originalred

and did i mention those of us who wear corrective lenses... or walk with a limp or do not have a daily BM? all reasons that an employer could refuse to hire a good nurse. Forgive me for posting the question

and when u find ur self working all alone dont whine. Those of us in the real world will be working somewhere that understands the real world... just me

im sure your eating a double bacon cheeseburger as you read this. I wonder if they will fire me for speeding a little on the way to work when im on call. Does your family have a history of cvd or diabetes?? ur next as we promote health. Do u wear sunblock? skin cancer is a health risk. Are ur tires properly inflated? health risk... just saying. And ur right.. the company has obligations but where do they draw the line?

Is there a hospital in Dallas that refuses to hire nurses that test positive for nicotine? Im all for not smoking but as a term of employment?? Where will it stop? Elevated Cholesterol... Genetic screening... Its getting out of hand. Or is it just me?

thats why im calling report... they need to have a bm. discharge criteria for pacu

Missing a little. Have worked with surgeons that used no local... pt wakes up in pacu miserable.... use local= much less narcs needed. I would never use a doc that did not use local.

Denton presby

Give aureus medical a call. they have been good to me

Dont be afraid to ask for more. housing counts. but gas, food...

Attitudes changing on propofol yet??

Great post tridil2000. Well put. I,m sure you will NOT be popular on this thread for long. Hang in there.

rn29306. I would rather suck it up and take care of my patients if 2, 5, or 3 more years of school would close my eyes to the rest of the world. There is an old saying about an ostrich but I will not get into it here. Open your eyes and look at the number of cases done BY NURSES with 2, 3, 4, 5 years of college and 2, 3, 5, 15, 20 years experience and let's see what is dangerous and what is not. There are still maps (and package inserts) floating around that show the world is flat...don't go on any cruises... I am glad that someone, somewhere stepped up to the plate and decided to take that leap of faith and proved that this theory was wrong. Someone (Drnaps) will do the same eventually. When someone opens their eyes.

We have been following the info and direction offered at drnaps.org. It is great to find a site where you are not threatened with legal action and called unsafe cowboys pushing anything, anywhere... We too use propofol for thousands of cases a year and have had far less reactions to it than with versed, demerol... And the reactions that were seen were handled by a well trained nurse and an ambu bag. Someone needs to look at the science and change the wording on a piece of paper and resolve this "great debate" once and for all. We MUST respect every drug we give. Aspirin can KILL. TYLENOL can kill. We do not see these drugs limited to those with 3 more years of education...

Hang in there guys. Our BON recently had a review of our practice act and RN administered propofol for endo... THEIR anesthesiologist stopped the rebuttal being offered by the BON exec after our Docs presented their data, and wanted to review our data in depth before any decision was made. His statement was "they have scientific evidence that needs to be reviewed before any decision is made". In the past, any time anesthesia providers were involved it was automatic...NO. We took this as a good sign. The package insert is a tough one to overcome. For years droperidol stated a 12 lead should be done prior to admin...Did I ever do that ...no. Did any one else...I don' know. Was anyone sued...I don't know. If you look at any insert you can probably find something to limit it's use. I do know that if I am having a procedure done...RN propofol is OK with me. Airway management....give me a trained, field tested paramedic any day of the week. Just like ACLS does not qualify you to manage an airway according to some opinions...3 more years of school does not qualify you to give a drug that is so damn dangerous. Not meant to offend anyone but the "tribal mentality" drives me crazy. Show me numbers of patient's that have had poor outcomes with dip vs those with the other agents used. If not...let's look at changing that little piece of paper.....that if I am not mistaken was written in part by an anesthesiologist. Show me the proof.

Most abstracts, discussions, arguments... are biased based on your experience. Some of these "articles" have thousands of procedures done with propofol and no negative outcomes...At some point we have to look at the big picture and total number of positives vs the occassional negative. People would stop driving cars if the only thing they thought about was the crash on I-5 yesterday. People died and it is tragic but look at the total number of people who do get where they are going. Same with planes... Same with propofol...

