime pay were words that did not exist together as a phrase. Medicare is not a public entitlement program funded by unearned funds. The annual statement I get from Social Security has broken down how much of MY INCOME HAS BEEN SET ASIDE TO HELP PAY FOR MY FUTURE MEDICAL CARE DURING MY RETIREMENT YEARS. Between what my employer and I have contributed, the amount is more than $60,000. Social Security and Medicare is not welfare. And thanks to King George, the enormous public programs that you refer to are more like the teeny, tiny, itsy, bitsy, extremely limited and almost impossible to qualify for programs. In fact, you should be THRILLED TO KNOW, welfare, food stamps and Medicaid combined comprise less than .05 of the Federal Budget and 2% of the Arizona budget.. We do not have a capitalistic society if it means the adjectives you list at the end of your statement; nearly every corporations is subsidized by the federal government, (just like they do in Russia and other Communist countries) when profits fall short due to poor management, inadequate production, bankruptcy, and/or criminal diversion of funds, or when they just fail to "get it done," stand on their own two feet, etc. In fact "CORPORATE WELFARE" COSTS TAXPAYERS BILLIONS ANNUALLY, which is the main reason there is literally no competition for consumer dollars which is the foundation of the success of any capitalistic society. Also, look up the words "ENRON, INC". Their employees worked in good faith that their 401 K monies would be there when they retired; where's the money? GONE!!! Since nearly ALL CORPORATIONS ARE SUBSIDIZED BY THE FEDERAL GOVERNMENT FOR ONE REASON OR ANOTHER, WE NO LONGER HAVE A CAPITALISTIC SOCIETY; WHAT WE REALLY HAVE IS COMMUNISM WHICH IS A SOCIETY WHERE THE GOVERNMENT CONTROLS THE BUSINESSES, THE SOCIETY'S RESOURCES, AND THE PEOPLE AS WELL. When it looks like a duck, and walks like a duck, and quacks like a duck.................... Corporations now move their production to third world countries to pay workers 50 cents a day instead of paying US workers $18/hour. yet did you ever wonder why then are you paying more than ever for new cars, appliances, clothes, homes, etc.??? I am sure that you think that all US auto workers, steel workers, and other manufacturing workers are greedy, lazy, SOB's too. Of course they should all have gone to college to make more money but you know what? Not every one has that desire. Some people actually like their jobs. And besides, who would work the fast food outlets, the cashiers at Walmart and Safeway, the Hotel clerks, bellboys, waiters, janitors, etc. ?? I don't mean to be rude, but either you are one of the plutocrats who are benefitting from this corrupt and thoroughly evil way of governing, or you have a lot of reading to catch up on. If you are among those who make more than $2 million/year single or $4million/year per couple and had to pay that horrid estate tax that King George is going to do away with so that the 1.7% billionaire creme de la creme won't ever be burdened by that cruel and unfair tax, you are living in the right city, county and state. According to the Annual America's Health Rankings 2005, produced coooperatively by the United Health Foundation, the American Public Health Association, and the Partnership for Prevention, www.unitedhealthfoundation.org, Arizona ranks 31st out of the 50 states in health care which is a drop from 23rd in 2004 so things are worse for us all. Arizona ranks 40th in number of people lacking health care, 39th in infectious disease cases per 100,000, 43rd in the number of children in poverty which is 21.1% of the kids, 43rd in adequacy of prenatal care, 40th in immunization coverage, 44th in motor vehicle deaths, 38th in violent crime, and 44th in per capita Public Health spending which is an anemic $81 per person as compared to Indiana which is ranked overall at 32 and spends $117 per person; which ranks 34th in child poverty, 25th in people lacking health insurance, 17th in infectious disease per 100,000, 31st in adequate prenatal care, 38th in immunization coverage, 22nd in violent crime, 16th in motor vehicle deaths, and 34th in per capita Public Health Spending which as noted is $117. Tennessee, Louisiana, Mississippi, and New Mexico are all worse than Arizona so you might want to move to one of them one day. You definitely do not want to go to any of the Healthiest States which include Minnesota, Vermont, and New Hampshire because a more humane approach toward its citizenry is bound to cost.

