Cameelrn

Running 20-40 meq KCL makes sense...though it can only be done with a central line...but 10 meq is just frustrating! It takes an hour to run in into a peripheral line and you know you could get 20 meq PO on board quicker than you could the IV (2 hours).

I'm glad there are nurses like you who can care for patients who come from prisons. I do not have difficulty with it, but I might if I knew what crime they committed. It is not my job to judge, but being a survivor of such people has left me with some scars that, while I've learned to live with them, I redognize that they do not go away. I do not judge them, but I do not choose to knowlingly spend any more time than necessary around them.

I have really enjoyed this thread. It has stirred up a lot of thoughts. Originally it was put out there to discuss physical security, but it seems to have brought out more on the attitude of the staff toward the patient-prisoner. Isn't that typical of a nurse? We are more concerned that the patient be treated right than worried about our own safety.

That's exactly why I don't want to know what my prisoner-patients did. We are pretty strict about that. Sometimes a guard will try to tell me and I'll tell them to stop that I'm afraid knowing will affect the care I give. I think it is human to be affected by knowing that a patient is a child molestor, so it just makes sense to take that knowledge out of the equation.

That's exactly why I don't have my last name on my name tag.

I'm pretty much in agreement with you. Actually, I think we would benefit from having RNs work as LPNs first, too. And let's not leave the doctors out. The best doctors I know were nurses first. Instead of saying for a year, though, I think we could come up with a minimum number of hours. That way they could get those hours in while going to school for the next level. Just a personal note, though, nurses do not rule over CNAs and those I work with would bite your head off for that! We work together as a team. Where I work, the boss has stated that he will fire a nurse if she walks out of the room to get a CNA to put a patient on a bedpan. We depend on our CNAs to do the baths and answer the call lights (if they are available), but if we're there and the patient needs to go to the bathroom, has a urinal to empty, wants a bedpan, more water, kleenex, whatever...we do it. If I am running like crazy, I will ask a CNA to take care of it, adding "While I go do...." to let them know that I really am not shirking the work but have other things to do. Uh, but back to your question, yes I think we should all have a minimum number of hours working as a CNA first.

The prisoners (or whatever you choose to call those who are normally incarcerated in a prison) who need so many guards (or whatever...), including those outside, are federal prisoners and, now it's only a guess here, but I think it's a logical one, they have committed some heinous crime(s) to require so much guarding. The prisons in our area (we have a whole valley full of them) have housed such criminals as the Oklahoma City bomber and other terrorists. All my patients get the same care. I just don't use endearments with my prisoner-patients, for instance. I do not know what they did, so it is easy not to be angry with them. I try to think of them as men and (a few) women who made mistakes when they were young and have been paying the price, but I keep in mind that many are sociopaths, who can be quite charming They know that if they complain of chest pain they will be brought to the hospital for testing and have a couple of days out of prison, but we do get some who do have serious health issues as well. By the way, guards who fall asleep on the job should be reported. We have a responsibility to the other patients and if that prisoner were dangerous and got loose because the guard was asleep and you didn't report it.... We usually try to keep a wash cloth between the patient's skin and the shackle. I know what you mean about how silly it is sometimes that they are shackled...I had one who was dying and still had to be shackled. We tried unsuccessfully to get the Warden to allow him to be unshackled.

I hope I won't find out what my prisoner-patient's are guilty of. I know it would affect how I feel about them if they were sexual predators. I found out a cute older gentleman that I enjoyed having as a patient had beat his wife to death, and it changed everything for me. I try not to think what my prisoner-patients did. Ideally we are not told. If a nurse knows and cannot give the patient the kind of care they need, and there are others who are available to give the patient care, then I think it would be a good idea to switch them. Difficult question....

How do you manage patients who need to be guarded? In our hospital they are in the general population and have the number of guards appropriate to their status. We refer to them by a number or initials so that families, friends, and perhaps enemies, don't show up. Sometimes that means one guard, and sometimes that means four guards in the room with one on the roof and more in vehicles parked around the buildings. We actually do not take any special measures in treating them other than to not empathize with them as deeply. They are usually the most appropriate and polite patients we have. In fact, we have more trouble with the guards being inappropriate. We don't lose track of the fact that they are prisoners (or dangerous mental patients), though.

I started out on a cardiac (telemetry) floor right out of school. I learned that in our hospital, where we do open heart, there is plenty of opportunity for medical/surgical experience. We also get a lot of patients who have MIs during surgery or shortly after, so we are not just dealing with heart patients (seldom is that their only problem) but typical med/surg patients with heart problems. Follow your heart.

Uh, oh. If spelling errors are a problem then I haven't a chance here. Don't sweat the small stuff.

From the time I could speak, when people asked me what I wanted to be I said "A nurse and a mommy." I wasn't blessed with kids and it took me 44 years to begin nursing school. The only reason I began it then was that, like you, I was at a crossroads and had to make some major life-altering decisions. I had been diagnosed with carpal tunnel just as I met someone who had finished nursing school and taught me that if you want to be a nurse you can find a way. So I did. You don't go into nursing for the money. I've never been happier.

I feel naked without my Littman around my neck! I have bought and made covers for it. That helps a lot. I have scratched my name into the bell and work in an area where a stethescope is protected for the owner (amazing!). In fact a co-worker dropped mine off at my house last night after she had borrowed it (a patient was going into respirator arrest and I didn't pause when she took it off my neck to take a listen). I do love working there!

It seems like it would be easier to just give PO k+ but when the patient complains of burning, I do like the originator of this thread and run it (with a second pump) as a primary so that it is mixing and being diluted by the primary, rather than as a secondary substituting the primary. I have also worked in a hospital where lidocaine was added. I don't know why the docs don't use this at my current employment. The pharmacy added the lidocaine, reducing the chances of dosage errors.

I lived in Kenai, Alaska for a little over two years. I really liked it but didn't like being so far away from the few family members I have, so I moved back to the lower 48. Summertime is wonderful, but you have to prepare for some amount of daylight all the time. It looks like dusk during the middle of the night. Wintertime can be brutal, but you adapt when you live there. You plug your car in to keep it warm enough to be able to start it in the morning. When it is really cold (-30) when you start to drive off it feels like you have a flat because the tire is flat where it sat on the pavement. It warms up after awhileSpring is called 'break-up' and it is the messiest time of the year. All the ice and snow begins to melt and everything is muddy...except that it re-freezes during the night. I had to park my car about 40' from my front door and wear fishing boots to walk out to it through about 8" of water.