klj836

This is another point that nursing has drifted from the basics of care and many time now we nurse machines instead of people. The bath, nutrition, and daily elimination takes second place to the cardiac monitors and all those other wonderful electronics that we have to "assess" patients. We'll see some dramatic changes in the years to come, unfortunately it will be the care givers of today that will reap and receive the rewards of care given.........do we always do our best?

I have done all this............39 years and counting. I think we cared more, our patient's were happier, and we enjoyed our work. Do you remember MS and Demerol tablets that were dissolved to give a narcotic IM?

I agree with part of this statement in that most new nurses do not want to work in med/surg. It is a tough area but one of the best to gain experience in patient care and time management. As the population ages we may be in trouble with the number of nurses but not necessarily in acute care. The focus is decreasing patient days so the number of patients in acute care is decreasing as a whole; it is the turnover of patients that challenges the delivery of care. A lot of care is being delivered in out-patient settings, home health and a variety of settings. As most nursing programs focus on acute care, I don't think they address the total scope of nursing practice. We have a different work setting and work force than we did years ago and as a whole, nursing is not organized as a profession with a focus just to graduate more licensed nurses.

It is conscious sedation and there are rules and regulations about this procedure and JCAHO has their eye on this and will ask for training for nurses and docs.

No where else will you get a good basis for clinical practice than on a med/surg unit. Sometimes med/surg units are not the first choice by new grads because you have to really work hard and know what you're doing. You don't just take care of a speciality disease or machines, you take care of patients that multiple co-morbities, are very complicated and require great orginazational skills. If you can master the care of patients on a med/surg unit, believe me, you can learn anything and work anywhere.

PE is not the worst......amputation of an extremity seems to be worst case I've heard of. The lawyers love our mistakes

Phenergan is a dangerous drug. It is a vesicant and I know personnaly of a patient that has had a finger amputated because the IV was leaking and the phenergan got into the tissue. Several years ago a patient eventually had hand amputated (was a law suit), the same thing. Unfortunatly, we don't heed warnings until a problem happens. Nurses need to be more proactive and not reactive.

As you progress in you studies you will understand the history of nursing and how the diploma, BSN, and ADN compare and where they came from. Nursing was primarily a "medicine based" practice - that means that we operated under the direction of the physician and autonomy and independent practice was non-existant. The demand for nursing was so great and primarily a task oriented practice thus the need to turn out the RN quickly. As a diploma nurse, I could work circles around the BSN and when in a position to hire always chose first the diploma, second the ADN and last the BSN. Nursing education/practice is changing and with the promotion of FNPs we are striving toward independent practice and recognition as a true "profession"

Unfortunately, our hospital still administers Phenergan IV and of course we have seen some poor outcomes. The positive thing that happened from this is at least we have to dilute it with 10 cc saline so the concentration is a little better. Hopefully this drug with go away like Dilantin which has the pH of battery acid.

There is quite a bit of difference between ADN, BSN, MSN and APN. I am a diploma grad and for years have fought the "education" thing because I was a good nurse and could work circles around anyone, never miss an IV stick, and you know that whole story of the 'good nurse.' I am in the RN to MSN (skipping my BSN) program at a local university. I have always said that BS is Bull S___ and MS is More S____ and PHD is piles and heaps of d____. But, I have learned a great deal in my classes; where nursing came from and where we need to go to define our profession separately and not be considered just the doctor's helpers. We, nurses, have given away many of the things I always considered nursing. If we have a bad decubitus ulcer......guess what, we refer to PT do the the wound care; and never could we do a nebulizer or RT tx or manage a vent.....that requires a specialists. You get the picture. We have become a task oriented 'profession' willing to give up the cumbersom tasks to others who are making (taking) money from the DRG/insurance. Wonder why hospital costs are high? Nursing needs to be in charge of the patient's care, directing and guiding; we are the profesionals that are in charge of patient care. Or are we?

The problem with the feeding tubes, even tho small, are the openings on the sides of the tubes are sometimes rough, more so that the 5F catheter. Size is the big issue and I cannot find a smaller tube. I think the 5's are fine and it's a performance of the task that's at issue. Thanks for your response.

I am from a small rural hospital and most nurses, except those of the nursery and pedi unit, are uncomfortable catheterizing babies not yet toilet trained. Our specimens are sometimes contaminated with bag useage, expecially with babies who have diarrhea. The docs have asked for cathed specimens. I say it's techniques and a knowledge deficit when the nurses don't want to cath and that a 5 F is too large, it causes trauma. I am looking for cooraborating evidence that 5's are OK and caths are OK if good technique is used.

Need information and advice regarding urinary catheterizations of neonates/pediatric patients. Is the smallest catheter a 5 French. What have you seen used.....and I don't want to hear about the 3.5 F feeding tube. Thanks.

I have been a nurse for over 30 years and love med-surg nursing. Everyone wants the speciality areas because of the patient ratio and they can focus on one modality. Med-Surg nurses are the cream of the crop. They don't nurse 'machines' as many of the ICU/CCU staff do; they have to know and relate multiple disease entities and prioritize care, have to be ready for emergencies at any time (often unsuspected) so they must react quickly, and they have excelent organizational skills and time management skills. It always amazed me that a Med-Surg nurse could float to ICU but the ICU staff COULDN"T float to Med-Surg. I mean that literally - COULD NOT, because they can't manage it. Med-Surg nusres need to stand up and be proud and realize that this is a speciality in it's own and a hard one to manage. Go out there and get those certifications and be proud of where you work and know you're the best.

It is the responsibility of the facility to provide a safe work enviornment. I hope you reported the incident and filled out whatever form you use. Ask the head of maintenance if they do preventetative safety rounds......OSHA has a lot of rules and people tend to ignore them. :)