Nothing surprises me anymore. This is not the country I grew up in. We are all victims of the Corporate-Government marriage. I took my husband who has a very serious and rare illness to Houston to see specialists; since my son lives there it was convenient for us to live with him for the 2 years we were there. Unfortunately, while we were there, our home was vandalized and burglarized to the tune of more than $90,000. State Farm dropped us. Our new insurance costs double what State Farm's was and our deductible is $1000 instead of $500. We also had to take more than $12,000 out of our limited retirement fund to finish repairs and purchase items not covered by the insurance. My health is failing and I can no longer work, thank God. We are living on $1300 a month and had to file bankruptcy. Our new homeowners insurance said they could not give us their lowest rate because of the bankruptcy. Now what does the cost of our homeowners insurance have to do with bankruptcy??? We aren't the criminals who caused the damage to our house. The guy who did still has not been sentenced but has never worked, is 52 years old and we will never see a cent of restitution from him. There is nothing that is guaranteed. No ones 401K will definitely be there when you need it. (Remember Enron??) No ones pension will definitely be there. (Remember the Teamsters??) No soldier in Iraq is guaranteed the best equipment to help him save his life and come home.( Remember the parents who have been sending flack jackets they bought at army surplus stores because their sons wrote and told them they weren't issued any? And they have been given the M16 rifles that jammed so frequently in the Viet Nam war that they quickly pulled them back then and replaced them with the M14's??) I am 57 and I could give a rat's ass because my life is winding down but no one is going to be eligible for hire after the age of around 35 or so. Anyone who lives into their 30's is going to suffer either a divorce, medical problems, a death in the family, bankruptcy or any of the hundreds of other things that befall us as human beings during a normal lifetime. Looks like everyone working in any profession anywhere will be 21-25, unmarried, childless, and in perfect health. Employers want a Utopian workforce. Good luck to them. As far as all you nurses, keep your heads down, don't talk about anything but the weather, smile at everyone unless the situation calls for a serious demeanor, agree with EVERYTHING your administration does, says, and asks of you. NEVER , NEVER, NEVER ASK WHY OR HOW COME OF ANYONE IN AUTHORITY. Never question anything done by President Bush or his administration. Remember, they have satellites that can read the printing on a quarter and they can hear conversations in your home as well as in your car. If you're going to say anything that could possibly be construed as subversive to your employer or government, only say it outside and take a boom box with you and turn the volume up to 10. "IN A TIME OF UNIVERSAL DECEIT TELLING THE TRUTH IS A REVOLUTIONARY ACT." Author unknown

All the info offered by P RN, Super Moderator were excellent and on the money as far as avoiding air emboli. I would only add one more CRUCIAL point: When removing any type of central line, make certain that the patient's position is flat during the time that the catheter is being removed. If the patient does not tolerate that position, remove dressing, sutures, and have an assistant to stabilize the catheter using sterile gloves while you lower the patient to the supine position just long enough to withdraw the catheter and place a sterile dressing over the site; the patient may be returned to his previous position while you maintain manual pressure until hemostasis is achieved. It is also recommended, if possible, that the patient avoid taking a breath during catheter removal since the normal physiologic increase in negative intrathoracic pressure that occurs with inspiration is a mechanism that can result in intraduction of air into the vessel when a breath coincides with the moment that the tip of the catheter exits the vessel opening. If the patient is ventilator dependent, your assistant can disconnect the patient from the vent for the few seconds required to actually remove the catheter and apply the dresing. At one hospital in which I worked, an intern removed a subclavian line from a young man who was due to go home the next day or two. He had survived a severe case of rhabdomyolysis and his hospital course had been long and complicated. He had been in the intermediate care unit and was no longer on any IV fluids or meds. Unfortunately, the intern removed the central line while the young man was in a recliner with his head elevated. I was the ICU nurse who answered the Code Blue and according to the intern, within seconds after he removed the catheter, the patient QUIT TALKING, lost consciousness, and suffered a full cardiorespiratory arrest. We were unable to resusitate him. All of our Critical Care nurses must review annually the procedures for more than 20 competencies and be tested on their abilities to perform them correctly and safely and I know that this is a requirement in most if not all Critical Care units. I do not know why the intern failed to follow the protocol for this procedure but it was a memorable lesson to me to review procedures more often than once a year, especially when it is one that I haven't performed recently.