I hope most of the participants from the gastroenterology thread do not find this nice little discussion. According to some, any RN who pushes Dip is guilty of capital murder and threatened with legal action if they discover your name...really ugly stuff. Open dialogue and open minds looking at SCIENCE BASED EVIDENCE will find the correct answer. Has anyone ever survived cs with Dip??? Has anyone ever had a "poor pt outcome" with versed, demerol, fentanyl?? Are the main concerns based on pt outcome or who gets reimbursed for pushing the drug?? I don't know the answers to all the ?? but I do know there is an increasing number of docs using it and an increase in the number of pts that ask for it.

Robrn, Thanks for having a open mind on the issue. The "tribal mentality" may start to weaken soon as more people become aware of the issue.

Has anyone seen the AHA guideline changes: BLS, 30-2 compression to ventilation ACLS, 1 shock then 2 minutes of CPR then the 2nd shock How could the science have been that far off to have changes this drastic over 4 years???

Anybody doing any research on this or does the "tribal mentality" still hold true? We can't do it because we never have??? Still see posts where a lot of patients have survived propofol admin by a damn nurse.

Thanks misschelei, Just to clarify for me....Our standard "premix" dopamine is 1600mcg/ml. Is there more potential for error by using 2 different concentrations for peds vs adults...in your opinion?? We are a small hospital (150 beds) and our pedi nurses also take care of adults...Pros and cons...

The position statements are interesting. Will we ever see one that does not mention "billing issues"? That ruins the validity of the evidence for me. Is it safe or is it not or is it a turf war over who gets paid? Or some combination of all 3?

Same reply. NONE of the critical care docs I know have been anesthesia providers. I wonder if the ISMP or anyone has numbers of deaths r/t all drugs given...Anesthesia may need to give all sedating drugs. I am pretty sure we have needed airway control after versed, mso4, fentanyl... And we all know that a weekend ACLS class doesn't help anyone at any time.

God Bless anesthesiologists. Without whom, the world would no longer turn. It does sound like we have gone past pt safety and entered into some sort of turf/ego thing. Sound off any way you need to on the board but stop and take a good look deep inside and make sure pt safety, pt satisfaction and ego are all in their place. And I travel quite a bit...not met an ER doc yet that was anesthesiologist. Interesting comment though. A glimpse into certain thought processes that help define your believes.

I know that ER and critical care docs all over the world will be glad to hear this. DUH.

Second, do you really believe that most gastroenterologists are capable of running a code? I've worked with surgeons who just stay sterile and step away--if called upon to do CPR, they do it wrong. In an operating room setting, anesthesia runs the code, the circulator is his right hand, giving drugs, starting IVs, defibrillating etc--and the scrub delivers CPR. It's a well choreographed ballet--we have all done it before. Most importantly, we generally already have a protected airway when a problem occurs. If not, we soon will have a protected airway. That's why we have skilled anesthesia professionals. So now it is not only nurses that shouldn't give prpofol but any Dr other than an anesthesia provider... How many codes do you guys have in OR??? And why are the anesthesia providers better versed in ACLS? We have a few anesthesia Drs that are the best in the world at codes. We have a couple that will come in and stop everything until they get the pt intubated...even if the pt is in vfib...and then leave. And you continue to downplay the weekend every 2 year ACLS class. How long have your anesthesia providers been out of school??? Did they take an ACLS course 2 years ago?? The REAL learning starts after class, after graduation...you have to be exposed to these situations on a frequent basis or continue to study or anyone will lose their skills. I still think there is an underlying cause for all the debate that no one will admit. Turf war, reimbursement, ego, pt safety??? I have seen very little proof from either side that would say it is OK to give or not. While the package insert is a heavy hitter, stop and read every package insert on every device or drug we give. We might all want to reconsider what we do.