I am 57 years old, been a nurse since 1975. When I was a little girl, my mother ALWAYS impressed on me the importance of going to college and having a career with which to support myself, "in case anything happened to my husband". (This was the 1950's you see.) I loved science, biology, and in 8th grade, my science teacher had us learn all the bones of the body. I was hooked. I wanted to know more. My parents weren't rich, student loans were rare, and only the Valedictorians got things like the National Merit Scholarship (one was given to each senior class.) I didn't even consider becoming a doctor back then although I might have if I had been born 10 or 20 years later. I decided to become a nurse and once I made that decision at around age 12, I never considered doing anything else. I had no idea how much money nurses made and I didn't care. I knew they got paid something and that was all I cared about that. I can honestly say that the first 24 years were great; I am truly one of the best nurses I know (NO BRAG, JUST FACT!) I always left my patients cleaner, happier, more comfortable, in less pain, or at least solved some minor problem that had been driving them nuts. My personal goal, my ethics if you will, that I lived and worked by were to find at least one thing each shift, with each patient that I could fix, resolve, make better in some way. My patients and their families loved me and so many times I would hear the words, "Will you be back tonight?" or "You really love your job, don't you?" or just "Thank you so much, dear". Unfortunately, in 1999, my nursing career began to deteriorate. I still don't really understand what I did or did not do. First, one nurse who had 10 years less experience than I but was an excellent nurse, began to complain about various things I did. Once he said I failed to answer a light and walked past it. Then he said I left an empty syringe on a patient's overbed table (I had been using 30cc syringes to irrigate a TURP patient's clotted foley catheter and the entire night had been one disaster after another.) I FORGOT. Then I was working in the same hospital's ER where they did not have an MD in house; we had to call him in when we got a patient. (It was a very small hospital) I had a patient come in who told me she had taken 3 Vicodin and 3 20mg Paxil because she had had an argument with her lover and wanted to relax. Then she was afraid that she might have taken too much and came in to be checked out but SHE SAID SHE DID NOT WANT TO SEE A DOCTOR BECAUSE SHE KNEW IT WOULD COST HER MORE AND SHE HAD NO MONEY AND NO INSURANCE BUT SHE WORKED AND DIDN'T WANT A BILL. SHE SAID SHE WOULD LEAVE IMMEDIATELY IF I CALLED THE DOCTOR TO COME IN. I was in a quandary about what to do so I asked the Charge Nurse who had worked in the ER too. I had never worked in an ER where there was no doctor in house before and I was uncertain as to what was my liability. I said I thought it would be better to try to keep her there to observe rather than have her leave and have something happen to her later; the Charge Nurse agreed. The patient agreed to stay until we were certain she was out of the woods. She left 3 hours later with no ill effects and she was charged for a Nurse Exam. I was fired and it was turned into the State Board who gave me a Letter of Censure. Then in 2001 a doctor I went to see with new insurance as a new PCP to refer me to an orthopedic surgeon for a severe knee injury accused me of being drug seeking and wrote in my chart that I was an RN that was probably addicted to narcotics and since it was the first time I had seen him, I probably went to new doctors all the time getting narcotics. He did not turn me into the State Board of Arizona until ONE YEAR LATER WHEN I WENT TO SEE MY NEW PCP (after my knee surgery I did not require the services of a PCP for another year). IT WAS THEN THAT MY NEW PCP ASKED IF I HAD HAD A PROBLEM WITH NARCOTICS WITH THE PREVIOUS PCP WHO HAD WRITTEN SUCH IN THE MEDICAL RECORD THAT WAS SENT OVER FROM HIS OFFICE. I wrote him a nasty letter and it was then that he turned me into the State Board who could not find any proof either with any of my former employers for the past 10 years, nor with my previous doctor who I had had for 8 years. STILL THE STATE BOARD KEEPS THE COMPLAINT ON RECORD AND LISTS IT WHENEVER SOMEONE CALLS THEIR AUTOMATED SYSTEM TO VERIFY LICENSES. Now I wish I had become ANYTHING BUT A NURSE. NURSES HAVE NO BACKBONE. THEY ARE PETTY, THEY ARE JEALOUS OF EACH OTHER, THEY WILL TURN ANOTHER NURSE IN WHERE A DOCTOR WOULD RARELY IF EVER TURN ON ANOTHER DOCTOR. EVEN WHEN I WROTE A FORMAL COMPLAINT TO THE ARIZONA BOARD OF MEDICAL EXAMINERS ABOUT *************, THEY DID NOT ADDRESS THE ISSUE OF HIS RUINING MY CAREER AND DEFAMING MY CHARACTER. THE SIMPLY SAID THAT HE COULD PRESCRIBE PAIN MEDS IF HE WANTED TO OR NOT. (I HAD TOLD HIM THAT THE ONLY PAIN MED THAT I CAN TOLERATE IS PERCOCET WHICH HE REFUSED TO PRESCRIBE SO I WENT HOME WITH NOTHING TILL I WENT TO THE ER 3 DAYS LATER WHERE THE MD DID GIVE ME PERCOCET AND IN FACT OFFERED ME MORPHINE OR DEMEROL BUT I CAN'T TAKE EITHER OF THEM.) I have seen many, many nurses turn on each other; I have seen many nurses treat each other poorly while they "suck up" to all the doctors, something I have never understood, since the doctors are not their employer, and since no doctor would ever put HIS license on the line to defend a nurse's license. IF I HAD MY DRUTHERS, I WOULD BE AN ATTORNEY; I HAVE EXCELLENT CRITICAL THINKING SKILLS AND CAN EASILY SEE ALL SIDES OF NEARLY ANY PROBLEM OR ISSUE. I am sorry for everyone who goes into nursing today. It is not what it used to be. The people who go into nursing often go into it solely because its a guaranteed job and there are so many different fields one can choose. Recently, my husband had to get an injection in his doctors office. When he came out he was white and furious. When I asked him why, he said that the nurse inserted the needle VERY SLOWLY, CAUSING HIS MUSCLES TO SPASM AND THEN INJECTED THE MEDICATION SLOWLY AS WELL. I would have liked to have asked her where she went to school and who taught or did not teach her how to give injections. I THOUGHT EVERY NURSE WOULD KNOW THE BASICS OF GIVING AN INJECTION. I GIVE MY HUSBAND INJECTIONS ONCE A MONTH AND HE NEVER FEELS THEM. Also, after having a cardiac cath, a nurse came in and told my husband to sit up so she could listen to his lungs; I wasn't in the room at the time, but he knew that he was not to sit up or bend his leg and he refused. When I got back, he told me what she had done and I went and found her and explained why she could have had him hemorrhaging to death. Another time, after spinal fusion, my husband had a foley catheter in place. A nurse came to take it out and WAS NOT GOING TO DEFLATE THE BALLOON FIRST!! My husband told her "don't you have to let the air out or something?" She then went and got a syringe and removed the saline before pulling the cath.The quality of nurses has deteriorated tremendously over the past 10 years or so. Please don't think I am going to be one of those OLD NURSES who thinks I know best, but I have seen so many errors by nurses in the last few years that I worked that I have a living will stating that I am not to be taken to any hospital under any circumstances, for any reason. Just let me die.